Impact of multi-agent systemic therapy on all-cause and disease-specific survival for people living with HIV who are diagnosed with non-Hodgkin lymphoma: population-based analyses from the state of Georgia.

For people living with HIV (PLWH) who are subsequently diagnosed with non-Hodgkin lymphoma (NHL), we investigate the impact of standard-of-care (SoC) cancer treatment on all-cause, NHL-specific, and HIV-specific survival outcomes. The focus is on a registry-derived, population-based sample of HIV + adults diagnosed with NHL within 2004-2012 in the state of Georgia. SoC treatment is defined as receipt of multi-agent systemic therapy (MAST). In multivariable survival analyses, SoC cancer treatment is significantly associated with better all-cause and NHL-specific survival, but not better HIV-specific survival across 2004-2017. Having a CD4 count <200 near the time of cancer diagnosis and Ann Arbor stage III/IV disease are associated with worse all-cause and HIV-specific survival; the effects on NHL survival trend negative but are not significant. Future work should expand the geographic base and cancers examined, deepen the level of clinical detail brought to bear, and incorporate the perspectives and recommendations of patients and providers.

Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia.

Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000-2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.

Biologic, clinical, and sociodemographic predictors of multi-agent systemic therapy for non-Hodgkin lymphoma in people living with HIV: a population-based investigation in the state of Georgia.

We conducted a population-based study of biologic, clinical, and sociodemographic factors associated with receipt of multi-agent systemic therapy (MAST) by people living with HIV (PLWH) who were diagnosed with non-Hodgkin lymphoma (NHL). Building on recent registry-based analyses, we linked records from the Georgia Cancer Registry, Georgia HIV/AIDS Surveillance Registry, and the Georgia Hospital Discharge Database to identify 328 PLWH adults (age ≥ 18) diagnosed with NHL within 2004-2012. Through logistic regression modeling, we examined factors associated with patients receiving MAST for NHL. Robust predictors included CD4 count ≥200 cells/mm3 around the time of cancer diagnosis, an advanced stage (III or IV) diagnosis of NHL, MSM HIV transmission, and having private health insurance. The strongest single predictor of MAST was CD4 count. Because there is now guideline-integrated evidence that PLWH receiving standard-of-care cancer therapy can achieve substantially improved outcomes, it is vital they have access to regimens routinely provided to HIV-negative cancer patients.

Quality of cancer registry data: findings from CDC-NPCR's Breast and Prostate Cancer Data Quality and Patterns of Care Study.

BACKGROUND: The Breast and Prostate Cancer Data Quality and Patterns of Care (POC-BP) Study enabled a reabstraction study of the quality of population-based, central cancer registry data on the characteristics and initial treatment of breast cancer in females and prostate cancer in the United States. METHODS: Stratified random samples of 9,103 female breast cancers and 8,995 prostate cancers were available for the analysis, using the independently reabstracted data as the gold standard to compute measurements of agreement. RESULTS: A slight majority (53% [8/15]) of the cancer site and treatment combinations showed kappa statistics > or = 0.60 and percent agreements, sensitivities, and predictive values positive > or = 80%: surgery and radiation for the 2 cancers, radiation completed and chemotherapy for breast cancer, and radiation modality and hormone therapy for prostate cancer. The qualities of the Collaborative Stage (CS) site-specific factors and derived variables for the 2 cancers were inconsistent, which confirmed the need to evaluate the recently-implemented CS algorithm. CONCLUSION: The data quality analysis from POC-BP underscores the importance of examining the quality of specific data variables by cancer site, thereby highlighting those variables for which data collection procedures could be improved.

Invasion characteristics of oral tongue cancer: frequency of reporting and effect on survival in a population-based study.

BACKGROUND: The 2000 College of American Pathologists (CAP) guidelines recommend that a characterization of carcinomas of the upper aerodigestive tract, including tongue cancer, should include depth of invasion (DI) and the presence of lymphovascular invasion (LVI) or perineural invasion (PNI). METHODS: This study included patients who were diagnosed with cancer of the oral tongue, who underwent tumor resection, and who were reported to either the Metropolitan Atlanta and Rural Georgia Surveillance, Epidemiology, and End Results (SEER) registry or the Los Angeles SEER registry. The authors assessed the completeness of pathology reporting with respect to the documentation of PNI or LVI and DI. Generalized estimating equations were used to examine factors that influenced reporting while taking into consideration clustering of observations within the hospitals. Univariate and multivariate survival analyses were conducted to examine the impact of tumor invasion characteristics on mortality while controlling for other prognostic factors. RESULTS: DI reporting increased from 13% between 1997 and 1999 to 23% between 2000 and 2004 after the CAP issued its recommendations; whereas mode of invasion (the presence of LVI and/or PNI) reporting for the same period increased from 13% to 38%. The observed increase in reporting was most pronounced in the first 2 years (2000 and 2001) and appeared to decline again afterward. Tumor invasion >3 mm in depth and the presence of PNI were among the strongest predictors of survival in multivariate analyses. CONCLUSIONS: The current results indicated the importance of reporting tumor invasion characteristics for patients diagnosed with cancer of the oral tongue. The findings also underscore the need for continuous monitoring of adherence to the CAP protocol.

Cancer outcomes research in a rural area: a multi-institution partnership model.

Whereas, most cancer research data come from high-profile academic centers, little is known about the outcomes of cancer care in rural communities. We summarize the experience of building a multi-institution partnership to develop a cancer outcomes research infrastructure in Southwest Georgia (SWGA), a primarily rural 33-county area with over 700,000 residents. The partnership includes eight institutions: the Emory University in Atlanta, the Centers for Disease Control and Prevention (CDC), the Georgia Comprehensive Center Registry (the Registry), the Southwest Georgia Cancer Coalition (the Coalition), and the four community cancer centers located within the SWGA region. The practical application of the partnership model, its organizational structure, and lessons learned are presented using two specific examples: a study evaluating treatment decisions and quality of life among prostate cancer patients, and a study of treatment discontinuation among prostate, breast, lung, and colorectal cancer patients. Our partnership model allowed us to (1) use the Coalition as a link between Atlanta-based researchers and local community; (2) collaborate with the area cancer centers on day-to-day study activities; (3) involve the Registry personnel and resources to identify eligible cancer cases and to perform data collection; and (4) raise community awareness and sense of study ownership through media announcements organized by the Coalition. All of the above activities were performed in consultation with the funding institution (CDC) and its project directors who oversee several other studies addressing similar research questions throughout the country. Our partnership model may provide a useful framework for cancer outcomes research projects in rural communities.

Demographics and tumor characteristics of colorectal cancers in the United States, 1998-2001.

BACKGROUND: Descriptions of population characteristics for intestinal cancers frequently combine colon and rectal sites. However, some studies suggest that cancers of subsites in the intestinal tract may differ both by demographics and biology. Examination of colon and rectal cancers' characteristics separately could identify different risk profiles for these sites. METHODS: Data from combined National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) databases were examined for risk characteristics by age, race, sex, and ethnicity, as well as for SEER-reported trends over 27 years. RESULTS: Males had higher incidences of both colon and rectal cancers, but this predominance was greater for rectal cancers. Colon cancer rates were higher for blacks than for whites but rectal cancer rates were slightly higher for whites than for blacks. The change in incidence rates by race occurred abruptly at sites in the lower colon. Asians had low rates of colon cancer, but their rectal cancer rates were similar to those of blacks. Trends for both sites showed declines in incidence rates in whites, but slight to no change in blacks. Mortality in blacks increased until about 10 years ago. CONCLUSIONS: Colon and rectal cancer sites should be studied independently because of major differences in their characteristics. Age-specific incidence rates differ by race and site. Any effect from screening is difficult to demonstrate because of changes in procedures over time, resulting in different levels of effective detection in the intestinal tract, and because of slow acceptance of screening by the public.