Durani, Urshila

e18091 Background: Allogeneic HCT is a potentially curative option for certain patients with AML. However, in-hospital outcomes and cost haven't been described. We use the NIS, a nationally weighted sample of hospital discharges in the US, to examine these outcomes. Methods: Years 2002-2013 of the NIS were queried for adults with a primary diagnosis of AML undergoing HCT. Mortality, length of stay, hospital charges, and complications were analyzed and predictors of increased charges and mortality were determined with multivariate regression analysis. Results: From 2002-2013 19,965 adults with AML were admitted for HCT. Donor sources included peripheral blood stem cells (PBSCTs) (79%); bone marrow (BMTs) (15%); umbilical cord blood (6%). In hospital mortality was 8%. Major complications included stomatitis (36%), total parenteral nutrition (TPN) (17%), neutropenic fever (14%), bacteremia (12%), mechanical ventilation (6%), and dialysis (3%). Median charges per hospitalization increased (p<0.01) from $161,894 (2002) to $324,765 (2013); median length of stay (27 days) remained stable over time. Multivariable regressions are depicted (Table). Umbilical cord blood transplants were associated with increased mortality (OR 2.25, p<0.01) and charges ($69,105, p<0.01) relative to PBSCTs. Conclusions: This study demonstrates increasing cost of BMT on a national level as well as increased cost and mortality with umbilical cord transplants. [Table: see text]

Abstract Background: In stage IV non-small cell lung cancer (NSCLC), survival has significantly improved with the use of novel therapies and better supportive care. Despite such trends, it has been noted that patients (pts) frequently refuse cancer treatment. Therefore, we explored the factors associated with treatment refusal in pts with stage IV NSCLC. Methods: Utilizing the National Cancer Database (NCDB), we identified all incident cases with stage IV NSCLC from 2004 to 2014. Patients who received cancer treatment outside of the reporting facility or died before receiving treatment were excluded. Multivariable logistic regression models were used to determine associations with treatment refusal. Results: A total of 341,993 pts were identified. On average, 5.4% of pts refused radiation therapy and 10.3% refused chemotherapy despite provider recommendations. The proportion of pts refusing radiation and chemotherapy increased over the study period from 4.2% to 7.3% and 7.9% to 15%, respectively (p&lt;0.001 for both). In multivariable analysis, men were less likely to refuse radiation or chemotherapy compared to women (OR: 0.82, 95%CI: 0.76-0.83, p&lt;0.001; OR: 0.84, 95%CI: 0.81-0.86, p&lt;0.001, respectively). Factors associated with radiation therapy refusal included: Medicaid or Medicare as primary insurance (OR: 1.95, 95%CI: 1.76-2.15, p&lt;0.001; OR: 1.25, 95%CI: 1.17-1.34, p&lt;0.001, respectively) or a &gt;2 Charlson Comorbidity Index (OR: 1.97, 95%CI: 1.85-2.10, p&lt;0.001). Moreover, receiving care at an academic center (OR: 0.57, 95%CI: 0.53-0.62, p&lt;0.001) was associated with less likelihood of refusing radiation. Regarding chemotherapy, uninsured pts (OR: 2.45, 95%CI: 2.26-2.66, p&lt;0.001), pts with Medicaid as primary insurance (OR: 2.17, 95%CI: 2.03-2.32, p&lt;0.001) or with a high comorbidity index (OR: 1.76, 95%CI: 1.68-1.84, p&lt;0.001) were more likely to refuse chemotherapy. Contrary to findings from previous studies, Non-Hispanic Blacks and Hispanics were less likely to refuse chemotherapy compared to non-Hispanic whites (OR: 0.86, 95%CI: 0.82-0.91, p&lt;0.001; OR: 0.78, 95%CI: 0.72-0.89, p&lt;0.001). Patients receiving care at an academic center and residing in high income neighborhoods were less likely to refuse chemotherapy (OR: 0.76, 95%CI: 0.72-0.80, p&lt;0.001; OR: 0.76, 95%CI: 0.71-0.81, p&lt;0.001, respectively). Distance from residence to treating facility and living in a rural county did not affect treatment refusal. Conclusions: Socioeconomic factors rather than race/ethnicity appear to influence refusal of cancer treatment in pts with stage IV NSCLC in the NCDB. Assessing socioeconomic challenges should be an essential part of patients' evaluation when discussing treatment options. Citation Format: Narjust Duma, Urshila Durani, Ryan Frank, Jonas Paludo, Gustavo Westin, Yanyan Lou, Leventakos Konstantinos, Julian Molina, Ronald Go, Aaron Mansfield, Sikander Ailawadhi, Alex Adjei. Influence of sociodemographic factors on treatment decisions in lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4230.

Abstract Background: Racial disparities in the treatment of lung cancer are well documented. However, research in disparities in palliative care is limited. Early integration of palliative care in advanced non-small cell lung cancer (NSCLC) has been proven to improve quality of life and overall survival in this subset of patients. We proposed to study the use of palliative treatments for stage IV NSCLC among Hispanic patients (pts). Methods: Using the National Cancer Database (NCDB), we identified all Hispanic pts (self-reported) diagnosed with stage IV NSCLC from 2005 to 2013. Cases with incomplete data, unknown life/death status or classified as Hispanic by surname only were excluded. Hispanics were grouped based on place of origin. Pearson chi-square tests were used to estimate differences in categorical data; predictors of palliative care referral/use were determined by logistic regression analysis. Results: 10,441 pts were included. The median age was 66 years. Regarding place of origin: 15.5% of pts were from Mexico, 8% from South/Central America, 7% from Cuba, 6% from Puerto Rico, 2.4% from the Dominican Republic and 57.6% were no-otherwise specified. When all Hispanic pts were included, 3.5% received surgery, 45% radiation and 52.9% chemotherapy. Overall, 2.2% of pts received a referral for palliative pain management +/- other palliative therapies. When divided by place of origin, Dominican pts had the highest percentage of pain management referrals at 5.5% (p&lt;0.01) followed by Puerto Rican patients (2.4%). On the other hand, only 1.3% of pts from South/Central America were referred to pain management. In multivariate analysis, Dominican Republic origin (OR: 3.30, 95%CI: 1.69-6.44, p&lt;0.01), bone metastasis (OR: 1.98, 95%CI: 1.17-3.3, p&lt;0.01) and a Charlson comorbidity index ≥2 (OR: 2.07, 95%CI: 1.11-3.85, p&lt;0.02) were significant predictors of receiving a pain management referral. We observed an increased number of pain management referrals over time with 1.4% of Hispanic patients getting a referral in 2004 vs. 2.9% in 2013 (p&lt;0.02). Conclusions: We observed that only a small percentage of Hispanic pts with metastatic NSCLC cancer are receiving referral for palliative care/pain management. Several cultural beliefs and barriers may play a role in these findings. Providers should offer early referrals to pain management/palliative care to all patients with metastatic NSCLC independent of their race or ethnicity. Citation Format: Narjust Duma, Urshila Durani, Julian Molina, Timothy J. Moynihan. Utilization of palliative therapies among Hispanics with stage IV non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1641.

Abstract The epidemiology and outcomes of tumor lysis syndrome (TLS) are understudied. We used the National Inpatient Sample (NIS), a nationally representative weighted sample of all U.S. hospital discharges, to study outcomes and predictors of mortality in hospitalized patients with TLS. The NIS was queried for patients with a discharge diagnosis of TLS (ICD-9 code 277.88) from 2010–2013. Baseline characteristics and outcomes were analyzed. A multivariable logistic regression analysis was performed to identify predictors of mortality. From 2010–2013, 28,370 patients were discharged with a diagnosis of TLS. The most common malignancies were non-Hodgkin lymphoma (30%), solid tumors (20%), acute myeloid leukemia (19%), and acute lymphocytic leukemia (13%). Overall in-hospital mortality was 21%. The median length of stay was 10 days (IQR 5-22). Sixty-nine percent of patients experienced a severe complication, including sepsis (22%, 95% confidence interval [CI] 21–23), dialysis (15%, 95% CI 14–16), acute respiratory failure (23%, 95% CI 22–24), mechanical ventilation (16%, 95% CI 15–17), gastrointestinal hemorrhage (6%, 95% CI 5–7), cerebral hemorrhage (2%, 95% CI 2–3), seizures (1%, 95% CI 0.6–1), and cardiac arrest (2%, 95% CI 2–3). Predictors of mortality were derived from a multivariable logistic regression and included age, Elixhauser comorbidity score, insurance status, teaching versus nonteaching hospital, and cancer type. Predictors of increased length of stay included age, race, teaching versus nonteaching hospital, and cancer type. In the U.S., many patients with TLS develop life-threatening complications and a quarter die during hospitalization. As more cancer treatments become available, strategies to improve the supportive care of patients with TLS should be a priority.

Venous thromboembolism (VTE) contributes to significant morbidity, mortality, and socioeconomic burden. There is a paucity of literature regarding sex-based sociodemographic differences in VTE presentation and short-term outcomes. We aimed to compare clinical outcomes between men and women hospitalized for VTE management. We performed a retrospective analysis using data from the National Inpatient Sample (NIS) database from 2012 to 2013. Inclusion criteria were age 18 years and older and a primary discharge diagnosis of VTE. Sociodemographic features and medical comorbidities were analyzed, as were hospital length of stay and in-hospital mortality rates. A total of 107,896 patients met the inclusion criteria; 53% were female. Median age was 65 years (interquartile range 51–77) and women were older than men (65 vs 62 years, p<0.001). There were significant differences between men and women with respect to race, primary insurance payer and medical comorbidities, and small differences with respect to VTE location. Female sex was associated with a small but significantly longer hospital length of stay (mean ratio 1.04, 95% CI 1.03–1.05, p<0.001) but no significant difference in in-hospital mortality (2.2% vs 2.1%, p=0.15). In a multivariate model, there was no significant difference between women and men with respect to hospital length of stay or in-hospital mortality. In conclusion, we used data from the NIS to study over 100,000 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 clinical outcomes.

297 Background: Unlike acute lymphoblastic leukemia, no studies have examined the effect of race on survival among AML in AYA using national data. Methods: We studied patients in the US National Cancer Data Base aged 15-39 diagnosed with AML from 2001-2011 (excluding acute promyelocytic leukemia). AMLs harboring inv(16) or t(8;21) were defined as good-risk. We examined overall survival (OS) according to race/ethnicity and survival trends over three time-periods: 2001-2004, 2005-2008, and 2009-2011. Results: We identified 8,986 patients, with a mean follow-up of 37 months. The median OS according to race/ethnicity was 56, 49, 41, and 22 months for Asians/Pacific Islanders (A/PI), Hispanics, Whites, and Blacks respectively (P < 0.001). OS improved over time among Whites only, with respective median OS of 31, 43, and 49 months (P < 0.001). Multivariate analysis adjusting for socio-demographics, travel distance, and AML type, showed that, compared to Whites, Blacks had a significantly worse and Hispanics a significantly better OS (Table). Conclusions: We found significant disparities in OS among racial/ethnic subgroups in AYA with AML despite adjustment for socio-demographic factors. Blacks had the worse and Hispanics the best outcome. In the past decade, OS improved only among the Whites. Further studies should examine provider and patient care delivery factors that may contribute to these disparities. [Table: see text]