PURPOSE:Advancing therapies have increased B-cell Non-Hodgkin's Lymphoma (B-NHL) patient survival. However, data are limited on the risk of type II diabetes mellitus (type II DM) in adult survivors following treatment. This study examines the risk of type II DM among a Utah population of B-NHL survivors, compared to the general population. METHODS:A cohort of 3529 adult survivors diagnosed with B-NHL in Utah between 1997 and 2013 in the Utah Cancer Registry and 13,339 individuals from the general population were identified using the Utah Population Database (UPDB). Multivariate Cox Proportional Hazard models were used to estimate adjusted hazard ratios (aHR) for developing type II DM, stratified for time post-diagnosis. RESULTS:Compared to the cancer-free population, B-NHL survivors had an overall increased risk of developing type II DM (HR: 1.49; 95% CI: 1.32, 1.69), largely within the first year (HR: 4.41; 95% CI: 3.52, 5.52) following diagnosis. Older B-NHL survivors were more likely to develop type II DM at any time compared to survivors < 40 years [40-65 years (HR: 2.66; 95% CI 1.48-4.79); ≥ 65 years (HR: 3.77; 95% CI 2.09-6.78)]. Obese (BMI > 30 kg/m2) survivors had a 4.06-fold increase in the risk of type II DM compared to normal BMI (18-24.9 kg/m2) cancer survivors. Cancer treatment did not increase the risk of type II DM compared to no treatment. CONCLUSIONS:Adult B-NHL cancer survivors were at an overall increased risk of developing type II DM compared to the general population, within the first year and overall, following a cancer diagnosis. This study provides evidence suggesting the importance of obesity prevention and improvement in care management oversight for B-NHL survivorship and DM outcomes.

Background: Oral cavity cancer (OCC) incidence is rising disproportionately among young adults lacking traditional risk factors of tobacco and alcohol exposure. While chronic inflammation and poor oral health are suspected contributors, their role remains inadequately characterized, particularly in historically low-risk populations. Objective: To evaluate associations between OCC risk and antecedent oral, allergic, and inflammatory conditions in a population-based cohort, with stratification by age (<50 versus ≥50 years) and tobacco/alcohol use status, to identify potentially modifiable risk factors for targeted prevention strategies. Methods: This population-based case-control study analyzed 754 adults diagnosed with OCC between 1996 and 2016 and 3758 frequency-matched cancer-free controls from a statewide population database. Pre-existing oral, allergic, and inflammatory conditions were identified via International Classification of Diseases (ICD)-9/10 and Current Procedural Terminology (CPT) codes recorded ≥1 year before diagnosis. Multivariable logistic regression estimated odds ratios (ORs) adjusted for age, sex, race/ethnicity, body mass index, Charlson Comorbidity Index, and smoking status. Subgroup analyses examined effect modification by age and substance use history. Results: Pre-existing oral diseases were associated with significantly elevated OCC risk (adjusted OR = 3.2). This association was most pronounced in non-smoking/non-drinking adults <50 years (OR = 8.8). Inflammatory disorders exhibited a weaker but significant association overall (OR = 1.7), with similar magnitude in older adults (OR = 1.7), non-smoking/non-drinking individuals (OR = 1.8), and non-smoking/non-drinking adults ≥50 years (OR = 1.9). No association between allergies and OCC was observed in any subgroup. Conclusion: Oral diseases are a dominant, modifiable risk factor for OCC, especially in young adults who neither smoke nor drink, supporting routine oral health screening for all adults regardless of lifestyle factors. The consistent, albeit smaller, excess risk associated with inflammatory disorders suggests that patients with such conditions should also be considered for heightened OCC surveillance.

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.

AIMS:To compare the risk of all-cause death and cardiovascular events in new users of insulin glargine, glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), particularly in subgroups defined by baseline haemoglobin A1C (HbA1C), body mass index (BMI) and estimated glomerular filtration rate (eGFR). MATERIALS AND METHODS:We conducted an active comparator, new user design study in a national cohort of 161 405 veterans with type 2 diabetes (T2D) on metformin and initiated insulin glargine (n = 54 375), GLP-1RA (n = 22 145) or SGLT2i (n = 84 885) between 1 January 2018 and 31 December 2021. Patients were followed until 31 March 2023. Inverse probability weighted Cox regression models were used for treatment comparisons on all-cause deaths and cardiovascular events in the entire cohort and above subgroups. RESULTS:There were 20 788 cardiovascular events/414 414 person-years and 15 268 all-cause deaths/446 458 person-years. Insulin glargine had a higher hazard of all-cause death compared to GLP-1RA (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.48-1.67) or SGLT2i (HR 1.55, 95% CI 1.48-1.61) in the entire cohort and across subgroups, especially in those with HbA1C levels <9.0%. Results were similar for secondary outcomes. Compared to GLP-1RA, SGLT2i had similar risk of all-cause death (HR 1.03, 95% CI 0.97-1.10) but higher hazard of cardiovascular events (HR 1.13, 95% CI 1.08-1.19). Across subgroups, GLP-1RA and SGLT2i had generally similar effects, with SGLT2i showing a slightly higher risk in some cases. CONCLUSIONS:Insulin glargine might be deleterious particularly in those with HbA1C <9.0%. There was no clear evidence for prioritization of SGLT2i versus GLP-1RA across subgroups.

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.

Supplementary Figure from Relations of Current and Past Cancer with Severe Outcomes among 104,590 Hospitalized COVID-19 Patients: The COVID EHR Cohort at the University of Wisconsin

ObjectiveTo evaluate the validity of the Utah statewide All-Payer Claims Database (APCD), we compared breast cancer-specific treatments and dosages with gold-standard abstraction of medical records.Study DesignIn this pilot study, breast cancer treatments were abstracted by a certified tumor registrar at the Utah Cancer Registry (UCR) for patients diagnosed in 2013 with breast cancer. The abstraction of medical records was the gold standard for comparison with treatments identified in the APCD. The reliability and agreement between the treatment identified in the APCD and abstraction data were measured with sensitivity and specificity. Dose consistency was measured with the intraclass correlation coefficients (ICC).ResultsCompared with the 186 abstractions, the sensitivity of the APCD to identify chemotherapy agents was high: 89% for any agent, 91% for carboplatin, 83% for docetaxel, 82% for doxorubicin, or 94.7% for biologic therapy. The consistency between the chemotherapy dosage identified in the claims and the abstraction varied from 63% to 76%. For radiotherapy, the sensitivity of the claims to identify the completed radiotherapy regimen was 66%. The ICC between radiotherapy doses identified in the claims and the abstraction was 54% (95% confidence interval [CI], 48%, 67%).ConclusionsEmploying these novel methods, the claims were highly reliable in identifying cancer treatment agents overall, namely carboplatin, docetaxel, and trastuzumab. The claims were of moderate utility in capturing the treatment dose information. In addition to the APCD, the use of multiple data sources improved the completeness of cancer treatment information.

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.

OBJECTIVES:The incidence of oropharyngeal cancer continues to rise in the United States, yet studies on the quality of life (QoL) of oropharyngeal cancer patients are limited. The objective of this pilot study was to assess the impact of oral health on the QoL in oropharyngeal cancer survivors. MATERIALS AND METHODS:Oropharyngeal cancer survivors with a confirmed cancer diagnosis from 1996 to 2016 were sampled from the Utah Cancer Registry. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was administrated between January and May of 2019. The impact of oral health on QoL was evaluated using simple linear regression (β-coefficient). RESULTS:Among the 260 oropharyngeal cancer survivors, the majority were male (84.6 %) and ≥ 60 years of age at the time of cancer diagnosis (74.0 %). The most frequently reported symptoms of OHIP-14 were discomfort while eating any foods (19.2 %) and worsening sense of taste (16.0 %). The overall OHIP-14 mean score was 13.3. Significantly worse OHIP-14 scores were observed for females (β = 12.85, p = 0.01), chemotherapy recipients (β = 6.60, p = 0.02), and past smokers (β = 5.25, p = 0.04). Better OHIP-14 scores (better oral QoL) were observed in patients with distant cancer stage (β = -7.66, p = 0.01), higher income (β = -2.50, p = 0.05), and older age at cancer diagnosis (β = -0.35, p = 0.03). CONCLUSION:The oral health-related quality of life scores observed in this pilot study suggest a need for improvement in patient symptom management over time.

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.

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.