scholarly journals LONG-LIVED INDIVIDUALS PRESENTING WITH LARGE BREAST AND COLON TUMORS HAVE A LOWER RISK OF CONCURRENT METASTASIS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S460-S461
Author(s):  
Benjamin Sweigart ◽  
Michelle R Johnson ◽  
Michael Voisine ◽  
Zeyuan Song ◽  
Kimberly Bertrand ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Age Groups ◽  
Small Cell ◽  
Breast Cancer Patients ◽  
Lung Cancers ◽  
Patients Âgés ◽  
Large Breast ◽  
Younger Age ◽  
Seer Data ◽  
Cancer Types

Abstract We hypothesized large tumors (stage T3 or T4) are less likely to metastasize in centenarians compared to younger patients. We analyzed 2004 to 2015 Surveillance, Epidemiology, and End Results (SEER) data for the most common cancer types (breast, colon, lung, and prostate) among patients with T3 or T4 tumors and compared rates of M1 (presence of metastases) at time of diagnosis according to ages 30-110 years. Among 44,066 breast cancer patients, metastasis rates fell after age 80 for T3 and after age 74 for T4 tumors. The relative risk of metastasis [RR] for T3 patients ages 90-110 years compared to ages 50-89 years was 0.73, 95% CI 0.57;0.94, and the RR for T4 patients was 0.48, 95% CI 0.42;0.55. Among 296,041 colon cancer patients, metastasis rates for T3 and T4 tumors steadily declined after age 60; RR for T3 patients was 0.66, 95% CI 0.62;0.71 and for T4 was 0.73, 95% CI 0.69;0.78 for the older and younger age groups. No difference in metastasis rates at diagnosis was observed for ages 90-110 with small cell and non-small cell lung cancers. Among 52,738 men presenting with stage T3 prostate cancer, the rate of metastasis steadily increased after age 70 (RR = 6.00, 95% CI 4.72;7.63) while there was no substantial difference in metastasis rate according to age for T4 patients. More work is needed to determine whether these findings are related to differences in screening and detection among those at older ages or whether they have a greater resilience to metastasis.

Low Morbidity and Mortality of Status Epilepticus in Children

PEDIATRICS ◽  
1989 ◽  
Vol 83 (3) ◽  
pp. 323-331
Author(s):  
Joseph Maytal ◽  
Shlomo Shinnar ◽  
Solomon L. Moshé ◽  
Luis A. Alvarez
Keyword(s):  
Status Epilepticus ◽  
Age Groups ◽  
Neurologic Disease ◽  
Neurologic Disorder ◽  
Patients Âgés ◽  
Symptomatic Group ◽  
Younger Age ◽  
The Status ◽  
Neurologic Sequelae ◽  
History Of

In an ongoing study of status epilepticus, 193 children with status epilepticus of varying causes have been followed up for a mean period of 13.2 months. Of these, 97 patients were recruited prospectively. The patients' ages ranged from 1 month to 18 years (mean, 5.0 years). The cause of the status epilepticus was classified as idiopathic in 46 cases, remote symptomatic in 45, febrile in 46, acute symptomatic in 45, and progressive neurologic in 11. The mortality and incidence of sequelae following status epilepticus was low and primarily a function of etiology. Seven children died within 3 months of having the seizure. New neurologic deficits were found in 17 (9.1%) of the 186 survivors. All of the deaths and 15 of the 17 sequelae occurred in the 56 children with acute or progressive neurologic insults. Only two of the 137 children with other causes sustained any new deficits (P < .001). Duration of the status epilepticus affected outcome only within the acute symptomatic group (P < .05). Neurologic sequelae occurred in 29% of infants younger than 1 year of age, 11% of children 1 to 3 years of age, and 6% of children older than 3 years of age. However, this was a reflection of the greater incidence of acute neurologic disease in the younger age groups. Within each cause, age did not affect outcome. Of the 193 children, 61 (32%) had a history of prior unprovoked seizures. Of the 125 surviving children with no history of prior unprovoked seizures, 37 (30%) had subsequent unprovoked seizures. It is concluded that the morbidity of aggressively treated status epilepticus in children, in the absence of an acute neurologic insult or progressive neurologic disorder, is low.

Factors affecting lymphovascular invasion in node-positive breast cancer patients.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 24-24
Author(s):  
L. B. Cornwell ◽  
K. McMasters ◽  
A. B. Chagpar
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Lymph Node Status ◽  
Breast Cancer Patients ◽  
Extracapsular Extension ◽  
Community Size ◽  
Factors Affecting ◽  
Younger Age ◽  
Clinicopathologic Factors ◽  
Pathology Reports

24 Background: Lymphatic and/or vascular invasion (LVI) is not uniformly reported in breast cancer tumors, and may be absent even in LN+ patients. The purpose of this study was to define factors associated with (a) the non-reporting of LVI, and (b) the finding of no LVI in LN+ patients. Methods: Data from 400 LN+ patients from a cohort of patients in a prospective multicenter study were reviewed. Institutional and clinicopathologic factors correlating with the reporting and finding of LVI were assessed using non-parametric statistical analysis. Results: Of the 400 LN+ patients in this cohort, LVI was not reported in 98 (24.5%) patients. Of the remaining 302 patients, LVI was reported as negative in 147 (48.7%). LVI was more often reported in later years (84.9% in 2001-2004 vs. 67.9% in 1997-2000, p<0.001). The reporting of LVI did not vary significantly by region, teaching affiliation, community size, or the surgeon’s proportion of breast practice or number of cases. Further, reporting of LVI was not associated with surgery type, patient age, number of positive nodes, size of largest metastasis, nor extracapsular extension. LVI was, however, more frequently reported in larger tumors (median tumor size 2.0 cm vs. 1.8 cm, p=0.030). Despite the finding that LVI was more frequently reported in later years, the proportion of patients found to have LVI did not vary by year (53.3% in 2001-2004 vs. 49.3% in 1997-2000, p=0.565), region, teaching affiliation, community size, or surgeon practice. LVI positivity was associated with younger age (median age 53 vs. 60, p=0.001), larger tumors (median size 2.5 vs. 1.8 cm, p<0.001), more positive lymph nodes (median 2.5 vs. 1, p<0.001), more macrometastases (58.7% vs. 36.5%, p=0.002), and more extracapsular extension (70.3% vs. 46.0%, p=0.001). Conclusions: Reporting of LVI has improved in recent years, and while the rate of LVI positivity has not changed in LN+ patients, it remains associated with poor prognostic factors in this cohort. Therefore, reporting of LVI should be encouraged as a standard part of synoptic pathology reports for breast cancer patients, regardless of lymph node status.

Referral trends for reproductive-age patients with breast cancer to a reproductive endocrinology clinic for fertility preservation counseling between 2004 and 2012.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 129-129
Author(s):  
Jonathan David Kort ◽  
Kira Seiger ◽  
Solomon Henry ◽  
Lynn Westphal
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Fertility Preservation ◽  
Reproductive Age ◽  
Oocyte Cryopreservation ◽  
Cancer Center ◽  
Research Database ◽  
Breast Cancer Patients ◽  
Reproductive Endocrinology ◽  
Patients Âgés

129 Background: As of October 2012, both embryo and oocyte cryopreservation are considered non-experimental fertility preservation (FP) options for cancer patients facing potentially gonadotoxic therapy. This study aims to assess the historical referral frequency of reproductive aged breast cancer patients from a major cancer center to an associated reproductive endocrinology and infertility (REI) clinic for counseling regarding FP and also assess how frequently these patients underwent FP after referral. Methods: Using the Stanford Cancer Center Research Database in conjunction with our EMR, a query was made for patients of reproductive age (13-45) who were seen at the Stanford Cancer Center for a new breast cancer diagnosis between 2004 and 2012. These patients’ records were then searched for referral encounters in the REI department. Those who were seen by REI were assessed for having undergone FP via embryo or oocyte cryopreservation prior to starting chemotherapy. Results: 420 women, ages 20 to 45, were seen at our cancer center for a new diagnosis of breast cancer between 2004 and 2012. Sixty (14.3%) of these patients, ages 20 to 42 at diagnosis, were referred to the REI department for FP counseling. Patients who were referred for FP counseling were 5.1 years younger at diagnosis than those who were not (p<.005). Of those referred, 33.3% underwent FP with embryo (77%) or oocyte cryopreservation (23%) under an experimental protocol. Among breast cancer patients ≤35 years old, 35% were referred to our REI department for FP counseling and 53.5% of those referred underwent FP. Conclusions: Despite advances in FP technology, the majority of reproductive aged breast cancer patients are still not referred for FP counseling by a reproductive endocrinologist. This trend was also seen among patients younger than 35—a subgroup who is more likely to undergo and benefit most from FP. This study does not reflect patients who decline this opportunity or seek FP elsewhere, however additional study and outreach is needed to improve referral rates, which are now a measure of the Quality Oncology Practice Initiative (QOPI).

Therapeutic and prognostic impacts of specific gene alterations for squamous cell lung cancer: A result of nationwide genome screening in Japan (LC-SCRUM-Japan).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9060-9060
Author(s):  
Terufumi Kato ◽  
Shingo Matsumoto ◽  
Shigeki Umemura ◽  
Kiyotaka Yoh ◽  
Kazumi Nishino ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Large Scale ◽  
Small Cell ◽  
Specific Gene ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Lung Cancer Patients ◽  
Genome Screening ◽  
Gene Alterations

9060 Background: Various gene alterations occur during the development of squamous cell lung cancer (SqLC), but specific gene alterations for SqLC and their clinical significance remain unknown. Methods: In a nationwide genome screening project (LC-SCRUM-Japan), we have prospectively analyzed lung cancer patients for genetic alterations using a next-generation sequencing (NGS) system, Oncomine Comprehensive Assay, and have established a large-scale clinico-genomic database. Results: Since February 2013 to December 2018, a total of 6692 lung cancer patients (686 SqLCs, 5360 non-squamous non-small cell lung cancers [Non-sq] and 646 small cell lung cancers [SCLCs]) had been enrolled in the LC-SCRUM-Japan. The success rate of the NGS assay was 91%. Of 639 SqLCs analyzed, 274 (48%) had potentially targetable gene alterations, including 77 NFE2L2 (encoding NRF2) mut, 50 PIK3CA mut, 46 FGFR1 amp, 40 EGFRmut/amp, 36 PTEN mut, 23 KRAS mut, 6 AKT1 mut, 6 MET ex14skip, 5 ALK fusions, 2 FGFR3 fusions. Among the alterations detected, NFE2L2 mut and FGFR1 amp were significantly frequent in SqLC than Non-sq or SCLC (NFE2L2, 12.1% vs. 1.0% vs. 1.3%; p < 0.001, and FGFR1, 7.2% vs. 1.1% vs. 3.4%; p < 0.001). In advanced SqLC patients who received platinum-containing chemotherapies, the median progression-free survival (mPFS) was significantly shorter in NFE2L2-mutated patients (NRF2-type) than NFE2L2/FGFR1-negative patients (nonNF-type) (3.8 [95%CI, 2.9-5.1] vs. 4.5 [95%CI, 3.8-5.4] months, p = 0.03), and similarly, the mPFS of FGFR1-amplified patients (FGFR1-type) (3.5 months [95%CI, 1.5-4.9]) tended to be shorter than that of nonNF-type (p = 0.07), although the response rates were equivalent among the three types. NRF2-type also showed shorter overall survival (OS) than nonNF-type (median OS, 10.4 [95%CI, 6.9-22.3] vs. 16.6 [95%CI, 13.6-21.7] months, p = 0.10). Therapeutic efficacy of nivolumab or pembrolizumab was not different among these types in the current follow-up data. Conclusions: Our large scale genome screening identified specific gene alterations for SqLC and the alterations were associated with a less efficacy of chemotherapy and worse prognosis, suggesting the need for the development of genotype-directed therapeutic strategy for SqLC patients.

Survival and cardiac outcomes in elderly individuals with breast cancer: A retrospective study from an academic center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13635-e13635
Author(s):  
Ruby Maini ◽  
Nitin Tandan ◽  
Manjari Rani Regmi ◽  
Priyanka Parajuli ◽  
Odalys Estefania Lara Garcia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cancer Patients ◽  
Age Groups ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Elderly Individuals ◽  
Coronary Syndrome ◽  
Cardiac Outcomes ◽  
Two Age Groups

e13635 Background: Approximately 40% of females over the age of 65 are newly diagnosed with breast cancer. When considering elderly patients with breast cancer ( > 65 years old), complex decision making is required as patients have multiple cardiac comorbidities that may confound treatment goals. In this abstract, we aim to identify survival and cardiac outcomes in elderly individuals. Methods: This study was conducted using a retrospective cohort design with use electronic patient records. ICD diagnoses codes were used to identify breast cancer patients. Our initial search criteria revealed 1618 patients. Our eligibility criteria included adult patients 18 years and older with newly diagnosed breast cancer from January 1st, 2014 – January 31st, 2017 which yielded 478 patients. All data was collected through retrospective chart review. Analysis was performed with SAS v9.4 software. Qualitative variables were analyzed using Chi-Square Test. Survival curves are estimated using Kaplan-Meier methodology and analyzed with a log rank test. Predictors of survival are assessed with Cox proportional hazards regression analyses. All significance was assumed at the p < 0.05 level and reported as hazard ratios (HR). Results: Of our 478 breast cancer patients, 260 (59.5%) patients were less than age 65 and 177 (40.5%) patients were older than age 65. Of these two age groups, cardiac events including new diagnosis of heart failure (HF), heart failure (HF) hospitalization, and acute coronary syndrome were studied. For patients with age less than 65: n = 11 for new diagnoses of HF, n = 4 for HF hospitalizations, and n = 3 for ACS. For patients with age greater than 65: n = 5 for new diagnoses of HF, n = 3 for HF hospitalizations, and n = 2 for ACS. Comparing these two groups, there was no statistically significant cardiac event (p = > 0.05). Comparing survival among these two age groups also did not yield statistically significant results (p > 0.05). Conclusions: Per our data, it appears that there is no statistically significant difference in cardiac outcomes in different age groups for patients with breast cancer. Additionally, there was no difference in mortality among different age groups with breast cancer patients. Further prospective studies should be performed to confirm trends of mortality.

scholarly journals A comparative study of the clinical characteristics and outcomes of HR-positive HER2-negative breast cancer patients over and under 65 years old

2021 ◽  
Vol 17 (1) ◽  
pp. 1-7
Author(s):  
Chang Shin Jung ◽  
Youn Joo Jung ◽  
Dong Il Kim ◽  
Seungju Lee ◽  
Seok Kyung Kang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Clinical Characteristics ◽  
Age Groups ◽  
Older Age ◽  
Age Group ◽  
Breast Cancer Patients ◽  
Her2 Breast Cancer ◽  
Surgical Methods ◽  
Two Age Groups

Purpose: The purpose of this study was to compare the clinical characteristics and outcomes of hormone receptor-positive (HR+) human epidermal growth factor 2-negative (HER2–) breast cancer among elderly patients (over 65 years old) and younger patients.Methods: This was a retrospective cohort study of 328 patients who were treated for breast cancer at Pusan National University Yangsan Hospital between January 2009 and December 2014. Tumor characteristics, surgical methods, and survival outcomes were compared between the two age groups (<65 and ≥65 years old). Kaplan-Meier curves for disease-free survival (DFS) and overall survival (OS) were also constructed according to the age groups.Results: Among the 328 patients with HR+ HER2– breast cancer, 184 (56.1%) were <65 years old and 144 (43.9%) were ≥65 years old. Breast cancer stages were similar between the two age groups, but the older patients were treated less often with chemotherapy (81% vs. 66%, P=0.002). During the follow-up period, 17 deaths and 36 cases of recurrence or metastasis were reported. There was no difference in DFS between the two groups (P=0.840); however, the OS of the older age group was significantly lower than that of the younger age group (P=0.015).Conclusion: This study suggested that HR+ HER2– breast cancer patients belonging to the two age groups had no significant difference in DFS. However, older age is an independent factor affecting OS rate. Therefore, even if patients are old, but their physical condition is satisfactory, standard and active treatment may be necessary, similar to that given to younger patients.

scholarly journals Molecular characteristics and clinical outcomes of complex ALK rearrangements identified by next-generation sequencing in non-small cell lung cancers

2021 ◽  
Author(s):  
Peiyi Xia ◽  
Lan Zhang ◽  
Pan Li ◽  
Enjie Liu ◽  
Wencai Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Next Generation Sequencing ◽  
Cancer Patients ◽  
Small Cell ◽  
Molecular Characteristics ◽  
Fusion Partner ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Lung Cancer Patients ◽  
Generation Sequencing

Abstract Background Complex kinase rearrangement, a mutational process involving one or two chromosomes with clustered rearrangement breakpoints, interferes with the accurate detection of kinase fusions by DNA-based next-generation sequencing (NGS). We investigated the characteristics of complex ALK rearrangements in non-small cell lung cancers using multiple molecular tests. Methods Samples of non-small cell lung cancer patients were analyzed by targeted-capture DNA-based NGS with probes tilling the selected intronic regions of fusion partner genes, RNA-based NGS, RT-PCR, immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Results In a large cohort of 6576 non-small cell lung cancer patients, 343 (5.2%) cases harboring ALK rearrangements were identified. Fourteen cases with complex ALK rearrangements were identified by DNA-based NGS and classified into three types by integrating various genomic features, including intergenic (n = 3), intragenic (n = 5) and “bridge joint” rearrangements (n = 6). All thirteen cases with sufficient samples actually expressed canonical EML4-ALK fusion transcripts confirmed by RNA-based NGS. Besides, positive ALK IHC was detected in 13 of 13 cases, and 9 of 11 cases were positive in FISH testing. Patients with complex ALK rearrangements who received ALK inhibitors treatment (n = 6), showed no difference in progression-free survival (PFS) compared with patients with canonical ALK fusions(n = 36, P = 0.9291). Conclusions This study firstly reveals the molecular characteristics and clinical outcomes of complex ALK rearrangements in NSCLC, sensitive to ALK inhibitors treatment, and highlights the importance of utilizing probes tilling the selected intronic regions of fusion partner genes in DNA-based NGS for accurate fusion detection. RNA and protein level assay may be critical in validating the function of complex ALK rearrangements in clinical practice for optimal treatment decision.

The Rorschach Ink-Blot Test as an Instrument for Evaluating Quality of Life in Breast-Cancer Victims

2005 ◽  
Vol 27 (1) ◽  
pp. 119-138
Author(s):  
G. Marchioro ◽  
F. Barbato ◽  
G. Azzarello ◽  
O. Vinante
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patients ◽  
Age Groups ◽  
Breast Cancer Diagnosis ◽  
Adjustment Disorder ◽  
Rorschach Test ◽  
Breast Cancer Patients ◽  
The Impact

Background. The psychological discomfort associated to breast-cancer diagnosis and related treatments is universally recognized. However homogeneous modalities of intervention are lacking. The questionnaires are the most employed tools to analyze pre-morbidity personality traits and the quality of life of cancer patients, but they lack valid indicators of the patients' overall quality of life. On the other hand, counseling along with administered psychological tests allows listening and mutual relationship between patient and examiner. The aim of this study was to evaluate the impact of the Rorschach test, a multidimensional method of collecting data on personality functioning, as an instrument to assess mood disorders, object relation, self-image and quality of life in breast cancer patients. Methods. 135 consecutive women affected by operable breast cancer underwent psychological counseling and the Rorschach test within 2–4 weeks after surgery. Results of the test were interpreted according to the structural and experiential approaches. The discrimination between “compact” and “noncompact” tables makes it possible to study the changes of patients identity during the illness, while the Experienced Stimulation and Experience Actual indices, providing information about the patient's coping to therapeutic approach, were calculated according to the Exner system. The records from a sample of 60 healthy women, equally distributed in three age groups (< 50, 50–59, > 60) coming from the same Italian region (regional sample) and the results from 736 nonpatient Italian subjects (national sample) were used as controls. Results. Quantitative results were comparable within groups, except for parameters of cognitive characteristics regulating the approach to reality (G, G+, F+, Anat, Ban). No patient fulfilled the parameter configuration corresponding to depressive disorder, but alexithymia with a state reaction interpreted as an adjustment disorder with depressive mood was recorded. This trait was correlated with lower educational levels and increasing age.

Breast cancer in "young" women: Age cutoff and clinicopathologic features.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12019-e12019
Author(s):  
Gang Nie ◽  
Haibo Wang ◽  
Yuhua Song ◽  
Yan Mao ◽  
Weihong Cao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Family History ◽  
Cancer Patients ◽  
Older Patients ◽  
Age Groups ◽  
Her2 Status ◽  
Lymph Node Status ◽  
Breast Cancer Patients ◽  
Ki 67

e12019 Background: Age of patients play a key role in outcome of breast cancer, and therefore influences choice of treatment. In most studies, "young" is defined as being below 40 or 35 years. However, there are conflicts concerning definition of younger and older patients. In this study, we aim to establish a more appropriate age cut-off between “younger” and “older” breast cancer patients. Methods: A total of 5984 female breast cancer patients recruited in the Breast Cancer Registry of the Affiliated Hospital of Qingdao University during 2008 to 2014 were enrolled. Patients were divided into 11 groups by every 5 years’ age difference. The clinical characteristics and overall survival (OS) were compared among these age groups. Results: Among the five groups under age 45 (n = 1771, 30.0%), larger proportion of patients underwent breast conservation surgery in the “30-34” group (p = .027), and more patients were found with family history in the “25-29” group than in other groups (p = .029). No significant difference was found in OS (p = .059), clinicopathological stage, lymph node status, ER/PR status, HER2 status, or Ki-67 status among those five groups. For patients above 45 (n = 4813, 70.0%), differences were found in OS (p = .001) and significant differences with clinicopathological features (lymph node status, ER/PR status, HER2 status and Ki-67 status) were shown between younger and the older age groups (p = .001) among the six groups, except for family history (p = .066). Conclusions: Clinicopathological characteristics and survival status are similar among breast cancer patients under 45 years and vitiate among older patients. Age 45 is an appropriate cut-off for clinical grouping of breast cancer patients by age .

Medicaid patients more likely to die at home without hospice during the pandemic versus before, exacerbating disparities with commercially insured patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6502-6502
Author(s):  
Laura Elizabeth Panattoni ◽  
Li Li ◽  
Qin Sun ◽  
Catherine R. Fedorenko ◽  
Hayley Sanchez ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Low Income ◽  
Place Of Death ◽  
Cancer Type ◽  
Breast Cancer Patients ◽  
Patients Âgés ◽  
Dying At Home ◽  
Insured Patients ◽  
At Home

6502 Background: The COVID-19 pandemic dramatically reduced family access to hospitals and created new barriers to home hospice care, raising concerns about how the pandemic has impacted cancer patients’ place of death and end of life home hospice support. Hypothesizing that Medicaid-enrolled cancer patients may be at greater risk of disruptions in end-of-life care compared to commercially insured patients, we examined changes in place of death and home hospice support for Medicaid and Commercial enrollees following the pandemic. Methods: We linked WA State cancer registry records with claims from Medicaid and approximately 75% of commercially insured cancer patients in the state. Patients ages 18-64 with solid-tumor malignancies who died March-June 2020 (COVID) were compared to those who died March-June 2017-2019 (Pre-COVID). Place of death was categorized as hospital, home with hospice, and home without hospice; nursing home deaths were excluded. Given our sample size, we examined differences in the likelihood of place of death with Fisher’s exact tests and multinomial logistic regressions stratified by payer and by COVID period, controlling for age, gender, race, stage, cancer type, and census tract-level neighborhood deprivation. We report marginal effects. Results: In Fisher’s exact analyses, Medicaid but not commercial patients were significantly less like to die in hospital and more likely to die at home without hospice during COVID (Table). In pre-post adjusted analysis of Medicaid patients, the probability of dying in the hospital was 12.3% (p=0.03) percentage points lower during the pandemic versus before, while the probability of dying at home without hospice was 11.1% (p=0.04) greater. Place of death did not change significantly pre-post for commercial patients. In addition, Pre-COVID, the probability of dying in the hospital was 10.7% (p=0.03) greater for Medicaid than commercial patients. During COVID, the probability of dying at home without hospice was 15.8% (p=0.04) greater for Medicaid versus commercial patients but lower for women (ME=20.2%; p=0.01) and colorectal versus breast cancer patients (ME=39.2%; p=0.01). Conclusions: Following COVID, Medicaid patients place of death shifted from hospital to homes, but without an increase in the use of home hospice services. In contrast, place of death and hospice use among commercial patients did not significantly change. This widening disparity in home deaths without hospice services raises concerns that the pandemic disproportionately worsened end of life experience for low income patients with cancer.[Table: see text]

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