Glioblastoma multiforme (GBM) is a destructive brain cancer that results in death 12 to 15 months after diagnosis. The purpose of this retrospective study was to determine if variations in tumor size at diagnosis, treatment options, and survival rate occur in GBM patients living in urban and rural areas of the United States. Using the behavior model of health services as the theoretical framework, this study used secondary data sets of GBM cases reported from 1988 to 2011 from the Surveillance, Epidemiology, and End Results program. Tumor size was measured in millimeters; treatment was evaluated by ascertaining the number of GBM patients who had surgical resection of their tumors, radiation, and chemotherapy; and survival rate was evaluated using Cox Regression analysis. With a sample size of 33,202 cases, data were examined using descriptive and multivariable analyses with SPSS. Results showed statistically significant differences in tumor size at diagnosis in rural patients compared to urban patients (p = 0.0085; p = 0.018), more urban patients were treated with radiation compared to rural patients (p < 0.001), and rural patients had poorer survival rates than urban patients (p < 0.001).Finally, when controlling for region, race, age, gender, education, and income, longer survival time was associated with urban status, female cases, and higher family income (p< 0.0001), and greater age was associated with reduced survival time (p < 0.0001). Study results could promote positive social change by identifying predictive variables associated with health outcomes of GBM patients. It may also educate providers on the risk of rurality of patients diagnosed with GBM, and inform lawmakers responsible for the creation of healthcare policy and the equitable allocation of healthcare resources.

objective Non-Small Cell Lung Cancer (NSCLC) patient survival depends on a number of factors including initiation of treatment. Standard treatment options for NSCLC patients include surgery, radiation therapy, and chemotherapy. The objective of this study is to evaluate the effect of timeliness of recommended treatment initiation on survival at 1 year among a cohort of privately insured NSCLC patients in South Carolina (SC). methods Data for the study was retrospectively linked between the SC state cancer registry and the state health plan (SHP) Blue Cross & Blue Shield (BCBS) claims data. The SHP is the primary insurance payer for SC state employees. We examined treatment initiation within 1-year post diagnosis for each treatment type separately, based on National Comprehensive Cancer Network stage-specific treatment guidelines, and compared the median time to treatment with the RAND Corporation maximum time interval of 6 weeks. Using Kaplan Meier curves, we explored time to treatment initiation for each treatment type separately and overall. Finally, we conducted Cox Proportional Hazards Modelling in SAS Version 9.4 to investigate the time-to-event (death) as a function of covariates including stage, race, age at diagnosis, and treatment initiation. results The majority of the study sample (N=872) was white (77.2%) and male (55.1%). Almost half (46.7%) were diagnosed at the distant metastasis stage. The mean time from diagnosis to initiation of recommended treatment according to cancer stage for surgery, radiation therapy and chemotherapy was 92.2 days, 54.4 days and 52.9 days, respectively – all longer than the 6 week recommended interval proposed by RAND. Patients who initiated surgery, radiation, and chemotherapy within 1 year of diagnosis lived longer than their counterparts, HR=0.82, HR=0.79, and HR=0.66, respectively. Compared to patients with distant metastasis, those with localized (HR=0.50) and regional (HR=0.74) stages also lived longer. Compared to males, females had a longer time-to-event (HR=0.94), as did patients in younger age categories (<50, 50-64, 65-74 vs. 75+ years). Patients diagnosed with non-small cell carcinoma (HR=1.28) died earlier than their counterparts diagnosed with adenocarcinoma. conclusion Initiation of all treatment types within 1 year post diagnosis may improve survival for NSCLC patients. Within 1 year of treatment initiation, patients in earlier stages and of younger age experience better survival outcomes.

Background: Sunscreen has been promoted for skin cancer prevention for several decades, yet there is a lack of conclusive evidence that it can prevent melanoma. Number of nevi (moles) in childhood can be used as a marker of melanoma risk. Methods: We established a cohort of 481 white children born in 1998 and assessed sun exposure, sun protection (including sunscreen), and total body nevus counts annually through age 15. Nevus counts were determined by skin exams. Sunscreen use was assessed with a 10 point scale that included thickness and frequency of application. The relationship between sunscreen use and number of nevi (natural log transformed) was examined in lagged multivariable linear regression analyses, controlling for sun exposure, sunburns, waterside vacations, skin, hair and eye color, freckling and use of other sun protection. Interaction terms and stratification were included where appropriate. Results: We found little evidence of a relationship between sunscreen use and number of nevi at age 15. Of many subgroups examined, we found that among lighter skinned children who had more than 3 sunburns while they were age 12-14, use of sunscreen between age 12 to 14 was associated with fewer nevi at age 15, such that every 1 unit increase in sunscreen use was associated with an 8% reduction in nevi (p=.02). Conclusion: Sunscreen is unlikely to prevent the development of nevi, a major risk factor for melanoma, and therefore must be questioned as an effective tool for prevention of this most deadly kind of skin cancer.

background: National epidemiological cancer data are commonly reported by aggregating racial/ethnic groups into broad categories such as “Hispanic.” Given the diversity of the Hispanic/Latino population this study aimed to (1) examine cancer mortality differentials among subgroups (Mexican, Puerto Rican, Cuban, and South/Central American), (2) compare mortality rates of Hispanic subgroups to non-Hispanic Whites, and (3) assess trends in cancer mortality over time. methods: Age-specific cancer mortality rates were calculated using publicly available data from the National Center for Health Statistics and U.S. population estimates from the Census Bureau for the years 2000-2013. Rates for the top 10 cancer deaths for all years combined were also determined. All rates were age standardized to the 2000 U.S. standard population. Furthermore, the age-adjusted rates were plotted and trend test were conducted. Additional calculations included descriptive statistics on the demographics of decedents. results: A total of 407,803 cancer deaths were identified for Hispanics during 2000-2013. Age-adjusted rates for Hispanic subgroups ranged from 93.9 among Central/South Americans to 468.3 among Cubans (deaths per 100,000). The overall age-adjusted rates for all Hispanics subgroups and Hispanics combined were lower as compared to non-Hispanic Whites. Decreasing trends in cancer mortality rates were observed for all Hispanic subgroups, non-Hispanic Whites, and Hispanics overall (p < 0.05). The lowest reduction in cancer mortality rates were observed among Mexicans and females. Notable differences were found among decedents by age, gender, race, and educational attainment. conclusion/implications: Overall, significant decreasing temporal trends were observed among non-Hispanic Whites and most of the Hispanic subgroups. Mortality rates of Hispanics compare favorably with those of non-Hispanic Whites, but given the wide range for the Hispanic subgroups, it is clear that differences exist. Our research shows that lumping Hispanics together as one group obscures differences in cancer mortality. This findings suggest that disaggregation of Hispanics allows a deeper understanding of the burden of cancer on this growing population.