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  • American Society of Clinical Oncology (ASCO)  (6)
  • 1
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. e16049-e16049
    Abstract: e16049 Background: Clear cell renal cell carcinoma (ccRCC) is the most common tumor of the kidney. Up to 70% are incidentally detected on multiphasic CT. The prognosis for patients with ccRCC is related to Fuhrman grade (FG) and is diagnosed by biopsy or excision. There is a great need for a non-invasive method to assess tumor grade which may help inform clinical decision-making. The purpose of our study is to determine if contrast enhancement on CT predicts FG and microvessel density (MVD) of ccRCC lesions and to assess which combination of quantitative and qualitative radiological features and clinical features predict high FG ccRCC lesions. Methods: With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a cohort of ccRCC with a preoperative multiphasic (unenhanced (U), corticomedullary (C), nephrographic (N), and excretory (E)) CT scan. Tumors were stained with CD4 to quantify % MVD. Spearman’s rank correlation was calculated to test the strength of the association between CT enhancement, %MVD and FG. Stepwise logistic regression analysis was performed to determine the quantitative and/or qualitative feature with the highest performance in predicting high FG tumor. The multivariate logistic regression analysis was evaluated using ROC curves and AUCs. Results: Our cohort had 127 patients with 89 low-grade tumors and 43 high-grade tumors. The %wash-in of enhancement from the U to the C phase showed a significant correlation with %MVD of the tumor (R 2 = 0.181,p 〈 . 001) as did enhancement of the tumor in the early C phase with %MVD (R 2 = 0.159,p 〈 . 001). There was a significant inverse correlation with %MVD and FG (R 2 = 0.137,p 〈 . 001). T-stage, tumor size, %MVD and presence of renal vein invasion were determined to be significant independent predictors of high grade lesions with an AUC of .838 (95% CI .748-.927). Conclusions: Lower grade ccRCC tumors have a higher MVD. Therefore, contrast material washes in at a faster rate from the UN to the CM phase, enabling low grade to be discriminated from high-grade tumors on CT.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2017
    detail.hit.zdb_id: 2005181-5
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  • 2
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 27_suppl ( 2019-09-20), p. 96-96
    Abstract: 96 Background: Though uninsurance rates declined after the Affordable Care Act, the number of underinsured, or individuals who spend 〉 10% of their income on out-of-pocket (OOP) medical costs, continues to rise. In patients with metastatic breast cancer (MBC), underinsurance may lead to financial toxicity (FT), or patient-level financial burden and distress, since diagnosis and treatment is extremely costly. This study explores health insurance literacy and the association between FT and health insurance status in women receiving treatment for MBC. Methods: This cross-sectional study utilized survey data collected from 2017-2019 in women age ≥18 receiving treatment for MBC at two academic medical centers in Alabama. FT was measured by the Comprehensive Score for Financial Toxicity (COST) tool (11-item scale from 0-44, with lower scores indicating worse FT). Health insurance status and OOP costs were self-reported. Effect sizes were calculated using Cohen’s d or Cramer’s V. Mixed and generalized linear models clustered by site and treating medical oncologist estimated the association between FT and health insurance status. Results: In 81 women with MBC, median COST score was 24 (interquartile range [IQR] 17-30), 44% had private insurance, 40% Medicare, and 16% Medicaid. Though 25% and 33% of surveyed patients did not know their health insurance premium or deductible cost, respectively, privately insured patients more often knew the cost of their premiums (97%; V = 0.58) and deductibles (81%; V = 0.33) compared to publicly insured patients. In adjusted models, FT levels did not differ significantly based on health insurance type (private insurance COST 21, 95% confidence interval [CI] 18-25; Medicaid COST 23, 95% CI 17-29; Medicare COST 24, 95% CI 20-27). However, risk of severe FT (COST ≤13) was 147% higher for privately insured patients versus Medicare beneficiaries (risk ratio 2.47, 95% CI 1.44-4.21). Conclusions: Despite higher levels of health insurance literacy, privately insured patients receiving treatment for MBC may be at increased risk of severe FT. Further research is needed to understand causes of underinsurance in patients with MBC, which could lead to cancer-related FT.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 3
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 28 ( 2015-10-01), p. 3096-3104
    Abstract: Previous studies have reported that survivors of non-Hodgkin lymphoma (NHL) have an increased risk of developing cutaneous melanoma; however, risks associated with specific treatments and immune-related risk factors have not been quantified. Patients and Methods We evaluated second melanoma risk among 44,870 1-year survivors of first primary NHL diagnosed at age 66 to 83 years from 1992 to 2009 and included in the Surveillance, Epidemiology, and End Results-Medicare database. Information on NHL treatments, autoimmune diseases, and infections was derived from Medicare claims. Results A total of 202 second melanoma cases occurred among survivors of NHL, including 91 after chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and 111 after other NHL subtypes (cumulative incidence by age 85 years: CLL/SLL, 1.37%; other NHL subtypes, 0.78%). Melanoma risk after CLL/SLL was significantly increased among patients who received infused fludarabine-containing chemotherapy with or without rituximab (n = 18: hazard ratio [HR], 1.92; 95% CI, 1.09 to 3.40; n = 10: HR, 2.92; 95% CI, 1.42 to 6.01, respectively). Significantly elevated risks also were associated with T-cell activating autoimmune diseases diagnosed before CLL/SLL (n = 36: HR, 2.27; 95% CI, 1.34 to 3.84) or after CLL/SLL (n = 49: HR, 2.92; 95% CI, 1.66 to 5.12). In contrast, among patients with other NHL subtypes, melanoma risk was not associated with specific treatments or with T-cell/B-cell immune conditions. Generally, infections were not associated with melanoma risk, except for urinary tract infections (CLL/SLL), localized scleroderma, pneumonia, and gastrohepatic infections (other NHLs). Conclusion Our findings suggest immune perturbation may contribute to the development of melanoma after CLL/SLL. Increased vigilance is warranted among survivors of NHL to maximize opportunities for early detection of melanoma.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 4
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 27_suppl ( 2019-09-20), p. 97-97
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 27_suppl ( 2019-09-20), p. 97-97
    Abstract: 97 Background: Shared decision-making (SDM), a process where patients partner with their physician to incorporate personal preferences into treatment decisions, is a tenet of high-value healthcare. It is unknown if high-value care associated with SDM manifests in the form of decreased out-of-pocket costs. Therefore, this study analyzes the relationship between patient preference for SDM and financial toxicity in metastatic breast cancer (MBC). Methods: This cross-sectional study utilized surveys of women age ≥ 18 with MBC who received care at two academic hospitals in Alabama between 2017 and 2019. SDM preference and financial toxicity were measured using the Control Preferences Scale and the Comprehensive Score for Financial Toxicity (COST) tool (11-item scale from 0-44, with lower scores indicating worse FT), respectively. Patient demographic and clinical data were abstracted from the electronic medical record. Effect sizes were calculated using Cohen’s d or Cramer’s V. Differences in financial toxicity by SDM preference were estimated using mixed models clustered by site and treating medical oncologist. Results: In 79 women with MBC, 41% preferred SDM, 33% preferred provider-driven decision making, and 22% preferred patient-driven decision making. Patients preferring SDM were more often college educated (48% vs. 40%; V = .15), higher income (52% vs. 44%; V = .09), and privately insured (47% vs. 41%; V = .11). Overall median COST score was 23 (interquartile range 16-30), which varied modestly by SDM preference. After adjusting for patient demographic and clinical characteristics, similar financial toxicity levels were found in patients who preferred SDM (COST 22, 95% confidence interval [CI] 19-25), patient-driven decision making (COST 22, 95% CI 18-26), and provider-driven decision making (COST 24, 95% CI 20-27). Conclusions: Similar levels of financial toxicity were found in patients with differing decision–making preferences regarding their MBC treatment, which may be secondary to lack of discussions about cost. Further research is needed to determine if and how financial toxicity is being identified or included within decision-making.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 5
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 7_suppl ( 2019-03-01), p. 625-625
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 7_suppl ( 2019-03-01), p. 625-625
    Abstract: 625 Background: Clear cell renal cell carcinoma (ccRCC) is a highly vascularized tumor and has a heterogeneous molecular profile, but the correlation between its tumor biology and radiomic features have only recently been investigated. As 70% of ccRCCs are detected incidentally at imaging, and tumor phenotypes are only available after surgery, a non-invasive biomarker to predict ccRCC phenotypes and aggressiveness on imaging may be clinically valuable, as low grade lesions may undergo active surveillance. Methods: With IRB approval and HIPAA compliance, our study cohort comprised 92 consecutive patients with 102 ccRCCs (mean age, 62 years (SD ± 14.2) with histopathology and molecular endpoints imaged preoperatively on CT with a four-phase renal protocol [unenhanced (U), corticomedullary (C), nephrographic (N), excretory (E)]. Radiomic data was obtained by contouring the entire ccRCC in each phase to obtain a 3D tumor volume of interest (VO I). The mean enhancement in each phase the and wash-in and wash-out of enhancement was calculated for each ccRCC. Molecular data was obtained through immunohistochemistry of resected ccRCCs to assess carbonic anhydrase-IX (CAIX), microvessel density (MVD), phosphatase and tension homolog (PTEN), and tumor grade (TG). Categorical variables were analyzed with logistic regression and odds ratio (OR) was reported. Continuous variables were analyzed with linear regression and Pearson correlation coefficient (r 2 ) was reported. P-values 〈 .05 were considered significant. Results: Significant radiomic associations included TG and 3D tumor enhancement in the C (OR = 4.72, p = .030), N (OR = 17.71, p 〈 .0001), and E phases (OR = 17.10, p 〈 .0001), and wash-in from U to C (OR = 8.27, p = .004). MVD had a significant positive association with 3D tumor enhancement in the C phase (r 2 = 0.410, p 〈 .0001), wash-in from U to C (r 2 = 0.435, p 〈 .0001) and wash-out from the C to N (r 2 = 0.435, p = .001). There were no significant radiomic correlates with CAIX or PTEN expression. Conclusions: A 3D ccRCC VOI on multiphasic CT had significant correlations with TG and MVD, independent of clinical features, potentially becoming a predictive imaging biomarker of ccRCC aggressiveness and clinical outcome.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 6
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 32, No. 15_suppl ( 2014-05-20), p. 1533-1533
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2014
    detail.hit.zdb_id: 2005181-5
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