Original Research

INTRODUCTION

Follicular thyroid cancer (FTC) is a common endocrine malignancy that is mainly treated with surgical resection. Few prior studies have investigated the optimal type of surgery for this FTC, particularly at a national registry level. The aim of this study is to examine the differences between surgical subtypes in the management of FTC.

METHODS

Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. The surgeries were categorized into sublobectomy, lobectomy, subtotal thyroidectomy, or thyroidectomy groups based on the surgical procedure performed. Additional variables were collected including age, sex, race, stage, radiation status, time to treatment, household income, and population size. Kaplan-Meier, Chi-square and logistic regression analyses were performed.

RESULTS

A total of 9,983 patients were included. Using Kaplan-Meier, there was improved survival for patients that received surgery (p<0.001). Patients who underwent lobectomy had greater survival than all groups (p<0.001) while thyroidectomy had greater survival compared to sub-lobectomy (p=0.015). On Chi-square, differences at one- and five-year survival were present between surgical groups (p=0.022 and p<0.001, respectively). However, logistic regression showed no survival difference between surgery type at one- and five-years. Additional findings include regional and distal staging having worse survival at one- and five-years (p’s<0.001) while median household income >$75,000 and receipt of radiation improved survival at one-year (p’s<0.05). Household income >$75,000 and radiation status no longer improved survival at five-years. Patients living outside metropolitan areas showed an improved survival at fiveyears (p=0.036).

CONCLUSIONS

The results of the preliminary Kaplan- Meier and Chi-square analysis showed that there are significant differences in survival between different surgery subtypes. However, after controlling for multiple variables, no survival differences were observed between surgical types. Despite minimal differences in FTC survival based on the type of surgical intervention, clinical factors like stage and radiation and socioeconomic factors like household income and population size may influence FTC survival. Identifying and controlling for these variables should be considered in future research on FTC.

INTRODUCTION

Follicular thyroid cancer (FTC) is a common endocrine malignancy that is mainly treated with surgical resection. Few prior studies have investigated the optimal type of surgery for this FTC, particularly at a national registry level. The aim of this study is to examine the differences between surgical subtypes in the management of FTC.

METHODS

Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. The surgeries were categorized into sublobectomy, lobectomy, subtotal thyroidectomy, or thyroidectomy groups based on the surgical procedure performed. Additional variables were collected including age, sex, race, stage, radiation status, time to treatment, household income, and population size. Kaplan-Meier, Chi-square and logistic regression analyses were performed.

RESULTS

A total of 9,983 patients were included. Using Kaplan-Meier, there was improved survival for patients that received surgery (p<0.001). Patients who underwent lobectomy had greater survival than all groups (p<0.001) while thyroidectomy had greater survival compared to sub-lobectomy (p=0.015). On Chi-square, differences at one- and five-year survival were present between surgical groups (p=0.022 and p<0.001, respectively). However, logistic regression showed no survival difference between surgery type at one- and five-years. Additional findings include regional and distal staging having worse survival at one- and five-years (p’s<0.001) while median household income >$75,000 and receipt of radiation improved survival at one-year (p’s<0.05). Household income >$75,000 and radiation status no longer improved survival at five-years. Patients living outside metropolitan areas showed an improved survival at fiveyears (p=0.036).

CONCLUSIONS

The results of the preliminary Kaplan- Meier and Chi-square analysis showed that there are significant differences in survival between different surgery subtypes. However, after controlling for multiple variables, no survival differences were observed between surgical types. Despite minimal differences in FTC survival based on the type of surgical intervention, clinical factors like stage and radiation and socioeconomic factors like household income and population size may influence FTC survival. Identifying and controlling for these variables should be considered in future research on FTC.

INTRODUCTION

Follicular thyroid cancer (FTC) is a common endocrine malignancy that is mainly treated with surgical resection. Few prior studies have investigated the optimal type of surgery for this FTC, particularly at a national registry level. The aim of this study is to examine the differences between surgical subtypes in the management of FTC.

METHODS

Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. The surgeries were categorized into sublobectomy, lobectomy, subtotal thyroidectomy, or thyroidectomy groups based on the surgical procedure performed. Additional variables were collected including age, sex, race, stage, radiation status, time to treatment, household income, and population size. Kaplan-Meier, Chi-square and logistic regression analyses were performed.

RESULTS

A total of 9,983 patients were included. Using Kaplan-Meier, there was improved survival for patients that received surgery (p<0.001). Patients who underwent lobectomy had greater survival than all groups (p<0.001) while thyroidectomy had greater survival compared to sub-lobectomy (p=0.015). On Chi-square, differences at one- and five-year survival were present between surgical groups (p=0.022 and p<0.001, respectively). However, logistic regression showed no survival difference between surgery type at one- and five-years. Additional findings include regional and distal staging having worse survival at one- and five-years (p’s<0.001) while median household income >$75,000 and receipt of radiation improved survival at one-year (p’s<0.05). Household income >$75,000 and radiation status no longer improved survival at five-years. Patients living outside metropolitan areas showed an improved survival at fiveyears (p=0.036).

CONCLUSIONS

The results of the preliminary Kaplan- Meier and Chi-square analysis showed that there are significant differences in survival between different surgery subtypes. However, after controlling for multiple variables, no survival differences were observed between surgical types. Despite minimal differences in FTC survival based on the type of surgical intervention, clinical factors like stage and radiation and socioeconomic factors like household income and population size may influence FTC survival. Identifying and controlling for these variables should be considered in future research on FTC.

OBJECTIVE

UroNav MRI/TRUS biopsy offers a more accurate test result regarding prostate cancer. The goal of the UroNav is to find more transitional zone prostate cancers that a standard mapping biopsy is unable to see. This paper aims to evaluate the utility of UroNav MRI/TRUS biopsy to detect clinically significant transition zone cancers in patients on active surveillance with low volume, low grade cancer.

METHODS

We retrospectively analyzed 268 prostate cancer patients from Minnesota Urology over a threeyear period who underwent a UroNav (MRI/TRUS) biopsy as part of standardized follow up in an active surveillance protocol. All patients underwent both biopsy of MRI PiRAD lesions and a standard mapping biopsy at the time of procedure. Patients with positive PiRAD transition zone and negative mapping biopsies were identified. Kaplan-Meier, Cox Proportional Hazards test, ANOVA and Chi-Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05.

RESULTS

Of the 268 patients, 68 (25%) of the patients had a normal standard mapping prostate biopsies. Using UroNav technology cancer was found showing a statistically significant amount of prostate cancer in the transitional zone missed by standard mapping biopsy (P value <0.05) Out of these 68 patients 35 (51.5%) were reported to have a Gleason score ≥7 indicating clinically significant prostate cancer.

CONCLUSIONS

The use of UroNav MRI/TRUS fusion biopsy allowed detection of clinically significant transition zone cancer missed by concurrent standard mapping biopsies in an active surveillance population. This should be continually explored to get a larger sample size to see if the UroNav can also detect missed clinically significant prostate cancer at a high rate.

OBJECTIVE

UroNav MRI/TRUS biopsy offers a more accurate test result regarding prostate cancer. The goal of the UroNav is to find more transitional zone prostate cancers that a standard mapping biopsy is unable to see. This paper aims to evaluate the utility of UroNav MRI/TRUS biopsy to detect clinically significant transition zone cancers in patients on active surveillance with low volume, low grade cancer.

METHODS

We retrospectively analyzed 268 prostate cancer patients from Minnesota Urology over a threeyear period who underwent a UroNav (MRI/TRUS) biopsy as part of standardized follow up in an active surveillance protocol. All patients underwent both biopsy of MRI PiRAD lesions and a standard mapping biopsy at the time of procedure. Patients with positive PiRAD transition zone and negative mapping biopsies were identified. Kaplan-Meier, Cox Proportional Hazards test, ANOVA and Chi-Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05.

RESULTS

Of the 268 patients, 68 (25%) of the patients had a normal standard mapping prostate biopsies. Using UroNav technology cancer was found showing a statistically significant amount of prostate cancer in the transitional zone missed by standard mapping biopsy (P value <0.05) Out of these 68 patients 35 (51.5%) were reported to have a Gleason score ≥7 indicating clinically significant prostate cancer.

CONCLUSIONS

The use of UroNav MRI/TRUS fusion biopsy allowed detection of clinically significant transition zone cancer missed by concurrent standard mapping biopsies in an active surveillance population. This should be continually explored to get a larger sample size to see if the UroNav can also detect missed clinically significant prostate cancer at a high rate.

OBJECTIVE

UroNav MRI/TRUS biopsy offers a more accurate test result regarding prostate cancer. The goal of the UroNav is to find more transitional zone prostate cancers that a standard mapping biopsy is unable to see. This paper aims to evaluate the utility of UroNav MRI/TRUS biopsy to detect clinically significant transition zone cancers in patients on active surveillance with low volume, low grade cancer.

METHODS

We retrospectively analyzed 268 prostate cancer patients from Minnesota Urology over a threeyear period who underwent a UroNav (MRI/TRUS) biopsy as part of standardized follow up in an active surveillance protocol. All patients underwent both biopsy of MRI PiRAD lesions and a standard mapping biopsy at the time of procedure. Patients with positive PiRAD transition zone and negative mapping biopsies were identified. Kaplan-Meier, Cox Proportional Hazards test, ANOVA and Chi-Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05.

RESULTS

Of the 268 patients, 68 (25%) of the patients had a normal standard mapping prostate biopsies. Using UroNav technology cancer was found showing a statistically significant amount of prostate cancer in the transitional zone missed by standard mapping biopsy (P value <0.05) Out of these 68 patients 35 (51.5%) were reported to have a Gleason score ≥7 indicating clinically significant prostate cancer.

CONCLUSIONS

The use of UroNav MRI/TRUS fusion biopsy allowed detection of clinically significant transition zone cancer missed by concurrent standard mapping biopsies in an active surveillance population. This should be continually explored to get a larger sample size to see if the UroNav can also detect missed clinically significant prostate cancer at a high rate.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel treatment for hematologic malignancies, with 6 FDA agents approved for commercial use. The Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) is currently the only VA facility accredited to administer these agents and we are reporting the TVHS experience thus far.

METHODS

TVHS became an authorized treatment center for CAR-T therapy in September 2019 and performed its first CAR-T infusion in December 2019. This is a retrospective electronic chart review of all CAR-T veterans referred to TVHS from the program’s inception, December 1, 2019 through July 31, 2022 to evaluate at least one year of post infusion data. The primary objective is to evaluate the outcomes of veterans who received CAR-T therapy at TVHS including overall response rates (ORR), progression free survival (PFS), and overall survival (OS). Secondary objectives include assessment of toxicities, including rates and maximum grades of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

RESULTS

A total of 41 veterans have received CAR-T infusion at TVHS to date. Twenty-nine of these veterans have at least one year post-CAR-T infusion data and are included in this analysis. The majority of veterans were White (72%), male (93%), and were treated for diffuse large B-cell lymphoma (86%). Twenty-eight percent of veterans were under-represented minorities. Average age was 61 years with 62% being 65 years and older and five (17%) veterans being over the age of 74. Day 30 ORR was 90% (45% complete response [CR]). One-year PFS was 55.2% and 1-year OS was 65.5%. Of the 19 veterans who achieved CR by day 100, 79% remain in CR to date. CRS toxicity was observed in 66% of veterans (0% Grade 3 or higher). ICANS was observed in 27.5% of veterans (24% Grade 3 or higher). Only 5 (26%) veterans required transfer to the intensive care unit for additional monitoring.

CONCLUSIONS

CAR-T therapy has become a wellestablished practice at TVHS and is a safe and effective treatment option for veterans with aggressive lymphoid malignancies. Our outcomes are similar to that seen nationally with better access to under-represented minorities in an aging population.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel treatment for hematologic malignancies, with 6 FDA agents approved for commercial use. The Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) is currently the only VA facility accredited to administer these agents and we are reporting the TVHS experience thus far.

METHODS

TVHS became an authorized treatment center for CAR-T therapy in September 2019 and performed its first CAR-T infusion in December 2019. This is a retrospective electronic chart review of all CAR-T veterans referred to TVHS from the program’s inception, December 1, 2019 through July 31, 2022 to evaluate at least one year of post infusion data. The primary objective is to evaluate the outcomes of veterans who received CAR-T therapy at TVHS including overall response rates (ORR), progression free survival (PFS), and overall survival (OS). Secondary objectives include assessment of toxicities, including rates and maximum grades of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

RESULTS

A total of 41 veterans have received CAR-T infusion at TVHS to date. Twenty-nine of these veterans have at least one year post-CAR-T infusion data and are included in this analysis. The majority of veterans were White (72%), male (93%), and were treated for diffuse large B-cell lymphoma (86%). Twenty-eight percent of veterans were under-represented minorities. Average age was 61 years with 62% being 65 years and older and five (17%) veterans being over the age of 74. Day 30 ORR was 90% (45% complete response [CR]). One-year PFS was 55.2% and 1-year OS was 65.5%. Of the 19 veterans who achieved CR by day 100, 79% remain in CR to date. CRS toxicity was observed in 66% of veterans (0% Grade 3 or higher). ICANS was observed in 27.5% of veterans (24% Grade 3 or higher). Only 5 (26%) veterans required transfer to the intensive care unit for additional monitoring.

CONCLUSIONS

CAR-T therapy has become a wellestablished practice at TVHS and is a safe and effective treatment option for veterans with aggressive lymphoid malignancies. Our outcomes are similar to that seen nationally with better access to under-represented minorities in an aging population.

BACKGROUND

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel treatment for hematologic malignancies, with 6 FDA agents approved for commercial use. The Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) is currently the only VA facility accredited to administer these agents and we are reporting the TVHS experience thus far.

METHODS

TVHS became an authorized treatment center for CAR-T therapy in September 2019 and performed its first CAR-T infusion in December 2019. This is a retrospective electronic chart review of all CAR-T veterans referred to TVHS from the program’s inception, December 1, 2019 through July 31, 2022 to evaluate at least one year of post infusion data. The primary objective is to evaluate the outcomes of veterans who received CAR-T therapy at TVHS including overall response rates (ORR), progression free survival (PFS), and overall survival (OS). Secondary objectives include assessment of toxicities, including rates and maximum grades of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).

RESULTS

A total of 41 veterans have received CAR-T infusion at TVHS to date. Twenty-nine of these veterans have at least one year post-CAR-T infusion data and are included in this analysis. The majority of veterans were White (72%), male (93%), and were treated for diffuse large B-cell lymphoma (86%). Twenty-eight percent of veterans were under-represented minorities. Average age was 61 years with 62% being 65 years and older and five (17%) veterans being over the age of 74. Day 30 ORR was 90% (45% complete response [CR]). One-year PFS was 55.2% and 1-year OS was 65.5%. Of the 19 veterans who achieved CR by day 100, 79% remain in CR to date. CRS toxicity was observed in 66% of veterans (0% Grade 3 or higher). ICANS was observed in 27.5% of veterans (24% Grade 3 or higher). Only 5 (26%) veterans required transfer to the intensive care unit for additional monitoring.

CONCLUSIONS

CAR-T therapy has become a wellestablished practice at TVHS and is a safe and effective treatment option for veterans with aggressive lymphoid malignancies. Our outcomes are similar to that seen nationally with better access to under-represented minorities in an aging population.

PURPOSE

This workforce project evaluated potential enhancement of health psychology services with the establishment of a dedicated and integrated psychooncology position at one VA.

BACKGROUND

Broad health psychology services have been offered across this VA healthcare system with some success (Bloor et al., 2017; Bloor et al., 2022). Previously, some services were enhanced when a dedicated psychology position was funded and integrated with the interdisciplinary pain team (Dadabeyev et al., 2019).

METHODS

We reviewed utilization of services with clinic data for a 4-month period prior to the new position, compared to the first 4-months the health psychologist integrated with Oncology. We also conducted a “perceptions of referring providers” survey, assessing Utility and Quality.

DATA ANALYSIS

For utilization of health psychology services, we explored descriptive statistics. An independent samples t-test was conducted to evaluate perceptions of the services’ Utility and Quality, comparing perceptions of referring providers across the healthcare system (Bloor et al., 2017) to Oncology providers’ perceptions when a dedicated psychologist became available.

RESULTS

For the first 4 months psychology services were dedicated to Oncology, 82 Veterans received 1 or more sessions for a total of 222 encounters compared to 44 Veterans receiving health psychology services for a total of 98 sessions in the 4-month period prior. Also, during the first 4-month period with integrated care, previously unavailable same-day services were offered to Veterans, ranging from 4-9 same-day sessions each week. For the referring providers’ survey, perceptions of Utility increased significantly from m=13.70 (SD=1.36) to m=14.90 (SD=0.32), t=2.76, (p-value=.0076).

IMPLICATIONS

These data suggest increased availability and usage of services, and enhanced perceptions of the Utility of health psychology services when funding for a dedicated position was implemented. Additional measures of service enhancement can be explored in the future to understand better the added value of integrated health psychology. This could explore improvement in distress and suicide risk screening, availability to identify and outreach to Veterans at risk, and/or enhancement for survivorship, prevention or other cancer care standards. Moreover, it is important to capture Veterans’ perceptions of services, including changes in mood, functioning and quality of life.

PURPOSE

This workforce project evaluated potential enhancement of health psychology services with the establishment of a dedicated and integrated psychooncology position at one VA.

BACKGROUND

Broad health psychology services have been offered across this VA healthcare system with some success (Bloor et al., 2017; Bloor et al., 2022). Previously, some services were enhanced when a dedicated psychology position was funded and integrated with the interdisciplinary pain team (Dadabeyev et al., 2019).

METHODS

We reviewed utilization of services with clinic data for a 4-month period prior to the new position, compared to the first 4-months the health psychologist integrated with Oncology. We also conducted a “perceptions of referring providers” survey, assessing Utility and Quality.

DATA ANALYSIS

For utilization of health psychology services, we explored descriptive statistics. An independent samples t-test was conducted to evaluate perceptions of the services’ Utility and Quality, comparing perceptions of referring providers across the healthcare system (Bloor et al., 2017) to Oncology providers’ perceptions when a dedicated psychologist became available.

RESULTS

For the first 4 months psychology services were dedicated to Oncology, 82 Veterans received 1 or more sessions for a total of 222 encounters compared to 44 Veterans receiving health psychology services for a total of 98 sessions in the 4-month period prior. Also, during the first 4-month period with integrated care, previously unavailable same-day services were offered to Veterans, ranging from 4-9 same-day sessions each week. For the referring providers’ survey, perceptions of Utility increased significantly from m=13.70 (SD=1.36) to m=14.90 (SD=0.32), t=2.76, (p-value=.0076).

IMPLICATIONS

These data suggest increased availability and usage of services, and enhanced perceptions of the Utility of health psychology services when funding for a dedicated position was implemented. Additional measures of service enhancement can be explored in the future to understand better the added value of integrated health psychology. This could explore improvement in distress and suicide risk screening, availability to identify and outreach to Veterans at risk, and/or enhancement for survivorship, prevention or other cancer care standards. Moreover, it is important to capture Veterans’ perceptions of services, including changes in mood, functioning and quality of life.

PURPOSE

This workforce project evaluated potential enhancement of health psychology services with the establishment of a dedicated and integrated psychooncology position at one VA.

BACKGROUND

Broad health psychology services have been offered across this VA healthcare system with some success (Bloor et al., 2017; Bloor et al., 2022). Previously, some services were enhanced when a dedicated psychology position was funded and integrated with the interdisciplinary pain team (Dadabeyev et al., 2019).

METHODS

We reviewed utilization of services with clinic data for a 4-month period prior to the new position, compared to the first 4-months the health psychologist integrated with Oncology. We also conducted a “perceptions of referring providers” survey, assessing Utility and Quality.

DATA ANALYSIS

For utilization of health psychology services, we explored descriptive statistics. An independent samples t-test was conducted to evaluate perceptions of the services’ Utility and Quality, comparing perceptions of referring providers across the healthcare system (Bloor et al., 2017) to Oncology providers’ perceptions when a dedicated psychologist became available.

RESULTS

For the first 4 months psychology services were dedicated to Oncology, 82 Veterans received 1 or more sessions for a total of 222 encounters compared to 44 Veterans receiving health psychology services for a total of 98 sessions in the 4-month period prior. Also, during the first 4-month period with integrated care, previously unavailable same-day services were offered to Veterans, ranging from 4-9 same-day sessions each week. For the referring providers’ survey, perceptions of Utility increased significantly from m=13.70 (SD=1.36) to m=14.90 (SD=0.32), t=2.76, (p-value=.0076).

IMPLICATIONS

These data suggest increased availability and usage of services, and enhanced perceptions of the Utility of health psychology services when funding for a dedicated position was implemented. Additional measures of service enhancement can be explored in the future to understand better the added value of integrated health psychology. This could explore improvement in distress and suicide risk screening, availability to identify and outreach to Veterans at risk, and/or enhancement for survivorship, prevention or other cancer care standards. Moreover, it is important to capture Veterans’ perceptions of services, including changes in mood, functioning and quality of life.

BACKGROUND

The safety and efficacy of biosimilars are carefully reviewed by the Food and Drug Administration (FDA) to ensure the biosimilar meets the high standards for approval. However, safety concerns from infusion nursing staff prompted a review of rituximab-PVVR and rituximab for any new trends in National VA, primary literature, and facility adverse events.

METHODS

Utilizing the VA ADERS (Veteran’s Affairs Adverse Drug Event Reporting System), data was analyzed from 01/01/21 thru 04/01/23. No clear trends were identified to support an increased reaction rate for Rituximab-PVVR or Rituximab. A total of 104 Rituximab product (both parent and biosimilar products) adverse reactions were reported nationally. Of those reported, about half 56 ADEs (54%) were specifically to Rituximab-PVVR.

RESULTS

Reviewing our facility specific VA ADERS data, Birmingham VA reported 7 ADEs. Similarly other sites reported a range of 0 to 13 Rituximab product ADEs. The total number of unique patients to receive a rituximab product in the Birmingham VA since 2021 is 106, resulting in an overall incidence rate of 6.6%.

DISCUSSION

Based on the recent publication, Safety of switching between rituximab biosimilars in onco-hematology “adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of biosimilars.” This prospective clinical trial published in 2021, reported grade 1 rituximab related infusion events in 7.1% of patients (n=83) which correlates closely to the reported incidence at our facility referenced above (6.6%). Our current pre-medications include acetaminophen, an antihistamine, and steroid 30 minutes prior to infusion. Although our interdisciplinary team deemed this appropriate, to improve and minimize infusion reaction symptoms, the following interventions were instituted including changing ORAL Diphenhydramine to intravenous Diphenhydramine 25mg IV and providing education to infusion nursing staff on the safety and efficacy of the rituximab and biosimilar products.

CONCLUSIONS

Following the intervention (04/07/23), 36 total unique patients received rituximab products with zero incidents reported. Although the results are limited, the data may suggest IV diphenhydramine reduces the severity of ADEs which may alter reporting or show a potential “nocebo” effect could be a factor with any rituximab infusion needing further evaluation.

BACKGROUND

The safety and efficacy of biosimilars are carefully reviewed by the Food and Drug Administration (FDA) to ensure the biosimilar meets the high standards for approval. However, safety concerns from infusion nursing staff prompted a review of rituximab-PVVR and rituximab for any new trends in National VA, primary literature, and facility adverse events.

METHODS

Utilizing the VA ADERS (Veteran’s Affairs Adverse Drug Event Reporting System), data was analyzed from 01/01/21 thru 04/01/23. No clear trends were identified to support an increased reaction rate for Rituximab-PVVR or Rituximab. A total of 104 Rituximab product (both parent and biosimilar products) adverse reactions were reported nationally. Of those reported, about half 56 ADEs (54%) were specifically to Rituximab-PVVR.

RESULTS

Reviewing our facility specific VA ADERS data, Birmingham VA reported 7 ADEs. Similarly other sites reported a range of 0 to 13 Rituximab product ADEs. The total number of unique patients to receive a rituximab product in the Birmingham VA since 2021 is 106, resulting in an overall incidence rate of 6.6%.

DISCUSSION

Based on the recent publication, Safety of switching between rituximab biosimilars in onco-hematology “adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of biosimilars.” This prospective clinical trial published in 2021, reported grade 1 rituximab related infusion events in 7.1% of patients (n=83) which correlates closely to the reported incidence at our facility referenced above (6.6%). Our current pre-medications include acetaminophen, an antihistamine, and steroid 30 minutes prior to infusion. Although our interdisciplinary team deemed this appropriate, to improve and minimize infusion reaction symptoms, the following interventions were instituted including changing ORAL Diphenhydramine to intravenous Diphenhydramine 25mg IV and providing education to infusion nursing staff on the safety and efficacy of the rituximab and biosimilar products.

CONCLUSIONS

Following the intervention (04/07/23), 36 total unique patients received rituximab products with zero incidents reported. Although the results are limited, the data may suggest IV diphenhydramine reduces the severity of ADEs which may alter reporting or show a potential “nocebo” effect could be a factor with any rituximab infusion needing further evaluation.

BACKGROUND

The safety and efficacy of biosimilars are carefully reviewed by the Food and Drug Administration (FDA) to ensure the biosimilar meets the high standards for approval. However, safety concerns from infusion nursing staff prompted a review of rituximab-PVVR and rituximab for any new trends in National VA, primary literature, and facility adverse events.

METHODS

Utilizing the VA ADERS (Veteran’s Affairs Adverse Drug Event Reporting System), data was analyzed from 01/01/21 thru 04/01/23. No clear trends were identified to support an increased reaction rate for Rituximab-PVVR or Rituximab. A total of 104 Rituximab product (both parent and biosimilar products) adverse reactions were reported nationally. Of those reported, about half 56 ADEs (54%) were specifically to Rituximab-PVVR.

RESULTS

Reviewing our facility specific VA ADERS data, Birmingham VA reported 7 ADEs. Similarly other sites reported a range of 0 to 13 Rituximab product ADEs. The total number of unique patients to receive a rituximab product in the Birmingham VA since 2021 is 106, resulting in an overall incidence rate of 6.6%.

DISCUSSION

Based on the recent publication, Safety of switching between rituximab biosimilars in onco-hematology “adverse events were similar, in terms of seriousness and frequency, to those described in the literature, providing further support to the clinical safety of biosimilars.” This prospective clinical trial published in 2021, reported grade 1 rituximab related infusion events in 7.1% of patients (n=83) which correlates closely to the reported incidence at our facility referenced above (6.6%). Our current pre-medications include acetaminophen, an antihistamine, and steroid 30 minutes prior to infusion. Although our interdisciplinary team deemed this appropriate, to improve and minimize infusion reaction symptoms, the following interventions were instituted including changing ORAL Diphenhydramine to intravenous Diphenhydramine 25mg IV and providing education to infusion nursing staff on the safety and efficacy of the rituximab and biosimilar products.

CONCLUSIONS

Following the intervention (04/07/23), 36 total unique patients received rituximab products with zero incidents reported. Although the results are limited, the data may suggest IV diphenhydramine reduces the severity of ADEs which may alter reporting or show a potential “nocebo” effect could be a factor with any rituximab infusion needing further evaluation.

OBJECTIVE

Transitional zone cancers are not accounted for when using standard prostate biopsy techniques. Using MRI/Transrectal ultrasound fusion biopsy (UroNav) can more accurately diagnose transitional zone prostate cancer. The goal of this study is to evaluate 375 patients with transitional zone only cancer found on a UroNav biopsy MRI/Transrectal ultrasound fusion biopsy over a three-year period to evaluate the clinical significance of their cancer.

METHOD

We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3 year period. 375 of these patients had transitional zone only cancers. The patients with transitional and peripheral zone cancer were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined.

RESULTS

Of the 1500 patients with a PIRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20%, respectively, for the TZ, PZ and combined zones. Kaplan- Meier, Cox Proportional Hazards test, ANOVA and Chi- Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant

CONCLUSIONS

The use of a UroNav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy.

OBJECTIVE

Transitional zone cancers are not accounted for when using standard prostate biopsy techniques. Using MRI/Transrectal ultrasound fusion biopsy (UroNav) can more accurately diagnose transitional zone prostate cancer. The goal of this study is to evaluate 375 patients with transitional zone only cancer found on a UroNav biopsy MRI/Transrectal ultrasound fusion biopsy over a three-year period to evaluate the clinical significance of their cancer.

METHOD

We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3 year period. 375 of these patients had transitional zone only cancers. The patients with transitional and peripheral zone cancer were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined.

RESULTS

Of the 1500 patients with a PIRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20%, respectively, for the TZ, PZ and combined zones. Kaplan- Meier, Cox Proportional Hazards test, ANOVA and Chi- Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant

CONCLUSIONS

The use of a UroNav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy.

OBJECTIVE

Transitional zone cancers are not accounted for when using standard prostate biopsy techniques. Using MRI/Transrectal ultrasound fusion biopsy (UroNav) can more accurately diagnose transitional zone prostate cancer. The goal of this study is to evaluate 375 patients with transitional zone only cancer found on a UroNav biopsy MRI/Transrectal ultrasound fusion biopsy over a three-year period to evaluate the clinical significance of their cancer.

METHOD

We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3 year period. 375 of these patients had transitional zone only cancers. The patients with transitional and peripheral zone cancer were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined.

RESULTS

Of the 1500 patients with a PIRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20%, respectively, for the TZ, PZ and combined zones. Kaplan- Meier, Cox Proportional Hazards test, ANOVA and Chi- Square tests were performed. Data was analyzed using IBM SPSS version 27 and statistical significance was set at α=0.05. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant

CONCLUSIONS

The use of a UroNav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy.

BACKGROUND

The incidence of adenocarcinoma, the most common type of small intestine cancer, is increasing. Prior studies found a 5-year survival of about 25% even with surgical resection and lymph node dissection. A recent study found higher survival in insured versus uninsured patients, yet differential outcomes and treatments between private insurance and Medicare, along with Medicaid and no insurance, are unknown. This study aims to determine differential survival and treatment of patients with small intestine adenocarcinoma based on insurance status.

METHODS

The National Cancer Database was used to identify patients diagnosed with small intestine adenocarcinoma from 2004-2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, ANOVA, and Cox Proportional Hazards tests were performed. Data was analyzed using IBM SPSS version 28 and statistical significance was set at α=0.05.

RESULTS

Of the 20,933 patients included, 7,629 (32.4%) had private insurance and 13,075 (55.5%) had Medicare. Patients with private insurance had a longer median survival (28.8 months) than patients with Medicare, Medicaid, and no insurance (p<.001), while patients with Medicare had a shorter median survival (12.2 months) than other insurance statuses (p<.001). No median survival difference existed between those with Medicaid (18.9 months) and no insurance (18.0 months) (p=.882). After controlling for age, co-morbidity score, grade, tumor size, low-income, academic facility, surgery of primary site, palliative care, and days between diagnosis and treatment, private insurance was associated with an independent decrease in hazard (HR=.874; p<.001). Patients with private insurance received more surgery (67.8%) than those with Medicaid (58.6%), no insurance (54.4%), and Medicare (52.9%) (p<.001). Patients with Medicare received more adjuvant radiation, but patients with private insurance received more adjuvant chemoradiation (p<.001). While patients with Medicare presented with greater co-morbidities and age, patients with private insurance presented with fewer co-morbidities, smaller sized tumors, and shorter time between diagnosis and treatment (p<.001).

CONCLUSIONS

Since patients with private insurance received the most surgery and displayed the highest overall survival, while patients with Medicare displayed the lowest survival, future research should explore ways to alleviate this disparity in surgical resections.

BACKGROUND

The incidence of adenocarcinoma, the most common type of small intestine cancer, is increasing. Prior studies found a 5-year survival of about 25% even with surgical resection and lymph node dissection. A recent study found higher survival in insured versus uninsured patients, yet differential outcomes and treatments between private insurance and Medicare, along with Medicaid and no insurance, are unknown. This study aims to determine differential survival and treatment of patients with small intestine adenocarcinoma based on insurance status.

METHODS

The National Cancer Database was used to identify patients diagnosed with small intestine adenocarcinoma from 2004-2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, ANOVA, and Cox Proportional Hazards tests were performed. Data was analyzed using IBM SPSS version 28 and statistical significance was set at α=0.05.

RESULTS

Of the 20,933 patients included, 7,629 (32.4%) had private insurance and 13,075 (55.5%) had Medicare. Patients with private insurance had a longer median survival (28.8 months) than patients with Medicare, Medicaid, and no insurance (p<.001), while patients with Medicare had a shorter median survival (12.2 months) than other insurance statuses (p<.001). No median survival difference existed between those with Medicaid (18.9 months) and no insurance (18.0 months) (p=.882). After controlling for age, co-morbidity score, grade, tumor size, low-income, academic facility, surgery of primary site, palliative care, and days between diagnosis and treatment, private insurance was associated with an independent decrease in hazard (HR=.874; p<.001). Patients with private insurance received more surgery (67.8%) than those with Medicaid (58.6%), no insurance (54.4%), and Medicare (52.9%) (p<.001). Patients with Medicare received more adjuvant radiation, but patients with private insurance received more adjuvant chemoradiation (p<.001). While patients with Medicare presented with greater co-morbidities and age, patients with private insurance presented with fewer co-morbidities, smaller sized tumors, and shorter time between diagnosis and treatment (p<.001).

CONCLUSIONS

Since patients with private insurance received the most surgery and displayed the highest overall survival, while patients with Medicare displayed the lowest survival, future research should explore ways to alleviate this disparity in surgical resections.

BACKGROUND

The incidence of adenocarcinoma, the most common type of small intestine cancer, is increasing. Prior studies found a 5-year survival of about 25% even with surgical resection and lymph node dissection. A recent study found higher survival in insured versus uninsured patients, yet differential outcomes and treatments between private insurance and Medicare, along with Medicaid and no insurance, are unknown. This study aims to determine differential survival and treatment of patients with small intestine adenocarcinoma based on insurance status.

METHODS

The National Cancer Database was used to identify patients diagnosed with small intestine adenocarcinoma from 2004-2019 using the histology code 8140 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, Chi-Square, ANOVA, and Cox Proportional Hazards tests were performed. Data was analyzed using IBM SPSS version 28 and statistical significance was set at α=0.05.

RESULTS

Of the 20,933 patients included, 7,629 (32.4%) had private insurance and 13,075 (55.5%) had Medicare. Patients with private insurance had a longer median survival (28.8 months) than patients with Medicare, Medicaid, and no insurance (p<.001), while patients with Medicare had a shorter median survival (12.2 months) than other insurance statuses (p<.001). No median survival difference existed between those with Medicaid (18.9 months) and no insurance (18.0 months) (p=.882). After controlling for age, co-morbidity score, grade, tumor size, low-income, academic facility, surgery of primary site, palliative care, and days between diagnosis and treatment, private insurance was associated with an independent decrease in hazard (HR=.874; p<.001). Patients with private insurance received more surgery (67.8%) than those with Medicaid (58.6%), no insurance (54.4%), and Medicare (52.9%) (p<.001). Patients with Medicare received more adjuvant radiation, but patients with private insurance received more adjuvant chemoradiation (p<.001). While patients with Medicare presented with greater co-morbidities and age, patients with private insurance presented with fewer co-morbidities, smaller sized tumors, and shorter time between diagnosis and treatment (p<.001).

CONCLUSIONS

Since patients with private insurance received the most surgery and displayed the highest overall survival, while patients with Medicare displayed the lowest survival, future research should explore ways to alleviate this disparity in surgical resections.

BACKGROUND

Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is www.mdedge.com/fedprac/avaho SEPTEMBER 2023 • S23 known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.

METHODS

This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Multivariate Cox regression models and Kaplan- Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM SPSS version 27.0 was used. p<0.05 was used to indicate statistical significance.

RESULTS

EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 43.5% for older patients vs. 64.5% for younger patients (p<0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 2.23; p<0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.2% vs. 9.6%; p<0.05), cranium (5.5% vs. 4.7%; p<0.05), and had a higher rate of axial tumors (43.3% vs. 32.4%; p<0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (29.85 days vs. 19.37 days; p<0.05). Despite presenting with larger tumors , older patients were less likely to undergo a surgical procedure of the primary site (47.6% vs. 52.2%; p<0.05) and had higher rates of micro- and macroscopic residual tumor following surgical resection.

CONCLUSIONS

An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.

BACKGROUND

Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is www.mdedge.com/fedprac/avaho SEPTEMBER 2023 • S23 known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.

METHODS

This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Multivariate Cox regression models and Kaplan- Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM SPSS version 27.0 was used. p<0.05 was used to indicate statistical significance.

RESULTS

EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 43.5% for older patients vs. 64.5% for younger patients (p<0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 2.23; p<0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.2% vs. 9.6%; p<0.05), cranium (5.5% vs. 4.7%; p<0.05), and had a higher rate of axial tumors (43.3% vs. 32.4%; p<0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (29.85 days vs. 19.37 days; p<0.05). Despite presenting with larger tumors , older patients were less likely to undergo a surgical procedure of the primary site (47.6% vs. 52.2%; p<0.05) and had higher rates of micro- and macroscopic residual tumor following surgical resection.

CONCLUSIONS

An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.

BACKGROUND

Ewing sarcoma (EWS) is a malignancy which primarily arises in adolescence and has been studied extensively in this population. Much less is www.mdedge.com/fedprac/avaho SEPTEMBER 2023 • S23 known about the rare patient cohort over the age of 40 at diagnosis. In this study, we describe the survival outcomes and clinical characteristics of this population.

METHODS

This retrospective cohort study utilized the National Cancer Database (NCDB) to identify 4600 patients diagnosed between 2004 through 2019. Of these patients, 4058 were under the age of 40 and 542 were over 40. Multivariate Cox regression models and Kaplan- Meier curves were used to estimate survival from diagnosis to death between age groups. Chi-square tests were used to compare demographic and socioeconomic patient characteristics. IBM SPSS version 27.0 was used. p<0.05 was used to indicate statistical significance.

RESULTS

EWS patients older than 40 experienced worse survival outcomes compared to patients under the age of 40. 5-year survival was 43.5% for older patients vs. 64.5% for younger patients (p<0.05). A multivariate Cox proportional hazards model showed that age was independently associated with inferior survival. (HR 2.23; p<0.05). EWS patients over the age of 40 were more likely to have tumors originating from the vertebral column (16.2% vs. 9.6%; p<0.05), cranium (5.5% vs. 4.7%; p<0.05), and had a higher rate of axial tumors (43.3% vs. 32.4%; p<0.05) compared to patients under 40. Additionally, patients older than 40 experienced a significantly longer delay between the date of diagnosis and initiation of systemic treatment (29.85 days vs. 19.37 days; p<0.05). Despite presenting with larger tumors , older patients were less likely to undergo a surgical procedure of the primary site (47.6% vs. 52.2%; p<0.05) and had higher rates of micro- and macroscopic residual tumor following surgical resection.

CONCLUSIONS

An age over 40 is associated with decreased survival for patients with EWS. Due to the rarity of EWS in this cohort, the optimal role of systemic treatment remains unknown and has yet to be clearly elucidated. Consequently, our findings suggest that older patients receive disparities in treatment which may be contributing to decreased survival rates.

BACKGROUND

Implementation of lung cancer screening (LCS) in high-risk individuals reduces the risk of dying from lung cancer. The mortality benefit of LCS, however, can only be fully actualized in patients who adhere to follow-up screening examinations. Question: Does a centralized program offer better adherence to lung cancer screening compared with a decentralized approach?

METHODS

A retrospective analysis of a large Veterans Affairs medical center LCS program was conducted to compare adherence to follow-up screening in veterans established through the consult-based (centralized) program with those screened by primary care providers (decentralized). In addition, imaging referral rates from the centralized program were longitudinally reviewed and compared. The cohort included patients completing an LCS imaging examination between 10/2020 and 1/2022. Annual adherence was assessed in patients with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2 and was defined as returning for follow-up imaging within 15 months. Outcomes among patients undergoing screening using a centralized and decentralized approach were compared using a two-proportion z-test.

RESULTS

A total of 1,114 patients with a baseline Lung-RADS score of 1 or 2 were included. The amount of low-dose CT (LDCT) imaging ordered for LCS increased exponentially from 2021 to 2023; however, a higher percentage of LDCT examinations were ordered via the decentralized approach, with no significant change observed over time (76%, 71%, and 74% in 2021, 2022, and 2023, respectively). Overall adherence was 42%. Within the centralized program, adherence was 74% compared to 34% using a decentralized approach (p <0.001).

IMPLICATIONS

Adherence to annual screening among eligible veterans is greater within a centralized program. Future research aimed at identifying barriers and maximizing adherence to LCS is needed.

BACKGROUND

Implementation of lung cancer screening (LCS) in high-risk individuals reduces the risk of dying from lung cancer. The mortality benefit of LCS, however, can only be fully actualized in patients who adhere to follow-up screening examinations. Question: Does a centralized program offer better adherence to lung cancer screening compared with a decentralized approach?

METHODS

A retrospective analysis of a large Veterans Affairs medical center LCS program was conducted to compare adherence to follow-up screening in veterans established through the consult-based (centralized) program with those screened by primary care providers (decentralized). In addition, imaging referral rates from the centralized program were longitudinally reviewed and compared. The cohort included patients completing an LCS imaging examination between 10/2020 and 1/2022. Annual adherence was assessed in patients with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2 and was defined as returning for follow-up imaging within 15 months. Outcomes among patients undergoing screening using a centralized and decentralized approach were compared using a two-proportion z-test.

RESULTS

A total of 1,114 patients with a baseline Lung-RADS score of 1 or 2 were included. The amount of low-dose CT (LDCT) imaging ordered for LCS increased exponentially from 2021 to 2023; however, a higher percentage of LDCT examinations were ordered via the decentralized approach, with no significant change observed over time (76%, 71%, and 74% in 2021, 2022, and 2023, respectively). Overall adherence was 42%. Within the centralized program, adherence was 74% compared to 34% using a decentralized approach (p <0.001).

IMPLICATIONS

Adherence to annual screening among eligible veterans is greater within a centralized program. Future research aimed at identifying barriers and maximizing adherence to LCS is needed.

BACKGROUND

Implementation of lung cancer screening (LCS) in high-risk individuals reduces the risk of dying from lung cancer. The mortality benefit of LCS, however, can only be fully actualized in patients who adhere to follow-up screening examinations. Question: Does a centralized program offer better adherence to lung cancer screening compared with a decentralized approach?

METHODS

A retrospective analysis of a large Veterans Affairs medical center LCS program was conducted to compare adherence to follow-up screening in veterans established through the consult-based (centralized) program with those screened by primary care providers (decentralized). In addition, imaging referral rates from the centralized program were longitudinally reviewed and compared. The cohort included patients completing an LCS imaging examination between 10/2020 and 1/2022. Annual adherence was assessed in patients with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2 and was defined as returning for follow-up imaging within 15 months. Outcomes among patients undergoing screening using a centralized and decentralized approach were compared using a two-proportion z-test.

RESULTS

A total of 1,114 patients with a baseline Lung-RADS score of 1 or 2 were included. The amount of low-dose CT (LDCT) imaging ordered for LCS increased exponentially from 2021 to 2023; however, a higher percentage of LDCT examinations were ordered via the decentralized approach, with no significant change observed over time (76%, 71%, and 74% in 2021, 2022, and 2023, respectively). Overall adherence was 42%. Within the centralized program, adherence was 74% compared to 34% using a decentralized approach (p <0.001).

IMPLICATIONS

Adherence to annual screening among eligible veterans is greater within a centralized program. Future research aimed at identifying barriers and maximizing adherence to LCS is needed.

BACKGROUND

Leiomyosarcoma is a rare neoplasm of smooth muscle that can originate from various organ systems. Of the gastrointestinal tract, the rarity and the difficulty of diagnosing small intestine leiomyosarcoma affect its poor prognosis. With an average age of diagnosis of 64 years and a median life expectancy of 45 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes.

METHODS

We used the National Cancer Database to identify patients diagnosed with small intestine leiomyosarcoma (ICD-O-3 histology code 8890) between 2004-2019 (N=406). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05.

RESULTS

When analyzing race, patients diagnosed with small intestine leiomyosarcoma were predominantly White (81.8%) and African American (14.3%); however, White patients had statistically worse survival outcomes than African Americans (67 vs 97 months) (p=0.004). Patients with private insurance had statistically better outcomes when compared to Medicare (p<0.001). When compared to White patients, African Americans had a higher proportion of private insurance (53.4% vs 37.2%) and lower proportion of Medicare coverage (5.2% and 48.2%), a lower average age of diagnosis (60.5 vs 64.7 years), shorter travel distances (14.7 vs 31.1 miles) and fewer days between staging procedure and surgical diagnostics from initial diagnosis (4.54 vs 12.5 days). Patients who received surgical intervention had a statistically significant improved survival outcome than those who did not (78 vs 15 months) (p<0.001) with the majority of these procedures being partial gastrectomies (53.6%). More patients of the cohort were treated at comprehensive community cancer programs (36.2%), followed by academic research programs (32.0%), integrated network cancer programs (18.5%) and community cancer programs (8.6%).

CONCLUSIONS

Factors associated with increased survival outcomes include race, average age of diagnosis, travel distance, fewer days between diagnostic procedure and initial diagnosis, insurance status and surgical treatment. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with small intestine leiomyosarcoma.

BACKGROUND

Leiomyosarcoma is a rare neoplasm of smooth muscle that can originate from various organ systems. Of the gastrointestinal tract, the rarity and the difficulty of diagnosing small intestine leiomyosarcoma affect its poor prognosis. With an average age of diagnosis of 64 years and a median life expectancy of 45 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes.

METHODS

We used the National Cancer Database to identify patients diagnosed with small intestine leiomyosarcoma (ICD-O-3 histology code 8890) between 2004-2019 (N=406). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05.

RESULTS

When analyzing race, patients diagnosed with small intestine leiomyosarcoma were predominantly White (81.8%) and African American (14.3%); however, White patients had statistically worse survival outcomes than African Americans (67 vs 97 months) (p=0.004). Patients with private insurance had statistically better outcomes when compared to Medicare (p<0.001). When compared to White patients, African Americans had a higher proportion of private insurance (53.4% vs 37.2%) and lower proportion of Medicare coverage (5.2% and 48.2%), a lower average age of diagnosis (60.5 vs 64.7 years), shorter travel distances (14.7 vs 31.1 miles) and fewer days between staging procedure and surgical diagnostics from initial diagnosis (4.54 vs 12.5 days). Patients who received surgical intervention had a statistically significant improved survival outcome than those who did not (78 vs 15 months) (p<0.001) with the majority of these procedures being partial gastrectomies (53.6%). More patients of the cohort were treated at comprehensive community cancer programs (36.2%), followed by academic research programs (32.0%), integrated network cancer programs (18.5%) and community cancer programs (8.6%).

CONCLUSIONS

Factors associated with increased survival outcomes include race, average age of diagnosis, travel distance, fewer days between diagnostic procedure and initial diagnosis, insurance status and surgical treatment. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with small intestine leiomyosarcoma.

BACKGROUND

Leiomyosarcoma is a rare neoplasm of smooth muscle that can originate from various organ systems. Of the gastrointestinal tract, the rarity and the difficulty of diagnosing small intestine leiomyosarcoma affect its poor prognosis. With an average age of diagnosis of 64 years and a median life expectancy of 45 months, there exists a lack of information on the disparities that exist in these patients and how patient demographics contribute to differences in survival outcomes.

METHODS

We used the National Cancer Database to identify patients diagnosed with small intestine leiomyosarcoma (ICD-O-3 histology code 8890) between 2004-2019 (N=406). General patient characteristics were assessed using descriptive statistics. Survival was evaluated using Kaplan-Meier curves and log-rank tests. Significance was set at p<0.05.

RESULTS

When analyzing race, patients diagnosed with small intestine leiomyosarcoma were predominantly White (81.8%) and African American (14.3%); however, White patients had statistically worse survival outcomes than African Americans (67 vs 97 months) (p=0.004). Patients with private insurance had statistically better outcomes when compared to Medicare (p<0.001). When compared to White patients, African Americans had a higher proportion of private insurance (53.4% vs 37.2%) and lower proportion of Medicare coverage (5.2% and 48.2%), a lower average age of diagnosis (60.5 vs 64.7 years), shorter travel distances (14.7 vs 31.1 miles) and fewer days between staging procedure and surgical diagnostics from initial diagnosis (4.54 vs 12.5 days). Patients who received surgical intervention had a statistically significant improved survival outcome than those who did not (78 vs 15 months) (p<0.001) with the majority of these procedures being partial gastrectomies (53.6%). More patients of the cohort were treated at comprehensive community cancer programs (36.2%), followed by academic research programs (32.0%), integrated network cancer programs (18.5%) and community cancer programs (8.6%).

CONCLUSIONS

Factors associated with increased survival outcomes include race, average age of diagnosis, travel distance, fewer days between diagnostic procedure and initial diagnosis, insurance status and surgical treatment. These findings make a valuable contribution to the ongoing research on disparities affecting survival in patients with small intestine leiomyosarcoma.