Background: Through its various provisions, the Patient Protection and Affordable Care Act (ACA) has the potential to increase access to cancer care, particularly among the most vulnerable, and reduce disparities in cancer care and outcomes. The ACA might ameliorate disparities in cancer stage by improving access to health care coverage and preventative care, such as screening. The purpose of the present analysis is to examine the change in the percent uninsured and early-stage diagnosis among nonelderly breast cancer patients who receive care in an urban safety-net institution. Methods: We conducted a retrospective, observational study using medical record and cancer registry data from an urban minority-serving hospital. Patients were identified through the cancer registry and included if they were non-Latina (nL) black, or Latina; diagnosed or treated with stage I-IV breast cancer between 2008-2016; and aged 18-64 years at diagnosis. The pre- and post-ACA periods of the expanded health care coverage provision were identified as 2008-2013 and 2014-2016, respectively. Descriptive statistics were calculated to compare patient demographic, insurance, health care use, and tumor characteristics between the pre- and post-ACA periods, overall and across racial/ethnic groups. Logistic regression models, with model-based standardization (predictive margins), were used to estimate proportion differences (PDs) with bias-corrected bootstrapped 95% confidence intervals. Results: A total of 174 nL black and 160 Latina patients were identified. Between pre- and post-ACA, the overall proportion of uninsured at the time of diagnosis decreased from 36.6% to 20.9% (p=0.00). The decrease in the uninsured population was statistically significant only for Latina women (p=0.00). There was a small shift in early-stage diagnoses. Post-ACA, the overall proportion of Stage I cancers increased from 26.8% to 31.8% (PD=5.0; p=0.33). However, this shift occurred among nL black women (PD=9.6%, p=0.18) but not among Latina women (PD=0.0, p=0.91). This pattern remained even after adjusting for age, insurance status, and history of outpatient preventative care use. Of note, compared with women diagnosed pre-ACA, those diagnosed post-ACA were less likely to have had a preventative care visit during the 24 months prior to diagnosis (26% versus 51%, p=0.00). Conclusion: Early results suggest that the ACA has increased access to insurance for underserved nL-black and Latina breast cancer patients. However, its impact on preventative care utilization and early cancer diagnosis is unclear. Post-ACA patients might be newly entering the health care system, due to having obtained insurance, and so may need assistance navigating to obtain preventative care, such as mammograms. Next steps include examining changes in screen-detected versus symptom-detected cancer, time to treatment, and conducting semistructured interviews to examine women's experiences with breast cancer care pre- and post-ACA. Citation Format: Abigail Silva, Arielle Guzman, Charlotte Picard, Yamile Molina, Alexandrina Balanean, Paramjeet Khosla. Did the Affordable Care Act improve insurance coverage and stage at diagnosis among nonelderly underserved breast cancer patients? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B076.
Background: Thousands of circulating tumor cells (CTCs) may be released into the blood stream of a cancer patient each day. However, only viable CTCs can cause metastasis. These viable CTCs hold the promise of deciphering the tumor heterogeneity, uncovering the mechanism of resistances to therapies, and enabling personalized treatments. Despite the continuously mounting interest, isolation of these cells remains challenging due to the multitude of factors, including rarity of the CTCs in blood, their constant exposure to therapeutic agents, and the harsh environment in the circulation. To address this, we have developed a novel microfluidic biochip capable of CTC isolation from unprocessed whole blood. Herein, we compare isolation of CTCs from the central and peripheral blood samples of metastatic breast cancer (MBC) patients using our biochip to assess impact of blood collection location on CTC count and viability. Methods: We included 19 patients with MBC, of which 26% are white, 63% are African American, and 11% are Latino. The median age of the cohort is 58 (34-75y). All patients are undergoing therapy. A total of 36 samples (7.5 mL each) were collected from either an antecubital vein (peripheral vein) or the subcutaneous port catheter (central vein) at different time points. All samples were processed within 5 hours of blood drawn in our novel microfluidic biochip (only 40 minutes per sample, without pretreatment), followed by in situ immunostaining. CK+/EpCAM+, DAPI+ and CD45- cells were counted as CTCs. In situ live/dead assay using Calcein AM and propidium iodide was performed for some samples right after CTC isolation. Results: CTCs were detected in all the samples (36/36), with a median of 15 CTCs per sample. A >5 CTCs count was found in 86% of the samples (31/36). No correlation was found between CTC count and race/ethnicity. The CTC count in central venous samples was in the range of 6-105 (median 27), while the range was 1-45 (median 10) in the peripheral samples. The difference was found to be statistically significant (p<0.001 using ANOVA). While no correlation between CTC count and patient age was found for the overall samples, we noted a significantly higher CTC count in central venous blood of younger patients (<60y) than of senior patients (p<0.05). Live/dead assay immediately following the microfluidic isolation found live CTCs in patient samples. Conclusions: Viable CTCs were rapidly isolated and detected in MBC samples using our novel microfluidic biochip. Our results show that CTC count in blood drawn from central vein yields significantly higher numbers than from the peripheral vein, suggesting that central venous samples might be preferred for prognosis and monitoring to drug response in MBC patients. Viable CTCs may provide an opportunity to evaluate the mechanism of resistance to therapies. More studies with larger cohorts are needed to further confirm these findings. Citation Format: Jian Zhou, Qiyue Luan, Celine Macaraniag, Arielle Guzman, Maria Mantice, Oana Danciu, Kent Hoskins, Ian Papautsky. Isolation of viable circulating tumor cells from peripheral and central venous blood using a rapid microfluidic biochip [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5124.
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