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Introduction Adolescents and young adults (AYA) with cancer are at risk of high cumulative healthcare system costs potentially associated with poor health and financial outcomes. Although this has been studied at academic centers, little data on AYA costs at community-based practices exist. The goals of this study were to understand direct health care costs for AYA patients, identify factors for high costs, and assess how total health care costs may relate to survival. Methods AYA patients (15-39 years) treated at a community hospital in Wisconsin (USA) between 2005 and 2020 were identified. Patient demographics, cancer characteristics, therapies, support services, and all direct health care charges (including up to 1 year prior to diagnosis to capture any diagnostic workup) were collected. Logistic and Cox proportional hazard regression models identified factors associated with high costs and survival, respectively. Results The 388 AYA patients had a median follow-up of 9 years (97% survival). Most were 30-39 years (62%), female (61%), white (95%), diagnosed early-stage (85%), and underwent surgery (83%). Complete health care costs were available for 233 patients (60%). Median total costs per patient were $123 K (range, $73-$215 K). On adjusted analysis, higher direct health care costs (> $125 K) were associated with greater odds of hospital admissions (odds ratio [OR] = 1.7, 95% CI = 1.35-2.27), chemotherapy (OR = 4.1, 95% CI = 1.44-12.70), and breast cancer diagnosis (OR = 3.8, 95% CI = 1.07-14.70). Living farther from the hospital (OR = 0.1, 95% CI = 0.02-0.50), later year of diagnosis (OR = 0.7, 95% CI = 0.55-0.77), and uninsured/unknown insurance status (OR = 0.1, 95% CI = 0.01-0.57) were associated with decreased odds of having higher health care costs. On adjusted analysis, death was associated with greater odds of higher direct health care costs per $125 K (hazards ratio [HR] = 7.9, 95% CI = 2.22-27.80) and radiation (HR = 31.8, 95% CI = 3.15-321) but lower odds of hormone therapy (HR = 0.1, 95% CI = 0.01-0.72) and later year of diagnosis (HR = 0.3, 95% CI = 0.12-0.60). Conclusion High direct health care costs among AYA patients are associated with hospital admissions, chemotherapy, breast cancer diagnosis, hospital proximity, and earlier year of diagnosis. Death was associated with high direct health care costs, earlier years of diagnosis, and radiation therapy. Total health care costs in community-based hospitals should be considered in the context of AYA patients with cancer.

Patients suspected of syncope frequently undergo laboratory and imaging studies to determine the etiology of the syncope. Variability exists in these workups across institutions. The purpose of this study was to evaluate the utilization and diagnostic yield of these workups and the patient characteristics associated with syncopal falls.A multi-institutional retrospective review was performed on adult patients admitted after a fall between 1/2017-12/2018. Syncopal falls were compared to non-syncopal falls.4478 patients were included. There were 795 (18%) patients with a syncopal fall. Electrocardiogram, troponin, echocardiogram, CT angiography (CTA), and carotid ultrasound were more frequently tested in syncope patients compared to non-syncope patients. Syncope patients had higher rates of positive telemetry/Holter monitoring, CTAs, and electroencephalograms.Patients who sustain syncopal falls frequently undergo diagnostic testing without a higher yield to determine the etiology of syncope.

The American Joint Committee on Cancer (AJCC) eighth staging classification system for non-small-cell lung cancer was based on data from a multinational study consisting of 94,708 patients. African Americans were not included in this large database.The authors aimed to compare the performance of the AJCC eighth staging system with that of the seventh in predicting overall survival among African Americans utilizing the National Cancer Database. Cases with T- and M- categories were classified into 2 groups based on the AJCC seventh and eighth edition staging systems. Kaplan-Meier curves for overall survival were then constructed for each subgroup. Concordance index was computed using Uno's methodology to assess the overall performance between the 2 staging systems in predicting the mortality. Time-dependent area under the curve was calculated at each follow-up event for the seventh and eighth edition clinical and pathologic staging using an inverse probability of censoring weighted methodology. A 2-sided P-value .05 was considered to show statistical significance.The database identified a total of 70,606 African American patients in the study period of 2004 through 2014. Area under the curve values were consistently higher for the eighth edition scheme compared with the seventh edition (concordance 0.630 vs. 0.624, respectively; P .0001 for clinical staging scheme and 0.596 vs. 0.591, respectively; P = .01 for pathologic staging scheme).The AJCC eighth edition staging system showed better prognostic value in predicting overall survival when compared with the AJCC seventh edition staging scheme among African American patients with non-small-cell lung cancer.

Introduction For patients with T1 or T2 N0 M0 small-cell lung cancer (SCLC), lobectomy followed by chemotherapy is the standard of care. However, because of its tendency for early dissemination, patients are often treated with concurrent chemo-radiation without surgery. This study was conducted to evaluate the utilization of surgery and its impact on survival in patients with early stage SCLC. Materials and Methods The National Cancer Database was queried to identify patients with T1 or T2 N0 M0 SCLC diagnosed from 2004 to 2013. Multivariate logistic regression modeling was utilized to identify factors associated with receipt of surgery. Patients were stratified into 3 groups: chemo-radiation, surgery followed by chemotherapy, and surgery followed by chemotherapy and prophylactic cranial irradiation (PCI). Kaplan-Meier estimators and Cox proportional-hazards regression were used to compare overall survival. Patients were matched on the propensity score. Results A total of 3879 SCLC cases were identified. Of those cases, 80.7% received chemo-radiation. Surgery followed by chemotherapy with or without PCI was associated with better median overall survival (93.0 months [lower 95% confidence interval (CI), 72.5] and 61.7 months [95% CI, 51.8-76.5], respectively) compared with chemo-radiation (31.2 months [95% CI, 26.3-37.0]). PCI offered survival benefit in addition to surgery and chemotherapy (hazard ratio, 0.75). Conclusions Our study showed a significant survival benefit with surgery (lobectomy or more), adjuvant chemotherapy, and PCI in patients with T1-T2 N0 M0 SCLC.

e18857 Background: Adolescent Young Adults (AYAs) are likely to live for decades after a cancer diagnosis and thus have the potential to accumulate high healthcare costs. Prior research has shown high costs can be associated with increased risk of morbidity and mortality. However, there is limited understanding of how costs impact AYAs, especially in a community hospital. The purpose of this study is to 1) understand total community hospital healthcare costs for AYA patients with cancer, 2) identify risk factors for high costs, and 3) assess the impact of costs on survival. Methods: AYA patients (ages 15-29) treated at a community hospital were identified. Data collected included patient demographics, cancer characteristics, treatments (chemotherapy, radiation, surgery, immunotherapy, hormone therapy), support services (financial counseling, social work, survivorship), hospital admissions, miles from the hospital (great-circle distance), and all healthcare charges from one year prior to cancer diagnosis until last follow-up between 2000-2020. Multivariate logistic regression analyses were used to identify patients with costs greater than the median ($125K). Cox Proportional Hazard (CPH) regression models were used to identify factors associated with the risk of all-cause mortality. Results: A total of 388 AYA patients were identified with a median follow-up of 9 years and 97% survival. Most patients were age 30-39 years (62%), female (61%), white (95%), married (63%), non-smoker (59%), had insurance (78%), had early-stage cancer (85%), and were treated with surgery (83%). The most common cancers were melanoma (17%), breast cancer (14%), and thyroid cancer (14%). Median distance from treatment site was 23 miles. Median number of admissions was one. About a third of patients received chemotherapy (37%), radiation (28%), or hormone therapy (30%). Two-hundred thirty-three patients (60%) had complete healthcare cost data with a median total costs per patient of $123K (range, $73K-$215K). In adjusted analysis, patients with higher than median healthcare cost ( > $125K) had greater odds of hospital admission (odds ratio [OR] = 1.5, p < .001) and chemotherapy treatment (OR = 3.4, p = .005) as well as lower odds of living further from the hospital per one mile (OR = 0.3, p = .049) and being uninsured/unknown insurance (OR = 0.1, p = .047). In adjusted analysis, increased risk of death was associated with receiving radiation therapy (HR = 7.8, p = .02) and higher healthcare costs per $125K (HR = 3.8, p = .001). Conclusions: High costs of healthcare among AYA patients with cancer are related to chemotherapy, hospital admissions, and hospital proximity. High healthcare costs and radiation therapy may be associated with increased risk of death in the AYA population. This data may guide physician decision making for AYA patients ensuring mindfulness of high costs of care and how it relates to poor survival outcomes in community hospitals.