Evaluating Factors Associated With Continuous Glucose Monitoring Utilization With the Type 1 Diabetes Exchange Registry

BACKGROUND

The 2022 American Diabetes Association (ADA) Standards of Care recommends considering use of continuous glucose monitoring (CGM) for insulin-managed diabetes mellitus (DM), but equitable access remains challenging. This study evaluates socioeconomic and demographic metrics associated with CGM use.

METHODS

RStudio 2021.09.1+372 was utilized to perform uni- and bivariable analysis, as well as binomial logistic regression modeling for categorical CGM use (yes/no) on the most recent cross-section from the Type 1 Diabetes Exchange (T1DX) Registry 2016-2018 cohort (n = 22 418).

RESULTS

Compared with White Non-Hispanic participants, Black Non-Hispanic (OR = 0.45, CI = 0.36-0.57, P < 0.001) and American Indian/Alaskan Native individuals (OR = 0.33, CI = 0.14-0.70, P = 0.008) had lower odds of CGM use. Compared with private insurance, government insurance had reduced odds of CGM use (OR = 0.59, CI = 0.52-0.66, P < 0.001). Individuals earning $100,000 or more were twice as likely to use CGMs (OR = 2.06, CI = 1.75-2.45, P < 0.001) compared with those earning <$25,000 annually. Subgroup analysis based on income bracket demonstrated that government insured individuals earning <$25,000 annually were the least likely to use CGMs (OR = 0.44, CI = 0.32-0.61, P < 0.001), as compared with private insurance.

CONCLUSIONS

T1DX Registry data demonstrate that CGM use follows the inverse care law, with health technology utilization inversely related to disease burden. Federal policies promoting CGM use in Medicare and Medicaid populations can facilitate the ADA's recommendation for patients with insulin-managed diabetes mellitus.

Individual-level home values and cancer mortality in a statewide registry

BACKGROUND

Prior work assessing disparities in cancer outcomes has relied on regional socioeconomic metrics. These metrics average data across many individuals, resulting in a loss of granularity and confounding with other regional factors.

METHODS

Using patients' addresses at the time of diagnosis from the Ohio Cancer Incidence Surveillance System, we retrieved individual home price estimates from an online real estate marketplace. This individual-level estimate was compared with the Area Deprivation Index (ADI) at the census block group level. Multivariable Cox proportional hazards models were used to determine the relationship between home price estimates and all-cause and cancer-specific mortality.

RESULTS

A total of 667 277 patients in Ohio Cancer Incidence Surveillance System were linked to individual home prices across 16 cancers. Increasing home prices, adjusted for age, stage at diagnosis, and ADI, were associated with a decrease in the hazard of all-cause and cancer-specific mortality (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.92 to 0.93, and HR = 0.95, 95% CI = 0.94 to 0.95, respectively). Following a cancer diagnosis, individuals with home prices 2 standard deviations above the mean had an estimated 10-year survival probability (7.8%, 95% CI = 7.2% to 8.3%) higher than those with home prices 2 standard deviations below the mean. The association between home price and mortality was substantially more prominent for patients living in less deprived census block groups (Pinteraction < .001) than for those living in more deprived census block groups.

CONCLUSION

Higher individual home prices were associated with improved all-cause and cancer-specific mortality, even after accounting for regional measures of deprivation.

Rotating Night Shift Work and Bladder Cancer Risk in Women: Results of Two Prospective Cohort Studies

Bladder cancer is the sixth most common cancer in the United States. Night shift work has previously been linked with cancer risk. Whether there is an association between rotating night shift work and bladder cancer in women has not been studied previously. Eligible participants in the Nurses' Health Study (NHS, n = 82,147, 1988-2016) and Nurses' Health Study II (NHSII, n = 113,630, 1989-2015) were prospectively followed and a total of 620 and 122 incident bladder cancer cases were documented during the follow-up of NHS and NHSII, respectively. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for bladder cancer incidence. We observed a significantly increased risk of bladder cancer among women with >5 years of night shift work history compared with women who never worked rotating night shifts in NHS (HR = 1.24; 95%CI = 1.01-1.54, p for trend = 0.06), but not in the pooled NHS and NHS II (HR = 1.18; 95%CI = 0.97-1.43, p for trend = 0.08). Secondary analyses stratified by smoking status showed no significant interaction (p = 0.89) between the duration of rotating night shift work and smoking status. In conclusion, our results did not provide strong evidence for an association between rotating night shift work and bladder cancer risk.

A systematic review and in silico study of potential genetic markers implicated in cases of overactive bladder

OBJECTIVE

The contribution of genetic factors to the presence of an overactive bladder is recognized. This study aimed to (1) assemble and synthesize available data from studies assessing differential gene expression in patients with overactive bladder vs controls without overactive bladder and (2) determine possible correlations and functional pathways between genes.

DATA SOURCES

We searched PubMed, Ovid or Medline, and Wiley Cochrane Central Register of Controlled Trials databases between January 1, 2000, and December 15, 2021.

STUDY ELIGIBILITY CRITERIA

Studies were included if gene expression was detected and quantified using molecular approaches performed on human bladder tissue specimens directly and excluded if the gene expression analysis was carried out from blood and urine specimens alone.

METHODS

A systematic review was completed to identify publications that reported differently expressed gene candidates among patients with overactive bladder vs healthy individuals. Gene networking connections and pathway analysis were performed employing Metascape software, where inputs were identified from our systematic review of differentially expressed genes in overactive bladder.

RESULTS

A total of 9 studies were included in the final analysis and 11 genes were identified as being up-regulated (purinergic receptor P2X 2 [P2RX2], smoothelin [SMTN], growth-associated protein 43 [GAP43], transient receptor potential cation channel subfamily M member 8 [TRPM8], cadherin 11 [CDH1], gap junction protein gamma 1 [GJC1], cholinergic receptor muscarinic 2 [CHRM2], cholinergic receptor muscarinic 3 [CHRM3], and transient receptor potential cation channel subfamily V member 4 [TRPV4]) or down-regulated (purinergic receptor P2X 2 [P2RX3] and purinergic receptor P2X 5 [P2RX5]) in patients with overactive bladder. Gene network analysis showed that genes are involved in chemical synaptic transmission, smooth muscle contraction, blood circulation, and response to temperature stimulus. Network analysis demonstrated a significant genetic interaction between TRPV4, TRPM8, P2RX3, and PR2X2 genes.

CONCLUSION

Outcomes of this systematic review highlighted potential biomarkers for treatment efficacy and have laid the groundwork for developing future gene therapies for overactive bladder in clinical settings.

Abstract 439: Physical activity among male cancer survivors during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has greatly disrupted the lives of cancer survivors. Beyond being at increased risk for COVID-19 infection and severe complications, cancer survivors may be at higher risk of other consequential health outcomes compared to those without a history of cancer. Engagement in physical activity has been shown to positively affect cancer survivorship outcomes, and as such, it is important to assess physical activity habits during the pandemic of cancer survivors.

Aim: To investigate the individual-level physical activity among male cancer survivors during the COVID-19 pandemic and compare to men without cancer.

Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Physical activity measures were analyzed descriptively between cancer survivors and individuals without a history of cancer. Outcomes were recoded dichotomously to reflect either: healthful (i.e., higher engagement since pandemic) vs unchanged/unhealthful behavior or high vs low engagement in an activity. Logistic regression models were employed to assess association with cancer survivor status and were adjusted for covariates such as age, race, pre-pandemic BMI, pre-pandemic physical activity, and other health information, as appropriate.

Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Of all eligible men (median age: 78 years) reporting on physical activity, over 50% walked for at least 2-3 hours per week, over 10% used a stationary bike for at least 1 hour per week, 14% engaged in yoga for at least 1 hour per week, and nearly 20% engaged in vigorous activity for at least 1 hour per week. Further, 42% engaged in high (1+ times per day) levels of mindfulness and 24% engaged in high (1+ times per day) levels of yoga. Engagement in vigorous physical activity was significantly lower among cancer survivors compared to individuals without a history of cancer (Chi-square p = 0.01).

Conclusion: Our findings suggest older men had high engagement in physical activity during the COVID-19 pandemic, with vigorous physical activity engagement significantly lower in cancer survivors.

Citation Format: Colleen B. McGrath, Alaina H. Shreves, Konrad Stopsack, Lilian Cheung, Ann Fisher, Sarah Markt, Lorelei A. Mucci. Physical activity among male cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 439.

Abstract 3226: Sleep disruption among prostate cancer survivors by metastatic disease status

Introduction: Advances in cancer screening, diagnosis, and treatment have resulted in an increasing population of cancer survivors, many of whom experience persistent cancer-related side effects. Multiple studies have found that cancer survivors report poorer sleep than the general population. More than 3 million men in the US are prostate cancer survivors, yet few existing studies have focused on sleep in this population, especially among men with metastatic disease. Thus, a better understanding of sleep problems among prostate cancer survivors could help characterize how sleep affects the quality of life among men with prostate cancer.

Aim: To describe sleep behaviors and problems among prostate cancer survivors overall and specifically among those with metastatic disease.

Methods: Self-reported sleep data, including sleep disruption, sleep apnea, and insomnia, were obtained from the 2018 Prostate Cancer Follow-up Survey (PCFS) administered to participants of the Health Professionals Follow-Up Study with a diagnosis of prostate cancer. We evaluated each item individually and calculated a score for clinical insomnia using the validated Women’s Health Initiative Insomnia Rating Scale (range 1-20; score &gt;10 indicative of clinically relevant insomnia). Descriptive analyses on sleep measures were conducted overall and stratified by metastatic disease. We utilized multivariable linear regression models to compare metastatic disease status and insomnia score, adjusting for age, race, body mass index, physical activity, smoking, and other health information.

Results: Of 2,431 men (median age: 83 years) who completed the 2018 survey, 87 had metastatic disease, de novo or men who progressed after diagnosis. Sleep disturbances were relatively common in this population. Among all men with prostate cancer, 33% (n=290) reported waking up several times a night five or more times a week, 14% (n=337) rated their sleep quality as restless, and 15% (n=368) reported a clinical diagnosis with sleep apnea. The Insomnia Rating Scale scores were relatively high among all prostate cancer survivors with a mean score of 9.0 (95% CI 6.0-12.0). Scores significantly differed by metastatic disease status and men with metastatic disease had scores that were 1.30 (95% CI 0.19-2.41) points higher than men without metastatic disease.

Conclusion: The growing global number of prostate cancer survivors with metastatic disease and the potentially high prevalence of negative cancer-related quality of life effects pose pressing challenges to health systems. Our findings suggest that sleep disturbances are common among prostate cancer survivors. Men with metastatic disease had poorer sleep overall and higher rates of clinical insomnia than men without metastatic disease. These results could highlight the importance of sleep among men with prostate cancer and could increase the clinical treatment of sleep problems.

Citation Format: Alaina H. Shreves, Lorelei Mucci, Unnur Valdimarsdottir, Sarah Markt, Kathryn Penney. Sleep disruption among prostate cancer survivors by metastatic disease status [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3226.

Abstract 440: Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has disrupted the lives of cancer survivors who may be at higher risk than people without cancer of other adverse health outcomes. For many individuals, a cancer diagnosis leads to lower physical activity and change in mental health status. Modifiable health behaviors, such as consumption of a healthy diet, can positively affect cancer survivorship outcomes.

Aim: To investigate the individual-level changes in diet and supplement use among male cancer survivors during the COVID-19 pandemic and compared to men without cancer.

Methods: Participants of the Health Professionals Follow-up Study, enrolled since 1986, were asked to self-report health behaviors during the pandemic on three web-based questionnaires administered during the COVID-19 pandemic (baseline COVID: October 2020, first follow-up: January 2021, second follow-up: April 2021). Diet and supplement use were analyzed descriptively between cancer survivors and individuals without a history of cancer. Further, outcomes were dichotomized to reflect whether a change was healthful or unchanged/unhealthful; for example, lower fast food consumption was classified as a healthful change. To assess the associations between cancer survivors and other men, logistic regression was used, adjusting for age, race, pre-pandemic body mass index, pre-pandemic physical activity, and other health information.

Results: Of 4,416 men who completed the baseline COVID-19 questionnaire, 962 were cancer survivors (after excluding those with non-melanoma skin cancer). Across all eligible men (median age: 78 years), there were considerable proportions of men engaging in healthful changes following the start of the pandemic in intake of fast food (19% decreased), sugary drinks (14% decreased), fresh fruit (26% increased), fresh vegetables (19% increased), fish (13% increased), and red meat (12% decreased) consumption. Similar changes in diet were reported on the second follow-up questionnaire. For most foods, a similar percentage of cancer survivors and individuals without a history of cancer increased healthy eating. Findings from multivariable logistic regression models were reflective of higher odds of cancer survivors to engage in a healthful diet change for unhealthy food categories (i.e., less fast food, less frozen food), though none of which were statistically significant. There was little change in supplement use during the pandemic, except for 6% who started use of vitamin D supplements between the baseline and first follow-up questionnaire.

Conclusion: Our findings suggest that older men engaged in healthful diet changes during the COVID-19 pandemic, without noticeable differences among cancer survivors.

Citation Format: Alaina H. Shreves, Colleen B. McGrath, Konrad Stopsack, Lilian Cheung, Ann Fisher, Edward Giovannucci, Sarah Markt, Eric Rimm, Lorelei Mucci. Diet and supplement use changes among male cancer survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 440.

Abstract 3057: Characterization and functional analysis of microbiome in bladder cancer

Background: The role of microbiome in genitourinary cancer is an emerging field, with evidence implicating the important role of microbiome as causative factors or cofactors in tumorigenesis and drug metabolism. Our study aims to characterize healthy and bladder cancer enterotypes in the gut and identify functional alterations through the use of metagenomics data.

Methods: After prospective collection of 29 rectal swab samples of bladder cancer (BCa) patients undergoing cystectomy, and 32 healthy volunteers, we perform 16S rRNA amplicon sequencing on 61 samples (29 with bladder cancer, 32 without cancer). Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) was applied to infer functional categories associated with taxonomic composition. The p values were adjusted using the false discovery rate. The a- and b-diversity analyses were performed using QIIME. The Mann- Whitney U test was employed to evaluate the statistical significance of b-diversity distances within and between groups of interest.

Results: Across all the bladder cancer stool samples, estimation of relative abundance revealed of the five most dominant bacterial populations was Bacteroidales ( 46.21%), Clostridiales ( 32.29%), Burkholderiales (9.07%), Erysipelotrichales (3.20%) and Lactobacillales ( 2.20%). In contrast, healthy controls exhibited an increased relative abundance of Enterobacteriales ( 10.75% vs 0.52%) and Pseudomonadales (8.33% vs 0.18%) as compared to tumor samples. The microbial diversity differences between Bca and normal samples showed no differences across alpha diversity metrics (Shannon diversity p &gt; 0.05) as compared to normal tissue. However, there was significant difference in clustering of organisms as determined by principal coordinate analysis ( PCoA) ordination of unweighted UniFrac Distances, (p = 0.002). Furthermore, upon stratification of patients on smoking status (all healthy = nonsmokers), clustering persisted, albeit non smokers with bladder cancer displayed an intermediate across PCoA. Bca samples exhibited higher LDA score Campylobacterales (log change 8.0, p &lt; 0.001, padj &lt; 0.001), Fusobacteriales (log change 6.11, p &lt; 0.001/padj&lt; 0.01), Epysipelotrichales (log 2.55, p &lt; 0.001/padj &lt; 0.001), Actinomycetales (log change 1.86, p = 0.001/padj&lt; 0.001), Verrucomicrobiales (log change 1.78, p = 0.017/padj= 0.031) and Enterobacteriales (log change -1.54,p = 0.017/padj= 0.132).

Conclusions: Our study provides preliminary evidence that the GI microbiota is different in bladder cancer patients. Collectively, our study highlights distinct microbial overexpression of Campylobacter and Fusobacterium in Bca cohort not previously reported, both implicated in tumorigenesis, and could serve as a target that could be modulated to enhance treatment response.

Citation Format: Laura Bukavina, Rashida Ginwala, Adam C. Calaway, Ilaha Isali, Megan Prunty, Mohit Sindhani, Lee Ponsky, Sarah Markt, Phillip Abbosh. Characterization and functional analysis of microbiome in bladder cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3057.

Risk factors for postoperative Clostridium difficile infection after radical cystectomy for bladder cancer: a NSQIP database analysis

INTRODUCTION

Patients undergoing cystectomy for bladder cancer are at an increased risk for Clostridium difficile infection (CDI) due to prolonged antibiotics and underlying comorbidities. We aim to evaluate CDI risk factors in cystectomy patients.

MATERIALS AND METHODS

Utilizing National Surgical Quality Improvement Program (NSQIP), patients undergoing cystectomy with diagnosis of bladder cancer between 2015-2017 were included. Baseline demographics including age, sex, comorbidities, and preoperative labs were collected. Univariate and multivariable logistic regression were used to evaluate risk factors for and complications of CDI during the index hospitalization.

RESULTS

There were a total of 6,432 patients included in the analysis, with 6,242 (96%) and 190 (4%) in the non-CDI vs. CDI groups, respectively. Patients with a diagnosis of postoperative CDI were more likely to be female [4.09% vs. 2.71%, p = 0.001] and have lower preoperative albumin [3.78 g/dL (0.52) vs. 3.92 g/dL (0.48), p = 0.003]. Patients with a history of female sex (OR 1.46, p = 0.03), neobladder (OR 1.57, p = 0.01), and low preoperative albumin (OR 1.45, p = 0.04) were at the highest risk for development of CDI postoperatively. Patients with a diagnosis of CDI were more likely to experience readmission within 30 days (31.1% vs. 19.2%, p < 0.001).

CONCLUSION

Utilizing the NSQIP database, we identified predictors for development of CDI in cystectomy patients. Female sex, continent diversion, and low preoperative albumin all significantly increased the rate of CDI. While our findings are retrospective, they are compelling enough to warrant further prospective investigation.

Gene network profiling in muscle-invasive bladder cancer: A systematic review and meta-analysis

BACKGROUND

Determining meta-analysis of transcriptional profiling of muscle-invasive bladder cancer (MIBC) through Gene Expression Omnibus (GEO) datasets has not been investigated. This study aims to define gene expression profiles in MIBC and to identify potential candidate genes and pathways.

OBJECTIVES

To review and evaluate gene expression studies in MIBC through publicly available RNA sequencing (RNA-Seq) and microarray data in order to identify potential prognostic and therapeutic targets for MIBC.

METHODS

A systematic literature search of the Ovid MEDLINE, PubMed, and Wiley Cochrane Central Register of Controlled Trials databases was performed using the terms "gene," "gene expression," and "bladder cancer" January 1, 1990 through March 2021 focused on populations with MIBC.

RESULTS

In the final analysis, GEO datasets were included. Fixed effect model was employed in the meta-analysis. Gene networking connections and gene-set functional analyses of the identified genes as differentially expressed in MIBC were performed using ImaGEO and GeneMANIA software. A heatmap for the upregulated and downregulated genes was generated along with the correlated pathways.

CONCLUSION

A total of 9 genes were reported in this analysis. Six genes were reported as upregulated (ProTα, SPINT1, UBE2E1, RAB25, KPNB1, HDAC1) and 3 genes as downregulated (NUP188, IPO13, NUP124). Genes were found to be involved in "ubiquitin mediated proteolysis," "protein processing in endoplasmic reticulum," "transcriptional misregulation in cancer," and "RNA transport" pathways.

Cost of Care in Open Cystectomy Patients Across Time and Space: Does it matter?

BACKGROUND: Many variables may affect the cost of open radical cystectomy (RC) care, including surgical approach, diversion type, patient comorbidities, and postoperative complications. OBJECTIVE: To determine factors associated with changes in cost of care following open radical cystectomy (ORC) for bladder cancer using the National Inpatient Sample (NIS). METHODS: Patients in the NIS with a diagnosis of bladder cancer who underwent ORC with ileal conduit from 2012–2017 using ICD-9-CM and ICD-10-CM codes were identified. Baseline demographics including age, race, region, postoperative complications, and length of stay were obtained. Univariable and multivariable logistic regression were used to identify factors associated with cost variation including demographics, clinical characteristics, surgical factors, and discharge quarter (Q1-Q4). RESULTS: 5,189 patients were included in the analysis, with 4,379 at urban teaching hospitals. On multivariable regression analysis, female sex [$1,734 ($1,024–2,444) p < 0.001)], a greater Elixhauser comorbidity score [$93 ($62–124), p < 0.001], presence of any inpatient complication [$1,531 ($894–2,168), p < 0.001], and greater length of stay [$1,665 ($1,536–1,793), p < 0.001] were associated with a greater cost of hospitalization. Discharge in Q3 (July to September) relative to Q2 (April to June) was associated with a higher cost [$1,113 ($292–1,933), p = 0.008. Trends were similar at urban non-teaching and rural hospitals, except discharge quarter was not associated with a significant change in cost. CONCLUSIONS: Significant differences in cost of ORC with ileal conduit exist with respect to patient sex, medical comorbidities, and discharge timing. These differences may relate to greater disease burden in female patients, patient complexity, and variation in postoperative care in academic programs.

The Impact of Race and Sex on Metastatic Bladder Cancer Survival

OBJECTIVE

To characterize the epidemiological profile of metastatic bladder cancer (BC) and assess mortality rate with respect to race and gender across the three most common histologies of bladder cancer-Transitional Cell Carcinoma, Adenocarcinoma, and SCC (Squamous Cell Carcinoma).

MATERIALS AND METHODS

The Surveillance, Epidemiology, and End Results Program database (2000-2017) was queried for all metastatic bladder cancer patients at presentation. Our primary exposure consists of four race/gender combinations. One-way ANOVA and Chi-square tests compared categorical and continuous variables across the exposure variable, respectively. Univariable and multivariable Cox proportional hazards regression analyses were used to examine the association between race/gender combinations and the overall and cancer specific survival adjusting for the other variables.

RESULTS

A total of 312,846 bladder cancer patients, 6337 with distant metastases and 11,446 with regional metastases were evaluated. Black female cancer specific survival in metastatic disease was disproportionally lower compared to all race/gender for Transitional Cell Carcinoma 4.3% (95% CI: 1.6-8.9), SCC 2.6% (95% CI: 0.2-11.8), and Adenocarcinoma 6.4% (0.4%-25%). In regional metastastatic disease, worse cancer specific mortality was associated with identifying as a Black Female (aHR 1.17, P = .023), SCC (aHR 1.8, P <.001), increasing age (aHR 1.3, P <.001), and poorly differentiated grade (aHR 2.01, P <.001).

CONCLUSION

Black females experience excess mortality in overall and cancer oncologic outcomes in metastatic BC. Our findings contribute to the body of research warranting examination of the impact of social determinants of health and provider decisions on BC survivorship and contribute to physician decision making in the treatment and surveillance of bladder cancer.

The impact of hormones and reproductive factors on the risk of bladder cancer in women: results from the Nurses' Health Study and Nurses' Health Study II

BACKGROUND

With three out of four new bladder cancer (BCa) cases occurring in men, an apparent gender disparity exists. We aimed to investigate the role of hormonal and reproductive factors in BCa risk using two large female US prospective cohorts.

METHODS

Our study population comprised 118 256 and 115 383 female registered nurses who were recruited in the Nurses' Health Study (NHS) and NHS II, respectively. Reproductive and hormonal factors and other relevant data were recorded in biennial self-administered questionnaires. Cox-regression analyses were performed to estimate age- and multivariable-adjusted incidence risk ratios (IRRs) and 95% confidence intervals (CIs). Inverse-variance-weighted meta-analysis was used to pool estimates across cohorts.

RESULTS

During up to 36 years of follow-up, 629 incident BCa cases were confirmed. In the NHS, 22 566 women (21.3%) were postmenopausal at baseline, compared with 2723 women (2.4%) in the NHS II. Among women in the NHS, younger age at menopause (≤45 years) was associated with an increased risk of BCa (IRR: 1.41, 95% CI: 1.11-1.81, Ptrend = 0.01) compared with those with menopause onset at age 50+ years, particularly among ever-smokers (IRR for age at menopause ≤45 years: 1.53, 95% CI: 1.15-2.04; PIntx = 0.16). Age at menarche and first birth, parity, oral-contraceptive use and postmenopausal hormone use were not associated with BCa risk.

CONCLUSIONS

Overall, we found little support for an association between female reproductive factors and BCa risk in these prospective cohort studies. Earlier age at menopause was associated with a higher risk of BCa, particularly among smokers, indicating the potential for residual confounding.

Gender Disparities in Bladder Cancer-Specific Survival in High Poverty Areas Utilizing Ohio Cancer Incidence Surveillance System (OCISS)

OBJECTIVE

To better understand the interplay of socioeconomic and demographic traits on bladder cancer outcomes utilizing the Ohio state cancer registry, Ohio Cancer Incidence Surveillance System (OCISS).

METHODS

We obtained demographic, clinical and outcome data on 47,182 bladder cancer cases diagnosed from 1996 to 2016 from OCISS. Multivariable Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between sex, race and poverty and survival, adjusting age, stage, and primary treatment.

RESULTS

Within the OCISS database, there were 47,182 patients with a diagnosis of bladder cancer identified, with females representing 12,056 (26%) of the population. There were a total of 9255(35.2%) deaths due to bladder cancer, with median follow-up time of 4.4 years. After adjusting for confounding variables, women were statistically significantly less likely to die from any cause (HR: 0.94, 95% CI: 0.91-0.96), compared with men, but more likely to die from bladder cancer (HR: 1.21, 95% CI: 1.15-1.27). We also found that after adjusting for confounding variables, including sex and poverty, black race was statistically significantly associated with a higher risk of overall (HR: 1.12, 95% CI: 1.06-1.18) and bladder cancer-specific mortality (HR: 1.25, 95% CI: 1.15-1.36).

CONCLUSION

Using the OCISS database, female gender, self-reported black race, and neighborhood poverty level were associated with worse bladder cancer-specific survival. By recognizing these disparities, we can prospectively address risk factors in efforts to improve survival among these patient populations.

Abstract D074: Variations in genomic testing across cancer sites and by demographic characteristics

Study Objective: Genomic testing is essential to identify the best treatment modalities for certain cancers; yet, its uptake has been relatively low, especially among disadvantaged subgroups of the population. The aim of this study is to identify demographic and clinical factors associated with receipt of genomic testing in Ohioans diagnosed with either incident female breast, kidney, bladder, prostate, colorectal, or lung cancer. Methods: We used data from the 2009 linked Ohio Cancer Incidence Surveillance System and Medicare files, and identified genomic testing using the appropriate procedure codes in claims data. Our study population included 10,945 patients. Independent variables examined were age at diagnosis (&lt; 65, 65-74, 75+), sex, race (White or All Other), dual enrollment in the Medicare and Medicaid program (or ‘dual’) as a marker for low income and heightened vulnerability, and advanced stage at diagnosis (Regional/Distant versus Local stage). We conducted multivariable logistic regression analysis to identify correlates of genomic testing by cancer site. Results: For all cancer sites combined, 11.1% were younger than 65, and 40.6% were older than 75 years of age. Eighty eight percent were White, 47.0% were women, 13.9% were duals, and one third were diagnosed with advanced-stage cancer. Overall, only 19.5% underwent genomic testing, ranging from a low of 6.7% in prostate cancer patients, to a high of 39.3% in breast cancer patients. In addition, we observed considerable variation in genomic testing by age, race, sex, dual status, and cancer stage across cancer sites. Adjusting for the independent variables listed above, being 75 years of age or older was significantly and positively associated with increased likelihood of undergoing genomic testing in breast (adjusted odds ratio: 1.17, 95% confidence interval: 1.04, 1.32), kidney and bladder combined (1.29 (1.09, 1.53)), and prostate cancer patients (1.45 (1.12, 1.89)). Advanced-stage disease was associated with increased likelihood of genomic testing in breast and colorectal cancer patients (1.40 (1.17, 1.67) and 3.07 (2.30, 4.11), respectively), but with decreased likelihood in kidney and bladder cancer patients (0.66 (0.48, 0.91)). Finally, we note that White patients with lung cancer were significantly more likely than others to undergo genomic testing (2.49 (1.29, 4.78)). Conclusion: Our data from 2009 provide baseline statistics on genomic testing uptake in Ohio. Data for subsequent years will help us to assess trends in providing personalized medicine.

Citation Format: Siran Koroukian, Weichuan Dong, Johnie Rose, Fredrick Schumacher, Sarah Markt. Variations in genomic testing across cancer sites and by demographic characteristics [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D074.

MULTIPLE CHRONIC CONDITIONS IN OLDER CANCER SURVIVORS WITH AND WITHOUT HIV

Background: With more effective treatment for both HIV and cancer, longevity among persons living with HIV (PLwHIV) has improved significantly. However, little is known about whether the comorbidity profile of cancer survivors differs between PLwHIV and their HIV-free counterparts. To address this critical gap in knowledge, we compared the occurrence and combination of multiple chronic conditions (MCCs) among older cancer survivors by HIV status. Methods: We used national data from the 2014 Chronic Conditions Data Warehouse (CCW) as part of the Medicare Beneficiary Summary File, which flags 66 conditions, including HIV/AIDS, and history of common cancers (colorectal, lung, prostate, and leukemias/lymphomas). We limited our study population to men age 65 years or older who were cancer survivors. In addition to descriptive analysis, we conducted association rule mining (ARM) analysis to compare the prevalence of the most common MCCs among cancer survivors, with and without HIV. Results: We identified 1.3 million individuals, of which 1,901 (0.15%) were PLwHIV. Compared to their HIV-free counterparts, PLwHIV were younger (mean of 72.5 and 77.0 years); more were non-White (41.8% vs. 13.5%); and more of them presented with anemia (44.8% vs. 35.3%), chronic kidney disease (CKD, 41.9% vs. 26.6%), depression (26.6% vs. 13.9%), viral hepatitis (20.4% vs. 0.70%), and/or liver disease (10.7% vs. 4.8%; p &lt; 0.001 for all comparisons). ARM results showed a prominence of CKD in the most common top 5 combinations of conditions. Conclusion: Despite being younger than their HIV-free counterparts, PLwHIV with history of cancer carry a significantly greater comorbidity burden.

Abstract 5045: Pineal gland volume and risk of prostate cancer

Background: The parenchyma of the pineal gland, an endocrine gland in the brain, produces the circadian hormone melatonin. Previously, we found low levels of melatonin were associated with an increased risk for advanced prostate cancer. This study used data from men in the Age, Gene/Environment Susceptibility-Reykjavik (AGES-Reykjavik) Study to evaluate the relationship between pineal volume, melatonin levels, and prostate cancer risk.

Methods: Participants were enrolled in the AGES-Reykjavik Study from 2002 to 2006 and underwent detailed clinical assessments at baseline that included biospecimen collection, MRI of the brain, medical history, and health questionnaires on dietary and lifestyle factors. We included 802 men who had information on pineal size, where parenchyma, calcification, and cyst volume were estimated individually and manually from the MRIs. Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals for risk of prostate cancer during follow-up through 2014, comparing parenchyma volume tertiles.

Results: There was a positive association between pineal parenchyma volume and urinary levels of melatonin. During follow-up, 135 men were diagnosed with prostate cancer, 30 of which were advanced prostate cancer. Men with volumes in the upper tertile had no statistically significant increased risk of prostate cancer compared to men with volumes in the lowest tertile (HR: 1.0, 95% CI: 0.7, 1.5), and men with volumes in the middle tertile had only a borderline statistically significant decreased risk of prostate cancer compared to men with volumes in the lowest tertile (HR: 0.7, 95% CI: 0.4, 1.0). Compared to men without pineal cysts, there was a borderline statistically significant association between men with pineal cysts and decreased risk of prostate cancer (HR: 0.7, 95% CI: 0.5, 1.0). Compared to men without pineal calcifications, there was no statistically significant association between men with pineal calcifications and increased risk of prostate cancer (HR: 1.1, 95% CI: 0.7, 1.6).

Conclusions: Pineal parenchyma volume was associated with melatonin levels, but there was no statistically significant association between parenchyma volume alone and prostate cancer risk. Further studies are needed to investigate the relationship between pineal parenchyma volume, presence of calcifications and cysts, melatonin, and prostate cancer.

Citation Format: Latifa A. Bazzi, Lara Sigurdardottir, Sigurdur Sigurdsson, Unnur Valdimarsdottir, Johanna Torfadottir, Thor Aspelund, Lenore Launer, Tamara Harris, Vilmundur Gudnason, Lorelei Mucci, Sarah Markt. Pineal gland volume and risk of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5045.

Inherited variation in circadian rhythm genes and risks of prostate cancer and three other cancer sites in combined cancer consortia

Circadian disruption has been linked to carcinogenesis in animal models, but the evidence in humans is inconclusive. Genetic variation in circadian rhythm genes provides a tool to investigate such associations. We examined associations of genetic variation in nine core circadian rhythm genes and six melatonin pathway genes with risk of colorectal, lung, ovarian and prostate cancers using data from the Genetic Associations and Mechanisms in Oncology (GAME-ON) network. The major results for prostate cancer were replicated in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial, and for colorectal cancer in the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO). The total number of cancer cases and controls was 15,838/18,159 for colorectal, 14,818/14,227 for prostate, 12,537/17,285 for lung and 4,369/9,123 for ovary. For each cancer site, we conducted gene-based and pathway-based analyses by applying the summary-based Adaptive Rank Truncated Product method (sARTP) on the summary association statistics for each SNP within the candidate gene regions. Aggregate genetic variation in circadian rhythm and melatonin pathways were significantly associated with the risk of prostate cancer in data combining GAME-ON and PLCO, after Bonferroni correction (ppathway  < 0.00625). The two most significant genes were NPAS2 (pgene  = 0.0062) and AANAT (pgene  = 0.00078); the latter being significant after Bonferroni correction. For colorectal cancer, we observed a suggestive association with the circadian rhythm pathway in GAME-ON (ppathway  = 0.021); this association was not confirmed in GECCO (ppathway  = 0.76) or the combined data (ppathway  = 0.17). No significant association was observed for ovarian and lung cancer. These findings support a potential role for circadian rhythm and melatonin pathways in prostate carcinogenesis. Further functional studies are needed to better understand the underlying biologic mechanisms.

Abstract 2498: Amine and lipid metabolites are enriched in advanced prostate cancer

Background: Obesity is an established risk factor for advanced prostate cancer. We performed whole body metabolomics profiling in pre-diagnostic blood specimens to identify metabolites associated with risk of advanced prostate cancer, and assess the extent to which obesity modifies this association.

Methods: Our study was nested within the prospective US Health Professionals Follow-up Study during the study period 1993 and 2014. We selected 212 advanced prostate cancer (≥ stage T3b, distant metastasis or cancer death during follow-up) patients and 212 matched controls for whom pre-diagnostic bloods were collected with a median 5.5 years prior to diagnosis. Metabolomics profiling was performed at the Broad Institute using liquid chromatography-tandem mass spectrometry to assay 295 known metabolites. We estimated odds ratios and 95% confidence intervals using multivariable conditional logistic regression to examine associations of individual metabolites and cancer risk. We also performed pathway analyses using a method adapted from gene set enrichment analysis to identify metabolite classes associated with advanced prostate cancer.

Results: We identified 29 circulating metabolites in pre-diagnostic bloods that were significantly associated with advanced prostate cancer risk. These metabolites included carnitines and phospholipids, diacylglycerols (DAG) and triacylglycerols (TAG). Using pathway analyses, we found metabolites in DAG and TAG pathways were highly significantly (FDR&lt;10-8) enriched in men with advanced prostate cancer. 166 of the 295 metabolites were significantly (p&lt;0.001) associated with obesity. When we stratified by a man’s obesity status, we observed unique metabolomics profiles associated with advanced prostate cancer. Circulating amines (including carnitines) were associated with advanced prostate cancer in overweight men while lipid metabolites (including DAGs and TAGs) were associated with advanced cancer in the healthy weight men.

Conclusion: Altered levels of TAG and DAG metabolites in prediagnostic bloods are strongly associated with an increased risk of advanced prostate cancer, independent of obesity. The finding that circulating lipids were specifically associated with advanced prostate cancer in healthy weight patients suggests there are men with normal body mass index but who are metabolically obese. The specific lipid metabolite classes enriched in advanced prostate cancer support the hypothesis that obesity acts through dysregulation of liver fatty acid metabolism rather than through metabolic actions of the adipose tissue itself.

Citation Format: Lorelei A. Mucci, Ericka Ebot, Clary Clish, Sarah Markt, Renea Taylor, Matthew Watt, Philip Kantoff, Edward Giovanucci, Matthew VAnder Heiden, Kathryn Wilson. Amine and lipid metabolites are enriched in advanced prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2498. doi:10.1158/1538-7445.AM2017-2498

Abstract 4962: Geographic disparities in prevalence of baseline prostate inflammation and prostate cancer risk: Results from a multinational trial

Introduction: Prostate cancer incidence rates vary 25-fold worldwide. The distribution of lifestyle factors also varies by geographic region and these factors may impact prostate inflammation, which is inversely associated with prostate cancer risk in the REduction by DUtasteride of prostate Cancer Events (REDUCE) trial. Herein, we examined geographic differences in the prevalence of histological prostate inflammation and geographic differences in prostate cancer risk using REDUCE, a multinational trial of men with a negative baseline prostate biopsy.

Methods: We conducted a retrospective analysis of data from 7,213 men with a negative baseline prostate biopsy in REDUCE from Europe (n=4,802), North America (n=1,796), South America (n=467), and Australia/New Zealand (n=148). Histological inflammation was classified as chronic (lymphocytes, macrophages) or acute (neutrophils) by central review of negative baseline prostate biopsies. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for associations between geographic region and prostate inflammation, and between geographic region and prostate cancer risk at trial-mandated repeat biopsy, adjusting for potential confounders. To avoid confounding by race, analyses were restricted to white men.

Results: Chronic and acute prostate inflammation was detected in 77% and 15% of men, respectively. Relative to Europeans, North Americans and Australians/New Zealanders were more likely to have acute prostate inflammation in the negative biopsy (OR 1.74; 95% CI 1.48-2.05 and OR 2.04; 95% CI 1.38-3.02, respectively), while South Americans were less likely to have acute inflammation (OR 0.42; 95% CI 0.28-0.61). Among North Americans, Canadians were more likely to have acute prostate inflammation than men from the United States (OR 1.40; 95% CI 1.07-1.83). Among Europeans, the prevalence of acute inflammation was lower in Northern, Southern and Eastern Europe, relative to Western Europe (OR 0.79; 95% CI 0.65-0.97, OR 0.84; 95% CI 0.66-1.07 and OR 0.62; 95% CI 0.45-0.87, respectively), with similar results for chronic inflammation. Regions with higher prevalence of prostate inflammation had lower prostate cancer risk at 2-year biopsy, including North America (OR 0.87; 95% CI 0.71-1.07) and Australia/New Zealand (OR 0.48; 95% CI 0.24-0.95), relative to Europe. Conversely, regions with lower prevalence of prostate inflammation had higher prostate cancer risk at 2-year biopsy, including Northern and Eastern Europe (OR 1.30; 95% CI 1.05-1.62 and OR 1.74; 95% CI 1.29-2.35, respectively), relative to Western Europe.

Conclusions: Geographic disparities in the prevalence of prostate inflammation is a potential biologic mechanism contributing to global differences in prostate cancer incidence rates.

Citation Format: Emma H. Allott, Sarah Markt, Lauren E. Howard, Adriana C. Vidal, Daniel M. Moreira, Ramiro Castro-Santamaria, Gerald L. Andriole, Lorelei A. Mucci, Stephen J. Freedland. Geographic disparities in prevalence of baseline prostate inflammation and prostate cancer risk: Results from a multinational trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4962. doi:10.1158/1538-7445.AM2017-4962

Abstract B72: Does prostate cancer risk vary by race after accounting for lifestyle factors in the Health Professionals Follow-up Study

Introduction: There are considerable differences in prostate cancer rates among white, black and Asian men, yet the underlying reasons for these differences are unknown. Our objectives were to study the association between race/ethnicity and prostate cancer risk, including aggressive cancer, accounting for differences in lifestyle factors and screening in a socioeconomically homogeneous population of US men.

Materials and Methods: We conducted a prospective analysis using the Health Professionals Follow-up study (HPFS), a prospective cohort of 46,108 men that began in 1986 with follow-up through 2012. These men were followed-up through biennial questionnaires that collected lifestyle, medical history and demographic data. After 26 years of follow up, 6,072 new cases of prostate cancer were identified. We used Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between race/ethnicity and prostate cancer risk adjusting for potential confounders and PSA screening history.

Results: At baseline in 1986, there were 44,795 Caucasian men, 470 black men and 834 Asian men. Black men had a significantly higher risk of overall prostate cancer (HR=1.38, 95% CI= 1.10 to 1.72) while Asian men had a lower risk (HR=0.73, 95% CI=0.58 to 0.92) compared to white men. These associations were independent of PSA testing history and family history. There was a suggestion of an increased risk of lethal and high-Gleason grade disease for both black (Lethal: HR=1.24, 95% CI= 0.68 to 2.28; High-grade: HR=1.12, 95% CI=0.58 to 2.18) and Asian men (Lethal: HR=1.29, 95% CI=0.75 to 2.23; High-grade: HR=1.43, 95% CI=0.86 to 2.37), compared to Caucasian men, despite the lower risk for overall prostate cancer among Asians. The positive associations with lethal cancer were even more striking in the era before PSA screening was common (before 1994).

Conclusion: The increased incidence of prostate cancer overall among black men and reduced incidence in Asian men cannot be explained by differences in PSA testing, family history or other lifestyle factors.

Citation Format: Nadine M. Hamieh, Sarah Markt, Sam Peisch, Edward Giovannucci, Kathryn Wilson, Lorelei Mucci. Does prostate cancer risk vary by race after accounting for lifestyle factors in the Health Professionals Follow-up Study. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B72.

Circadian dysrhythm and advanced prostate cancer

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Background: The circadian rhythm regulates diverse biologic pathways including tumor oncogenes, metabolism, and cell proliferation. Dysregulation of the circadian rhythm arises from faulty input signals such as exposure to light at night, variability in core circadian rhythm genes, and variation in outputs that regulate circadian behavior including melatonin. There is compelling biologic rationale, but little human data, on circadian dysrhythm and advanced prostate cancer. Methods: We undertook an integrative molecular epidemiology study of circadian dysrhythm and advanced prostate cancer among men in the Icelandic AGES-Reykjavik cohort and the U.S. Health Professionals Follow-up Study, which allowed integration of questionnaire data, biorepositories, and long-term follow-up. We characterized circadian dysrhythm using complimentary approaches: information on sleep problems from questionnaires, prediagnostic melatonin (6-sulfatoxymelatonin) measured on first morning void urine samples, and genetic variation across twelve circadian clock genes. We used multivariable regression models to estimate relative risks (RR) and 95% confidence intervals (CI) of associations with advanced prostate cancer, adjusted for potential confounders. Results: Twenty percent of men reported sleep problems. Men who had trouble falling asleep (RR = 2.1; 95% CI 0.7-6.2) and staying asleep (RR=3.2, 95% CI 1.1-9.7) had an increased risk of developing advanced prostate cancer. Men with sleep problems had significantly lower melatonin levels compared to those without. Low melatonin levels were associated with a statistically significant 4-fold higher risk of advanced prostate cancer compared to those with high levels (95% CI: 1.25-10.0). Variant alleles in two SNPs in cryptochrome (CRY1), involved in generating and maintaining circadian rhythms, were significantly associated with risk of advanced prostate cancer in both cohorts, with a gene-level p-value<0.01. Conclusions: Our results suggest there are multiple nodes in the circadian rhythm that are associated with an increased risk of advanced prostate cancer. As such, there is the potential for complimentary strategies to target circadian disruption and reduce the risk of advanced prostate cancer.