Demographic and Clinical Factors Associated With Health-Related Quality-of-Life Profiles Among Prostate Cancer Survivors.

PURPOSE: Our purpose was to describe the prevalence and predictors of symptom and function clusters related to physical, emotional, and social components of general health-related quality of life (HRQOL) in a population-based sample of prostate cancer (PCa) survivors. METHODS: Participants (N = 1,162) completed a baseline survey at a median of 9 months after diagnosis to ascertain the co-occurrence of eight symptom and functional domains that are common across all cancers and not treatment-specific. We used latent profile analysis (LPA) to identify subgroup profiles of survivors with low, moderate, or high HRQOL levels. Multinomial logistic regression models were used to identify clinical and sociodemographic factors associated with survivors' membership in the low versus moderate or high HRQOL profile. RESULTS: The LPA identified 16% of survivors who were categorized in the low HRQOL profile at baseline, indicative of the highest symptom burden and lowest functioning. Factors related to survivors' membership in the low versus higher HRQOL profile groups included less than age 65 years at diagnosis, identifying as non-Hispanic Black race, not working, being a former versus never smoker, systemic therapy, less companionship, more comorbidities, lower health care financial well-being, or less spirituality. Several factors remained associated with remaining in the low versus higher HRQOL profiles on the follow-up survey (n = 699), including younger age, Black race, comorbidity, and lower financial and spiritual well-being. CONCLUSION: About one of six PCa survivors experienced elevated physical and psychosocial symptoms that were independent of local curative therapy, but with younger age, race, comorbidity, and lower financial and spiritual well-being as stable risk factors for poor HRQOL over time.

Hormonal treatment for newly diagnosed metastatic prostate cancer: a population-based study from the California cancer registry.

INTRODUCTION: To evaluate how often men with metastatic prostate cancer (mPC) receive standard of care treatment with androgen deprivation therapy (ADT). METHODS: Men aged ≥20 years with newly diagnosed mPC (stage IV) between 2010 and 2018 were identified using California Cancer Registry data. Receipt of hormonal therapy as initial cancer treatment was examined by patient/tumor characteristics at time of diagnosis. Chi-square tests and logistic regression, adjusted for covariates, were performed to assess association between receipt of hormonal therapy and patient/tumor characteristics. RESULTS: We identified 13,680 men with newly diagnosed mPC, of which 3637 had local metastasis (N1) only while 9596 had distant metastasis (M1) with or without N1 disease. 21.8 % (n = 2980) of men did not receive ADT. The highest rate of receiving ADT was among men between ages 75-84 (81.6%) and the lowest rate was in men over 85 (76.0%). Asian men had the largest proportion receiving ADT (n = 962, 81.5%) with remaining subgroups having similar proportion of men receiving ADT (76.8% to 77.2%). Once adjusted for covariates, regression results showed men with a higher Gleason score (8-10) were more likely to receive ADT (OR 2.04, 1.82-2.27, p = < 0.001) as well as men with distant sites of metastatic disease (OR 4.02, 3.62-4.46, p = < 0.001). Men residing in neighborhoods with the lowest socioeconomic status were least likely to receive ADT (OR 0.79, 0.68-0.93, p = 0.0032). No differences in receipt of ADT were observed by race/ethnicity. DISCUSSION: Despite significant advancements in the treatment of mPC in recent years, over one-fifth of patients did not receive ADT, which is the backbone for all new systemic therapies. This dataset might help address some of the prostate cancer care disparities in California.

Underutilization of intravesical chemotherapy and immunotherapy for high grade non-muscle invasive bladder cancer in California between 2006-2018: Effect of race, age and socioeconomic status on treatment disparities.

OBJECTIVE: Among patients diagnosed with non-muscle invasive bladder cancer (NMIBC), those with high risk disease have the greatest risk of recurrence and disease progression. The underutilization of intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) has been a longstanding concern in clinical practice. This study aimed to determine the disparities present in receipt of adjuvant intravesical chemotherapy and immunotherapy in treatment of patients with high grade NMIBC following initial transurethral resection of a bladder tumor (TURBT). METHODS: The California Cancer Registry data was used to identify 19,237 patients diagnosed with high grade NMIBC who underwent TURBT. Treatment variables include re-TURBT, re-TURBT and intravesical chemotherapy (IVC) and/or BCG. Independent variables include age, sex, race/ethnicity, neighborhood socioeconomic status (nSES), primary insurance payer and marital status at diagnosis. Multiple logistic regression and multinomial regression models were used to examine variation in the treatments received following TURBT. RESULTS: The proportion of patients receiving TURBT followed by BCG was similar across all racial and ethnic groups (28%-32%). BCG therapy was higher in patients belonging to the highest nSES quintile (37% for highest vs. 23%-26% for the 2 lowest quintiles). In multiple variable analyses, receipt of any intravesical therapy (IVT) was influenced by nSES, age, marital status, race/ethnicity, and insurance type. Patients in the lowest nSES quintile had a 45% less likelihood of receiving IVT compared to the highest nSES group (OR [95%CI]: 0.55[0.49, 0.61]). Race/ethnicity differences in receipt of any adjuvant therapy were noted in the middle to lowest nSES quintile for Hispanic and Asian/Pacific Islander patients when compared to non-Hispanic White patients. When comparing variation in treatment by insurance type at diagnosis, those with Medicare or other insurance were 24% and 30% less likely to receive BCG after TURBT compared to those with private insurance, (OR [95%CI]: 0.76 [0.70, 0.82] and 0.70[0.62, 0.79]) respectively. CONCLUSION: In patients with a diagnosis of high risk NMIBC, disparities in utilization of BCG are seen based on SES, age, and insurance type.

Association of Sociodemographic Characteristics With Survival Among Patients With Urachal Cancer in California From 1988 to 2019.

This cohort study evaluates the sociodemographic characteristics of patients with urachal cancer, cancer treatments, and the association of patient characteristics with overall survival.

Are We Undercounting MDS? An Analysis of Incidence Patterns of Myelodysplastic Syndromes in SEER 21 Regions: 2001-2016.

Background: Myelodysplastic syndromes (MDSs), a group of reportable malignancies in the Surveillance, Epidemiology, and End Results (SEER) Program since 2001, are poorly understood neoplasms. There have been several updates since they became reportable, with several changes introduced to cases diagnosed in 2010 and onwards. None have examined changes in patterns of MDS incidence over the long term, accounting for such changes. Objective: The objective of this analysis was to assess changes in incidence of MDS from 2001 to 2016 by demographic characteristics and histology, applying coding changes implemented in 2010. Methods: Incidence-SEER 21 region data for the 2001-2016 period were used to estimate incidence rates using SEER*Stat version 8.3.6. Cases were included that were diagnosed as MDS during this period having the following International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) histology codes: 9980, 9982-9986, 9989, and 9991-9992. Annual incidence rates for the total population, as well as by demographic characteristics and histology, were estimated. All incidence rates were age adjusted using the 2000 US standard population (19 age groups; census P25-1130). Results: A total of 86,146 MDS cases were diagnosed during the 2001-2016 period, with an age-adjusted incidence rate of 4.7 cases per 100,000 population. The majority (~61%) were classified as MDS, unclassifiable (MDS-U, ICD-O-3: 9989). Annual rates steadily increased from 3.7 per 100,000 in 2001 to 5.6 per 100,000 in 2010, then declined to 3.8 per 100,000 in 2016, making an inverted V-shaped pattern. This pattern was observed for both sexes and all assessed racial and ethnic groups, as well as among the ≥65-year age groups. When the rates were assessed by histology, this pattern was observed for MDS-U, but not for other subtypes. Conclusion: MDS-U subtype dominates the observed trend in incident rates. The decline in rates since 2010 is most likely due to changes in coding and diagnostic criteria introduced in 2010. Further analysis is warranted to conclusively determine all factors leading to the changes observed.

An empirical investigation of time-varying cost-effectiveness across the product life cycle.

Cost-effectiveness is traditionally treated as a static estimate driven by clinical trial efficacy and drug price at launch. Prior studies suggest that cost-effectiveness varies over the drug's lifetime. We examined the impact of "learning by doing," one of the least studied drivers of changes in cost-effectiveness across the product life cycle. We combined time-series trends in effectiveness over time by cancer regimen using the Surveillance, Epidemiology, and End Results-Medicare database. We estimated the time-varying effects of treatments in colorectal and pancreatic cancer over their life cycle, including FOLFOX (leucovorin, 5-fluorouracil, and oxaliplatin) and gemcitabine, on survival of patients. Mean prices over time by strength and dosage form were calculated using historical wholesale acquisition costs. We found consistent downward trends in the mortality hazard ratios, which suggest that effectiveness improves over time. In the case of first-line FOLFOX for colorectal cancer, the implied incremental cost-effectiveness ratio based on the observational data fell from $610,000 per life year gained in 2004 to $27,000 per life year gained in 2011. Cost-effectiveness estimated at launch is unlikely to be representative of cost-effectiveness over the drug's lifetime. In the drugs studied, the impact of time-varying clinical effectiveness dominated the impact of changing prices overtime.

Prenatal exposure to air toxics and risk of Wilms' tumor in 0- to 5-year-old children.

OBJECTIVE: To study prenatal air toxic exposure and Wilms' tumor in children. METHODS: We identified 337 Wilms' tumor cases among children younger than 6 years (1988 to 2008) from the California Cancer Registry, randomly selected 96,514 controls from California birth rolls in 20:1 ratio matched to all cancer cases, then linked birth addresses to air monitors within 15 miles to assess exposures. Multiple logistic regressions were applied to estimate effects. RESULTS: Children prenatally exposed to formaldehyde, polycyclic aromatic hydrocarbons, perchloroethylene, or acetaldehyde in the third trimester had an increased odds of Wilms' tumor per interquartile increase in concentration (odds ratio [95% confidence interval]: 1.28 [1.12 to 1.45], 1.10 [0.99 to 1.22], 1.09 [1.00 to 1.18], 1.25 [1.07 to 1.45], respectively). CONCLUSIONS: We found positive associations for four air toxics. This is the first study of this kind. Future studies are needed to confirm our findings.

Early life factors and risk of childhood rhabdomyosarcoma.

Although little is known about etiology of childhood rhabdomyosarcoma (RMS), early life factors are suspected in the etiology. We explored this hypothesis using linked data from the California Cancer Registry and the California birth rolls. Incident cases were 359 children <6-year-old (218 embryonal, 81 alveolar, 60 others) diagnosed in 1988-2008. Controls (205, 173), frequency matched on birth year (1986-2007), were randomly selected from the birth rolls. We examined association of birth characteristics such as birth weight, size for gestational age, and timing of prenatal care with all-type RMS, embryonal, and alveolar subtypes. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression. In contrast to a previous study, we observed statistically non-significant association for embryonal subtype among high birth weight (4000-5250 g) children for term births [OR (95% CI): 1.28 (0.85, 1.92)] and all births adjusted for gestational age [OR (95% CI): 1.21 (0.81, 1.81)]. On the other hand, statistically significant 1.7-fold increased risk of alveolar subtype (95% CI: 1.02, 2.87) was observed among children with late or no prenatal care and a 1.3-fold increased risk of all RMS subtypes among children of fathers ≥35 years old at child birth (95% CI: 1.00, 1.75), independent of all covariates. Our finding of positive association on male sex for all RMS types is consistent with previous studies. While we did not find a convincingly positive association between high birth weight and RMS, our findings on prenatal care supports the hypothesis that prenatal environment modifies risk for childhood RMS.

Smoking and alcohol use during pregnancy and age of menarche in daughters.

BACKGROUND: We assessed whether exposure to prenatal smoking or alcohol accelerates age of menarche (AOM) in offspring. METHODS: We studied a Danish cohort of 3169 singleton females born in April 1984-April 1987. Linear regressions were conducted to examine associations between prenatal smoking or alcohol exposure and offspring's AOM on: (i) the daughters who provided data on both month and the year of menarche (n= 1634) and (ii) the entire sample that provided at least the year of menarche (n= 3169). We also examined associations between only pre-pregnancy smoking or childhood exposure to smoking and AOM. The full model was adjusted for maternal pre-pregnancy body mass index, maternal age at childbirth, parental socio-economic status, parity, consumption of milk products during pregnancy and marital status. RESULTS: Among those who provided both year and month, AOM was accelerated by 2.8 months (95% CI in months: -5.3, -0.4) among those exposed to 10+ cigarettes/day throughout pregnancy and by 4.1 months (95% CI in months: -7.7, -0.5) among those with mothers who quit smoking sometime during pregnancy, compared with the unexposed group after adjustment for covariates. Similar, but much weaker, associations were observed among girls whose mothers smoked 1-9 cigarettes/day throughout pregnancy or whose fathers smoked compared with their unexposed counterparts after adjustment for covariates [-0.8 months (95% CI: -2.6, 1.0)]. No associations were observed between AOM and only pre-pregnancy smoking or only childhood exposure or prenatal alcohol exposure. CONCLUSIONS: Our study indicates that heavy smoking throughout the pregnancy may be important in prenatal programming of AOM.

Parental age at childbirth and age of menarche in the offspring.

BACKGROUND: Early age of menarche (AOM) is associated with serious health problems including breast cancer and heart disease. Rising parental age at childbirth is associated with some adverse health outcomes in the offspring, but whether early menarche is one of them is not known. METHODS: We studied a Danish cohort of singleton females (n = 3168) born in 1984-1987. Prenatal data were collected from mothers around 36th week of pregnancy (self-administered questionnaire), although the menarcheal age was collected from daughters aged 17-21 years in 2005 (Web-based questionnaire). We assessed each parental age association in separate linear regression models adjusted for covariates (socioeconomic status, parity, maternal pre-pregnancy BMI, marital status, maternal smoking and daughter's self-reported BMI), then included both ages in a third model. RESULTS: Each year increase in maternal age showed a 9 day earlier onset of menarche in daughters [95% confidence interval (CI): -15.98, -2.90] and a 5 day earlier onset for each year increase in paternal age [95% CI: -10.85, 0.00], after adjusting for covariates. However, these associations attenuated when adjusted for the other parent [change in AOM in days: (i) maternal: -8.49 (95% CI: -17.09, 0.12), (ii) paternal: -1.14 (95% CI: -8.13, 5.84)]. CONCLUSIONS: We found no significant association between parental age and AOM, but the small sample of advance aged parents (over 30 years) limits the information we have. Future studies with a larger sample or a sample with over-representation of older parents will be of value.