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MP69-12 UNDERUTILIZATION OF PALLIATIVE SERVICES IN ADVANCED GENITOURINARY MALIGNANCIES
THE JOURNAL OF UROLOGYâ
e930
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
MP69-11 PATTERNS OF SURVEILLANCE INTENSITY IN KIDNEY CANCER Suzanne Merrill*, Eric Schaefer, Chris Hollenbeak, Hershey, PA
Source of Funding: None
MP69-10 TRENDS IN STAGE I NON-SEMINOMATOUS GERM CELL TUMORS IN THE UNITED STATES Nahid Punjani*, London, Canada; Thomas Seisen, Claire Beard, Christoper Sweeney, Quoc-Dien Trinh, Jennifer Rider, Mark Preston, Boston, MA INTRODUCTION AND OBJECTIVES: Testicular malignancies are the most common solid tumor in men 15-34 years and affect approximately 8400 men in the United States each year. Almost half can be classified as non-seminomatous germ cell tumors (NSGCT). Treatment options for stage I include surveillance, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Our study aimed to examine demographic and socioeconomic trends around treatment patterns. METHODS: Using the National Cancer Database, we retrospectively examined 55,756 patients between January 1, 2004 and December 31, 2013. Data was extracted on 7,657 individuals with ICD histology diagnosis for stage I NSGCT. We obtained data on various demographic and socioeconomic variables including race, education, income, location and health insurance. We used multivariable logistic regression models to estimate odds ratios with 95% confidence intervals. RESULTS: Throughout 2004-2013 fewer patients received RPLND (OR 0.65 [0.55-0.76] p<0.01), and more received chemotherapy (OR 1.26 [1.10-1.43] p<0.01). Compared to other treatments, RPLND was less commonly seen in non-academic centers (OR 0.47 [0.33-0.66] p<0.01), more commonly in the highest volume institutions compared to the lowest volume institutions (OR 4.57 [2.47-8.46] p<0.01), and more commonly seen in those with low income (OR 1.24 [1.06-1.46] p<0.01). Patients living in rural counties compared to metro counties were more likely to receive chemotherapy (OR 1.72 [1.08-2.75] p¼0.03). As distance from hospital increased, individuals were more likely to receive any form of treatment versus observation for their disease (OR 1.51 for the greatest vs. the lowest quartile [1.31-1.74] p<0.01). Low income and Medicaid predicted greater chance for any treatment (OR 1.17 [1.04-1.32] p¼0.01 and OR 1.45 [1.20-1.74] p<0.01, respectively). No trends were seen for race or education status. CONCLUSIONS: Our study illustrates that fewer patients are undergoing RPLND, which may be due to increased surveillance. RPLND is more commonly practiced at higher volume and academic centers. Education and race do not predict choice of treatment, whereas distance, income and insurance type do predict increased likelihood for receiving treatment overall. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Multiple surveillance guidelines exist for kidney cancer following surgical intervention. Although these recommendations lack conformity, the majority do use stage as well as surgery type to stratify surveillance intensity. Due to guideline heterogeneity, it remains unclear what factors influence surveillance intensity in current practice. Our objective was to assess the patterns of surveillance intensity in kidney cancer after primary surgical intervention among patients 66 years. METHODS: Using SEER-Medicare, we identified patients diagnosed with non-metastatic kidney cancer who had undergone primary surgical intervention (n ¼ 2433) from 2007 to 2011. Surveillance intensity was measured as the number of unique inpatient and outpatient claims made for kidney cancer (ICD-9 diagnosis code 189.0) starting 60 days after primary intervention. Using multivariable linear regression, we assessed the relationships between patient related factors and surveillance intensity (log-transformed). Parameters from the model were reported using risk ratios (RRs). RESULTS: Patients diagnosed in later years experienced more surveillance with an estimated 10% greater number of visits/12months occurring with each subsequent calendar year (RR 1.10 for every 1-year increase, 95% CI 1.07-1.13, p<0.001). As compared to pT1 stage, patients with pT2-4 disease experienced 108% more surveillance visits/12 months (RR 2.08, 95%CI 1.90-2.27, p<0.001). Both older age and living in a metro/urban area, as compared to a big metropolitan location, were associated with significantly fewer follow-up visits (10-year increase in age: RR 0.89, 95%CI 0.83-0.95, p<0.001; metro/urban: RR 0.86, 95%CI 0.79-0.93, p<0.001). Surgery type (radical, partial or ablation), gender, race and Charlson comorbidity score were not significantly associated with surveillance. CONCLUSIONS: Similar to guidelines, surveillance intensity in current practice was found to correlate with disease stage. However, surgery type played less of a role. Other factors such as year of diagnosis, location and younger patient age were associated with more surveillance administered. Further analysis is warranted to understand the reasons for this variation in current surveillance practice and its impact on oncologic care. Source of Funding: None
MP69-12 UNDERUTILIZATION OF PALLIATIVE SERVICES IN ADVANCED GENITOURINARY MALIGNANCIES Adrien Bernstein*, Ron Golan, Brian Dinerman, Jonathan Fainberg, Bashir Al Hussein Al Awamlh, Jim C. Hu, NEW YORK, NY INTRODUCTION AND OBJECTIVES: Comprehensive cancer care aims to reduce disease mortality while simultaneously maximizing patient quality of life. Palliative care addresses the morbidity of cancer and cancer treatments and should be offered in conjunction with traditional therapy. Recent randomized trials demonstrate that early referral to palliative care for advanced malignancy is associated with not only improved quality of life, but survival as well. Despite these findings, their services may remain underutilized. The aim of this study was to assess patterns of care in the use of palliative care services for advanced genitourinary malignancies. METHODS: Data from the National Cancer Database was queried for Stage III and IV genitourinary malignancies (prostate, renal, bladder, penile, and testicular). Patient and facility characteristics were compared in those who received palliative care treatments versus those who did not. Comorbidities were stratified by Charlson-Deyo score. Logistic regression models were used to identify factors associated with palliative care.
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
RESULTS: We identified 377,248 patients with advanced GU malignancies between 2004-2014. Only 24,224 (6%) were referred to palliative care and 12,284 (15%) died within 1 year of diagnosis. Multivariable analysis revealed that advanced disease and death within one year of diagnosis were most strongly associated with palliative care. Additionally, older age, more co-morbidities, uninsured, female gender, lower income and decreased education and treatment at low volume and academic centers were associated with utilization of palliative care, p<0.05, respectively (Table). Over the study period there was a significant, although, modest increase in the utilization of palliative services (5.5% in 2004 to 7.7% in 2014, p<.001). CONCLUSIONS: Relatively few patients with advanced GU malignancies receive palliative care. While referrals increased in recent years, palliative care remains under-utilized and remains an opportunity for educational engagement with patients and physicians alike.
e931
Patients were surveyed longitudinally with a panel of health questionnaires, including the SF-36, a measure of general quality of life. The SF36 contains 36 questions that assess several health domains, including physical functioning, physical health problems, pain, general health perception, emotional well-being, emotional health problems, social functioning and energy/fatigue. Patients surveyed in this study completed the SF-36 prior to cystectomy and at 3, 6 and 12-months following RC. Generalized linear models were used to examine differences in SF-36 scores by the primary exposure of interest (receipt of NAC) and adjusted for clinical and demographic factors. RESULTS: 87 patients completed the SF-36 at both baseline and 6 months. The mean age was 68 years and 66 (75.8%) were men. More than half (46, 52.9%) received NAC. Patients who were not treated with NAC had lower SF-36 scores 6 months after RC (change in physical composite score (PCS) -1.47 vs. +1.95 and mental composite score (MCS) -1.96 vs. +3.68) compared to those who did. After adjusting for age, gender, diversion type and stage, receipt of NAC was significantly associated with higher general health perceptions (PE 5.29, p¼0.012), emotional well-being (PE 5.41, p¼0.012), and mental composite score (PE 6.02, p¼0.005). There was no difference with NAC in PCS after controlling for confounders (p¼0.10). CONCLUSIONS: Receipt of NAC is a significant predictor of better quality of life 6 months after cystectomy as measured by SF-36. We found significant differences between patients treated with and without NAC in several domains, including mental composite score, general health perception, and emotional well-being. The exact mediators of this association need to be examined in larger studies.
Source of Funding: Florida Bankhead-Coley Research Program
MP69-14 ACADEMIC AND HIGH-VOLUME HOSPITALS ARE ASSOCIATED WITH IMPROVED OUTCOMES IN THE MANAGEMENT OF RETROPERITONEAL SARCOMA Jessica Yih*, Matthew Maurice, Robert Abouassaly, John Ammori, Cleveland, OH Source of Funding: none
MP69-13 PATIENT REPORTED HEALTH AND QUALITY OF LIFE AFTER NEOADJUVANT CHEMOTHERAPY AND CYSTECTOMY: RESULTS FROM BLADDER CANCER OUTCOMES AND IMPACT STUDY Dominic Tang*, Andrew Leone, Juan Chipollini, Tampa, FL; Paul Crispen, Carl Henriksen, Gainesville, FL; Michael Poch, Wade Sexton, Scott Gilbert, Tampa, FL INTRODUCTION AND OBJECTIVES: Prior quality of life (QOL) research in bladder cancer has predominantly focused on differences between patients treated with radical cystectomy (RC) and different forms of urinary diversion. Other aspects of bladder cancer treatment, such as receipt of neoadjuvant chemotherapy (NAC), have gone unexamined. Using validated health questionnaires, we sought to determine the relationship between receipt of NAC and patient QOL. METHODS: 124 patients were enrolled in a prospective complication and QOL assessment study between 2013 and 2015.
INTRODUCTION AND OBJECTIVES: Retroperitoneal sarcoma (RPS) is a rare malignancy. Principles of management include surgical management (SM) and complete resection (CR) with negative microscopic margins (NMM). We aimed to evaluate the role of provider characteristics on RPS outcomes. METHODS: Adult patients diagnosed with non-metastatic RPS from 2004-2013 were identified from the National Cancer Database. Volume was classified based on average annual number of RPS cases as low (<5) or high (>¼5), with high-volume hospitals (HVH) corresponding to top 10th percentile. Univariate and multivariable statistical methods were used to examine the association between hospitals volume and academic status on SM, CR, NMM and OS, adjusted for other covariates. RESULTS: We identified 3,093 patients with RPS (median age 61 years). Histologic subtypes included liposarcoma (49.6%), leiomyosarcoma (26.3%), and other subtypes (24.1%). SM offered improved overall survival (OS) compared to non-surgical management (84.2 vs. 43.2 months, p<.001). CR improved OS compared to incomplete resection (85.9 vs. 39.9 months, p<.01). In patients who had CR, achieving NMM improved OS (97.6 vs. 71.1 months, p<.01). Surgery was used to treat 2,168 (70.0%) patients, and the odds of SM
e930
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
MP69-11 PATTERNS OF SURVEILLANCE INTENSITY IN KIDNEY CANCER Suzanne Merrill*, Eric Schaefer, Chris Hollenbeak, Hershey, PA
Source of Funding: None
MP69-10 TRENDS IN STAGE I NON-SEMINOMATOUS GERM CELL TUMORS IN THE UNITED STATES Nahid Punjani*, London, Canada; Thomas Seisen, Claire Beard, Christoper Sweeney, Quoc-Dien Trinh, Jennifer Rider, Mark Preston, Boston, MA INTRODUCTION AND OBJECTIVES: Testicular malignancies are the most common solid tumor in men 15-34 years and affect approximately 8400 men in the United States each year. Almost half can be classified as non-seminomatous germ cell tumors (NSGCT). Treatment options for stage I include surveillance, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Our study aimed to examine demographic and socioeconomic trends around treatment patterns. METHODS: Using the National Cancer Database, we retrospectively examined 55,756 patients between January 1, 2004 and December 31, 2013. Data was extracted on 7,657 individuals with ICD histology diagnosis for stage I NSGCT. We obtained data on various demographic and socioeconomic variables including race, education, income, location and health insurance. We used multivariable logistic regression models to estimate odds ratios with 95% confidence intervals. RESULTS: Throughout 2004-2013 fewer patients received RPLND (OR 0.65 [0.55-0.76] p<0.01), and more received chemotherapy (OR 1.26 [1.10-1.43] p<0.01). Compared to other treatments, RPLND was less commonly seen in non-academic centers (OR 0.47 [0.33-0.66] p<0.01), more commonly in the highest volume institutions compared to the lowest volume institutions (OR 4.57 [2.47-8.46] p<0.01), and more commonly seen in those with low income (OR 1.24 [1.06-1.46] p<0.01). Patients living in rural counties compared to metro counties were more likely to receive chemotherapy (OR 1.72 [1.08-2.75] p¼0.03). As distance from hospital increased, individuals were more likely to receive any form of treatment versus observation for their disease (OR 1.51 for the greatest vs. the lowest quartile [1.31-1.74] p<0.01). Low income and Medicaid predicted greater chance for any treatment (OR 1.17 [1.04-1.32] p¼0.01 and OR 1.45 [1.20-1.74] p<0.01, respectively). No trends were seen for race or education status. CONCLUSIONS: Our study illustrates that fewer patients are undergoing RPLND, which may be due to increased surveillance. RPLND is more commonly practiced at higher volume and academic centers. Education and race do not predict choice of treatment, whereas distance, income and insurance type do predict increased likelihood for receiving treatment overall. Source of Funding: None
INTRODUCTION AND OBJECTIVES: Multiple surveillance guidelines exist for kidney cancer following surgical intervention. Although these recommendations lack conformity, the majority do use stage as well as surgery type to stratify surveillance intensity. Due to guideline heterogeneity, it remains unclear what factors influence surveillance intensity in current practice. Our objective was to assess the patterns of surveillance intensity in kidney cancer after primary surgical intervention among patients 66 years. METHODS: Using SEER-Medicare, we identified patients diagnosed with non-metastatic kidney cancer who had undergone primary surgical intervention (n ¼ 2433) from 2007 to 2011. Surveillance intensity was measured as the number of unique inpatient and outpatient claims made for kidney cancer (ICD-9 diagnosis code 189.0) starting 60 days after primary intervention. Using multivariable linear regression, we assessed the relationships between patient related factors and surveillance intensity (log-transformed). Parameters from the model were reported using risk ratios (RRs). RESULTS: Patients diagnosed in later years experienced more surveillance with an estimated 10% greater number of visits/12months occurring with each subsequent calendar year (RR 1.10 for every 1-year increase, 95% CI 1.07-1.13, p<0.001). As compared to pT1 stage, patients with pT2-4 disease experienced 108% more surveillance visits/12 months (RR 2.08, 95%CI 1.90-2.27, p<0.001). Both older age and living in a metro/urban area, as compared to a big metropolitan location, were associated with significantly fewer follow-up visits (10-year increase in age: RR 0.89, 95%CI 0.83-0.95, p<0.001; metro/urban: RR 0.86, 95%CI 0.79-0.93, p<0.001). Surgery type (radical, partial or ablation), gender, race and Charlson comorbidity score were not significantly associated with surveillance. CONCLUSIONS: Similar to guidelines, surveillance intensity in current practice was found to correlate with disease stage. However, surgery type played less of a role. Other factors such as year of diagnosis, location and younger patient age were associated with more surveillance administered. Further analysis is warranted to understand the reasons for this variation in current surveillance practice and its impact on oncologic care. Source of Funding: None
MP69-12 UNDERUTILIZATION OF PALLIATIVE SERVICES IN ADVANCED GENITOURINARY MALIGNANCIES Adrien Bernstein*, Ron Golan, Brian Dinerman, Jonathan Fainberg, Bashir Al Hussein Al Awamlh, Jim C. Hu, NEW YORK, NY INTRODUCTION AND OBJECTIVES: Comprehensive cancer care aims to reduce disease mortality while simultaneously maximizing patient quality of life. Palliative care addresses the morbidity of cancer and cancer treatments and should be offered in conjunction with traditional therapy. Recent randomized trials demonstrate that early referral to palliative care for advanced malignancy is associated with not only improved quality of life, but survival as well. Despite these findings, their services may remain underutilized. The aim of this study was to assess patterns of care in the use of palliative care services for advanced genitourinary malignancies. METHODS: Data from the National Cancer Database was queried for Stage III and IV genitourinary malignancies (prostate, renal, bladder, penile, and testicular). Patient and facility characteristics were compared in those who received palliative care treatments versus those who did not. Comorbidities were stratified by Charlson-Deyo score. Logistic regression models were used to identify factors associated with palliative care.
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Monday, May 15, 2017
RESULTS: We identified 377,248 patients with advanced GU malignancies between 2004-2014. Only 24,224 (6%) were referred to palliative care and 12,284 (15%) died within 1 year of diagnosis. Multivariable analysis revealed that advanced disease and death within one year of diagnosis were most strongly associated with palliative care. Additionally, older age, more co-morbidities, uninsured, female gender, lower income and decreased education and treatment at low volume and academic centers were associated with utilization of palliative care, p<0.05, respectively (Table). Over the study period there was a significant, although, modest increase in the utilization of palliative services (5.5% in 2004 to 7.7% in 2014, p<.001). CONCLUSIONS: Relatively few patients with advanced GU malignancies receive palliative care. While referrals increased in recent years, palliative care remains under-utilized and remains an opportunity for educational engagement with patients and physicians alike.
e931
Patients were surveyed longitudinally with a panel of health questionnaires, including the SF-36, a measure of general quality of life. The SF36 contains 36 questions that assess several health domains, including physical functioning, physical health problems, pain, general health perception, emotional well-being, emotional health problems, social functioning and energy/fatigue. Patients surveyed in this study completed the SF-36 prior to cystectomy and at 3, 6 and 12-months following RC. Generalized linear models were used to examine differences in SF-36 scores by the primary exposure of interest (receipt of NAC) and adjusted for clinical and demographic factors. RESULTS: 87 patients completed the SF-36 at both baseline and 6 months. The mean age was 68 years and 66 (75.8%) were men. More than half (46, 52.9%) received NAC. Patients who were not treated with NAC had lower SF-36 scores 6 months after RC (change in physical composite score (PCS) -1.47 vs. +1.95 and mental composite score (MCS) -1.96 vs. +3.68) compared to those who did. After adjusting for age, gender, diversion type and stage, receipt of NAC was significantly associated with higher general health perceptions (PE 5.29, p¼0.012), emotional well-being (PE 5.41, p¼0.012), and mental composite score (PE 6.02, p¼0.005). There was no difference with NAC in PCS after controlling for confounders (p¼0.10). CONCLUSIONS: Receipt of NAC is a significant predictor of better quality of life 6 months after cystectomy as measured by SF-36. We found significant differences between patients treated with and without NAC in several domains, including mental composite score, general health perception, and emotional well-being. The exact mediators of this association need to be examined in larger studies.
Source of Funding: Florida Bankhead-Coley Research Program
MP69-14 ACADEMIC AND HIGH-VOLUME HOSPITALS ARE ASSOCIATED WITH IMPROVED OUTCOMES IN THE MANAGEMENT OF RETROPERITONEAL SARCOMA Jessica Yih*, Matthew Maurice, Robert Abouassaly, John Ammori, Cleveland, OH Source of Funding: none
MP69-13 PATIENT REPORTED HEALTH AND QUALITY OF LIFE AFTER NEOADJUVANT CHEMOTHERAPY AND CYSTECTOMY: RESULTS FROM BLADDER CANCER OUTCOMES AND IMPACT STUDY Dominic Tang*, Andrew Leone, Juan Chipollini, Tampa, FL; Paul Crispen, Carl Henriksen, Gainesville, FL; Michael Poch, Wade Sexton, Scott Gilbert, Tampa, FL INTRODUCTION AND OBJECTIVES: Prior quality of life (QOL) research in bladder cancer has predominantly focused on differences between patients treated with radical cystectomy (RC) and different forms of urinary diversion. Other aspects of bladder cancer treatment, such as receipt of neoadjuvant chemotherapy (NAC), have gone unexamined. Using validated health questionnaires, we sought to determine the relationship between receipt of NAC and patient QOL. METHODS: 124 patients were enrolled in a prospective complication and QOL assessment study between 2013 and 2015.
INTRODUCTION AND OBJECTIVES: Retroperitoneal sarcoma (RPS) is a rare malignancy. Principles of management include surgical management (SM) and complete resection (CR) with negative microscopic margins (NMM). We aimed to evaluate the role of provider characteristics on RPS outcomes. METHODS: Adult patients diagnosed with non-metastatic RPS from 2004-2013 were identified from the National Cancer Database. Volume was classified based on average annual number of RPS cases as low (<5) or high (>¼5), with high-volume hospitals (HVH) corresponding to top 10th percentile. Univariate and multivariable statistical methods were used to examine the association between hospitals volume and academic status on SM, CR, NMM and OS, adjusted for other covariates. RESULTS: We identified 3,093 patients with RPS (median age 61 years). Histologic subtypes included liposarcoma (49.6%), leiomyosarcoma (26.3%), and other subtypes (24.1%). SM offered improved overall survival (OS) compared to non-surgical management (84.2 vs. 43.2 months, p<.001). CR improved OS compared to incomplete resection (85.9 vs. 39.9 months, p<.01). In patients who had CR, achieving NMM improved OS (97.6 vs. 71.1 months, p<.01). Surgery was used to treat 2,168 (70.0%) patients, and the odds of SM