Jessica Yasmine Islam

Background: Although a rare malignancy, anal cancer incidence is increasing with a growing proportion diagnosed at advanced stages. Our objective was to evaluate factors associated with advanced stage-at-diagnosis (stage 3+) of squamous cell carcinoma of the anus (SCCA) among men and women with and without HIV. Methods: We analyzed U.S. National Cancer Database data (2004-2020) for patients aged 18-89 years with SCCA (ICD-O-3: C210-C218). The outcome was advanced stage at diagnosis (stage 3/4). Stratified by sex, we assessed associations with demographics, HIV status, healthcare access (facility type, insurance), and geographic factors using hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Among 36,389 patients with SCCA, 2,600 (7.1%) were living with HIV and 42% were diagnosed at stage 3-4. Women without HIV were more likely to be diagnosed at an advanced stage compared to men without HIV (aPR: 1.20, 95% CI: 1.05-1.37). Among both sexes, NH-Black race (aPR: 1.09, 95% CI: 1.04-1.14), being uninsured (aPR: 1.31, 95% CI: 1.23-1.39), Medicaid insurance (aPR: 1.19, 95% CI: 1.13-1.24), and residing in the least-educated zip codes (aPR: 1.09, 95% CI: 1.04-1.15) were associated with advanced-stage diagnosis. Among women, advanced-stage diagnosis was associated with NH-Asian race (aPR: 1.23, 95% CI: 1.06-1.42). HIV status was not independently associated. Conclusions: Correlates of advanced-stage SCCA differed by sex; living with HIV was not associated with advanced-stage presentation. Impact: These findings identify NH-Black and NH-Asian women, uninsured individuals, and Medicaid enrollees as populations more likely to be diagnosed with advanced-stage SCCA.

OBJECTIVE: To assess the associations of time to treatment initiation and overall survival with race and ethnicity by socioeconomic status (SES) among women with advanced endometrial cancer. We also aimed to evaluate the role of social and clinical determinants in time to treatment initiation and overall survival. METHODS: We conducted a retrospective cohort study using the Flatiron Health Research Database among adult women diagnosed with advanced (stages III–IV) endometrial cancer or who developed recurrence between 2013 and 2022. The main outcomes included delayed treatment initiation (more than 6 weeks) and all-cause mortality. Primary exposures included race and ethnicity and quintiles of area-level SES (Yost Index). We computed adjusted prevalence ratios with 95% CIs using multivariable modified Poisson regressions to assess racial and ethnic disparities in time to treatment initiation, and we computed adjusted hazard ratios (HRs) using Cox proportional hazards models to assess disparities in mortality. All models were adjusted for sociodemographic factors, comorbidities, and cancer and histology characteristics. RESULTS: Among the 4,177 women included in this study, the racial and ethnic composition included 68.1% non-Hispanic White, 15.2% non-Hispanic Black, 5.3% Hispanic/Latina, and 2.2% non-Hispanic Asian. The median time to treatment initiation was 26 days, and the median survival time was 3.1 years. After adjustments for participant characteristics, delayed treatment initiation was associated with living in areas of the lowest SES quintile among non-Hispanic Black (adjusted prevalence ratio 1.07, 95% CI, 1.00–1.13) and Hispanic/Latina (adjusted prevalence ratio 1.12, 95% CI, 1.00–1.25) participants compared with non-Hispanic White participants. We observed an inverted moderating effect on all-cause mortality in which non-Hispanic Black participants living in areas of the highest SES quintile had a higher risk of death compared with non-Hispanic White participants (adjusted HR 2.49, 95% CI, 1.55–4.00). CONCLUSION: Our findings demonstrated that racial and ethnic disparities in treatment initiation and survival persist among women with advanced endometrial cancer and are significantly modified by socioeconomic factors.

Background: People with HIV (PWH) have a disproportionately high burden of chronic comorbidities. However, how their multimorbidity patterns differ from those of the general population and how COVID-19 infection may affect this burden have not been well characterized. Methods: We conducted a retrospective cohort study using the National COVID Cohort Collaborative (N3C), including adults aged ≥18 years with a confirmed COVID-19 diagnosis between January 1, 2018 and December 31, 2024. Fourteen chronic comorbidities were identified using N3C concept sets. Exploratory factor analysis was used to identify multimorbidity patterns before and after COVID-19 diagnosis. Results: Among 7 500 765 patients with COVID-19, 52,015 (0.7%) were PWH. The median age was 48 years (IQR, 33–63) and 57.3% were female. PWH consistently had a higher multimorbidity burden than PWoH, and this disparity widened after COVID-19: the proportion with ≥ 3 comorbidities rose from 45.0% to 55.9% among PWH versus 22.2% to 29.7% among PWoH. Four multimorbidity factors were identified in both periods: transplant and multiorgan disease; cardiometabolic disorder; substance use, psychiatric disorder, and liver disease; and obesity. After COVID-19, the leading pattern among PWH shifted toward cardiometabolic disorder. Conclusions: PWH experience a disproportionately high multimorbidity burden, with disparities further amplified after COVID-19 diagnosis and the leading pattern shifting toward cardiometabolic dominance. These findings highlight the need for integrated, multimorbidity-focused care for PWH.

Background: Breast cancer screening is crucial for early detection and improved survival in Alzheimer disease and related dementias (ADRD) patients, but real-world evidence of its effects on survival and prognosis remains insufficient. Methods: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results–Medicare data (1999-2019) to analyze the impact of breast cancer screening on prognosis (ie, cancer stage) and survival in ADRD women with breast cancer diagnosed at ages 67 years and older. Logistic and Cox regression models were employed to assess the relationship between screening and risk of advanced stage at diagnosis and length of survival, adjusted for relevant covariates (eg, marital status, comorbidities, age at screening). Results: The cohort included 8739 ADRD patients with breast cancer, with 4483 completed at least 1 screening between their ADRD and first breast cancer diagnosis. The cohort completed screening had statistically significant lower rates of advanced-stage diagnosis (22.2% vs 42.6%) and longer survival (65.9 vs 45.7 months) compared with the cohort without any screening history. Unscreened patients had 2.7 times higher odds of advanced-stage diagnosis and 2 times higher hazard of death than patients with at least 1 screening completed before breast cancer diagnosis. Effects of comorbidities, age, and race were statistically significant on diagnosis stage and survival in breast cancer patients. Conclusion: Our study demonstrated the benefit of screening in early diagnosis and longer survival in ADRD patients with breast cancer, which advocates for an expansion of current breast cancer screening recommendations to more effectively guide cancer care for ADRD patients.

Introduction: Nutrition counselling is recommended after pancreatic cancer surgery given the complex nutritional problems patients experience. In practice, access and delivery of nutrition counselling after pancreatic surgery varies across settings. To address this gap, our study team developed the Support Through Remote Observation and Nutrition Guidance (STRONG) programme, an implementation strategy that addresses common barriers to nutrition care delivery in oncology. Methods and analysis: The STRONG programme includes a standardised protocol to specify the timing and amount of nutrition counselling that should be delivered and patient-mediated implementation strategies including collection of patient-reported information, an educational brochure summarising common nutrition problems and recommended dietary strategies after pancreatic surgery and a question prompt list for the patient-dietitian encounter. A pilot randomised controlled trial will be conducted to assess the feasibility and acceptability of the STRONG programme compared with usual care in pancreatic cancer surgery patients after hospital discharge (n = 80). The trial is designed to be pragmatic and integrated into existing workflows and clinic teams. The primary goal will be to compare feasibility and acceptability outcomes against pre-planned benchmarks. Data will be collected from patients and caregivers and healthcare providers who assist with STRONG implementation. Secondary goals include collecting preliminary data on effectiveness and implementation outcomes that will support a future definitive hybrid implementation-effectiveness trial. Ethics and dissemination: This study was approved by the Moffitt Cancer Center Institutional Review Board of Record, Advarra (Pro00071143). Participants will be required to provide written consent prior to enrolment. Study findings will be disseminated through plain language summaries, conference abstracts and peer-reviewed publications. Trial registration number: ClinicalTrials.gov NCT06001268 . Registered on 21 August 2023, prior to participant enrolment.

While disparities in COVID-19 therapeutic access have been documented, the effect of HIV status on treatment access and how it intersects with other sociodemographic factors has not been well explored. Using data from the National Clinical Cohort Collaborative (N3C), we investigated disparities in COVID-19 therapeutic prescription among persons with HIV and without HIV. This was a retrospective cohort study of patients’ data from January 2020 to November 2024. The study included 7 806 412 patients with a COVID-19 diagnosis, of whom 45 508 (0.58%) were persons with HIV. We employed logistic and linear regression models to assess associations between therapeutic receipt and patient characteristics. Persons with HIV had significantly higher adjusted odds of receiving COVID-19 therapeutics compared to persons without HIV (remdesivir, aOR 1.26 [95% CI: 1.20, 1.33]; nirmatrelvir/ritonavir, aOR 2.86 [95% CI: 2.77, 2.95]). Despite this, significant racial/ethnic inequities were observed. American Indian or Alaskan Native persons with HIV (estimated coefficient 0.997) and Hispanic/Latinx persons with HIV (estimated coefficient 0.992) had a lower estimated prevalence of remdesivir receipt compared to White Non-Hispanic individuals. For nirmatrelvir/ritonavir, Black/African American individuals (persons with HIV, estimated coefficient 0.947; persons without HIV, estimated coefficient 0.943), American Indian or Alaskan Native persons with HIV (estimated coefficient 0.996), and Hispanic/Latinx individuals (estimated coefficient 0.992) showed a lower estimated prevalence of receipt compared to their White counterparts. Persons with HIV demonstrated higher odds of receiving COVID-19 therapeutics than persons without HIV. However, persistent racial and ethnic inequities in treatment uptake were evident.