- Email: [email protected]
Type I uterine cancer in United States (US)-born vs immigrants: A study of 4834 patients
Abstracts / Gynecologic Oncology 133 (2014) 2–207
and Hispanics for 7% of our study population. The majority of patients were privately insured (n = 441), followed by Medicare (n = 375). The mean interval time from diagnosis to treatment was 47.5 days (range, 0– 363 days). A statistically significant difference was noted for this time interval with regard to both race and insurance status: white and African Americans (42.6 vs 57.3 days, P = 0.048), privately insured and Medicare (38.4 vs 54.1 days, P b 0.001). There was a significant association with increased risk of death with a longer delay (43.3 vs 64.8 days, P b 0.001). No statistically significance difference was noted for distance from medical center or BMI. Conclusions: A significant increase in interval of time from diagnosis to treatment of endometrial cancer was seen for both race and insurance status. A longer interval from diagnosis to treatment was associated with increased mortality. The causes of these delays are likely multifactorial but need further investigation.
doi:10.1016/j.ygyno.2014.03.395
376 - Poster Session B Patterns of care of women with low-grade cervical cytologic abnormalities R. Kupets1, L. Paszat2. 1Sunnybrook Cancer Center/University of Toronto, Toronto, ON, Canada, 2Institute of Clinical Evaluative Sciences, Toronto, ON, Canada. Objectives: The most common abnormal cervical cytology diagnoses are atypical squamous cells of unknown significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL). When these diagnoses are made on specimens collected in the absence of any prior cervical cytology during the previous year, it is recommended to repeat the sampling 6 months later. Those patients exhibiting abnormal cytology 6 months after the diagnosis of ASCUS or LSIL should proceed to colposcopy, whereas those with normal cytology 6 months later may return to screening. Methods: Reports of cervical cytology are contained in a database of health-care provision in a jurisdiction serving 10 million people, deterministically linkable to all other health services databases, including physician reimbursement claims for colposcopy. We identified all women who had abnormal cytology reports of ASCUS or LSIL during 2008 and 2009, preceded by an interval of at least 1 year without a cervical cytology report. We searched for additional cytology reports and for colposcopy billing claims during the 24 months following the date of the first abnormal report. We linked the postal code of each woman to an aggregate measure of socioeconomic status. Results: We identified 74,770 women with ASCUS or LSIL cytology ≥12 months since any prior cytology during the study period. Among women with ASCUS, 69.7% underwent repeat cytology as did 60.3% of women with LSIL. Repeat cytology following ASCUS disclosed normal (68.2%), ASCUS (19.3%), LSIL (10.6%), and HSIL (1.4%); following LSIL, the corresponding percentages were 48.3%, 18.0%, 30.8%, and 2.6%. Among women with ASCUS, 16.2% went directly to colposcopy, and 14.0% did not repeat cytology or go to colposcopy. Among women with LSIL, 26.4% went directly to colposcopy, but 13.4% went nowhere. Conclusions: We have demonstrated substantial improvement in cervical cytology 6 months after ASCUS and LSIL, highlighting unnecessary referrals of many women with ASCUS and LSIL directly to colposcopy without repeat cytology, and lack of follow-up for one sixth of women with low-grade cytology.
doi:10.1016/j.ygyno.2014.03.396
151
377 - Poster Session B Utilizing peer teen advocates and social media to increase human papillomavirus (HPV) vaccination awareness in urban settings S. Tyree Francis1, M.A. Kiepczynski2, S. Young3, D. Uyar3. 1The Boys & Girls Clubs of Greater Milwaukee, Milwaukee, WI, USA, 2The City of Milwaukee Health Department, Milwaukee, WI, USA, 3Medical College of Wisconsin, Milwaukee, WI, USA. Objectives: HPV vaccination has demonstrated efficacy in reducing HPV prevalence. Lack of knowledge about HPV is consistently noted as a barrier to HPV vaccination. The vaccination rate in Milwaukee is b30%. The Medical College of Wisconsin, The City of Milwaukee Health Department, and The Boys & Girls Clubs of Greater Milwaukee initiated a community-based research pilot aimed at increasing teens’ HPV knowledge with a multimedia campaign designed for their peers. Our goal was to determine the feasibility of incorporating teens into development of HPV-related health messages using social media and conventional media and learn whether their culturally relevant materials would resonate with other teens. Methods: Six youth leaders recruited from select Boys & Girls Clubs formed the core peer educators. These educators recruited 30 youths, who received age- and culturally-appropriate HPV education. The youths met with community mentors and developed an HPV "brand," logo, and website. The core educators and their recruits formed six teams who designed relevant brochures, billboards, and/ or public service announcements (PSAs). Results: Our website www.itsjust3HPV.org promoted the project, displayed the teen-developed materials and encouraged the community to vote for their favorites over a 2-week period. Winners were announced at the 2nd Annual Spread the Word PSA premiere held on May 9, 2013, in Milwaukee, a citywide teen health event. The winning billboards have been displayed locally, and the winning brochure is being disseminated in local health clinics. The website was launched in April 2013 and logged N3000 views in first 5 months. August 2013 metrics indicate 29 views/day. The PSA videos, which remain viewable on YouTube, have been viewed N300 times. Conclusions: Adolescents can and should be engaged in the development of culturally relevant health messaging. Our strategy represents one approach to developing materials that appeal to this demographic. In a relatively short period of time, the HPV health message has been successfully disseminated based on our current metrics. The ability to track metrics from the website should allow us to monitor continued dissemination. Ultimately, we would like to see if innovative campaigns result in increased HPV vaccination rates. doi:10.1016/j.ygyno.2014.03.397
378 - Poster Session B Type I uterine cancer in United States (US)-born vs immigrants: A study of 4834 patients E.J. Simons1, K.W. Blansit1, T.N. Tsuei1, R.A. Brooks1, S.M. Ueda1, D.S. Kapp2, J.K. Chan1. 1UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA, 2Stanford University, Stanford, CA, USA. Objectives: To determine the association of type I endometrioid uterine cancer in US-born vs immigrant Asians. Methods: Data were obtained from the National Cancer Institute from 2001 to 2009. Chi-square, t-test, and binomial regression methods were used for statistical analyses. Results: Of 4834 Asians with uterine cancer in our study, 62% were USborn and 38% were immigrants. Of all patients, 2972 (61%) had type I (grade 1 or 2, endometrioid histology) uterine cancer. Compared to type II disease (grade 3, clear cell and serous histology), type I patients were younger (55 vs 59 years, P b 0.01) and had lower-stage disease (90% vs
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Abstracts / Gynecologic Oncology 133 (2014) 2–207
71%, P b 0.01). Immigrants had a significantly lower proportion of type I uterine cancers compared to their US-born counterparts (56% vs 65%, P b 0.01). Of the immigrants, Japanese (48% vs 68%, P b 0.01) had a lower proportion of type I cancers compared to Chinese (52% vs 63%, P b 0.01) and Filipino (58% vs 66%, P b 0.01). The 5-year disease-specific survivals of immigrant vs US-born Asians with type I cancer was 92%. Conclusions: US-born Asians are more likely to be diagnosed with type I uterine cancer compared to immigrant Asians. Among all ethnic groups, Japanese immigrants had the lowest proportion of type I cancers. doi:10.1016/j.ygyno.2014.03.398
379 - Poster Session B The use of a geographic information system to identify advanced cervical cancer patients in California G. Westhoff1, K.W. Blansit1, B.J. Monk2, R.A. Brooks1, S.M. Ueda1, D.S. Kapp3, J.K. Chan1. 1UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA, 2University of Arizona Cancer Center, Phoenix, AZ, USA, 3Stanford University, Stanford, CA, USA. Objectives: Novel biologic therapy has been shown to have activity in advanced and recurrent cervical cancer patients. Geographic information system (GIS) analysis integrates geospatial data with population-based reporting summaries. We propose to use GIS to target cervical cancer patients who may benefit from this treatment. Methods: Geographic, demographic, socioeconomic, and outcomes data were obtained from the 2012 United States Census and National Cancer Institute Databases from 2001 to 2009. Chi-square and t-test methods were used for statistical analyses. Results: Of 11,561 patients in California, 1330 (14%) had advanced stage IV disease. The median age was 51 years (range, 20–98 years). White, Hispanic, Asian, and black comprised 46%, 34%, 12%, and 8% of the population, respectively. The overall 5-year survival was 39%, with worsened survival in counties with higher poverty rates (21%, P = 0.03). The survival of these advanced cancers based on race was 16% for whites, 24% for Hispanics, 23% for Asians, and 12% for blacks (P b 0.01). To evaluate trends, we divided the study into three time periods: 2001– 2003, 2004–2006, and 2007–2009. The percentage of advanced-stage disease increased from 13% to 14% to 16% according to time period (P b 0.01). Using GIS to target these patients, we found that N56% of advanced cervical cancer patients resided in southern California. More specifically, 433 (33%) in Los Angeles, 86 (6%) in San Diego, 79 (6%) in Orange, 73 (5%) in San Bernardino, and 68 (5%) in Riverside county with corresponding survivals of 20%, 24%, 18%, 7%, and 5% (P b 0.01). Using United States census data to define poverty as 15% of the population, 53% of advanced cervical cancer patients resided in counties with higher poverty. Conclusions: The proportion of advanced cervical cancer patients in California has increased over our study period. GIS targeted the women who may benefit from novel biologic agents, with most cases being diagnosed in Los Angeles and San Diego counties. Because the majority of these women reside in lower-resource settings, these regions may require additional resources from state or federal insurance agencies.
University School of Medicine, St. Louis, MO, USA, 2Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. Objectives: To examine the impact of sarcopenia (low skeletal muscle mass) on surgical complications and prognosis in patients with endometrial cancer. Methods: We performed a retrospective review of 122 endometrial cancer patients who underwent surgery between 2005 and 2009. Sarcopenia was assessed on preoperative CT scan by measuring the lumbar psoas muscle cross-sectional area and was defined as any value below the median (b4.38 cm2). Sarcopenic obesity was defined as sarcopenia plus body mass index (BMI) of ≥30. Microsatellite instability (MSI) was analyzed using the National Cancer Institute consensus markers and tumor from hysterectomy specimens. Outcome variables included postoperative complications, length of hospital stay, 90-day readmission rate, recurrence-free survival (RFS), and overall survival (OS). The Kaplan–Meier method was used to establish the estimate survival curves, and distributions were compared using the log-rank test. Variables known to affect survival were entered into a multivariable Cox proportional hazards model. Results: Of the 122 patients, 30 (25%) met criteria for sarcopenic obesity. Sarcopenic patients were typically older (mean age, 69.7 vs 62.1 years, P b 0.001), had lower BMIs (31.1 vs 39.4, P b 0.001), and had more comorbidities (P = 0.048). MSI was not associated with sarcopenia (61% sarcopenic vs 72% nonsarcopenic patients, P = 0.25). Overall sarcopenia was not associated with such clinical outcomes as hospital stay, 90-day readmission rate, or early/late complications. Compared to nonsarcopenic patients, those with sarcopenia had a shorter time to recurrence (log-rank P = 0.02) (Fig. 1), but there was no difference in OS (log-rank P = 0.20). After adjusting for race and BMI, sarcopenia was associated with more rapid recurrence (HRadj 3.55; 95% CI 1.25, 10.1). It did not predict OS in crude or after adjustment for race, BMI, and clear cell tumor (HRadj 1.89; 95% CI 0.78, 4.57). Conclusions: Sarcopenia is linked to RFS but does appear to negatively impact surgical outcomes or OS in endometrial cancer patients. Sarcopenic obesity may have more clinical implications in this population and warrants further investigation.
doi:10.1016/j.ygyno.2014.03.399
380 - Poster Session B Sarcopenia: Preoperative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer L.M. Kuroki1, M. Mangano2, J. Allsworth1, C. Menias1, L.S. Massad1, A.R. Hagemann1, M.A. Powell1, D.G. Mutch1, P.H. Thaker1. 1Washington
Fig. 1. Recurrence-free survival by Kaplan Meier analysis between patients with sarcopenia and those with no sarcopenia.
doi:10.1016/j.ygyno.2014.03.400
and Hispanics for 7% of our study population. The majority of patients were privately insured (n = 441), followed by Medicare (n = 375). The mean interval time from diagnosis to treatment was 47.5 days (range, 0– 363 days). A statistically significant difference was noted for this time interval with regard to both race and insurance status: white and African Americans (42.6 vs 57.3 days, P = 0.048), privately insured and Medicare (38.4 vs 54.1 days, P b 0.001). There was a significant association with increased risk of death with a longer delay (43.3 vs 64.8 days, P b 0.001). No statistically significance difference was noted for distance from medical center or BMI. Conclusions: A significant increase in interval of time from diagnosis to treatment of endometrial cancer was seen for both race and insurance status. A longer interval from diagnosis to treatment was associated with increased mortality. The causes of these delays are likely multifactorial but need further investigation.
doi:10.1016/j.ygyno.2014.03.395
376 - Poster Session B Patterns of care of women with low-grade cervical cytologic abnormalities R. Kupets1, L. Paszat2. 1Sunnybrook Cancer Center/University of Toronto, Toronto, ON, Canada, 2Institute of Clinical Evaluative Sciences, Toronto, ON, Canada. Objectives: The most common abnormal cervical cytology diagnoses are atypical squamous cells of unknown significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL). When these diagnoses are made on specimens collected in the absence of any prior cervical cytology during the previous year, it is recommended to repeat the sampling 6 months later. Those patients exhibiting abnormal cytology 6 months after the diagnosis of ASCUS or LSIL should proceed to colposcopy, whereas those with normal cytology 6 months later may return to screening. Methods: Reports of cervical cytology are contained in a database of health-care provision in a jurisdiction serving 10 million people, deterministically linkable to all other health services databases, including physician reimbursement claims for colposcopy. We identified all women who had abnormal cytology reports of ASCUS or LSIL during 2008 and 2009, preceded by an interval of at least 1 year without a cervical cytology report. We searched for additional cytology reports and for colposcopy billing claims during the 24 months following the date of the first abnormal report. We linked the postal code of each woman to an aggregate measure of socioeconomic status. Results: We identified 74,770 women with ASCUS or LSIL cytology ≥12 months since any prior cytology during the study period. Among women with ASCUS, 69.7% underwent repeat cytology as did 60.3% of women with LSIL. Repeat cytology following ASCUS disclosed normal (68.2%), ASCUS (19.3%), LSIL (10.6%), and HSIL (1.4%); following LSIL, the corresponding percentages were 48.3%, 18.0%, 30.8%, and 2.6%. Among women with ASCUS, 16.2% went directly to colposcopy, and 14.0% did not repeat cytology or go to colposcopy. Among women with LSIL, 26.4% went directly to colposcopy, but 13.4% went nowhere. Conclusions: We have demonstrated substantial improvement in cervical cytology 6 months after ASCUS and LSIL, highlighting unnecessary referrals of many women with ASCUS and LSIL directly to colposcopy without repeat cytology, and lack of follow-up for one sixth of women with low-grade cytology.
doi:10.1016/j.ygyno.2014.03.396
151
377 - Poster Session B Utilizing peer teen advocates and social media to increase human papillomavirus (HPV) vaccination awareness in urban settings S. Tyree Francis1, M.A. Kiepczynski2, S. Young3, D. Uyar3. 1The Boys & Girls Clubs of Greater Milwaukee, Milwaukee, WI, USA, 2The City of Milwaukee Health Department, Milwaukee, WI, USA, 3Medical College of Wisconsin, Milwaukee, WI, USA. Objectives: HPV vaccination has demonstrated efficacy in reducing HPV prevalence. Lack of knowledge about HPV is consistently noted as a barrier to HPV vaccination. The vaccination rate in Milwaukee is b30%. The Medical College of Wisconsin, The City of Milwaukee Health Department, and The Boys & Girls Clubs of Greater Milwaukee initiated a community-based research pilot aimed at increasing teens’ HPV knowledge with a multimedia campaign designed for their peers. Our goal was to determine the feasibility of incorporating teens into development of HPV-related health messages using social media and conventional media and learn whether their culturally relevant materials would resonate with other teens. Methods: Six youth leaders recruited from select Boys & Girls Clubs formed the core peer educators. These educators recruited 30 youths, who received age- and culturally-appropriate HPV education. The youths met with community mentors and developed an HPV "brand," logo, and website. The core educators and their recruits formed six teams who designed relevant brochures, billboards, and/ or public service announcements (PSAs). Results: Our website www.itsjust3HPV.org promoted the project, displayed the teen-developed materials and encouraged the community to vote for their favorites over a 2-week period. Winners were announced at the 2nd Annual Spread the Word PSA premiere held on May 9, 2013, in Milwaukee, a citywide teen health event. The winning billboards have been displayed locally, and the winning brochure is being disseminated in local health clinics. The website was launched in April 2013 and logged N3000 views in first 5 months. August 2013 metrics indicate 29 views/day. The PSA videos, which remain viewable on YouTube, have been viewed N300 times. Conclusions: Adolescents can and should be engaged in the development of culturally relevant health messaging. Our strategy represents one approach to developing materials that appeal to this demographic. In a relatively short period of time, the HPV health message has been successfully disseminated based on our current metrics. The ability to track metrics from the website should allow us to monitor continued dissemination. Ultimately, we would like to see if innovative campaigns result in increased HPV vaccination rates. doi:10.1016/j.ygyno.2014.03.397
378 - Poster Session B Type I uterine cancer in United States (US)-born vs immigrants: A study of 4834 patients E.J. Simons1, K.W. Blansit1, T.N. Tsuei1, R.A. Brooks1, S.M. Ueda1, D.S. Kapp2, J.K. Chan1. 1UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA, 2Stanford University, Stanford, CA, USA. Objectives: To determine the association of type I endometrioid uterine cancer in US-born vs immigrant Asians. Methods: Data were obtained from the National Cancer Institute from 2001 to 2009. Chi-square, t-test, and binomial regression methods were used for statistical analyses. Results: Of 4834 Asians with uterine cancer in our study, 62% were USborn and 38% were immigrants. Of all patients, 2972 (61%) had type I (grade 1 or 2, endometrioid histology) uterine cancer. Compared to type II disease (grade 3, clear cell and serous histology), type I patients were younger (55 vs 59 years, P b 0.01) and had lower-stage disease (90% vs
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Abstracts / Gynecologic Oncology 133 (2014) 2–207
71%, P b 0.01). Immigrants had a significantly lower proportion of type I uterine cancers compared to their US-born counterparts (56% vs 65%, P b 0.01). Of the immigrants, Japanese (48% vs 68%, P b 0.01) had a lower proportion of type I cancers compared to Chinese (52% vs 63%, P b 0.01) and Filipino (58% vs 66%, P b 0.01). The 5-year disease-specific survivals of immigrant vs US-born Asians with type I cancer was 92%. Conclusions: US-born Asians are more likely to be diagnosed with type I uterine cancer compared to immigrant Asians. Among all ethnic groups, Japanese immigrants had the lowest proportion of type I cancers. doi:10.1016/j.ygyno.2014.03.398
379 - Poster Session B The use of a geographic information system to identify advanced cervical cancer patients in California G. Westhoff1, K.W. Blansit1, B.J. Monk2, R.A. Brooks1, S.M. Ueda1, D.S. Kapp3, J.K. Chan1. 1UCSF Helen Diller Comprehensive Cancer Center, San Francisco, CA, USA, 2University of Arizona Cancer Center, Phoenix, AZ, USA, 3Stanford University, Stanford, CA, USA. Objectives: Novel biologic therapy has been shown to have activity in advanced and recurrent cervical cancer patients. Geographic information system (GIS) analysis integrates geospatial data with population-based reporting summaries. We propose to use GIS to target cervical cancer patients who may benefit from this treatment. Methods: Geographic, demographic, socioeconomic, and outcomes data were obtained from the 2012 United States Census and National Cancer Institute Databases from 2001 to 2009. Chi-square and t-test methods were used for statistical analyses. Results: Of 11,561 patients in California, 1330 (14%) had advanced stage IV disease. The median age was 51 years (range, 20–98 years). White, Hispanic, Asian, and black comprised 46%, 34%, 12%, and 8% of the population, respectively. The overall 5-year survival was 39%, with worsened survival in counties with higher poverty rates (21%, P = 0.03). The survival of these advanced cancers based on race was 16% for whites, 24% for Hispanics, 23% for Asians, and 12% for blacks (P b 0.01). To evaluate trends, we divided the study into three time periods: 2001– 2003, 2004–2006, and 2007–2009. The percentage of advanced-stage disease increased from 13% to 14% to 16% according to time period (P b 0.01). Using GIS to target these patients, we found that N56% of advanced cervical cancer patients resided in southern California. More specifically, 433 (33%) in Los Angeles, 86 (6%) in San Diego, 79 (6%) in Orange, 73 (5%) in San Bernardino, and 68 (5%) in Riverside county with corresponding survivals of 20%, 24%, 18%, 7%, and 5% (P b 0.01). Using United States census data to define poverty as 15% of the population, 53% of advanced cervical cancer patients resided in counties with higher poverty. Conclusions: The proportion of advanced cervical cancer patients in California has increased over our study period. GIS targeted the women who may benefit from novel biologic agents, with most cases being diagnosed in Los Angeles and San Diego counties. Because the majority of these women reside in lower-resource settings, these regions may require additional resources from state or federal insurance agencies.
University School of Medicine, St. Louis, MO, USA, 2Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. Objectives: To examine the impact of sarcopenia (low skeletal muscle mass) on surgical complications and prognosis in patients with endometrial cancer. Methods: We performed a retrospective review of 122 endometrial cancer patients who underwent surgery between 2005 and 2009. Sarcopenia was assessed on preoperative CT scan by measuring the lumbar psoas muscle cross-sectional area and was defined as any value below the median (b4.38 cm2). Sarcopenic obesity was defined as sarcopenia plus body mass index (BMI) of ≥30. Microsatellite instability (MSI) was analyzed using the National Cancer Institute consensus markers and tumor from hysterectomy specimens. Outcome variables included postoperative complications, length of hospital stay, 90-day readmission rate, recurrence-free survival (RFS), and overall survival (OS). The Kaplan–Meier method was used to establish the estimate survival curves, and distributions were compared using the log-rank test. Variables known to affect survival were entered into a multivariable Cox proportional hazards model. Results: Of the 122 patients, 30 (25%) met criteria for sarcopenic obesity. Sarcopenic patients were typically older (mean age, 69.7 vs 62.1 years, P b 0.001), had lower BMIs (31.1 vs 39.4, P b 0.001), and had more comorbidities (P = 0.048). MSI was not associated with sarcopenia (61% sarcopenic vs 72% nonsarcopenic patients, P = 0.25). Overall sarcopenia was not associated with such clinical outcomes as hospital stay, 90-day readmission rate, or early/late complications. Compared to nonsarcopenic patients, those with sarcopenia had a shorter time to recurrence (log-rank P = 0.02) (Fig. 1), but there was no difference in OS (log-rank P = 0.20). After adjusting for race and BMI, sarcopenia was associated with more rapid recurrence (HRadj 3.55; 95% CI 1.25, 10.1). It did not predict OS in crude or after adjustment for race, BMI, and clear cell tumor (HRadj 1.89; 95% CI 0.78, 4.57). Conclusions: Sarcopenia is linked to RFS but does appear to negatively impact surgical outcomes or OS in endometrial cancer patients. Sarcopenic obesity may have more clinical implications in this population and warrants further investigation.
doi:10.1016/j.ygyno.2014.03.399
380 - Poster Session B Sarcopenia: Preoperative assessment of muscle mass to predict surgical complications and prognosis in patients with endometrial cancer L.M. Kuroki1, M. Mangano2, J. Allsworth1, C. Menias1, L.S. Massad1, A.R. Hagemann1, M.A. Powell1, D.G. Mutch1, P.H. Thaker1. 1Washington
Fig. 1. Recurrence-free survival by Kaplan Meier analysis between patients with sarcopenia and those with no sarcopenia.
doi:10.1016/j.ygyno.2014.03.400