BACKGROUND:Little is known about non-curative lung cancer care, including palliative care, for adults with intellectual, or developmental disabilities. Clinical management may vary due to health status, ability to communicate, access to inclusive healthcare, and healthcare bias. AIM:We examined the receipt of cancer-directed consultations, treatments and palliative care among stage IV non-small-cell lung cancer (NSCLC) patients with and without intellectual or developmental disabilities. DESIGN:This was a population-based retrospective cohort study using provincial routinely collected health data. Receipt of consultations with surgeons, medical oncologists, and radiation oncologists, receipt of systemic therapy, radiation, and surgery as well as receipt of palliative care in the year following diagnosis were compared between people with and without intellectual or developmental disabilities. Cause-specific Cox proportional hazards regression, accounting for death as a competing event, was used. SETTING/PARTICIPANTS:Adults diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario, Canada. RESULTS:The study included 33,184 individuals diagnosed with stage IV NSCLC (n intellectual or developmental disabilities = 106). Adults with intellectual or developmental disabilities were significantly less likely to receive any cancer-directed consultation (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.49-0.78), any cancer-directed cancer treatment (HR = 0.52; 95% CI 0.39-0.70), and radiation or systemic therapy (HR = 0.49; 95% CI 0.36-0.66) than non-disabled adults. There was no statistical difference in receipt of palliative care (HR = 1.15; 95% CI 0.93-1.41). CONCLUSION:These findings contribute to an emerging evidence base documenting differences in cancer treatment and outcomes among adults with intellectual or developmental disabilities. Person-center research is needed that examines end-of-life lung cancer care treatment decision-making to identify and mitigate barriers to optimal management.

The impact of socioeconomic factors on cancer outcomes is well documented; however, their role in access to and receipt of care within universal health systems for advanced lung cancer is less established. We investigated inequalities in specialized cancer consultation and treatment for stage IV non-small cell lung cancer (NSCLC). We used a population-based cohort with administrative health data to study people aged 18+ diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario. We measured consultations with medical oncologists, radiation oncologists, and thoracic surgeons as well as systemic therapy, radiation, surgery, and palliative care in the year following diagnosis, comparing consultation and treatment rates across quintiles of census measures of community material resources. Multivariable cause-specific Cox proportional hazards regression, accounting for death, was used. We included 32,902 stage IV NSCLC patients. People living in the least materially resourced neighborhoods were less likely to have a cancer-directed consultation with a medical oncologist, radiation oncologist, or thoracic surgeon (hazard ratio [HR] = 0.91; 95

Introduction Bladder cancer, the most prevalent urological malignancy worldwide, accounts for a staggering 600,000 new cases annually. Its etiology is complex and multifactorial, influenced by various risk factors. Recent advances in genomic research, particularly genome-wide association studies (GWAS), have led to the discovery of new single nucleotide polymorphisms (SNPs) and associations in diverse cohorts. GWASs have proven to be a powerful tool for identifying links between genetic variants and SNPs. Additionally, phenome-wide association studies (PheWAS) have explored associations between specific genetic variants and a wide range of phenotypes, enabling the identification of genetic variants associated not only with bladder cancer but also with other diseases and traits that may share genetic risk factors. Our study, conducted using data from the UK Biobank's prospective cohort, aims to combine the findings from GWAS and PheWAS to identify both epidemiological and genetic risk factors associated with bladder cancer. Methods 375,981 healthy individuals and 5,090 bladder cancer patients analyzed. Genotype calling, quality control, and imputation processes;previously described. Generic risk variants, like;single nucleotide polymorphisms (SNPs), selected based on conventional genome-wide significance thresholds (p<5×10-6) and specific criteria (MAF >0.01 and r 2 <0.001 for LD). Functional GWAS analysis using FUMA;performed to annotate GWAS results, prioritize genes,assess chromatic interaction mapping and tissue enrichment.To explore association between bladder cancer and other phenotypes, PheWas (phenome-wide association studies) associations conducted using GLM function in R. Covariates like sex, smoking, age, alcohol consumption, air pollution exposure, daily traffic intensity, dietary habits, and workplace exposure were included in all associations. Logistic regression models with log-transformed odds ratios;used for binary dependent variables. Statistical inferences relied on two-sided tests at significance level of 0.05, unless specified differently. The analysis done;using SAS software v.9.4 (SAS Institute, Cary, NC) and R v.3.6.0 software. Results Our study identified;SNPs;associated with increased bladdercancer risk, including variants in;PSCA;TMEM129;TERT;LYNX1-SLURP2;LSP1, and;HIPK1;(Fig1A). Protective associations for bladder cancer with SNPs within;UGTA1, THEM6, RAPGEF5, LY6K, LY6D, LNCOC1, JRK, and CLPTML;(Figure1A,B). Gene prioritization using FUMA and tissue mapping with chromatin interaction analysis revealed 9 lead SNPs across 8 genomic risk loci, with exonic SNPs exhibiting highest Combined Annotation Dependent Depletion;(CADD) scores indicating deleteriousness (Figure1C,D). Additionally, gene set enrichment analysis of common SNPs uncovered significant associations with biological processes like;Flavonoid & Xenobiotic Glucuronidation and Glucuronosyltransferase, closely linked to bladdercancer (Fig1E). PheWAS analysis revealed four phenotypes linked to bladder cancer risk, including prostate cancer (rs2242652), seborrheic keratosis and skin conditions (rs2242652), and BPH (rs31489) (Figure1F). Regression analysis for modifiable risk factors;demonstrated significant associations with bladder cancer susceptibility for BMI, heavy smoking, and male sex. Conversely, alcohol intake 3-4 drinks/week is protective. Conclusions The study sheds light on various relevant SNPs and novel associations among germline mutations in bladder cancer, which have not been previously reported. Through further functional analysis, we discovered germline variants associated with glucuronosyltransferase activity, providing supporting evidence of toxin metabolism and its impact on bladder cancer risk. Additionally, our PheWAS analysis revealed co-associations with prostate cancer, prostatic hyperplasia, and dermatologic conditions linked to specific SNPs.Furthermore, our study reaffirmed well-known risk factors associated with bladder cancer, including sex and smoking, while also highlighting the protective effect of moderate alcohol consumption in the context of carcinogenesis.These findings have the potential to offer valuable insights into common pathways underlying bladder cancer, inform screening recommendations, and identify potential therapeutic targets for the disease.

Introduction: Renal Cell Carcinoma (RCC) is among the most frequently diagnosed malignancies in both genders with over 81,000 estimated cases in 2024. Despite increasing incidence of renal cell carcinomas <4 cm, up to 1/3 of patients diagnosed with RCC exhibit metastatic disease (mRCC) at time of diagnosis. Cytoreductive nephrectomy (CN), a procedure which encompasses the surgical removal of the primary tumor in patients with metastatic disease, was offered upfront as standard of care during the cytokine era; however, as systemic treatment has evolved, the role of CN in mRCC patients has become less clear. Purpose of Review: We sought to review the evolution of CN in mRCC patients from historical treatments through current standard of care considering ongoing clinical trials and perioperative considerations for CN in patients treated with tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors (ICI). Conclusion: CN following immunotherapy is safe and beneficial in appropriately selected patients. The choice to perform CN in patients with mRCC amidst an ever-changing treatment landscape is nuanced. Clinical trial enrollment is critical to refine selection criteria and timing of CN. As treatment options continue to progress, shared decision-making and multidisciplinary collaboration remain paramount in selecting the optimal treatment course for each patient.

Background and objectiveThe rationale for oophorectomy during female cystectomy is not adequately supported. The co-occurrence and timing of bladder cancer (BC) and ovarian cancer (OC) in females harboring OC germline mutations remain unclear. Our objective was to determine the frequency and temporal occurrence of OC germline variants among females with BC.MethodsWe used genetic and phenotypic data from the UK Biobank (UKB). The study cohort was defined using ICD-10/ICD-9 codes for BC and further stratified to identify 1347 females. Analysis was restricted to variants with high/moderate impact for initial regression. ClinVar was used to interpret pathogenicity. Pathogenic/likely pathogenic (P/LP) variants were assessed by age of presentation, family history, and concomitant malignancies. Statistical analysis was performed using UKB DNAnexus JupyterLab and RStudio.Key findings and limitationsSome 3.4% of the patients had at least one of 15 variants for OC. CHEK2 and PALB2 mutations represented the highest ratio of overall/pathogenic variants (15.8% and 6.6%). Although females with P/LP OC mutations had a higher risk of OC, diagnosis of OC preceded BC by 11.3 yr (±12.5 yr) in the group with mutations and by 15.6 yr (±11.3 yr) in the group without mutations. The group with P/LP variants had higher rates of maternal (14.63% vs 8.12%; p = 0.04) and sibling (9.76% vs 3.98%; p = 0.02) breast cancer and of maternal colon cancer (9.76% vs 4.21%), and lower maternal life expectancy (75.34 vs 68.15 yr; p = 0.0014). UKB provides limited staging/treatment history and its exome sequencing platform may miss variants or provide insufficient coverage for genotyping.Conclusions and clinical implicationsThis study provides evidence against routine oophorectomy for reducing OC risk in females with BC. The results highlight that the development of OC occurred 11 yr before diagnosis of BC for patients with OC mutations and 15 yr before diagnosis of BC for patients without OC mutations.Patient summaryAlthough removal of the ovaries in women with bladder cancer is common, no studies have shown that this strategy has a benefit. Our study of women diagnosed with bladder cancer who had genetic mutations associated with ovarian cancer shows that their risk of developing ovarian cancer after bladder cancer is low. These findings provide evidence against removal of the ovaries when the bladder is being removed as treatment for bladder cancer.

INTRODUCTION:Despite poor agreement, neighbourhood income is used as a proxy for household income, due to a lack of data availability. We quantified misclassification between household and neighbourhood income and demonstrate quantitative bias analysis (QBA) in scenarios where only neighbourhood income is available in assessing income inequalities on colorectal cancer mortality. METHODS:This was a retrospective study of adults with colorectal cancer diagnosed 2006-14 from Statistics Canada's Canadian Census Health and Environment Cohort. Neighbourhood income quintiles from Statistics Canada were used. Census household income quintiles were used to determine bias parameters and confirm results of the QBA. We calculated positive and negative predictive values using multinomial models, adjusting for age, sex and rural residence. Probabilistic QBA was conducted to explore the implication of exposure misclassification when estimating the effect of income on 5-year mortality. RESULTS:We found poor agreement between neighbourhood and household income: positive predictive values ranged from 21% to 37%. The bias-adjusted risk of neighbourhood income on 5-year mortality was similar to the risk of mortality by household income. The bias-adjusted relative risk of the lowest income quintile compared with the highest was 1.42 [95% simulation interval (SI) 1.32-1.53] compared with 1.46 [95% confidence interval (CI) 1.39-1.54] for household income and 1.18 (95% CI 1.12-1.24) for neighbourhood income. CONCLUSION:QBA can be used to estimate adjusted effects of neighbourhood income on mortality which represent household income. The predictive values from our study can be applied to similar cohorts with only neighbourhood income to estimate the effects of household income on cancer mortality.

IntroductionPeople with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval.MethodsThis was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis.ResultsA total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest.ConclusionThese findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.

Patients with lung cancer can experience significant psychological morbidities including depression. We characterize patterns and factors associated with interventions for symptoms of depression in stage IV non-small cell lung cancer (NSCLC). We conducted a population-based cohort study using health services administrative data in Ontario, Canada of stage IV NSCLC diagnosed from January 2007 to September 2018. A positive symptom of depression score was defined by reporting at least one ESAS (Edmonton Symptom Assessment System) depression score ≥ 2 following diagnosis until the end of follow-up (September 2019). Patient factors included age, sex, comorbidity burden, rurality of residence, and neighbourhood income quintile. Interventions included psychiatry assessment, psychology referral, social work referral and anti-depressant medical therapy (for patients ≥ 65 years with universal drug coverage). Multivariable modified Poisson regression models were used to examine the association between patient factors and intervention use for patients who reported symptoms of depression. In the cohort of 13,159 patients with stage IV NSCLC lung cancer, symptoms of depression were prevalent (71.4

ABS T R A C T Objective(s): To measure the success rate of primary medical therapy in managing retained products of conception (RPOC) in women with secondary postpartum haemorrhage (PPH) and to identify factors associated with need for surgical management.Study design: Postpartum patients presenting to a tertiary women's hospital Emergency Department between July 2020 and December 2022 with secondary PPH and evidence of RPOC on ultrasound were recruited. Clinical information relating to the presentation was collected prospectively. Antenatal and intrapartum data were collected from medical record and Birthing Outcome System database review. The primary outcome was the success of medical management for RPOC, defined by the implementation of medical or expectant management without subsequent need for surgical intervention.Results: Forty-one patients with RPOC underwent primary medical or expectant management. Twelve patients (29%) were managed successfully with medical management, while twenty-nine (71%) proceeded to surgical management. Medical management involved antibiotics (n = 37, 90%), prostaglandin E1 analogue (n = 14, 34%) and other uterotonics (n = 3, 7%). A greater endometrial thickness on ultrasound was significantly associated with a requirement for secondary surgical intervention (p < 0.05). There was an association approaching statistical significance between a higher sonographic volume of RPOC and the failure of medical management (p = 0.07). There was no statistically significant association between the mode of delivery or the number of days postpartum with the success of medical management.Conclusion(s): For patients presenting with secondary PPH and sonographic RPOC, over two thirds required surgical management. Increased endometrial thickness was associated with an increased requirement for surgical management.

INTRODUCTION:Cancer symptom screening has the potential to improve cancer outcomes, including reducing symptom burden among patients with major mental illness (MMI). We determined rates of symptom screening with the Edmonton Symptom Assessment System (ESAS-r) and risk of severe symptoms in cancer patients with MMI. METHODS:This retrospective cohort study used linked administrative health databases of adults diagnosed with cancer between 2007 and 2020. An MMI was measured in the 5 years prior to cancer diagnosis and categorized as inpatient, outpatient, or no MMI. Outcomes were defined as time to first ESAS-r screening and time to first moderate-to-severe symptom score. Cause-specific and Fine and Gray competing events models were used for both outcomes, controlling for age, sex, rural residence, year of diagnosis and cancer site. RESULTS:Of 389,870 cancer patients, 4049 (1.0%) had an inpatient MMI and 9775 (2.5%) had an outpatient MMI. Individuals with inpatient MMI were least likely to complete an ESAS-r (67.5%) compared to those with outpatient MMI (72.3%) and without MMI (74.8%). Compared to those without MMI, individuals with an inpatient or outpatient MMI had a lower incidence of symptom screening records after accounting for the competing risk of death (subdistribution Hazard Ratio 0.77 (95% CI 0.74-0.80) and 0.88 (95% CI 0.86-0.90) respectively). Individuals with inpatient and outpatient MMI status consistently had a significantly higher risk of reporting high symptom scores across all symptoms. CONCLUSIONS:Understanding the disparity in ESAS-r screening and management for cancer patients with MMI is a vital step toward providing equitable cancer care.

Pain is a common symptom in stage IV non-small cell lung cancer (NSCLC). The objective of the study was to examine the use of interventions and factors associated with interventions for pain. A population-based cohort study in Ontario, Canada was conducted with patients diagnosed with stage IV NSCLC from January 2007 to September 2018. An Edmonton Symptom Assessment System (ESAS) score of ≥4 defined moderate-to-severe pain following diagnosis. The study cohort included 13,159 patients, of which 68.5% reported at least one moderate-to-severe pain score. Most patients were assessed by a palliative care team (85.4%), and the majority received radiation therapy (73.2%). The use of nerve block was rare (0.8%). For patients ≥65 years of age who had drug coverage, 59.6% received an opiate prescription. Patients with moderate-to-severe pain were more likely to receive palliative assessment or radiation therapy compared to patients with none or mild pain. Patients aged ≥70 years and with a greater comorbidity burden were associated with less likelihood to receive radiation therapy. Patients from rural/non-major urban residence and with a greater comorbidity burden were also less likely to receive palliative care assessment. Factors associated with interventions for pain are described to inform future symptom management in this population.

BackgroundSecondary postpartum haemorrhage (PPH) is a condition which affects 0.2-3.0% of women. Despite its impact on maternal morbidity, there is a lack of understanding of the cost burden of disease. AimsTo determine the economic cost of secondary PPH in the postpartum period, compared to the costs for women without this diagnosis. Materials and methodsData were prospectively collected on a cohort of 97 women who presented with secondary PPH to the emergency department (ED) between July 2020 and February 2021. A case-control design was then used to compare postpartum cost data from these patients to a group of 97 controls who were matched to maternal demographics, and who did not present with secondary PPH. ResultsFor women with secondary PPH, there were significantly more hospital attendances, and postpartum costs were higher for all cost subcategories across ED, admissions, and outpatient attendances (P < 0.0001), compared to controls. The total cost of postpartum care for 97 patients with secondary PPH was $254 377.62 with an average cost per patient of $2622.45, compared to $26 670.46 for 97 controls with an average cost of $274.95 per patient (P < 0.0001). This demonstrates a 9.5-fold increase in postpartum costs per woman with secondary PPH. ConclusionsSecondary PPH is an under-researched condition which presents a significant cost burden for the health system. Evidence-based guidelines addressing the prevention and management of secondary PPH may assist in minimising this cost burden for both the health service and the patient.

You have accessJournal of UrologyCME1 Apr 2023LBA02-07 SEX-DEPENDENT DISTRIBUTION OF PATHOGENIC GERMLINE VARIANTS IN BLADDER CANCER: A POPULATION-BASED ANALYSIS OF 400,000 INDIVIDUALS Laura Bukavina, Danly Omil-Lima, Laura Davis, Raju Chelluri, Andres Correa, Lee Ponsky, Alexander Kutikov, and Philip Abbosh Laura BukavinaLaura Bukavina More articles by this author , Danly Omil-LimaDanly Omil-Lima More articles by this author , Laura DavisLaura Davis More articles by this author , Raju ChelluriRaju Chelluri More articles by this author , Andres CorreaAndres Correa More articles by this author , Lee PonskyLee Ponsky More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , and Philip AbboshPhilip Abbosh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003361.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Characterizing the impact of germline mutational burden on bladder carcinogenesis has been a challenge. Prior studies implicate genes of unknown pathogenicity and lack cross-population comparisons. In the current study, we sought to evaluate the impact of pathogenic germline mutations in a cohort of bladder cancer (BC) patients compared to a large sample of non-cancer controls. METHODS: Using the UK Biobank, a biomedical database containing genetic information on over 500,000 patients from the United Kingdom, we analyzed germline mutations in patients diagnosed with BC. A genome-wide regression approach in REGENIE was used for downstream analysis, combined with individual values for the trait of interest. We restricted our analysis to high and moderate impact variants for initial regression. Utilization of pathologic/likely pathologic (P/LP) germline variants within each respective cohort as defined by REGENIE outputs was then re-defined within each population (BC male/female, CTRL male/female). RESULTS: Of 502,387 database patients, 5,090 were identified with BC and genetic data. Compared to men with BC (n=3744), women with BC (n=1346) exhibited a higher mutational carrier rate (20.4% vs 14.0%, p=0.02, Figure 1A). Males with BC presented with higher rates of P/LP mutations compared to male CTRLs in APC (p=0.019), and RECQL4 (p=0.044). While overall P/LP percentage was higher in females compared to males, no statistically significant difference was seen in specific genes compared to female CTRLs. Despite this, female carriers had younger age at BC diagnosis (56.7yo) compared to women and men without P/LP variants detected, and men with P/LP (62.0, 64.1, and 63.9, respectively; p<0.01; Figure 1B). CONCLUSIONS: Our study demonstrates notable differences in germline mutations between male and female bladder cancer cohorts. Specifically, women were noted to harbor a greater frequency of germline mutations and demonstrated associations between germline mutations and early disease onset not seen in men. Further research is needed to determine the interplay between genetic and environmental factors influencing BC pathogenesis. Such investigations will aid in advancing personalized cancer care. Source of Funding: Society of Women in Urology (SWIU) Elizabeth Pickett Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1188 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Bukavina More articles by this author Danly Omil-Lima More articles by this author Laura Davis More articles by this author Raju Chelluri More articles by this author Andres Correa More articles by this author Lee Ponsky More articles by this author Alexander Kutikov More articles by this author Philip Abbosh More articles by this author Expand All Advertisement PDF downloadLoading ...

EDITORIAL COMMENT: This paper provides a useful review of the clinical features and management of secondary postpartum haemorrhage. Table 1A shows comparable statistics from an Australian hospital which the incidence was 2–3 times higher than the 0.5% reported by the authors from their hospital in Hong Kong. Since there are no predictive factors for secondary postpartum haemorrhage the important data concerns proper management. The high incidence of suction evacuation (87%) is noteworthy as was the authors' finding that the procedure stopped the bleeding in all 72 patients requiring this operation. The 1 case of uterine perforation serves as a reminder that the uterus may be soft and friable in these patients. Hysterectomy is seldom required in patients with secondary postpartum haemorrhage but when it is necessary, an experienced surgeon is required, since it is often difficult to secure haemostasis, and ligation of internal iliac arteries may be necessary. The 1 subtotal hysterectomy required in this series was performed before secondary postpartum haemorrhage occurred. The 3 other useful pieces of information provided in this Hong Kong series were that 24% of patients required blood transfusion, that bacteriology although useful on occasions was positive in only 12% of patients, and that histologically proven placental tissue was obtained at suction evacuation in 42% of patients — oedematous decidua is often macroscopically mistaken for placental tissue at the time of surgery in these patients.Summary: Eighty‐three cases of secondary postpartum haemorrhage managed in this teaching unit over a 3‐year period are described. Bleeding occurred most frequently between the 8th and 14th day of the puerperium; 73% of the patients had already been discharged from hospital and required readmission. Suction evacuation was performed in 72 patients and was successful in arresting haemorrhage whether retained placental tissue could be demonstrated on histology or not. There was histological confirmation of retained gestational products in only 30 (42%) of the patients treated surgically. No predictive factors for secondary postpartum haemorrhage could be identified in the obstetric profiles or antenatal course of most of these patients. Patients with retained gestational products could not be distinguished from those without on the basis of history or examination alone apart from 4 patients noted to have incomplete membranes at delivery.

Introduction With increasing interest in income-related differences in cancer outcomes, accurate measurement of income is imperative. Misclassification of income can result in wrong conclusions as to the presence of income inequalities. We determined misclassification between individual- and neighborhood-level income and their association with overall survival among colorectal cancer (CRC) patients. Methods The Canadian Census Health and Environment Cohorts were used to identify CRC patients diagnosed from 1992 to 2017. We used neighborhood income quintiles from Statistics Canada and created individual income quintiles from the same data sources to be as similar as possible. Agreement between individual and neighborhood income quintiles was measured using cross-tabulations and weighted kappa statistics. Cox proportional hazards and Lin semiparametric hazards models were used to determine the effects of individual and neighborhood income independently and jointly on survival. Analyses were also stratified by rural residence. Results A total of 103 530 CRC patients were included in the cohort. There was poor agreement between individual and neighborhood income with only 17% of respondents assigned to the same quintile (weighted kappa = 0.18). Individual income had a greater effect on relative and additive survival than neighborhood income when modeled separately. The interaction between individual and neighborhood income demonstrated that the most at risk for poor survival were those in the lowest individual and neighborhood income quintiles. Misclassification was more likely to occur for patients residing in rural areas. Conclusion Cancer researchers should avoid using neighborhood income as a proxy for individual income, especially among patients with cancers with demonstrated inequalities by income.

We explored perspectives of patients with metastatic non-small cell lung cancer (mNSCLC) on symptom screening and population-level patient-reported outcome (PRO) data regarding common symptom trajectories in the year after diagnosis. A qualitative study of patients with mNSCLC was conducted at a Canadian tertiary cancer centre. English-speaking patients diagnosed ≥ 6 months prior to study invitation were recruited, and semi-structured one-on-one interviews were conducted. Patient and treatment characteristics were obtained via chart review. Anonymized interview transcripts underwent deductive-inductive coding and thematic content analysis. Among ten participants (5 (50