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Race Is Associated With Poor Outcomes in Head and Neck Cancer
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Volume 96 Number 2S Supplement 2016
3001 Race Is Associated With Poor Outcomes in Head and Neck Cancer A.O. Naghavi,1 M. Echevarria,1 T. Strom,1 Y.A. Abuodeh,1 K.A. Ahmed,1 P.S. Venkat,1 A. Trotti,2 L.B. Harrison,1 B.L. Green,1 K. Yamoah,1 and J.J. Caudell1; 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 2Moffitt Cancer Center and Research Institute, Tampa, FL Purpose/Objective(s): Patient race has been shown to predict for differences in outcomes and has been attributed to socioeconomic factors such as social support and access to healthcare. In head and neck cancer (HNC), a disease without recommended screening, we sought to investigate whether race is associated with outcome. Materials/Methods: Records of 1802 patients with non-metastatic squamous cell HNC were assessed from an institutional database between 1998 and 2013. Patient demographics, tumor and treatment characteristics, and patient outcomes were abstracted from the chart. Differences between groups were assessed via logistic regression multivariate analysis (MVA). Outcomes including locoregional control (LRC) and overall survival (OS) were then estimated via Kaplan-Meier and Cox-regression MVA. Results: Median follow-up was 34 months. Patient races included White (n Z 1671, 93%), Black (n Z 80, 4%), Asian (n Z 18, 1%), and other (n Z 33, 2%). Most patients were Married/domestic partner (62%), currently employed (60%), current smokers (43%) and with stage IV disease (67%). On logistic regression MVA, Black patients were less likely to be married (39% vs. 63%; OR 0.5 95% CI 0.32-0.85, P Z 0.008) or be currently employed (43% vs. 61%; OR 0.53 95% CI 0.32-0.83, P Z 0.011). Black patients were also younger (54 vs. 59 years, P Z 0.001), more likely to present with advanced tumor stage (T4: 48% vs. 25%, P Z 0.001), and more often had >45 days elapse from diagnosis to treatment initiation (OR 1.8 95% 1.1-3, P Z 0.014). Black patients also had different primary site profile treated when compared to non-blacks (P Z 0.021), with a higher rate of larynx (30% vs. 19%, P Z 0.008) and nasopharynx (10% vs. 4%, P Z 0.033). HPV status, tobacco status, and treatment factors (IMRT, RT dose, RT duration, surgery, chemotherapy use) were not associated with race on MVA. Black patients had a lower rate of 3-year LRC (65% vs. 81%, P<0.001) and OS (43% vs. 69%, P<0.001). Patients with >45 days elapsed from diagnosis to treatment had a detriment in 3-year LRC (77% vs. 83%, P Z 0.002) and OS (66% vs. 69%, P Z 0.009). On Cox MVA, Black race was independently prognostic for poor LRC (HR 1.8 95% CI 1.2-2.8, P Z 0.005) and OS (HR 1.6 95% CI 1.2-2.1, P Z 0.001). Additional socioeconomic factors associated with OS on MVA included patient unemployment status (HR 1.4 95% CI 1.2-1.7, P<0.001), and marriage status (HR 0.72 95% CI 0.62-0.84, P<0.001). Conclusion: Race is independently prognostic for LRC and OS. Black patients presented with more advanced tumor stage and had longer delays in treatment initiation that may be attributed to socioeconomic factors such as employment status and social support. Author Disclosure: A.O. Naghavi: None. M. Echevarria: None. T. Strom: None. Y.A. Abuodeh: None. K.A. Ahmed: None. P.S. Venkat: None. A. Trotti: None. L.B. Harrison: None. B. Green: None. K. Yamoah: None. J.J. Caudell: None.
3002 The Benefits of Clinical Pathways (CP) for Radiation Oncology in a Large Cancer Care Network D.E. Heron,1 B.J. Gebhardt,1 S. Beriwal,2 H. Benson,3 Z. Lorinc,3 A. Barry,3 and K. Lokay3; 1University of Pittsburgh Cancer Institute, Pittsburgh, PA, 2Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, 3Via Oncology, LLC, Pittsburgh, PA Purpose/Objective(s): The cancer center implemented a radiation oncology CP program (now incorporated separately as Via Pathways)
beginning in 2001 to standardize care throughout a network of radiation oncology sites. The program exists to ensure consistency and rapid adoption of best evidence-based care in a large, integrated NCI-designated comprehensive cancer center. Materials/Methods: The web-based CP portal integrates with electronic medical records to provide point-of-care patient-specific decision support. The system sequentially displays possible treatment options as defined by the clinical pathway based upon the specific disease and stage entered by the physician, and the system then records the management decisions of the physician. CP content is developed and maintained by committees of both academic and community oncologists selected from the network. Meetings occur semi-annually to review and update treatment recommendations for the nearly 95% of cancers covered. All oncologists throughout the network are invited to participate through in-person meetings or via teleconference. Evidence is evaluated hierarchically on efficacy, toxicity, and then cost. When the committee modifies CP content, the software is updated within 35 days and new recommendations are available to the 37 network providers. Through analysis of the utilization data, leaders can monitor adherence to the CP recommendations and research practice patterns at an unprecedented level of granularity. Results: Since data collection in the portal began in 2009, the cancer center has captured more than 58,000 visits. A total of 35,750 treatment decisions were entered, of which 33,968 (95.0%) were considered onpathway. Off-pathway decisions were approved prior to treatment by a designated peer review radiation oncologist from within the network. Reasons for going off pathway and the alternative approach to care were recorded. Conclusion: CP is an integral tool for standardizing high-value care across large networks and geographic regions. The collaborative committee process, rapid electronic deployment, and easy access to evidence reviews have garnered high physician buy-in and consistent adherence to CP recommendations. Efforts to increase efficiencies and trial accruals have been successful due in large part to access to such a vast and comprehensive database. Other benefits of the program include: a transition from volume to value care models; facilitation of onboarding new physicians, residency trainees, and fellows; and providing transparency through peer review, a committee process, and evidence reviews. CP is now used by more than 1000 physicians across the US in a variety of academic and community settings. Author Disclosure: D.E. Heron: Via Oncology is an affiliated company of UPMC and the University of Pittsburgh Cancer Institute; Via Oncology. B.J. Gebhardt: None. S. Beriwal: advisory role; Via Oncology. H. Benson: None. Z. Lorinc: None. A. Barry: None. K. Lokay: leadership; Via Oncology.
3003 A Comprehensive Analysis of the Portfolio of Clinical Trials Involving Brachytherapy Over the Past 15 Years B. Odei,1 D. Boothe,2 S. Lloyd,3 and D.K. Gaffney4; 1David Geffen School of Medicine at UCLA, Los Angeles, CA, 2University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 3Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 4Huntsman Cancer Hospital, Salt Lake City, UT Purpose/Objective(s): Clinical trials (CTs) involving brachytherapy (BT) are crucial in establishing the role of BT in the evolving landscape of cancer treatment. An analysis of all CTs involving BT is warranted to better understand the factors driving the success of brachytherapy CTs, and the future direction of the field. Materials/Methods: We queried the clinicaltrials.gov website using the general search terms “radiation therapy” or “irradiation” or “EBRT” or “brachytherapy” or “internal radiation.” This yielded a total of 10,417 CTs between 2000 and 2015. Trials not using BT were then excluded, yielding 319 CTs incorporating BT for analysis. Characteristics of individual CTs were then obtained. Least squared linear regression was employed to
Volume 96 Number 2S Supplement 2016
3001 Race Is Associated With Poor Outcomes in Head and Neck Cancer A.O. Naghavi,1 M. Echevarria,1 T. Strom,1 Y.A. Abuodeh,1 K.A. Ahmed,1 P.S. Venkat,1 A. Trotti,2 L.B. Harrison,1 B.L. Green,1 K. Yamoah,1 and J.J. Caudell1; 1H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 2Moffitt Cancer Center and Research Institute, Tampa, FL Purpose/Objective(s): Patient race has been shown to predict for differences in outcomes and has been attributed to socioeconomic factors such as social support and access to healthcare. In head and neck cancer (HNC), a disease without recommended screening, we sought to investigate whether race is associated with outcome. Materials/Methods: Records of 1802 patients with non-metastatic squamous cell HNC were assessed from an institutional database between 1998 and 2013. Patient demographics, tumor and treatment characteristics, and patient outcomes were abstracted from the chart. Differences between groups were assessed via logistic regression multivariate analysis (MVA). Outcomes including locoregional control (LRC) and overall survival (OS) were then estimated via Kaplan-Meier and Cox-regression MVA. Results: Median follow-up was 34 months. Patient races included White (n Z 1671, 93%), Black (n Z 80, 4%), Asian (n Z 18, 1%), and other (n Z 33, 2%). Most patients were Married/domestic partner (62%), currently employed (60%), current smokers (43%) and with stage IV disease (67%). On logistic regression MVA, Black patients were less likely to be married (39% vs. 63%; OR 0.5 95% CI 0.32-0.85, P Z 0.008) or be currently employed (43% vs. 61%; OR 0.53 95% CI 0.32-0.83, P Z 0.011). Black patients were also younger (54 vs. 59 years, P Z 0.001), more likely to present with advanced tumor stage (T4: 48% vs. 25%, P Z 0.001), and more often had >45 days elapse from diagnosis to treatment initiation (OR 1.8 95% 1.1-3, P Z 0.014). Black patients also had different primary site profile treated when compared to non-blacks (P Z 0.021), with a higher rate of larynx (30% vs. 19%, P Z 0.008) and nasopharynx (10% vs. 4%, P Z 0.033). HPV status, tobacco status, and treatment factors (IMRT, RT dose, RT duration, surgery, chemotherapy use) were not associated with race on MVA. Black patients had a lower rate of 3-year LRC (65% vs. 81%, P<0.001) and OS (43% vs. 69%, P<0.001). Patients with >45 days elapsed from diagnosis to treatment had a detriment in 3-year LRC (77% vs. 83%, P Z 0.002) and OS (66% vs. 69%, P Z 0.009). On Cox MVA, Black race was independently prognostic for poor LRC (HR 1.8 95% CI 1.2-2.8, P Z 0.005) and OS (HR 1.6 95% CI 1.2-2.1, P Z 0.001). Additional socioeconomic factors associated with OS on MVA included patient unemployment status (HR 1.4 95% CI 1.2-1.7, P<0.001), and marriage status (HR 0.72 95% CI 0.62-0.84, P<0.001). Conclusion: Race is independently prognostic for LRC and OS. Black patients presented with more advanced tumor stage and had longer delays in treatment initiation that may be attributed to socioeconomic factors such as employment status and social support. Author Disclosure: A.O. Naghavi: None. M. Echevarria: None. T. Strom: None. Y.A. Abuodeh: None. K.A. Ahmed: None. P.S. Venkat: None. A. Trotti: None. L.B. Harrison: None. B. Green: None. K. Yamoah: None. J.J. Caudell: None.
3002 The Benefits of Clinical Pathways (CP) for Radiation Oncology in a Large Cancer Care Network D.E. Heron,1 B.J. Gebhardt,1 S. Beriwal,2 H. Benson,3 Z. Lorinc,3 A. Barry,3 and K. Lokay3; 1University of Pittsburgh Cancer Institute, Pittsburgh, PA, 2Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, 3Via Oncology, LLC, Pittsburgh, PA Purpose/Objective(s): The cancer center implemented a radiation oncology CP program (now incorporated separately as Via Pathways)
beginning in 2001 to standardize care throughout a network of radiation oncology sites. The program exists to ensure consistency and rapid adoption of best evidence-based care in a large, integrated NCI-designated comprehensive cancer center. Materials/Methods: The web-based CP portal integrates with electronic medical records to provide point-of-care patient-specific decision support. The system sequentially displays possible treatment options as defined by the clinical pathway based upon the specific disease and stage entered by the physician, and the system then records the management decisions of the physician. CP content is developed and maintained by committees of both academic and community oncologists selected from the network. Meetings occur semi-annually to review and update treatment recommendations for the nearly 95% of cancers covered. All oncologists throughout the network are invited to participate through in-person meetings or via teleconference. Evidence is evaluated hierarchically on efficacy, toxicity, and then cost. When the committee modifies CP content, the software is updated within 35 days and new recommendations are available to the 37 network providers. Through analysis of the utilization data, leaders can monitor adherence to the CP recommendations and research practice patterns at an unprecedented level of granularity. Results: Since data collection in the portal began in 2009, the cancer center has captured more than 58,000 visits. A total of 35,750 treatment decisions were entered, of which 33,968 (95.0%) were considered onpathway. Off-pathway decisions were approved prior to treatment by a designated peer review radiation oncologist from within the network. Reasons for going off pathway and the alternative approach to care were recorded. Conclusion: CP is an integral tool for standardizing high-value care across large networks and geographic regions. The collaborative committee process, rapid electronic deployment, and easy access to evidence reviews have garnered high physician buy-in and consistent adherence to CP recommendations. Efforts to increase efficiencies and trial accruals have been successful due in large part to access to such a vast and comprehensive database. Other benefits of the program include: a transition from volume to value care models; facilitation of onboarding new physicians, residency trainees, and fellows; and providing transparency through peer review, a committee process, and evidence reviews. CP is now used by more than 1000 physicians across the US in a variety of academic and community settings. Author Disclosure: D.E. Heron: Via Oncology is an affiliated company of UPMC and the University of Pittsburgh Cancer Institute; Via Oncology. B.J. Gebhardt: None. S. Beriwal: advisory role; Via Oncology. H. Benson: None. Z. Lorinc: None. A. Barry: None. K. Lokay: leadership; Via Oncology.
3003 A Comprehensive Analysis of the Portfolio of Clinical Trials Involving Brachytherapy Over the Past 15 Years B. Odei,1 D. Boothe,2 S. Lloyd,3 and D.K. Gaffney4; 1David Geffen School of Medicine at UCLA, Los Angeles, CA, 2University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, 3Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 4Huntsman Cancer Hospital, Salt Lake City, UT Purpose/Objective(s): Clinical trials (CTs) involving brachytherapy (BT) are crucial in establishing the role of BT in the evolving landscape of cancer treatment. An analysis of all CTs involving BT is warranted to better understand the factors driving the success of brachytherapy CTs, and the future direction of the field. Materials/Methods: We queried the clinicaltrials.gov website using the general search terms “radiation therapy” or “irradiation” or “EBRT” or “brachytherapy” or “internal radiation.” This yielded a total of 10,417 CTs between 2000 and 2015. Trials not using BT were then excluded, yielding 319 CTs incorporating BT for analysis. Characteristics of individual CTs were then obtained. Least squared linear regression was employed to