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Pagadala MS, Ryan S, Carter H, Javier-DesLoges J. Comparison of Genomic Inflation Estimates in Genome-Wide Association Studies Using Genetically Identified Ancestry vs Self-Identified Race/Ethnicity in Prostate Cancer Patients in ELLIPSE Cohort. J Urol 2024; 211:465-468. [PMID: 38010907 DOI: 10.1097/ju.0000000000003794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Meghana S Pagadala
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, La Jolla, California
| | - Stephen Ryan
- Division of Urology, Maine Medical Center, Portland, Maine
| | - Hannah Carter
- Department of Medicine, Division of Medical Genetics, University of California San Diego School of Medicine, La Jolla, California
| | - Juan Javier-DesLoges
- Department of Urology, University of California, San Diego, La Jolla, California
- Online Content Assistant Editor
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Satpathy Y, Nam P, Moldovan M, Murphy JD, Wang L, Derweesh I, Rose BS, Javier-DesLoges J. Comparison of Capture Rates of the National Cancer Database Across Race and Ethnicity. JAMA Netw Open 2023; 6:e2350237. [PMID: 38150248 PMCID: PMC10753391 DOI: 10.1001/jamanetworkopen.2023.50237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/12/2023] [Indexed: 12/28/2023] Open
Abstract
Importance The National Cancer Database (NCDB) is an invaluable and widely used resource for cancer research, but the current state of representation of different racial and ethnic groups compared with the United States Cancer Statistics (USCS) database is unknown. Objective To examine whether Hispanic and American Indian or Alaska Native individuals have lower representation in the NCDB compared with the USCS database. Design, Setting, and Participants This multicenter, retrospective cohort study assessed individuals diagnosed with breast, colorectal, lung, and prostate cancer from January 1, 2004, to December 31, 2006, and January 1, 2017, to December 31, 2019, in the NCDB and USCS databases. Data analysis was performed from September 2022 to October 2023. Exposure Time. Main Outcomes and Measures The primary outcome was the absolute percentage change (APC) in capture rate across the study period. Results The cohort included 5 175 007 individuals (0.50% American Indian or Alaska Native, 3.10% Asian or Pacific Islander, 12.01% Black, 6.58% Hispanic, and 77.81% White) who were diagnosed with breast, colorectal, lung, and prostate cancer. Capture rates were the lowest for individuals who were Hispanic (40.83% in 2004-2006 and 54.75% in 2017-2019; P < .001) or American Indian or Alaska Native (20.72% in 2004-2006 and 41.41% in 2017-2019; P < .001). The APCs were positive for both racial categories across all 4 cancers. However, overall APCs for Hispanic individuals (13.92%) remained lower than the overall APCs of White individuals (22.23%; P < .001). The APCs were greater for American Indian or Alaska Native individuals than for White individuals for prostate (14.68% vs 11.57%) and breast (21.61% vs 17.90%) cancer (P < .001), but the APCs for American Indian or Alaska Native individuals were lower than for White individuals for lung cancer (24.54% vs 33.03%; P < .001). Conclusions and Relevance In this cohort study of individuals diagnosed with cancer in the NCDB, Hispanic and American Indian or Alaska Native individuals diagnosed with breast, colorectal, lung, and prostate cancer were undercaptured in the NCDB, but their representation improved over time. Increased study is needed to determine where these populations predominantly seek cancer care.
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Affiliation(s)
- Yasoda Satpathy
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Percival Nam
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Matthew Moldovan
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - James D. Murphy
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla
| | - Luke Wang
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla
| | - Juan Javier-DesLoges
- Department of Urology, University of California San Diego School of Medicine, La Jolla
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Javier-DesLoges J, Bagrodia A, Crawford ED, Kane CJ. Editorial Comment. J Urol 2023; 210:637-638. [PMID: 37527395 DOI: 10.1097/ju.0000000000003603.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/14/2023] [Indexed: 08/03/2023]
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Javier-DesLoges J, Dall'Era MA, Brisbane W, Chamie K, Washington SL, Chandrasekar T, Marks LS, Nguyen H, Daneshvar M, Gin G, Kane CJ, Bagrodia A, Cooperberg MR. The state of focal therapy in the treatment of prostate cancer: the university of California collaborative (UC-Squared) consensus statement. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00702-1. [PMID: 37553435 DOI: 10.1038/s41391-023-00702-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/24/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Affiliation(s)
| | - Marc A Dall'Era
- Department of Urology, University of California-Davis, Sacramento, CA, USA
| | - Wayne Brisbane
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Karim Chamie
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Samuel L Washington
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | | | - Leonard S Marks
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Hao Nguyen
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Michael Daneshvar
- Department of Urology, University of California-Irvine, Irvine, CA, USA
| | - Gregory Gin
- Department of Urology, University of California-Irvine, Irvine, CA, USA
| | - Christopher J Kane
- Department of Urology, University of California-San Diego, La Jolla, CA, USA
| | - Aditya Bagrodia
- Department of Urology, University of California-San Diego, La Jolla, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA.
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Kalavacherla S, Riviere P, Javier-DesLoges J, Banegas MP, McKay RR, Murphy JD, Rose BS. Low-Value Prostate-Specific Antigen Screening in Older Males. JAMA Netw Open 2023; 6:e237504. [PMID: 37040113 PMCID: PMC10091155 DOI: 10.1001/jamanetworkopen.2023.7504] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Importance The US Preventive Services Task Force guidelines advise against prostate-specific antigen (PSA) screening for prostate cancer in males older than 69 years due to the risk of false-positive results and overdiagnosis of indolent disease. However, this low-value PSA screening in males aged 70 years or older remains common. Objective To characterize the factors associated with low-value PSA screening in males 70 years or older. Design, Setting, and Participants This survey study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the Centers for Disease Control and Prevention that collects information via telephone from more than 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. The final cohort comprised male respondents to the 2020 BRFSS survey who were categorized into the following age groups: 70 to 74 years, 75 to 79 years, or 80 years or older. Males with a former or current prostate cancer diagnosis were excluded. Main Outcomes and Measures The outcomes were recent PSA screening rates and factors associated with low-value PSA screening. Recent screening was defined as PSA testing within the past 2 years. Weighted multivariable logistic regressions and 2-sided significance tests were used to characterize factors associated with recent screening. Results The cohort included 32 306 males. Most of these males (87.6%) were White individuals, whereas 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic individuals. Within this cohort, 42.8% of respondents were aged 70 to 74 years, 28.4% were aged 75 to 79 years, and 28.9% were 80 years or older. The recent PSA screening rates were 55.3% for males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group. Among all racial groups, non-Hispanic White males had the highest screening rate (50.7%), and non-Hispanic American Indian males had the lowest screening rate (32.0%). Screening increased with higher educational level and annual income. Married respondents were screened more than unmarried males. In a multivariable regression model, discussing PSA testing advantages with a clinician (odds ratio [OR], 9.09; 95% CI, 7.60-11.40; P < .001) was associated with increased recent screening, whereas discussing PSA testing disadvantages had no association with screening (OR, 0.95; 95% CI, 0.77-1.17; P = .60). Other factors associated with a higher screening rate included having a primary care physician, a post-high school educational level, and income of more than $25 000 per year. Conclusions and Relevance Results of this survey study suggest that older male respondents to the 2020 BRFSS survey were overscreened for prostate cancer despite the age cutoff for PSA screening recommended in national guidelines. Discussing the benefits of PSA testing with a clinician was associated with increased screening, underscoring the potential of clinician-level interventions to reduce overscreening in older males.
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Affiliation(s)
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | | | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Rana R McKay
- Division of Hematology-Oncology, University of California San Diego, La Jolla
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
| | - Brent S Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla
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Javier-DesLoges J, Monga M, Derweesh I. EDITORIAL COMMENT. Urology 2022; 163:79-80. [DOI: 10.1016/j.urology.2021.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/02/2021] [Indexed: 12/01/2022]
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Javier-DesLoges J, Nelson TJ, Murphy JD, McKay RR, Stewart TF, Kader AK, Derweesh I, Martinez ME, Rose BS. An evaluation of trends in the representation of patients by age, sex, and diverse race/ethnic groups in bladder and kidney cancer clinical trials. Urol Oncol 2022; 40:199.e15-199.e21. [PMID: 35431133 PMCID: PMC10441556 DOI: 10.1016/j.urolonc.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine the representation of women, minorities, and the elderly groups in clinical trials and whether participation has changed over time. METHODS Retrospective study in the National Cancer Institute (NCI) Clinical Data Update System and Center for Disease Control and Prevention United States Cancer Statistics 2000 to 2019. We compared cancer incidence proportion to proportion of patients enrolled in an NCI trial when stratified by race/ethnicity, sex, and age. We performed multivariable analysis to determine the odds of participating in a clinical trial in 2015 to 2019 when compared to 2000 to 2004. RESULTS This study included 14,094 patients, 12,169 (86.3%) non-Hispanic White patients, 662 (4.7%) Black patients, and 660 (4.7%) Hispanic patients. There were 3,701 (26.3%) female patients and 10,393 (73.7%) male patients. For bladder cancer clinical trials, Black patients and Hispanic patients were underrepresented in clinical trials compared to Non-Hispanic White patients (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.57-0.88, P = 0.002) and (OR 0.69, 95%CI 0.54-0.88, P = 0.003), respectively. For kidney cancer trials, Black and Hispanic patients were underrepresented in clinical trials compared to Non-Hispanic White patients (OR 0.42, OR 0.33-0.54, P < 0.001) and (OR 0.68, 95% CI 0.55-0.83, P < 0.001), respectively. Women were underrepresented in kidney cancer trials compared to men (OR 0.80, 95% CI 0.72-0.89) and similarly for bladder cancer trials (OR 0.72, 95% CI 0.64-0.81, P < 0.001). For bladder cancer trials, the participation of Black patients over time (OR 1.04, P = 0.814) and female patients over time (OR 1.03, P = 0.741) were unchanged. For kidney cancer trials, the participation of Black patients over time (OR 1.17, P = 0.293) and female patients over time (OR 1.03, P = 0.663) participation was also unchanged. CONCLUSION In this study of clinical trials in bladder and kidney cancer, we identified that Blacks, Hispanics, and females were underrepresented. Additionally, Black and female participation was unchanged over the span of 20 years.
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Affiliation(s)
- Juan Javier-DesLoges
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA.
| | - Tyler J Nelson
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, CA
| | - Rana R McKay
- Department of Medicine, Division of Medical Oncology, University of California San Diego School of Medicine, La Jolla, CA
| | - Tyler F Stewart
- Department of Medicine, Division of Medical Oncology, University of California San Diego School of Medicine, La Jolla, CA
| | - A Karim Kader
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Ithaar Derweesh
- Department of Urology, University of California San Diego School of Medicine, La Jolla, CA
| | - Maria Elena Martinez
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA
| | - Brent S Rose
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, CA
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Javier-DesLoges J, Meagher M, Soliman S, Yuan J, Hakimi K, Ghali F, Nalawade V, Patel DN, Monga M, Murphy JD, Derweesh I. Disparities in Telemedicine Utilization for Urology Patients During the COVID-19 Pandemic. Urology 2022; 163:76-80. [PMID: 34979219 PMCID: PMC8719918 DOI: 10.1016/j.urology.2021.11.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the odds of accessing telemedicine either by phone or by video during the COVID-19 pandemic. METHODS We performed a retrospective study of patients who were seen at a single academic institution for a urologic condition between March 15, 2020 and September 30, 2020. The primary outcome was to determine characteristics associated with participating in a telemedicine appointment (video or telephone) using logistic regression multivariable analysis. We used a backward model selection and variables that were least significant were removed. We adjusted for reason for visit, patient characteristics such as age, sex, ethnicity, race, reason for visit, preferred language, and insurance. Variables that were not significant that were removed from our final model included median income estimated by zip code, clinic location, provider age, provider sex, and provider training. RESULTS We reviewed 4234 visits: 1567 (37%) were telemedicine in the form of video 1402 (33.1%) or telephone 164 (3.8%). The cohort consisted of 2516 patients, Non-Hispanic White (n = 1789, 71.1%) and Hispanic (n = 417, 16.6%). We performed multivariable logistic regression analysis and demonstrated that patients who were Hispanic, older, or had Medicaid insurance were significantly less likely to access telemedicine during the pandemic. We did not identify differences in telemedicine utilization when stratifying providers by their age, sex, or training type (physician or advanced practice provider). CONCLUSION We conclude that there are differences in the use of telemedicine and that this difference may compound existing disparities in care. Additionally, we identified that these differences were not associated with provider attributes. Further study is needed to overcome barriers in access to telemedicine.
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Affiliation(s)
| | - Margaret Meagher
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Shady Soliman
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Julia Yuan
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Kevin Hakimi
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Fady Ghali
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Vinit Nalawade
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA
| | - Devin N Patel
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - Manoj Monga
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA
| | - Ithaar Derweesh
- Department of Urology, UC San Diego School of Medicine, La Jolla, CA.
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Javier-DesLoges J, Salmasi A, Jamieson CA, Anger JT. RE: Cancer Stage, Treatment, and Survival Among Transgender Patients in the United States. J Natl Cancer Inst 2022; 114:1203-1204. [PMID: 35191502 PMCID: PMC9360451 DOI: 10.1093/jnci/djac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Juan Javier-DesLoges
- Correspondence to: Juan Javier-DesLoges, MD, MS, Department of Urology, UC San Diego Moores Comprehensive Cancer Center, University of California, San Diego, 3855 Health Sciences Dr, La Jolla, CA 92037, USA (e-mail: )
| | - Amirali Salmasi
- Department of Urology, UC San Diego Moores Comprehensive Cancer Center, University of California, La Jolla, San Diego, CA, USA
| | - Christina Am Jamieson
- Department of Urology, UC San Diego Moores Comprehensive Cancer Center, University of California, La Jolla, San Diego, CA, USA
| | - Jennifer T Anger
- Department of Urology, UC San Diego Moores Comprehensive Cancer Center, University of California, La Jolla, San Diego, CA, USA
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Javier-DesLoges J, McKay RR, Swafford AD, Sepich-Poore GD, Knight R, Parsons JK. The microbiome and prostate cancer. Prostate Cancer Prostatic Dis 2022; 25:159-164. [PMID: 34267333 PMCID: PMC8767983 DOI: 10.1038/s41391-021-00413-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 12/13/2022]
Abstract
There is growing evidence that the microbiome is involved in development and treatment of many human diseases, including prostate cancer. There are several potential pathways for microbiome-based mechanisms for the development of prostate cancer: direct impacts of microbes or microbial products in the prostate or the urine, and indirect impacts from microbes or microbial products in the gastrointestinal tract. Unique microbial signatures have been identified within the stool, oral cavity, tissue, urine, and blood of prostate cancer patients, but studies vary in their findings. Recent studies describe potential diagnostic and therapeutic applications of the microbiome, but further clinical investigation is needed. In this review, we explore the existing literature on the discovery of the human microbiome and its relationship to prostate cancer.
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Affiliation(s)
| | - Rana R McKay
- Department of Urology, UC San Diego Health, La Jolla, CA, USA
- Department of Medicine, Division of Hematology/Oncology, UC San Diego Health, La Jolla, CA, USA
| | | | | | - Rob Knight
- Department of Bioengineering, UC San Diego, La Jolla, CA, USA
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Javier-DesLoges J, Derweesh I, McKay RR. Targeted Therapy for Renal Cell Carcinoma. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Javier-DesLoges J, Nelson TJ, Murphy JD, McKay RR, Pan E, Parsons JK, Kane CJ, Kader AK, Derweesh IH, Nodora J, Patel SP, Martinez ME, Rose BS. Disparities and trends in the participation of minorities, women, and the elderly in breast, colorectal, lung, and prostate cancer clinical trials. Cancer 2021; 128:770-777. [PMID: 34806168 DOI: 10.1002/cncr.33991] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study was done to determine the representation of minorities, women, and the elderly in National Cancer Institute (NCI) clinical trials. METHODS This is an analysis in the NCI Clinical Data Update System. Patients were evaluated in breast, colorectal, lung, and prostate cancer trials from 2000 to 2019. Representation in a trial was determined by race/ethnicity, sex, and age. Secondarily, the change in trial participation by multivariable analysis by comparing years 2000 through 2004 to 2015 through 2019 was evaluated. RESULTS The cohort included 242,720 participants: 197,320 Non-Hispanic White (81.3%), 21,190 Black (8.7%), 11,587 Hispanic (4.8%), and 6880 Asian/Pacific Islander (2.8%). Black and Hispanic patients were underrepresented for colorectal (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.50-0.67; P < .001 and OR, 0.74; 95% CI, 0.64-0.87; P < .001, respectively), lung (OR, 0.83; 95% CI, 0.76-0.91; P < .001 and 0.66; 95% CI, 0.57-0.77; P < .001, respectively), and prostate cancer trials (OR, 0.85; 95% CI, 0.79-0.92; P < .001 and OR, 0.58; 95% CI, 0.51-0.66; P < .001) between 2015 and 2019. The odds of participation in 2015 to 2019 increased among Black patients in breast (OR, 2.19; 95% CI, 2.07-%2.32; P < .001), lung (OR, 1.54; 95% CI, 1.38-1.73; P < .001), and prostate cancer trials (OR, 1.14; 95% CI, 1.04-1.26; P < .001). The odds of participation in a trial among Hispanic patients increased for breast (OR, 3.32; 95% CI, 3.09-3.56; P < .001), colorectal (OR, 2.46; 95% CI, 2.04-2.96; P < .001), lung (OR, 3.88; 95% CI, 3.20-4.69; P < .001), and prostate cancer (OR, 1.70; 95% CI, 1.42-2.04; P = .005). CONCLUSIONS This study identified that Black and Hispanic patients remain underrepresented in trials, but in recent years, participation has increased. These findings indicate that minority participation has increased over time, but further efforts are needed.
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Affiliation(s)
- Juan Javier-DesLoges
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
| | - Tyler J Nelson
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, California
| | - James D Murphy
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, California
| | - Rana R McKay
- Department of Hematology and Medical Oncology, University of California San Diego School of Medicine, La Jolla, California
| | - Elizabeth Pan
- Department of Hematology and Medical Oncology, University of California San Diego School of Medicine, La Jolla, California
| | | | - Christopher J Kane
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, California
| | - A Karim Kader
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, California
| | - Ithaar H Derweesh
- Department of Radiation Medicine and Applied Science, University of California San Diego School of Medicine, La Jolla, California
| | - Jesse Nodora
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California
| | - Sandip P Patel
- Department of Hematology and Medical Oncology, University of California San Diego School of Medicine, La Jolla, California
| | - Maria Elena Martinez
- Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, California
| | - Brent S Rose
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California
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Javier-DesLoges J, Hakimi K, Yuan J, Soliman S, Meagher M, Ghali F, Nawalade V, Patel D, Murphy J, Jolla, CA L, Kim S, Derweesh I. MP45-12 THE ASSOCIATION BETWEEN THE AFFORDABLE CARE ACT ON INSURANCE STATUS, CANCER STAGE, AND OVERALL SURVIVAL IN PATIENTS WITH RENAL CELL CARCINOMA. J Urol 2021. [DOI: 10.1097/ju.0000000000002066.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nelson TJ, Javier-DesLoges J, Deka R, Courtney PT, Nalawade V, Mell L, Murphy J, Parsons JK, Rose BS. Association of Prostate-Specific Antigen Velocity With Clinical Progression Among African American and Non-Hispanic White Men Treated for Low-Risk Prostate Cancer With Active Surveillance. JAMA Netw Open 2021; 4:e219452. [PMID: 33999164 PMCID: PMC8129822 DOI: 10.1001/jamanetworkopen.2021.9452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IMPORTANCE The association of prostate-specific antigen velocity (PSAV) with clinical progression in patients with localized prostate cancer managed with active surveillance remains unclear and, to our knowledge, has not been studied in African American patients. OBJECTIVES To test the hypothesis that PSAV is associated with clinical progression in patients with low-risk prostate cancer treated with active surveillance and to identify differences between African American and non-Hispanic White patients. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective population-based cohort study using patient records from the Veterans Heath Administration Informatics and Computing Infrastructure on 5296 patients with a diagnosis of localized prostate cancer from January 1, 2001, to December 31, 2015, who were managed with active surveillance. Follow-up extended through March 31, 2020. Low-risk prostate cancer was defined as International Society of Urologic Pathology grade group (GG) 1 clinical tumor stage 2A or lower, PSA level of 10 ng/dL or lower, active surveillance, and no definitive treatment within the first year after diagnosis with at least 1 additional staging biopsy after diagnostic biopsy. EXPOSURES Prostate-specific antigen testing. MAIN OUTCOMES AND MEASURES The primary outcome was GG progression detected after repeated biopsy or prostatectomy, defined as GG2 or higher or GG3 or higher. The secondary outcome was incident metastases. Cumulative incidence functions and multivariable Cox proportional hazards regression models were used to test associations between PSAV and outcomes. RESULTS The final cohort (n = 5296) included 3919 non-Hispanic White men (74.0%; mean [SD] age, 65.7 [5.8] years) and 1377 African American men (26.0%; mean [SD] age, 62.8 [6.6] years). Compared with African American patients, non-Hispanic White patients were older (mean [SD] age, 65.7 [5.8] years vs 62.8 [6.6] years; P < .001), presented with higher cT stage (stage T2, 608 [15.5%] vs 111 [8.1%]; P < .001), had a higher Charlson Comorbidity Index score (1 and ≥2, 912 [23.3%] vs 273 [19.8%]; P = .002), had higher median income ($60 000 to ≥$100 000, 1223 [31.2%] vs 282 [20.5%]; P < .001), and had a higher median level of education (20% to ≥30% with college degree, 1192 [30.4%] vs 333 [24.2%]; P < .001). Progression to GG2 or higher occurred in 2062 patients (38.9%), with a cumulative incidence of 43.2%, and progression to GG3 or higher occurred in 728 patients (13.7%). Fifty-four patients (1.0%) developed metastases. On multivariable analysis, PSAV was significantly associated with progression to GG2 (hazard ratio, 1.32 [95% CI, 1.26-1.39]), GG3 (hazard ratio, 1.51 [95% CI, 1.41-1.62]), and metastases (hazard ratio, 1.38 [95% CI, 1.10-1.74]). Optimal PSAV thresholds that were associated with progression were significantly lower for African American patients (0.44 ng/mL/y) compared with non-Hispanic White patients (1.18 ng/mL/y). CONCLUSIONS AND RELEVANCE This study suggests that PSAV is significantly associated with grade progression among patients with low-risk prostate cancer managed with active surveillance, but at lower values for African American patients compared with non-Hispanic White patients. These data suggest that serial PSA measures may potentially substitute for multiple prostate biopsies and that African American patients may merit increased frequency of PSA testing.
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Affiliation(s)
- Tyler J. Nelson
- Department of Medicine, Veterans Health Administration San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Science, University of California, San Diego, School of Medicine, La Jolla
| | - Juan Javier-DesLoges
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - Rishi Deka
- Department of Medicine, Veterans Health Administration San Diego Health Care System, La Jolla, California
- Department of Radiation Medicine and Applied Science, University of California, San Diego, School of Medicine, La Jolla
| | - P. Travis Courtney
- Department of Radiation Medicine and Applied Science, University of California, San Diego, School of Medicine, La Jolla
| | - Vinit Nalawade
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - Loren Mell
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - James Murphy
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
| | - J. Kellogg Parsons
- Department of Radiation Medicine and Applied Science, University of California, San Diego, School of Medicine, La Jolla
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Science, University of California, San Diego, School of Medicine, La Jolla
- Department of Urology, University of California, San Diego, School of Medicine, La Jolla
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Ernst M, Javier-DesLoges J. Update from the American Urological Association's Residents and fellows committee. BJU Int 2021; 127:614. [PMID: 33913249 DOI: 10.1111/bju.15424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Su J, Javier-DesLoges J, Leapman M. MP51-09 EXAMINING POST-OPERATIVE OPIOID PRESCRIBING PATTERNS FOLLOWING UROLOGIC SURGERY USING AN ENTERPRISE-WIDE ELECTRONIC MEDICAL RECORD. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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