Background
Biliary tract cancers (BTCs) are rare but deadly cancers (gallbladder cancer GBC, intrahepatic cholangiocarcinoma ICC, extrahepatic cholangiocarcinoma ECC, and ampulla of Vater cancer ...AVC). A recent US study reported increasing GBC incidence among people younger than 45 years and blacks; however, it did not examine trends for other biliary tract sites.
Methods
This study characterized demographic differences in BTC incidence rates and time trends by anatomic site. Population‐based North American Association of Central Cancer Registries data were used to calculate age‐adjusted incidence rates, incidence rate ratios (IRRs), and estimated annual percent changes (eAPCs) for 1999‐2013 by site and demographic group. For sites with significant differences in eAPC by age group, IRRs were compared by age group.
Results
GBC incidence rates declined among women (eAPC, –0.5%/y; P = .01) and all racial/ethnic groups except for non‐Hispanic blacks, among whom rates increased (1.8%/y; P < .0001). Although GBC rates increased among 18‐ to 44‐year‐olds (eAPC, 1.8%/y; P = .01), they decreased among people 45 years old or older (–0.4%/y; P = .009). Sex (P < .0001) and racial/ethnic differences (P = .003 to .02) in GBC incidence were larger for younger people than older people. During this period, ICC (eAPC, 3.2%/y; P < .0001) and ECC rates (1.8%/y; P = .001) steadily increased across sex and racial/ethnic groups. Although AVC incidence rates increased among younger adults (eAPC, 1.8%/y; P = .03) but not older adults (–0.20%/y; P = .30), sex and racial/ethnic IRRs did not differ by age.
Conclusions
Differential patterns of BTC rates and temporal trends have been identified by anatomic site and demographic groups. These findings highlight the need for large pooling projects to evaluate BTC risk factors by anatomic site.
Significant and novel variations in biliary tract cancer incidence rates and trends are identified across anatomic sites by demographic group among adults in the United States between 1999 and 2013. Differences in sex‐ and race/ethnicity‐specific gallbladder cancer incidence rate ratios are larger among younger adults than older adults, and this may reflect underlying differences in the prevalence of and trends in risk factors by demographic group.
Background
Social needs may affect cancer survivors' health‐related quality of life (HRQOL) above and beyond sociodemographic and cancer‐related factors. The purpose of this study was to estimate ...associations between social needs and HRQOL.
Methods
Results included data from 1754 participants in the Detroit Research on Cancer Survivors cohort, a population‐based study of African American survivors of breast, colorectal, lung, and prostate cancer. Social needs included items related to food insecurity, utility shutoffs, housing instability, not getting health care because of cost or a lack of transportation, and perceptions of neighborhood safety. HRQOL was measured with the validated Functional Assessment of Cancer Therapy–General (FACT‐G). Linear regression models controlled for demographic, socioeconomic, and cancer‐related factors.
Results
More than one‐third of the survivors (36.3%) reported social needs including 17.1% of survivors reported 2 or more. The prevalence of social needs ranged from 14.8% for food insecurity to 8.9% for utility shutoffs. FACT‐G score differences associated with social needs were –12.2 (95% confidence interval CI to –15.2 to –9.3) for not getting care because of a lack of transportation, –11.3 (95% CI, –14.2 to –8.4) for housing instability, –10.1 (95% CI, –12.7 to –7.4) for food insecurity, –9.8 (95% CI, –12.7 to –6.9) for feeling unsafe in the neighborhood, –8.6 (95% CI, –11.7 to –5.4) for utility shutoffs, and –6.7 (95% CI, –9.2 to –4.1) for not getting care because of cost.
Conclusions
Social needs were common in this cohort of African American cancer survivors and were associated with clinically significant differences in HRQOL. Clinical oncology care and survivorship care planning may present opportunities to screen for and address social needs to mitigate their impact on survivors' HRQOL.
More than one‐third of African American cancer survivors experience social needs. Social needs, particularly those related to neighborhood safety, transportation, and housing stability, are associated with dramatically lower health‐related quality of life.
Background
Laboratory testing and treatments for chronic lymphocytic leukemia (CLL) have changed dramatically within the last decade. The authors evaluated changes in patterns of real‐world testing ...and treatment over time by comparing 2 population‐based cohorts.
Methods
The National Cancer Institute–sponsored Patterns of Care study was conducted among patients with CLL who were sampled from 14 Surveillance, Epidemiology, and End Results (SEER) program registries. Demographics, testing, and treatment data were ed from medical records within 24 months of diagnosis.
Results
A total of 1008 patients diagnosed in 2008 and 1367 patients diagnosed in 2014 were included. There was a significant increase in fluorescence in situ hybridization (FISH) testing, immunoglobulin heavy‐chain variable region gene (IgVH) mutation analyses, and lymph node biopsies between 2008 and 2014. FISH testing was performed in the majority of, but not all, treated patients (53% in 2008, which increased to 62% in 2014). Some differences in the receipt of FISH testing by age and insurance status were observed over time (older patients and Medicare patients without private insurance were less likely to be tested in 2014). There were contrasting testing patterns noted by practice type and year, with nonteaching hospitals more likely to perform bone marrow biopsies in 2008, and teaching hospitals more likely to perform FISH and IgVH testing in 2014. There also were differences in treatments over time, with the use of bendamustine and rituximab being more common in 2014, at the expense of fludarabine, cyclophosphamide, and rituximab.
Conclusions
There have been rapidly changing practices in the testing and treatment patterns of patients with CLL within the last decade.
There have been advancements in both prognostic testing and therapy for chronic lymphocytic leukemia over the last decade. Using the National Cancer Institute Surveillance, Epidemiology, and End Results Patterns of Care data set from 2008 through 2010 and 2014 through 2016, the authors demonstrate that both testing and treatment patterns have evolved rapidly in a short period of time, and report some differences in testing by age, insurance status, and type of oncology practice.
Background
Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger ...survivors’ relatively low incomes and wealth.
Methods
The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self‐reported several forms of social risks, including food insecurity, housing instability, utility shut‐offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer‐related factors.
Results
Overall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20–39 years (47%) followed by those aged 40–54 years (43%), 55–64 years (38%), and 65 years and older (24%; p for trend < .001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42–2.16) for survivors aged 20–39 years, 1.76 (95% CI, 1.52–2.03) for survivors aged 40–54 years, and 1.41 (95% CI, 1.23–1.60) for survivors aged 55‐64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks.
Conclusions
In this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors.
This report evaluates associations between age at diagnosis and the prevalence of social risks, such as food insecurity, housing instability, and forgoing care because of lack of transportation in a population‐based cohort of Black cancer survivors. Age at diagnosis was inversely associated with social risks, and young adult survivors reported the highest prevalence of any social risks, multiple social risks, and several individual social risks.
The use of electronic cigarettes (e-cigarettes) is increasing rapidly in the United States, although the negative health outcomes associated with these products are still unknown. Emerging research ...has examined the use of e-cigarettes in the cancer survivor population as a whole, yet none has focused on e-cigarette use in the African American (AA) cancer survivor population.
The authors used data from the Detroit Research on Cancer Survivors cohort study, comprised of AA adult cancer survivors. Logistic regression models were used to evaluate factors potentially associated with e-cigarette ever use and current use.
Of 4443 cancer survivors who completed a baseline interview, 8.3% (n = 370) reported ever using e-cigarettes, and 16.5% (n = 61) of those reporting ever use also reported current use of e-cigarettes. Ever users and current users were on average younger than those who did not use e-cigarettes (57.5 vs. 61.2 years; p < .001). Current cigarette smokers were >20 times more likely (odds ratio, 20.75; 95% confidence interval, 12.84-33.55) and former smokers were almost 10 times more likely (odds ratio, 9.50; 95% confidence interval, 6.03-14.97) to have ever used e-cigarettes than never-smokers. Preliminary data suggested that ever use of e-cigarettes is associated with later stage at diagnosis for breast and colorectal cancers.
As the use of e-cigarettes increases in the general population, it is important to continue to monitor their use in cancer survivors and to gain more insight as it pertains to the AA cancer survivor population. Elucidation of the factors associated with e-cigarette use in this population may help inform comprehensive cancer survivorship recommendations and interventions.
A causal link between chronic inflammation and carcinogenesis is explored by reviewing illustrative examples of specific cancers and causal agents and mechanisms. The causal agents or pathologic ...conditions include microbial agents, gastroesophageal reflux, chronic cholecystitis and cholelithiasis, inflammatory bowel disease, and specific agents that cause chronic obstructive or diffuse interstitial lung disease. The proportion of total cancer deaths attributable to infectious agents is estimated to be about 20% to 25% in developing countries and 7% to 10% in more industrialized countries. Recurrent or persistent inflammation may induce, promote, or influence susceptibility to carcinogenesis by causing DNA damage, inciting tissue reparative proliferation, and/or creating a stromal “soil” that is enriched with cytokines and growth factors. Future research on the complex cascade of cellular and humoral factors participating in the chronic inflammatory process will further understanding of the pathogenesis of various cancers and potentially provide a rationale for targeted chemopreventive interventions.
Background
Coronavirus disease 2019 (COVID‐19) has had profound effects on population health to date. African American cancer survivors are particularly vulnerable to developing severe consequences; ...therefore, understanding the impact of the virus on this patient population is critical.
Methods
The Detroit Research on Cancer Survivors cohort is a unique effort to understand the determinants of poor outcomes in African American cancer survivors. To date, more than 4500 cancer survivors and nearly 950 primary caregivers have been enrolled; participation includes a survey and the collection of biospecimens, medical records, and tumor tissue. Beginning in the spring of 2020, a supplemental survey focusing on the impact of COVID‐19 was offered to enrolled participants. The analysis included 890 survivors.
Results
Nearly all survivors (>99%) reported changes in their daily activities in an effort to reduce the risk of infection. More than 40% of the survivors reported some disruption in their access to medical care. A substantial proportion of the survivors (>40%) reported feeling anxious, depressed, and/or isolated during the COVID‐19 pandemic. Approximately 40% of the patients reported changes in health behaviors shown to negatively affect survivorship outcomes (physical inactivity, smoking, and alcohol use) as a result of the pandemic.
Conclusions
The influence of the COVID‐19 pandemic on African American cancer survivors is substantial: it has affected both their physical and mental health. Coupled with changes in health behaviors, these factors will likely affect outcomes in this high‐risk patient population, and this makes further study and interventions necessary to mitigate the long‐term impact of the pandemic on cancer outcomes.
The COVID‐19 pandemic has had a profound impact on the physical and mental health of African American cancer survivors living in Detroit, Michigan. Strategies focusing on health behaviors such as physical activity would improve patient health and quality of life.
Background
The benefit of regular exercise in improving cancer outcomes is well established. The American Cancer Society (ACS) released a recommendation that cancer survivors should engage in at ...least 150 minutes of moderate to vigorous physical activity (PA) per week; however, few report meeting this recommendation. This study examined the patterns and correlates of meeting ACS PA recommendations in the Detroit Research on Cancer Survivors (ROCS) cohort of African American cancer survivors.
Methods
Detroit ROCS participants completed baseline and yearly follow‐up surveys to update their health and health behaviors, including PA. This study examined participation in PA by select characteristics and reported health‐related quality of life (HRQOL) as measured with the Functional Assessment of Cancer Therapy and Patient‐Reported Outcomes Measurement Information System instruments.
Results
Among the first 1500 ROCS participants, 60% reported participating in regular PA, with 24% reporting ≥150 min/wk. Although there were no differences by sex, prostate cancer survivors were the most likely to report participating in regular PA, whereas lung cancer survivors were the least likely (P = .022). Survivors who reported participating in regular PA reported higher HRQOL (P < .001) and lower depression (P = .040).
Conclusions
Just 24% of African American cancer survivors reported meeting the ACS guidelines for PA at the baseline, but it was encouraging to see increases in activity over time. Because of the established benefits of regular exercise observed in this study and others, identifying and reducing barriers to regular PA among African American cancer survivors are critical for improving outcomes and minimizing disparities.
Regular exercise is critically beneficial in improving quality of life and in reducing anxiety and depression in African American cancer survivors. Eliminating barriers to participation in physical activity will be important in reducing cancer disparities.
Background
Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer.
Methods
This study examined the association between prediagnosis cardiovascular health ...and total and cause‐specific mortality among 12,076 postmenopausal women who developed local‐ or regional‐stage invasive cancer in the Women's Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity‐related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non‐Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival.
Results
After a median follow‐up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all‐cause mortality (HR, 1.99; 95% CI, 1.73‐2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88‐5.57), cancer‐specific mortality (HR, 1.37; 95% CI, 1.1‐1.72), and other‐cause mortality (HR, 2.14; 95% CI, 1.70‐2.69). A higher waist circumference was associated with greater all‐cause mortality (HR, 1.17; 95% CI, 1.06‐1.30) and cancer‐specific mortality (HR, 1.22; 95% CI, 1.04‐1.42).
Conclusions
Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all‐cause, CVD, cancer‐specific, and other‐cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation.
Lay Summary
This study uses information from the Women's Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country.
The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors.
It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer.
Among postmenopausal women with select early‐stage cancers associated with metabolic syndrome, a higher number of cardiometabolic abnormalities is associated with a significantly higher risk of overall death in addition to a higher risk of death due to cancer, heart disease, and other causes. These findings highlight a major gap in the care of patients with cancer and the need for improved efforts by public health systems to improve cancer survivorship.
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