Suchergebnisse

BACKGROUND: Young age may be associated with an increased risk of lymph node involvement at diagnosis of colorectal cancer. Accessibility to care, which is related to cancer detection, tumor stage, and therefore lymph node positivity, may vary by age and thus influence research results. OBJECTIVE: Investigate whether young patients had an increased risk of lymph node-positive colon and rectal cancers in the Department of Defense's Military Health System, which provides universal healthcare to its beneficiaries. DESIGN: Retrospective cross-sectional study. SETTINGS: Patients were identified from the United States Department of Defense's Automated Central Tumor Registry. PATIENTS: Were diagnosed with histologically-confirmed primary stage I-III colon and rectal adenocarcinomas between 1989–2013, had surgery and ≥1 lymph node examined, and did not receive pre-operative radiotherapy. Logistic regression was used to examine the relationships between age at diagnosis (18–49, 50–59, 60–69, and ≥70 years) and lymph node positivity overall and stratified by tumor T stage and number of lymph nodes examined. MAIN OUTCOME MEASURES: Lymph node-positivity of colon and rectal cancers. RESULTS: The youngest patients (18–49 years old) were more likely to have lymph node-positive colon and rectal cancers compared to those who were 70 or older after adjustment for potential confounders (odds ratio: 2.04, 95% confidence interval: 1.63–2.56 for colon cancer; odds ratio: 1.73, 95% confidence interval: 1.11–2.70 for rectal cancer). A similar tendency was shown in most colon and rectal cancer subgroups stratified by tumor T stage and number of lymph nodes examined. LIMITATIONS: Small sample size for certain subgroup analyses. No information on comorbidities, body mass index, or other indicators of health status. CONCLUSIONS: In a universal healthcare system, young age was associated with increased lymph node-positivity of colon and rectal cancers, suggesting that factors other than access to care may play a role in this association. ...

PURPOSE: We investigated the association between comorbidities and stage at diagnosis among NSCLC patients in the U.S. Military Health System (MHS), which provides universal health care to its beneficiaries. METHODS: The linked data from the Department of Defense's Central Cancer Registry (CCR) and the MHS Data Repository (MDR) were used. The study included 4,768 patients with histologically confirmed primary NSCLC. Comorbid conditions were extracted from the MDR data. Comorbid conditions were those included in the Charlson Comorbidity Index (CCI) and were defined as a diagnosis during a 3-year time frame prior to the NSCLC diagnosis. Multivariable logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (95% CI) of late stage (stages III and IV) versus early stage (stages I and II) in relation to pre-existing comorbidities. RESULTS: Compared to patients with no comorbidities, those with prior comorbidities tended to be less likely to have lung cancer diagnosed at late stage. When specific comorbidities were analyzed, decreased odds of being diagnosed at late stage was observed among those with chronic obstructive pulmonary disease (COPD) (adjusted OR=0.78, 95% CI=0.68 to 0.90). In contrast, patients with a congestive heart failure or a liver cirrhosis/chronic hepatitis had an increased likelihood of being diagnosed at late stage (adjusted OR=1.30, 95% CI=1.00 to 1.69 and adjusted OR=1.87, 95% CI=1.24 to 2.82, respectively). CONCLUSIONS: Among NSCLC patients in an equal access health system, the likelihood of late stage at diagnosis differed by specific comorbid diseases.

AIM: Larger tumour size and lymph node involvement traditionally predict poorer survival in colon cancer patients. However, it has been recently suggested that very small tumours (<5 mm) may be a predictor of poor prognosis in colon cancer patients when lymph nodes are involved. This study investigated whether node-positive colon cancer patients with small tumours had worse survival compared to those with larger tumours in the Department of Defense's (DoD) Military Health System (MHS), a universal health care system. METHODS: Surgically treated colon cancer patients were identified from the DoD's Automated Central Tumour Registry (ACTUR). They were diagnosed with stage I-III colon cancer between 1989 and 2010, with ≥1 lymph node examined, and did not receive pre-operative radiotherapy, and were followed through 2013 for vital status. Multivariable Cox models were used to examine survival differences by tumour size groups and stratified by lymph node status and age. RESULTS: There were no differences in overall survival by tumour size in the study population. These findings remained similar in stratified analysis by lymph node status and age. CONCLUSION: In a universal health care system, small tumour size is not associated with worse prognosis in node-positive colon cancer patients.

IMPORTANCE: Racial disparities in time to surgery (TTS) after a breast cancer diagnosis and whether these differences account for disparities in overall survival have been understudied in the US population. OBJECTIVES: To compare TTS in non-Hispanic black (NHB) and non-Hispanic white (NHW) women with breast cancer and to examine whether racial differences in TTS may explain possible racial disparities in overall survival in a universal health care system. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort identified from the Department of Defense Central Cancer Registry and Military Health System Data Repository linked databases containing records between January 1, 1998, and December 31, 2008, of 998 NHB women and 3899 NHW women who received a diagnosis of stages I to III breast cancer and underwent breast-conserving surgery (BCS) or mastectomy in the US Military Health System during the study period. Data analyses were conducted from July 5, 2017, to December 29, 2017. MAIN OUTCOMES AND MEASURES: The main outcome was time to breast cancer surgery. Non-Hispanic black and NHW women were compared at the 25th, 50th (median), 75th, and 90th percentiles of TTS by using multivariable quantile regression. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause death in NHB compared with NHW women after controlling for potential confounders first without and then with TTS. RESULTS: Among the 4887 NHB and NHW women in the cohort, the mean (SD) age was 50.0 (9.4) years. The median TTS was 21 days (95% CI, 20.6-21.4 days) among NHW women and 22 days (95% CI, 20.6-23.4 days) among NHB women. Non-Hispanic black women had a significantly greater estimated TTS at the 75th (3.6 days; 95% CI, 1.6-5.5 days) and 90th (8.9 days; 95% CI, 5.1-12.6 days) percentiles than NHW women in multivariable models. The estimated differences were similar by surgery type. Non-Hispanic black women had a higher adjusted risk for death (HR, 1.45; 95% CI, 1.06-2.01) compared with NHW women ...

<p><strong>Purpose: </strong>Breast cancer mortality rates are higher for African American women (AAW) than for any other ethnic group in the United States. Recent reports suggest that outcome disparities between AAW and European American women (EAW) are present in the ER+HER2- subtype. To improve our understanding, pathological characteristics, mortality and molecular profiles from women treated within an equal-access health care system were evaluated. <strong></strong></p><p><strong>Procedures: </strong>All AAW (n=90) and EAW (n=308) with ER+HER2- tumors were identified. Gene expression profiles were generated from primary breast tumors from 57 AAW and 181 EAW. Pathological characteristics, survival and gene expression analysis were evaluated using chi-square analysis, log-rank tests and ANOVA. </p><p><strong>Results: </strong>Tumors from AAW were significantly more likely to be PR-, Ki67+ and of higher grade. Tumor stage, size and lymph node status did not differ significantly, nor did mortality rates (P=.879). At the molecular level, genes PSPHL and CRYBB2P1 were expressed at significantly higher levels in tumor tissues as well as normal stroma and blood from AAW. Polymorphisms controlling expression of each gene were identified with minor allele frequencies differing significantly between populations but not between cases and controls within each population. <strong></strong></p><p><strong>Conclusions: </strong>Survival disparities were not detected in patients with ER+HER2- tumors treated within an equal-access health care system and molecular differences in tumors were not causal. Thus, outcome disparities in AAW with ER+HER2- tumors are largely attributable to socioeconomic factors affecting access to screening and treatment, rather than reflecting underlying biological differences. <em>Ethn Dis. </em>2016;26(3):407-416; doi:10.18865/ed.26.3.407 </p>

BACKGROUND: Glioma is the most common malignant brain cancer. Accessibility to health care is an important factor affecting cancer outcome in the U.S. general population. The U.S. Military Health System (MHS) provides universal health care to its beneficiaries. It is unknown whether the universal health care has translated into improved survival outcomes among MHS beneficiaries with glioma. We compared overall survival of glioma patients in the MHS with that of the general population. METHODS: The MHS cases were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR). Glioma cases from the general population were identified from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. SEER cases were matched 2:1 to ACTUR cases by age, sex, race, histology and diagnosis year. All cases had histologically confirmed glioma diagnosed between January 1, 1987 and December 31, 2013. Kaplan-Meier analysis was conducted to compare survival among the ACTUR and SEER cases. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The study included 2,231 glioma cases from ACTUR and 4,462 cases from SEER. ACTUR cases exhibited significantly better overall survival than SEER cases (HR = 0.74, 95% CI= 0.67–0.83). The survival advantage of the ACTUR patients was observed in most subgroups stratified by age, gender, race, diagnosis year, and histology. For glioblastoma, the survival advantage was observed in both the pre- and post-temozolomide periods. CONCLUSIONS: Universal MHS health care may have translated into improved survival outcomes in glioma. Future studies are warranted to identify factors contributing to the improved survival.

Studies have shown that whites have a higher colorectal cancer survival rate than blacks. However, it is unclear whether racial disparities result from unequal access to medical care or factors other than healthcare access or both. This study assessed whether non-Hispanic Whites (NHWs) and non-Hispanic Blacks (NHBs) differ in colon cancer (CC) survival in an equal-access healthcare system and examined whether racial differences varied by demographic and tumor characteristics. The study included 2,537 Military Health System patients diagnosed with CC between 1998 and 2007. Median follow-up time was 31.4 months. Cox models estimated hazard ratios (HR) and 95% confidence intervals (CI) for race, overall and stratified by age at diagnosis, sex, and tumor stage. No difference in overall survival (OS) between NHWs and NHBs was observed in general. However, among patients younger than 50 years old, NHBs experienced significantly worse OS than NHWs (HR: 2.27, 95% CI: 1.48–3.49). Further stratification by sex and tumor stage showed that this racial disparity was confined to women (HR: 2.80, 95% CI: 1.30–6.00) and patients with distant stage disease (HR: 2.65, 95% CI: 1.38–5.08) in this age group. When medical care is equally available to NHWs and NHBs, similar overall CC survival was observed; however, evidence of racial differences in survival was apparent for patients younger than 50 years old. This study suggests that factors other than access to care may be related to racial disparities in CC survival among younger, but not older, patients.

BACKGROUND: The U.S. military health system (MHS) provides universal health care access to its beneficiaries. However, whether the universal access has translated into improved patient outcome is unknown. This study compared survival of non-small cell lung cancer (NSCLC) patients in the MHS with that in the U.S. general population. METHODS: The MHS data were obtained from The Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR) and the U.S. population data were drawn from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. The study subjects were NSCLC patients diagnosed between January 1, 1987 and December 31, 2012 in ACTUR and a sample of SEER patients who were matched to the ACTUR patients on age group, sex, race, and year of diagnosis group with a matching ratio of 1:4. Patients were followed through December 31, 2013. RESULTS: 16,257 NSCLC patients were identified from ACTUR and 65,028 matched patients from SEER. Compared with SEER patients, ACTUR patients had significantly better overall survival (Log Rank P<0.001). The better overall survival among the ACTUR patients remained after adjustment for potential confounders (HR=0.78, 95% CI=0.76 to 0.81). The survival advantage of the ACTUR patients was present regardless of cancer stage, grade, age group, sex or race. CONCLUSIONS: The MHS's universal care and lung cancer care programs may have translated into improved survival among NSCLC patients. IMPACT: This study supports improved survival outcome among NSCLC patients with universal care access.

Research suggests that metformin may be associated with improved survival in cancer patients with type II diabetes. This study assessed whether metformin use after non-small cell lung cancer (NSCLC) diagnosis is associated with overall survival among type II diabetic patients with NSCLC in the U.S. military health system (MHS). The study included 636 diabetic patients with histologically confirmed NSCLC diagnosed between 2002 and 2007, identified from the linked database from the Department of Defense's Central Cancer Registry (CCR) and the Military Health System Data Repository (MDR). Time-dependent multivariate Cox proportional hazards models were used to assess the association between metformin use and overall survival during follow up. Among the 636 patients, 411 died during the follow up. The median follow up time was 14.6 months. Increased post-diagnosis cumulative use (per one-year of use) conferred a significant reduction in mortality (adjusted hazard ratio (HR)=0.76; 95% CI=0.65 to 0.88). Further analysis by duration of use revealed that compared to non-users, the lowest risk reduction occurred among patients with the longest duration of use (i.e. use for more than 2 years) (HR=0.19; 95% CI=0.09 to 0.40). Finally, the reduced mortality was particularly observed only among patients who also used metformin before lung cancer diagnosis and among patients at early stage of diagnosis. Prolonged duration of metformin use in the study population was associated with improved survival, especially among early stage patients. Future research with a larger number of patients is warranted.

OBJECTIVE: The mortality rate for Black women with endometrial cancer (EC) is double that of White women, although the incidence rate is lower among Black women. Unequal access to care may contribute to this racial disparity. This study aimed to assess whether survival varied between non-Hispanic Black (NHB) and non-Hispanic White (NHW) women with EC in the Military Health System (MHS) which provides equal access care to its beneficiaries despite racial/ethnic background. METHODS: The study was conducted using data from the U.S. Department of Defense's (DoD) Automated Central Tumor Registry (ACTUR). Study subjects included NHB and NHW women with histologically confirmed and surgically managed EC diagnosed between 1988 and 2013. The study outcome was all-cause death. Overall survival between NHB and NHW women was compared using multivariable Cox modeling. RESULTS: The study included 144 NHB and 1,439 NHW women with EC. Kaplan-Meier curves showed NHB women had worse survival than NHW women (log-rank P<0.0001). The disparity in survival between NHB and NHW women persisted after adjusting for age, diagnosis period, tumor stage, tumor histology/grade, and adjuvant treatment (HR=1.64, 95% CI=1.19 to 2.27). Multivariable analyses stratified by tumor features or treatment showed that the racial disparity was confined to women with low-risk features (stage I/II disease or low-grade EC) or no adjuvant treatment. CONCLUSION: There were racial differences in overall survival between NHB and NHW women with EC in the MHS equal access healthcare system, suggesting that factors other than access to care may be related to this racial disparity.

PURPOSE: Linked cancer registry and medical claims data have increased the capacity for cancer research. However, few efforts have described methods to select information between data sources, which may affect data use. We developed a systematic process to evaluate and consolidate cancer diagnosis and treatment information between the linked Department of Defense Central Cancer Registry (CCR) and Military Health System Data Repository (MDR) administrative claims database, called Military Cancer Epidemiology Data System (MilCanEpi). METHODS: MilCanEpi contains information on cancer diagnosis and treatment of patients receiving care from 1998 to 2014. We used an iterative process guided by knowledge of data features, current literature, and logical comparisons between the CCR and MDR data to evaluate and consolidate cancer diagnosis and treatment received (yes or no) and their dates. We applied the processes to breast cancer data as an example. Agreement between diagnosis and treatment dates in the two data sources was evaluated using Cohen's κ with 95% CIs. RESULTS: In MilCanEpi, we identified 15,965 patients with a breast cancer diagnosis and 15,145 patients who underwent breast cancer surgery; 97.9% and 84.1% of patients had records in both CCR and MDR for diagnosis and surgery, respectively. Exact agreement was 13.7% for diagnosis dates (Cohen's κ = 0.14; 95% CI, 0.13 to 0.14) and 68.9% for surgery dates (Cohen's κ = 0.69; 95% CI, 0.68 to 0.70) between the two data sources. After applying systematic processes, 98.1% of patients with a breast cancer diagnosis and 99.7% of patients with surgery had information selected for analytic data sets. CONCLUSION: The developed processes resulted in high consolidation rates of breast cancer data in MilCanEpi and may serve as a data selection template for other tumor sites and linked data sources.

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale.

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale.

One hundred sixty-one patients with stage I–III colon cancer were assigned randomly to standard histopathologic evaluation or sentinel lymph node mapping and ultrastaging with pan-cytokeratin IHC in conjunction with standard histopathology. Targeted nodal assessment identified small volume nodal disease and improved staging in patients with resectable colon cancer.

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale.