Treatment and survival outcomes for Medicaid patients with pancreatic, colon-rectosigmoid, and liver cancers at a national comprehensive cancer center.

e18524 Background: Treatment and survival disparities faced by Medicaid patients are documented for pancreatic, colon-rectosigmoid, and liver cancers at a national level. Studies show these disparities persist at academic medical centers. We assessed Medicaid treatment and survival outcomes among University of Wisconsin-Health (UWH) pancreatic, colon-rectosigmoid, and liver cancer patients to determine whether national trends persisted at this academic medical center. Methods: We included UWH registry data for 1567 pancreatic, 2313 colon-rectosigmoid, and 1027 liver cancer patients ages 18+ from 2004-2016. We performed multivariable logistic regression to estimate odds ratios (ORs) to assess insurance disparities in intended resection and Cox Proportional regression to estimate hazard ratios (HRs) to assess all-cause mortality disparities for each cancer, adjusting for age, sex, race/ethnicity, BMI, comorbidity, stage, rurality, and insurance. Results: Median overall survival was 6.5 months (range 0.1-147.5) for pancreatic, 12.8 months (0.1-167.5) for colon-rectosigmoid, and 12.5 months (0.1-168.7) for liver cancer patients. 3% of pancreatic, 5% of colon-rectosigmoid, and 9% of liver cancer patients had Medicaid Insurance. Medicaid patients were less likely to be older and non-Hispanic White than private insurance (private) patients for each cancer. Medicaid patients were diagnosed with more distant disease for colon-rectosigmoid and liver cancers and less distant disease for pancreatic cancer. Medicaid patients were less likely to receive surgery vs private patients for pancreatic (OR 0.41, 95% CI 0.16-1.08) and liver (OR 0.62, 0.26-1.49) cancers, though confidence intervals were wide. Insurance was not associated with surgery in colon-rectosigmoid cancer patients (OR 0.97, 0.48-1.97). Medicaid patients had a higher risk of death vs private patients for colon rectosigmoid cancer (HR 1.50, 1.12-2.01). Risk of death was modestly elevated for Medicaid vs private patients for pancreatic (HR 1.35, 0.97-1.87) but not liver (HR 1.07, 0.77-1.48) cancer. Conclusions: Medicaid pancreatic and liver cancer patients may be less likely to receive surgery than private patients in our one center study. Results suggested that Medicaid pancreatic and colon-rectosigmoid cancer patients may have a slightly elevated risk of death vs private patients, though this needs confirmation in larger samples. Future studies should explore at which local, state, and regional levels Medicaid pancreatic, colon-rectosigmoid, and liver cancer patients experience treatment and survival disparities vs private insurance patients. These studies, combined with Medicaid expansion studies, can guide healthcare leaders and policy makers to design context-appropriate interventions to reduce insurance-related disparities in cancer treatment and outcomes.

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Phase III Trial Adding Vincristine-Topotecan-Cyclophosphamide to the Initial Treatment of Patients With Nonmetastatic Ewing Sarcoma: A Children's Oncology Group Report

Journal of Clinical Oncology ◽

10.1200/jco.21.00358 ◽

2021 ◽

Author(s):

Patrick J. Leavey ◽

Nadia N. Laack ◽

Mark D. Krailo ◽

Allen Buxton ◽

R. Lor Randall ◽

...

Keyword(s):

Ewing Sarcoma ◽

Tumor Volume ◽

Phase Iii ◽

Pelvic Bone ◽

Experimental Therapy ◽

Survival Outcomes ◽

Primary Tumors ◽

Risk Of Death ◽

Increased Risk ◽

To Receive

PURPOSE The primary aim of this phase III randomized trial was to test whether the addition of vincristine, topotecan, and cyclophosphamide (VTC) to interval compressed chemotherapy improved survival outcomes for patients with previously untreated nonmetastatic Ewing sarcoma. METHODS Patients were randomly assigned to receive standard five-drug interval compressed chemotherapy (regimen A) for 17 cycles or experimental therapy with five cycles of VTC within the 17 cycles (regimen B). Patients were stratified by age at diagnosis (< 18 years and ≥18 years) and tumor site (pelvic bone, nonpelvic bone, and extraosseous). Tumor volume at diagnosis was categorized as < 200 mL or ≥ 200 mL. Local control occurred following six cycles. Histologic response was categorized as no viable or any viable tumor. Event-free survival (EFS) and overall survival (OS) were compared between randomized groups with stratified log-rank tests. RESULTS Of 642 enrolled patients, 309 eligible patients received standard and 320 received experimental therapy. The 5-year EFS and OS were 78% and 87%, respectively. There was no difference in survival outcomes between randomized groups (5-year EFS regimen A v regimen B, 78% v 79%; P = .192; 5-year OS 86% v 88%; P = .159). Age and primary site did not affect the risk of an EFS event. However, age ≥ 18 years was associated with an increased risk of death at 5 years (hazard ratio 1.84; 95% CI, 1.15 to 2.96; P = .009). The 5-year EFS rates for patients with pelvic, nonpelvic bone, and extraosseous primary tumors were 75%, 78%, and 85%, respectively. Tumor volume ≥ 200 mL was significantly associated with lower EFS. CONCLUSION While VTC added to five-drug interval compressed chemotherapy did not improve survival, these outcomes represent the best survival estimates to date for patients with previously untreated nonmetastatic Ewing sarcoma.

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A comparison of chemotherapy use in stage IV pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.257 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 257-257

Author(s):

Naomi Whittaker ◽

Kristin Hueftle ◽

Mary Warlaumont ◽

Lauren Brin ◽

David C. Olson ◽

...

Keyword(s):

Pancreatic Cancer ◽

Native American ◽

Cancer Patients ◽

Private Insurance ◽

Stage Iv ◽

Standard Of Care ◽

Uninsured Patients ◽

Asian Pacific Islander ◽

Asian Pacific ◽

To Receive

257 Background: Palliative chemotherapy is the standard of care for stage IV pancreatic cancer patients (SFPC). Methods: This study compares the amount of chemotherapy given for SFPC across insurance types using the National Cancer Database (NCDB), which contains 70% of U.S. cancer cases. Results: The NCDB reported 115,512 patients diagnosed with SFPC from 2000 to 2009. Overall, 38.3% of SFPC patients received chemotherapy. The VAH (28.3%) and Medicare (29.7%) provided significantly less chemotherapy to SFPC patients as compared to Managed Care (48.2%), Private Insurance (46.7%), Tricare/Military (42.8%), Medicaid (37.8%), Medicare Plus Supplement (35.5%), and Uninsured (34.4%). From 2000 to 2009, the rate of chemotherapy for SFPC increased for both VAH (22.9% to 34.3%) and non-VAH (31.1% to 44.1%). At time of diagnosis, the percent of patients less than 60 at the VAH was 32%, non-VAH was 25.5% and Medicare was 7%. From age 20 to 59, the rate of chemo was stable at approximately 49%, but each successive decade demonstrated a marked reduction in use of chemotherapy (from 44% for 60 to 69 years of age to 21% for 80 to 89 and 5% for >90). The VAH PC population diagnosed with PC included 71.1% whites (W), 21.1% blacks (B), 4.8% Hispanics (H), 0.8% Asian-Pacific Islander (API), and 0.6% Native American (NA). Among all insurance types, only Medicaid (25%* B, 14%* H, 6%* API) and Uninsured (20% B, 15%* H, 4%* API) had a greater percentage of minorities. Compared to the average of all patients treated for SFPC (38.3%), blacks (34.7%*) and Hispanics (35.7%*) received less chemotherapy and whites received more (39.1%*). Conclusions: This is the largest study to analyze the use of chemotherapy in stage IV pancreatic cancer. Patients treated within the VAH were less likely to receive chemotherapy compared to all other patients except those with Medicare, who tend to be older at time of diagnosis. As age increases above 59, chemotherapy treatment for SFPC decreases. VAH patients receive less chemotherapy than Medicaid and Uninsured patients, though Medicaid and Uninsured have a greater percentage of minorities, who tend to get less chemotherapy for SFPC.

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Olfm4 Is Highly Expressed In Liver Cancer Patients And As A Biomarker And Therapeutic Target For Liver Cancer

10.21203/rs.3.rs-686335/v1 ◽

2021 ◽

Author(s):

Qingzhu Song

Keyword(s):

Liver Cancer ◽

Cancer Patients ◽

Cancer Tissue ◽

Cancer Cell Proliferation ◽

Mrna Expression Level ◽

Healthy Individuals ◽

Predictive Capacity ◽

Novel Drugs ◽

Liver Cancers ◽

Cancer Types

Abstract Liver cancer is one of important cancer types causing a large number death in the world, and the incidence is still increasing. Conventional therapies against liver cancer are not satisfied and pathogenesis of liver cancer remains unclear. Thus, the more effective therapies are needed to treat liver cancers, and the discovery of key genes involving in pathogenesis of liver cancers is important for developing more effective therapies to treat liver cancer. In the present study, we found that OLFM4 blood level is higher in liver cancer patients than in healthy individuals, and mRNA expression level in liver cancer tissue than in liver paracancerous tissues. OLFM4 has high predictive capacity as a biomarker for liver cancer and closely correlated to tumor size. Importantly, it is confirmed that OLFM4 contributes to cancer cell proliferation, and HIF-1α involves in this activity. We believe that OLFM4/HIF-1α axis might be a target signaling pathway for developing novel drugs to treat liver cancer.

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The Human TOR Signaling Regulator Is the Key Indicator of Liver Cancer Patients’ Overall Survival: TIPRL/LC3/CD133/CD44 as Potential Biomarkers for Early Liver Cancers

Cancers ◽

10.3390/cancers13122925 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2925

Author(s):

Soo Young Jun ◽

Hyang Ran Yoon ◽

Ji-Yong Yoon ◽

Su-Jin Jeon ◽

Jeong-Ju Lee ◽

...

Keyword(s):

Liver Cancer ◽

Cancer Patients ◽

Cancer Cell ◽

Characteristic Curve ◽

Tor Signaling ◽

Kaplan Meier ◽

Cancer Aggressiveness ◽

Liver Cancers ◽

Potential Biomarkers

Recently, we reported the involvement of TIPRL/LC3/CD133 in liver cancer aggressiveness. This study assessed the human TOR signaling regulator (TIPRL)/microtubule-associated light chain 3 (LC3)/prominin-1 (CD133)/cluster of differentiation 44 (CD44) as potential diagnostic and prognostic biomarkers for early liver cancer. For the assessment, we stained tissues of human liver disease/cancer with antibodies against TIPRL/LC3/CD133/CD44/CD46, followed by confocal observation. The roles of TIPRL/LC3/CD133/CD44/CD46 in liver normal and cancer cell lines were determined by in vitro studies. We analyzed the prognostic and diagnostic potentials of TIPRL/LC3/CD133/CD44/CD46 using the receiver-operating characteristic curve, a Kaplan–Meier and uni-/multi-Cox analyses. TIPRL and LC3 were upregulated in tissues of HCCs and adult hepatocytes-derived liver diseases while downregulated in iCCA. Intriguingly, TIPRL levels were found to be critically associated with liver cancer patients’ survivability, and TIPRL is the key player in liver cancer cell proliferation and viability via stemness and self-renewal induction. Furthermore, we demonstrate that TIPRL/LC3/CD133 have shown prominent efficiency for diagnosing patients with grade 1 iCCA. TIPRL/LC3/CD133/CD44 have also provided excellent potential for prognosticating patients with grade 1 iCCA and grade 1 HCCs, together with demonstrating that TIPRL/LC3/CD133/CD44 are, either individually or in conjunction, potential biomarkers for early liver cancer.

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Insurance status and survival among prostate cancer patients: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16563 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16563-e16563 ◽

Cited By ~ 1

Author(s):

Grace L. Lu-Yao ◽

Jianming He ◽

William Kevin Kelly ◽

David J. Delgado ◽

Leonard G. Gomella

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Disease Risk ◽

Private Insurance ◽

Population Based ◽

Survival Outcomes ◽

Insurance Status ◽

Uninsured Patients ◽

Population Based Study ◽

All Cause Mortality

e16563 Background: This population-based study assesses the relationship between insurance status and survival outcomes among men with prostate cancer diagnosed before 65 years of age. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 114,871 prostate cancer patients diagnosed before age 65 in 2007-2013. Insurance type was classified as uninsured, Medicaid, and other (including private insurance and coverage from the military or veterans affairs). Disease risk group was based on the NCCN criteria. We used multivariable Cox proportional hazards models to estimate the relative risks of all-cause mortality and prostate cancer specific mortality (PCSM), adjusted by age, race, marital status, region, diagnosis period, and primary treatment. Results: Compared with patients with other insurance, Medicaid and uninsured patients experienced 103% and 41% higher all-cause mortality. The corresponding increase for PCSM were 61% and 32%. Medicaid patients experienced 44% (HR=1.44, 95% 1.25-1.65) higher all-cause mortality than uninsured patients. Table 1 provides data stratified by risk status at diagnosis. Conclusions: Uninsured and Medicaid patients experienced higher PCSM and all-cause mortality compared to other insured patients across all disease severity. Medicaid patients experienced worse all-cause mortality compared with uninsured patients. Further studies are warranted to investigate factors related to poor survival outcomes among uninsured and Medicaid patients. [Table: see text]

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Epidemiology and Survival Outcomes in Elderly Acute Myeloid Leukemia Patients: An NCDB Study

Blood ◽

10.1182/blood-2019-131233 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3840-3840

Author(s):

Hussain I Rangoonwala ◽

Jonathan Gootee ◽

Peter T. Silberstein

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplant ◽

Private Insurance ◽

Marrow Transplant ◽

Survival Outcomes ◽

Insurance Status ◽

National Cancer Database ◽

Survival Probabilities ◽

Facility Type ◽

To Receive

Background: Recent data suggests that more elderly AML patients are receiving treatment today compared to no treatment. With this in mind, there have been no recent studies looking at prognostic variables and survival outcomes in this patient population. We are conducting this retrospective study utilizing the National Cancer Database to help better prognosticate these patients and improve clinical outcomes. Methods: A total of 43,270 patients with AML over the age of 60 were identified utilizing the National Cancer Database. Patients were identified by the histology codes 9840, 9861, 9867, 9871-4, 9896, 9897, and 9920. Survival tables and Kaplan-Meier curves were utilized to calculate both 1- and 3-year survival probabilities with log-rank analysis to compare the variables. Variables analyzed include cytogenetics, sex, facility type, race, insurance status, income and education quartiles, and treatment including adjuvant therapies to chemotherapy and type of bone marrow transplant. Results: Approximately 55.3% of the cohort was male and Caucasian patients represented 88.1% of the cohort. The median age for the cohort was 73 years of age. The most common insurance was Medicare at 71.8% of the cohort followed by private insurance at 20.3%, Medicaid at 2.8%, and not insured at 1.7%. Approximately 34% of the cohort lived in zip codes with incomes of >$63,333, followed by 23.4% living in $50,354-63,332, 23.1% living in $40,227-50,353, and 17.9% living in <$40,227. The majority (43.5%) elected to receive treatment at academic and research programs followed by 37.5% at comprehensive community cancer programs, 11.9% at integrated network cancer programs and 7.1% at community cancer programs. Approximately 68% of the cohort elected to have chemotherapy with 1,897 patients electing to have an adjuvant bone marrow transplant and 229 patients elected to receive adjuvant immunotherapy. The overall 1- and 3-year survival probabilities for the cohort was 29.0% and 11.3%, respectively. Asian patients had the best survival outcomes, followed by Caucasians and African Americans. The type of AML resulted in significant difference in survival outcomes with AML with abnormal marrow eosinophils having the best 1- and 3- year survival probabilities of 48.7% and 29.5%, respectively, while acute myelomonocytic leukemia had the worst 1-year survival at 27.2% and AML with minimal differentiation had the worst 3-year survival at 9.4%. Patient that received treatment at academic or research centers had the best 1- and 3-year survivals of 35.6% and 14.4%, respectively. Patients that received treatment at community cancer programs had the worst survival outcomes (1-year:22.3% and 3-year:8.3%). Patients with private insurance had the highest 1- and 3-year survival probabilities of 41.8% and 20.4% followed by Medicaid (1-year:36.7% and 3-year:16.5%), not insured (1-year:33.9% and 3-year:17.4%), and Medicare (1-year:24.8% and 3-year:8.3%). As income and education levels increased, the probability of survival also increased. Patients that received an adjuvant bone marrow transplant to chemotherapy had the highest survival probability (1-year:76.3% and 3-year:46.7%) followed by adjuvant immunotherapy (1-year:53.8% and 3-year:18.8%), and chemotherapy alone (1-year:38.5% and 3-year:15.0%). Patients that didn't receive chemotherapy had 1- and 3-year survival probabilities of 9.6% and 3.5%, respectively. Conclusion: To date, this is the largest study on the prognostic factors in patients over 60 years of age with AML. Major prognostic factors include type of AML, facility type, race, insurance status, median income quartile, educational level, and adjuvant therapy. Disclosures No relevant conflicts of interest to declare.

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Hepcidin Downregulation Correlates With Disease Aggressiveness And Immune Infiltration in Liver Cancers

Frontiers in Oncology ◽

10.3389/fonc.2021.714756 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jinhu Wang ◽

Wang Liu ◽

Jean C. Li ◽

Mingyi Li ◽

Benyi Li ◽

...

Keyword(s):

Risk Factors ◽

Liver Cancer ◽

Patient Survival ◽

Survival Outcomes ◽

Hepcidin Expression ◽

Immune Infiltration ◽

Huh7 Cells ◽

Liver Cancers ◽

Cancer Tissues ◽

Hepcidin Gene

BackgroundHepcidin is a polypeptide hormone mainly produced by hepatocytes to modulate systemic iron balance. A drastic downregulation of the hepcidin gene was found in liver cancers. However, there is a paucity of information about the clinical significance of hepcidin gene downregulation in liver cancers.MethodsHepcidin expression profiles were assessed using multiple public datasets via several bioinformatics platforms. Clinical and pathological information was utilized to stratify patients for comparison. Patient survival outcomes were evaluated using the Kaplan-Meier plotter, a meta-analysis tool. Tumor immune infiltration was analyzed using the single sample gene set enrichment analysis (ssGSEA) approach on the Cancer Genome Atlas (TCGA) dataset. Hepcidin antagonist Fursultiamine was used to treat liver cancer HepG2 and Huh7 cells together with Sorafenib.ResultsHepcidin gene was predominantly expressed in benign liver tissues but drastically decreased in liver cancer tissues. Hepcidin reduction in liver cancers correlated with risk factors like non-alcoholic fatty liver disease (NAFLD) and liver fibrosis, as well as cancer grade and tumor stage. Hepcidin downregulation was associated with a rapid cancer progression and worse disease-specific survival, especially in patients of the White race without alcohol consumption history. Hepcidin expression in liver cancer tissues positively correlated with the bone morphogenetic protein-6 (BPM6)/interleukin-6 (IL6) cytokines and cytotoxic immune infiltration. Blocking hepcidin action with its antagonist Fursultiamine moderately reduced Sorafenib-induced apoptotic cell death in HepG2 and Huh7 cells.ConclusionHepcidin downregulation in liver cancers correlated with liver cancer risk factors, cancer aggressiveness, cytotoxic immune cell infiltration, and patient survival outcomes. BMP6/IL6 pathway insufficiency is a potential cause of hepcidin downregulation in liver cancers.

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Biomarker testing, treatment (Tx) and survival outcomes in Medicaid compared to commercially insured (CI) patients with advanced NSCLC (aNSCLC).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18119 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18119-e18119

Author(s):

Yeun Mi Yim ◽

Ning Wu ◽

William Bruce Wong

Keyword(s):

Targeted Therapy ◽

Survival Outcomes ◽

Risk Of Death ◽

Insurance Type ◽

Kaplan Meier ◽

Hazard Ratios ◽

Biomarker Testing ◽

Baseline Characteristics ◽

Insured Patients ◽

To Receive

e18119 Background: Prior studies suggest cancer patients with Medicaid may have worse outcomes, however there is limited understanding on the drivers behind these observations. This study aimed to describe the association between insurance type with Tx patterns, biomarker testing, and survival outcomes in a real-world aNSCLC population. Methods: The Flatiron Health EHR-derived database was used to identify patients < 65 years of age diagnosed with aNSCLC between 1/1/2011 to 10/31/2018. Logistic regression was used to assess the association between insurance type and (1) the likelihood of receiving first-line Tx of cancer immunotherapy (CIT)/other targeted therapy, or no Tx, and (2) the likelihood of receiving EGFR/ALK testing. Median OS, estimated by Kaplan Meier, was compared between patients with CI and Medicaid coverage, and hazard ratios were derived from Cox proportional hazard models adjusting for baseline characteristics. Results: 6639 aNSCLC patients were identified with CI (n = 6022) and Medicaid (n = 617). After adjusting for baseline characteristics, Medicaid patients were less likely to receive ALK or EGFR testing [OR 0.59, 95% CI (0.49, 0.72)]. Medicaid patients were also less likely to receive CIT or targeted therapy [OR 0.49, 95% CI (0.36,0.67)] and more likely to not receive any systemic Tx [OR 1.45, 95% CI (1.22, 1.73)]. Medicaid patients had a higher risk of death than commercially insured patients, however this difference varied by Tx group (table). Conclusions: Medicaid insured patients were associated with a higher risk of mortality compared to CI patients. Factors influencing this difference may be access to biomarker testing, subsequent receipt of CIT/targeted therapy and differences in care among untreated patients. [Table: see text]

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