ABSTRACT Background New‐Onset Diabetes Mellitus (NODM) is often an early manifestation of pancreatic cancer (Pancreatic Ductal Adenocarcinoma, PDAC). However, there is limited information about (1) the duration prior to PDAC diagnosis when the annual incidence of NODM starts significantly exceeding that in age‐matched controls, (2) the percentage of PDAC patients diagnosed with NODM in the years preceding, and (3) the risk of PDAC following NODM in time when the PDAC risk is significantly higher than in controls. Methods Using the nationwide VA database, we evaluated the annual incidence of NODM for 15 years preceding the PDAC diagnosis and in the age‐ and sex‐matched controls (1:5 matching). In the second part, we evaluated the long‐term risk and predictors of PDAC in NODM patients and controls. Results The case–control study comprised 8198 PDAC patients and 40,992 matched controls. The higher annual incidence of NODM in PDAC patients was statistically significant up to 15 years before PDAC diagnosis. 69.2% of PDAC patients had NODM in the preceding 15 years versus 38.0% of controls. PDAC risk in the 15 years following NODM was 0.60% compared to 0.13% in the controls (aHR 3.83, 95% CI 3.68–3.98, p < 0.001). The risk of PDAC is more pronounced in the 1 year following NODM (aHR 9.07, 95% CI 8.33–9.87) than the subsequent 5 years (aHR 2.98, 95% CI 2.82–3.15). Conclusion NODM pre‐dates PDAC diagnosis in most patients with PDAC. Further evaluation of NODM patients for PDAC has the potential to become a feasible strategy for diagnosing more early‐stage resectable PDACs.

Population-based data on the life expectancy and mortality for acute (AP) and chronic pancreatitis (CP) in the United States are limited. This study evaluates the life expectancy, mortality rates and the cause of death in AP and CP patients. Using the nationwide Veterans Administration database from 1999 to 2015, we identified AP and CP patients (using ICD-9 codes) and non-pancreatitis patients (controls). Age at the time of death was used as a surrogate indicator of life expectancy. Life expectancy in AP and CP patients was compared with the controls, using Cox-proportional hazards model. The mortality rates and cause of death for AP, CP, and controls were also assessed. Overall, we selected 35,550 AP and 12,545 CP patients and 100,000 controls. The life expectancy was significantly lower for both AP (69 years) and CP (71 years) patients compared to the controls (81 years, p < 0.001). The risk of mortality was higher for AP (adjusted hazard ratio (aHR) 1.61, 95

Purpose Examining the associations between sleep duration and lifestyle risk factors and assessed whether sex modify such associations among U.S. adolescents. Design Cross-sectional study among high school students from the 2015-19 national Youth Risk Behavior Survey. Setting US, national. Subjects High school students grade 9-12 (n = 31 871). Measures Students reported hours of sleep on an average school night categorized into “less than 6 hours”, “6 to 7 hours” and “8 hours and more”. Lifestyle risk factors including physical inactivity, insufficient breakfast consumption, current tobacco use, and current binge drinking were self-reported and dichotomized. Analysis Multivariable logistic regression models were used to estimate associations between sleep duration and lifestyle risk factors, adjusting for confounders. Results Compared to students with 8 hours and more of sleep, students with 6 to 7 hours and less than 6 hours of sleep had 79% and 228% ( P < .01) increased odds of insufficient breakfast consumption; and had 22% ( P = 0.0014) and 74% ( P < .01) increased odds of binge drinking, respectively. There is a significant interaction between sleep duration and sex ( P < .05) for physical inactivity and current tobacco use. Conclusion Insufficient sleep is common among US adolescents and is associated with increased risks of multiple lifestyle risk factors, which suggests great needs for multilevel interventions to address sleep deprivation and promote good sleep hygiene among adolescents.

Background: Diabetes mellitus (DM) is a global health challenge affecting patient well-being and quality of life (QoL). This study aimed to validate the Mongolian version of the Diabetes Quality of Life Brief Clinical Inventory (MVDQOL-BCI) in patients with type II DM in Mongolia.

PURPOSE:To translate and culturally adapt the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) into Turkish and assess the psychometric properties of the translated version. METHODS:A forward-backward translation process was conducted in conformity with international guidelines. A total of 150 patients with type 2 diabetes mellitus (T2DM) completed the Turkish version of DQoL-BCI (DQoL-BCI-Tr). The factor structure, test-retest reliability, and construct validity were evaluated. RESULTS:In the DQoL-BCI-Tr, the three-factor structure was found optimal and explained 68.7% of the variance. The DQoL-BCI-Tr showed excellent internal consistency (Cronbach's alpha = 0.90) and test-retest reliability (ICC = 0.98). Cronbach's alpha values ranged from 0.85 to 0.91 for subscales (satisfaction, worry, impact). A negative correlation was found between the total scores of the DQoL-BCI-Tr and the EuroQoL-5 dimensions (EQ-5D) indexes (r= -0.22, p < 0.01). The DQoL-BCI-Tr total score and satisfaction and worry subscale scores differentiated between groups defined by glycated hemoglobin (HbA1c>9%) and the use of insulin. CONCLUSIONS:The study results showed that the DQoL-BCI-Tr can be served as a reliable and valid instrument to obtain information from Turkish patients with T2DM diagnosis, including satisfaction with treatment, the impact of the disease, and worry about the social/vocational issues.Implications for rehabilitationThe Turkish version of the Diabetes Quality of Life Brief Clinical Inventory (DQoL-BCI) is a valid and reliable instrument.The DQoL-BCI Questionnaire in Turkish (DQoL-BCI-Tr) is an easy and quick way to determine satisfaction with treatment, impact of disease, and worry about the social/vocational issues.The DQoL-BCI-Tr is a reliable instrument for assessing disease-specific effects, emotional loads, and satisfaction of Turkish patients with type 2 diabetes in clinical and research settings.

INTRODUCTION: In animal models, inflammation caused by experimental acute pancreatitis (AP) promotes pancreatic carcinogenesis that is preventable by suppressing inflammation. Recent studies noted higher long-term risk of pancreatic ductal adenocarcinoma (PDAC) after AP. In this study, we evaluated whether the long-term PDAC risk after AP was influenced by the etiology of AP, number of recurrences, and if it was because of progression to chronic pancreatitis (CP). METHODS: This retrospective study used nationwide Veterans Administration database spanning 1999–2015. A 2-year washout period was applied to exclude patients with preexisting AP and PDAC. PDAC risk was estimated in patients with AP without (AP group) and with underlying CP (APCP group) and those with CP alone (CP group) and compared with PDAC risk in patients in a control group, respectively, using cause-specific hazards model. RESULTS: The final cohort comprised 7,147,859 subjects (AP-35,550 and PDAC-16,475). The cumulative PDAC risk 3–10 years after AP was higher than in controls (0.61% vs 0.18%), adjusted hazard ratio (1.7 [1.4–2.0], P < 0.001). Adjusted hazard ratio was 1.5 in AP group, 2.4 in the CP group, and 3.3 in APCP group. PDAC risk increased with the number of AP episodes. Elevated PDAC risk after AP was not influenced by the etiology of AP (gallstones, smoking, or alcohol). DISCUSSION: There is a higher PDAC risk 3–10 years after AP irrespective of the etiology of AP, increases with the number of episodes of AP and is additive to higher PDAC risk because of CP.

BACKGROUND:Nonsteroidal anti-inflammatory drugs (NSAIDs) have been linked recently to a lower expression of pro-inflammatory cytokines in humans with acute pancreatitis. Because it is unclear if this effect results in clinical benefits, the aim of this study was to determine if prior NSAID exposure improves immediate clinical outcomes. METHODS:Retrospective medical record review of adult patients admitted with acute pancreatitis. Cases were extracted from a national Veterans Affairs database using International Classification of Diseases, Ninth Revision codes. Prior NSAIDs use was determined through pharmacy data claims. The rates of acute kidney injury, respiratory failure, cardiovascular failure, and in-hospital mortality were compared between those with prior NSAID use (AP+NSAID) and those without it (AP-NSAID) using univariate and multivariate analysis. RESULTS:A total of 31,340 patients were identified: 28,364 AP+NSAID and 2976 AP-NSAID. The median age was 60 years, 68% were white, and the median hospital stay was 4 days. Approximately 2% of patients died during the hospitalization. After adjusting for demographics and other covariates, patients in the AP+NSAID arm had lower rates of acute kidney injury, P = .0002), cardiovascular failure (P = .025), any organ failure (P ≤ .0001), and in-hospital mortality (P < .0001). CONCLUSION:Prior use of NSAIDs is associated with a lower incidence of organ failure and in-hospital mortality in adult patients with acute pancreatitis. The role of NSAIDs as therapeutic agents in this condition should be evaluated in interventional trials.

Background Chronic pancreatitis (CP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC); nevertheless, the true incidence of PDAC in CP patients in the United States remains unclear. Aims We evaluated the risk of developing PDAC two or more years after a new diagnosis of CP. Methods Retrospective study of veterans from September 1999 to October 2015. A three-year washout period was applied to exclude patients with preexisting CP and PDAC. PDAC risk was evaluated in patients with new-diagnosis CP and compared with controls without CP using Cox-proportional hazards model. CP, PDAC, and other covariates were extracted using ICD-9 codes. Results After exclusions, we identified 7,883,893 patients [new-diagnosis CP - 21,765 (0.28%)]. PDAC was diagnosed in 226 (1.04%) patients in the CP group and 15,858 (0.20%) patients in the control group (p < 0.001). CP patients had a significantly higher PDAC risk compared to controls > 2 years [adjusted hazard ratio (HR) 4.28, 95% confidence interval (CI) 3.74-4.89, p < 0.001], 5 years (adjusted HR 3.32, 95% CI 2.75-4.00, p < 0.001) and 10 years of follow-up (adjusted HR 3.14, 95% CI 1.99-4.93, p < 0.001), respectively. By multivariable analysis, age (odds ratio 1.02, 95% CI 1.00-1.03, p = 0.03), current smoker (odds ratio 1.67, 95% CI 1.02-2.74, p = 0.042), current smoker + alcoholic (odds ratio 2.29, 95% CI 1.41-3.52, p < 0.001), and diabetes (odds ratio 1.51, 95% CI 1.14-1.99, p = 0.004) were the independent risk factors for PDAC. Conclusion Our data show that after controlling for etiology of CP and other cofactors, the risk of PDAC increased in CP patients after two years of follow-up, and risk was consistent and sustained beyond 5 years and 10 years of follow-up.

Background China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China. Methods A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM). Results Compared to women not involved in any physical activity, those who participated in physical exercise 1–2 times, 3–4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval [95% CI]: 0.68–0.92), 30% (aOR: 0.70, 95% CI: 0.60–0.82), and 32% (aOR: 0.68, 95% CI: 0.59–0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day. Conclusion Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.

Objective: Self-referral community cardiovascular screening programs (CCSPs) have a potential to reduce outcome events through early detection of disease. This study evaluated the characteristics of a population that could predict a positive test. Materials and Methods: Participants who completed a cardiovascular screening protocol were compared. The screening protocol included a blood pressure (BP), Doppler ankle brachial index (ABI) testing, a limited carotid sonogram, a limited aortic sonogram, electrocardiogram (ECG), and limited transthoracic echocardiogram (TTE). Results: Screenings were performed on 205 participants (58% female, 68 ± 9 years of age). Sixty-seven (34%) participants were abnormal in at least one of the following screening tests: ABI (2%), carotid sonogram (6%), aortic sonogram (3%), ECG (11%), and TTE (22%). Although 60.5% of the participants reported recent symptoms, there were no differences in normal or abnormal results of participants presenting with or without symptoms ( P = .06). Income was not a predictor of abnormal test results (odds ratio, 0.76; 95% confidence interval, 0.55–0.97; P = .19). Multivariate analysis demonstrated, when controlling for age greater than 75 years, that participants taking BP medication was the only variable that predicted a positive test result. Conclusion: One-third of patient results were abnormal, regardless of symptoms or lack thereof, suggestive of subclinical disease. Further large-scale studies would demonstrate the role of CCSPs in risk stratifying participants.

This study aimed to examine the factors associated with diagnosed depression among patients with a metastatic cancer. We conducted a cross-sectional analysis of 39,223 hospital records from 2008 to 2013 National Inpatient Sample for patients with metastatic cancer. Diagnosed depression was defined using ICD-9-CM for major depression. Weighted, multivariable hierarchical regression model was used to examine the association between sociodemographic and clinical factors and depression among patients with a metastatic cancer. The prevalence of clinically diagnosed depression in patients with a metastatic cancer in our study sample was 7.3% (5.9% for males and 8.6% for females). The prevalence rate of diagnosed depression increased from 5.3 to 9.4% between 2008 and 2013. In multivariable analysis, patients were more likely to be diagnosed with depression if they were females (aOR = 1.44; 95% CI 1.25–1.66) compared to males; and had higher number of comorbidities (aOR = 1.11 per 1-unit increase in Elixhauser comorbidity score, 95% CI 1.07–1.15). In contrast, patients were less likely to be diagnosed with depression if they were blacks (aOR = 0.59; 95% CI 0.47–0.74) or other race (aOR = 0.58; 95% CI 0.47–0.72) compared with white patients. Women and individuals with more comorbidities were diagnosed with depression more frequently, whereas black patients were diagnosed less. Our findings could help providers to identify hospitalized patients with the higher risk of depression and screened patients with signs and symptoms of clinical depression.

Background Depression contributes to persistent opioid analgesic use (OAU). Treating depression may increase opioid cessation. Aims To determine if adherence to antidepressant medications (ADMs) v . non-adherence was associated with opioid cessation in patients with a new depression episode after >90 days of OAU. Method Patients with non-cancer, non-HIV pain ( n = 2821), with a new episode of depression following >90 days of OAU, were eligible if they received ≥1 ADM prescription from 2002 to 2012. ADM adherence was defined as >80% of days covered. Opioid cessation was defined as ≥182 days without a prescription refill. Confounding was controlled by inverse probability of treatment weighting. Results In weighted data, the incidence rate of opioid cessation was significantly ( P = 0.007) greater in patients who adhered v . did not adhered to taking antidepressants (57.2/1000 v . 45.0/1000 person-years). ADM adherence was significantly associated with opioid cessation (odds ratio (OR) = 1.24, 95% CI 1.05–1.46). Conclusions ADM adherence, compared with non-adherence, is associated with opioid cessation in non-cancer pain. Opioid taper and cessation may be more successful when depression is treated to remission. Declaration of interest None.

Abstract Introduction: Hookah smoking is becoming an increasingly popular choice of tobacco use and is remarkably common among young adults in the United States. This study aimed to evaluate the prevalence and correlates of hookah awareness and perceived harmfulness among US adults and to examine its association with cigarette smoking quit intention and attempt. Methods: Data from the Health Information National Trends Survey 2013 to 2017 were analyzed. The sample included 6,711 adults aged ≥ 18 years. Weighted multivariable logistic regression analyses were performed and adjusted for age, gender, race/ethnicity, education, household income, region, and cigarette smoking status. Results: Overall, 78% of US adults were aware of hookah. Of these, 72% believed hookah pipes were equally harmful as cigarettes, whereas 17.6% believed otherwise. Those who were aware of hookah were less likely to be older (aOR=0.12, 95% CI=0.09 - 0.16), Black (aOR=0.56, 95% CI=0.43 - 0.72) and Hispanic (aOR=0.61, 95% CI=0.48 - 0.79), and lesser-educated (aOR=0.40, 95% CI=0.29 - 0.54) adults. Compared to never smokers, former smokers were 64% (95% CI=1.37 - 1.96) more likely to be aware of hookah. Among those aware of hookah, older (aOR=0.49, 95% CI=0.37 - 0.65), Black (aOR=0.73; 95% CI=0.58 - 0.97), and lesser-educated (aOR=0.69; 95% CI=0.48 - 0.95) were less likely to perceive hookah as less harmful than cigarettes. Those who perceived hookah to be just as harmful as cigarettes were less likely to try to quit cigarette smoking in the past year (aOR=0.49, 95% CI=0.25 - 0.93). Those who perceived hookah to be less harmful than cigarettes were more likely to consider quitting cigarette smoking in the next 6 months (aOR=2.86, 95% CI=1.29 - 6.33). Conclusions: Young, White, and college graduate adults are more likely to believe that hookah smoking is less harmful that cigarettes. These disparities can be used to target behavioral interventions aimed at increasing individuals' perceived risk, knowledge, and perceived harmfulness of hookah smoking. Citation Format: Kahee A. Mohammed, Martin W. Schoen, Nosayaba Osazuwa-Peters, Divya S. Subramaniam, Lauren D. Arnold, Leslie Hinyard, Thomas E. Burroughs. Hookah pipe awareness and perceived harmfulness: Prevalence, correlates, and association with smoking cessation outcomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4244.

A LT H 2 1 ( 2 0 1 8 ) S 1 -S 2 6 8 analysis included a total of 1,021,935 patients from 2009 to 2016 .In 2009 -2012 , the number of patients was 629,874 and between 2013 and 2016, 392,061 , 392,061 were added.Patient mean age decreased slightly from 59.64 (2009-2012) to 58.72 years (2013-2016) and majority were female (58.37% and 55.84%, respectively).The mean duration of diabetes decreased from 6.41 to 5.15 years in latter years.There was a higher rate HbA1c target achievement (< 6.5%) in 2016 (26.99%) than in 2012 (23.63%) but mean HbA1C was very similar 8.09% (2016) and 8.11% (2012).Rates of dyslipidaemia were higher in 2016 (68.92%) than 2012 (59.58%) as was hypertension (76.78% vs 74.21%).The commonest complications were the same: nephropathy, retinopathy and ischaemic heart disease.Majority of patients were on at least two oral antidiabetics (OAD) in both datasets.However, combination use of OAD and insulin was higher in 2016 (24.92%) than in 2012 (18.46%).ConClusions: Data from the Malaysian NDR indicates that there has been some changes in the characteristics and outcomes of patients in recent years.The percentage of patients on insulin and also those who have achieved HbA1c target seems to have increased slightly.Due to limitations of descriptive analysis, further confirmatory analysis is needed.

Abstract Background: The human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with nearly 80 million people currently infected. It causes virtually all cervical cancers in the United States. There are three prophylactic HPV vaccines approved and recommended in the United States, and they protect against 70-90% of the HPV types that cause cervical cancer. Although the HPV vaccine is safe and effective, vaccination rates remain suboptimal. Physicians' recommendation of the HPV vaccine is known to be the most important predictor of vaccine uptake, and prior research suggests that promoting the HPV vaccine as an anticancer vaccine increases vaccination rates. However, no previous national study has evaluated how physicians' recommendation of the HPV vaccine might influence patients' or parental views of the vaccines' effectiveness. We sought to assess how physicians' recommendation of the HPV vaccine influenced patients' view of the effectiveness of the vaccine in preventing cervical cancer. Methods: Nationally representative data (n=1171) on respondents who were or had immediate family between the ages of 9 and 27 years old were obtained from the 2014 Health Information National Trends Survey 4, Cycle 4. Outcome of interest was an “effective” response to the question: “In your opinion, how successful is the HPV vaccine at preventing cervical cancer?” Main independent variable was physician HPV vaccine recommendation in the last 12 months (yes, no, don't know). Weighted, multivariable logistic regression was used to evaluate the effect of physicians' recommendation of the HPV vaccine on patients' perception on the effectiveness of the vaccine in preventing cervical cancer. Results: Approximately 26% of respondents reported receiving a physician recommendation for the HPV vaccine and 28% perceived the vaccine as effective in preventing cervical cancer. Respondents who did not have a physician's HPV recommendation, or did not know they had one in the last 12 months were 55% (aOR = 0.45, 95% CI, 0.27 - 0.73) and 76% (aOR = 0.24, 95% CI, 0.12 - 0.48) less likely to perceive the HPV vaccine as effective against cervical cancer, respectively. Respondents were less likely to perceive the HPV vaccine as effective in preventing cervical cancer if they were aged 35-49 (aOR = 0.46, 95% CI, 0.25 - 0.82) vs. 18-34 and had a high school diploma (aOR = 0.44, 95% CI, 0.24 - 0.81) or some college education (aOR = 0.39, 95% CI, 0.23 - 0.66) compared with college degree. Conclusions: Only one in four respondents with an immediate family member eligible for the HPV vaccine received a physician recommendation in our study. However, those who received a recommendation were significantly more likely to perceive the HPV vaccine as effective in preventing cervical cancer. Our finding provides added impetus for more physicians to utilize every clinical encounter as an opportunity to recommend the HPV vaccine to age-eligible parents and patients. Citation Format: Eric Adjei Boakye, Nosayaba Osazuwa-Peters, Vy Pham, Betelihem B. Tobo, Matthew C. Simpson, Thomas Burroughs, Paula Buchanan. Effect of physicians' recommendation on the perceived effectiveness of the HPV vaccine in preventing cervical cancer [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C58.

Purpose: An estimated 8,200 cases of anal cancer will be diagnosed in 2017, accounting for nearly 1,100 deaths. Though anal cancer is a relatively rare malignancy, its increasing incidence has coincided with the increase in prevalence of risky sexual practices associated with anal human papillomavirus (HPV) infection, especially among men. At least 9 in 10 anal cancers are associated with HPV. Due to the rarity of anal cancer, little is known about factors affecting survivorship of anal cancer patients. The aim of this study was to evaluate clinical and nonclinical factors associated with anal squamous cell carcinoma (ASCC) survival in the United States. Methods: A retrospective cohort study of patients aged ≥18 years with ASCC in the National Cancer Institute Surveillance, Epidemiology, and End Results registry (2004-2014) was analyzed. ASCC (site codes C21.0-C21.9 and C20.9), were coded for invasive squamous cell carcinomas per the International Classification of Diseases for Oncology, third edition. The outcome was survival (alive or dead) and the exposures were clinical (stage of presentation and treatment modality), and nonclinical (marital status, age, sex, race/ethnicity). Fine and Gray proportional hazards regression model were used to assess differences in survival among sociodemographic and clinical factors. Results: There were 13,142 patients diagnosed with ASCC between 2004 and 2014. Mortality rate during the study period was 34.9% and median survival time was 113 months. In the adjusted model, a one-year increase in age was associated with 2% increased risk of death (adjusted hazard ratio (aHR) =1.02; 95% confidence interval (CI): 1.02-1.03). Compared with female patients, male patients (aHR=1.54; 95% CI: 1.40-1.70) had higher hazard of death, as did patients who were non-Hispanic black (aHR=1.40; 95% CI: 1.23-1.60) or non-Hispanic other (aHR=1.34; 95% CI: 1.09-1.65) versus non-Hispanic white. Patients who were never married (aHR=1.29; 95% CI: 1.15-1.44) or widowed (aHR=1.37; 95% CI: 1.18-1.59) had higher hazard of death compared to married patients. Patients had higher hazard of death if they were had stage II (aHR=2.01; 95% CI: 1.62-2.49), stage III (aHR=4.58; 95% CI: 3.70-5.67) or stage IV cancer (aHR=13.43; 95% CI: 10.74-16.78); and had not received surgery (aHR=1.41; 95% CI: 1.26-1.57). Conclusion: Besides the clinical factors known to impact survival, including stage and treatment modality, several nonclinical factors are associated with the survival of anal cancer in the United States: age, sex, race/ethnicity, and marital status. It is important that interventions considering these factors are developed to improve survivorship, especially among the unmarried, males, and minority patients. Citation Format: Eric Adjei Boakye, Matthew Simpson, Rebecca Rohde, Lauren Anderson, Betelihem B. Tobo, Thomas E. Burroughs, Nosayaba Osazuwa-Peters. Anal cancer survivorship: Clinical and nonclinical factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4253.

Drug-related attentional bias may have significant implications for the treatment of cocaine use disorder (CocUD). However, the neurobiology of attentional bias is not completely understood. This study employed dynamic causal modeling (DCM) to conduct an analysis of effective (directional) connectivity involved in drug-related attentional bias in treatment-seeking CocUD subjects. The DCM analysis was conducted based on functional magnetic resonance imaging (fMRI) data acquired from fifteen CocUD subjects while performing a cocaine-word Stroop task, during which blocks of Cocaine Words (CW) and Neutral Words (NW) alternated. There was no significant attentional bias at group level. Although no significant brain activation was found, the DCM analysis found that, relative to the NW, the CW caused a significant increase in the strength of the right (R) anterior cingulate cortex (ACC) to R hippocampus effective connectivity. Greater increase of this connectivity was associated with greater CW reaction time (relative to NW reaction time). The increased strength of R ACC to R hippocampus connectivity may reflect ACC activation of hippocampal memories related to drug use, which was triggered by the drug cues. This circuit could be a potential target for therapeutics in CocUD patients. No significant change was found in the other modeled connectivities.