INTRODUCTION:Prostate cancer is the most common malignancy among men in the United States. Few studies have evaluated cardiovascular disease (CVD) risk comprehensively among prostate cancer patients with treatment dose-response assessments. The primary aim of our study is to estimate the incidence of CVDs among prostate cancer patients compared to the general population cohort. A secondary aim is to investigate socioeconomic status (SES) and clinical risk factors for CVD among prostate cancer patients. PATIENTS AND METHODS:Cohorts of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73,470 men without cancer matched on age, birth state, and follow-up time were identified. CVD diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios, adjusted for potential confounders after evaluation. RESULTS:The risks of CVDs, including hypertension, arterial diseases, and venous diseases, among prostate cancer survivors compared to the general population were increased for all follow-up periods after cancer diagnosis. The risk of CVD was increased with obesity, baseline comorbidities, lower SES, and advanced-stage cancer, and differed by first-course cancer treatment, with CVD risks higher for androgen deprivation therapy (ADT) and conservative treatment. We also observed that increasing duration of ADT was associated with an increased risk of arterial diseases. CONCLUSION:We found an increased risk of CVDs that lasted through 10 to 16 years post-prostate cancer diagnosis. Lifestyle interventions to decrease the risk of CVDs in prostate cancer survivors may be potentially beneficial to increasing life expectancy.

BACKGROUND:We investigated mental health diagnoses (MHDs) in mycosis fungoides (MF) patients compared to the general population, evaluated risk factors, and studied survival outcomes in a large population database. METHODS:MF patients from the Utah Cancer Registry diagnosed from 2001 to 2014 were matched with up to five general population individuals from the Utah Population Database. MHDs were retrospectively tracked in both populations (median follow-up = 6.67 years). Risk factors for new MHDs among MF patients were studied using the Cox proportional hazards model. Overall survival (OS) and disease-specific survival (DSS) were assessed using Kaplan-Meier analysis. RESULTS:The incidence of anxiety disorders (HR = 1.99, 95% CI [1.16, 3.42]) and delirium/dementia disorders (HR = 2.43, 95% CI [1.05, 5.63]) was higher among MF patients than the matched general population. Among MF patients, Charlson Comorbidity Index (CCI) ≥ 2 and BMI < 18 kg/m2 were risk factors for new anxiety disorders. Radiation therapy, CCI ≥ 2, and female gender were risk factors for new delirium/dementia disorders. The 15-year OS was worse for MF patients with versus without an MHD (36% vs. 81%, HR 2.62, 95%CI [1.24, 5.65]). The 15-year DSS also worsened for MF patients with versus without an MHD (63% vs. 97%, HR 6.55, 95%CI [1.64, 26.2]). CONCLUSIONS:MF patients developed anxiety and delirium/dementia disorders at rates above the general population, and MHDs correlated with worse DSS and OS. Careful mental health monitoring may be an actionable step towards improving health-related quality of life in this population.

INTRODUCTION:Obesity in prostate cancer survivors may increase mortality. Better characterization of this effect may allow better counseling on obesity as a targetable lifestyle factor to reduce mortality in prostate cancer survivors. The purpose of this study was to determine whether pre- and post-diagnostic obesity and weight change affect all-cause mortality, cardiovascular disease specific mortality, and prostate cancer specific mortality in patients with nonmetastatic prostate cancer. PATIENTS AND METHODS:We performed a retrospective cohort analysis of 5,077 patients diagnosed with localized prostate cancer from 1997 to 2017 with median follow-up of 15.5 years. The Utah Population Database linked to the Utah Cancer Registry was used to identify patients at a variety of treatment centers. RESULTS:Pre-diagnosis obesity was associated with a 62% increased risk of cardiovascular disease specific mortality and a 34% increased risk of all-cause mortality (HR 1.62, 95% CI 1.05-2.50; HR 1.34, 95% CI 1.07-1.67, respectively). Post-diagnosis obesity increased the risk of cardiovascular disease specific mortality (HR 1.83, 95% CI 1.31-2.56) and all-cause mortality (HR 1.37, 95% CI 1.16-1.64) relative to non-obese men. We found no association between pre-diagnostic obesity or post-diagnostic weight gain and prostate cancer specific mortality. CONCLUSION:Our study strengthens the conclusion that pre-, post-diagnostic obesity and weight gain increase cardiovascular disease and all-cause mortality but not prostate cancer specific mortality compared to healthy weight men. An increased emphasis on weight management may improve mortality for prostate cancer survivors who are obese.

Introduction In 2021, 59.6% of low-risk prostate cancer patients were under active surveillance as their first course of treatment. However, active surveillance and watchful waiting are difficult to define in population-based cohorts. The primary aim of our study is to develop and validate a population-level machine learning model for distinguishing active surveillance (AS) and watchful waiting (WW) in the conservative treatment group. A secondary aim is to investigate initial cancer management trends from 2004 to 2017 and the risk of chronic diseases among prostate cancer patients with different treatment modalities. Methods A cohort of 18,134 cancer patients with prostate adenocarcinomas were diagnosed between 2004 and 2017 in Utah Cancer Registry. As a subset, 1,926 patients with available AS/WW information were diagnosed from 2010 to 2017 from the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting Database. Models were trained by four machine learning algorithms, and 10-fold cross-validation was performed. The area under the receiver operating curve, F-score, Brier score, and accuracy were used for model evaluation. Comorbidities diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs) for the risk of chronic diseases. Results Logistic regression models performed better than other models in identifying AS from WW accurately. The developed model achieved a test area under the receiver operating curve of 0.73 (range 0.68-0.79), F-score of 0.79, accuracy of 0.71(range 0.66-0.76), and Brier score of 0.29 demonstrating good calibration, precision, and recall values. The top predictors were clinical factors, including Gleason Grade groups (p=0.0003), AJCC stage (p=0.017807), and T stage (p=0.0000109), and demographic characteristics, including race (p=0.007904) and birth year (p=0.046533). We noted a sharp increase in AS use between 2004 and 2016 among patients with low-risk prostate cancer and a moderate increase among intermediate-risk patients between 2008 and 2017. Compared to the AS group, radical treatment was associated with a lower risk of prostate cancer-specific mortality;but higher risks of Alzheimer's disease, anemia, glaucoma, hyperlipidemia, and hypertension. Conclusions A machine learning approach accurately distinguished AS and WW groups in conservative treatment in this decision analytical model study. Our results provide insight into the necessity to separate AS and WW in population-based studies.

Background: Few studies have evaluated mental health disorders comprehensively among patients with prostate cancer on long-term follow-up. The primary aim of our study was to assess the incidence of mental health disorders among patients with prostate cancer compared with a general population cohort. A secondary aim was to investigate potential risk factors for mental health disorders among patients with prostate cancer.Methods: Cohorts of 18 134 patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73470 men without cancer matched on age, birth state, and follow-up time were identified. Mental health diagnoses were identified from electronic health records and statewide health-care facilities data. Cox proportional hazard models were used to estimate hazard ratios. All statistical tests were 2-sided.Results: The hazard ratios for mood disorders, including depression, among prostate cancer survivors increased for all follow-up periods compared with the general population. The hazard ratios for any mental illness increased with Hispanic, Black, or multiple races; people who were underweight or obese; those with advanced prostate cancer; and those undergoing their first course cancer treatment. We also observed statistically significantly increased hazard ratios for mental health disorders among patients with lower socioeconomic status (P < .0001) and increasing duration of androgen-deprivation therapy (P = .0348). Prostate cancer survivors had a 61% increased hazard ratio for death with a depression diagnosis.Conclusion: Prostate cancer diagnosis was associated with a higher risk of mental health disorders compared with the general population, which was observed as long as 10-16 years after cancer diagnosis. Providing long-term mental health support may be beneficial to increasing life expectancy for patients with prostate cancer.

BACKGROUND:In the United States, approximately 63,000 Americans develop head and neck cancer (HNC) annually. Our study aims were to investigate cardiovascular complications and risk factors for development of CVD among HNC survivors. METHODS:Utilizing the Utah Populations Database, a total of 1,901 HNC patients diagnosed and 7,796 birth year, sex, and birth state matched individuals from the general population were identified. Multivariate Cox proportional hazard models were used. RESULTS:Within the first two years after cancer diagnosis, HNC survivors had a higher likelihood of developing cardiovascular disease (CVD). High Charleston Comorbidity Index (CCI) score at baseline (Hazard Ratio (HR) 1.67, 95 % 1.28-2.17), stage II and IV disease (HR 1.80, 95 % 1.29-2.51), age >=65 years old (HR 2.31, 95 % 1.85-2.88), chemotherapy (HR 1.47, 95 % 1.15-1.88) were associated with increased CVD risk. CONCLUSIONS:Compared to the general population, HNC survivors were more likely to develop cardiovascular diseases, particularly if they had the following risk factors: older age, stage II or IV cancer, high baseline CCI score, and chemotherapy were risk factors for development of CVD.

306 Background: Prostate cancer treatment has been widely associated with developing and/or worsening metabolic syndrome. While numerous studies have explored the interplay between prostate cancer and metabolism, there have been very few studies investigating endocrine and metabolic disease diagnoses among prostate cancer survivors with long term follow up. The aim of this study is to examine the incidence of endocrine and metabolic disease among prostate cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for endocrine and metabolic disease among prostate cancer survivors. Methods: Cohorts of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73,470 men without cancer matched by age, birth state and follow up time from the general population were identified. Incidental endocrine and metabolic diseases diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Results: Prostate cancer patients had increased risks of endocrine and metabolic diseases for the overall 16-year follow-up after cancer diagnosis (1-5 years: HR=1.26, 99%CI=1.22-1.31; 5-10 years: HR=1.21, 99%CI=1.16-1.26; 10-16 years: HR=1.20, 99%CI=1.12-1.28) compared to the general population. Elevated risks of thyroid disorder among prostate cancer patients were observed across follow-up periods (1-5 years: HR=1.19, 99%CI=1.11-1.28; 5-10 years: HR=1.12, 99%CI=1.03-1.22; 10-16 years: HR=1.17, 99%CI=1.02-1.35). Similarly, disorders of lipid metabolism risks were higher for all follow-up periods (1-5 years: HR=1.53, 99%CI=1.41-1.66; 5-10 years: HR=1.21, 99%CI=1.15-1.26; 10-16 years: HR=1.20, 99%CI=1.11-1.29). The risks of obesity and diabetes mellitus were also increased within 1-10 years and 1-5 years, respectively. Risk factors for endocrine and metabolic diseases among prostate cancer survivors included non-Hispanic ethnicity, unhealthy BMI, CCI≥1, family history of cancer, older age at diagnosis, and higher cancer stage throughout the overall follow-up periods after prostate cancer diagnosis. Significant risk factors for endocrine and metabolic diseases within 1-10 years after prostate cancer diagnosis included family history of prostate cancer, single marital status, government health insurance, high socioeconomic level, and high household incomes. Moreover, prostate cancer survivors with a diagnosis of endocrine and metabolic diseases faced a 13% increased risk of death. Conclusions: This study highlights a heightened risk of endocrine and metabolic diseases among prostate cancer survivors throughout the entire follow-up period after cancer diagnosis. It underscores the importance of multidisciplinary care to monitor and manage endocrine and metabolic diseases in this population of survivors.

PURPOSE:In 2021, 59.6% of low-risk patients with prostate cancer were under active surveillance (AS) as their first course of treatment. However, few studies have investigated AS and watchful waiting (WW) separately. The objectives of this study were to develop and validate a population-level machine learning model for distinguishing AS and WW in the conservative treatment group, and to investigate initial cancer management trends from 2004 to 2017 and the risk of chronic diseases among patients with prostate cancer with different treatment modalities.METHODS:In a cohort of 18,134 patients with prostate adenocarcinoma diagnosed between 2004 and 2017, 1,926 patients with available AS/WW information were analyzed using machine learning algorithms with 10-fold cross-validation. Models were evaluated using performance metrics and Brier score. Cox proportional hazard models were used to estimate hazard ratios for chronic disease risk.RESULTS:Logistic regression models achieved a test area under the receiver operating curve of 0.73, F-score of 0.79, accuracy of 0.71, and Brier score of 0.29, demonstrating good calibration, precision, and recall values. We noted a sharp increase in AS use between 2004 and 2016 among patients with low-risk prostate cancer and a moderate increase among intermediate-risk patients between 2008 and 2017. Compared with the AS group, radical treatment was associated with a lower risk of prostate cancer-specific mortality but higher risks of Alzheimer disease, anemia, glaucoma, hyperlipidemia, and hypertension.CONCLUSION:A machine learning approach accurately distinguished AS and WW groups in conservative treatment in this decision analytical model study. Our results provide insight into the necessity to separate AS and WW in population-based studies.

267 Background: Prostate cancer is the most prevalent malignancy among men in the United States. However, only a limited number of studies have explored the impact of rural-urban disparities in survival among prostate cancer patients with long-term follow-up. In order to investigate disparities in prostate cancer survival, we assess prostate cancer mortality and prognostic factors based on rural-urban residence. Methods: A cohort of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 was identified. Residential location information at the time of cancer diagnosis was used to stratify on rural-urban residence. All-cause death and prostate cancer-cause death risks were estimated using Cox proportional hazard regression models. Results: Among prostate cancer patients, 15.1% resided in rural counties in Utah. Patients living in rural counties were different in demographic and clinical characteristics compared to their urban counterparts. An association was observed between rural residence and elevated risks of all-cause mortality (HR=1.19, 99%CI=1.10-1.29) and prostate cancer-specific mortality (HR=1.21, 99%CI=1.03-1.43). Elevated risks of both all-cause and prostate cancer-specific mortality were associated to factors such as unhealthy BMI, comorbidity index ≥1, family history of cancer or prostate cancer, single marital status, low income, low socioeconomic status, government insurance, earlier year of diagnosis, advanced prostate cancer stage, and extensive cancer treatment. Furthermore, the observed disparities in demographic and clinical profiles appeared to contribute to the disparities in all-cause and prostate cancer-specific mortality risks between rural and urban prostate cancer patients. Conclusions: Rural residence exhibited a significant association with the risk of prostate cancer-related and all-cause mortality. Patients residing in rural areas demonstrated distinct factors influencing mortality risks, encompassing both demographic and clinical aspects. These findings underscore the imperative for targeted interventions aimed at mitigating the rural-urban disparities in prostate cancer outcomes.

ABSTRACTBackgroundAnnual or biennial breast cancer screenings are recommended for women 40 and older. Women residing in rural areas have worse breast cancer survival rates than urban women, but no study has focused on rural versus urban residence in Utah regarding breast cancer screening and mortality.MethodsCases (n = 14,516) were women aged > 39 diagnosed with a first primary invasive breast cancer between 1998 and 2017 in Utah. Controls (n = 63,117) without a history of breast cancer were matched to cases by birth year and birth state. Mammography screening status was identified by Current Procedural Terminology (CPT) codes. Logistic regression was used to assess the odds of breast cancer diagnosis. The Cox proportional hazards model was used to assess survival outcomes for rural and urban breast cancer patients based on screening status.ResultsScreening mammography usage among rural patients diagnosed with breast cancer was lower (17.7%) than urban usage (20.7%). Usage of screening mammograms resulted in higher odds of breast cancer diagnosis at localized stage rather than at a regional and distant stage. Rural breast cancer cases had a higher proportion of deaths, and a lower proportion screened, than urban breast cancer cases. Hazard ratios showed that screening mammography usage was associated with better survival among both rural (HR = 0.50, 95% CI = 0.44–0.57) and urban (HR = 0.56, 95% CI = 0.39–0.82) breast cancer cases.ConclusionScreening mammography usage was associated with better overall survival regardless of place of residence. Removing barriers and improving information regarding breast cancer screenings are needed in both rural and urban settings in Utah to increase mammography usage, with the overall goal of increasing early detection and outcomes of breast cancer.

Outcomes1. Participants will be able to identify differences in antidepressant prescriptions in family members of patients with and without dementia before and after death.2. Participants will be able to identify additional caregiver and patient factors associated with antidepressant prescriptions including demographics, caregiver-patient relationship, nursing home status, and family size.Key MessagePersons with dementia often have more protracted long-term care and end-of-life caregiving needs, compared to those with other chronic illnesses with caregiving typically managed by spouses and adult children. Dementia-related responsibilities are particularly stressful, with high rates of depression before death and more intense grief reactions following death.ImportanceLittle is known, however, about how the emotional stress of caregiving may differ before and after the death of persons with and without dementia. Given that antidepressant prescriptions are a strong indicator of clinically relevant levels of caregiver stress and bereavement outcomes, we explored the rates of antidepressant prescriptions among family members of decedents with and without dementia, during the one year prior and one year following a family member's death.Objective(s)To examine antidepressant prescriptions in kin of decedents with and without dementia before and after death.Scientific Methods UtilizedThis retrospective cohort study used data from the novel Utah Caregiving Population Science (Utah C-PopS) dataset and focused on the widows/widowers (n=47,117) and sons/daughters (n=210,572) of decedents who died in Utah between 1998-2016 with dementia (n=29,401) or without dementia (n=98,017). Descriptive statistics were used to describe the study sample and multivariable logistic regressions were used to predict whether someone had an antidepressant prescription during the one-year prior and one-year post death by dementia status, controlling for decedent age, kin age, co-residence status, presence/type/number of other kin, prior antidepressant use, and other variables.ResultsMultivariable logistic regression models revealed spouses of dementia decedents had higher odds of an antidepressant prescription compared to spouses of non-dementia decedents during pre-death (End of life caregiving) [OR = 1.22 (1.01, 1.46)], including higher odds of prescriptions in female spouses [OR =1.64 (1.39, 1.96)]. Adult children of dementia decedents had higher odds of an antidepressant prescription compared to adult children of non-dementia decedents during pre-death (End of life (EOL) caregiving) [OR = 1.36 (95% 1.17, 1.58)], including higher odds of prescriptions in daughters [OR=1.74 (1.51, 2.00)]. Conversely, there was no difference in odds of antidepressant prescription 1 year after death in either spouses or adult children of decedents with and without dementia [OR = 1.12 (0.93, 1.33); OR = 1.12 (0.96, 1.31) respectively].Conclusion(s)Differences in antidepressant prescriptions during pre-death periods suggests that caregiving and bereavement may be more intense for spouses and adult children of persons with dementia and for females compared to males. Dementia status did not have a significant effect on the odds of post-death grief antidepressant prescriptions.ImpactThese results underscore the need for pre-death support for caregivers of persons with dementia, particularly female caregivers. Furthermore, these results demonstrate the utility of population-based datasets to investigate associations between dementia kin and medical outcomes including antidepressant prescriptions. Further analysis should examine if larger family sizes and multiple available caregivers impact antidepressant prescriptions an indicator that other family members may be more likely to share the caregiving responsibilities and provide grief support.KeywordsFamily caregivers/Psychosocial support

Breast cancer is the most common non-skin cancer in women and an increasing number of people are living as breast cancer survivors. While the prognosis of breast cancer continues to improve, the rates of sexual dysfunction and the risk related to cancer treatments have not been well characterized in a population-based study. We identified a cohort of 19,709 breast cancer survivors diagnosed between 1997 and 2017 from the Utah Cancer Registry, and 93,389 cancer-free women who were matched by age and birth state from the Utah Population Database. Sexual dysfunction diagnoses were identified through ICD-9 and ICD-10 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios for risk of sexual dysfunction. Breast cancer survivors were at higher risk of sexual dysfunction diagnosis (9.1% versus 6.9%, HR 1.60, 95% CI 1.51–1.70) compared to the general population. This risk increased 2.05-fold within 1 to 5 years after cancer diagnosis (95% CI 1.89–2.22) and 3.05-fold in individuals diagnosed with cancer at < 50 years of age (95% CI 2.65–3.51). Cancer treatments including endocrine therapy, chemotherapy and radiation therapy were associated with an increased risk of sexual dysfunction among breast cancer survivors. Risk of sexual dysfunction in breast cancer survivors is higher than in the general population, but may be underdiagnosed in the clinical setting. Health care professionals should be encouraged to address the topic of sexual health early on in the treatment of breast cancer, and routinely screen patients for symptoms of sexual dysfunction.

To better understand the risk of developing a mental health disorder and the association on outcomes in endometrial cancer patients. Endometrial cancer patients >18 years old diagnosed between 1997-2012 were identified from the Utah Population Database and matched with up to 5 cancer free women from the general population. Mental health disorders were identified by International Classification of Diseases ICD-9 diagnostic codes. Endometrial cancer survivors with pre-existing mental health issues were excluded. Diagnosis of a mental health disorder in endometrial cancer patients was compared with the endemic rate. The impact of a mental health disorders on overall survival (OS) and cause specific survival (CSS) was evaluated. There were 2941 endometrial cancer patients and 12,192 general population matched subjects that met criteria with a median follow up time of 7.1 years (range 0-19.2) and 7.7 years (0.4- 19.2) respectively. Within the first 1.5 years from diagnosis, there was an association of endometrial cancer patients being diagnosed with a mental health disorder (Hazard radio (HR) 3.09, 95% confidence interval (CI) 2.66-3.59). However, no association was found in endometrial cancer patients being diagnosed with a mental health disorder between 1.5-3 years (HR 1.07, 95% CI 0.83-1.38) and >3 years (HR 1.09, 95% CI 0.95- 1.26). Treatment with tri-modality (surgery, radiation and chemotherapy) and advanced disease was associated with mental health disorders. OS was worse in endometrial cancer survivors who developed an anxiety disorder (p = 0.0265). CSS was worse in endometrial cancer patients diagnosed with all mental health disorders and anxiety disorders (p < 0.0001, p = 0.002). Endometrial cancer patients have an increased diagnosis of mental health disorders within the first 1.5 years of cancer diagnosis compared to the general population. Endometrial cancer survivors with anxiety disorder have worse OS. Anxiety disorders and all mental health disorders have a worse CSS.

Purpose: Rural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship. Materials and Methods: Data were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1-3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years. Results: Results revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008). Conclusions: This study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event. (c) 2023 Elsevier Inc. All rights reserved.

Obesity is associated with increased cancer risk. Because of the substantial and sustained weight loss following bariatric surgery, postsurgical patients are ideal to study the association of weight loss and cancer.

Background: Limited population-based studies have focused on breast cancer survivors in rural populations. We sought to evaluate the risk of adverse health outcomes among rural and urban breast cancer survivors and to evaluate potential predictors for the highest risk outcomes.Methods: A population-based cohort of rural and urban breast cancer survivors diagnosed between 1997 and 2017 was identified in the Utah Cancer Registry (UCR). Rural breast cancer survivors were matched on year (+/- 1 year) and age at cancer diagnosis (+/- 1 year) with up to 5 urban breast cancer survivors (2,359 rural breast cancer survivors; 11,748 urban breast cancer survivors). Cox proportional hazards models were used to calculate HRs with 99% confidence intervals (CI) for adverse health outcomes overall, within 5 years, and >5 years after cancer diagnosis.Results: Compared with urban breast cancer survivors, rural breast cancer survivors had a 39% (HR, 1.39; 95% CI, 1.02-1.65) higher risk of heart failure (HF) within the 5 years of follow-up. Overall, there was no increase in the risk of other evaluated adverse health outcomes. A higher baseline body mass index and Charlson Comorbidity Index, family history of cardiovascular diseases, family history of breast cancer, and advanced cancer stage were risk factors for HF for rural and urban breast cancer survivors, with similar levels of HF risk.Conclusions: Rural residence was associated with an increased risk of HF among breast cancer survivors.Impact: Our study highlights the need for primary preventive strategies for rural cancer survivors at risk of heart failure.

PURPOSE:Patients with advanced solid tumors may receive intensive treatments near the end of life. This study aimed to create a machine learning (ML) model using limited features to predict 6-month mortality at treatment decision points (TDPs).METHODS:We identified a cohort of adults with advanced solid tumors receiving care at a major cancer center from 2014 to 2020. We identified TDPs for new lines of therapy (LoTs) and confirmed mortality at 6 months after a TDP. Using extreme gradient boosting, ML models were developed, which used or derived features from a limited set of electronic health record data considering the literature, clinical relevance, variability, availability, and predictive importance using Shapley additive explanations scores. We predicted and observed 6-month mortality after a TDP and assessed a risk stratification strategy with different risk thresholds to support communication of chance of survival.RESULTS:Four thousand one hundred ninety-two patients were included. Patients had 7,056 TDPs, for which the 6-month mortality increased from 17.9% to 46.7% after starting first to sixth LoT, respectively. On the basis of internal validation, models using both 111 (Full) or 45 (Limited-45) features accurately predicted 6-month mortality (area under the curve ≥ 0.80). Using a 0.3 risk threshold in the Limited-45 model, the observed 6-month survival was 34% (95% CI, 28 to 40) versus 81% (95% CI, 81 to 82) among those classified with low or higher chance of survival, respectively. The positive predictive value of the Limited-45 model was 0.66 (95% CI, 0.60 to 0.72).CONCLUSION:We developed and validated a ML model using a limited set of 45 features readily derived from electronic health record data to predict 6-month prognosis in patients with advanced solid tumors. The model output may support shared decision making as patients consider the next LoT.

You have accessJournal of UrologyCME1 Apr 2023PD21-05 CARDIOVASCULAR OUTCOMES IN A POPULATION-BASED COHORT OF PROSTATE CANCER PATIENTS Siqi Hu, Chun-Pin Chang, John Snyder, Vikrant Deshmukh, Michael Newman, Ankita Date, Carlos Carlos, Benjamin Haaland, Christy Porucznik, Lisa Gren, Alejandro Sanchez, Alejandro Sanchez, Shane Lloyd, Brock O’Neil, and Mia Hashibe Siqi HuSiqi Hu More articles by this author , Chun-Pin ChangChun-Pin Chang More articles by this author , John SnyderJohn Snyder More articles by this author , Vikrant DeshmukhVikrant Deshmukh More articles by this author , Michael NewmanMichael Newman More articles by this author , Ankita DateAnkita Date More articles by this author , Carlos CarlosCarlos Carlos More articles by this author , Benjamin HaalandBenjamin Haaland More articles by this author , Christy PorucznikChristy Porucznik More articles by this author , Lisa GrenLisa Gren More articles by this author , Alejandro SanchezAlejandro Sanchez More articles by this author , Alejandro SanchezAlejandro Sanchez More articles by this author , Shane LloydShane Lloyd More articles by this author , Brock O’NeilBrock O’Neil More articles by this author , and Mia HashibeMia Hashibe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003287.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is the most common malignancy among men in the United States. Few studies have evaluated cardiovascular disease (CVD) risk comprehensively among prostate cancer patients with treatment dose-response relations. The primary aim of our study is to assess the incidence of cardiovascular diseases among prostate cancer patients compared to a general population cohort. A secondary aim is to investigate socioeconomic status (SES) and clinical risk factors for cardiovascular disorders among prostate cancer patients. METHODS: Cohorts of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73,470 men without cancer matched on age, birth state and follow-up time were identified. CVD diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs), adjusted for race/ethnicity, education, baseline Body Mass Index (BMI), baseline Charlson Comorbidity Index (CCI), risk group, age at diagnosis, hyperlipidemia, smoking status, therapy type, and diagnosis year based on a comprehensive evaluation of confounding variables. RESULTS: The risks of CVDs, including hypertension, arterial diseases, and venous diseases, among prostate cancer survivors compared to general population were increased for all follow-up periods after cancer diagnosis (1-5 years: HR=1.17, 95% CI=1.13-1.20; 5-10 years: HR=1.11, 95% CI=1.07-1.16; 10-16 years: HR=1.13, 95% CI=1.06-1.21). The risk of CVD was increased with obesity, baseline comorbidities, lower SES, and advanced-stage cancer, and differed by first-course cancer treatment, with CVDs higher for androgen deprivation therapy (ADT) and conservative treatment. Compared to intermittent ADT, continuous ADT was associated with increased risks of all-cause mortality among prostate cancer patients (HR=1.78, 95% CI=1.04-3.05). We also observed that an increasing duration of ADT was associated with an increased risk of arterial diseases (dose-response p=0.022) and an increased risk of all-cause mortality (dose-response p value=0.0439). CONCLUSIONS: We found an increased risk of CVDs that lasted through 10-16 years post-prostate cancer diagnosis. Lifestyle interventions to decrease the risk of CVDs in prostate cancer survivors may be potentially beneficial to increasing life expectancy. Source of Funding: This work was supported by grants from the NIH (R01 CA244326, R21 CA185811, R03 CA159357, M.Hashibe, PI), the Huntsman Cancer Institute, and the Cancer Control and Population Sciences Program (HCI Cancer Center Support Grant P30CA042014). This research was supported by the Utah Cancer Registry, which is funded by the National Cancer Institute's SEER Program, Contract No. HHSN261201800016I, the US Center for Disease Control and Prevention's National Program of Cancer Registries, Cooperative Agreement No. NU58DP0063200-01, with additional support from the University of Utah and Huntsman Cancer Foundation. Partial support for all datasets within the Utah Population Database is provided by the University of Utah, Huntsman Cancer Institute and the Huntsman Cancer Institute Cancer Center Support grant, P30 CA42014 from the National Cancer Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e591 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Siqi Hu More articles by this author Chun-Pin Chang More articles by this author John Snyder More articles by this author Vikrant Deshmukh More articles by this author Michael Newman More articles by this author Ankita Date More articles by this author Carlos Carlos More articles by this author Benjamin Haaland More articles by this author Christy Porucznik More articles by this author Lisa Gren More articles by this author Alejandro Sanchez More articles by this author Alejandro Sanchez More articles by this author Shane Lloyd More articles by this author Brock O’Neil More articles by this author Mia Hashibe More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Rural cancer survivors experience considerable health disparities compared to urban cancer survivors for cancer treatment and survival. The objective of our study was to investigate the risk of developing diseases for rural compared to urban prostate cancer survivors in Utah.Methods: We identified a cohort of 3575 rural prostate cancer survivors and 17,778 urban prostate cancer survivors from the Utah Cancer Registry. The Fine-Gray subdistribution hazards model was used to estimate hazard ratios and 95 % confidence intervals for diseases in major body systems among rural compared to urban prostate cancer survivors at > 1-5 years and > 5 years after prostate cancer diagnosis.Results: Rural residence was associated with an increased risk of diseases of the respiratory system at > 5 years (HR: 1.16, 95 % CI: 1.01-1.32) after cancer diagnosis compared to urban residence among prostate cancer survivors in Utah. Decreased risks were observed in infectious and parasitic diseases, diseases of the blood and blood-forming organs, diseases of the nervous system and sense organs, and diseases of the skin and subcutaneous tissue for rural prostate cancer survivors between 1 and 5 years after cancer diagnosis.Conclusions: Rural prostate cancer survivors in Utah were somewhat healthier compared to urban prostate cancer survivors. Further studies are needed to confirm whether these associations are also supported for rural prostate cancer survivors in other regions of the U.S.