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Sedrak MS, Lee MK, Ji J, Satele DV, Freedman RA, Poorvu PD, O'Connor T, Williams GR, Hopkins JO, Muss HB, Cohen HJ, Partridge AH, Carey LA, Chow SL, Subbiah N, Le-Rademacher J, Jatoi A. Palbociclib in adults aged 70 years and older with advanced breast cancer: A phase 2 multicenter trial (Alliance A171601). J Geriatr Oncol 2024; 15:101813. [PMID: 38852379 DOI: 10.1016/j.jgo.2024.101813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Palbociclib is a widely used treatment for advanced breast cancer in older adults. However, the existing evidence regarding its safety and tolerability in this age group is inconsistent and limited to retrospective subgroup or pooled analyses. MATERIALS AND METHODS We conducted a prospective single-arm multicenter phase 2 study to evaluate the safety and tolerability of palbociclib in participants aged 70 years or older with advanced hormone receptor-positive breast cancer. Participants were given palbociclib in combination with their physician's choice of endocrine therapy (letrozole or fulvestrant). The primary endpoint was the incidence of grade 3+ adverse events (AEs) by six months. Secondary endpoints included AE-related dose delays, dose reductions, early discontinuations, and hospitalizations. Additionally, we compared these endpoints by age groups (70-74 and ≥ 75 years). RESULTS Of the 90 participants (median age 74 years [70-87]) enrolled, 75.6% (95% confidence interval [CI], 65.4-84.0) had grade 3+ AEs by six months. The most frequent grade 3+ AEs were neutropenia (61%), fatigue (4%), and nausea (3%). Febrile neutropenia was uncommon (1.1%). Due to AEs, 36% had dose delays, 34% had dose reductions, 10% had early discontinuations, and 10% had hospitalizations. Compared to those aged 70-74 years, participants aged ≥75 years had higher rates of early discontinuations (5.9% vs 15.9%, a difference of 9.5% [95% CI 3.5%-22.5%]). DISCUSSION Palbociclib has an overall favorable safety profile in adults aged ≥70 with advanced breast cancer. However, adults ≥75 years had a trend toward higher rates of AE-related early discontinuations compared to those 70-74 years. Further research is needed to evaluate tolerability and improve the delivery of palbociclib in older adults. CLINICALTRIALS gov:NCT03633331.
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Affiliation(s)
- Mina S Sedrak
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Minji K Lee
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Daniel V Satele
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tracey O'Connor
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Grant R Williams
- Department of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Judith O Hopkins
- SCOR/NCORP/Novant Health Cancer Institute, Winston-Salem, NC, USA
| | - Hyman B Muss
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Harvey Jay Cohen
- Department of Medicine, Duke University School Medical Center, Durham, NC, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lisa A Carey
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Selina L Chow
- Alliance Protocol Operations Office, Chicago, IL, USA
| | | | | | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
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Sedrak MS, Sun CL, Bae M, Freedman RA, Magnuson A, O'Connor T, Moy B, Wildes TM, Klepin HD, Chapman AE, Tew WP, Dotan E, Fenton MA, Kim H, Katheria V, Muss HB, Cohen HJ, Gross CP, Ji J. Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study. J Cancer Surviv 2024:10.1007/s11764-024-01594-3. [PMID: 38678525 DOI: 10.1007/s11764-024-01594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both. METHODS We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. The primary endpoint was the change in PF-10 scores from T1 to T2, analyzed continuously and dichotomously (Yes/No, with "yes" indicating a PF-10 decline > 10 points, i.e., a substantial and clinically meaningful difference). RESULTS Baseline PF-10 scores were similar across all groups. The BC Chemo group experienced a significant decline at T2, with a median change in PF-10 of -5 (interquartile range [IQR], -20, 0), while BC Control and NC Control groups showed a median change of 0 (IQR, -5, 5; p < 0.001). Over 30% of BC Chemo participants had a substantial decline in PF-10 vs. 8% in the BC Control and 5% in the NC Control groups (p < 0.001). CONCLUSION In this cohort of older adults with early-stage breast cancer, the combination of breast cancer and chemotherapy contributes to accelerated functional decline. Our findings reinforce the need to develop interventions aimed at preserving physical function, particularly during and after chemotherapy. IMPLICATIONS FOR CANCER SURVIVORS The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes. CLINICAL TRIAL NCT01472094, Hurria Older PatiEnts (HOPE) with Breast Cancer Study.
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Affiliation(s)
- Mina S Sedrak
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Cancer & Aging Program, UCLA Health Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA.
- UCLA David Geffen School of Medicine, 650 Charles Young Drive South, Room A2-125 CHS, Los Angeles, CA, 90095-6900, USA.
| | - Can-Lan Sun
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Marie Bae
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Tracey O'Connor
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tanya M Wildes
- Department of Medicine, Medical Center/Nebraska Medicine, University of Nebraska, Omaha, NE, USA
| | - Heidi D Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew E Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA, USA
| | - William P Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efrat Dotan
- Department of Hematology-Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - Heeyoung Kim
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Vani Katheria
- Department of Supportive Care, City of Hope, Duarte, CA, USA
- Center for Cancer and Aging, City of Hope, Duarte, CA, USA
| | - Hyman B Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Cary P Gross
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA, USA
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Ma X, Wu S, Zhang X, Chen N, Yang C, Yang C, Cao M, Du K, Liu Y. Adjuvant chemotherapy and survival outcomes in older women with HR+/HER2- breast cancer: a propensity score-matched retrospective cohort study using the SEER database. BMJ Open 2024; 14:e078782. [PMID: 38490656 PMCID: PMC10946384 DOI: 10.1136/bmjopen-2023-078782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the impact of adjuvant chemotherapy (ACT) on survival outcomes in older women with hormone receptor-positive and human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer (BC). DESIGN A retrospective cohort study using data from the Surveillance, Epidemiology, and End Results database, which contains publicly available information from US cancer registries. SETTING AND PARTICIPANTS The study included 45 762 older patients with BC aged over 65 years diagnosed between 2010 and 2015. METHODS Patients were divided into two groups based on age: 65-79 years and ≥80 years. Propensity score matching (PSM) was employed to balance clinicopathological characteristics between patients who received ACT and those who did not. Data analysis used the χ2 test and Kaplan-Meier method, with a subgroup analysis conducted to identify potential beneficiaries of ACT. OUTCOME MEASURES Overall survival (OS) and cancer-specific survival (CSS). RESULTS Due to clinicopathological characteristic imbalances between patients with BC aged 65-79 years and those aged ≥80 years, PSM was used to categorise the population into two groups for analysis: the 65-79 years age group (n=38 128) and the ≥80 years age group (n=7634). Among patients aged 65-79 years, Kaplan-Meier analysis post-PSM indicated that ACT was effective in improving OS (p<0.05, HR=0.80, 95% CI 0.73 to 0.88), particularly in those with advanced disease stages, but did not show a significant benefit in CSS (p=0.09, HR=1.13, 95% CI 0.98 to 1.31). Conversely, for patients aged ≥80 years, ACT did not demonstrate any improvement in OS (p=0.79, HR=1.04, 95% CI 0.79 to 1.36) or CSS (p=0.09, HR=1.46, 95% CI 0.69 to 2.26) after matching. Subgroup analysis also revealed no positive impact on OS and CSS. CONCLUSIONS Patients with HR+/HER2- BC ≥80 years of age may be considered exempt from ACT because no benefits were found in terms of OS and CSS.
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Affiliation(s)
- Xindi Ma
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
| | - Shang Wu
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
| | - Xiangmei Zhang
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Nannan Chen
- Department of Pharmacology, Hebei Medical University, Shijiazhuang City, China
| | - Chenhui Yang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
| | - Chao Yang
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
| | - Miao Cao
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kaiye Du
- Department of Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yunjiang Liu
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei, China
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4
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Marine BT, Mengistie DT. An Analysis of Various Factors Underlying Covid-19 Prevention Practice and Strategy in Jigjiga Town, Northeast Ethiopia. Infect Drug Resist 2024; 17:187-206. [PMID: 38283111 PMCID: PMC10813233 DOI: 10.2147/idr.s441538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024] Open
Abstract
Background COVID-19, a severe respiratory illness, is caused by the SARS-CoV-2 virus. The pandemic has devastated public health, economies, and social structures worldwide. In Ethiopia, the government and health authorities have implemented various COVID-19 prevention strategies to contain the spread of the virus. This study aims to investigates the factors influencing the implementation and effectiveness of COVID-19 prevention strategies in Jigjiga Town, Ethiopia. Methods A community-based cross-sectional study was conducted from April 2022 to December 2022, involving 593 participants in Jigjiga town. Multi-stage sampling techniques were used, and data was collected using a structured questionnaire covering demographic characteristics, socioeconomic status, attitude, knowledge, prevention practices, misconceptions, and COVID-19 prevention strategies. A multivariate model was developed to control for confounding, using variables suitable for multivariate logistic regression analysis with p-values less than 0.25. A variable is considered significant in multivariable logistic regression analysis if its p-value is less than 0.05. Results The study found that only 12.2% of participants used COVID-19 prevention strategies. Those with a bachelor's degree or higher had a strong association with prevention strategies (AOR: 20.08, 95% CI: 2.13-188.85). Participants informed about COVID-19 prevention were 6.886 times more likely to use strategies (95% CI: 2.975-15.938). People who received the COVID-19 vaccine were 1.14 times more likely to engage in reasonable preventive measures compared to those who did not get vaccinated. Conclusion The study reveals low COVID-19 prevention practices among participants, with only 12.2% utilizing preventive strategies. The covariate, the kinds of information received on COVID-19 prevention mechanisms, participants with a favorable attitude toward COVID-19, educational level, mask-wearing, social distancing, vaccination, hand hygiene, public health communication, and household income were significantly associated with COVID-19 prevention strategies. The COVID-19 vaccination promotes preventive practices, reduces infection risk, protects against severe illness, and decreases community spread.
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Affiliation(s)
- Buzuneh Tasfa Marine
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Dagne Tesfaye Mengistie
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia
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5
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Ong C, Blue CM, Khan J, Deng X, Bandyopadhyay D, Louie RJ, McGuire KP. Luminal A Versus B After Choosing Wisely: Does Lymph Node Surgery Affect Oncologic Outcomes? Ann Surg Oncol 2024; 31:335-343. [PMID: 37831277 DOI: 10.1245/s10434-023-14407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/17/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND In 2016, the Choosing Wisely campaign recommended against routine sentinel lymph node biopsy (SLNB) in women ≥ 70 years old diagnosed with early-stage hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer. No distinction is made between luminal A and luminal B phenotypes, despite luminal B being considered more aggressive. This study evaluates the effect of SLNB on oncologic outcomes in HER2- luminal B versus luminal A breast cancer. PATIENTS AND METHODS We performed an IRB-approved, single institution, retrospective cohort study from 2010 to 2020 of women aged ≥ 70 years with clinically node negative, HR+ breast cancer undergoing definitive surgical treatment. Luminal status was defined by gene expression panel testing, Ki67%, and/or pathologic grading. Primary endpoints included locoregional recurrence (LRR), disease free survival (DFS), and overall survival (OS). RESULTS SLNB did not correlate with significant differences in LRR in luminal A (p = 0.92) or luminal B (p = 0.96) disease. SLNB correlated with improved DFS (p < 0.01) and OS (p < 0.001) in luminal A disease, but not in luminal B disease (DFS p = 0.73; OS p = 0.36). On multivariate analysis, age (HR = 1.17; p < 0.01) and tumor size (HR = 1.03; p < 0.05) were associated with DFS, while SLNB was not (p = 0.71). Luminal status (HR = 0.52, p < 0.05), age (HR = 1.15, p < 0.01), and comorbidities (HR = 1.35, p < 0.05) were associated with OS, but not SLNB (p = 0.71). CONCLUSIONS Our results suggest that SLNB may be safely omitted in patients aged ≥ 70 years with luminal B disease given similar LRR in luminal A disease. Our findings suggest that DFS and OS are driven by tumor biology, patient age, and comorbidities rather than receipt of SLNB.
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Affiliation(s)
- Cynthia Ong
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian M Blue
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Jamal Khan
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Xiaoyan Deng
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Raphael J Louie
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University Health, Richmond, VA, USA.
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6
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Blue CM, Ong C, Khan J, Deng X, Bandyopadhyay D, Louie RJ, McGuire KP. Concordant care in sentinel lymph node omission following Choosing Wisely® recommendations at a comprehensive cancer center. Am J Surg 2024; 227:183-188. [PMID: 37821293 DOI: 10.1016/j.amjsurg.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND In 2016, the SSO and ABIM released a Choosing Wisely® guideline stating SLNB can be safely omitted in women ≥70 with HR + HER-invasive breast cancer. No study evaluating concordance of care with this guideline has been performed within a comprehensive cancer center. METHODS From 2005 to 2020, there were 382 patients with cT1-2N0 invasive carcinoma ER+/PR+ and HER2-identified as having undergone SLNB. These patients were then separated into two groups; those in the pre-guideline concordance cohort (2005-2015) and those in the post-guideline concordance (2016-2020) cohort. Axillary management concordance was trended over time. RESULTS 382 patients from 2005 to 2020 with HR + HER- IBC were identified. No difference was seen in SLNB pre-versus post-guidelines (p = 0.35). Increased concordance was noted as age increased (p = 0.0068) and adjuvant radiation therapy exclusion (p < 0.0001) post-guideline release. Concordance improved over the years post-guideline release (R2 = 0.45). CONCLUSIONS Surgical guideline adoption occurs over time but may also be affected by outside decisions and factors. Further study into patterns of guideline adoption may facilitate improving adherence to guidelines.
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Affiliation(s)
- Christian M Blue
- Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA.
| | - Cynthia Ong
- Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Jamal Khan
- Virginia Commonwealth University, School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA
| | - Xiaoyan Deng
- Virginia Commonwealth University, Department of Biostatistics, 830 E Main Street, One Capitol Square 734, PO Box 980032, Richmond, VA, 23219, USA
| | - Dipankar Bandyopadhyay
- Virginia Commonwealth University, Department of Biostatistics, 830 E Main Street, One Capitol Square 734, PO Box 980032, Richmond, VA, 23219, USA
| | - Raphael J Louie
- Virginia Commonwealth University, Department of Surgery, 1200 E Broad St PO Box 980645 Richmond, VA, 23298, USA
| | - Kandace P McGuire
- Virginia Commonwealth University, Department of Surgery, 1200 E Broad St PO Box 980645 Richmond, VA, 23298, USA.
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Tasfa Marine B, Mengistie DT. Application of parametric survival analysis to women patients with breast cancer at Jimma University Medical Center. BMC Cancer 2023; 23:1223. [PMID: 38087229 PMCID: PMC10714515 DOI: 10.1186/s12885-023-11685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Public health systems in both industrialized and undeveloped countries continue to struggle with the worldwide problem of breast cancer. In sub-Saharan African countries, notably Ethiopia, it is the form of cancer that strikes women the most commonly. Despite the extreme difficulties, the causes of mortality in Ethiopia have not yet been identified. In addition, little study has been done in this area. Therefore, the major objective of this analysis was to pinpoint the factors that were most responsible for the decreased life expectancy of breast cancer patients at the University of Jimma Medical Center. 552 women who had been treated for breast cancer at Jimma University Medical Center between October 2018 and December 2022 were included in this study, which used a retrospective cohort study design and five-year follow-up data. The most frequent and widely used test for comparing the probability of survival curves between several categorical independent variables was the log-rank test. Next, semi-parametric methods for multivariable analysis using the Cox proportional hazards model were used. Furthermore, a parametric strategy that includes fully parametric survival models better achieves the goal of the analysis. Among covariate, age of patient (ϕ = 254.06; 95% CI (3.95, 7.13), P-value = 0.000), patient live in urban (ϕ = 0.84; 95% CI (-0.35,-0.00), P-value = 0.047), preexisting comorbidity (ϕ = 2.46; 95% CI (0.39, 1.41), P-value = 0.001), overweight women cancer patient (ϕ = 0.05; 95% CI(-4.41,-1.57), P-value = 0.000, positive Axillary Node status cancer patient (ϕ = 0.04; 95% CI(-4.45,-1.88), P-value = 0.000), both surgery and chemotropic baseline treatment patient (ϕ = 0.53; 95% CI(-1.12,-0.16), P-value = 0.009) significantly affected the survival of women breast cancer. Age of breast cancer patient, patient education level, place of residence, marital status, pre-existing comorbidity, axillary node status, estrogen receptor, tumor size, body mass index at diagnosis, stage of cancer, and baseline treatment were found to have a significant effect on time to survive for women with breast cancer at the University of Jimma Medical Center, Oromia region, Ethiopia. However, the covariate histologic grade, number of positive lymph nodes involved, and type of hormone used were insignificant to the survival of breast cancer patients.
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Affiliation(s)
- Buzuneh Tasfa Marine
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Dagne Tesfaye Mengistie
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia
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Alhadeethi A, Atia A, Alkhawaldeh IM, Ibrahim AA, Afifi E, Elwekel A, Nouh A, Morsi MH. Risk Factors for Cardiovascular-Specific Mortality in Patients With Prostate Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Based Study. Cureus 2023; 15:e51279. [PMID: 38288190 PMCID: PMC10823189 DOI: 10.7759/cureus.51279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Prostate cancer (PC) is responsible for large numbers of cancer-related deaths in males worldwide, and it has been linked to an increase in cardiovascular morbidity and mortality (CVM). The purpose of this research is to identify the incidence and risk factors for CVM in PC patients. METHODS In this retrospective cohort study, we collected data from patients with PC diagnosed between 2000 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. CVM among PC patients was identified and compared to the general population using the standardized mortality ratio (SMR). The multivariable competing risk model with subdistribution hazard ratio (SHR) was used to analyze the data in a more complex method to discover the risk factors associated with CVM among PC patients. RESULTS Of the 171,147 identified PC patients, the median survival time was 117 months, with 17,168 dying from cardiovascular disease (CVD). Patients diagnosed at age 45-54 had a higher CVM risk than the age-standardized general population (SMR (95% CI): 19.01 (17.17-21.0)). Using multivariate competing risk regression analysis, aged 85 and older (SHR (95% CI): 20.9 (18.628-23.467)), black ethnicities (SHR (95% CI): 1.3 (1.264-1.398)), and patients without surgical intervention (SHR (95% CI): 1.35 (1.305-1.410)) had higher CVM. On the other hand, being of Asian/Pacific Islander or American Indian/Native Alaskan ethnicity (SHR (95% CI): 0.94 (0.891-0.993)), being diagnosed between 2007 and 2014 (SHR (95% CI): 0.63 (0.613-0.655)), and having an advanced disease stage and a lack of disease differentiation in the histology were found to be related with a lower CVM. CONCLUSION Patients with PC have a greater likelihood of dying from CVD. Several important risk factors for CVD have been discovered, including advanced age, black ethnicity, and patients without surgical intervention. These findings are limited by the retrospective nature of the analysis, relying solely on the SEER database, which imposes restrictions on accessing comprehensive patient data, including lifestyle factors and medical history.
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Affiliation(s)
- Abdulhameed Alhadeethi
- General Medicine, Al-Salam Teaching Hospital, Mosul, IRQ
- General Medicine, Medical Research Group of Egypt, Negida Academy LCC, Arlington, USA
| | - Ahmed Atia
- Oncology, Faculty of Medicine Kasr Al-Ainy, Cairo University, Cairo, EGY
| | | | - Ahmed A Ibrahim
- Cardiology, Faculty of Medicine, Menoufia University, Shibin El Kom, EGY
| | - Eslam Afifi
- Urology, Faculty of Medicine, Benha University, Benha, EGY
| | - Ahmed Elwekel
- Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, EGY
| | - Abdallah Nouh
- Oncology, Faculty of Medicine, Sohag University, Sohag, EGY
| | - Maha H Morsi
- Urology, Misr University for Science and Technology, 6th of October City, EGY
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Waaijer MEC, Lemij AA, de Boer AZ, Bastiaannet E, van den Bos F, Derks MGM, Kroep JR, Liefers GJ, Portielje JEA, de Glas NA. The impact of geriatric characteristics and comorbidities on distant metastases and other cause mortality in older women with non-metastatic breast cancer treated with primary endocrine therapy. Breast Cancer Res Treat 2023; 201:471-478. [PMID: 37479944 PMCID: PMC10460719 DOI: 10.1007/s10549-023-07029-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/28/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION In recent years, primary surgical treatment of older women with non-metastatic breast cancer has decreased in favor of primary endocrine therapy (PET). PET can be considered in women with a remaining life expectancy of less than five years. The aim of this study was to (1) assess the risk of distant metastases and other cause mortality over ten years in women aged 65 and older with stage I-III breast cancer treated with PET, (2) whether this was associated with geriatric characteristics and comorbidities and to (3) describe the reasons on which the choice for PET was made. METHODS Women were included from the retrospective FOCUS cohort, which comprises all incident women diagnosed with breast cancer aged 65 or older between January 1997 and December 2004 in the Comprehensive Cancer Center Region West in the Netherlands. We selected women (N = 257) with stage I-III breast cancer and treated with PET from this cohort. Patient characteristics (including comorbidity, polypharmacy, walking, cognitive and sensory impairment), treatment and tumor characteristics were retrospectively extracted from charts. Outcomes were distant metastasis and other cause mortality. Cumulative incidences were calculated using the Cumulative Incidence for Competing Risks method (CICR); and subdistribution hazard ratios (SHR) were tested between groups based on age, geriatric characteristics and comorbidity with the Fine and Gray model. RESULTS Women treated with PET were on average 84 years old and 41% had one or more geriatric characteristics. Other cause mortality exceeded the cumulative incidence of distant metastasis over ten years (83 versus 5.6%). The risk of dying from another cause further increased in women with geriatric characteristics (SHR 2.06, p < 0.001) or two or more comorbidities (SHR 1.72, p < 0.001). Often the reason for omitting surgery was not recorded (52.9%), but if recorded surgery was omitted mainly at the patient's request (18.7%). DISCUSSION This study shows that the cumulative incidence of distant metastasis is much lower than other cause mortality in older women with breast cancer treated with PET, especially in the presence of geriatric characteristics or comorbidities. This confirms the importance of assessment of geriatric characteristics to aid counseling of older women.
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Affiliation(s)
- M E C Waaijer
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Lemij
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - A Z de Boer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - F van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M G M Derks
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - J R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - G J Liefers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands
| | - N A de Glas
- Department of Medical Oncology, Leiden University Medical Center, Post zone C7-Q, P.O. Box 9600 RC, Leiden, the Netherlands.
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10
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Raychaudhuri S, Kyko JM, Ruterbusch JJ, Pandolfi SS, Beebe‐Dimmer JL, Schwartz AG, Simon MS. The impact of preexisting comorbidities on receipt of cancer therapy among women with Stage I-III breast cancer in the Detroit Research on Cancer Survivors cohort. Cancer Med 2023; 12:19021-19032. [PMID: 37563982 PMCID: PMC10557862 DOI: 10.1002/cam4.6456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Pre-existing comorbidities play an important role in choice of cancer treatment. We retrospectively evaluated the relationship between pre-existing comorbidities and receipt of local and systemic therapy in a cohort of Black women with Stage I-III breast cancer. METHODS The study population for analysis included 1169 women with Stage I-III disease enrolled in the Detroit Research on Cancer Survivors (ROCS) cohort. Information on comorbidities, socio-demographic, and clinical variables were obtained from self-reported questionnaires and the cancer registry. Comorbidities were analyzed individually, and comorbidity burden was categorized as low (0-1), moderate (2-3) or high (≥4). We used logistic regression analysis to evaluate factors associated with receipt of local treatment (surgery ± radiation; N = 1156), hormonal (N = 848), and chemotherapy (N = 680). Adjusted models included variables selected a priori that were significant predictors in univariate analysis. RESULTS Receipt of treatment was categorized into local (82.6%), hormonal (73.7%), and/or chemotherapy (79.9%). Prior history of arthritis and depression were both associated with a lower likelihood to receive local treatment, [odds ratio (OR), 95% confidence interval (CI), 0.66, 0.47-0.93, and 0.53, 0.36-0.78], respectively. Obesity was associated with higher likelihood of receiving hormonal therapy (OR: 1.64, 95% CI: 1.19, 2.26), and heart failure a lower likelihood (OR: 0.46, 95% CI: 0.23, 0.90). Older age (Ptrend <0.01) and increasing co-morbidity burden (Ptrend = 0.02) were associated with lower likelihood of receiving chemotherapy. CONCLUSION History of prior co-morbidities has a potentially detrimental influence on receipt of recommended cancer-directed treatment among women with Stage I-III breast cancer.
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Affiliation(s)
- Sreejata Raychaudhuri
- Department of Medical Oncology/HematologyUniversity of Pittsburgh, Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jaclyn M. Kyko
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
| | - Julie J. Ruterbusch
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
| | - Stephanie S. Pandolfi
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
| | - Jennifer L. Beebe‐Dimmer
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
- Population Studies and Disparities Research ProgramKarmanos Cancer InstituteDetroitMichiganUSA
| | - Ann G. Schwartz
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
- Population Studies and Disparities Research ProgramKarmanos Cancer InstituteDetroitMichiganUSA
| | - Michael S. Simon
- Department of OncologyKarmanos Cancer Institute at Wayne State UniversityDetroitMichiganUSA
- Population Studies and Disparities Research ProgramKarmanos Cancer InstituteDetroitMichiganUSA
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11
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Misganaw M, Zeleke H, Mulugeta H, Assefa B. Mortality rate and predictors among patients with breast cancer at a referral hospital in northwest Ethiopia: A retrospective follow-up study. PLoS One 2023; 18:e0279656. [PMID: 36701343 PMCID: PMC9879427 DOI: 10.1371/journal.pone.0279656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Breast cancer is one of the common global health concerns that affects2.1 million women each year and causes the highest number of cancer-related morbidity and mortality among women. The objective of this study was to determine the mortality rate and its predictors among breast cancer patients at the referral hospitals, in northwest Ethiopia. METHODS A retrospective follow-up study was conducted on breast cancer patients registered between February 01, 2015 and February 28, 2018. They were selected by simple random sampling using computer-generated method and followed until February 29, 2020, in Amhara region referral hospital. A pre-tested data extraction checklist was used to collect data from the registration book and patient medical records. The collected data were entered into Epi-Data version 3.1 and exported to STATA version 14 for analysis. The mortality rate by person-year observation was computed. The Kaplan-Meier survival curve with the log-rank test was used to estimate the survival probabilities of the patients. Bivariate and multivariate Cox regression model was used to identify predictors of mortality. RESULTS The overall mortality rate of breast cancer was 16.9 per 100 person-years observation. The median survival time was 38.3 (IQR: 26.23, 49.4) months. Independent predictors of breast cancer mortality was; Clinical stage IV and stage III (aHR:10.44,95% CI: 8.02,11.93 and aHR: 9.43, 95% CI: 6.29,11.03respectively), number of positive lymph node in the category of 10 and more and number of positive lymph node within the category of 4-9 (aHR:12.58, 95%CI: 5.2, 30.46 and aHR: 4.78, 95% CI: 2.19, 10.43respectively), co-morbidities (aHR:1.5, 95%CI: 1.01,2.21), Postmenopausal (aHR:2.03,95% CI: 1.37, 3), histologic grade III (aHR:2.12, 95% CI: 1.26,3.55) and not received hormonal therapy (aHR: 2.19, 95%CI: 1.52,3.15) were independent predictors of mortality. CONCLUSION The overall mortality rate was 16.9 per 100 person-years. The finding was higher compared to high-income countries. Advanced clinical stage, co-morbidities, menopausal status, and hormonal therapy are the significant predictors of mortality. Early detection and treatment of breast cancer is needed to reduce the mortality rate.
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Affiliation(s)
- Mekides Misganaw
- Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Haymanote Zeleke
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Birtukan Assefa
- Department of Pediatric Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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12
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Freedman RA, Li T, Sedrak MS, Hopkins JO, Tayob N, Faggen MG, Sinclair NF, Chen WY, Parsons HA, Mayer EL, Lange PB, Basta AS, Perilla-Glen A, Lederman RI, Wong A, Tiwari A, McAllister SS, Mittendorf EA, Miller PG, Gibson CJ, Burstein HJ. 'ADVANCE' (a pilot trial) ADjuVANt chemotherapy in the elderly: Developing and evaluating lower-toxicity chemotherapy options for older patients with breast cancer. J Geriatr Oncol 2023; 14:101377. [PMID: 36163163 PMCID: PMC10080267 DOI: 10.1016/j.jgo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Older adults with breast cancer receiving neo/adjuvant chemotherapy are at high risk for poor outcomes and are underrepresented in clinical trials. The ADVANCE (ADjuVANt Chemotherapy in the Elderly) trial evaluated the feasibility of two neo/adjuvant chemotherapy regimens in parallel-enrolling cohorts of older patients with human epidermal growth factor receptor 2-negative breast cancer: cohort 1-triple-negative; cohort 2-hormone receptor-positive. MATERIALS AND METHODS Adults age ≥ 70 years with stage I-III breast cancer warranting neo/adjuvant chemotherapy were enrolled. Cohort 1 received weekly carboplatin (area under the curve 2) and weekly paclitaxel 80 mg/m2 for twelve weeks; cohort 2 received weekly paclitaxel 80 mg/m2 plus every-three-weekly cyclophosphamide 600 mg/m2 over twelve weeks. The primary study endpoint was feasibility, defined as ≥80% of patients receiving ≥80% of intended weeks/doses of therapy. All dose modifications were applied per clinician discretion. RESULTS Forty women (n = 20 per cohort) were enrolled from March 25, 2019 through August 3, 2020 from three centers; 45% and 35% of patients in cohorts 1 and 2 were age > 75, respectively. Neither cohort achieved targeted thresholds for feasibility. In cohort 1, eight (40.0%) met feasibility (95% confidence interval [CI] = 19.1-63.9%), while ten (50.0%) met feasibility in cohort 2 (95% CI = 27.2-72.8). Neutropenia was the most common grade 3-4 toxicity (cohort 1-65%, cohort 2-55%). In cohort 1, 80% and 85% required ≥1 dose holds of carboplatin and/or paclitaxel, respectively. In cohort 2, 10% required dose hold(s) for cyclophosphamide and/or 65% for paclitaxel. DISCUSSION In this pragmatic pilot examining chemotherapy regimens in older adults with breast cancer, neither regimen met target goals for feasibility. Developing efficacious and tolerable regimens for older patients with breast cancer who need chemotherapy remains an important goal. CLINICALTRIALS gov Identifier: NCT03858322.
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Affiliation(s)
- Rachel A Freedman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Tianyu Li
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mina S Sedrak
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Judith O Hopkins
- Novant Health Cancer Institute / SCOR NCORP, Winston Salem, NC, USA
| | - Nabihah Tayob
- Harvard Medical School, Boston, MA, USA; Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Meredith G Faggen
- Dana-Farber Brigham Cancer Center at South Shore Hospital, South Weymouth, MA, USA
| | - Natalie F Sinclair
- Dana-Farber Brigham Cancer Center at Milford Regional Medical Center, Milford, MA, USA
| | - Wendy Y Chen
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Heather A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Erica L Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Paulina B Lange
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ameer S Basta
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Ruth I Lederman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Andrew Wong
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Abhay Tiwari
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA, USA
| | - Sandra S McAllister
- Harvard Medical School, Boston, MA, USA; Hematology Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Stem Cell Institute, Cambridge, MA, USA; Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
| | - Elizabeth A Mittendorf
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter G Miller
- Harvard Medical School, Boston, MA, USA; Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA; Center for Cancer Research, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher J Gibson
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Harold J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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13
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Steinman MA, Jing B, Shah SJ, Rizzo A, Lee SJ, Covinsky KE, Ritchie CS, Boscardin WJ. Development and validation of novel multimorbidity indices for older adults. J Am Geriatr Soc 2023; 71:121-135. [PMID: 36282202 PMCID: PMC9870862 DOI: 10.1111/jgs.18052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/24/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes. METHODS Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow-up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study. RESULTS The development cohort included 5012 subjects with median age 76 years; 58% were female. Claims-based markers of disease severity and disease-disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c-statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c-statistics were 0.02-0.03 higher than c-statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS-HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C-statistics for both new and legacy indices varied substantially across derivation and validation cohorts. CONCLUSIONS A new series of claims-based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods.
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Affiliation(s)
- Michael A. Steinman
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Bocheng Jing
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Sachin J. Shah
- Division of Hospital Medicine, UCSF, San Francisco, California, USA
| | - Anael Rizzo
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- David Geffen School of Medicine at UCLA, San Francisco, California, USA
| | - Sei J. Lee
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Kenneth E. Covinsky
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and the Mongan Institute Center for Aging and Serious Illness, Boston, MA, USA
| | - W. John Boscardin
- Division of Geriatrics, UCSF, San Francisco, California, USA
- The San Francisco VA Health Care System, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
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14
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Battisti NML, De Glas N, Soto-Perez-de-Celis E, Liposits G, Bringuier M, Walko C, Lichtman SM, Aapro M, Cheung KL, Biganzoli L, Ring A, Portielje J, Wildiers H, Brain E. Chemotherapy and gene expression profiling in older early luminal breast cancer patients: An International Society of Geriatric Oncology systematic review. Eur J Cancer 2022; 172:158-170. [PMID: 35777273 PMCID: PMC10861271 DOI: 10.1016/j.ejca.2022.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The benefit of chemotherapy for older patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (EBC) is a key area of debate. Gene expression profiling (GEP) may identify patients deriving benefit, but their predictive role has not been established for older adults. We summarise evidence on efficacy, safety, and quality-of-life impacts of chemotherapy and on GEP use and impact in older HR-positive, HER2-negative EBC patients. METHODS We conducted a literature search of PubMed and Embase on publications describing prospective studies evaluating chemotherapy in older adults with HR-positive, HER2-negative EBC and on publications describing retrospective and prospective studies evaluating GEP in older adults. RESULTS Eight publications on chemotherapy use, including 2,035 older patients with EBC were selected. Only one trial evaluated chemotherapy survival benefits in older adults, showing no benefit. Of four studies comparing different regimens, only one showed the superiority of taxanes versus anthracyclines alone. Those investigating alternative regimens did not show improvements over standard regimens despite significant limitations. Five publications on GEP, including 445,323 older patients, were included and investigated Oncotype DX. Limited evidence shows that GEP aids treatment decisions in this population. GEP was offered less frequently to older versus younger patients. Higher Recurrence Score was prognostic for distant recurrence, but chemotherapy did not improve prognosis. CONCLUSIONS In older patients with HR-positive, HER2-negative, chemotherapy survival benefits EBC are unclear and GEP is less used. Although its prognostic role is well established, its predictive role remains unknown.
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Affiliation(s)
- Nicolò Matteo Luca Battisti
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom.
| | - Nienke De Glas
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Gabor Liposits
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense, Denmark.
| | - Michael Bringuier
- Interdisciplinary Supportive Care Department for Cancer Patients and Medical Oncology Department, Institut Curie/Saint-Cloud, Paris, France.
| | - Christine Walko
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL, USA.
| | - Stuart M Lichtman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Matti Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland.
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, UK.
| | - Laura Biganzoli
- "Sandro Pitigliani" Department of Medical Oncology, Nuovo Ospedale di Prato, Prato, Italy.
| | - Alistair Ring
- Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom.
| | - Johanneke Portielje
- Department of Internal Medicine and Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Center, University Hospitals Leuven, Leuven, Belgium.
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint-Cloud, Paris, France.
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15
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Savaridas SL, Gierlinski M, Warwick VR, Evans AE. Opting into breast screening over the age of 70 years: seeking evidence to support informed choice. Clin Radiol 2022; 77:666-672. [PMID: 35710529 DOI: 10.1016/j.crad.2022.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/26/2022] [Indexed: 11/18/2022]
Abstract
AIM To provide evidence specific to the Scottish population regarding the risk-benefit balance of women >70 years opting into continued breast screening, which may be used as a basis for patient information documentation. MATERIALS AND METHODS The present study consisted of a parallel, retrospective data analysis of breast cancer mortality data for breast cancer cases diagnosed between 2009 and 2013 (n=22,013) followed up to 31/12/18, and breast screening programme data from 2010 and 2015 (n=47,235). Screening outcome measures included recall for assessment, oncome of assessment, and tumour features. Tumours were classified as high, intermediate, or low risk according to grade and presence of invasion. Mortality data were linked to age at diagnosis and cause of death was recorded. RESULTS The proportion of all deaths due breast cancer is inversely related to age at diagnosis. From 77 years, women are more likely to die with breast cancer, than directly due to breast cancer. Mammographic screening accurately identifies breast cancer in older women; however, many of the cancers detected were considered intermediate or low risk. CONCLUSIONS Harms may outweigh the benefits of continued breast screening in older women. This information should be available to all older women.
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Affiliation(s)
| | - M Gierlinski
- Department of Radiology, University of Dundee, UK
| | - V R Warwick
- Department of Radiology, University of Dundee, UK
| | - A E Evans
- Department of Radiology, University of Dundee, UK
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16
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Castelo M, Hansen BE, Paszat L, Baxter NN, Scheer AS. Omission of Axillary Staging and Survival in Elderly Women With Early Stage Breast Cancer: A Population-Based Cohort Study. ANNALS OF SURGERY OPEN 2022; 3:e159. [PMID: 37601604 PMCID: PMC10431311 DOI: 10.1097/as9.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Determine if axillary staging is associated with survival in elderly women with breast cancer. Background Axillary staging in women ≥ 70 years with early-stage breast cancer is controversial. Older randomized evidence has not shown axillary staging improves survival, but recent observational studies have been mixed and widespread de-implementation of the practice has not occurred. Methods This was a population-based cohort study using the Surveillance, Epidemiology, and End Results registry. Women ≥ 70 years diagnosed with T1-T2 invasive breast cancer from 2005 to 2015 were included. Overlap propensity score weighting was used to adjust for confounders. Overall survival (OS) was determined and hazard ratios (HRs) reported with 95% confidence intervals (CIs). Breast cancer-specific survival (BCSS) was determined using competing risks analysis and subdistribution hazard ratios (sdHRs) reported. Additional adjustment was performed for receipt of chemotherapy and radiotherapy. Results One hundred forty-four thousand three hundred twenty-nine elderly women were included, of whom 22,621 (15.7%) did not undergo axillary staging. After overlap propensity score weighting, baseline characteristics were well balanced between the 2 groups. Women who did not undergo axillary staging were significantly less likely to receive chemotherapy (adjusted relative risk, 0.58; 95% CI, 0.54-0.62) or radiotherapy (adjusted relative risk, 0.53; 95% CI, 0.52-0.54), and had significantly worse OS (adjusted HR, 1.22; 95% CI, 1.19-1.25), and BCSS (adjusted sdHR, 1.14; 95% CI, 1.08-1.21) compared to those that had staging. Conclusions These findings suggest elderly women with early-stage breast cancer who do not undergo axillary staging experience worse outcomes. Reasons for this disparity may be multifactorial and require further investigation.
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Affiliation(s)
- Matthew Castelo
- From the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bettina E. Hansen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lawrence Paszat
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy N. Baxter
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Adena S. Scheer
- From the Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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17
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Battisti NML, Welch CA, Sweeting M, de Belder M, Deanfield J, Weston C, Peake MD, Adlam D, Ring A. Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies. JACC CardioOncol 2022; 4:238-253. [PMID: 35818547 PMCID: PMC9270631 DOI: 10.1016/j.jaccao.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. Objectives We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. Methods The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. Results Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. Conclusions There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes.
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18
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McCleary NJ, Zhang S, Ma C, Ou FS, Bainter TM, Venook AP, Niedzwiecki D, Lenz HJ, Innocenti F, O'Neil BH, Polite BN, Hochster HS, Atkins JN, Goldberg RM, Ng K, Mayer RJ, Blanke CD, O'Reilly EM, Fuchs CS, Meyerhardt JA. Age and comorbidity association with survival outcomes in metastatic colorectal cancer: CALGB 80405 analysis. J Geriatr Oncol 2022; 13:469-479. [PMID: 35105521 PMCID: PMC9058225 DOI: 10.1016/j.jgo.2022.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about the interaction of comorbidities and age on survival outcomes in colorectal cancer (mCRC), nor how comorbidities impact treatment tolerance. METHODS We utilized a cohort of 1345 mCRC patients enrolled in CALGB/SWOG 80405, a multicenter phase III trial of fluorouracil/leucovorin + oxaliplatin (FOLFOX) or irinotecan (FOLFIRI) plus bevacizumab, cetuximab or both. Endpoints were overall survival (OS), progression-free survival (PFS), and grade ≥ 3 toxicities assessed using NCI CTCAE v.3.0. Participants completed a questionnaire, including a modified Charlson Comorbidity Index. Adjusted Cox and logistic regression models tested associations of comorbidities and age on the endpoints. RESULTS In CALGB/SWOG 80405, 1095 (81%) subjects were < 70 years and >70 250 (19%). Presence of ≥1 comorbidity was not significantly associated with either OS (HR 1.10, 95% CI 0.96-1.25) or PFS (HR 1.03, 95% CI 0.91-1.16). Compared to subjects <70 with no comorbidities, OS was non-significantly inferior for ≥70 with no comorbidities (HR 1.21, 95% CI 0.98-1.49) and significantly inferior for ≥70 with at least one comorbidity (HR 1.51, 95% CI 1.22-1.86). There were no significant associations or interactions between age or comorbidity with PFS. Comorbidities were not associated with treatment-related toxicities. Age ≥ 70 was associated with greater risk of grade ≥ 3 toxicities (OR 2.15, 95% CI 1.50-3.09, p < 0.001). CONCLUSIONS Among participants in a clinical trial of combination chemotherapy for mCRC, presence of older age with comorbidities was associated with worse OS but not PFS. The association of age with toxicity suggests additional factors of care should be measured in clinical trials.
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Affiliation(s)
- Nadine J McCleary
- Dana-Farber Cancer Institute, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Sui Zhang
- Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Chao Ma
- Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Fang-Shu Ou
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, United States of America
| | - Tiffany M Bainter
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, United States of America
| | | | | | - Heinz-Josef Lenz
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, United States of America
| | - Federico Innocenti
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Bert H O'Neil
- Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Blase N Polite
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States of America
| | - Howard S Hochster
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, Brunswick, NJ, United States of America
| | - James N Atkins
- Southeast Cancer Control Consortium, CCOP, Goldsboro, NC, United States of America
| | - Richard M Goldberg
- West Virginia University Cancer Institute, Morgantown, WV, United States of America
| | - Kimmie Ng
- Dana-Farber Cancer Institute, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Robert J Mayer
- Dana-Farber Cancer Institute, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Charles D Blanke
- SWOG and Oregon Health & Science University, Portland, OR, United States of America
| | - Eileen M O'Reilly
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Charles S Fuchs
- Yale Cancer Center and Smillow Cancer Hospital, Yale School of Medicine, New Haven, CT, United States of America
| | - Jeffrey A Meyerhardt
- Dana-Farber Cancer Institute, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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19
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Takada Y, Kawashima H, Ohno E, Ishikawa T, Mizutani Y, Iida T, Yamamura T, Kakushima N, Furukawa K, Nakamura M, Honda T, Ishigami M, Ito A, Hirooka Y. The impact of the age-adjusted Charlson comorbidity index as a prognostic factor for endoscopic papillectomy in ampullary tumors. J Gastroenterol 2022; 57:199-207. [PMID: 35098349 DOI: 10.1007/s00535-022-01853-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognostic nutritional index (PNI) and Charlson comorbidity index (CCI) have been useful for predicting the prognosis based on nutritional condition and comorbidities in surgery and endoscopic mucosal dissection. The age-adjusted CCI (ACCI) has also been reported to be useful in surgery, but it has not been applied to endoscopic treatment. We therefore clarified the prognostic factors associated with ampullary tumors treated with endoscopic papillectomy (EP). METHODS From January 2003 to December 2020, 236 patients who underwent EP for sporadic ampullary tumors at Nagoya University Hospital were included in this study. The 5-year survival and ability to predict the prognosis were evaluated in terms of the sex, PNI, ACCI, final pathological diagnosis, and intraductal extension. RESULTS During a median follow-up period of 1558 days, 17 patients died. No patient died of the primary disease. The 5-year survival rate was 91.1%. In a univariate analysis, only a high ACCI (≥ 5) was extracted as a significant prognostic factor (Odds ratio, 12.2; 95% confidence interval, 3.81-39.3; p < 0.001). The 5-year survival rates for a low ACCI (≤ 4) and high ACCI were 96.6% and 73.5%, respectively (p < 0.001). CONCLUSIONS A high ACCI is an important prognostic factor associated with the 5-year survival and a risk of death from other illness. Ampullary tumors suitable for EP are less likely to be a prognostic factor, and treatment-free follow-up may be acceptable in patients with a high ACCI.
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Affiliation(s)
- Yoshihisa Takada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan. .,Department of Endoscopy, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Ito
- Nishinoho Ito Medical Clinic, Kitanagoya, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
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20
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van der Plas-Krijgsman WG, Morgan JL, de Glas NA, de Boer AZ, Martin CL, Holmes GR, Ward SE, Chater T, Reed MW, Merkus JW, van Dalen T, Vulink AJ, van Gerven L, Guicherit OR, Linthorst-Niers E, Lans TE, Bastiaannet E, Portielje JE, Liefers GJ, Wyld L. Differences in treatment and survival of older patients with operable breast cancer between the United Kingdom and the Netherlands – A comparison of two national prospective longitudinal multi-centre cohort studies. Eur J Cancer 2022; 163:189-199. [PMID: 35081505 PMCID: PMC8887607 DOI: 10.1016/j.ejca.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/17/2023]
Abstract
Background Previous studies have shown that survival outcomes for older patients with breast cancer vary substantially across Europe, with worse survival reported in the United Kingdom. It has been hypothesised that these differences in survival outcomes could be related to treatment variation. Objectives We aimed to compare patient and tumour characteristics, treatment selection and survival outcomes between two large prospective cohorts of older patients with operable breast cancer from the United Kingdom (UK) and The Netherlands. Methods Women diagnosed with operable breast cancer aged ≥70 years were included. A baseline comprehensive geriatric assessment was performed in both cohorts, with data collected on age, comorbidities, cognition, nutritional and functional status. Baseline tumour characteristics and treatment type were collected. Univariable and multivariable Cox regression models were used to compare overall survival between the cohorts. Results 3262 patients from the UK Age Gap cohort and 618 patients from the Dutch Climb cohort were included, with median ages of 77.0 (IQR: 72.0–81.0) and 75.0 (IQR: 72.0–81.0) years, respectively. The cohorts were generally comparable, with slight differences in rates of comorbidity and frailty. Median follow-up for overall survival was 4.1 years (IQR 2.9–5.4) in Age Gap and 4.3 years (IQR 2.9–5.5) in Climb. In Age Gap, both the rates of primary endocrine therapy and adjuvant hormonal therapy after surgery were approximately twice those in Climb (16.6% versus 7.3%, p < 0.001 for primary endocrine therapy, and 62.2% versus 38.8%, p < 0.001 for adjuvant hormonal therapy). There was no evidence of a difference in overall survival between the cohorts (adjusted HR 0.94, 95% CI 0.74–1.17, p = 0.568). Conclusions In contrast to previous studies, this comparison of two large national prospective longitudinal multi-centre cohort studies demonstrated comparable survival outcomes between older patients with breast cancer treated in the UK and The Netherlands, despite differences in treatment allocation. No survival difference between UK and Netherlands for older breast cancer patients. Similar patient and tumour characteristics seen in both cohorts. Higher rates of mastectomy for older breast cancer patients in Netherlands. Higher rates of adjuvant therapies for older breast cancer patients in UK.
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21
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Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:8-35. [PMID: 34991091 DOI: 10.1159/000521288] [Citation(s) in RCA: 343] [Impact Index Per Article: 171.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient's unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.
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Affiliation(s)
- Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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22
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Sharma S, Patel D, Pavuluri S, Stein A, Patel B, Qureshi N, Hasnuddin I, Todorova T, Srinivasan K, Ghouse M. Breast Cancer in the Elderly: An Observational Study Investigating Compliance of Screening Mammography in an Underserved Community. World J Oncol 2021; 12:155-164. [PMID: 34804278 PMCID: PMC8577604 DOI: 10.14740/wjon1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of breast cancer increases with age. Individuals living in higher socioeconomic communities also have higher incidence secondary to early detection of breast cancer from increased accessibility to mammograms. This retrospective study studied the percentage of new breast cancer cases in the elderly between 2010 and 2019, and investigated the compliance of screening mammography in some of the medically underserved suburbs of southern Chicago. Methods The parameters used to power this study include “age greater than 70” and “2010 to present” at the time the study was first initiated. The final data set contained 381 electronic health records (EMRs) that met the parameters of interest. We specifically looked at method of diagnosis, stage at diagnosis, date of last normal screening mammogram, hormone status, histology, race, and smoking history. Results Thirty percent of the breast cancer patients diagnosed at our institution were over 70 years of age between 2010 and 2019. Of the 381 patients included in the overall sample, 45% were diagnosed with breast cancer by screening mammogram, and 52% of individuals in the 70 - 75 age group were diagnosed with breast cancer by screening mammography. Only 40% of individuals in the 75+ age group were diagnosed with breast cancer by screening mammogram (P = 0.0234). Furthermore, in the overall sample, 63% had a normal screening mammogram at some time prior to their breast cancer diagnosis. In the 70 - 75 age group, 76% had a normal screening mammogram at some time prior to their breast cancer diagnosis. In the 75+ age group, only 54% had a normal screening mammogram at some time prior to their breast cancer diagnosis (P < 0.0001). Individuals in both age groups were more likely to have early-stage breast cancers and luminal A hormone expression. Conclusions Decreased compliance to screening mammography is observed in the elderly living in underserved communities. Since the elderly are underrepresented in research, organizations do not have sufficient information to recommend screening mammography in the elderly. With increasing life expectancy, observational studies have demonstrated a mortality benefit with screening mammography by early detection of breast cancer, favorable breast cancer characteristics and potentially higher cure rates. Socioeconomic factors also affect screening compliance and likely influenced the results of our study. Future studies should investigate how individual factors influence screening mammography compliance in the elderly in underserved communities.
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Affiliation(s)
- Shruti Sharma
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Dixita Patel
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Sushma Pavuluri
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Amy Stein
- Office of Research and Sponsored Programs, Midwestern University, 19555 N 59th Avenue, Glendale, AZ 85308, USA
| | - Binal Patel
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Nadia Qureshi
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Imran Hasnuddin
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Tsvetelina Todorova
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Krishnan Srinivasan
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
| | - Masood Ghouse
- Comprehensive Cancer Institute, Franciscan Health Olympia Fields, 3900 West 203rd Street, Olympia Fields, IL 60461, USA
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23
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Papaleontiou M, Norton EC, Reyes-Gastelum D, Banerjee M, Haymart MR. Competing Causes of Death in Older Adults with Thyroid Cancer. Thyroid 2021; 31:1359-1365. [PMID: 33764188 PMCID: PMC8591088 DOI: 10.1089/thy.2020.0929] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Understanding the impact of comorbidities and competing risks of death when caring for older adults with thyroid cancer is key for personalized management. The objective of this study was to determine whether older adults with thyroid cancer are more likely to die from thyroid cancer or other etiologies, and determine patient factors associated with each. Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify patients aged ≥66 years diagnosed with thyroid cancer (papillary, follicular, Hürthle cell, medullary, anaplastic, and other) between 2000 and 2015 (median follow-up, 50 months). We analyzed time to event (i.e., death from other causes or death from thyroid cancer) using cumulative incidence functions. Competing risk hazards regression was used to determine the association between patient (e.g., age at diagnosis and specific comorbidities) and tumor characteristics (e.g., SEER stage) with two competing mortality outcomes: death from other causes and death from thyroid cancer. Results: Of 21,509 patients with a median age of 72 years (range 66-106), 4168 (19.4%) died of other causes and 2644 (12.3%) died of thyroid cancer during the study period. For differentiated thyroid cancer patients, likelihood of dying from other causes exceeds likelihood of dying from thyroid cancer, whereas the opposite is true for anaplastic thyroid cancer. For medullary thyroid cancer, after 6.25 years patients are more likely to die from other etiologies than thyroid cancer. Using competing risks hazards regression, male sex (hazards ratio [HR] 1.47; 95% confidence interval [CI 1.37-1.57]), black race (HR 1.30; CI [1.16-1.46]), and comorbidities (e.g., heart disease, HR 1.34; CI [1.25-1.44]; chronic lower respiratory disease, HR 1.25; CI [1.17-1.34]) were associated with death from other causes. Tumor characteristics such as histology, tumor size, and stage correlated with death from thyroid cancer (e.g., distant SEER stage compared with localized, HR 12.65; CI [10.91-14.66]). Conclusions: The clinical context, including patients' specific comorbidities, should be considered when diagnosing and managing thyroid cancer. Our findings can be used to develop decision models that account for competing causes of death, as an aid for clinical decision making.
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Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward C. Norton
- Department of Economics, Health Management & Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Address correspondence to: Megan R. Haymart, MD, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 408E, Ann Arbor, MI 48109, USA.
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Singh JC, Lichtman SM. Targeted Agents for HER2-Positive Breast Cancer: Optimal Use in Older Patients. Drugs Aging 2021; 38:829-844. [PMID: 34423398 DOI: 10.1007/s40266-021-00889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
The human epidermal growth factor-2 (HER2) gene is overexpressed in 15-20 % of all breast cancers. HER2 overexpression is a predictive factor in breast cancer and is associated with high rates of disease recurrence and death in the absence of adjuvant systemic therapy. With the advent of HER2-directed therapies, there has been a significant improvement in the outcome of HER2-positive (HER2+) breast cancer in all clinical settings. Patients aged > 65 years remain under-represented in most clinical trials. Existing literature suggests that older patients with HER2+ disease derive a similar benefit from anti-HER2 therapies as do their younger counterparts, in both adjuvant and metastatic settings. Cardiotoxicity from HER2-directed therapy is a major concern with older patients, especially in the setting of pre-existing co-morbidities. Older patients need a geriatric assessment before beginning any systemic therapy, to identify patients predisposed to developing toxicity and to plan therapy. Many onco-geriatric tools have been developed to further identify frail patients. In this article, we discuss the most up-to-date clinical data on existing therapies for HER2+ breast cancer in adjuvant, neoadjuvant, and metastatic settings, and their application in older patients. We attempt to highlight clinical benefits and toxicities in this group that may aid clinicians in therapeutic decision making.
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Affiliation(s)
| | - Stuart M Lichtman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, 10065, USA
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25
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Hodgson A, Bernardin T, Westermeyer B, Hagopian E, Radtke T, Noman A. Development of a specialty intensity score to estimate a patient's need for care coordination across physician specialties. Health Sci Rep 2021; 4:e303. [PMID: 34084946 PMCID: PMC8142625 DOI: 10.1002/hsr2.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUNDS AND AIMS This article develops a Specialty Intensity Score, which uses patient diagnosis codes to estimate the number of specialist physicians a patient will need to access. Conceptually, the score can serve as a proxy for a patient's need for care coordination across doctors. Such a measure may be valuable to researchers studying care coordination practices for complex patients. In contrast with previous comorbidity scores, which focus primarily on mortality and utilization, this comorbidity score approximates the complexity of a patient's the interaction with the health care system. METHODS We use 2015 inpatient claims data from the Centers for Medicare and Medicaid Services to model the relationship between a patient's diagnoses and physician specialty usage. We estimate usage of specialist doctors by using a least absolute shrinkage and selection operator Poisson model. The Specialty Intensity Score is then constructed using this predicted specialty usage. To validate our score, we test its power to predict the occurrence of patient safety incidents and compare that with the predictive power of the Charlson comorbidity index. RESULTS Our model uses 127 of the 279 International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis subchapters to predict specialty usage, thus creating the Specialty Intensity Score. This score has significantly greater power in predicting patient safety complications than the widely used Charlson comorbidity index. CONCLUSION The Specialty Intensity Score developed in this article can be used by health services researchers and administrators to approximate a patient's need for care coordination across multiple specialist doctors. It, therefore, can help with evaluation of care coordination practices by allowing researchers to restrict their analysis of outcomes to the patients most impacted by those practices.
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26
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Marrie RA, Maxwell C, Mahar A, Ekuma O, McClintock C, Seitz D, Groome P. Breast Cancer Survival in Multiple Sclerosis: A Matched Cohort Study. Neurology 2021; 97:e13-e22. [PMID: 34011575 DOI: 10.1212/wnl.0000000000012127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To test the hypotheses that overall survival and cancer-specific survival after breast cancer diagnosis would be lower in persons with multiple sclerosis (MS) as compared to persons without MS using a retrospective matched cohort design. METHODS We applied a validated case definition to population-based administrative data in Manitoba and Ontario, Canada, to identify women with MS. We linked the MS cohorts to cancer registries to identify women with breast cancer. Then we selected 4 breast cancer controls without MS matched on birth year, cancer diagnosis year, and region. We compared all-cause survival between cohorts using Cox proportional hazards regression adjusting for age at cancer diagnosis, cancer diagnosis period, income quintile, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a multivariable cause-specific hazards model. We pooled findings between provinces using meta-analysis. RESULTS We included 779 patients with MS and 3,116 controls with breast cancer. Most patients with stage data (1,976/2,822 [70.0%]) were diagnosed with stage I or II breast cancer and the mean (SD) age at diagnosis was 57.8 (10.7) years. After adjustment for covariates, MS was associated with a 28% increased hazard for all-cause mortality (hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.08-1.53), but was not associated with altered cancer-specific survival (HR 0.98; 95% CI 0.65-1.46). CONCLUSION Women with MS have lower all-cause survival after breast cancer diagnosis than women without MS. Future studies should confirm these findings in other populations and identify MS-specific factors associated with worse prognosis.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada.
| | - Colleen Maxwell
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Alyson Mahar
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Okechukwu Ekuma
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Chad McClintock
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Dallas Seitz
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Patti Groome
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
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Oshima SM, Tait SD, Fish L, Greenup RA, Grimm LJ. Primary care provider perspectives on screening mammography in older women: A qualitative study. Prev Med Rep 2021; 22:101380. [PMID: 33996393 PMCID: PMC8093928 DOI: 10.1016/j.pmedr.2021.101380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/08/2021] [Accepted: 04/10/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Guidelines informing screening mammography for older women are lacking. This study sought to characterize PCP perspectives on screening mammography for patients aged 75 and older. Methods This was an exploratory, qualitative study based on semi-structured, one-on-one interviews with PCPs from six clinics affiliated with a tertiary medical center. Two independent coders analyzed interview transcripts and identified themes, subthemes, and representative quotes using inductive analysis methodology. Results Ten providers completed interviews. The majority (90%) of providers reported insufficient evidence to suggest a best practice for screening in this population. Providers relied on shared decision-making with patients, a process facilitated by strong provider-patient relationships. Providers took into consideration factors such as functional status, personal risk of breast cancer, and patient preference. Time constraints disincentivized providers to engage in discussions. Conclusions PCPs make decisions about screening mammography for older patients on an individualized basis, taking into account patient overall health status and desire for aggressive intervention. They often rely on shared decision-making given unclear clinical guidelines. Practice implications These findings suggest that fostering strong provider-patient relationships, addressing patient knowledge gaps, and compensating providers for time spent on counseling may facilitate cost-efficient and patient-centered utilization of screening mammography.
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Affiliation(s)
| | - Sarah D Tait
- Duke University School of Medicine, Durham, United States
| | - Laura Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, United States
| | - Rachel A Greenup
- Department of Surgery, Yale University, New Haven, Connecticut, United States
| | - Lars J Grimm
- Department of Radiology, Duke University School of Medicine, Durham, United States
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Jauhari Y, Dodwell D, Gannon MR, Horgan K, Clements K, Medina J, Cromwell DA. The influence of age, comorbidity and frailty on treatment with surgery and systemic therapy in older women with operable triple negative breast cancer (TNBC) in England: A population-based cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:251-260. [PMID: 33268213 DOI: 10.1016/j.ejso.2020.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgery and chemotherapy use were studied among older women with early stage triple negative breast cancer (TNBC) in a population-based cohort. METHODS Women aged ≥50 years with unilateral early (stage 1-3a) TNBC diagnosed in 2014-2017 were identified from English cancer registration data. Information on surgery and chemotherapy was from linked Hospital Episode Statistics and Systemic Anti-Cancer Therapy datasets, respectively. Logistic regression was used to investigate the influences of patient age, comorbidity and frailty on uptake of surgery and chemotherapy. RESULTS There were 7094 women with early stage TNBC. Overall rate of surgery was 94%, which only decreased among women aged ≥85 years (74%) and among the most frail. Among the 6681 women receiving surgery, 16% had neoadjuvant and 42% had adjuvant chemotherapy; the use of both decreased with age. More comorbidities and greater frailty were associated with lower rates of chemotherapy. There were differences in the uptake of chemotherapy across geographical regions and in the neoadjuvant and adjuvant chemotherapy regimens between age groups. CONCLUSION Majority of older women with early TNBC had surgery, although some physically fit older women did not. Chemotherapy use varied by age and fitness.
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Affiliation(s)
- Yasmin Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Karen Clements
- National Disease Registration Service, Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Cancer, Cardiovascular Disease, and Body Weight: a Complex Relationship. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Chen R, Ryan P, Natarajan K, Falconer T, Crew KD, Reich CG, Vashisht R, Randhawa G, Shah NH, Hripcsak G. Treatment Patterns for Chronic Comorbid Conditions in Patients With Cancer Using a Large-Scale Observational Data Network. JCO Clin Cancer Inform 2020; 4:171-183. [PMID: 32134687 PMCID: PMC7113074 DOI: 10.1200/cci.19.00107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Patients with cancer are predisposed to developing chronic, comorbid conditions that affect prognosis, quality of life, and mortality. While treatment guidelines and care variations for these comorbidities have been described for the general noncancer population, less is known about real-world treatment patterns in patients with cancer. We sought to characterize the prevalence and distribution of initial treatment patterns across a large-scale data network for depression, hypertension, and type II diabetes mellitus (T2DM) among patients with cancer. METHODS We used the Observational Health Data Sciences and Informatics network, an international collaborative implementing the Observational Medical Outcomes Partnership Common Data Model to standardize more than 2 billion patient records. For this study, we used 8 databases across 3 countries—the United States, France, and Germany—with 295,529,655 patient records. We identified patients with cancer using SNOMED (Systematized Nomenclature of Medicine) codes validated via manual review. We then characterized the treatment patterns of these patients initiating treatment of depression, hypertension, or T2DM with persistent treatment and at least 365 days of observation. RESULTS Across databases, wide variations exist in treatment patterns for depression (n = 1,145,510), hypertension (n = 3,178,944), and T2DM (n = 886,766). When limited to 6-node (6-drug) sequences, we identified 61,052 unique sequences for depression, 346,067 sequences for hypertension, and 40,629 sequences for T2DM. These variations persisted across sites, databases, countries, and conditions, with the exception of metformin (73.8%) being the most common initial T2DM treatment. The most common initial medications were sertraline (17.5%) and escitalopram (17.5%) for depression and hydrochlorothiazide (20.5%) and lisinopril (19.6%) for hypertension. CONCLUSION We identified wide variations in the treatment of common comorbidities in patients with cancer, similar to the general population, and demonstrate the feasibility of conducting research on patients with cancer across a large-scale observational data network using a common data model.
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Affiliation(s)
- Ruijun Chen
- Department of Biomedical Informatics, Columbia University, New York, NY.,Observational Health Data Sciences and Informatics, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University, New York, NY.,Observational Health Data Sciences and Informatics, New York, NY.,Epidemiology Analytics, Janssen Research and Development, Titusville, NJ
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY.,Observational Health Data Sciences and Informatics, New York, NY
| | - Thomas Falconer
- Department of Biomedical Informatics, Columbia University, New York, NY.,Observational Health Data Sciences and Informatics, New York, NY
| | - Katherine D Crew
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Christian G Reich
- Observational Health Data Sciences and Informatics, New York, NY.,IQVIA, Cambridge, MA
| | - Rohit Vashisht
- Observational Health Data Sciences and Informatics, New York, NY.,Center for Biomedical Informatics Research, Stanford University, Palo Alto, CA
| | - Gurvaneet Randhawa
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Nigam H Shah
- Observational Health Data Sciences and Informatics, New York, NY.,Center for Biomedical Informatics Research, Stanford University, Palo Alto, CA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY.,Observational Health Data Sciences and Informatics, New York, NY.,Medical Informatics Services, New York-Presbyterian Hospital, New York, NY
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Association between number of medications and mortality in geriatric inpatients: a Danish nationwide register-based cohort study. Eur Geriatr Med 2020; 11:1063-1071. [DOI: 10.1007/s41999-020-00390-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022]
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Adjuvant endocrine therapy is associated with improved overall survival in elderly hormone receptor-positive breast cancer patients. Breast Cancer Res Treat 2020; 184:63-74. [PMID: 32776217 DOI: 10.1007/s10549-020-05823-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE There is controversy regarding the survival benefit of endocrine therapy (ET) in elderly patients with early invasive hormone receptor-positive (HR+) breast cancer. In this study, we characterize a single institution's practice patterns using adjuvant ET for these patients and evaluated the effect of ET on outcomes. METHODS A review of a prospectively maintained database identified 483 women ≥ 70 years old who underwent breast -conserving surgery (BCS) for stage I-III HR+ tumors from 2004-2013. We compared clinicopathologic characteristics, overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and breast cancer-specific survival (BCSS) in patients who did and did not receive ET. RESULTS Compared to patients who did not get ET, patients who received ET were younger (median age 76 vs 78 years, p = 0.006), had larger tumors (median size 15 vs 14 mm, p = 0.016), underwent sentinel lymph node (LN) biopsy (83.7 vs 67.8%, p < 0.001), had positive LNs (25.5 vs 9.8%, p = 0.008), and received radiation (XRT, 76 vs 43%, p < 0.001). After adjusting for ASA score, age, LN status, tumor grade, and XRT, receipt of ET was associated with improved OS (HR 0.44; 95% CI 0.25-0.77; p = 0.004) and DFS (HR 0.42; 95% CI 0.28-0.64; p < 0.01). Receipt of ET was associated with improved LRR on univariate analysis (HR 0.25; 95% CI 0.09-0.70; p = 0.008); however, after adjusting for grade and XRT, this was not statistically significant on multivariable analysis (HR 0.38; 95% CI 0.13-1.08; p = 0.069) and was not associated with BCSS (HR 0.59; 95% CI 0.16-2.16; p = 0.43). CONCLUSIONS ET was associated with significant improvements in OS and DFS, regardless of clinicopathological features; however, receipt of ET did not impact LRR and BCSS.
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Parise CA, Caggiano V. The influence of comorbidity on treatment and survival of triple-negative breast cancer. Breast J 2020; 26:1729-1735. [PMID: 32488903 DOI: 10.1111/tbj.13924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Abstract
Concomitant comorbidity is a key factor in treatment decision-making for breast cancer. The aim of this study was to determine how the Charlson Comorbidity Index (CCI) affected treatment and risk of mortality of women with TNBC, the subtype with the poorest prognosis. We accessed 20 177 cases of TNBC from the California Cancer Registry 2000-2015 with documented Charlson Comorbidity Index (CCI). Cox Regression was used to compute the adjusted risk of breast cancer-specific mortality for a CCI of 1 (low comorbidity) and 2+ (high comorbidity) vs a CCI of 0 (no comorbidity). Logistic regression was used to compute the association of CCI with treatment of mastectomy, lumpectomy + radiation, and chemotherapy. Analyses were conducted separately for each stage. Patients with high comorbidity CCI (2+) were less likely to receive systemic chemotherapy irrespective of Stage. High comorbidity was associated with higher breast-specific mortality in all stages of disease. High comorbidity did not have an effect on the use of lumpectomy and radiation of stage 1 breast cancer but was associated with reduced use in stages 2-4. Comorbidity was not associated with decreased risk of mastectomy except for patients with high comorbidity in stage 3. Concomitant comorbidity influences treatment decisions and breast cancer-specific mortality in patients with TNBC.
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Affiliation(s)
- Carol A Parise
- Sutter Institute for Medical Research, Sacramento, CA, USA
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Viuff JH, Vejborg I, Schwartz W, Bak M, Mikkelsen EM. Morbidity as a Predictor for Participation in the Danish National Mammography Screening Program: A Cross-Sectional Study. Clin Epidemiol 2020; 12:509-518. [PMID: 32547242 PMCID: PMC7259444 DOI: 10.2147/clep.s250418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose In this cross-sectional study, we evaluated the association between morbidity and participation in the prevalence round of the Danish national mammography screening program. Patients and Methods Morbidity was assessed by the Charlson Comorbidity Index (CCI) score (0, 1-2, and ≥3) and by 19 individual diagnoses. We retrieved data on participation from The Danish Quality Database of Mammography Screening and on diagnoses from The Danish National Patient Registry. We estimated prevalence proportion ratios (PR) with 95% confidence intervals (CI). Results In total, 519,009 (79.8%) women participated in the first national breast cancer screening round. Relative to women with a CCI score of 0, the adjusted PRs were 0.96 (95% CI: 0.95-0.96) for a CCI score of 1-2 and 0.80 (95% CI: 0.79-0.81) for a CCI score of ≥3. Compared with no disease, the PRs for a diagnosis of the most prevalent, but less severe diseases, chronic pulmonary disease, cerebrovascular disease, diabetes I and II were 0.93 (95% CI: 0.93-0.94), 0.96 (95% CI: 0.94-0.96), and 0.96 (95% CI: 0.95-0.97), respectively. Among women with low prevalent, but most severe diseases, the PRs were 0.69 (95% CI: 0.60-0.81) for AIDS and 0.73 (95% CI: 0.70-0.76) for metastatic solid tumor. Conclusion Women with a high CCI score or one severe chronic condition are less likely to participate in breast cancer screening compared to women without disease. However, these women account for a small proportion of all non-participating women. Thus, it might be most beneficial to maximize breast cancer screening participation in women with less severe although more common morbidities.
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Affiliation(s)
- Jakob H Viuff
- Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus N 8200, Denmark
| | - Ilse Vejborg
- Department of Radiology, University Hospital of Copenhagen Rigshospitalet, Copenhagen 2100, Denmark
| | - Walter Schwartz
- Department of Radiology, Odense University Hospital, Odense C 5000, Denmark
| | - Martin Bak
- Department of Pathology, Sydvestjysk Sygehus, Esbjerg 6700, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital,Aarhus N 8200, Denmark
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Delgado-Ramos GM, Nasir SS, Wang J, Schwartzberg LS. Real-world evaluation of effectiveness and tolerance of chemotherapy for early-stage breast cancer in older women. Breast Cancer Res Treat 2020; 182:247-258. [PMID: 32447595 DOI: 10.1007/s10549-020-05684-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Older patients with early-stage breast cancer (ESBC) tend to receive less aggressive treatment, have higher mortality rates, and are underrepresented in clinical trials. Outcomes, tolerance and toxicity of chemotherapy are underreported. Thus, we assessed the outcomes of chemotherapy in the real-world in a community oncology setting. METHODS We retrospectively chart reviewed consecutive older patients (≥ 70 years) with ESBC diagnosed between January 1, 2010, and December 31, 2016, who received chemotherapy at our institution. Study outcomes were survival estimates. Logistic regression determined associations with measures of intolerance. RESULTS Of 1296 patients, 229 received chemotherapy. Overall, 24% had early chemotherapy cessation; 18% had dose reductions; and 27% had dose delays. Severe, life threatening and lethal toxicities occurred in 38%, 1.3%, and 2.2%, respectively; constitutional toxicity (37%) was the most common. The 1- and 3-year overall survivals were 94% and 79%; 1- and 3-year breast-specific survivals were 96% and 89%, while 1- and 3-year disease-free survivals were 95% and 82%, respectively. Anthracyclines were the most poorly tolerated regimen having associations with hospital visits (OR 10.97, 95% CI 2.10-57.23) and severe toxicities (OR 5.28, 95% CI 1.27-21.89). Anti-HER2 therapies (OR 3.03, 95% CI 1.18-7.78) and poorer performance status (PS) (OR 7.48, 95% CI 1.75-31.98) were associated with severe toxicities. Older age (> 80 years) was associated with early cessation of therapy (OR 3.64, 95% CI 1.34-9.83). CONCLUSIONS Chemotherapy can be effectively delivered to older patients with ESBC and is reasonably well tolerated. The high rate of anthracycline intolerability, poorer PS, and advanced age should be considered when tailoring treatment regimens.
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Affiliation(s)
- Glenda M Delgado-Ramos
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Division of Hematology/Oncology, Loyola University Medical Center, Chicago, IL, USA
| | - Syed Sameer Nasir
- Division of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, Memphis, TN, USA
| | - Jiajing Wang
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lee S Schwartzberg
- Division of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, 7945 Wolf River Boulevard, Germantown, Memphis, TN, USA.
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Samayoa C, Santoyo-Olsson J, Escalera C, Stewart AL, Ortiz C, Márquez-Magaña L, Urias A, Gonzalez N, Cervantes SA, Torres-Nguyen A, Parada-Ampudia L, Nápoles AM. Participant-Centered Strategies for Overcoming Barriers to Biospecimen Collection among Spanish-Speaking Latina Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2020; 29:606-615. [PMID: 32132128 PMCID: PMC7062229 DOI: 10.1158/1055-9965.epi-19-0942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/12/2019] [Accepted: 01/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Latinos are underrepresented in biomedical research, particularly biomarker research, yet they constitute the nation's largest ethnic/racial minority. Optimal methods for obtaining biospecimens for biomarker research among Latinos need to be identified. To minimize barriers and enhance participation, this study developed and tested tailored strategies for collecting biomarkers of chronic stress and premature aging among Spanish-speaking Latina breast cancer survivors. METHODS This study used a community-based participatory approach and selected hair and saliva as noninvasive biospecimens to assess telomere length, the cortisol awakening response (CAR), and hair cortisol concentration. We developed bilingual multimedia instructional materials, and community health workers assisted in collections. Telephone surveys assessed willingness to participate in future studies, barriers to sample collection, and recommendations for improving the strategies. RESULTS A total of 103 participants were recruited over 18 months from two rural sites in California, and 88 were retained at 6-month follow-up. At baseline, rates of donating salivary DNA for telomere length measurement, saliva for CAR analysis, and hair for cortisol concentration were 98%, 89%, and 52%, respectively. At follow-up, rates were 83%, 76%, and 55%, respectively. The majority of participants reported being very willing to provide hair (72%) or saliva (74%) for future studies. CONCLUSIONS Our results support the feasibility of including minorities in biomedical research. We report excellent rates of saliva collection when community partners are engaged in the process, and when patient-centered and culturally tailored recruitment methods are implemented. IMPACT The development of methods to facilitate the inclusion of minorities in biomedical research is critical to eliminate racial/ethnic health disparities.
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Affiliation(s)
- Cathy Samayoa
- Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California.
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Cristian Escalera
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, San Francisco, California
- Center for Aging in Diverse Communities, University of California San Francisco, San Francisco, California
| | - Carmen Ortiz
- Círculo de Vida Cancer Support and Resource Center, San Francisco, California
| | - Leticia Márquez-Magaña
- Health Equity Research Lab, Department of Biology, San Francisco State University, San Francisco, California
| | - Aday Urias
- Cancer Resource Center of the Desert, El Centro, California
| | | | - Silvia A Cervantes
- Community Outreach Department, Kaweah Delta Health District, Visalia, California
| | - Alma Torres-Nguyen
- Community Outreach Department, Kaweah Delta Health District, Visalia, California
| | - Lorenia Parada-Ampudia
- WomenCARE/Entre Nosotras, Family Service Agency of the Central Coast, Soquel, California
| | - Anna M Nápoles
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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Pundole X, Zamora NV, Siddhanamatha H, Lin H, Tayar J, Hong LC, Li L, Suarez-Almazor ME. Utilization of biologic disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis and cancer. Clin Rheumatol 2020; 39:787-794. [PMID: 31853733 DOI: 10.1007/s10067-019-04874-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Biologic disease-modifying anti-rheumatic drugs (bDMARDs) interfere with the immune system and could theoretically increase risk of malignancies. However, recent evidence has not substantiated such concerns and physicians are less reluctant in treating patients with underlying cancer with such bDMARDs. We aimed to understand the current utilization patterns of bDMARDs for the treatment of rheumatoid arthritis (RA) in cancer patients. METHODS We performed a retrospective cohort study of patients with prevalent RA and cancer initially seen at MD Anderson Cancer Center between 2002 and 2014. A cohort of cancer patients was identified from the tumor registry, and patients with RA were identified through ICD-9 codes, followed by review of electronic medical records. We included patients 18 years and older, with a cancer diagnosis, and a diagnosis of RA by a rheumatologist. Patients were followed until 2016. RESULTS We identified 431 patients with RA and cancer that met our inclusion criteria. Overall, 111 (26%) received bDMARDs after their cancer diagnosis; of these, 60 (54%) had received bDMARDs prior to their cancer diagnosis and continued to receive this therapy following their diagnosis. Thirteen (22%) switched to a different bDMARD, and the rest continued to receive the same agent after their cancer diagnosis. Of all patients on a bDMARD, 91 (82%) received tumor necrosis factor inhibitors (TNFi). CONCLUSIONS The treatment landscape of patients with a history of cancer and RA is changing. Future studies evaluating the safety of bDMARDs in patients with a recent history of cancer or with active cancer are needed. Part of the data of this project was presented as a poster at the 2016 American College of Rheumatology annual meeting. Zamora NV, Siddhanamatha H, Barbo A, Tayar J, Lin H, Suarez-Almazor M. Utilization of Biologic Therapy in Patients with Rheumatoid Arthritis and Cancer [abstract].Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/utilization-of-biologic-therapy-in-patients-with-rheumatoid-arthritis-and-cancer/. Accessed September 30, 2019. Key Points • One in four patients with RA and concomitant cancer received bDMARDs, including TNFi, after their cancer diagnosis, at our institution. • Half of the patients with RA and cancer who received bDMARDs had initiated therapy prior to the cancer diagnosis, continuing thereafter.
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Affiliation(s)
- Xerxes Pundole
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Natalia V Zamora
- Sección Reumatología, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Harish Siddhanamatha
- Department of Data Integrity and Analytics, Augusta University Medical Center, Augusta, Georgia
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean Tayar
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Leung Cheuk Hong
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Mahumud RA, Alam K, Dunn J, Gow J. The burden of chronic diseases among Australian cancer patients: Evidence from a longitudinal exploration, 2007-2017. PLoS One 2020; 15:e0228744. [PMID: 32049978 PMCID: PMC7015395 DOI: 10.1371/journal.pone.0228744] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Cancer is a major public health concern in terms of morbidity and mortality worldwide. Several types of cancer patients suffer from chronic comorbid conditions that are a major clinical challenge for treatment and cancer management. The main objective of this study was to investigate the distribution of the burden of chronic comorbid conditions and associated predictors among cancer patients in Australia over the period of 2007-2017. METHODS The study employed a prospective longitudinal design using data from the Household, Income and Labour Dynamics in Australia survey. The number of chronic comorbid conditions was measured for each respondent. The longitudinal effect was captured using a fixed-effect negative binomial regression model, which predicted the potential factors that played a significant role in the occurrence of chronic comorbid conditions. RESULTS Sixty-one percent of cancer patients experienced at least one chronic disease over the period, and 21% of patients experienced three or more chronic diseases. Age (>65 years old) (incidence rate ratio, IRR = 1.15; 95% confidence interval, CI: 1.05, 1.40), inadequate levels of physical activity (IRR = 1.25; 95% CI: 1.09, 1.59), patients who suffered from extreme health burden (IRR = 2.30; 95% CI: 1.73, 3.05) or moderate health burden (IRR = 1.90; 95% CI: 1.45, 2.48), and patients living in the poorest households (IRR = 1.21; 95% CI: 1.11, 1.29) were significant predictors associated with a higher risk of chronic comorbid conditions. CONCLUSIONS A large number of cancer patients experience an extreme burden of chronic comorbid conditions and the different dimensions of these in cancer survivors have the potential to affect the trajectory of their cancer burden. It is also significant for health care providers, including physical therapists and oncologists, who must manage the unique problems that challenge this population and who should advocate for prevention and evidence-based interventions.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- Health Economics Research, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Health and Epidemiology Research, Department of Statistics, Rajshahi, Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
- Prostate Cancer Foundation of Australia, St Leonards, New South Wales, Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia
- School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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The role of comorbidity assessment in guiding treatment decision-making for women with early breast cancer: a systematic literature review. Support Care Cancer 2019; 28:1041-1050. [PMID: 31828493 DOI: 10.1007/s00520-019-05218-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/27/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Comorbidity in breast cancer patients impacts treatment choice, toxicity, and outcomes. While comorbidity measurement tools are frequently used by researchers, little is known about their use in clinical practice. The aim of this review was to examine the use of comorbidity measurement tools in clinical practice and their role in treatment decision-making in breast cancer. METHODS Six electronic databases were searched from inception to 21 March 2019. Quantitative or mixed methods studies addressing primary treatment of breast cancer and identifying a comorbidity measurement tool used in clinical practice treatment decision-making were included. Data was extracted on tool utilized, impact on treatment decisions or outcomes, pattern of use, and psychometric properties. RESULTS A systematic search of literature yielded 752 studies. Of the four studies that met inclusion criteria, each utilized a comprehensive geriatric assessment tool, though only in a subset of patients. No studies found direct comorbidity measurement tools utilized independently of geriatric assessment. Assessment results had variable impact on treatment decisions. Impacts on patient mortality and treatment toxicity, cost-effectiveness, and psychometric characteristics of the tools were not identified. CONCLUSIONS There is little evidence on use of specific comorbidity tools in clinical decision-making in breast cancer outside of comorbidity assessment as part of geriatric assessment tools. There was limited impact on decision-making or patient outcomes when these were utilized. Further research is needed to identify barriers to comorbidity assessment in clinical practice and identify comorbidity tools that have the potential to improve patient outcomes.
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Prevalence of comorbidity in cancer patients scheduled for systemic anticancer treatment in Austria. MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2019. [DOI: 10.1007/s12254-019-00542-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Summary
The purpose of this observational study was to determine the prevalence of comorbid conditions in cancer patients with solid tumours selected for specific treatment at 12 divisions of medical oncology in Austria. Data from 1137 patients were collected using a standardized questionnaire; of these, 1036 datasets were evaluable for further analysis. Data were prospectively collected from patients during an in- or outpatient hospital visit over a 4-month period in 2011. Of these patients 42% had gastrointestinal cancer, 31% had breast cancer, 9% lung cancer and the remaining had urogenital cancer, sarcoma or other types of rare cancers. Around two-thirds of patients had metastatic disease (59%), confined to a single organ site in 55% of patients. A high proportion of patients had a good performance status (Eastern Cooperative Oncology Group [ECOG] 0, 1: 82%). Comorbid conditions were classified according to the Charlson scheme score and were present in 86% of patients with a median age of 64 years. The predominant conditions were cardiovascular diseases (57%), metabolic diseases (44%), endocrinological diseases (30%), gastrointestinal diseases (26%), neurological (23%) and respiratory diseases (23%). As has been reported by others we found a clear association between number of comorbid conditions and age. While 60% of the whole population had at least 2 comorbidities, most patients of the elderly population (89%) had more than three comorbidities. The high proportion of patients with comorbidities and accompanying medication represents a substantial challenge for medical oncologists in selecting the optimal cancer-specific treatment especially in the era of novel targeted and immunotherapies. Comorbid conditions and accompanying comedications require special precautions concerning potential interactions and unexpected adverse reactions from prescribed tumour-specific treatment.
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Jauhari Y, Gannon MR, Tsang C, Horgan K, Dodwell D, Clements K, Medina J, Tang S, Pettengell R, Cromwell DA. Surgery and adjuvant radiotherapy for unilateral ductal carcinoma in situ (DCIS) in women aged over 70 years: A population based cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:1378-1387. [PMID: 30878169 DOI: 10.1016/j.ejso.2019.02.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is little clinical evidence to guide treatment decisions for ductal carcinoma in situ (DCIS) in older women. This study evaluated how the management of DCIS in women aged 70 or more compared with women aged 50-69 in England and Wales. METHOD The study identified women aged ≥50 years with new unilateral DCIS diagnosed between 2014 and 2016 from linked cancer registration and routine hospital datasets for England and Wales. Rates of surgery and adjuvant radiotherapy were examined by age, deprivation, fitness measures (comorbidity and frailty), method of presentation and tumour grade using multilevel logistic regression. RESULTS 12,716 women were diagnosed with unilateral DCIS between 2014 and 2016, of whom 2,754 (22%) were aged ≥70 years and 74% were screen detected. High grade DCIS was common, irrespective of age and method of presentation. Fewer women aged ≥70 had surgery compared to women aged 50-69 (81% vs. 94%), which was only partly explained by poor fitness. Use of radiotherapy following breast conserving surgery was strongly associated with grade, and was received by less than 16% of all patients with low grade tumours. Over 70% of women aged 50-69 with high grade DCIS received radiotherapy, but this fell to 35% among women aged ≥80. Use of radiotherapy was not associated with patient fitness. CONCLUSION Treatment decisions for women with DCIS varied by age at diagnosis. Lower rates of surgery and adjuvant radiotherapy in older women were only partly explained by patient fitness. Better evidence is needed to aid treatment selection for older women with DCIS.
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Affiliation(s)
- Yasmin Jauhari
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; St Georges Healthcare NHS Trust, London, UK.
| | - Melissa Ruth Gannon
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Carmen Tsang
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Clements
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Sarah Tang
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - Ruth Pettengell
- Public Health England, 1st Floor, 5 St Philip's Place, Birmingham, UK
| | - David Alan Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
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P Brockway J, Murari K, Rosenberg A, Saigh O, Press MJ, Lin JJ. Differences in primary care providers’ and oncologists’ views on communication and coordination of care during active treatment of patients with cancer and comorbidities. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519857582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Management of comorbid diseases in patients with cancer is often unclear. The purpose of our study was to identify differences and similarities between primary care providers and oncologists’ knowledge, attitudes, and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment. Methods We conducted a cross-sectional study using an anonymous self-administered survey which was available to approximately 600 providers in primary care and medical oncology practicing in both outpatient and inpatient settings from March to December 2014 at three academic hospitals in New York City (Mount Sinai Hospital, Mount Sinai Beth Israel, and Weill Cornell). Our survey instrument assessed physician knowledge, attitudes, and beliefs using a clinical vignette of a cancer patient undergoing active treatment. Descriptive statistics were used to summarize the demographic and practice details of survey responses, and univariate analyses were used to assess differences in responses between primary care providers and oncologists. Results The survey was completed by 203 providers, including 127 primary care providers (62.5%), 32 medical oncologists (15.8%), 11 palliative care physicians (5.4%), and 33 nurse practitioners or physician assistants (16.3%). Medical oncologists admitted more uncertainty regarding who should manage preventive care as compared to primary care providers (34.4% vs. 16.5%, p = 0.02), whereas primary care providers were more concerned about duplicated care (22.8% vs. 6.3%, p = 0.03). Both primary care providers and medical oncologists agreed that diabetes should be actively managed during cancer treatment. More primary care providers felt less strict glycemic control was allowable (56.8% vs. 37.5%, p = 0.05) and that it is allowable for patients to miss some diabetes-related visits (80.6% vs. 56.3%, p = 0.01). Discussion Primary care providers and medical oncologists differ in their knowledge, attitudes, and beliefs regarding coordination of care and management of comorbid conditions in patients undergoing cancer treatment. These differences reflect systemic challenges to provision of care to cancer patients and the need for a model of care coordination.
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Affiliation(s)
| | | | | | | | - Matthew J Press
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Jenny J Lin
- Icahn School of Medicine at Mount Sinai, USA
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Ayeni OA, Joffe M, Cubasch H, Rinaldi S, Taljaard C, Vorster E, Romieu I, Norris SA. Prevalence of comorbidities in women with and without breast cancer in Soweto, South Africa: Results from the SABC study. S Afr Med J 2019; 109:264-271. [PMID: 31084693 PMCID: PMC7577897 DOI: 10.7196/samj.2019.v109i4.13465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Comorbidities occurring concurrently in breast cancer patients can be burdensome, as they may negatively influence time and stage of presentation. OBJECTIVES To describe the comorbid health conditions among South African (SA) black women with and without breast cancer and to determine factors associated with advanced-stage presentation of breast cancer. METHODS A population-based case-control study on breast cancer was conducted in black women in Soweto, SA, the SABC (South Africa Breast Cancer) study. Lifestyle information and blood samples were collected from 399 women with histologically confirmed new cases of invasive primary breast cancer, recruited prior to any therapy, and 399 age- and neighbourhood-matched controls without breast cancer. We compared self-reported metabolic diseases, depression, anthropometric measurements, blood pressure, HIV status and point-of-care lipid and glucose levels between patients with breast cancer and the control group. RESULTS In the whole population, the mean (standard deviation) age was 54.6 (12.9) years, the majority (81.2%) of the participants were overweight or obese, 85.3% had abdominal adiposity, 61.3% were hypertensive, 47.1% had impaired fasting plasma glucose, 8.4% had elevated total cholesterol, 74.8% had low high-density lipoprotein and 10.9% were assessed to be depressed. Ninety-one percent of the whole cohort had at least one metabolic disease. In the breast cancer group, 72.2% had one or more metabolic diseases only (HIV-negative and no evidence of depression), compared with 64.7% of the control group. From a multivariate logistic regression adjusted model, higher household socioeconomic status conferred a 19% reduction in the odds of having advanced-stage breast cancer at diagnosis, while hypertension, dyslipidaemia and HIV were not significantly associated with stage at breast cancer diagnosis in the adjusted model. CONCLUSIONS A large proportion of women experience several comorbidities, highlighting the need to address the chronic non-communicable disease epidemic in SA and to co-ordinate multidisciplinary primary-, secondary- and tertiary-level care in the country's complex healthcare system for better outcome.
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Affiliation(s)
- O A Ayeni
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa.
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Sowunmi A, Olatunji T, Ketiku K, Campbell O. Sociodemographic correlates and management of breast cancer in Radiotherapy Department, Lagos University Teaching Hospital: A 10-year review. JOURNAL OF CLINICAL SCIENCES 2019. [DOI: 10.4103/jcls.jcls_82_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sheppard JP, Lagman C, Romiyo P, Nguyen T, Azzam D, Alkhalid Y, Duong C, Yang I. Racial Differences in Hospital Stays among Patients Undergoing Craniotomy for Tumour Resection at a Single Academic Hospital. Brain Tumor Res Treat 2019; 7:122-131. [PMID: 31686443 PMCID: PMC6829091 DOI: 10.14791/btrt.2019.7.e29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 01/17/2023] Open
Abstract
Background Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California. Methods We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition. Results In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [rpb (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)]. Conclusion Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.
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Affiliation(s)
- John P Sheppard
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Carlito Lagman
- Department of Radiation Oncology, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Prasanth Romiyo
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Thien Nguyen
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel Azzam
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Yasmine Alkhalid
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Courtney Duong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Department of Radiation Oncology, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, CA, USA.,Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, CA, USA.
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Lin YC, Chang CH, Chang CJ, Wang YC, Hsieh PH, Chang Y. Vascular injury during primary total knee arthroplasty: A nationwide study. J Formos Med Assoc 2019; 118:305-310. [DOI: 10.1016/j.jfma.2018.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 03/14/2018] [Accepted: 05/09/2018] [Indexed: 11/26/2022] Open
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Bea VJ, Cunningham JE, Alberg AJ, Burshell D, Bauza CE, Knight KD, Hazelton TR, Varner H, Kramer R, Bolick S, Hurley D, Mosley C, Ford ME. Alcohol and Tobacco Use in an Ethnically Diverse Sample of Breast Cancer Patients, Including Sea Island African Americans: Implications for Survivorship. Front Oncol 2018; 8:392. [PMID: 30319964 PMCID: PMC6170649 DOI: 10.3389/fonc.2018.00392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/31/2018] [Indexed: 11/13/2022] Open
Abstract
Background/Objective: Data suggest that modifiable risk factors such as alcohol and tobacco use may increase the risk of breast cancer (BC) recurrence and reduce survival. Female BC mortality in South Carolina is 40% higher among African Americans (AAs) than European Americans (EAs). Given this substantial racial disparity, using a cross-sectional survey design we examined alcohol and tobacco use in an ethnically diverse statewide study of women with recently diagnosed invasive breast cancer. This included a unique South Carolina AA subpopulation, the Sea Islanders (SI), culturally isolated and with the lowest European American genetic admixture of any AA group. Methods: Participants (42 EAs, 66 non-SI AAs, 29 SIs), diagnosed between August 2011 and December 2012, were identified through the South Carolina Central Cancer Registry and interviewed by telephone within 21 months of diagnosis. Self-reported educational status, alcohol consumption and tobacco use were obtained using elements of the Behavior and Risk Factor Surveillance System questionnaire. Results:Alcohol: EAs were approximately twice as likely to consume alcohol (40%) and to be moderate drinkers (29%) than either AA group (consumers: 24% of non-SI AAs, 21% of SIs; moderate drinkers 15 and 10% respectively). Users tended to be younger, significantly among EAs and non-SI AAs, but not SIs, and to have attained more education. Heavy drinking was rare (≤1%) and binge drinking uncommon (≤10%) with no differences by race/ethnicity. Among both AA subgroups but not EAs, alcohol users were six to nine times more likely to have late stage disease (Regional or Distant), statistically significant but with wide confidence intervals. Tobacco: Current cigarette smoking (daily or occasional) was reported by 14% of EAs, 14% of non-SI AAs and 7% of SIs. Smoking was inversely associated with educational attainment. Use of both alcohol and cigarettes was reported by 3–6% of cases. Conclusions: Prevalences of alcohol and cigarette use were similar to those in the general population, with alcohol consumption more common among EAs. Up to half of cases used alcohol and/or tobacco. Given the risks from alcohol for disease recurrence, and implications of smoking for various health outcomes, these utilization rates are of concern.
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Affiliation(s)
- Vivian J Bea
- Department of Breast Surgical Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ, United States
| | - Joan E Cunningham
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,National Coalition of Independent Scholars, San Antonio, TX, United States
| | - Anthony J Alberg
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Dana Burshell
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Colleen E Bauza
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kendrea D Knight
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Tonya R Hazelton
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Heidi Varner
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Rita Kramer
- Department of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Susan Bolick
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Deborah Hurley
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Catishia Mosley
- South Carolina Department of Health and Environmental Control, Columbia, SC, United States
| | - Marvella E Ford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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Farrell C, Heaven C. Understanding the impact of chemotherapy on dignity for older people and their partners. Eur J Oncol Nurs 2018; 36:82-88. [DOI: 10.1016/j.ejon.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
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Skelton WP, Parekh H, Starr JS, Trevino J, Cioffi J, Hughes S, George TJ. Clinical Factors as a Component of the Personalized Treatment Approach to Advanced Pancreatic Cancer: a Systematic Literature Review. J Gastrointest Cancer 2018; 49:1-8. [PMID: 29110227 DOI: 10.1007/s12029-017-0021-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pancreatic cancer is often diagnosed at late stages, where disease is either locally advanced unresectable or metastatic. Despite advances, long-term survival is relatively non-existent. DISCUSSION This review article discusses clinical factors commonly encountered in practice that should be incorporated into the decision-making process to optimize patient outcomes, including performance status, nutrition and cachexia, pain, psychological distress, medical comorbidities, advanced age, and treatment selection. CONCLUSION Identification and optimization of these clinical factors could make a meaningful impact on the patient's quality of life.
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Affiliation(s)
- William Paul Skelton
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
| | - Hiral Parekh
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Jason S Starr
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Jose Trevino
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jessica Cioffi
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
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