Science and Health Policy最新文献

{"title":"Abstract 3351: Overall survival prediction of glioblastoma patients combining clinical factors with texture features extracted from 3-D convolutional neural networks","authors":"Weiwei Zong, Joon Lee, Chang Liu, James M. Snyder, N. Wen","doi":"10.1158/1538-7445.AM2019-3351","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3351","url":null,"abstract":"Objective: We aim to predict overall survival (OS) in Glioblastoma treated with gross total resection (GTR) using pre-operative MRI images. Methods: A cohort of 87 GBM patients (59 patients for training and 28 patients for validation) who underwent GTR was analyzed using multi-institutional data from brain tumor segmentation (BraTS) challenge 2018 (Menze BH, et al. TMI 2015; Bakas S, et al. NSD 2017). Each patient consisted of a series of pre-surgical MR images including T1 pre contrast, T1-Contrast Enhanced, T2 and Flair images. A group of experienced radiologists delineated edema, tumor core and enhanced tumor for each testing patient using these image sequences. A 2D U-net was trained to segment these structures on the validation cohort. A 3D CNN model with orthogonalized random filters was used to learn images features from the three segmented subregions including texture, size, location, etc. Global maximum pooling was performed on intermediate convolutional layers to obtain representative image features for each patient. Since mid-term survivors (6-18 months) outnumbered short ( 18 months) survivors for a large margin, the MR images from both short and long term survivors were augmented with random rotations to balance the number of patients among three cohorts of patients. The extracted image features was then fed into an RBF-kernel based L-2 norm regression algorithm (Huang GB, IEEE SMC, 2012) to predict patient’s OS. Results: The average [standard deviation] of dice similarity coefficient (DSC) for the whole tumor, enhanced tumor, and tumor core contours were 0.882[0.080], 0.712 [0.294], and 0.769 [0.263], respectively for the validation cohort. Parameters of regression algorithm was optimized using leave one out cross validation. One convolutional layer was used in the CNN archietecture due to limited training samples. The model performance deteriorated when using deeper layers. The best architecture to classify patients into short, mid and long term survivors was one convolutional layer with 30 filters. The prediction accuracy was 64.3%, and the spearman’r sank correlation was 0.395. The model performance was slightly improved by including clinical factors such as age, tumor location, ratio of the whole tumor size to the entire brain etc. The Spearman’s rank correlation coefficient was increased to 0.432 while the accuracy maintained the same. Conclusions: We developed a 3D CNN model followd with kernel regression to extract image features from pre-operative MR images and predict OS of GBM patients after GTR. These signatures have shown potential values as biomarkers to predict OS. Citation Format: Weiwei Zong, Joon Lee, Chang Liu, James Snyder, Ning Wen. Overall survival prediction of glioblastoma patients combining clinical factors with texture features extracted from 3-D convolutional neural networks [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Phila","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84994277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3352: Cost-effectiveness of current and potential serum based colorectal screening strategies: Can a serum based test do better","authors":"A. Jalali, R. Nelson, R. Nirula","doi":"10.1158/1538-7445.SABCS18-3352","DOIUrl":"https://doi.org/10.1158/1538-7445.SABCS18-3352","url":null,"abstract":"","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78063721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3355: Challenges in the implementation of molecular diagnostic testing for non-small cell lung cancer","authors":"Pearl A Campbell, K. Thavorn, B. Lo, Ali Karimnezhad, T. Perkins, R. Urquhart, S. Kamel‐Reid, H. Sekhon, D. Stewart","doi":"10.1158/1538-7445.AM2019-3355","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3355","url":null,"abstract":"Next generation sequencing (NGS) has been used to catalogue genetic mutations in cancer. Recent studies employing NGS have identified specific genetic mutations that reliably predict therapeutic success with targeted treatment in many forms of cancer, and particularly in non-small cell lung cancer (NSCLC). Importantly, patients with oncogenic driver mutations have better tumor control with targeted agents than with chemotherapy, while those lacking such a mutation derive more benefit from chemotherapy. To detect actionable mutations, all patients with metastatic disease must be tested. Mutation assays are generally developed using tissues derived from surgical samples. However, for many patients with metastatic NSCLC the only tissue available is from fine needle aspirates (FNAs). Given the limited number and heterogeneity of cells found in FNAs and the expanding number of clinically actionable mutations, the development and implementation of testing strategies that rapidly and accurately define driver mutations in NSCLC remains a challenge. Our project focuses on the identification of best methods (pre-analytical, analytical, and bioinformatic) to identify driver mutations in lung FNAs to standardize targeted NGS testing for NSCLC. The overarching goal of this project is to develop a strategy for Canada-wide implementation of the developed test. As a first step in this process, our team organized a stakeholder meeting to: A) Identify potential individual and/or system level challenges and barriers to implementation of standardized protocols for molecular oncology diagnostics; B) Outline guidelines and strategies to overcome identified challenges and barriers; and C) Initiate a research project to further study the barriers and facilitators of implementing Canada-wide diagnostic testing strategies for personalized cancer care. For this presentation, we will outline key challenges that impact implementation of the new test, including tumor characteristics (cellularity, heterogeneity); cost and reimbursement issues; required turn around times; bioinformatic requirements; testing strategy (technical limitations of test, panel size); technical staffing and infrastructure requirements; and barriers to implementation of the test into routine standard of care. Finally, we will present a preliminary workflow map, which builds upon the Lung Cancer Pathway Maps provided by Cancer Care Ontario (https://www.cancercareontario.ca/en/pathway-maps/lung-cancer) and addresses these barriers and explores various scenarios for implementation of new testing strategies. Citation Format: Pearl A. Campbell, Kednapa Thavorn, Bryan Lo, Ali Karimnezhad, Theodore J. Perkins, Robin Urquhart, Suzanne Kamel-Reid, Harmanjatinder Sekhon, David J. Stewart. Challenges in the implementation of molecular diagnostic testing for non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Phi","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83682607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3357: The fibrolamellar registry: A model for the study of rare diseases","authors":"M. Desmond, Julie Latone, Siobhan Lett, Rachael D. Migler, Elana P. Simon, S. Simon","doi":"10.1158/1538-7445.AM2019-3357","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3357","url":null,"abstract":"Advances in genomics and proteomics have enabled more precise characterizations of tumors with the consequence that many cancers are being segregated into smaller categories. With this larger number of categories, more cancers are being categorized as rare. The downside to such categorizations is that the reduced numbers of patients in each category makes it difficult to gather enough information about each cancer. We are a group of patients and caregivers who have joined together to form a repository for patient-shared data and reports in an IRB-approved, non-profit medical registry for the rare and usually lethal childhood liver cancer, fibrolamellar hepatocellular carcinoma (FLC). Since the Fibrolamellar Registry is patient-run and patient-owned, we have the trust of the patient community that the records will not be sold for profit. This has enabled us, in our first two years, to gather detailed medical records, scans and tests from over 140 patients. With input from scientists and clinicians who study FLC, we have written 600 questions of specific interest to this disease. Most of our patients have also opted to allow these medical records to be shared with a tissue FLC repository that already has samples from 110 patients. We have initiated two different collaborations with the clinical-research community to explore the records and our patients have been answering additional questions when pertinent to a particular study. Our ability to gather so many records for what is a rare cancer comes from our ability to involve patients from across institutions and across the globe. We are working with other patient groups and we feel that the Fibrolamellar Registry could be a model for gathering and organizing data for many rare diseases. Citation Format: Michelle Desmond, Julie Latone, Siobhan Lett, Rachael D. Migler, Elana P. Simon, Sanford M. Simon. The fibrolamellar registry: A model for the study of rare diseases [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 3357.","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75911551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract LB-164: Transdisciplinary research in energetics and cancer (TREC) early career investigator training program: First year results","authors":"M. Irwin, Diana Lowry, M. Neuhouser, J. Ligibel, K. Schmitz, R. Patterson, G. Colditz, Fang-yong Li, L. Nebeling","doi":"10.1158/1538-7445.AM2019-LB-164","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-LB-164","url":null,"abstract":"Purpose: Obesity, poor diet and physical inactivity increase the burden of cancer by increasing risk of incident cancer, mortality, and long term adverse treatment effects. It is critical that scientists receive training in conducting rigorous and impactful energy balance and cancer research. To address this need, we developed an annual one-week, in residence NCI-R25-funded Transdisciplinary Research in Energetics and Cancer (TREC) Training Course for early career investigators in basic, clinical and population sciences. This analysis examined the impact of the TREC Training Program on course satisfaction, knowledge gained, publications and awards among TREC Year 1 program participants (i.e., TREC Fellows). Methods: The TREC program consists of two components: an intensive, in-person, one-week Course, followed by a one-year TREC mentorship program. TREC Faculty are comprised of a TD team of ~20 international expert faculty members. TREC Faculty and Fellows completed surveys before and immediately after the course. The Wilcoxon Signed Rank Test was used to determine course-related changes in knowledge and skills. At the end of the one-year mentorship period, a survey was sent inquiring about TREC-related research productivity and collaborations. Number of publications and grant-funding between June 2017 and December 2018 was compiled and summarized for the 20 TREC Fellows participating in the inaugural TREC course. Results: Information about the program was shared with ~30 organizations, resulting in 77 applications for the inaugural course. Twenty TREC Fellows completed the program, including three basic, seven clinical, and 10 population scientists. Sixteen of the TREC fellows were junior faculty and four were postdoctoral fellows. The 5-day course included over 50 lectures, small-group breakouts and Faculty-Fellow sessions. Attendees rated the course as very high, with an average 96.7% of responses scoring in the top two categories of “good” or “very good”. Knowledge related to conducting energy balance and cancer research significantly improved in 37 out of 39 competencies (94.8%). Between the end of the TREC Year 1 program in June 2017 and December 2018, TREC Year 1 Fellows published 20 manuscripts, with 15 co-authored with other TREC Fellows and/or Faculty. Fifteen % of manuscripts were published in journals with an impact factor > 10. A total of 19 grant applications were funded to TREC Fellows (i.e., five NIH awards, three ACS awards, three foundation awards, and eight internal pilot awards). Seven TREC Fellows were appointed or promoted in academic positions. Conclusion: The overall impact of the TREC Program will be defined by the degree to which TREC Fellows produce innovative research approaches and discoveries that could improve the health of populations at risk for cancer as well as cancer survivors. Upon completion of the 5th year of the TREC Training Program in 2021, we will disseminate the TREC Training Program material for adopti","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76323911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3353: Four vs six cycles of docetaxel and cyclophosphamide (TC) in early stage triple-negative breast cancer","authors":"A. Basu, H. Mohammed, S. Mahmood, V. Dabak, R. Loutfi","doi":"10.1158/1538-7445.AM2019-3353","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3353","url":null,"abstract":"Background: ABC trials established the use of non-anthracycline containing regimen, docetaxel and cyclophosphamide (TC) in the adjuvant setting in early stage breast cancer. In clinical practice, TC is commonly used in Stage I Triple-Negative Breast Cancer (TNBC). However, no specific recommendations exist in literature, regarding the number of cycles that can be used. i.e. TC4 vs TC6. Our aim, was to determine if TC4 is non-inferior to TC6 when used as adjuvant therapy in early stage TNBC. Methods: We retrospectively reviewed 77 patients who were diagnosed with early stage TNBC between 2007 to 2017, at our institution who had received either TC4 or TC6 as adjuvant therapy. The number of cycles the patients received were based on provider preference. The two groups (TC4, TC6) were compared in regard to stage of cancer at diagnosis based on AJCC 7thedition, grade of adverse events, recurrence and death from breast cancer recurrence. Results: Out of 77 patients, based on T stage, 25 (32.5%) were T1b, 38(49.4%) were T1c, 13(16.9%) were T2 and 1(1.3%) was T3. All patients were node negative. 53(68.8%) received TC4 and 24(31.2%) received TC6. Regarding side effects, adverse of any grade were seen in 42(79.2%) patients who received TC4 and 23(95.8%) in patients who received TC6(p=0.091). Adverse events which were grade 3 or higher were seen in 7(15.9%) in TC4 group and 3(13%) in the TC6 group (p=1.000). Recurrence in the TC4 group was seen in 4 patients (7.5%) and 3(12.5%) patient in the TC6 group (p=0.259). Death due to breast cancer recurrence was seen in 1 patient (1.9%) in the TC4 group and 1(4.1%) patient in the TC6 group. Conclusions: In this limited series, TC4 appears to be equally effective to TC6, with fewer adverse events of any grade. However, a longer follow up and a larger patient base is required to be studied for a more definitive conclusion. Citation Format: Aparna Basu, Hadi A. Mohammed, Sharmeen Mahmood, Vrushali Dabak, Randa Loutfi. Four vs six cycles of docetaxel and cyclophosphamide (TC) in early stage triple-negative breast 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 3353.","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89924678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3340: Lung cancer stigma: A ten year look at public attitudes about lung cancer","authors":"M. Rigney, E. Rapsomaniki, J. King","doi":"10.1158/1538-7445.AM2019-3340","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3340","url":null,"abstract":"Background: Lung cancer is the leading cause of cancer death in the United States in both men and women (ACS Facts and Figures, 2018). The presence of lung cancer stigma is well documented (Chapple et al, 2004; Chambers et al, 2012; Marlow et al, 2015) and has been shown to impact the care and treatment of lung cancer survivors (Tod et al. 2008; Carter-Harris et al 2014). In 2008, a large survey of over 1000 members of the general population revealed that most participants felt lung cancer was principally caused by external factors, that it was preventable, and that lung cancer patients were at least partly to blame for their illness (Weiss et al. 2014; 2017). We replicated the survey to understand whether perceptions have changed over the last decade. Methods: 1001 members of the general public were surveyed with the identical survey instrument from 2008 survey along with three additional questions at the end. The survey was carried out by phone and online between June 6 and July 26, 2018. Statistical analysis was performed comparing 2008 and 2018 datasets using paired t-tests if normally distributed or Mann-Whitney U tests for continuous data and Chi-squared or Fisher’s exact test for categorical data. Results: General awareness about lung cancer has significantly improved over the last decade with 94% of the public reporting familiarity with lung cancer (p Conclusions: After a decade of research progress in lung cancer, these data show that lung cancer awareness has been considerably elevated. Unfortunately, they also indicate that the stigma surrounding the disease remains pervasive. This work underscores the need to address stigma with proactive multilevel approaches (Hamann, 2018). Citation Format: Maureen Rigney, Eleni Rapsomaniki, Jennifer C. King. Lung cancer stigma: A ten year look at public attitudes about lung 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 3340.","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78559519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3345: Making the link between breastfeeding and breast cancer risk reduction among Hispanic women of childbearing age","authors":"Karoline Sondgeroth, Rosalba Ruiz-Holguín, J. Padilla, R. Ramos, R. Palacios","doi":"10.1158/1538-7445.AM2019-3345","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3345","url":null,"abstract":"Background/Purpose. Breast Cancer (BC) is the most commonly diagnosed cancer and the second leading cause of cancer related deaths for women in Texas (TX). In the border county of El Paso, TX, the breast cancer incidence and mortality rates are higher for Hispanic women relative to all races combined. Evidence indicates that breastfeeding can be protective against BC by (1) limiting breast cells’ ability to act abnormally, (2) lowering estrogen levels, and (3) promoting healthier lifestyle choices. Research also indicates that the longer a woman breastfeeds, the lower her risk of developing BC. Unfortunately, among all infants born in TX in 2015, only 48% were exclusively breastfed for up to 3 months and only 24.1% were exclusively breastfed for up to 6 months. The goal of the Breastfeeding Breast Cancer Connection Program (BFBCCP) is to increase intent to breastfeed among Hispanic women of childbearing age (18-44 years) by providing a brief education intervention focused on the importance of breastfeeding and BC prevention. Methods. Study participants included 50 Hispanic women of childbearing age living at the El Paso Housing Authority in El Paso, TX. The study consisted of an intervention group (n=25) and a control group (n=25). The control group received only educational brochures about breastfeeding, whereas, the intervention group received an educational presentation about the importance of breastfeeding and BC prevention. Measures assessed in this study included: 1) knowledge of breastfeeding and BC 2) attitudes towards breastfeeding in the workplace, and 3) behavioral intentions to breastfeed. All measures were assessed via a pre and post self-report survey in the participants preferred language. Results/Findings. Overall, Hispanic women participating in the BFBCCP learned more about the importance of breastfeeding, particularly as it relates to BC prevention, reported greater levels of intent to breastfeed, and reported more positive attitudes towards breastfeeding in the workplace compared to the control group. Given their high BC incidence and mortality rates, Hispanic women in the TX border region would benefit from interventions like BFCCP that promote exclusive breastfeeding for a duration of six mos. to one year as a means of reducing their BC risk. The next step is to assess the efficacy of the BFCCP in increasing breastfeeding completion and duration among pregnant Hispanic women. Citation Format: Karoline Sondgeroth, Rosalba Ruiz-Holguin, Joe Padilla, Rebeca Ramos, Rebecca Palacios. Making the link between breastfeeding and breast cancer risk reduction among Hispanic women of childbearing age [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 3345.","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78596097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3341: Rural and urban disparities in colonoscopy use persisted despite cost-sharing reduction among Medicare beneficiaries","authors":"Min Jee Lee, W. Jenkins, E. Boakye, S. Ganai","doi":"10.1158/1538-7445.AM2019-3341","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3341","url":null,"abstract":"Background: Due to passage of the Patient Protection and Affordable Care Act (ACA), Medicare began waiving Part B deductibles and eliminating coinsurance for all colonoscopies in 2011. As rural populations have significantly lower income than urban, there is hope the cost reduction would decrease rural screening disparities. We thus examined rural-urban colonoscopy use pre-/post-ACA implementation. Methods: We used Behavioral Risk Factor Surveillance System data (2008-2016) to examine colonoscopy utilization for two years pre-ACA (2008 and 2010) and three years post-ACA (2012, 2014, and 2016) with stratification by rural/urban residence. Multivariate logistic regression was used to examine the differences in screening likelihood across rural and urban groups, while controlling for other factors such as age, sex, marital status, race/ethnicity, household income, educational attainment, gastroenterologist availability, exercise, smoking, and years. Results: Of the 302,941 eligible Medicare beneficiaries, 203,426 (67.2%) received a colonoscopy. Colonoscopy receipt increased from 62.8% pre-ACA to 70.2% post-ACA years (p Conclusions: Despite cost-sharing reduction of Medicare coverage for colonoscopy, rural and urban differences in colonoscopy use persisted over time among Medicare beneficiaries. Although the receipt of colonoscopy increased over time, the gap between rural and urban populations has remained. Citation Format: Min Jee Lee, Wiley Jenkins, Eric Adjei Boakye, Sabha Ganai. Rural and urban disparities in colonoscopy use persisted despite cost-sharing reduction among Medicare beneficiaries [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 3341.","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78771977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstract 3336: Changes in prescriptions for breast cancer medications after Medicaid expansion","authors":"J. Maclean, M. Halpern, S. Hill, M. Pesko","doi":"10.1158/1538-7445.AM2019-3336","DOIUrl":"https://doi.org/10.1158/1538-7445.AM2019-3336","url":null,"abstract":"Introduction: As of summer 2018, 34 states have expanded Medicaid eligibility under the Affordable Care Act. While the Medicaid expansions decreased rates of being uninsured among women with breast cancer and increased early breast cancer detection, it is unknown whether expansions increased receipt of medications used to prevent and treat breast cancer. This study examines differences over time in receipt of two types of breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) and associated payments for these medications in states that did vs. did not expand Medicaid during the period 2011-2017. Methods: The study’s data source is the Medicaid State Drug Utilization Database (SDUD). This data set, compiled by the Centers for Medicaid and Medicare (CMS), is administrative data submitted by state Medicaid programs. The data comprise outpatient prescription medications that are covered under the Medicaid Drug Rebate Program for which Medicaid serves as a third-party payer; this includes aggregate numbers of prescriptions and associated payments for individuals enrolled in both fee for service and managed care Medicaid programs. Both branded and generic prescriptions for three aromatase inhibitors (anastrozole, exemestane, and letrozole) were included in the study’s analyses. Analyses used differences-in-differences and event study models (controlling for state characteristics) to compare changes in Medicaid expansion states to changes in non-expansion states before vs. after expansion. Results: Initial regression analyses indicate that prescriptions for all hormonal therapy medications increased by 27% (p Conclusions: Our findings indicate that states that expanded Medicaid with the ACA experienced increased prescriptions for breast cancer hormonal therapies relative to states that did not expand Medicaid; this effect of Medicaid expansion increased over time. The increased prescriptions were financed by Medicaid, not by patients. Citation Format: Johanna Catherine Maclean, Michael T. Halpern, Steven C. Hill, Michael F. Pesko. Changes in prescriptions for breast cancer medications after Medicaid expansion [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 3336.","PeriodicalId":21579,"journal":{"name":"Science and Health Policy","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79101425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}