US veterans administration diabetes risk (VADR) national cohort: cohort profile

PurposeThe veterans administration diabetes risk (VADR) cohort facilitates studies on temporal and geographic patterns of pre-diabetes and diabetes, as well as targeted studies of their predictors. The cohort provides an infrastructure for examination of novel individual and community-level risk factors for diabetes and their consequences among veterans. This cohort also establishes a baseline against which to assess the impact of national or regional strategies to prevent diabetes in veterans.ParticipantsThe VADR cohort includes all 6 082 018 veterans in the USA enrolled in the veteran administration (VA) for primary care who were diabetes-free as of 1 January 2008 and who had at least two diabetes-free visits to a VA primary care service at least 30 days apart within any 5-year period since 1 January 2003, or veterans subsequently enrolled and were diabetes-free at cohort entry through 31 December 2016. Cohort subjects were followed from the date of cohort entry until censure defined as date of incident diabetes, loss to follow-up of 2 years, death or until 31 December 2018.Findings to dateThe incidence rate of type 2 diabetes in this cohort of over 6 million veterans followed for a median of 5.5 years (over 35 million person-years (PY)) was 26 per 1000 PY. During the study period, 8.5% of the cohort were lost to follow-up and 17.7% died. Many demographic, comorbidity and other clinical variables were more prevalent among patients with incident diabetes.Future plansThis cohort will be used to study community-level risk factors for diabetes, such as attributes of the food environment and neighbourhood socioeconomic status via geospatial linkage to residence address information.

Case Study: A Transactional Analysis Model for a Single Mother and Her Adult Child With Bipolar Disorder

This case study describes a transactional analysis model based on the strain of a single mother with an adult son suffering from bipolar I disorder. The study examines interaction patterns within the clinical setting; the therapeutic view examines contextual factors that affect this mother and her adult son through assessment and recovery with transactional analysis therapy. The 16-session therapeutic experience of a client and his mother is presented. The subjects in the case study were administered the Sixteen Personality Factor Questionnaire (16PF) assessment tool during the second and 16th sessions. There was a significant change from pretest to posttest stens scores regarding increased scores in emotional stability from 2 (extremely low) to 4 (average), rule consciousness from 1 (extremely low) to 3 (moderately low), openness to change from 6 (average) to 8 (moderately high), and self-control from 1 (extremely low) to 4 (average). Decreased scores included apprehension from 9 (extremely high) to 7 (average) and tension from 6 (average) to 3 (moderately low). Behavioral changes after a 1-month follow-up included taking the bus to sign up for a college class, taking his medication as prescribed, getting a part-time job in the kitchen at the Veteran Administration Medical Center, and developing a budget to manage his disability check.

The demography of human papillomavirus (HPV) infections in oropharyngeal cancer patients from 2011-2016: A single Veteran Administration institution.

e17532 Background: Human papilloma virus (HPV) is a known biologic (viral) carcinogen and has a predilection for tissue in head and neck sites- HPV types 16/18. Current NCCN guidelines recommend HPV testing on newly diagnosed cancers - Head and Neck region - specifically the oropharynx. Methods: After IRB approval, data from our center ranging from 01/01/2011 to 12/31/2016 were collected by using international classification codes (ICD-9) 142, 143, and 146. We enrolled 81 patients for review from of these anatomic sites: Base of tongue, Tonsils, Posterior hypo-pharyngeal wall, soft palate and unknown primary + neck nodes. Data collected: HPV status / age / stage at diagnosis. Risk factors collected were marital status, ethnicity, age, alcohol and tobacco use, and other co-factors. Results: A total of 73 of 81 cases met our criteria for inclusion into review: excluded - 5 with Non-Hodgkin’s lymphoma; 1 with plasma cell neoplasm; 2 excluded - p16 testing only. All enrollees were male. Age range 45 - 91. Mean age: HPV + 64.11 / HPV – 66.76yrs. Anatomic site:BOT-35(48%) /Tonsil-25 (34%) /unknown primacy- 6(8%) /Soft palate– 4(0.05%) /Hypo-pharnyx-3(0.04%). Ethnicity: Non-Hispanic White– 32(44%) /Black-19(26%) /Hispanic – 20 (27%) /American Indian – 1(0.01%) /Unknown – 0. Seventy-three tested for HPV: 36 pos (49%) /37 neg (51% ). Whites were of 49% HPV+. HPV16/18+ in 34 of 36 (94%) tumors. Tobacco exposure ever:32/37(75%) HPV + and 26/36 (75%) HPV - groups. Alcohol use ever: HPV+ 75%; HPV – 67%. Location:BOT/Tonsils were 32/36 (80%) HPV+ cases and 27/37(73%) of HPV – cases. HPV + Marital status: Married 9 (26%) / Never mar 9/Divced 15/Sep 2/Wid 1 - 74% not married. HPV – 37: Married 12 (32%) /Never mar 9 /Divced 9/Sep 5/Wid 2 – 68% not married. Conclusions: HPV +16/18 (34 of 36) infections in our patients (73) were 49% of the overall group. BOT and Tonsil cancers most were the common sites in both groups (+/-). Compared to non-VA patients, our HPV + group used more alcohol and smoked more, and were older - though both groups (+/-) had high usage rates. We noted more divorcees, and lower marriage rate in the HPV+ group. Whites were 44% overall but 49% of HPV + group.

Type 2 diabetes mellitus is associated with increased risk of pancreatic cancer: A veteran administration registry study

Background: The etiology of pancreatic cancer remains elusive. Several studies have suggested a role for diabetes mellitus, but the magnitude of its contribution remains controversial. Objectives: Utilizing a large administrative database, this retrospective cohort study was designed to investigate the relationship between type 2 diabetes mellitus and pancreatic cancer. Patients and design: Using the Veterans Integrated Services Network 16 database, 322,614 subjects were enrolled in the study, including 110,919 with type 2 diabetes mellitus and 211,695 diabetes-free controls matched by gender, year of birth and healthcare facility. Results: A significantly higher incidence of pancreatic cancer was observed in patients with type 2 diabetes mellitus, with an adjusted hazard ratio (95% confidence interval) of 2.17 (1.70–2.77) for type 2 diabetes mellitus compared to controls (p < 10−9) after controlling for the matching factors. Conclusion: The association between type 2 diabetes mellitus and pancreatic cancer was statistically significant and may, in part, explain the rising incidence of pancreatic cancer.

Mixed-histology small cell lung cancer: The University of Missouri, Columbia, experience.

e17525 Background: In 1999, we reported demographics, staging, and treatment outcomes of patients with mixed histology small cell lung cancer (MHSCLC). The purpose of this abstract is to report pattern of presentation and survival in patients during 2000-2009. Methods: Records from 24 patients diagnosed with MHSCLC were reviewed under an institutional review board outcomes study. One patient was excluded as records were missing. Patient and disease characteristics, treatment, and outcomes were analyzed. Results: Twenty-three patients were analyzed, with median age at diagnosis of 63 (range 50 to 84). Twenty (86%) patients were Caucasian. Fourteen (61%) patients were female, 9 (39%) were male. Twenty-one (91%) patients were current or former smokers. Staging was as follows: 1-2: 3, 3: 6, 4: 11, extensive-stage: 1, limited-stage: 2. Sites of diagnosis were lung in 18 (78%), and metastatic sites in 5 (22%). Presenting symptoms were cough or shortness of breath in 12 (52%), CNS in 4 (17%), chest pain in 2 (9%), various others in 5 patients. Paraneoplastic syndrome was seen in 2 patients, and 6 patients reported weight loss of 10-15 lbs within 3-6 months of diagnosis. Metastatic presentation was as follows: 4 brain, 1 bone, and 1 soft tissue. Histology included 15 large cell, 6 adenocarcinoma, and 1 squamous cell. Seventeen patients were treated as follows: chemotherapy (14), 5 thoracic radiotherapy (RT), 3 cranial RT, with treatment status unknown in 1 patient with 3 year survival. Twenty-one (91%) patients had expired, with median survival of 4.6 months (range <1 month-53 months). Two patients were alive at 24.1 and 38.5 months. Conclusions: This review revealed female predominance, which is in line with the increasing number of women diagnosed with small cell lung cancer (SCLC), but could be due to exclusion of veteran administration patients. Best survival was seen in one patient with squamous cell carcinoma, followed by patients with adenocarcinoma, opening a possible role for targeted biologics in this subset of MHSCLC. In memory of Michael Perry, MD, 1945-2011, dedicated physician, researcher, and teacher who started as primary mentor on this project before his passing.