Abstract PO-228: Racial disparities and the impact on recurrence and survival in non-metastatic colon cancer patients undergoing colectomy at a comprehensive cancer center

4004 Background: Despite recent advances in the treatment of metastatic colorectal cancer, tailoring adjuvant treatment of stage II and III colon cancer patients remains controversial. Identifying a reliable panel of prognostic and predictive markers for tumor recurrence is critical in selecting an individualized and tailored chemotherapy. Tumor angiogenesis plays an important role in tumor development, progression and metastasis. In this retrospective study, we tested whether a specific pattern of 40 functionally significant polymorphisms in 37 genes involved in angiogenesis and tumor microenvironment will predict the risk of tumor recurrence in stage II and III colon cancer patients treated with adjuvant chemotherapy. Methods: Between 1999 and 2006 blood specimens from 140 patients (69 females and 71 males with a median age of 59 years; range=28–86) were obtained at the University of Southern California/Norris Comprehensive Cancer Center (USC/NCCC). Sixty-three patients had stage II and 77 had stage III colon cancer. The median follow-up was 5.4 years (range=2.0–16.8). 51 of 140 patients (36.4%) developed tumor recurrence with a 5-year probability of 0.28 ± 0.06 for stage II and 0.40 ± 0.06 for stage III colon cancer patients. Genomic DNA was extracted from peripheral blood and genotypes were determined using PCR based RFLP. Results: Polymorphisms in VEGF (C936T; p=0.009, log-rank) and VEGFR2 (+4422 AC- repeat; p=0.04, log-rank and +1416 T/A; p=0.0009, log-rank) were associated with risk of tumor recurrence in stage III colon cancer patients (n=77). VEGFR2 AC-repeat polymorphisms were additionally associated with risk of recurrence in Stage II colon cancer patients (n=63, p=0.02, log-rank). Conclusion: VEGF C936T and VEGFR2 (+4422 AC-repeat and +1416 T/A) polymorphisms may help to identify Stage II and III colon cancer patients who are at increased risk for developing tumor recurrence. Angiogenesis seems to play a crucial role in tumor recurrence, thus targeting VEGF and VEGFR2 may be of clinical benefit for stage II and stage III colon cancer patients. Large prospective trials are needed to validate these preliminary data. No significant financial relationships to disclose.

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Patient attitudes toward oncofertility care in male cancer patients receiving targeted and immune therapies.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21593 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21593-e21593

Author(s):

Katy K. Tsai ◽

Puneet Kamal ◽

Joris Ramstein ◽

Alain Patrick Algazi ◽

Adil Daud ◽

...

Keyword(s):

Cancer Patients ◽

Checkpoint Inhibitors ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Patient Attitudes ◽

Durable Response ◽

Care Plans ◽

Future Fertility ◽

Long Term Treatment ◽

The Impact

e21593 Background: Tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI) have resulted in durable response for many cancer patients. The impact of these agents on future fertility are not well described, and patients are often committed to long-term treatment without adequate oncofertility counseling. We sought to better characterize patient attitudes toward oncofertility and challenges faced by male cancer patients undergoing treatment with TKI or ICI. Methods: Men receiving TKI/ICI at the UCSF Helen Diller Family Comprehensive Cancer Center were retrospectively identified. Eligible men had received at least one dose of TKI/ICI. Detailed questionnaires addressing cancer history, possible effects of treatment on fertility, and obstacles to fertility preservation were completed. Results: Between January 2013 to September 2016, 51 men with a mean age of 46 years (SD 12, range 21-72), 65% white, completed questionnaires. Most (61%) were CML patients, with 12% RCC, 10% GIST, 6% melanoma, and NET, oligodendroglioma, and HCC comprising remaining histologies. 96% were treated with TKI, and 4% with ICI. At the time of diagnosis, 35% of patients indicated a desire to father future children, and 53% believed that cancer treatment might affect their fertility. Despite this, 45% were not asked whether having children was important to them, and 47% did not receive information from any provider on their oncology care team about the possible risks of TKI/ICI to future fertility. The majority of patients felt there was inadequate discussion of how treatment might affect testosterone levels (73%) and their ability to father a child (53%), yet only 14% recalled adequate referrals to a fertility specialist. Conclusions: These data demonstrate that male cancer patients perceive treatment-related infertility risks as important, yet have few opportunities to discuss these concerns with providers. Care plans to address oncofertility needs, especially as TKI/ICI are increasingly used in multiple cancer types, are needed as part of the diagnosis, treatment, and follow up of these patients. Larger retrospective and prospective studies are ongoing to further characterize this patient cohort.

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Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

Palliative & Supportive Care ◽

10.1017/s1478951516000158 ◽

2016 ◽

Vol 15 (6) ◽

pp. 638-643 ◽

Cited By ~ 14

Author(s):

Julio Silvestre ◽

Akhila Reddy ◽

Maxine de la Cruz ◽

Jimin Wu ◽

Diane Liu ◽

...

Keyword(s):

Emergency Department ◽

Patient Education ◽

Cancer Patients ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Prescription Opioid ◽

Opioid Use ◽

Pain Medications ◽

The Impact ◽

At Home

AbstractObjective:Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center.Method:We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids.Results:The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home.Significance of Results:Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.

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Practice of venous thromboembolism (VTE) prophylaxis in hospitalized cancer patients at a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.149 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 149-149

Author(s):

M.Alma Rodriguez ◽

Alma Yvette DeJesus ◽

Lee Cheng ◽

Michael Kroll

Keyword(s):

Risk Assessment ◽

Cancer Patients ◽

Comprehensive Cancer Center ◽

Categorical Variables ◽

Cancer Center ◽

Moderate Risk ◽

Pharmacological Prophylaxis ◽

Vte Prophylaxis ◽

National Quality ◽

The Impact

149 Background: VTE prophylaxis measures are endorsed by the National Quality Forum in alignment with quality indicators from the Centers for Medicare & Medicaid Services. Accordingly, documentation of VTE risk, prophylaxis measures, and contraindications are recommended for hospitalized patients. To standardize practice we embedded a VTE risk assessment and prophylaxis module into admission and post-surgical order sets (OS), starting August 15, 2011. Methods: A retrospective study of 9,065 cancer patients (≥18 years) admitted to The University of Texas MD Anderson Cancer Center between June 01, 2013 through September 30, 2013. Pharmacological prophylaxis was executed with low-molecular-weight heparin or unfractionated heparin. Mechanical prophylaxis was executed with graduated compression stockings and/or sequential compression devices. Chi-square testing was used to determine the association between categorical variables. All statistically significant levels were determined with P values < 0.05. Results: 7,366 (81%) of all hospital admissions had documented VTE risk assessment and prophylaxis through the standardized VTE module. Before implementation of the new OS, only 40% of eligible patients received an order for VTE prophylaxis. The majority of patients were designated high or moderate risk (91.1%). Patients with high risk were more likely to receive pharmacological prophylaxis than those with moderate risk (74.1% vs. 38.2%, P<0.01). The most frequent contraindications to pharmacological prophylaxis were major surgery with risk of bleeding and thrombocytopenia (Table). Conclusions: Most patients received VTE prophylaxis based on VTE risk levels presented in a standardized OS. There is is limited information in the clinical literature about the impact of VTE prophylaxis on outcomes among cancer patients, we plan to assess anticoagulation-related outcomes in this cohort of patients. [Table: see text]

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LMTK3 polymorphism in patients with metastatic colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.471 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 471-471 ◽

Cited By ~ 5

Author(s):

Fotios Loupakis ◽

Wu Zhang ◽

Armin Gerger ◽

Dongyun Yang ◽

Pierre Oliver Bohanes ◽

...

Keyword(s):

Colon Cancer ◽

Overall Survival ◽

Estrogen Receptor ◽

Prognostic Factor ◽

Cox Model ◽

White Blood Cells ◽

Comprehensive Cancer Center ◽

Rank Test ◽

Cancer Center ◽

Metastatic Colon Cancer

471 Background: LMTKs are a family of serine-threonine-tyrosine kinases. LMTK3 isoform is a potent regulator of estrogen receptor activity LMTK3 gene polymorphisms affect DFS and OS of breast cancer patients. Cumulative evidence implies that estrogen receptor signalling plays a role in colon carcinoma development and progression. We investigated whether the LMTK3 rs9989661 SNP is a prognostic factor in patients with advanced colon cancer. Methods: 318 patients with metastatic colon cancer treated at the USC/Norris Comprehensive Cancer Center or the LA County/USC Medical Center were included in this study. Genomic DNA was extracted from white blood cells of peripheral blood samples using the QiaAmp kit (Qiagen, Valencia, CA). The LMTK3 polymorphism was genotyped by PCR-RFLP. The association between the LMTK3 polymorphism and overall survival was examined using the log-rank test and multivariate Cox-model. Results: There were 141 females and 177 males, with a median age of 58 years (range 25-86). The cohort comprised 234 whites, 43 Asians, 15 Blacks, 24 Hispanics, and 2 Native Americans. The median survival was 13.7 months with a median follow-up of 2.3 years. The median overall survival was 16.6 vs. 12.8 months for patients with C/- vs. patients with T/T (HR=0.78; 95% CI: 0.56-1.08; p=0.055). At a multivariate analysis restricted to subjects with left-sided disease (n=126) the median OS for patients with C/- genotype was 23.8 months compared to 14.9 months of T/T patients (HR=0.51; 95%CI: 0.28-0.91; p=0.014). Conclusions: This study suggests that LMTK3 may be an independent prognostic factor for patients with metastatic colon cancer and raise the issue of possible disparities according to primary tumor location. Our group produced similar results also in the adjuvant setting. Functional correlative preclinical analyses and external clinical validation studies are currently ongoing.

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Association of Methylenetetrahydrofolate Reductase Gene Polymorphisms and Sex-Specific Survival in Patients With Metastatic Colon Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.11.4710 ◽

2007 ◽

Vol 25 (24) ◽

pp. 3726-3731 ◽

Cited By ~ 49

Author(s):

Wu Zhang ◽

Oliver A. Press ◽

Christopher A. Haiman ◽

Dong Yun Yang ◽

Michael A. Gordon ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Patients ◽

Gene Polymorphisms ◽

Southern California ◽

Methylenetetrahydrofolate Reductase ◽

Mthfr Gene ◽

Comprehensive Cancer Center ◽

Metastatic Colon Cancer ◽

University Of Southern California ◽

A1298c Polymorphism

Purpose Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme regulating intracellular folate levels, which affects DNA synthesis and methylation. Two MTHFR gene polymorphisms, C677T and A1298C, are linked to altered enzyme activity. Several studies have shown these two polymorphisms to be associated with response to fluorouracil (FU) -based treatment in advanced colon cancer patients, but data are inconsistent and contradictory. Meanwhile, epidemiologic studies demonstrated that these MTHFR polymorphisms were associated with cancer risk in a sex-specific manner. We tested the hypothesis of whether these two polymorphisms are associated with sex-specific clinical outcome in metastatic colon cancer patients treated with FU-based chemotherapy. Patients and Methods This study included 318 patients (177 men and 141 women) with metastatic colon cancer treated between 1992 and 2003 at the University of Southern California/Norris Comprehensive Cancer Center or Los Angeles County/University of Southern California Medical Center. Peripheral blood samples were collected from each patient, and genomic DNA was extracted from WBCs. Two MTHFR gene polymorphisms (C677T and A1298C) were tested by fluorogenic 5′-nuclease assay. Results The A1298C polymorphism showed statistically significant differences in overall survival (OS) in female, but not male, patients with metastatic colon cancer (log-rank test, P = .038). Among females, OS was greater for patients with the A/A genotype (n = 67; median OS, 18.4 months) compared with patients with the A/C genotype (n = 50; median OS, 13.9 months) or C/C genotype (n = 10; median OS, 15.6 months). Conclusion Although preliminary, these data support the role of the A1298C polymorphism in MTHFR as prognostic marker in female patients with metastatic colon cancer. Further studies are needed to confirm these findings.

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Managing the Oral Health of Cancer Patients During the COVID-19 Pandemic: Perspective of a Dental Clinic in a Cancer Center

Journal of Clinical Medicine ◽

10.3390/jcm9103138 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3138

Author(s):

Sunita Manuballa ◽

Marym Abdelmaseh ◽

Nirmala Tasgaonkar ◽

Vladimir Frias ◽

Michael Hess ◽

...

Keyword(s):

Oral Health ◽

Cancer Patients ◽

Dental Care ◽

Healthcare Delivery ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Dental Clinic ◽

Federal Guidelines ◽

Dental Assistants ◽

The Impact

The practice of dentistry has been dramatically altered by the coronavirus disease 2019 (COVID-19) pandemic. Given the close person-to-person contact involved in delivering dental care and treatment procedures that produce aerosols, dental healthcare professionals including dentists, dental assistants and dental hygienists are at high risk of exposure. As a dental clinic in a comprehensive cancer center, we have continued to safely provide medically necessary and urgent/emergent dental care to ensure that patients can adhere to their planned cancer treatment. This was accomplished through timely adaptation of clinical workflows and implementation of practice modification measures in compliance with state, national and federal guidelines to ensure that risk of transmission remained low and the health of both immunocompromised cancer patients and clinical staff remained protected. In this narrative review, we share our experience and measures that were implemented in our clinic to ensure that the oral health needs of cancer patients were met in a timely manner and in a safe environment. Given that the pandemic is still on-going, the impact of our modified oral healthcare delivery model in cancer patients warrants continued monitoring and assessment.

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The impact of comorbidity on costs and effects of second-line treatment among elderly metastatic colon cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.536 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 536-536

Author(s):

Andinet Woldemichael ◽

Ebere Onukwugha ◽

Zhiyuan Zheng ◽

Nader Hanna ◽

Brian S. Seal ◽

...

Keyword(s):

Colon Cancer ◽

Cost Effectiveness ◽

Incremental Cost ◽

Cancer Patients ◽

Metastatic Colon Cancer ◽

Line Treatment ◽

Second Line ◽

Elderly Age ◽

Co Morbidity ◽

The Impact

536 Background: The Charleston Co-morbidity Index (CCI) was developed as in hospital mortality indicatory and subsequently has been used to both predict and adjust survival differences in cancer patients. We therefore sought to examine how the incremental cost effectiveness of treating elderly metastatic colon cancer (mCC) patients with second-line treatment (Tx2) will vary based upon their baseline CCI. Methods: We identified 2,897 elderly (age 66+) mCC patients who received NCCN recommended first-line treatment (Tx1) between 2003 and 2009 in the SEER-Medicare dataset. Approximately 6% and 1% of patients with missing CCI and outlier costs, respectively, were excluded. We categorized patients by their CCI for 12 months prior to diagnosis into three categories: low (CCI = 0), medium (CCI = 1) and high (CCI = 2+). We calculated 5-years cost-effectiveness of Tx2. Patients enrolled in HMOs, lost part A and/or B, and died of causes other than colon cancer are censored. Costs are inflation adjusted to January 2009 dollars using U.S. Medical Price Index (MPI). We adjusted for censoring using Inverse Probability Weighting (IPW) method and selection bias on observables using Propensity Score Bin Bootstrapping method. Results: Among patients who received Tx1, 56% (n = 1,285) proceeded to receive Tx2. Of those who received Tx2, 67% (n = 864), 23% (n = 289), and 10% (n = 132) have low, medium and high comorbidities, respectively. Compared to those who do not received Tx2, patients who received Tx2 with low, medium, and high baseline comorbidities live 18 (se = 4), 253 (se = 4), and 183 (se = 3) days longer and incur added costs of $66,693 (se = $675), $80,217 (se = $723), and $49,610 (se = $1,136), respectively. The median Incremental Cost-Effectiveness Ratios (ICERs) of Tx2 for patients with low, medium, and high comorbidity are $80,049, $114,693, and $151,627, respectively. Conclusions: Survival benefits from receiving Tx2 vary from an average of 18 days to 253 days and added costs from $49,610 to $80,217 depending on baseline comorbidity levels. The median ICERs associated with Tx2 increase as baseline comorbidity level of patients increase.

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Does a treatment delay affect the survival of octogenarian patient population?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.149 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 149-149

Author(s):

Ali Mehmood Raufi ◽

Hassaan Jafri ◽

Todd W. Gress

Keyword(s):

Cancer Treatment ◽

Cancer Patients ◽

Patient Population ◽

Gynecological Cancer ◽

Eastern Cooperative Oncology Group ◽

Treatment Delay ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Cancer Management ◽

The Impact

149 Background: The cancer management of the elderly patient is an increasingly important and challenging issue. The aim of this retrospective analysis is to evaluate the impact of treatment delay on survival outcome of cancer in octogenarian patients. Methods: From 2006 to 2015, established cancer patients age 80 and above who received treatment at our comprehensive cancer center were retrospectively reviewed. We evaluated the relationship between a delay in cancer treatment of more than 30 days in the octogenarian patient and survival using Kaplan-Meier survival and Cox proportional hazards models. Results: There were 235 octogenarian cancer patients available for evaluation and 115 of these had a delay in initiation of cancer treatment ( > 30 days). Mean age was 83.7 years the treatment delay (TD) group and 83.9 in the no treatment delay (NTD) group (p = 0.70) Eastern Cooperative Oncology Group (ECOG) score of 2 or more was present in 22.6% of the TD group and 18.3% of the NTD group (p = 0.42). Metastatic disease was higher in the NTD group (22.5% vs. 11.3% TD group; p = 0.051). There were more breast (36.5% TD vs. 12.5% NTD group) and lung cancer (26.9% TD vs. 18.3% NTD group) in the TD group, and more genitourinary (20.8% NTD vs. 9.6% TD group) and gynecological cancer (20.8% NTD vs. 15.6% TD group) in the NTD group (p < 0.001 for overall comparison). Median overall survival was higher in the TD group (50 vs. 24 months NTD group; p = 0.001). Treatment delay was still associated with improved survival even after adjusting for age, gender, ECOG, stage of disease, and type of tumor (HR 0.64, CI 0.44-0.92). Conclusions: We found that a delay in cancer treatment in the octogenarian patient was associated with better overall survivial. Bias in regards to the reasons for the treatment delay may exist and could have affected our results. We attempted to minimize this bias by adjusting for characteristics that influence treatment between our two study groups. Nevertheless, our findings suggest that a delay in cancer treatment at minimum did not adversely affect mortality in this older patient population.

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Effect of a supportive medicine program for cancer patients on patient connectivity to care and health care utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2034 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2034-2034

Author(s):

Brooke Worster ◽

Gregory D. Garber ◽

Rebecca Cammy ◽

Liana Yocavitch ◽

Ayako Shimada ◽

...

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Hospital Admissions ◽

Cost Of Care ◽

Emergency Department Visits ◽

Comprehensive Cancer Center ◽

Categorical Variables ◽

Cancer Center ◽

Ed Visits ◽

The Impact

2034 Background: The benefits of supportive medicine (SM) for cancer patients include improved quality of life, increased patient satisfaction, improved symptom management, increased cost savings and improved survival rates. At one NCI-designated cancer center, all patients were screened for distress; those who screened positive or were directly referred by a provider were enrolled into our multi-disciplinary SM program. Here, we document the impact of the supportive medicine program on outcomes of emergency department (ED) visits, hospital readmission, and non-billable touchpoints associated with patient navigation and resource referrals. Methods: The program systematically screened for biopsychosocial distress utilizing the National Comprehensive Cancer Center Distress Thermometer (DT) and the Problem Checklist (PC) to identify practical, emotional, spiritual and physical issues. Patients were categorized into three types: screened and enrolled in the SM program, and screened and not enrolled in the SM program, or provider referral into the SM program. Data included patient’s age, number of hospital admissions, emergency department visits, and non-billable touchpoints at 90 and 180 days after the distress screening or referral. Descriptive data were analyzed with counts and percentages for categorical variables and summarized with mean and standard deviation for numerical variables. For investigation of the effects of time and patient type on the change in utilization rate, generalized estimation equations for Poisson regression were conducted for each outcome. Results: In all, 2,738 patients were included in the analysis. Patients who were referred from a provider tended to be younger (p < .01) and more likely to die within 90 days (p < .001). At 180 days, ED visits decreased 18% for patients referred to the SM program and 42% for patients screened into the SM program, compared to a 3% decrease in ED visits among those not enrolled in the SM program (p < .01). Similarly, hospital admissions decreased 34% for patients referred to and 39% screened into the SM program, compared to a 4% increase for patients not enrolled in the SM program (p < .01). Non-billable touchpoints increased among all types of patients. Conclusions: An SM program reduces hospital admissions and ED visits, therefore improving outcomes and potentially reducing the cost of care for cancer patients. Future research should link this data to claims data to definitely evaluate the impact of SM programs on cost.

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