Abstract PO-046: Predicting breast cancer survival outcomes in a tri-racial/ethnic population

Abstract Objective: In the United States, breast cancer is the most common cancer for women, and it alone accounts for 30% of all new cancer diagnoses in women. Considered the complexity of decision on breast cancer therapy decision, we develop a model to predict 5-year overall survival at the time of diagnosis based on demographic and pathological factors, and estimate the potential benefit from different breast cancer treatment regimens for each individual patient. Methods: Using tumor registry data from University of Miami Health System and Jackson Memorial Hospital from 2008 to 2018, 4021 breast cancer patients were selected. After preliminary screening of data, based on previous research and clinical evidence, univariate and multivariate Cox regression analysis were performed to assess the effect of the potential prognosticators of overall survival. Twelve variables from multivariate Cox model were selected to build the prediction model with adjustment of interaction between predictors. Results: This prediction model based on race/ethnicity, age at diagnosis, smoking status, tumor stage, tumor grade, hormone receptor status, human epidermal growth factor 2, surgery, radiotherapy, chemotherapy, hormone therapy, and immunotherapy had good discrimination and calibration in bootstrap validation set with an C-statistic 0.82, and no significant difference between the predicted and the observed probabilities. Conclusion: We have developed a robust, relatively accurate, and easy-demonstrated tool that is able to predict 5-year overall survival in patients with invasive breast cancer, with reference to indicate the impact of potential treatment on prognosis. This allowed better communication between clinician and individual patient to make joint clinical decision. Citation Format: Kaicheng Wang, George R. Yang, Jennifer J. Hu, Isildinha M. Reis, Wei Zhao, Stuart Herna. Predicting breast cancer survival outcomes in a tri-racial/ethnic population [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-046

Abstract PO-209: Breast cancer survival disparities by insurance status or racial/ethnic in specific patient populations

Abstract Introduction: Health insurance status reflects patients’ socioeconomic status, which determines healthcare access and is associated with prognosis and survival. Limited research has reported the association between insurance status and breast cancer survival, potentially mediated through healthcare access. Method: Tumor registry data from University of Miami Health System and Jackson Memorial Hospital between 2008 to 2018 were used to estimate the association between race/ethnicity, insurance status and tumor stage at diagnosis; effect of insurance status on the likelihood of receiving specific breast cancer treatment; and overall survival by race/ethnicity and insurance status. Overall, 4392 breast cancer patients were included in the study. Odds ratios (ORs) and 95% confidence intervals (CIs) for the likelihood of being diagnosed with advanced stage breast cancer by race/ethnicity and insurance status, and likelihood of receiving specific treatments by insurance status and race/ethnicity were evaluated. Five-year overall survival probabilities and hazard ratios (HRs) by race/ethnicity and insurance status were also examined. Results: African-American patients and patients who had Medicaid or were uninsured were more likely to be diagnosed with advanced stage breast cancer. Under-coverage patients were less likely to receive cancer-specific treatment. Five- year survival rate was significantly lower in African-Americans compared to non- Hispanic whites (74.2% and 85.7%; p<.001). Overall survival was also significantly worse in African-Americans compared to non-Hispanic Whites (HR, 1.40; 95%CI, 1.12-1.76). Patients who had Medicare (<65 years of age) (HR, 1.84; 95%CI, 1.19- 2.86) or Medicaid (HR, 1.23; 95%CI, 1.00-1.51) had significantly worse survival compared to patients with private insurance. Among HER2 positive patients, those who were covered by Medicare (≥65 years) (HR, 3.02; 95%CI, 1.04-8.80), Medicaid (HR, 2.31; 95%CI, 1.14-4.69), or no insurance (HR, 3.02; 95%CI, 1.44-6.32) had significantly higher hazards of death than privately insured patients. Conclusions: This study identified Medicare, Medicaid, and uninsured patients as having higher hazards of death compared to privately insured patients, which can inform health professionals and policy makers to advocate for equal health outcomes regardless of insurance. Citation Format: Kaicheng Wang, Jennifer J. Hu, Isildinha M. Reis, Wei Zhao, George R. Yang, Stuart Herna. Breast cancer survival disparities by insurance status or racial/ethnic in specific patient populations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-209

Survival of patients with de-novo metastatic breast cancer: analysis of data from a large breast cancer-specific private practice, a university-based cancer center and review of the literature

Approximately 6 % of patients with breast cancer are diagnosed with de-novo distant metastases. We set out to look at two cohorts of patients seen at breast cancer-specific practices, compare the results to other reports and larger databases, and see how advances in treatment have impacted overall survival (OS). The records from a large breast cancer oncology private practice and a second data set from the University of Miami/Sylvester Comprehensive Cancer Center (UM/SCCC) tumor database were, retrospectively, reviewed to identify patients with de-novo metastases. We included those patients identified to have metastatic disease within 3 months of diagnosis of a breast primary cancer. Patients diagnosed between 1996 and 2006 were chosen for our study population. The OS for the private practice was 41.0 months (46.0 for ER positive and 26.0 for ER negative) and 36.0 months for UM/SCCC (52 months for ER positive and 36 months for ER negative). ER negativity and CNS- or visceral-dominant disease were associated with a significantly worse prognosis within the private practice. Dominant site was associated with a significantly worse prognosis within the UM/SCCC database but with a trend also for ER negativity. Age and ethnicity did not contribute significantly to the survival of patients within either cohort. The median survival in both cohorts and most other reported series was larger than that seen in the surveillance, epidemiology, and end results program and the National Cancer Database. The median OS among patients with de-novo metastatic breast cancer treated within two breast-specific oncology practices was over 3 years, which appears better than larger, more inclusive databases and publications from earlier decades

Cholangiocarcinoma: A joint cancer database analysis.

268 Background: Cholangiocarcinoma is an uncommon malignancy. In addition, only 10-30% of patients are eligible for curative surgical resection due to advanced disease at diagnosis. The role of adjuvant therapy is not yet established. The objective of this analysis is to assess the outcome of patients with cholangiocarcinoma managed with surgery, chemotherapy, radiation, and/or chemo-radiation. Methods: From 1997 to 2007, patients with biliary cancer from the joint tumor registry database at UMH, SCCC, and JHS had their demographics, stage, pathology, treatment (surgical management, adjuvant and palliative therapy) and survival collected. A total of 800 patients with the diagnoses of biliary cancer were reviewed. The site of cancer was the bile duct in 351 patients, gallbladder in 173, and ampulla of vater in 239 patients. Results: Cholangiocarcinoma - adenocarcinoma of the bile duct – in 334 patients of the 351 with bile duct tumors were analyzed. The mean age at diagnosis was 65 (range 26-92) and 55% of patients were male. Stage at presentation was as follows: 22% of patients presented with stage I, 18% with stage II, 21% with stage III, 26% with stage IV, and 13% were unknown. Potentially curative surgical resection was performed in 45% of the patients. 24% received chemotherapy, 20% received radiation, and 14% received chemo-radiation in combination. The overall median survival (MS) of all patients was 13 months - 22, 16, 14, and 10 months for stages I, II, III, and IV respectively. Surgery provided an overall survival benefit for all stages (24 vs. 9 months, p<.001), including stage III (n=31/71; 20 vs. 10 months, p=.026) and stage IV (n=28/88; 23 vs. 6 months, p<.001). Chemotherapy offered a trend to survival benefit for patients with stage IV (13 vs. 6 months, p=.06) and combined stages III and IV (13 vs. 10 months, p=.07). Combination chemo-radiation had a significant survival benefit in stage IV (19 vs. 6 months, p=.022) and in combined stages III and IV (14 vs. 10 months, p=.026). Conclusions: Chemotherapy and chemo-radiation had a positive impact on survival in patients with late stage cholangiocarcinoma. Surgery improved survival in both early and advanced stages. The lack of data on performance status and organ function did not allow factoring these variables in the analysis

Management and 1-year outcomes of patients with newly diagnosed atrial fibrillation and chronic kidney disease: Results from the prospective garfield-af registry

Background-—Using data from the GARFIELD-AF (Global Anticoagulant Registry in the FIELD–Atrial Fibrillation), we evaluated the impact of chronic kidney disease (CKD) stage on clinical outcomes in patients with newly diagnosed atrial fibrillation (AF). Methods and Results-—GARFIELD-AF is a prospective registry of patients from 35 countries, including patients from Asia (China, India, Japan, Singapore, South Korea, and Thailand). Consecutive patients enrolled (2013–2016) were classified with no, mild, or moderate-to-severe CKD, based on the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative guidelines. Data on CKD status and outcomes were available for 33 024 of 34 854 patients (including 9491 patients from Asia); 10.9% (n=3613) had moderate-to-severe CKD, 16.9% (n=5595) mild CKD, and 72.1% (n=23 816) no CKD. The use of oral anticoagulants was influenced by stroke risk (ie, post hoc assessment of CHA2DS2-VASc score), but not by CKD stage. The quality of anticoagulant control with vitamin K antagonists did not differ with CKD stage. After adjusting for baseline characteristics and antithrombotic use, both mild and moderate-to-severe CKD were independent risk factors for all-cause mortality. Moderate-to-severe CKD was independently associated with a higher risk of stroke/systemic embolism, major bleeding, new-onset acute coronary syndrome, and new or worsening heart failure. The impact of moderate-to-severe CKD on mortality was significantly greater in patients from Asia than the rest of the world (P=0.001). Conclusions-—In GARFIELD-AF, moderate-to-severe CKD was independently associated with stroke/systemic embolism, major bleeding, and mortality. The effect of moderate-to-severe CKD on mortality was even greater in patients from Asia than the rest of the world