AVAHO

BACKGROUND: Colorectal cancer (CRC) accounts for about 10% of all cancers in the VA. Three-year survival is associated with both age at diagnosis and CRC stage. Yet, the minority of cases are detected at an early stage and the overall incidence of cancer in the VA patient population is forecast to rise. CRC survival and pathogenesis differ by tumor location Increases in CRC cases in individuals younger than fifty-years-of age and at more advanced stages have been reported in large, U.S. population-based cohorts (Meester et al., 2019). Here, we present a preliminary investigation of these trends amongst CRC patients in the VA.

METHODS: Briefly, a cohort of veteran patients (n = 40,951) was identified from 2000 – 2017 using the VA Central Cancer Registry (VACCR). We required all included patients to have a histologically-confirmed case of CRC as consistent with previous studies (Zullig et al., 2016) and only one registry entry. We constructed Kaplan- Meier curves and created a Cox-Proportional Hazards model to examine survival. Additional filtering by age at the date of diagnosis was used to identify patients between ages 40 and 49 and tumor location as abstracted in the VACCR. Regression analysis was used to examine trends in stage at diagnosis and in those between aged 40 and 49.

RESULTS: Our findings indicate that proximal (rightsided) colon cancer is associated with poorer survival than distal (left-sided), consistent with previous findings. During this time period, 3% of the cohort or 1,249 cases were diagnosed amongst individuals of ages 40 – 49. Regression analysis indicated differences in trends amongst VHA patients younger than fifty years of age and in stage at diagnosis. Though, the time period of this study was shorter than those previously published.

CONCLUSION: Further work is underway to identify the sources of these differences in survivorship in VHA patients, including the analysis of therapeutic regimens. This work was performed under R&D and IRB protocols reviewed approved by the VA Boston Healthcare System.

BACKGROUND: Colorectal cancer (CRC) accounts for about 10% of all cancers in the VA. Three-year survival is associated with both age at diagnosis and CRC stage. Yet, the minority of cases are detected at an early stage and the overall incidence of cancer in the VA patient population is forecast to rise. CRC survival and pathogenesis differ by tumor location Increases in CRC cases in individuals younger than fifty-years-of age and at more advanced stages have been reported in large, U.S. population-based cohorts (Meester et al., 2019). Here, we present a preliminary investigation of these trends amongst CRC patients in the VA.

METHODS: Briefly, a cohort of veteran patients (n = 40,951) was identified from 2000 – 2017 using the VA Central Cancer Registry (VACCR). We required all included patients to have a histologically-confirmed case of CRC as consistent with previous studies (Zullig et al., 2016) and only one registry entry. We constructed Kaplan- Meier curves and created a Cox-Proportional Hazards model to examine survival. Additional filtering by age at the date of diagnosis was used to identify patients between ages 40 and 49 and tumor location as abstracted in the VACCR. Regression analysis was used to examine trends in stage at diagnosis and in those between aged 40 and 49.

RESULTS: Our findings indicate that proximal (rightsided) colon cancer is associated with poorer survival than distal (left-sided), consistent with previous findings. During this time period, 3% of the cohort or 1,249 cases were diagnosed amongst individuals of ages 40 – 49. Regression analysis indicated differences in trends amongst VHA patients younger than fifty years of age and in stage at diagnosis. Though, the time period of this study was shorter than those previously published.

CONCLUSION: Further work is underway to identify the sources of these differences in survivorship in VHA patients, including the analysis of therapeutic regimens. This work was performed under R&D and IRB protocols reviewed approved by the VA Boston Healthcare System.

BACKGROUND: Colorectal cancer (CRC) accounts for about 10% of all cancers in the VA. Three-year survival is associated with both age at diagnosis and CRC stage. Yet, the minority of cases are detected at an early stage and the overall incidence of cancer in the VA patient population is forecast to rise. CRC survival and pathogenesis differ by tumor location Increases in CRC cases in individuals younger than fifty-years-of age and at more advanced stages have been reported in large, U.S. population-based cohorts (Meester et al., 2019). Here, we present a preliminary investigation of these trends amongst CRC patients in the VA.

METHODS: Briefly, a cohort of veteran patients (n = 40,951) was identified from 2000 – 2017 using the VA Central Cancer Registry (VACCR). We required all included patients to have a histologically-confirmed case of CRC as consistent with previous studies (Zullig et al., 2016) and only one registry entry. We constructed Kaplan- Meier curves and created a Cox-Proportional Hazards model to examine survival. Additional filtering by age at the date of diagnosis was used to identify patients between ages 40 and 49 and tumor location as abstracted in the VACCR. Regression analysis was used to examine trends in stage at diagnosis and in those between aged 40 and 49.

RESULTS: Our findings indicate that proximal (rightsided) colon cancer is associated with poorer survival than distal (left-sided), consistent with previous findings. During this time period, 3% of the cohort or 1,249 cases were diagnosed amongst individuals of ages 40 – 49. Regression analysis indicated differences in trends amongst VHA patients younger than fifty years of age and in stage at diagnosis. Though, the time period of this study was shorter than those previously published.

CONCLUSION: Further work is underway to identify the sources of these differences in survivorship in VHA patients, including the analysis of therapeutic regimens. This work was performed under R&D and IRB protocols reviewed approved by the VA Boston Healthcare System.

PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.

BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.

METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.

DATA ANALYSIS: We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.

RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.

IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.

PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.

BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.

METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.

DATA ANALYSIS: We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.

RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.

IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.

PURPOSE: To describe the frequency of Veterans reporting and the factors associated with transportation barriers to or from colorectal cancer (CRC) care visits.

BACKGROUND: Transportation barriers limit access to healthcare services and contribute to suboptimal clinical outcomes across the cancer care continuum. The relationship between patient-level characteristics, travel-related factors (e.g., mode of transportation), and transportation barriers among Veterans with CRC has been poorly described.

METHODS: Between November 2015 and September 2016, Veterans with incident stage I, II, or III CRC completed the Colorectal Cancer Patient Adherence to Survivorship Treatment survey to assess their perceived barriers to, and adherence with, recommended care. The survey measured: (1) demographics; (2) travel-related factors, including distance traveled to and convenience of care; and (3) perceived chaotic lifestyle (e.g., ability to organize, predictability of schedules) using the Confusion, Hubbub, and Order Scale. Veterans who reported “Always”, “Often”, or “Sometimes” experiencing difficulty with transportation to or from CRC care appointments were categorized as having transportation barriers.

DATA ANALYSIS: We assessed pairwise correlations between transportation barriers, travel-related factors, and chaotic lifestyle and used logistic regression to evaluate the association between the reporting of transportation barriers, distance traveled to care, and chaotic lifestyle.

RESULTS: Of the 115 Veterans included in this analysis, 21 (18%) reported transportation barriers to or from CRC care visits. A majority of Veterans who reported transportation barriers were previously married (62%), traveled more than 20 miles for care (81%), and had a chaotic lifestyle (57%). Distance to care was not strongly correlated with reporting transportation barriers (Spearman’s ρ=0.12, p=0.19), whereas a chaotic lifestyle was both positively and significantly correlated with experiencing transportation barriers (Spearman’s ρ=0.22, p=0.02). Results from the logistic regression model modestly supported the findings from the pairwise correlations, but were not statistically significant.

IMPLICATIONS: Transportation is an important barrier to or from CRC care visits, especially among Veterans who experience chaotic lifestyles. Identifying Veterans with chaotic lifestyles would allow for timely intervention (e.g., patient navigation, organizational skills training), which could result in the potential modification of observed risk factors and thus, support access to healthcare services and treatment across the cancer care continuum.

PURPOSE: This retrospective analysis was designed to determine the incidence of venous and arterial thromboembolic events (TEEs) in lung cancer patients treated with either conventional chemotherapy (CC) alone, immunotherapy (IT) alone, or a combination of the two (C+I).

BACKGROUND: TEEs are a serious complication in cancer patients. Lung cancer is among the more thrombogenic malignancies and platinum-based chemotherapy used commonly in this setting is among the more thrombogenic CC regimens. IT and C+I have an increasing role among frontline management options for advanced stage lung cancers. However, the incidence of TEEs associated with IT agents has not been well characterized.

METHODS: Veterans with lung cancer were retrospectively identified in a VINCI CDW research database by ICD code. Treatment with CC and/or IT, and incidence of and time to TEEs (defined as deep vein thrombosis, pulmonary embolism, stroke, or myocardial infarction) were retrieved from the database using custom queries. Time to TEE was assessed relative to treatment start date, with censoring at a maximum of 180 days.

DATA ANALYSIS: We performed chi-squared tests and Kaplan-Meier time-to-event analyses among CC, C+I, and IT cohorts, controlling for platinum-containing v. non-platinum regimens. RESULTS: We identified 77,472 Veterans (97.7 % male, average age 66) with lung cancer treated between 1992-2019, 93.6% of whom received CC, while 4.5% and 1.9% received C+I or IT, respectively. We observed the highest rate of TEE in the IT cohort (13% v. 7.3% and 5.4% in the CC and C+I cohorts), and found that platinum-based chemotherapy decreased the likelihood of TEE (r = -3.13 and -4.06 for platinum-only and platinum-based with immunotherapy regimens), whereas IT strongly increased the likelihood of TEE (r = 8.05) (p<0.001). Finally, we confirm a decrease in time to TEE between the IT compared with CC and C+I cohorts (average 41 v. 57 and 65 days, respectively; <0.0001).

IMPLICATIONS: We found increased TEEs among lung cancer patients who received frontline IT compared with CC or C+I. With uncertainty in use of prophylactic anticoagulation for ambulatory cancer patients being treated with systemic therapy, cancer-associated TEE incidence and prevention in the IT setting warrants further evaluation.

PURPOSE: This retrospective analysis was designed to determine the incidence of venous and arterial thromboembolic events (TEEs) in lung cancer patients treated with either conventional chemotherapy (CC) alone, immunotherapy (IT) alone, or a combination of the two (C+I).

BACKGROUND: TEEs are a serious complication in cancer patients. Lung cancer is among the more thrombogenic malignancies and platinum-based chemotherapy used commonly in this setting is among the more thrombogenic CC regimens. IT and C+I have an increasing role among frontline management options for advanced stage lung cancers. However, the incidence of TEEs associated with IT agents has not been well characterized.

METHODS: Veterans with lung cancer were retrospectively identified in a VINCI CDW research database by ICD code. Treatment with CC and/or IT, and incidence of and time to TEEs (defined as deep vein thrombosis, pulmonary embolism, stroke, or myocardial infarction) were retrieved from the database using custom queries. Time to TEE was assessed relative to treatment start date, with censoring at a maximum of 180 days.

DATA ANALYSIS: We performed chi-squared tests and Kaplan-Meier time-to-event analyses among CC, C+I, and IT cohorts, controlling for platinum-containing v. non-platinum regimens. RESULTS: We identified 77,472 Veterans (97.7 % male, average age 66) with lung cancer treated between 1992-2019, 93.6% of whom received CC, while 4.5% and 1.9% received C+I or IT, respectively. We observed the highest rate of TEE in the IT cohort (13% v. 7.3% and 5.4% in the CC and C+I cohorts), and found that platinum-based chemotherapy decreased the likelihood of TEE (r = -3.13 and -4.06 for platinum-only and platinum-based with immunotherapy regimens), whereas IT strongly increased the likelihood of TEE (r = 8.05) (p<0.001). Finally, we confirm a decrease in time to TEE between the IT compared with CC and C+I cohorts (average 41 v. 57 and 65 days, respectively; <0.0001).

IMPLICATIONS: We found increased TEEs among lung cancer patients who received frontline IT compared with CC or C+I. With uncertainty in use of prophylactic anticoagulation for ambulatory cancer patients being treated with systemic therapy, cancer-associated TEE incidence and prevention in the IT setting warrants further evaluation.

PURPOSE: This retrospective analysis was designed to determine the incidence of venous and arterial thromboembolic events (TEEs) in lung cancer patients treated with either conventional chemotherapy (CC) alone, immunotherapy (IT) alone, or a combination of the two (C+I).

BACKGROUND: TEEs are a serious complication in cancer patients. Lung cancer is among the more thrombogenic malignancies and platinum-based chemotherapy used commonly in this setting is among the more thrombogenic CC regimens. IT and C+I have an increasing role among frontline management options for advanced stage lung cancers. However, the incidence of TEEs associated with IT agents has not been well characterized.

METHODS: Veterans with lung cancer were retrospectively identified in a VINCI CDW research database by ICD code. Treatment with CC and/or IT, and incidence of and time to TEEs (defined as deep vein thrombosis, pulmonary embolism, stroke, or myocardial infarction) were retrieved from the database using custom queries. Time to TEE was assessed relative to treatment start date, with censoring at a maximum of 180 days.

DATA ANALYSIS: We performed chi-squared tests and Kaplan-Meier time-to-event analyses among CC, C+I, and IT cohorts, controlling for platinum-containing v. non-platinum regimens. RESULTS: We identified 77,472 Veterans (97.7 % male, average age 66) with lung cancer treated between 1992-2019, 93.6% of whom received CC, while 4.5% and 1.9% received C+I or IT, respectively. We observed the highest rate of TEE in the IT cohort (13% v. 7.3% and 5.4% in the CC and C+I cohorts), and found that platinum-based chemotherapy decreased the likelihood of TEE (r = -3.13 and -4.06 for platinum-only and platinum-based with immunotherapy regimens), whereas IT strongly increased the likelihood of TEE (r = 8.05) (p<0.001). Finally, we confirm a decrease in time to TEE between the IT compared with CC and C+I cohorts (average 41 v. 57 and 65 days, respectively; <0.0001).

IMPLICATIONS: We found increased TEEs among lung cancer patients who received frontline IT compared with CC or C+I. With uncertainty in use of prophylactic anticoagulation for ambulatory cancer patients being treated with systemic therapy, cancer-associated TEE incidence and prevention in the IT setting warrants further evaluation.

BACKGROUND: There has been an unprecedented increase in vaping by young people. In 2019, an outbreak of acute lung injuries linked to vaping was later recognized as a disease entity known as e-cigarette or vaping product-use associated lung injury (EVALI). A number of cancer therapeutics have been associated with pulmonary toxicity, and the incidence and severity of immune- and chemotherapy-related pneumonitis may be additionally compounded by EVALI. Here we present the case of a 42-year-old male with good-risk advanced seminoma treated with three cycles of bleomycin, etoposide, and cisplatin for curative intent.

CASE REPORT: The patient developed febrile neutropenia after the third cycle of treatment, and upon count recovery, he rapidly deteriorated into acute hypoxic respiratory failure that was ultimately fatal and most consistent with bleomycin-induced lung toxicity. It was later revealed that the patient had been an avid user of tetrahydrocannabinol-containing vaping products, and whether this contributed to a more progressive injurious picture is unknown.

DISCUSION: We have also encountered several cases of non-infectious hypoxic respiratory failure in patients who reported a history of vaping while receiving checkpoint inhibitor immunotherapy for advanced lung cancer. While the incidence of EVALI has declined following its highly publicized notoriety, vaping remains quite popular despite known hazards and represents a significant public health challenge. The risks posed by the use of vaping products may be higher for individuals with cancer who are often older and more frequently suffer from comorbidities that may increase susceptibility to drug-induced lung injury. Consequently, additional efforts should be made to increase awareness of the harmful effects of vaping, especially in the era of COVID-19. To minimize oncology-related pulmonary complications for which vaping may be a risk factor, we updated our infusion nursing evaluation to include questions on vaping activities and implemented provider notification before administering cancer-directed therapy. We have also educated our oncology team about the importance of obtaining a vaping history.

CONCLUSION: As oncology providers for the Veteran population, we should be mindful to counsel our cancer patients about the health risks of vaping and encourage alternative nicotine replacement therapy for those who use nicotine-based vaping products for smoking cessation.

BACKGROUND: There has been an unprecedented increase in vaping by young people. In 2019, an outbreak of acute lung injuries linked to vaping was later recognized as a disease entity known as e-cigarette or vaping product-use associated lung injury (EVALI). A number of cancer therapeutics have been associated with pulmonary toxicity, and the incidence and severity of immune- and chemotherapy-related pneumonitis may be additionally compounded by EVALI. Here we present the case of a 42-year-old male with good-risk advanced seminoma treated with three cycles of bleomycin, etoposide, and cisplatin for curative intent.

CASE REPORT: The patient developed febrile neutropenia after the third cycle of treatment, and upon count recovery, he rapidly deteriorated into acute hypoxic respiratory failure that was ultimately fatal and most consistent with bleomycin-induced lung toxicity. It was later revealed that the patient had been an avid user of tetrahydrocannabinol-containing vaping products, and whether this contributed to a more progressive injurious picture is unknown.

DISCUSION: We have also encountered several cases of non-infectious hypoxic respiratory failure in patients who reported a history of vaping while receiving checkpoint inhibitor immunotherapy for advanced lung cancer. While the incidence of EVALI has declined following its highly publicized notoriety, vaping remains quite popular despite known hazards and represents a significant public health challenge. The risks posed by the use of vaping products may be higher for individuals with cancer who are often older and more frequently suffer from comorbidities that may increase susceptibility to drug-induced lung injury. Consequently, additional efforts should be made to increase awareness of the harmful effects of vaping, especially in the era of COVID-19. To minimize oncology-related pulmonary complications for which vaping may be a risk factor, we updated our infusion nursing evaluation to include questions on vaping activities and implemented provider notification before administering cancer-directed therapy. We have also educated our oncology team about the importance of obtaining a vaping history.

CONCLUSION: As oncology providers for the Veteran population, we should be mindful to counsel our cancer patients about the health risks of vaping and encourage alternative nicotine replacement therapy for those who use nicotine-based vaping products for smoking cessation.

BACKGROUND: There has been an unprecedented increase in vaping by young people. In 2019, an outbreak of acute lung injuries linked to vaping was later recognized as a disease entity known as e-cigarette or vaping product-use associated lung injury (EVALI). A number of cancer therapeutics have been associated with pulmonary toxicity, and the incidence and severity of immune- and chemotherapy-related pneumonitis may be additionally compounded by EVALI. Here we present the case of a 42-year-old male with good-risk advanced seminoma treated with three cycles of bleomycin, etoposide, and cisplatin for curative intent.

CASE REPORT: The patient developed febrile neutropenia after the third cycle of treatment, and upon count recovery, he rapidly deteriorated into acute hypoxic respiratory failure that was ultimately fatal and most consistent with bleomycin-induced lung toxicity. It was later revealed that the patient had been an avid user of tetrahydrocannabinol-containing vaping products, and whether this contributed to a more progressive injurious picture is unknown.

DISCUSION: We have also encountered several cases of non-infectious hypoxic respiratory failure in patients who reported a history of vaping while receiving checkpoint inhibitor immunotherapy for advanced lung cancer. While the incidence of EVALI has declined following its highly publicized notoriety, vaping remains quite popular despite known hazards and represents a significant public health challenge. The risks posed by the use of vaping products may be higher for individuals with cancer who are often older and more frequently suffer from comorbidities that may increase susceptibility to drug-induced lung injury. Consequently, additional efforts should be made to increase awareness of the harmful effects of vaping, especially in the era of COVID-19. To minimize oncology-related pulmonary complications for which vaping may be a risk factor, we updated our infusion nursing evaluation to include questions on vaping activities and implemented provider notification before administering cancer-directed therapy. We have also educated our oncology team about the importance of obtaining a vaping history.

CONCLUSION: As oncology providers for the Veteran population, we should be mindful to counsel our cancer patients about the health risks of vaping and encourage alternative nicotine replacement therapy for those who use nicotine-based vaping products for smoking cessation.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that account for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within basaloid squamous cell carcinoma subtype and its impact on survival.

METHODS: A cohort of 1,999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy.

RESULTS: In this cohort, 82% were male with a median age of 59 years. The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The majority of the cohort had stage IV disease, while 3.9% had metastases. The presence of metastasis increased probability of mortality (HR=2.14; 95% CI: 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR=2.45; 95% CI: 1.83-3.29), hypopharynx (HR=2.58; 95% CI: 1.64-4.05), and larynx (HR=2.89; 95% CI: 2.25-3.73). Adjuvant chemoradiation (HR=0.36; 95% CI: 0.23-0.58) and adjuvant radiation (HR=0.38; 95% CI: 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy alone. Patients with microscopic tumor margins had better survival outcomes when compared to no surgery (HR=0.38, 98% Cl: 0.23-0.64) while there was no better survival outcomes of patients with macroscopic margins compared to no surgery.

CONCLUSION: This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, microscopic margins or residual tumor were associated with greater survival. This study demonstrates the importance of these factors as independent prognostic factors when considering survival of patients diagnosed with BSCC of the head and neck.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that account for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within basaloid squamous cell carcinoma subtype and its impact on survival.

METHODS: A cohort of 1,999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy.

RESULTS: In this cohort, 82% were male with a median age of 59 years. The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The majority of the cohort had stage IV disease, while 3.9% had metastases. The presence of metastasis increased probability of mortality (HR=2.14; 95% CI: 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR=2.45; 95% CI: 1.83-3.29), hypopharynx (HR=2.58; 95% CI: 1.64-4.05), and larynx (HR=2.89; 95% CI: 2.25-3.73). Adjuvant chemoradiation (HR=0.36; 95% CI: 0.23-0.58) and adjuvant radiation (HR=0.38; 95% CI: 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy alone. Patients with microscopic tumor margins had better survival outcomes when compared to no surgery (HR=0.38, 98% Cl: 0.23-0.64) while there was no better survival outcomes of patients with macroscopic margins compared to no surgery.

CONCLUSION: This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, microscopic margins or residual tumor were associated with greater survival. This study demonstrates the importance of these factors as independent prognostic factors when considering survival of patients diagnosed with BSCC of the head and neck.

BACKGROUND: Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that account for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within basaloid squamous cell carcinoma subtype and its impact on survival.

METHODS: A cohort of 1,999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy.

RESULTS: In this cohort, 82% were male with a median age of 59 years. The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The majority of the cohort had stage IV disease, while 3.9% had metastases. The presence of metastasis increased probability of mortality (HR=2.14; 95% CI: 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR=2.45; 95% CI: 1.83-3.29), hypopharynx (HR=2.58; 95% CI: 1.64-4.05), and larynx (HR=2.89; 95% CI: 2.25-3.73). Adjuvant chemoradiation (HR=0.36; 95% CI: 0.23-0.58) and adjuvant radiation (HR=0.38; 95% CI: 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy alone. Patients with microscopic tumor margins had better survival outcomes when compared to no surgery (HR=0.38, 98% Cl: 0.23-0.64) while there was no better survival outcomes of patients with macroscopic margins compared to no surgery.

CONCLUSION: This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, microscopic margins or residual tumor were associated with greater survival. This study demonstrates the importance of these factors as independent prognostic factors when considering survival of patients diagnosed with BSCC of the head and neck.

PURPOSE: To evaluate outcomes of disease progression based on the sequence of abiraterone and enzalutamide in veterans diagnosed with metastatic castration-resistant prostate cancer (mCRPC). BACKGROUND: Two of the current options for mCRPC treatment are the novel oral hormonal agents abiraterone and enzalutamide. After progression on one of these agents, one option is to switch to the other agent not previously used. Previously published retrospective studies and one prospective study have shown a difference in outcomes favoring abiraterone followed by enzalutamide, while others have shown no difference based on sequence. The optimal sequence of abiraterone and enzalutamide is still unclear.

METHODS: This was a retrospective chart review of patients who received abiraterone and enzalutamide in sequence for the treatment of mCRPC within our healthcare system from April 28, 2011 through October 31, 2019. Baseline demographic information such as age, race, Gleason score, and prior treatments were collected. The primary outcome was combined prostate-specific antigen progression-free survival (cPSA-PFS). Secondary outcomes included radiographic PFS (rPFS), overall survival (OS), adverse events causing treatment discontinuation, and medication adherence. Between-group survival differences were estimated by the Kaplan-Meier method and an unadjusted Cox regression model.

RESULTS: A total of 77 patients met criteria for study inclusion, with 51 in the abiraterone-to-enzalutamide group (ABI-ENZ) and 26 in the enzalutamide-to-abiraterone group (ENZ-ABI). For the primary outcome of cPSA-PFS, the median survival of the ABI-ENZ and ENZ-ABI groups was 17.3 months (95% CI, 10.3-24.3 months) and 10.2 months (95% CI, 8.5-11.8 months), respectively, which was significantly different (log-rank P=0.009) in favor of the ABI-ENZ sequence (HR 0.46; 95% CI, 0.26-0.83). Secondary outcomes of rPFS and OS were not significantly different between groups.

CONCLUSION: This study adds to the evidence supporting the sequence of abiraterone before enzalutamide for improving PSA-PFS. It is thought this might be related to differences in mechanisms of resistance between the two drugs. This benefit has not yet translated to an improvement in rPFS and OS. Based on the results of this study in conjunction with previously published studies, use of abiraterone before enzalutamide should be considered over the alternate sequence.

PURPOSE: To evaluate outcomes of disease progression based on the sequence of abiraterone and enzalutamide in veterans diagnosed with metastatic castration-resistant prostate cancer (mCRPC). BACKGROUND: Two of the current options for mCRPC treatment are the novel oral hormonal agents abiraterone and enzalutamide. After progression on one of these agents, one option is to switch to the other agent not previously used. Previously published retrospective studies and one prospective study have shown a difference in outcomes favoring abiraterone followed by enzalutamide, while others have shown no difference based on sequence. The optimal sequence of abiraterone and enzalutamide is still unclear.

METHODS: This was a retrospective chart review of patients who received abiraterone and enzalutamide in sequence for the treatment of mCRPC within our healthcare system from April 28, 2011 through October 31, 2019. Baseline demographic information such as age, race, Gleason score, and prior treatments were collected. The primary outcome was combined prostate-specific antigen progression-free survival (cPSA-PFS). Secondary outcomes included radiographic PFS (rPFS), overall survival (OS), adverse events causing treatment discontinuation, and medication adherence. Between-group survival differences were estimated by the Kaplan-Meier method and an unadjusted Cox regression model.

RESULTS: A total of 77 patients met criteria for study inclusion, with 51 in the abiraterone-to-enzalutamide group (ABI-ENZ) and 26 in the enzalutamide-to-abiraterone group (ENZ-ABI). For the primary outcome of cPSA-PFS, the median survival of the ABI-ENZ and ENZ-ABI groups was 17.3 months (95% CI, 10.3-24.3 months) and 10.2 months (95% CI, 8.5-11.8 months), respectively, which was significantly different (log-rank P=0.009) in favor of the ABI-ENZ sequence (HR 0.46; 95% CI, 0.26-0.83). Secondary outcomes of rPFS and OS were not significantly different between groups.

CONCLUSION: This study adds to the evidence supporting the sequence of abiraterone before enzalutamide for improving PSA-PFS. It is thought this might be related to differences in mechanisms of resistance between the two drugs. This benefit has not yet translated to an improvement in rPFS and OS. Based on the results of this study in conjunction with previously published studies, use of abiraterone before enzalutamide should be considered over the alternate sequence.

PURPOSE: To evaluate outcomes of disease progression based on the sequence of abiraterone and enzalutamide in veterans diagnosed with metastatic castration-resistant prostate cancer (mCRPC). BACKGROUND: Two of the current options for mCRPC treatment are the novel oral hormonal agents abiraterone and enzalutamide. After progression on one of these agents, one option is to switch to the other agent not previously used. Previously published retrospective studies and one prospective study have shown a difference in outcomes favoring abiraterone followed by enzalutamide, while others have shown no difference based on sequence. The optimal sequence of abiraterone and enzalutamide is still unclear.

METHODS: This was a retrospective chart review of patients who received abiraterone and enzalutamide in sequence for the treatment of mCRPC within our healthcare system from April 28, 2011 through October 31, 2019. Baseline demographic information such as age, race, Gleason score, and prior treatments were collected. The primary outcome was combined prostate-specific antigen progression-free survival (cPSA-PFS). Secondary outcomes included radiographic PFS (rPFS), overall survival (OS), adverse events causing treatment discontinuation, and medication adherence. Between-group survival differences were estimated by the Kaplan-Meier method and an unadjusted Cox regression model.

RESULTS: A total of 77 patients met criteria for study inclusion, with 51 in the abiraterone-to-enzalutamide group (ABI-ENZ) and 26 in the enzalutamide-to-abiraterone group (ENZ-ABI). For the primary outcome of cPSA-PFS, the median survival of the ABI-ENZ and ENZ-ABI groups was 17.3 months (95% CI, 10.3-24.3 months) and 10.2 months (95% CI, 8.5-11.8 months), respectively, which was significantly different (log-rank P=0.009) in favor of the ABI-ENZ sequence (HR 0.46; 95% CI, 0.26-0.83). Secondary outcomes of rPFS and OS were not significantly different between groups.

CONCLUSION: This study adds to the evidence supporting the sequence of abiraterone before enzalutamide for improving PSA-PFS. It is thought this might be related to differences in mechanisms of resistance between the two drugs. This benefit has not yet translated to an improvement in rPFS and OS. Based on the results of this study in conjunction with previously published studies, use of abiraterone before enzalutamide should be considered over the alternate sequence.

PURPOSE: To evaluate outcomes of disease progression based on the sequence of abiraterone and enzalutamide in veterans diagnosed with metastatic castration-resistant prostate cancer (mCRPC).

BACKGROUND: Two of the current options for mCRPC treatment are the novel oral hormonal agents abiraterone and enzalutamide. After progression on one of these agents, one option is to switch to the other agent not previously used. Previously published retrospective studies and one prospective study have shown a difference in outcomes favoring abiraterone followed by enzalutamide, while others have shown no difference based on sequence. The optimal sequence of abiraterone and enzalutamide is still unclear.

METHODS: This was a retrospective chart review of patients who received abiraterone and enzalutamide in sequence for the treatment of mCRPC within our healthcare system from April 28, 2011 through October 31, 2019. Baseline demographic information such as age, race, Gleason score, and prior treatments were collected. The primary outcome was combined prostate-specific antigen progression-free survival (cPSA-PFS). Secondary outcomes included radiographic PFS (rPFS), overall survival (OS), adverse events causing treatment discontinuation, and medication adherence. Between-group survival differences were estimated by the Kaplan-Meier method and an unadjusted Cox regression model.

RESULTS: A total of 77 patients met criteria for study inclusion, with 51 in the abiraterone-to-enzalutamide group (ABI-ENZ) and 26 in the enzalutamide-to-abiraterone group (ENZ-ABI). For the primary outcome of cPSA-PFS, the median survival of the ABI-ENZ and ENZ-ABI groups was 17.3 months (95% CI, 10.3-24.3 months) and 10.2 months (95% CI, 8.5-11.8 months), respectively, which was significantly different (log-rank P=0.009) in favor of the ABI-ENZ sequence (HR 0.46; 95% CI, 0.26-0.83). Secondary outcomes of rPFS and OS were not significantly different between groups.

CONCLUSION: This study adds to the evidence supporting the sequence of abiraterone before enzalutamide for improving PSA-PFS. It is thought this might be related to differences in mechanisms of resistance between the two drugs. This benefit has not yet translated to an improvement in rPFS and OS. Based on the results of this study in conjunction with previously published studies, use of abiraterone before enzalutamide should be considered over the alternate sequence.

PURPOSE: To evaluate outcomes of disease progression based on the sequence of abiraterone and enzalutamide in veterans diagnosed with metastatic castration-resistant prostate cancer (mCRPC).

BACKGROUND: Two of the current options for mCRPC treatment are the novel oral hormonal agents abiraterone and enzalutamide. After progression on one of these agents, one option is to switch to the other agent not previously used. Previously published retrospective studies and one prospective study have shown a difference in outcomes favoring abiraterone followed by enzalutamide, while others have shown no difference based on sequence. The optimal sequence of abiraterone and enzalutamide is still unclear.

METHODS: This was a retrospective chart review of patients who received abiraterone and enzalutamide in sequence for the treatment of mCRPC within our healthcare system from April 28, 2011 through October 31, 2019. Baseline demographic information such as age, race, Gleason score, and prior treatments were collected. The primary outcome was combined prostate-specific antigen progression-free survival (cPSA-PFS). Secondary outcomes included radiographic PFS (rPFS), overall survival (OS), adverse events causing treatment discontinuation, and medication adherence. Between-group survival differences were estimated by the Kaplan-Meier method and an unadjusted Cox regression model.

RESULTS: A total of 77 patients met criteria for study inclusion, with 51 in the abiraterone-to-enzalutamide group (ABI-ENZ) and 26 in the enzalutamide-to-abiraterone group (ENZ-ABI). For the primary outcome of cPSA-PFS, the median survival of the ABI-ENZ and ENZ-ABI groups was 17.3 months (95% CI, 10.3-24.3 months) and 10.2 months (95% CI, 8.5-11.8 months), respectively, which was significantly different (log-rank P=0.009) in favor of the ABI-ENZ sequence (HR 0.46; 95% CI, 0.26-0.83). Secondary outcomes of rPFS and OS were not significantly different between groups.

CONCLUSION: This study adds to the evidence supporting the sequence of abiraterone before enzalutamide for improving PSA-PFS. It is thought this might be related to differences in mechanisms of resistance between the two drugs. This benefit has not yet translated to an improvement in rPFS and OS. Based on the results of this study in conjunction with previously published studies, use of abiraterone before enzalutamide should be considered over the alternate sequence.

PURPOSE: To evaluate outcomes of disease progression based on the sequence of abiraterone and enzalutamide in veterans diagnosed with metastatic castration-resistant prostate cancer (mCRPC).

BACKGROUND: Two of the current options for mCRPC treatment are the novel oral hormonal agents abiraterone and enzalutamide. After progression on one of these agents, one option is to switch to the other agent not previously used. Previously published retrospective studies and one prospective study have shown a difference in outcomes favoring abiraterone followed by enzalutamide, while others have shown no difference based on sequence. The optimal sequence of abiraterone and enzalutamide is still unclear.

METHODS: This was a retrospective chart review of patients who received abiraterone and enzalutamide in sequence for the treatment of mCRPC within our healthcare system from April 28, 2011 through October 31, 2019. Baseline demographic information such as age, race, Gleason score, and prior treatments were collected. The primary outcome was combined prostate-specific antigen progression-free survival (cPSA-PFS). Secondary outcomes included radiographic PFS (rPFS), overall survival (OS), adverse events causing treatment discontinuation, and medication adherence. Between-group survival differences were estimated by the Kaplan-Meier method and an unadjusted Cox regression model.

RESULTS: A total of 77 patients met criteria for study inclusion, with 51 in the abiraterone-to-enzalutamide group (ABI-ENZ) and 26 in the enzalutamide-to-abiraterone group (ENZ-ABI). For the primary outcome of cPSA-PFS, the median survival of the ABI-ENZ and ENZ-ABI groups was 17.3 months (95% CI, 10.3-24.3 months) and 10.2 months (95% CI, 8.5-11.8 months), respectively, which was significantly different (log-rank P=0.009) in favor of the ABI-ENZ sequence (HR 0.46; 95% CI, 0.26-0.83). Secondary outcomes of rPFS and OS were not significantly different between groups.

CONCLUSION: This study adds to the evidence supporting the sequence of abiraterone before enzalutamide for improving PSA-PFS. It is thought this might be related to differences in mechanisms of resistance between the two drugs. This benefit has not yet translated to an improvement in rPFS and OS. Based on the results of this study in conjunction with previously published studies, use of abiraterone before enzalutamide should be considered over the alternate sequence.

BACKGROUND: Signet ring cell carcinoma of the esophagus (SRCCE) is an aggressive tumor that represents approximately 3.5-5.0% of all esophageal cancers. Prior studies have shown a strong correlation between treating facility and survival for different cancers, but this has not been studied in SRCCE. The goal of this study is to assess differences in survival based on the type of treatment facility.

METHODS: There were 1,442 patients with SRCCE identified using the histology 8490 and topography codes C15.0-C15.9 in the National Cancer Database (NCDB). Descriptive analysis, Kaplan-Meier curves, and a multivariable Cox hazard regression analysis were all utilized to determine the significance and impact of treatment facility type, race, age, sex, tumor stage, use of adjuvant or neoadjuvant radiation, and surgical margins on survival.

RESULTS: The cohort was mostly male (86.6%) and Non-Hispanic Caucasian (96.3%) with 52.7% receiving treatment at academic centers followed by 35.9% at community programs and 11.4% at integrated cancer programs. As age increased, mortality also increased (HR = 1.02; 95% CI: 1.01-1.02, p < 0.001). Both Hispanic Caucasians (HR = 2.09; 95% CI: 1.21-3.62, = 0.009) and Africans Americans (HR = 1.69; 95% CI: 1.04-2.75, = 0.036) had an increased risk of mortality when compared to Non-Hispanic Caucasians. Patients at academic facilities demonstrated a decreased risk of mortality when compared to community programs (HR = 0.73; 95% CI: 0.63-0.86, p < 0.001) and integrated cancer programs (HR = 0.74; 95% CI: 0.60- 0.93, = 0.008).

CONCLUSION: For patients diagnosed with SRCCE, receiving treatment at academic centers resulted in better survival probabilities compared to nonacademic facilities. Older patients, African Americans and Hispanic Caucasians, increasing tumor stage, positive surgical margins, and comorbidities with Charlson- Deyo scores of 1 and 2+ were all associated with an increased risk of mortality from SRCCE.

BACKGROUND: Signet ring cell carcinoma of the esophagus (SRCCE) is an aggressive tumor that represents approximately 3.5-5.0% of all esophageal cancers. Prior studies have shown a strong correlation between treating facility and survival for different cancers, but this has not been studied in SRCCE. The goal of this study is to assess differences in survival based on the type of treatment facility.

METHODS: There were 1,442 patients with SRCCE identified using the histology 8490 and topography codes C15.0-C15.9 in the National Cancer Database (NCDB). Descriptive analysis, Kaplan-Meier curves, and a multivariable Cox hazard regression analysis were all utilized to determine the significance and impact of treatment facility type, race, age, sex, tumor stage, use of adjuvant or neoadjuvant radiation, and surgical margins on survival.

RESULTS: The cohort was mostly male (86.6%) and Non-Hispanic Caucasian (96.3%) with 52.7% receiving treatment at academic centers followed by 35.9% at community programs and 11.4% at integrated cancer programs. As age increased, mortality also increased (HR = 1.02; 95% CI: 1.01-1.02, p < 0.001). Both Hispanic Caucasians (HR = 2.09; 95% CI: 1.21-3.62, = 0.009) and Africans Americans (HR = 1.69; 95% CI: 1.04-2.75, = 0.036) had an increased risk of mortality when compared to Non-Hispanic Caucasians. Patients at academic facilities demonstrated a decreased risk of mortality when compared to community programs (HR = 0.73; 95% CI: 0.63-0.86, p < 0.001) and integrated cancer programs (HR = 0.74; 95% CI: 0.60- 0.93, = 0.008).

CONCLUSION: For patients diagnosed with SRCCE, receiving treatment at academic centers resulted in better survival probabilities compared to nonacademic facilities. Older patients, African Americans and Hispanic Caucasians, increasing tumor stage, positive surgical margins, and comorbidities with Charlson- Deyo scores of 1 and 2+ were all associated with an increased risk of mortality from SRCCE.

BACKGROUND: Signet ring cell carcinoma of the esophagus (SRCCE) is an aggressive tumor that represents approximately 3.5-5.0% of all esophageal cancers. Prior studies have shown a strong correlation between treating facility and survival for different cancers, but this has not been studied in SRCCE. The goal of this study is to assess differences in survival based on the type of treatment facility.

METHODS: There were 1,442 patients with SRCCE identified using the histology 8490 and topography codes C15.0-C15.9 in the National Cancer Database (NCDB). Descriptive analysis, Kaplan-Meier curves, and a multivariable Cox hazard regression analysis were all utilized to determine the significance and impact of treatment facility type, race, age, sex, tumor stage, use of adjuvant or neoadjuvant radiation, and surgical margins on survival.

RESULTS: The cohort was mostly male (86.6%) and Non-Hispanic Caucasian (96.3%) with 52.7% receiving treatment at academic centers followed by 35.9% at community programs and 11.4% at integrated cancer programs. As age increased, mortality also increased (HR = 1.02; 95% CI: 1.01-1.02, p < 0.001). Both Hispanic Caucasians (HR = 2.09; 95% CI: 1.21-3.62, = 0.009) and Africans Americans (HR = 1.69; 95% CI: 1.04-2.75, = 0.036) had an increased risk of mortality when compared to Non-Hispanic Caucasians. Patients at academic facilities demonstrated a decreased risk of mortality when compared to community programs (HR = 0.73; 95% CI: 0.63-0.86, p < 0.001) and integrated cancer programs (HR = 0.74; 95% CI: 0.60- 0.93, = 0.008).

CONCLUSION: For patients diagnosed with SRCCE, receiving treatment at academic centers resulted in better survival probabilities compared to nonacademic facilities. Older patients, African Americans and Hispanic Caucasians, increasing tumor stage, positive surgical margins, and comorbidities with Charlson- Deyo scores of 1 and 2+ were all associated with an increased risk of mortality from SRCCE.

BACKGROUND: Colorectal cancer (CRC) screening guidelines generally recommend healthy lifestyle choices for cancer prevention. However, studies have shown inconsistent associations between various risk factors and advanced neoplasia (AN) development. AIM: To identify potentially modifiable baseline dietary and lifestyle risk factors associated with AN among an asymptomatic Veteran population, while accounting for prior colonoscopic findings and varying surveillance intensity.

METHODS: We used data from a prospective colonoscopy screening study collected by the VA Cooperative Studies Program. From 1994 to 1997, 3,121 asymptomatic Veterans aged 50-75 received a baseline colonoscopy screening, at which time they selfreported dietary and lifestyle information. Veterans were subsequently assigned to colonoscopy surveillance regimens and followed for 10 years. AN was defined as invasive CRC or any adenoma ≥1 cm, or with villous histology, or high-grade dysplasia. To detect associations with AN diagnosis, we utilized a longitudinal joint model with two sub-models. A multivariate logistic regression modeled the longitudinal probability of AN, while a time-to-event process adjusted for survival. Here we focus on the multivariate logistic regression, representing associations of dietary and lifestyle risk factors with the odds of being diagnosed with AN.

RESULTS: Of the 3,121 Veterans, 1,915 received at least one colonoscopy following baseline screening. Among the 1,915, we detected a significant positive association with AN for current daily smokers (odds ratio (OR) 1.43, 95% CI: 1.02-2.01) compared to those with prior or no history. We found a protective effect for each 100 IU of dietary vitamin D consumed (OR 0.95, 95% CI: 0.95-0.99). We did not detect any significant associations with BMI, red meat consumption, or physical activity. We found that African American race had a lower odds of AN compared to Caucasian race (OR 0.57, 95% CI: 0.32-0.97).

CONCLUSIONS: We identified smoking status and vitamin D consumption as potentially modifiable baseline risk factors associated with AN development. While these results suggest possible points of intervention and targeted screening, more evidence is required across more diverse populations. Future efforts should focus on understanding changes in such risk factors on associations with AN for patients over time. Finally, racial differences in AN incidence merit further investigation.

BACKGROUND: Colorectal cancer (CRC) screening guidelines generally recommend healthy lifestyle choices for cancer prevention. However, studies have shown inconsistent associations between various risk factors and advanced neoplasia (AN) development. AIM: To identify potentially modifiable baseline dietary and lifestyle risk factors associated with AN among an asymptomatic Veteran population, while accounting for prior colonoscopic findings and varying surveillance intensity.

METHODS: We used data from a prospective colonoscopy screening study collected by the VA Cooperative Studies Program. From 1994 to 1997, 3,121 asymptomatic Veterans aged 50-75 received a baseline colonoscopy screening, at which time they selfreported dietary and lifestyle information. Veterans were subsequently assigned to colonoscopy surveillance regimens and followed for 10 years. AN was defined as invasive CRC or any adenoma ≥1 cm, or with villous histology, or high-grade dysplasia. To detect associations with AN diagnosis, we utilized a longitudinal joint model with two sub-models. A multivariate logistic regression modeled the longitudinal probability of AN, while a time-to-event process adjusted for survival. Here we focus on the multivariate logistic regression, representing associations of dietary and lifestyle risk factors with the odds of being diagnosed with AN.

RESULTS: Of the 3,121 Veterans, 1,915 received at least one colonoscopy following baseline screening. Among the 1,915, we detected a significant positive association with AN for current daily smokers (odds ratio (OR) 1.43, 95% CI: 1.02-2.01) compared to those with prior or no history. We found a protective effect for each 100 IU of dietary vitamin D consumed (OR 0.95, 95% CI: 0.95-0.99). We did not detect any significant associations with BMI, red meat consumption, or physical activity. We found that African American race had a lower odds of AN compared to Caucasian race (OR 0.57, 95% CI: 0.32-0.97).

CONCLUSIONS: We identified smoking status and vitamin D consumption as potentially modifiable baseline risk factors associated with AN development. While these results suggest possible points of intervention and targeted screening, more evidence is required across more diverse populations. Future efforts should focus on understanding changes in such risk factors on associations with AN for patients over time. Finally, racial differences in AN incidence merit further investigation.

BACKGROUND: Colorectal cancer (CRC) screening guidelines generally recommend healthy lifestyle choices for cancer prevention. However, studies have shown inconsistent associations between various risk factors and advanced neoplasia (AN) development. AIM: To identify potentially modifiable baseline dietary and lifestyle risk factors associated with AN among an asymptomatic Veteran population, while accounting for prior colonoscopic findings and varying surveillance intensity.

METHODS: We used data from a prospective colonoscopy screening study collected by the VA Cooperative Studies Program. From 1994 to 1997, 3,121 asymptomatic Veterans aged 50-75 received a baseline colonoscopy screening, at which time they selfreported dietary and lifestyle information. Veterans were subsequently assigned to colonoscopy surveillance regimens and followed for 10 years. AN was defined as invasive CRC or any adenoma ≥1 cm, or with villous histology, or high-grade dysplasia. To detect associations with AN diagnosis, we utilized a longitudinal joint model with two sub-models. A multivariate logistic regression modeled the longitudinal probability of AN, while a time-to-event process adjusted for survival. Here we focus on the multivariate logistic regression, representing associations of dietary and lifestyle risk factors with the odds of being diagnosed with AN.

RESULTS: Of the 3,121 Veterans, 1,915 received at least one colonoscopy following baseline screening. Among the 1,915, we detected a significant positive association with AN for current daily smokers (odds ratio (OR) 1.43, 95% CI: 1.02-2.01) compared to those with prior or no history. We found a protective effect for each 100 IU of dietary vitamin D consumed (OR 0.95, 95% CI: 0.95-0.99). We did not detect any significant associations with BMI, red meat consumption, or physical activity. We found that African American race had a lower odds of AN compared to Caucasian race (OR 0.57, 95% CI: 0.32-0.97).

CONCLUSIONS: We identified smoking status and vitamin D consumption as potentially modifiable baseline risk factors associated with AN development. While these results suggest possible points of intervention and targeted screening, more evidence is required across more diverse populations. Future efforts should focus on understanding changes in such risk factors on associations with AN for patients over time. Finally, racial differences in AN incidence merit further investigation.