Cancer Informatics for Cancer Centers (CI4CC): Building a Community Focused on Sharing Ideas and Best Practices to Improve Cancer Care and Patient Outcomes.

Cancer Informatics for Cancer Centers (CI4CC) is a grassroots, nonprofit 501c3 organization intended to provide a focused national forum for engagement of senior cancer informatics leaders, primarily aimed at academic cancer centers anywhere in the world but with a special emphasis on the 70 National Cancer Institute-funded cancer centers. Although each of the participating cancer centers is structured differently, and leaders' titles vary, we know firsthand there are similarities in both the issues we face and the solutions we achieve. As a consortium, we have initiated a dedicated listserv, an open-initiatives program, and targeted biannual face-to-face meetings. These meetings are a place to review our priorities and initiatives, providing a forum for discussion of the strategic and pragmatic issues we, as informatics leaders, individually face at our respective institutions and cancer centers. Here we provide a brief history of the CI4CC organization and meeting highlights from the latest CI4CC meeting that took place in Napa, California from October 14-16, 2019. The focus of this meeting was "intersections between informatics, data science, and population science." We conclude with a discussion on "hot topics" on the horizon for cancer informatics

Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data.

Background and objectiveEarly detection methods for pancreatic cancer are lacking. We aimed to develop a prediction model for pancreatic cancer based on changes in health captured by healthcare claims data.MethodsWe conducted a case-control study on 29,646 Medicare-enrolled patients aged 68 years and above with pancreatic ductal adenocarcinoma (PDAC) reported to the Surveillance Epidemiology an End Results (SEER) tumor registries program in 2004-2011 and 88,938 age and sex-matched controls. We developed a prediction model using multivariable logistic regression on Medicare claims for 16 risk factors and pre-diagnostic symptoms of PDAC present within 15 months prior to PDAC diagnosis. Claims within 3 months of PDAC diagnosis were excluded in sensitivity analyses. We evaluated the discriminatory power of the model with the area under the receiver operating curve (AUC) and performed cross-validation by bootstrapping.ResultsThe prediction model on all cases and controls reached AUC of 0.68. Excluding the final 3 months of claims lowered the AUC to 0.58. Among new-onset diabetes patients, the prediction model reached AUC of 0.73, which decreased to 0.63 when claims from the final 3 months were excluded. Performance measures of the prediction models was confirmed by internal validation using the bootstrap method.ConclusionModels based on healthcare claims for clinical risk factors, symptoms and signs of pancreatic cancer are limited in classifying those who go on to diagnosis of pancreatic cancer and those who do not, especially when excluding claims that immediately precede the diagnosis of PDAC

Geographic disparities in colorectal cancer survival

© 2009 Henry et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

A review of radiotherapy-induced late effects research after advanced technology treatments

The number of incident cancers and long-term cancer survivors is expected to increase substantially for at least a decade. Advanced technology radiotherapies, e.g., using beams of protons and photons, offer dosimetric advantages that theoretically yield better outcomes. In general, evidence from controlled clinical trials and epidemiology studies are lacking. To conduct these studies, new research methods and infrastructure will be needed. In the paper, we review several key research methods of relevance to late effects after advanced technology proton-beam and photon-beam radiotherapies. In particular, we focus on the determination of exposures to therapeutic and stray radiation and related uncertainties, with discussion of recent advances in exposure calculation methods, uncertainties, in silico studies, computing infrastructure, electronic medical records, and risk visualization. We identify six key areas of methodology and infrastructure that will be needed to conduct future outcome studies of radiation late effects

Cancer

BackgroundGranulocyte colony-stimulating factors(G-CSF), used for prevention of complications from chemotherapy-related neutropenia, are linked to risk of developing second primary myelodysplastic syndrome and acute myeloid leukemia(MDS/AML). Our purpose was to examine the relationship between use of a specific G-CSF agent and risk of MDS/AML among older patients with non-Hodgkin lymphoma(NHL).MethodsWe conducted a retrospective cohort study of adults aged >65 years with first primary NHL between 2001\u20132011, using the Surveillance Epidemiology and End Results-Medicare linked database. We estimated adjusted hazard ratios(HR) and 95% confidence intervals(CI) for MDS/AML risk associated with G-CSF(filgrastim and pegfilgrastim) use in Cox proportional hazards models stratified by treatment accounting for confounding by indication.ResultsAmong 18,245 NHL patients with median follow up of 3.5 years, 56% received chemotherapy and/or immunotherapy, and G-CSF was most commonly used in those receiving rituximab plus multiple chemotherapy regimens(77%). Subsequent MDS/AML diagnoses were identified in 666(3.7%) patients. We observed modest increased risk of MDS/AML with use of G-CSF(HR=1.28, 95% CI 1.01\u20131.62) and a trend with increasing doses(P-trend <0.01). When analyzing specific agents, increased MDS/AML risk was consistently observed with filgrastim(10+ doses: HR=1.67, 95% CI 1.25\u20132.23), but not pegfilgrastim(10+ doses: HR=1.11, 95% CI 0.84\u20131.45).ConclusionsWe found higher MDS/AML risk among those receiving G-CSF that was specific to the use of filgrastim( 6510 doses), but not pegfilgrastim. Neutropenia prophylaxis is an essential component of highly effective NHL treatment regimens. Differential risk related to the type of G-CSF agents used warrants further study given their increasing use and newly available FDA-approved biosimilar products.HHSN261201000035C/CA/NCI NIH HHS/United StatesR21 MD011439/MD/NIMHD NIH HHS/United StatesHHSN261201000035I/CA/NCI NIH HHS/United StatesUL1 TR002003/TR/NCATS NIH HHS/United StatesHHSN261201000034C/CA/NCI NIH HHS/United StatesHHSN261201000140C/CA/NCI NIH HHS/United StatesKL2 TR002002/TR/NCATS NIH HHS/United StatesU58 DP003862/DP/NCCDPHP CDC HHS/United StatesKL2 TR000048/TR/NCATS NIH HHS/United States2020-04-01T00:00:00Z30548485PMC64203877469vault:3174

Cancer-Specific Mortality, Cure Fraction, and Noncancer Causes of Death Among Diffuse Large B-cell Lymphoma Patients in the Immunochemotherapy Era.

BACKGROUND Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. METHODS Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). RESULTS Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. CONCLUSIONS Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017. © 2017 American Cancer Society

Cancer Epidemiol Biomarkers Prev

Background.Racial and ethnic disparities in guideline-recommended breast cancer treatment are well documented, however studies including diagnostic and staging procedures necessary to determine treatment indications are lacking. The purpose of this study was to characterize patterns in delivery of evidence-based services for the diagnosis, clinical workup, and first-line treatment of breast cancer by race-ethnicity.Methods.SEER-Medicare data were used to identify women diagnosed with invasive breast cancer between 2000 and 2017 at age 66 or older (n = 215,605). Evidence-based services included diagnostic procedures (diagnostic mammography and breast biopsy), clinical workup (stage and grade determination, lymph node biopsy, and HR and HER2 status determination), and treatment initiation (surgery, radiation, chemotherapy, hormone therapy, and HER2-targeted therapy). Poisson regression was used to estimate rate ratios (RRs) and 95% Confidence Intervals (CIs) for each service.Results.Black and American Indian/Alaska Native (AIAN) women had significantly lower rates of evidence-based care across the continuum from diagnostics through first-line treatment compared to non-Hispanic White (NHW) women. AIAN women had the lowest rates of HER2-targeted therapy and hormone therapy initiation. While Black women also had lower initiation of HER2-targeted therapy than NHW, differences in hormone therapy were not observed.Conclusions.Our findings suggest patterns along the continuum of care from diagnostic procedures to treatment initiation may differ across race-ethnicity groups.Impact.Efforts to improve delivery of guideline-concordant treatment and mitigate racial-ethnic disparities in healthcare and survival should include procedures performed as part of the diagnosis, clinical workup, and staging processes.HHSN261201000140C/CA/NCI NIH HHSUnited States/HHSN261201000035C/CA/NCI NIH HHSUnited States/P30 CA086862/CA/NCI NIH HHSUnited States/HHSN261201000035I/CA/NCI NIH HHSUnited States/HHSN261201000034C/CA/NCI NIH HHSUnited States/U58 DP003862/DP/NCCDPHP CDC HHSUnited States

The Changing Landscape Of Oral Cavity Cancer: Analysis Of Epidemiological And Genomic Data

Background: Oral cavity squamous cell carcinoma (OCSCC) has been reported to have stagnant survival rates over the last generation. This report represents the first population-based study with a rigorous subsite analysis of OCSCC. Recently, The Cancer Genome Atlas (TCGA) released a broad molecular characterization of Head and Neck Squamous Cell Carcinoma (HNSCC) – however comparative genomics has not yet been performed on individual oral cavity subsites. Methods: The Surveillance, Epidemiology, and End Results (SEER) database (1988–2010) was used to examine 16,298 adult cases of OCSCC. Trends in tumor subsite, staging, patient demographics, treatment characteristics, and survival over time were examined. Subsequently, data from TCGA were used to evaluate mutation, copy number, and expression profiles of clinical subgroups of interest identified by epidemiological data. Results: The overall incidence of OCSCC decreased between 1988 and 2007, but there was a marked increase in the incidence oral tongue squamous cell carcinoma (OTSCC). There were also trends towards oral tongue (OT) cancers being diagnosed in younger individuals and at earlier stages. Five-year overall survival of OCSCC increased between 1988 and 2007 (39.9% to 50.4%, p\u3c .01), independent of changes in patient and tumor characteristics. Much of this survival increase was specifically attributable to increases in survival of OT cancers. Multivariate analysis revealed that age, stage, and grade were important covariates with survival, but oral subsite was not. Genomic analyses aimed at characterizing OT tumors higher rates of mutation in p53 and CDKN2A, and lower rates of mutation in most other genes. CASP8 mutations were found almost exclusively in non-tongue oral subsites. OT and oral cavity (OC) cancers, even in non-smokers, did not show the characteristic molecular changes associated with Human Papillomavirus (HPV) -related cancers, but instead closely resembled traditional smoking-related tumors. Clustering analysis revealed that OT tumors possess a distinct expression signature. Conclusions: Survival for OCSCC has improved significantly over the past 20 years. Additionally, OTSCC now has a superior 5-year survival compared to other OC subsites; this can be attributed to trends towards earlier staging and younger population. The molecular profile of OTSCC, including tumors occurring in young, non-smokers, resemble that of traditional head and neck cancers (related to environmental carcinogens) – and is very different from HPV-related oropharyngeal cancers

Temporal and Spatial Analysis of Cancer Rates in the United States

Introduction: Spatial, temporal and racial patterns of cancer remain largely unexplained in the United States. Time trends of cancer incidence and mortality can be used to estimate the current cancer burden, anticipate clinical care needs, and suggest hypotheses regarding possible etiologic explanations for underlying trends. Methods: Using U.S. 1979-2003 cancer incidence and 1969-2003 cancer mortality data, age-period-cohort and Joinpoint regression models were fit to summarize gender- and race-specific temporal trends for three broad cancer categories that include tobacco-related cancer, screen-detectable cancer, and cancer unrelated to tobacco and screening. Demographic patterns and time trends of non-Hodgkin's lymphoma (NHL) incidence between Pennsylvania and the U.S. from 1985 to 2004 were compared. Using Idaho cancer incidence, 1990-2005, and arsenic levels in ground water, 1990-2005, spatial analysis was conducted to identify geographic patterns of cancer incidence and to evaluate the relationship between arsenic exposure in ground water and cancer incidence in Idaho. Results: Over the last three decades, tobacco-related cancer incidence declined among men and increased among women. Screen-detectable cancer incidence increased, more rapidly among men than women. For cancer unrelated to tobacco and screening, incidence increased in every gender-and-race group. Though not identical, NHL incidence patterns, with substantial increases, were similar in the U.S. and Pennsylvania. NHL incidence was higher in Pennsylvania counties with a greater percentage of urban residents. Although spatial clustering was demonstrated in Idaho cancer incidence, no relationship was found between arsenic exposure in ground water and Idaho cancer incidence. Conclusion: NHL and other cancers unrelated to smoking or screening have increased in the U.S. in the past two decades in white and black men and women. Etiologic research should attempt to identify modifiable risk factors, including environmental exposures, responsible for the increasing incidence of NHL and cancer unrelated to tobacco and screening. The ecologic association observed in Pennsylvania between NHL incidence and urban residence may be relevant to NHL risk in the entire United States. Additional environmental and demographic information should be evaluated in order to clarify the arsenic-related cancer risk in Idaho counties where ground water has been found to contain higher levels of arsenic. Public Health Significance: Age, period and cohort modeling of cancer incidence and mortality provides important indications of current and future health care needs and also suggests hypotheses for future research. The results of this analysis provide health professionals, researchers, and policy-makers with detailed information and an understandable overview of cancer patterns in the United States. Hypotheses should be generated about these unexplained patterns of cancer so that avoidable cancer risks can be identified that will decrease the cancer burden and associated requirements for health care