Background The Affordable Care Act (ACA) included provisions to extend dependent healthcare coverage up to the age of 26 years in 2010. We examined the early impact of the ACA (prior to implementation of insurance exchanges in 2014) on insurance rates in young adults with cancer, a historically underinsured group. Methods Using National Cancer Institute Surveillance, Epidemiology and End Results (SEER) data for 18 cancer registries, we examined insurance rates pre-(January 2007–September 2010) vs. post-(October 2010–December 2012) dependent insurance provisions among young adults aged 18–29 years when diagnosed with cancer during 2007–2012. Using multivariate generalized mixed effect models, we conducted difference-in-differences analysis to examine changes in overall and Medicaid insurance after the ACA among young adults eligible (18–25 years) and ineligible (26–29 years) for policy changes. Results Among 39,632 young adult cancer survivors, we found an increase in overall insurance rates in 18–25 year-olds after the dependent provisions (83.5% pre vs. 85.4% post, p<0.01), but not among 26–29 year-olds (83.4% pre vs. 82.9% post, p=0.38). After adjusting for patient socio-demographics and cancer characteristics, we found 18–25 year-olds had a 3.1% increase in being insured relative to 26–29 year-olds (p<0.01); however, there were no significant changes in Medicaid enrollment (p=0.17). Conclusions Our findings identify an increase in insurance rates for young adults 18–25 relative to those 26–29 (1.9% vs. −0.5%) that were not due to increases in Medicaid enrollment, demonstrating a positive impact of the ACA dependent care provisions on insurance rates in this population.

Therapeutic combinations targeting innate and adaptive immunity and predictive biomarkers of response in esophagogastric cancer (EGC) are needed. We assessed safety and clinical utility of DKN-01 (a novel DKK1-neutralizing IgG4 antibody) combined with pembrolizumab and retrospectively determined DKK1 tumoral expression as a biomarker. Patients with advanced EGC received intravenous DKN-01 (150 or 300 mg) on days 1 and 15 with pembrolizumab 200 mg on day 1 in 21-day cycles. Clinical response was assessed by RECIST v1.1. Association of tumoral DKK1 mRNA expression (H-score: high ≥upper-tertile, low

Background: The American Society of Clinical Oncology's recommendation for “dedicated palliative care services, early in the disease course, concurrent with active treatment” for cancer patients is a challenge for cancer centers to accommodate. Despite demonstrated benefits of concurrent care, disparities among socioeconomic and ethnic groups in access to supportive care services have been described. The aim of this project was to evaluate: (a) how insurance coverage and ethnicity impact patient symptom burden and, (b) how those factors influence palliative access for patients at a South Texas NCI-designated cancer center.Methods: During a 5-month prospective period, 604 patients from five ambulatory oncology clinics completed the 10 question Edmonton Symptom Assessment Scale (ESAS) surveys during their clinic visit. Patient demographics, ESAS scores, palliative referral decisions, and time to palliative encounters were collected. We compared symptom burden and time to consult based on ethnicity and insurance status (insured = Group A; under-insured and safety net = Group B).Results: The mean ESAS score for all patients at the initial visit was 19.9 (SD = 18.1). Safety net patients were significantly more likely to be Hispanic, younger in age, and have an underlying GI malignancy in comparison to insured patients; however, the symptom severity was similar between groups with over 40% of individuals reporting at least one severe symptom. Twenty-one referrals were made to palliative care. On average, Group B had 33.3 days longer wait times until their first potential visit (p < 0.01) when compared to Group A. Time to actual visit was on average 57.6 days longer for patients in Group B compared to patients in Group A (p = 0.01), averaging at 73.8 days for safety net patients.Conclusions: This project highlights the high symptom burden of oncology patients and disparities in access to services based on insurance coverage. This investigation revealed a 4-fold increase in the time to the first scheduled palliative care visit based on whether patients were insured vs. under-insured. While this study is limited by a small sample size, data suggest that under-insured oncology patients may have significant barriers to palliative care services, which may influence their cancer care quality.

PurposeResearch in palliative care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent palliative care in patients with advanced cancer and high symptom burden, integrating palliative services is challenging. Our aims were to quantitatively describe the palliative referral rates and symptom burden in a South Texas cancer center and establish a palliative referral system by implementing the Edmonton Symptom Assessment Scale (ESAS). MethodsAs part of our Plan-Do-Study-Act process, all staff received an educational overview of the ESAS tool and consultation ordering process. The ESAS form was then implemented across five ambulatory oncology clinics to assess symptom burden and changes therein longitudinally. Referral rates and symptom assessment scores were tracked as metrics for quality improvement.

No abstract