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Calip GS, Nabulsi NA, Hubbard C, Asfaw AA, Lee I, Zhou J, Cueto J, Mitra D, Ko NY, Hoskins KF, Law EH. Impact of time to distant recurrence on breast cancer-specific mortality in hormone receptor-positive breast cancer. Cancer Causes Control 2022; 33:793-799. [PMID: 35226243 PMCID: PMC9010392 DOI: 10.1007/s10552-022-01561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/10/2022] [Indexed: 11/15/2022]
Abstract
Women with hormone receptor (HR)-positive early-stage breast cancer (BC) have five-year survival rates of > 90% but remain at serious risk for developing distant metastases beyond five years from diagnosis. This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results (SEER) registries to examine associations between distant recurrence-free interval (DRFI) and risk of BC-specific mortality following distant relapse. The analysis includes 1,057 women with second primary stage IV BC who were initially diagnosed with AJCC stages I–III HR-positive BC between1990 and 2016. Overall, 65% of women had a preceding DRFI of ≥ 5 years. Five-year BC-specific survival following development of distant recurrence was 52% for women with DRFI ≥ 5 years compared to 31% in women with DRFI of < 5 years. In multivariable analyses, risks of cancer-specific mortality following distant recurrence were lower in women with DRFI of 5 years or more (subdistribution hazard ratio = 0.72, 95% CI 0.58–0.89, p = 0.002). The results of this study may inform patient-clinician discussions surrounding prognosis and treatment selection among HR-positive patients who develop a distant recurrence of disease.
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Affiliation(s)
- Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, US. .,Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 South Wood Street MC 871, Chicago, IL, 60612, US.
| | - Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, US
| | - Colin Hubbard
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, US
| | - Alemseged A Asfaw
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, US
| | - Inyoung Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, US
| | - Jifang Zhou
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, US
| | - Jenilee Cueto
- Patient & Health Impact, Pfizer, Inc, New York, NY, US
| | | | - Naomi Y Ko
- School of Medicine, Section of Hematology Oncology, Boston University, Boston, MA, US
| | - Kent F Hoskins
- Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL, US
| | - Ernest H Law
- Patient & Health Impact, Pfizer, Inc, New York, NY, US
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Nabulsi NA, Naing KW, Deng H, Cueto J, Asfaw AA, Hubbard CC, Zhou J, Lee I, Mitra D, Calip GS, Law EH. Health-related Quality of Life in Hormone Receptor-Positive Early Breast Cancer: Analyses From the Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey. J Patient Exp 2022; 9:23743735221113058. [PMID: 35846244 PMCID: PMC9277434 DOI: 10.1177/23743735221113058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study describes health-related quality of life (HRQoL) among older Medicare
beneficiaries with hormone receptor-positive (HR+) early breast cancer (eBC).
Women aged ≥65 years diagnosed with stage I-III HR+ eBC between 1997 and 2014
using the Surveillance, Epidemiology, and End Results Medicare Health Outcomes
Survey Data Resource were included. HRQoL was measured using the Short Form
Health Survey including physical/mental component summary (PCS/MCS) scores and
subscales. Patient surveys ≤ 24 months post-diagnosis were matched to
non-cancer controls. Mean differences in HRQoL were compared using analysis of
covariance. Among 1880 HR+ eBC patients versus 5640 matched non-cancer controls,
eBC patients surveyed ≤ 6 months post-diagnosis (n = 530) scored lower on
component scores (PCS mean difference = 1.6 [95%CI: 0.6-2.6]; MCS mean
difference = 2.0 [95%CI: 1.0-3.0]) and multiple subscales. Among women
surveyed 19 to 24 months post-diagnosis (n = 402), mean differences in HRQoL
were modest (PCS: 1.2 [95%CI: 0.1-2.4]; MCS: −1.5 [95%CI: −2.7 to −0.3]). Most
differences in HRQoL following diagnosis of eBC did not indicate statistical
significance or minimally important difference, emphasizing that preservation of
HRQoL is an important and realistic goal among patients with eBC.
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Affiliation(s)
- Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Khatija W Naing
- Division of Health Policy and Administration, University of Illinois at Chicago, Chicago, IL, USA
| | - Huiwen Deng
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jenilee Cueto
- Formerly Patient & Health Impact, Pfizer, Inc., New York, NY, USA
| | - Alemseged A Asfaw
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Colin C Hubbard
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jifang Zhou
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Inyoung Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Flatiron Health, New York, NY, USA
| | - Ernest H Law
- Patient & Health Impact, Pfizer, Inc., New York, NY, USA
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Zhou J, Cueto J, Ko NY, Hoskins KF, Nabulsi NA, Asfaw AA, Hubbard CC, Mitra D, Calip GS, Law EH. Population-based recurrence rates among older women with HR-positive, HER2-negative early breast cancer: Clinical risk factors, frailty status, and differences by race. Breast 2021; 59:367-375. [PMID: 34419726 PMCID: PMC8379689 DOI: 10.1016/j.breast.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multiple independent risk factors are associated with the prognosis of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer (BC), the most common BC subtype. This study describes U.S. population-based recurrence rates among older, resected women with HR+/HER2- early BC. METHODS We conducted a retrospective cohort study of older women diagnosed with incident, invasive stages I-III HR+/HER2- BC who underwent surgery to remove the primary tumor using the Surveillance, Epidemiology, and End Results (SEER)-Medicare Linked Database (2007-2015). SEER records and administrative health claims data were used to ascertain patient and tumor-specific characteristics, treatment, and frailty status. Cumulative incidences of BC recurrence were estimated using a validated algorithm for administrative claims data. Multivariable Fine-Gray competing risk models estimated adjusted subdistribution hazards ratios and 95 % confidence intervals for associations with BC recurrence risk. RESULTS Overall, 46,027 women age ≥65 years were included in our analysis. Over a median follow up of 7 years, 6531 women experienced BC recurrence with an estimated 3 and 5-year cumulative incidence rates of 10 % and 16 %, respectively. Higher 3- and 5-year cumulative incidences were observed in women with larger tumor size (5+ cm, 21 % and 28 %), lymph node involvement (4+ nodes, 27 % and 37 %), and with frail health status at diagnosis (13 % and 20 %). Independent of these clinical risk factors, Black, Hispanic and American Indian/Alaskan Native women had significantly increased BC recurrence risks. CONCLUSIONS Rates of recurrence in HR+/HER2- early BC differs by several patient and clinical factors, including high-risk tumor characteristics. Racial differences in BC outcomes deserve continued attention from clinicians and policymakers.
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Affiliation(s)
- Jifang Zhou
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA; School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jenilee Cueto
- Pfizer, Inc., Patient & Health Impact, New York, NY, USA
| | - Naomi Y Ko
- Boston University School of Medicine, Section of Hematology and Oncology, Boston, MA, USA
| | - Kent F Hoskins
- University of Illinois at Chicago, Division of Hematology and Oncology, Chicago, IL, USA
| | - Nadia A Nabulsi
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | - Alemseged A Asfaw
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | - Colin C Hubbard
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | | | - Gregory S Calip
- University of Illinois at Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA; Flatiron Health, New York, NY, USA.
| | - Ernest H Law
- Pfizer, Inc., Patient & Health Impact, New York, NY, USA
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Calip GS, Patel PR, Sweiss K, Wu Z, Zhou J, Asfaw AA, Adimadhyam S, Lee TA, Chiu BCH. Targets of biologic disease-modifying antirheumatic drugs and risk of multiple myeloma. Int J Cancer 2020; 147:1300-1305. [PMID: 31997371 DOI: 10.1002/ijc.32891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/17/2022]
Abstract
Several commonly used immune-suppressing biologic drugs target proteins and cytokines involved in myeloma pathogenesis. Our objective was to determine whether targeted biologic disease-modifying antirheumatic drugs (DMARDs) are associated with risk of multiple myeloma (MM). We conducted a nested case-control study within a retrospective cohort of 56,886 commercially insured adults undergoing treatment for rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis between 2009 and 2015 using the Truven Health MarketScan Databases. MM cases (n = 287) were matched to up to 10 controls (n = 2,760) on age, sex and rheumatologic indication using incidence density sampling without replacement. Our exposures of interest were biologic DMARDs targeting tumor necrosis factor-alpha, interleukin 6, cytotoxic t-lymphocyte-associated protein-4 and depletion of B cells. Relative risks were estimated as adjusted odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression models. Cases and controls were similar with respect to use of prescription NSAIDs and concurrent conventional-synthetic DMARDs. Cases had slightly fewer etanercept users (4% vs. 7%) and slightly more tocilizumab users (1.4% vs. 0.4%). Compared to patients treated with only conventional-synthetic DMARDs, those receiving concomitant conventional-synthetic plus biologic DMARDs had lower risk of developing MM (OR = 0.48; 95% CI 0.30-0.88; p = 0.02). Risks differed by drug target with an inverse association observed with use of etanercept inhibiting tumor necrosis factor-alpha (OR = 0.55; 95% CI 0.30-1.02; p = 0.06) and a positive association with tocilizumab inhibiting interleukin-6 (OR = 4.33; 95% CI 1.33-14.19; p = 0.02) compared to biologic DMARD-naïve patients. Further investigation is warranted to understand the roles of drugs suppressing tumor necrosis factor-alpha and interleukin-6 in myeloma pathogenesis.
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Affiliation(s)
- Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Pritesh R Patel
- Division of Hematology and Oncology, University of Illinois at Chicago, Chicago, IL
| | - Karen Sweiss
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL
| | - Zhaoju Wu
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL
| | - Jifang Zhou
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL
| | - Alemseged A Asfaw
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL
| | - Sruthi Adimadhyam
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Brian C-H Chiu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
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Zolekar A, Nabulsi NA, Asfaw AA, Zhou J, Sweiss K, Patel PR, Chiu BCH, Nutescu EA, Calip GS. Abstract 5748: Declines in health-related quality of life among older patients diagnosed with hematologic malignancies. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The diagnosis of cancer and its treatment have meaningful impacts on health-related quality of life (HRQOL). Although advances in novel therapy and stem cell transplantation have increased survival in patients with hematologic malignancies (HM), less evidence exists on the subsequent impacts of HM on HRQOL. The objective of this study was to evaluate changes in HRQOL following diagnosis of HM in a cohort of older Medicare beneficiaries.
Methods: This was a retrospective study utilizing the Surveillance, Epidemiology and End Results Medicare Health Outcomes Survey Data Resource, a linkage of longitudinal surveys and cancer registry data. We included patients ages ≥65 years diagnosed with first primary leukemia, lymphoma or multiple myeloma between 1998 and 2014 who completed at least one survey within two years pre- and post-diagnosis. HRQOL was measured using the Short Form Health Survey (SF-36) composite scores with a minimum clinically important difference of 2 points. We also measured self-reported general health, depressive symptoms, and the deficit-accumulation frailty index before and after HM diagnosis. Patients with HM were compared to up to four patients without cancer with exact matching on age, sex, race, marital status, smoking status, education, comorbid conditions, proxy response and calendar time of HM diagnosis. Comparisons of means were performed between groups using ANOVA with adjustment for survey type.
Results: Among 401 patients with HM included in our analysis, mean (SD) age of diagnosis was 75.98 (6.2) years and 26% were diagnosed with leukemia, 57% with lymphoma, and 17% with multiple myeloma. No significant differences in HRQOL, self-reported health, depressive symptoms, or frailty were observed between patients with HM and their non-cancer matches (n=1578) before diagnosis. Substantial declines in HRQOL were observed across all types of HM after cancer diagnosis. Mean decreases in composite SF-36 scores among patients with HM (physical component score [PCS] -7.1, 95% CI -8.8, -5.5; mental component score [MCS] -3.4, 95% CI -4.9, -1.8) were greater in magnitude compared to declines in matched non-cancer patients (PCS -1.6, 95% CI -2.4, -0.7; MCS -0.6, 95% CI -1.3, 0.1). During follow-up, patients with HM also had higher rates of low self-reported health (46% vs. 27%), depressive symptoms (34% vs. 25%) and frailty (56% vs. 43%).
Conclusion: Our study found decreases in HRQOL measures among older patients with HM that were more than three-fold higher than the minimum clinically important differences in the general population and twice that reported in older patients with common solid tumors. Prospective studies and clinical trials in patients with leukemia, lymphoma, and multiple myeloma should include measures that assess whether life-prolonging, novel therapies are also effective in preserving HRQOL.
Citation Format: Ashwini Zolekar, Nadia A. Nabulsi, Alemseged A. Asfaw, Jifang Zhou, Karen Sweiss, Pritesh R. Patel, Brian C.-H. Chiu, Edith A. Nutescu, Gregory S. Calip. Declines in health-related quality of life among older patients diagnosed with hematologic malignancies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5748.
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Affiliation(s)
- Ashwini Zolekar
- 1University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Nadia A. Nabulsi
- 1University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | | | - Jifang Zhou
- 1University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | | | | | | | - Edith A. Nutescu
- 1University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Gregory S. Calip
- 1University of Illinois at Chicago College of Pharmacy, Chicago, IL
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Nabulsi NA, Alobaidi A, Talon B, Asfaw AA, Zhou J, Sharp LK, Sweiss K, Patel PR, Ko NY, Chiu BCH, Calip GS. Self-reported health and survival in older patients diagnosed with multiple myeloma. Cancer Causes Control 2020; 31:641-650. [PMID: 32356139 DOI: 10.1007/s10552-020-01305-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Patient-reported outcomes such as self-reported health (SRH) are important in understanding quality cancer care, yet little is known about links between SRH and outcomes in older patients with multiple myeloma (MM). We evaluated associations between SRH and mortality among older patients with MM. METHODS We analyzed a retrospective cohort of patients ages ≥ 65 years diagnosed with first primary MM using the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) data resource. Pre-diagnosis SRH was grouped as high (excellent/very good/good) or low (fair/poor). We used Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between SRH and all-cause and MM-specific mortality. RESULTS Of 521 MM patients with mean (SD) age at diagnosis of 76.8 (6.1) years, 32% reported low SRH. In multivariable analyses, low SRH was suggestive of modest increased risks of all-cause mortality (HR 1.32, 95% CI 1.02-1.71) and MM-specific mortality (HR 1.22, 95% CI 0.87-1.70) compared to high SRH. CONCLUSION Findings suggest that low pre-diagnosis SRH is highly prevalent among older patients with MM and is associated with modestly increased all-cause mortality. Additional research is needed to address quality of life and modifiable factors that may accompany poor SRH in older patients with MM.
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Affiliation(s)
- Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA
| | - Ali Alobaidi
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA
| | - Brian Talon
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA
| | - Alemseged A Asfaw
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA
| | - Jifang Zhou
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA
| | - Karen Sweiss
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Pritesh R Patel
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Naomi Y Ko
- Section of Hematology Oncology, Boston University School of Medicine, Boston, MA, USA
| | - Brian C-H Chiu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, 833 S. Wood St. MC 871, Chicago, IL, 60612, USA. .,Division of Public Health Sciences, Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Zhou J, Asfaw AA, Nabulsi NA, Mukand NA, Lee I, Ko NY, Boudreau DM, Calip GS. HSR20-113: Diabetes Complications and Risks of Breast Cancer Recurrence Among Older Women. J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2019.7475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jifang Zhou
- aUniversity of Illinois at Chicago, Chicago, IL
| | | | | | | | - Inyoung Lee
- aUniversity of Illinois at Chicago, Chicago, IL
| | - Naomi Y. Ko
- bBoston University School of Medicine, Boston, MA
| | - Denise M. Boudreau
- cKaiser Permanente Washington Health Research Institute, Seattle, WA
- dUniversity of Washington, Seattle, WA
| | - Gregory S. Calip
- aUniversity of Illinois at Chicago, Chicago, IL
- eUniversity of Illinois Cancer Center, Chicago, IL
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Lee I, Adimadhyam S, Nutescu EA, Zhou J, Asfaw AA, Sweiss K, Patel PR, Calip GS. Bevacizumab Use and the Risk of Arterial and Venous Thromboembolism in Patients with High-Grade Gliomas: A Nested Case-Control Study. Pharmacotherapy 2019; 39:921-928. [PMID: 31332810 PMCID: PMC7395667 DOI: 10.1002/phar.2310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE Bevacizumab is used in the treatment of recurrent glioblastoma, but evidence is limited on the incidence of thromboembolic complications regarding the use of this drug in real-world settings. We evaluated the risk of arterial thromboembolism (ATE) and venous thromboembolism (VTE) associated with the use of bevacizumab among adults diagnosed with high-grade gliomas in a commercially insured U.S. POPULATION DESIGN Nested case-control study. DATA SOURCE Truven Health MarketScan Commercial and Medicare Supplemental health claims databases (2009-2015). PATIENTS A total of 2157 patients with high-grade gliomas who underwent incident (first-time) craniotomy, radiation, and concurrent temozolomide treatment between 2009 and 2015 were identified. Overall, 25 cases of ATE and 99 cases of VTE were each identified in this cohort, and each case was matched to up to 10 controls (170 for ATE and 819 for VTE) based on sex, age, quarter year of index time, and follow-up duration by using incidence density sampling without replacement from the overall cohort. Controls were at risk for the outcome of interest (ATE or VTE) at the time of case occurrence and survived at least as long as their referent case. MEASUREMENTS AND MAIN RESULTS Exposure to bevacizumab was determined during inpatient or outpatient encounters between the index date (date of the incident craniotomy) and the ATE or VTE event or corresponding matched control date. Multivariable conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of ATE and VTE separately. A higher proportion of patients with ATE received bevacizumab compared with controls (28% vs 17%; adjusted OR 1.51, 95% CI 0.54-4.24), but this excess in odds was not statistically significant. Similarly, bevacizumab was not significantly associated with VTE (13% vs 9%; adjusted OR 1.40, 95% CI 0.71-2.75). CONCLUSION We found no significant association between the use of bevacizumab and the occurrence of thromboembolic events in patients with high-grade gliomas, although our study was limited by the small number of ATE events. Because the potential for complications from arterial thrombosis cannot be completely ruled out, further research is needed to confirm the thromboembolic safety of bevacizumab in a larger sample of patients with high-grade gliomas.
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Affiliation(s)
- Inyoung Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Sruthi Adimadhyam
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Edith A. Nutescu
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
- Center for Pharmacoepidemiology & Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Jifang Zhou
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Alemseged A. Asfaw
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Karen Sweiss
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Pritesh R. Patel
- Division of Hematology Oncology, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
- Center for Pharmacoepidemiology & Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
- Division of Public Health Sciences, Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, WA
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