Citations

PURPOSE: Gender disparity persists in academic medicine. Female faculty are underrepresented in leadership positions and have lower research output. We studied gender differences in faculty rank and departmental leadership and contributing factors among academic hematologists and oncologists in the United States. METHODS: For clinical faculty at 146 hematology or oncology fellowship programs listed in the Fellowship and Residency Electronic Interactive Database, we collected data on demographics, academic rank, and research output using the Doximity and Scopus databases. We compared unadjusted characteristics of men and women by using 2-sided t tests and χ2 tests where appropriate. To predict probability of full professorship or leadership position among men versus women, we performed multivariable logistic regression analysis adjusted for clinical experience in years, number of publications, h-index, clinical trial investigator status, National Institutes of Health funding, and workplace ranking (top 20 v not). RESULTS: Two thousand one hundred sixty academic hematologists and oncologists were included. Women composed 21.9% (n = 142) of full professors, 35.7% (n = 169) of associate professors, and 45.4% (n = 415) of assistant professors. Thirty percent (n = 70) of departmental leaders were women. Female faculty, compared with male faculty, had a lower mean h-index (12.1 v 20.9, respectively; P < .001) and fewer years of professional experience since fellowship (10 v 16 years, respectively; P < .001). After adjusting for duration of clinical experience, academic productivity, and workplace ranking, the odds of obtaining professorship (odds ratio [OR], 1.05; 95% CI, 0.71 to 1.57; P = .85) or divisional leadership (OR, 0.57; 95% CI, 0.20 to 1.58; P = .28) for female physicians were not different compared with male physicians. CONCLUSION: Gender disparity exists in senior ranks of academic hematology and oncology; however, gender is not a significant predictor in achieving professorship or department leadership position.

Summary Tumour lysis syndrome (TLS) is a significant complication of haematologic malignancies and their management. The syndrome consists of laboratory abnormalities either alone (laboratory TLS) or with clinical sequelae including renal failure, seizures, and arrhythmias (clinical TLS). Clinical TLS is a predictor for worse overall morbidity and mortality in cancer patients, but can be prevented. Thus, accurate prognostication is critical to appropriate management of patients at risk for TLS, and incorporates both disease factors (tumour type and burden) and patient factors (baseline renal insufficiency or hyperuricaemia). Strategies to prevent TLS include hydration and allopurinol in low‐ and intermediate‐risk patients and rasburicase in high‐risk patients.

Abstract Background: Venous thromboembolism (VTE) contributes to significant morbidity, mortality, and socioeconomic burden. Though male sex is a known risk factor for recurrent VTE, there is a paucity of literature regarding sex-based sociodemographic differences as well as differences in VTE outcomes including hospital length of stay and mortality rates. Methods: We conducted a retrospective analysis from the National Inpatient Sample (NIS) database from 2012-2013. Inclusion criteria were age 18 years and older and primary discharge diagnosis of VTE Sociodemographic features and medical comorbidities were analyzed, as were hospital length of stay and in-hospital mortality rates. Results: 107,896 patients in the NIS, representing a national estimate of 539,480 patients hospitalized for VTE between 2012 and 2013, met inclusion criteria. 53% were female and 47% were male. Mean age was 63 years and on average women were older than men (65 years versus 62 years, p<0.001). There were significant differences between men and women with respect to race, primary insurance payor, and VTE location as well as medical comorbidities (Table 1). Median overall length of stay (LOS) was 4 days and in-hospital mortality rates were 2.1%. Female sex was associated with a small but significantly longer hospital LOS (RR 1.04, CI 1.03-1.05, p<0.001) which was also seen in subgroup analyses of lower extremity DVT (RR 1.05, CI 1.03-1.06, p<0.001) and pulmonary embolism (RR 1.03, CI 1.02-1.05, p<0.001) but not upper extremity (RR 1.04, CI 0.96-1.12, p=0.36). There were no significant sex-based differences in in-hospital mortality (2.2% in women versus 2.1% in men, p=0.15). In a multivariate model correcting for sociodemographic differences and medical comorbidities, there were no significant differences between women and men with respect to hospital LOS or in-hospital mortality (Table 2). Conclusion: We used data from the NIS to study a large number of patients hospitalized for VTE, and identified several sex-based disparities in sociodemographic factors and location of VTE. However, in a multivariable analysis correcting for these factors, sex was not associated with significant differences in hospital LOS or inpatient mortality rates. Disclosures Kapoor: Celgene: Research Funding; Takeda: Research Funding; Amgen: Research Funding.

Introduction: We have previously reported underrepresentation of female faculty at senior academic ranks in hematology/oncology (H/O). In this analysis we aimed to investigate the influence of sex in attaining leadership positions amongst academic hematologists/oncologists in United States. Methods: Faculty members were identified at 146 H/O fellowship programs listed on fellowship and residency electronic interactive database (FREIDA.) Data was collected on demographics, academic rank and research output using Doximity and Scopus databases. We compared the unadjusted characteristics of men and women by using two-sided t-tests and χ2 tests where appropriate. In primary analysis, logistic regression models were used to evaluate sex differences on probability of having full professorship (versus assistant and associate professorship) and of achieving leadership positions including division chief, Program Director (PD) and Associate Program Director (APD). Adjusted models included the following variables: clinical experience in years, number of publications, h-index, appointment at top 20 hospital, clinical trial investigator status and National Institutes of Health funding. Stratified analysis was performed adjusting for duration of clinical experience (≤15 vs >15 years) Results: Fewer women were full Professors (21.9% vs 78.1%), division chiefs (16.7% vs 83.3%), and PDs (30.5% vs 69.5) but the number was similar for Associate Program Directors (47.1% vs 52.9%). In a univariate unadjusted model, women were less likely to be full professors compared to men (OR 0.39; 95% confidence interval [CI], 0.31-0.48; P<.001). However, in the multivariable adjusted model no statistically significant sex difference in full professorship was found (OR 1.05; 95% CI 0.71, 1.57; P=.85; Table). The likelihood of full professorship was positively associated with clinical experience in years, number of first/last author publications, h-index, and being a primary investigator on at least one clinical trial.In a univariate unadjusted model, women were less likely to be division chiefs as compared to males (OR 0.35; 95% CI, 0.16, 0.80; P=.01). However, in the multivariable adjusted model, there was no statistically significant sex difference in achieving the position of division chief (OR 0.57; 95% CI 0.20, 1.58; P=.28; Table). No significant difference was found between females and males for being program directors or associate program directors in both univariate and multivariate analysis. Similarly, a stratified analysis adjusting for duration of clinical experience (≤15 vs >15 years) found no significant sex differences in attaining leadership position (Table) Conclusion: We found that women are underrepresented at higher academic ranks and in leadership positions in hematology/oncology, but that sex is not a significant negative predictor to women obtaining leadership positions after correcting for traditional predictors of academic success. However, "non-traditional" and therefore less measurable and analyzable factors such as networking, mentorship, sponsorship, gender bias, balancing work and home responsibilities and many others may contribute and should be further investigated. Disclosures No relevant conflicts of interest to declare.

Introduction: Several recent studies have shown a gender disparity in professional doctoral introductions at major medical conferences, with female speakers being less likely to be introduced with a professional title. We sought to examine whether a similar disparity existed at the American Society of Hematology (ASH) Annual Meeting. Methods: In this retrospective observational study, 8 investigators reviewed available presentations from video archives of the 2018 ASH Annual Meeting. Presentations were excluded if gender could not be identified and/or speaker did not have a doctoral degree. We collected data on speaker gender, speaker academic/non-academic rank, speaker geographic location, speaker training status, speaker session type and introducer gender were all collected. A "professional address" was defined as either "Dr. [First and Last Name]" or "Dr. [Last Name]." Descriptive statistics and regression modelling were used to analyze the data. Results:Of the videos reviewed, 645 presentations were eligible for analysis; 380 (59%) speakers were men and 264 (41%) were women. A comparison of male and female speaker cohorts is seen in Table 1. Forty-eight percent of both men and women held a Medical Doctor degree (MD), and the rest were MD/PhD or PhD graduates. Substantially more men (28%) were full professors compared to women (13%). Almost half (47%) of session types for both men and women speakers were designated as "basic science." In an adjusted analysis, more women (N=174, 66%) compared to men (N=225, 59%) received a professional address (P&lt;.01). 43% of women were introduced by a female introducer and 42% of men were introduced by a female introducer (P=.79). In addition, 48 of the introducers (19%) for women and 68 of the introducers (18%) for men had a PhD or MD/PhD. In a logistic regression model adjusting for session type, academic rank, degree, geographic location, trainee status, and gender of introducer, there were no significant gender-based differences in professional introduction [Table 1; Odds Ratio (OR) 0.71, P=.06]. In addition, speakers with MD introducers were more likely to have a professional introduction compared to PhD introducers (OR 2.15, P=.03) regardless of sex. Conclusions: Our study demonstrates that women were at least as likely as men to receive a professional address at the 2018 ASH Annual Meeting. These results differ from previous studies of other professional medical conferences. These findings may reflect the strong presence of PhD graduates as both speakers and introducers. Both forms of bias (gender and degree-based) merit further study and interventions including speaker training to ensure combatting unconscious bias. Disclosures Velazquez: Midatech: Other: Husband owns stock in this company; Portola Pharmaceuticals: Other: Husband owns stock in this company; Corbus Pharmaceuticals: Other: Husband owns stock in this company; Johnson & Johnson: Other: Husband is employed by this company.

Background: Adherence to surveillance guidelines in resected colon cancer has significant implications for patient morbidity, cost of care, and healthcare utilization. This study measured the underuse and overuse of imaging for staging and surveillance in stage I–II colon cancer. Methods: The OptumLabs database was queried for administrative claims data on adult patients with stage I–II colon cancer who underwent surgery alone in 2008 through 2016. Use of PET and CT imaging was evaluated during both initial staging (n=6,921) and surveillance for patients with at least 1 year of follow-up (n=5,466). “High use” was defined as >2 CT abdominal/pelvic (CT A/P) or PET scans per year during surveillance. Results: Overall, 27% of patients with stage I–II colon cancer did not have a staging CT A/P or PET scan and 95% did not have a CT chest scan. However, rates of staging CT A/P and CT chest scans increased from 62.0% (2008) to 74.8% (2016) and from 2.3% (2008) to 7.1% (2016), respectively. Staging PET use was overall very low (5.2%). During surveillance, approximately 30% of patients received a CT A/P or PET and 5% received a CT chest scan within the first year after surgery. Of patients who had surveillance CT A/P or PET scans, the proportion receiving >2 scans within the first year (high use) declined from 32.4% (2008) to 9.6% (2016) (P = .01). Conclusions: Although PET use remains appropriately low, many patients with stage I–II colon cancer do not receive appropriate staging and surveillance CT chest scans. Among those who do receive these scans during surveillance, high use has declined significantly over time.

144 Background: Small cell lung cancer (SCLC) is highly responsive to cytotoxic therapy and can be cured in early stages of disease. In this setting, disparities in patient refusal despite provider recommendations are unknown. Methods: All incident limited stage (LS)-SCLC cases from the National Cancer Database were identified from 2004 to 2014. Logistic regression was used to determine factors associated with treatment refusal. Results: 65,664 patients (pts) were identified with LS-SCLC: 44% male, median age 68 years. 3.4% of pts refused radiation and 3.8% refused chemotherapy. The proportion of chemotherapy refusal increased over the study period: 3% in 2004-2006 compared to 5.4% in 2013-2014 [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.55-2.01]; this was not observed for radiation. In multivariate analysis, women were more likely to refuse radiation (OR 1.18, 95% CI 1.06-1.32) and chemotherapy (OR 1.30, 95% CI 1.19-1.43) than men. Women who accepted treatment had higher overall survival compared to those who refused radiation (19.8 vs 5.2 months) or chemotherapy (17.4 vs 3.9 months) (both p < 0.001). Hispanic, Black, and Asian pts were not more likely to refuse treatment than White pts. Older pts were more likely to refuse radiation (OR 1.09 per year, 95% CI 1.08-1.09) and chemotherapy (OR 1.10 per year, 95% CI 1.09-1.11). Charlson comorbidity index (CCI) of 2 was associated with more frequent treatment refusal compared to CCI of 0 (radiation OR 1.96, 95% CI 1.68-2.30; chemotherapy OR 1.54, 95% CI 1.34-1.76). Medicaid as primary insurance predicted a higher risk of refusal compared to private insurance for radiation (OR 2.36, 95% CI 1.81-3.07) and chemotherapy (OR 2.23, 95% CI 1.78-2.80). Treatment at an academic facility predicted a lower risk of radiation refusal (OR 0.71, 95% CI 0.59-0.84) but not chemotherapy refusal. Conclusions: Female sex, comorbidities, and Medicaid insurance were predictors of treatment refusal in LS-SCLC, suggesting that socioeconomic and sex disparities may affect treatment decisions in this life-threatening disease. Further research to identify reasons for refusal via patient and provider interviews can improve care of vulnerable populations with potentially curable cancer.

Abstract Introduction: The role of surveillance imaging in diffuse large B-cell lymphoma (DLBCL) after treatment with curative intent is debated. In 2013, the American Society of Hematology (ASH) Choosing Wisely® campaign (Hicks LK, et al. Blood 2013) released a recommendation to "limit surveillance CT scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma." This was based on previous studies demonstrating a lack of survival benefit as well as a significant impact on the patient in terms of cost, anxiety, incidental findings and radiation exposure. Similar findings have been described regarding the use of PET imaging, especially in low risk patients. We aimed to study the changes in practice patterns of surveillance imaging for DLBCL survivors treated with curative intent before and after the publication of the ASH Choosing Wisely® campaign. Methods: Administrative claims data from a large U.S commercial insurance database (OptumLabs Data Warehouse) were used to retrospectively identify adult patients with an incident diagnosis of DLBCL between 2008 and 2016 and at least one year of follow-up. We excluded those who did not receive treatment with curative intent: RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) x 6 cycles or RCHOP x 3-5 cycles plus radiation. Patients were also excluded if they had a co-existing or second cancer, or if they received any chemotherapy/radiation during their surveillance period, as to exclude anyone with a recurrence of their lymphoma. The surveillance period started 90 days after the last chemotherapy or radiation and continued for the duration of follow-up. Surveillance imaging was defined as any PET, PET-CT, CT chest, CT abdomen, and/or CT pelvis. To examine trends over time, three time periods were defined: 2008-2010, 2011-2013 and 2014-2016. The Cochran Armitage test was used to test the trend hypothesis. Results: A total of 1,472 patients were included. Cohort characteristics by time period are described in Table 1. Surveillance imaging frequency decreased from 84% in Year 1 of surveillance to 43% in Year 5 (Figure 1). Overall, surveillance imaging during the first 3 surveillance years significantly decreased over the three time periods (Figure 2) (P<0.01 for Years 1 and 2, P=0.04 for Year 3). Imaging surveillance for the first two years of surveillance did not significantly decrease from 2008-2010 to 2011-2013 (P>0.05), but significantly decreased from 2011-2013 to 2014-2016 (P<0.01). Of the groups that received imaging surveillance during year 1, the median number of scans during the first year was 2 (inter-quartile range, 1-2) and did not significantly change over time. In addition, PET/PET-CT surveillance decreased from 49% in Year 1 to <10% in Year 5. PET/PET-CT also decreased over the three time periods, from 62% (2008-2010) to 48% (2011-2013) to 43% (2014-2016) during the first year of surveillance and 40% to 31% to 25% during the second year. Younger age (<65 years versus ≥65 years) was associated with higher imaging utilization (86% versus 81%, respectively), and specifically PET/PET-CT utilization (55% versus 43%, respectively), during the first year of surveillance. However, race (white versus non-white) did not significantly affect imaging (85% versus 83%) or PET utilization (50% versus 47%) during the first year of surveillance. Conclusions: Our study demonstrates that the rate of surveillance CT and PET imaging in DLBCL patients treated with curative intent decreased significantly in the years after the publication of the ASH Choosing Wisely® campaign. However, over half of the DLBCL patients diagnosed in 2014-2016 continued to undergo surveillance imaging, indicating either incomplete guideline dissemination or ongoing debate regarding optimal surveillance practice. Future studies are necessary to determine whether such a decline in surveillance imaging is sustained and to examine factors (patient, provider, and payer) associated with surveillance imaging in DLBCL. Disclosures No relevant conflicts of interest to declare.

Abstract Background Hodgkin lymphoma is a rare hematological malignancy, with 8,500 new cases per year in the United States. Prior studies in oncology have shown that higher patient volume, whether at the treatment facility or provider level, is associated with reduced mortality and improved overall survival (OS). We used a national oncology data set to test our hypothesis that a volume-outcome relationship may also exist in classical Hodgkin lymphoma. Methods Using the National Cancer Data Base (NCDB), we identified patients diagnosed with classical Hodgkin lymphoma between 2003 and 2014. The NCDB is a nationwide oncology outcomes database for ~70% of newly diagnosed cases from more than 1,500 accredited cancer programs in the United States and Puerto Rico. We classified the facilities by quartiles (Q; mean patients with HL treated per year): Q1: < 3.19, Q2: 3.2 to 5.0, Q3: 5.01 to 9.19, and Q4: ≥9.2. Our primary outcome of interest was all-cause mortality. We used random intercepts to account for clustering of patients within facilities and a Cox regression model to determine the volume-outcome relationship, adjusting for demographic (sex, age, race, ethnicity), socioeconomic (income, education, insurance type), geographic (area of residence, treatment facility location, travel distance), and comorbid (Charlson-Deyo score) factors, as well as year of diagnosis. Kaplan-Meier analysis was performed to examine the impact of patient volume (by quartile) on overall survival. Results There were 47,633 patients with classical Hodgkin lymphoma treated at 1,310 facilities. The median age at diagnosis was 40 years, and 54.2% were men. The median annual facility volume was 2.7 patients per year (range, 1 to 42.8). The distribution of facilities according to patient volume was: Q1: 58.4%, Q2: 22.4%, Q3: 13.3%, and Q4: 5.9%. After a median follow-up of 58 months, the highest volume quartile (Q4) had significantly higher 5- and 12-year overall survival rates compared to Q1-Q3 (Table 1). Overall survival by quartile is depicted as a Kaplan-Meier curve (Figure 1). Compared to the patients treated at Q4 facilities, those treated at lower-quartile facilities had a higher risk of death (Q3 hazard ratio [HR], 1.18 [95% CI, 1.10 to 1.27]; Q2 HR, 1.21 [95% CI, 1.13 to 1.30]; Q1 HR, 1.19 [95% CI, 1.11 to 1.28]) after adjustment for the sociodemographic factors discussed in our methods. Multivariable analysis showed that facility volume as a continuous variable was independently associated with all-cause mortality (Figure 2) (P<0.0001). Compared with facilities treating 10 patients per year, facilities treating 20, 30, and 40 patients per year had approximately 10%, 17%, and 23% lower overall mortality rates. Conclusions Patients treated for classical Hodgkin lymphoma at higher-volume facilities had a lower risk of mortality compared with those treated at lower-volume facilities. This adds to the growing body of evidence that a volume-outcomes relationship exists in some of the less common hematologic malignancies. Further research is needed to ascertain whether such differences in survival are related to provider-level or facility-level attributes, and whether patients with Hodgkin lymphoma will benefit from referral to high-volume centers. Disclosures No relevant conflicts of interest to declare.