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Ahmed A, Khanna P, Al Omari O, Jani C, Patel D, Singh H, Schiffman R. Ixekizumab-induced Interstitial Lung Disease. Am J Ther 2024; 31:e315-e318. [PMID: 37418343 DOI: 10.1097/mjt.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Affiliation(s)
- Alaaeldin Ahmed
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Prateek Khanna
- Division of Hematology and Oncology, Department of Medicine, St Elizabeth Medical Center, Boston, MA
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Dipesh Patel
- Harvard Medical School, Boston, MA
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA
| | - Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI; and
| | - Robert Schiffman
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
- Harvard Medical School, Boston, MA
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA
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Guram K, Huang J, Mouchati C, Abdallah N, Jani C, Navani V, Xie W, El Zarif T, Adib E, Gebrael G, Agarwal N, Li H, Labaki C, Labban M, Ruiz Morales JM, Choueiri TK, Chin Heng DY, Mittal A, Hansen AR, Rose BS, McKay RR. Comparison of outcomes for Hispanic and non-Hispanic patients with advanced renal cell carcinoma in the International Metastatic Renal Cell Carcinoma Database. Cancer 2024. [PMID: 38297953 DOI: 10.1002/cncr.35216] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/03/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Existing data on the impact of Hispanic ethnicity on outcomes for patients with renal cell carcinoma (RCC) is mixed. The authors investigated outcomes of Hispanic and non-Hispanic White (NHW) patients with advanced RCC receiving systemic therapy at large academic cancer centers using the International Metastatic Renal Cell Carcinoma Database (IMDC). METHODS Eligible patients included non-Black Hispanic and NHW patients with locally advanced or metastatic RCC initiating systemic therapy. Overall survival (OS) and time to first-line treatment failure (TTF) were calculated using the Kaplan-Meier method. The effect of ethnicity on OS and TTF were estimated by Cox regression hazard ratios (HRs). RESULTS A total of 1563 patients (181 Hispanic and 1382 NHW) (mostly males [73.8%] with clear cell RCC [81.5%] treated with tyrosine kinase inhibitor [TKI] monotherapy [69.9%]) were included. IMDC risk groups were similar between groups. Hispanic patients were younger at initial diagnosis (median 57 vs. 59 years, p = .015) and less likely to have greater than one metastatic site (60.8% vs. 76.8%, p < .001) or bone metastases (23.8% vs. 33.4%, p = .009). Median OS and TTF was 38.0 months (95% confidence interval [CI], 28.1-59.2) versus 35.7 months (95% CI, 31.9-39.2) and 7.8 months (95% CI, 6.2-9.0) versus 7.5 months (95% CI, 6.9-8.1), respectively, in Hispanic versus NHW patients. In multivariable Cox regression analysis, no statistically significant differences were observed in OS (adjusted hazard ratio [HR], 1.07; 95% CI, 0.86-1.31, p = .56) or TTF (adjusted HR, 1.06; 95% CI, 0.89-1.26, p = .50). CONCLUSIONS The authors did not observe statistically significant differences in OS or TTF between Hispanic and NHW patients with advanced RCC. Receiving treatment at tertiary cancer centers may mitigate observed disparities in cancer outcomes.
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Affiliation(s)
- Kripa Guram
- University of California, San Diego Health, La Jolla, California, USA
| | - Jiaming Huang
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christian Mouchati
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Nour Abdallah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Chinmay Jani
- Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
- University of Miami-Sylvester Comprehensive Cancer Center/Jackson Health System, Miami, Florida, USA
| | - Vishal Navani
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Wanling Xie
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Talal El Zarif
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elio Adib
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Haoran Li
- Department of Medical Oncology, University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Chris Labaki
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Muhieddine Labban
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel Yick Chin Heng
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Abhenil Mittal
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brent S Rose
- University of California, San Diego Health, La Jolla, California, USA
| | - Rana R McKay
- University of California, San Diego Health, La Jolla, California, USA
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Okoli U, Singh H, Jani C, Franco R, Barash M, Alhariri HE. Propofol-Associated Priapism. Am J Ther 2023; 30:e589-e591. [PMID: 36730546 DOI: 10.1097/mjt.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Unoma Okoli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Harpreet Singh
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Rose Franco
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Mark Barash
- Department of Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI
| | - Housam E Alhariri
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
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4
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Nagaraj G, Vinayak S, Khaki AR, Sun T, Kuderer NM, Aboulafia DM, Acoba JD, Awosika J, Bakouny Z, Balmaceda NB, Bao T, Bashir B, Berg S, Bilen MA, Bindal P, Blau S, Bodin BE, Borno HT, Castellano C, Choi H, Deeken J, Desai A, Edwin N, Feldman LE, Flora DB, Friese CR, Galsky MD, Gonzalez CJ, Grivas P, Gupta S, Haynam M, Heilman H, Hershman DL, Hwang C, Jani C, Jhawar SR, Joshi M, Kaklamani V, Klein EJ, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Labaki C, Lammers PE, Lathrop KI, Lewis MA, Li X, Lopes GDL, Lyman GH, Makower DF, Mansoor AH, Markham MJ, Mashru SH, McKay RR, Messing I, Mico V, Nadkarni R, Namburi S, Nguyen RH, Nonato TK, O'Connor TL, Panagiotou OA, Park K, Patel JM, Patel KG, Peppercorn J, Polimera H, Puc M, Rao YJ, Razavi P, Reid SA, Riess JW, Rivera DR, Robson M, Rose SJ, Russ AD, Schapira L, Shah PK, Shanahan MK, Shapiro LC, Smits M, Stover DG, Streckfuss M, Tachiki L, Thompson MA, Tolaney SM, Weissmann LB, Wilson G, Wotman MT, Wulff-Burchfield EM, Mishra S, French B, Warner JL, Lustberg MB, Accordino MK, Shah DP. Clinical characteristics, racial inequities, and outcomes in patients with breast cancer and COVID-19: A COVID-19 and cancer consortium (CCC19) cohort study. eLife 2023; 12:e82618. [PMID: 37846664 PMCID: PMC10637772 DOI: 10.7554/elife.82618] [Citation(s) in RCA: 1] [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] [Received: 08/11/2022] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
Background Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations. Methods This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity. Results 1383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32-1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70-6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83-12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63-3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20-2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66-3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89-22.6]). Hispanic ethnicity, timing, and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status. Conclusions Using one of the largest registries on cancer and COVID-19, we identified patient and BC-related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to non-Hispanic White patients. Funding This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L Warner; P30-CA046592 to Christopher R Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K Shah and Dimpy P Shah; KL2 TR002646 for Pankil Shah and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE) and P30-CA054174 for Dimpy P Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. Clinical trial number CCC19 registry is registered on ClinicalTrials.gov, NCT04354701.
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Affiliation(s)
| | - Shaveta Vinayak
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | | | - Tianyi Sun
- Vanderbilt University Medical CenterNashvilleUnited States
| | - Nicole M Kuderer
- University of WashingtonSeattleUnited States
- Advanced Cancer Research GroupKirklandUnited States
| | | | - Jared D Acoba
- University of Hawaii Cancer CenterHonoluluUnited States
| | - Joy Awosika
- University of Cincinnati Cancer CenterCincinnatiUnited States
| | | | | | - Ting Bao
- Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Babar Bashir
- Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson UniversityPhiladelphiaUnited States
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory UniversityAtlantaUnited States
| | - Poorva Bindal
- Beth Israel Deaconess Medical CenterBostonUnited States
| | - Sibel Blau
- Northwest Medical SpecialtiesTacomaUnited States
| | - Brianne E Bodin
- Herbert Irving Comprehensive Cancer Center, Columbia UniversityNew YorkUnited States
| | - Hala T Borno
- Helen Diller Family Comprehensive Cancer Center, University of California, San FranciscoSan FranciscoUnited States
| | | | - Horyun Choi
- University of Hawaii Cancer CenterHonoluluUnited States
| | - John Deeken
- Inova Schar Cancer InstituteFairfaxUnited States
| | | | | | - Lawrence E Feldman
- University of Illinois Hospital & Health Sciences SystemChicagoUnited States
| | | | | | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Cyndi J Gonzalez
- Rogel Cancer Center, University of Michigan-Ann ArborAnn ArborUnited States
| | - Petros Grivas
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | | | - Marcy Haynam
- The Ohio State University Comprehensive Cancer CenterColumbusUnited States
| | - Hannah Heilman
- University of Cincinnati Cancer CenterCincinnatiUnited States
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia UniversityNew YorkUnited States
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford HospitalDetroitUnited States
| | | | - Sachin R Jhawar
- The Ohio State University Comprehensive Cancer CenterColumbusUnited States
| | - Monika Joshi
- Penn State Health St Joseph Cancer CenterReadingUnited States
| | - Virginia Kaklamani
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
| | | | - Natalie Knox
- Stritch School of Medicine, Loyola UniversityMaywoodUnited States
| | - Vadim S Koshkin
- Helen Diller Family Comprehensive Cancer Center, University of California, San FranciscoSan FranciscoUnited States
| | - Amit A Kulkarni
- Masonic Cancer Center, University of MinnesotaMinneapolisUnited States
| | - Daniel H Kwon
- Helen Diller Family Comprehensive Cancer Center, University of California, San FranciscoSan FranciscoUnited States
| | | | | | - Kate I Lathrop
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
| | - Mark A Lewis
- Intermountain HealthcareSalt Lake CityUnited States
| | - Xuanyi Li
- Vanderbilt University Medical CenterNashvilleUnited States
| | - Gilbert de Lima Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of MedicineMiamiUnited States
| | - Gary H Lyman
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | - Della F Makower
- Montefiore Medical Center, Albert Einstein College of MedicineBronxUnited States
| | | | - Merry-Jennifer Markham
- Division of Hematology and Oncology, University of Florida Health Cancer CenterGainesvilleUnited States
| | | | - Rana R McKay
- Moores Cancer Center, University of California, San DiegoSan DiegoUnited States
| | - Ian Messing
- Division of Radiation Oncology, George Washington UniversityWashingtonUnited States
| | - Vasil Mico
- Sidney Kimmel Comprehensive Cancer Center, Thomas Jefferson UniversityPhiladelphiaUnited States
| | | | | | - Ryan H Nguyen
- University of Illinois Hospital & Health Sciences SystemChicagoUnited States
| | | | | | | | - Kyu Park
- Loma Linda University Cancer CenterLoma LindaUnited States
| | | | | | | | - Hyma Polimera
- Penn State Health St Joseph Cancer CenterReadingUnited States
| | | | - Yuan James Rao
- Division of Radiation Oncology, George Washington UniversityWashingtonUnited States
| | - Pedram Razavi
- Moores Cancer Center, University of California, San DiegoSan DiegoUnited States
| | - Sonya A Reid
- Vanderbilt University Medical CenterNashvilleUnited States
| | - Jonathan W Riess
- UC Davis Comprehensive Cancer Center, University of California, DavisDavisUnited States
| | - Donna R Rivera
- Division of Cancer Control and Population Sciences, National Cancer InstituteRockvilleUnited States
| | - Mark Robson
- Memorial Sloan Kettering Cancer CenterNew YorkUnited States
| | - Suzanne J Rose
- Carl & Dorothy Bennett Cancer Center, Stamford HospitalStamfordUnited States
| | - Atlantis D Russ
- Division of Hematology and Oncology, University of Florida Health Cancer CenterGainesvilleUnited States
| | | | - Pankil K Shah
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
| | | | - Lauren C Shapiro
- Montefiore Medical Center, Albert Einstein College of MedicineBronxUnited States
| | | | - Daniel G Stover
- The Ohio State University Comprehensive Cancer CenterColumbusUnited States
| | | | - Lisa Tachiki
- Fred Hutchinson Cancer Research CenterSeattleUnited States
- University of WashingtonSeattleUnited States
- Seattle Cancer Care AllianceSeattleUnited States
| | | | | | | | - Grace Wilson
- Masonic Cancer Center, University of MinnesotaMinneapolisUnited States
| | - Michael T Wotman
- Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | | | - Sanjay Mishra
- Vanderbilt University Medical CenterNashvilleUnited States
| | | | | | - Maryam B Lustberg
- Yale Cancer Center, Yale University School of MedicineNew HavenUnited States
| | - Melissa K Accordino
- Herbert Irving Comprehensive Cancer Center, Columbia UniversityNew YorkUnited States
| | - Dimpy P Shah
- Mays Cancer Center, The University of Texas Health San Antonio MD Anderson Cancer CenterSan AntonioUnited States
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5
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Gulati S, Hsu CY, Shah S, Shah PK, Zon R, Alsamarai S, Awosika J, El-Bakouny Z, Bashir B, Beeghly A, Berg S, de-la-Rosa-Martinez D, Doroshow DB, Egan PC, Fein J, Flora DB, Friese CR, Fromowitz A, Griffiths EA, Hwang C, Jani C, Joshi M, Khan H, Klein EJ, Heater NK, Koshkin VS, Kwon DH, Labaki C, Latif T, McKay RR, Nagaraj G, Nakasone ES, Nonato T, Polimera HV, Puc M, Razavi P, Ruiz-Garcia E, Saliby RM, Shastri A, Singh SRK, Tagalakis V, Vilar-Compte D, Weissmann LB, Wilkins CR, Wise-Draper TM, Wotman MT, Yoon JJ, Mishra S, Grivas P, Shyr Y, Warner JL, Connors JM, Shah DP, Rosovsky RP. Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:1390-1400. [PMID: 37589970 PMCID: PMC10436185 DOI: 10.1001/jamaoncol.2023.2934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/10/2023] [Indexed: 08/18/2023]
Abstract
Importance Systematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking. Objective To assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022. Exposure Treatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs], immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19. Main Outcomes and Measures Main outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up. Results Of 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR], 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13). Conclusions and Relevance In this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19-related thromboembolism in patients with cancer.
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Affiliation(s)
- Shuchi Gulati
- University of California Davis Comprehensive Cancer Center, Sacramento
- University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Surbhi Shah
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix
| | - Pankil K. Shah
- Mays Cancer Center at University of Texas Health San Antonio MD Anderson
| | - Rebecca Zon
- Dana-Farber Cancer Institute and Massachusetts General Brigham, Boston
| | | | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alicia Beeghly
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee
| | | | | | - Deborah B. Doroshow
- Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pamela C. Egan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Joshua Fein
- Hartford HealthCare Cancer Institute, Hartford, Connecticut
| | | | | | - Ariel Fromowitz
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan
| | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Elizabeth J. Klein
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | | | - Vadim S. Koshkin
- UCSF Helen Diller Family Comprehensive Cancer Center at the University of California San Francisco
| | - Daniel H. Kwon
- UCSF Helen Diller Family Comprehensive Cancer Center at the University of California San Francisco
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tahir Latif
- University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Rana R. McKay
- Moores Cancer Center, University of California San Diego
| | | | - Elizabeth S. Nakasone
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Taylor Nonato
- Moores Cancer Center, University of California San Diego
| | | | | | - Pedram Razavi
- Moores Cancer Center, University of California San Diego
| | | | | | - Aditi Shastri
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | | | - Vicky Tagalakis
- Division of Internal Medicine and Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | - Cy R. Wilkins
- Memorial Sloan Kettering Cancer Center, New York, New York
- New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | | | - Michael T. Wotman
- Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, New York, New York
| | - James J. Yoon
- University of Michigan Rogel Cancer Center, Ann Arbor
| | | | - Petros Grivas
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeremy L. Warner
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee
- Lifespan Cancer Institute, Providence, Rhode Island
| | - Jean M. Connors
- Division of Hematology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Dimpy P. Shah
- Mays Cancer Center at University of Texas Health San Antonio MD Anderson
| | - Rachel P. Rosovsky
- Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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Singh H, Jani C, Marshall DC, Franco R, Bhatt P, Podder S, Shalhoub J, Kurman JS, Nanchal R, Uluer AZ, Salciccioli JD. Cystic fibrosis-related mortality in the United States from 1999 to 2020: an observational analysis of time trends and disparities. Sci Rep 2023; 13:15030. [PMID: 37699961 PMCID: PMC10497589 DOI: 10.1038/s41598-023-41868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023] Open
Abstract
Cystic fibrosis transmembrane conductance regulator modulators have revolutionized cystic fibrosis (CF) care in the past decade. This study explores the CF-related mortality trends in the US from 1999 to 2020. We extracted CF-related mortality data from the CDC WONDER database. CF age-standardized mortality rates (ASMRs) were identified by ICD-10 code E84 and were stratified by demographic and geographical variables. Temporal trends were analyzed using Joinpoint modeling. CF-related ASMRs decreased from 1.9 to 1.04 per million population (p = 0.013), with a greater reduction in recent years. This trend was replicated in both sexes. The median age of death increased from 24 to 37 years. CF mortality rates decreased across sex, white race, non-Hispanic ethnicity, census regions, and urbanization status. Incongruent trends were reported in non-white races and Hispanic ethnicity. A lower median age of death was observed in women, non-white races, and Hispanic ethnicity. SARS-CoV-2 infection was the primary cause of death in 1.7% of CF decedents in 2020. The national CF-related mortality rates declined and the median age of death among CF decedents increased significantly indicating better survival in the recent years. The changes were relatively slow during the earlier period of the study, followed by a greater decline lately. We observed patterns of sex, ethnic, racial, and geographical disparities associated with the worsening of the gap between ethnicities, narrowing of the gap between races and rural vs. urban counties, and closing of the gap between sexes over the study period.
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Affiliation(s)
- Harpreet Singh
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
- Medical Data Research Collaborative, London, UK.
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Medical Data Research Collaborative, London, UK
| | - Dominic C Marshall
- National Heart and Lung Institute, Imperial College London, London, UK
- Medical Data Research Collaborative, London, UK
| | - Rose Franco
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Padmanabh Bhatt
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Medical Data Research Collaborative, London, UK
| | - Shreya Podder
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Joseph Shalhoub
- Imperial College Healthcare NHS Trust, London, UK
- Medical Data Research Collaborative, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Rahul Nanchal
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Ahmet Z Uluer
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin D Salciccioli
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Medical Data Research Collaborative, London, UK
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7
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Jani C, Mouchati C, Abdallah N, Mariano M, Jani R, Salciccioli JD, Marshall DC, Singh H, Sheng I, Shalhoub J, McKay RR. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database. Prostate Cancer Prostatic Dis 2023; 26:552-562. [PMID: 36522462 DOI: 10.1038/s41391-022-00628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States of America (USA), prostate cancer (PC) is the most common cancer in men and the second cause of cancer mortality. Black men (BM) have a higher incidence and worse mortality when compared to white men (WM). We compared trends in PC mortality in the USA by race and state from 1999 to 2019. METHODS We extracted PC mortality data from the Centers for Disease Control (CDC) WONDER database using the International Classification of Diseases (ICD) 10 code C61. Age-Standardized Mortality Rates (ASMR) were divided into racial groups and reported by year and state. Due to the lack of available data in many states, analyses were conducted only for WM and BM using Joinpoint regression for trend comparisons. RESULTS Between 1999-2019, ASMR decreased at the national level in Black (-44.6%), Asian (-44.8%), White (-31.8%), and American Indian or Alaskan native men (-19.0%). ASMR decreased in all states for both races. The greatest drop in ASMR was in Kentucky (-47.0%) for WM and Delaware (-57.8%) for BM. In 2019, ASMRs in BM (13.4/100 000) were significantly higher than WM (7.3/100 000), American Indian or Alaskan Native (3.2/100 000), and Asian men (3.2/100 000) (p < 0.001). The highest ASMRs were in Nebraska (33.5/100 000) for BM and Alaska (11/100 000) for WM. CONCLUSIONS During the last 20 years, the PC mortality rate dropped in all states for all races, suggesting an advancement in management strategies. Although a higher decrease in ASMR was observed in BM, ASMR remain higher among BM. ASMRs were also found to be increasing in many states post USPSTF guideline change (2012), indicating a need for more education around optimized prostate cancer screening.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christian Mouchati
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ruchi Jani
- Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Justin D Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Dominic C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harpreet Singh
- Division of Pulmonary and Critical Care, University of Wisconsin, Milwaukee, WI, USA
| | - Iris Sheng
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Hematology and Oncology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rana R McKay
- University of California San Diego, San Diego, CA, 2021, USA
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8
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Amini M, Sharma R, Jani C. Gender differences in leukemia outcomes based on health care expenditures using estimates from the GLOBOCAN 2020. Arch Public Health 2023; 81:151. [PMID: 37605241 PMCID: PMC10440892 DOI: 10.1186/s13690-023-01154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Leukemia contributes significantly to the global cancer burden. Due to the importance of evaluating improvements in leukemia outcomes, the current study aimed to examine the variations in mortality-to-incidence ratio (MIR) between genders and association of MIR with the health expenditures in selected countries. METHODS The leukemia incidence and mortality rates were extracted from the GLOBOCAN 2020 database. In total, 56 countries were included based on the data quality reports and the exclusion of missing data. The associations of MIR and changes in MIR over time ([Formula: see text]MIR) with the human development index (HDI), current health expenditure (CHE) per capita, and current health expenditure as a percentage of gross domestic product (CHE/GDP) were investigated using Spearman's rank correlation coefficient. RESULTS In 2020, an estimated 474,519 new cases of leukemia were diagnosed globally, and 311,594 deaths occurred due to the disease. Male patients exhibited a higher incidence and mortality of leukemia compared to females on a global scale. Our analysis revealed that the MIRs were the highest and lowest in Egypt (0.79) and the United States (0.29), respectively. Remarkably, countries with greater HDI, higher CHE per capita, and a higher CHE/GDP tended to have lower MIR in both genders and within gender-specific subgroups. The δMIR demonstrated a significant negative correlation with HDI and CHE per capita, whereas no significant associations were observed among female patients for CHE/GDP. Besides, all three indicators showed trends towards negative correlations with δMIR among males, though these trends were not statistically significant (p>0.05). CONCLUSIONS Generally, leukemia MIRs tended to be most favorable (i.e., lower) in countries with high HDI and high health expenditure. The gender differences observed in leukemia outcomes may reflect the potential influence of social, material, behavioral, and biological factors.
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Affiliation(s)
- Maedeh Amini
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Rajesh Sharma
- Humanities and Social Sciences, National Institute of Technology Kurukshetra, Kurukshetra, India
| | - Chinmay Jani
- Mount Aubrun Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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9
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Moey MYY, Hennessy C, French B, Warner JL, Tucker MD, Hausrath DJ, Shah DP, DeCara JM, Bakouny Z, Labaki C, Choueiri TK, Dent S, Akhter N, Ismail-Khan R, Tachiki L, Slosky D, Polonsky TS, Awosika JA, Crago A, Wise-Draper T, Balanchivadze N, Hwang C, Fecher LA, Gomez CG, Hayes-Lattin B, Glover MJ, Shah SA, Gopalakrishnan D, Griffiths EA, Kwon DH, Koshkin VS, Mahmood S, Bashir B, Nonato T, Razavi P, McKay RR, Nagaraj G, Oligino E, Puc M, Tregubenko P, Wulff-Burchfield EM, Xie Z, Halfdanarson TR, Farmakiotis D, Klein EJ, Robilotti EV, Riely GJ, Durand JB, Hayek SS, Kondapalli L, Berg S, O'Connor TE, Bilen MA, Castellano C, Accordino MK, Sibel B, Weissmann LB, Jani C, Flora DB, Rudski L, Dutra MS, Nathaniel B, Ruíz-García E, Vilar-Compte D, Gupta S, Morgans A, Nohria A. COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease. Transl Oncol 2023; 34:101709. [PMID: 37302348 PMCID: PMC10235676 DOI: 10.1016/j.tranon.2023.101709] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Background Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited. Objectives To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF. Methods Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated. Results Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001). Conclusions Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).
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Affiliation(s)
- Melissa Y Y Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC, United States
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jeremy L Warner
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Matthew D Tucker
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States
| | - Daniel J Hausrath
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States
| | - Dimpy P Shah
- Mays Cancer Center at UTHealth San Antonio MD Anderson, San Antonio, TX, United States
| | - Jeanne M DeCara
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, United States
| | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, MA, United States
| | | | - Susan Dent
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and Moffitt Cancer Center, Tampa, FL, United States
| | - Lisa Tachiki
- University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - David Slosky
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Joy A Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | - Audrey Crago
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | | | - Nino Balanchivadze
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States
| | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, United States
| | | | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute at Oregon Health and Science University, Portland, OR, United States
| | - Michael J Glover
- Stanford Cancer Institute at Stanford University, Stanford, CA, United States
| | - Sumit A Shah
- Stanford Cancer Institute at Stanford University, Stanford, CA, United States
| | - Dharmesh Gopalakrishnan
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Elizabeth A Griffiths
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Daniel H Kwon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Vadim S Koshkin
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Sana Mahmood
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Taylor Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Pedram Razavi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Gayathri Nagaraj
- Division of Medical Oncology and Hematology, Loma Linda University, Loma Linda, CA, United States
| | - Eric Oligino
- Cardio-Oncology, Hartford HealthCare Cancer, Hartford, CT, United States
| | | | - Polina Tregubenko
- The University of Kansas Health System, Kansas City, KS, United States
| | | | - Zhuoer Xie
- Mayo Clinic, Rochester, MN, United States
| | | | | | - Elizabeth J Klein
- Brown University and Lifespan Cancer Institute, Providence, RI, United States
| | | | - Gregory J Riely
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Lavanya Kondapalli
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stephanie Berg
- Loyola University Medical Center, Chicago, IL, United States
| | | | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States
| | - Cecilia Castellano
- Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States
| | - Melissa K Accordino
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, United States
| | - Blau Sibel
- Northwest Medical Specialties, Tacoma, WA, United States
| | | | - Chinmay Jani
- Mount Auburn Hospital, Cambridge, MA, United States
| | | | - Lawrence Rudski
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Miriam Santos Dutra
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | | | | | | | - Alicia Morgans
- Dana-Farber Cancer Institute, Boston, MA, United States.
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, United States.
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10
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Singh H, Agarwal L, Jani C, Bhatt P, Hartley A, Shalhoub J, Kurman JS, Al Omari O, Ahmed A, Marshall DC, Salciccioli JD. Pulmonary hypertension associated mortality in the United States from 2003 to 2020: an observational analysis of time trends and disparities. J Thorac Dis 2023; 15:3256-3272. [PMID: 37426148 PMCID: PMC10323561 DOI: 10.21037/jtd-22-1468] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/12/2023] [Indexed: 07/11/2023]
Abstract
Background Pulmonary hypertension (PH) is an independent risk factor for morbidity and mortality. In the last two decades, significant advances have been made in management of World Health Organization (WHO) group 1 PH. However, there are no approved targeted pharmacotherapies for PH secondary to left-sided heart diseases or chronic hypoxic lung diseases which are thought to account for more than 70-80% of the disease burden. No recent investigation has analyzed and compared the mortality burden related to WHO group 1 PH with the mortality burden with WHO groups 2-5 PH at the national level in the United States (US). We hypothesize that WHO group 1 PH-related mortality has improved over the last two decades in comparison to WHO groups 2-5 PH. Methods In this study, we used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) the underlying cause of death database to study age-standardized mortality rates related to PH in the US from 2003 to 2020. Results A total of 126,526 deaths were recorded from PH in the US between 2003 and 2020. Across the study period, PH-related ASMR increased from 17.81 per million population in 2003 to 23.89 in 2020 with a percentage change (PC) of +34%. However, there are contrasting mortality trends in WHO group 1 PH when compared to WHO groups 2-5 PH. Data demonstrated a decline in mortality from group 1 PH regardless of gender. In contrast, an increase in mortality from WHO groups 2-5 PH was observed, accounting for the major proportion of the overall PH mortality burden in recent years. Conclusions PH-related mortality continues to an increase primarily due to increase in mortality attributed to WHO groups 2-5 PH. These findings have notable public health implications. Screening and risk assessment tools for secondary PH, risk factor modification, and novel management strategies are vital to improve outcomes.
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Affiliation(s)
- Harpreet Singh
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical Data Research Collaborative, London, UK
| | - Lipisha Agarwal
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chinmay Jani
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Padmanabh Bhatt
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Adam Hartley
- Medical Data Research Collaborative, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London, UK
- Imperial College Healthcare NHS Trust, London, UK & Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan S. Kurman
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar Al Omari
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alaaeldin Ahmed
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dominic C. Marshall
- Medical Data Research Collaborative, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Justin D. Salciccioli
- Medical Data Research Collaborative, London, UK
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA, USA
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11
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Jani C, Abdallah N, Chrysafi P, Mouchati C, Herchenhorn D, McKay RR. New drug approvals in prostate cancer and their effect on the treatment landscape. Clin Adv Hematol Oncol 2023; 21:321-340. [PMID: 37530638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Prostate cancer is the most frequently diagnosed non-skin cancer and the second leading cause of cancer-related mortality in men in the United States. Over the past decade, the treatment landscape for advanced prostate cancer has rapidly shifted. For decades, androgen deprivation therapy has been the cornerstone of systemic treatment for patients with metastatic hormone-sensitive prostate cancer (mHSPC). However, more recently, we have seen the emergence of doublet and triplet combinations in the mHSPC setting. At the same time, there is an expanding list of treatments for patients with metastatic castration-resistant prostate cancer (mCRPC), including hormonal treatments, chemotherapy, immunotherapy, bone-targeted agents, radioligand therapy, and targeted therapy. The shifting of the treatment landscape for advanced prostate cancer has raised many questions regarding patient selection, therapy choice, and sequencing of different approved agents, particularly in the mCRPC setting with the earlier use of chemotherapy and androgen receptor signaling inhibitors. Since then, multiple trials have been conducted to improve the management of mHSPC and delay its progression to mCRPC. This review article discusses various clinical trials that focus on novel therapeutic targets for prostate cancer and how the initiation of newer clinical trials has affected older therapies and trials.
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Pavlina Chrysafi
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Mouchati
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Rana R McKay
- University of California San Diego, San Diego, California
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12
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Singh H, Rupal A, Al Omari O, Jani C, Ahmed A, Khaliqdina S, Walker A, Shalhoub J, Thomson C, Marshall DC, Salciccioli JD. Trends in pulmonary tuberculosis mortality between 1985 and 2018: an observational analysis. BMC Pulm Med 2023; 23:184. [PMID: 37237250 DOI: 10.1186/s12890-023-02458-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (TB) is a major source of global morbidity and mortality. Latent infection has enabled it to spread to a quarter of the world's population. The late 1980s and early 1990s saw an increase in the number of TB cases related to the HIV epidemic, and the spread of multidrug-resistant TB. Few studies have reported pulmonary TB mortality trends. Our study reports and compares trends in pulmonary TB mortality. METHODS We utilized the World Health Organization (WHO) mortality database from 1985 through 2018 to analyze TB mortality using the International Classification of Diseases-10 codes. Based on the availability and quality of data, we investigated 33 countries including two countries from the Americas; 28 countries from Europe; and 3 countries from the Western Pacific region. Mortality rates were dichotomized by sex. We computed age-standardized death rates per 100,000 population using the world standard population. Time trends were investigated using joinpoint regression analysis. RESULTS We observed a uniform decrease in mortality in all countries across the study period except the Republic of Moldova, which showed an increase in female mortality (+ 0.12 per 100,000 population). Among all countries, Lithuania had the greatest reduction in male mortality (-12) between 1993-2018, and Hungary had the greatest reduction in female mortality (-1.57) between 1985-2017. For males, Slovenia had the most rapid recent declining trend with an estimated annual percentage change (EAPC) of -47% (2003-2016), whereas Croatia showed the fastest increase (EAPC, + 25.0% [2015-2017]). For females, New Zealand had the most rapid declining trend (EAPC, -47.2% [1985-2015]), whereas Croatia showed a rapid increase (EAPC, + 24.9% [2014-2017]). CONCLUSIONS Pulmonary TB mortality is disproportionately higher among Central and Eastern European countries. This communicable disease cannot be eliminated from any one region without a global approach. Priority action areas include ensuring early diagnosis and successful treatment to the most vulnerable groups such as people of foreign origin from countries with a high burden of TB and incarcerated population. Incomplete reporting of TB-related epidemiological data to WHO excluded high-burden countries and limited our study to 33 countries only. Improvement in reporting is crucial to accurately identify changes in epidemiology, the effect of new treatments, and management approaches.
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Affiliation(s)
- Harpreet Singh
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical Data Research Collaborative, London, UK
| | - Arashdeep Rupal
- Medical Data Research Collaborative, London, UK
- Division of Pulmonary, Critical Care Medicine, University of South Florida, Tampa, FL, USA
| | - Omar Al Omari
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chinmay Jani
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alaaeldin Ahmed
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shoheera Khaliqdina
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexander Walker
- Medical Data Research Collaborative, London, UK
- Division of Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London, UK
- Department of Surgery and Cancer, Imperial College of London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Carey Thomson
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
| | - Dominic C Marshall
- Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA.
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Justin D Salciccioli
- Medical Data Research Collaborative, London, UK
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
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Al Omari O, Jani C, Ahmed A, Singh H, Radwan A, Bhatt P, Walker A, Agarwal L, Goodall R, Shalhoub J, Marshall DC, Thomson CC, Salciccioli JD, Tapan U. Lung Cancer Mortality in the United States between 1999 and 2019: An Observational Analysis of Disparities by Sex and Race. Ann Am Thorac Soc 2023; 20:612-616. [PMID: 36476451 PMCID: PMC10112410 DOI: 10.1513/annalsats.202206-510rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Omar Al Omari
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Chinmay Jani
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Alaaeldin Ahmed
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | | | - Amr Radwan
- Boston University School of Medicine and Boston Medical CenterBoston, Massachusetts
| | - Padmanabh Bhatt
- Imperial College of LondonLondon, United Kingdom
- Imperial College Healthcare NHS TrustLondon, United Kingdom
| | - Alexander Walker
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | - Lipisha Agarwal
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | | | | | | | - Carey Conley Thomson
- Mount Auburn Hospital/Beth Israel Lahey HealthCambridge, Massachusetts
- Harvard Medical SchoolBoston, Massachusetts
| | | | - Umit Tapan
- Boston University School of Medicine and Boston Medical CenterBoston, Massachusetts
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14
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Johnson DB, Atkins MB, Hennessy C, Wise-Draper T, Heilman H, Awosika J, Bakouny Z, Labaki C, Saliby RM, Hwang C, Singh SRK, Balanchivadze N, Friese CR, Fecher LA, Yoon JJ, Hayes-Lattin B, Bilen MA, Castellano CA, Lyman GH, Tachiki L, Shah SA, Glover MJ, Flora DB, Wulff-Burchfield E, Kasi A, Abbasi SH, Farmakiotis D, Viera K, Klein EJ, Weissman LB, Jani C, Puc M, Fahey CC, Reuben DY, Mishra S, Beeghly-Fadiel A, French B, Warner JL. Impact of COVID-19 in patients on active melanoma therapy and with history of melanoma. BMC Cancer 2023; 23:265. [PMID: 36949413 PMCID: PMC10033295 DOI: 10.1186/s12885-023-10708-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 09/09/2022] [Accepted: 03/06/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION COVID-19 particularly impacted patients with co-morbid conditions, including cancer. Patients with melanoma have not been specifically studied in large numbers. Here, we sought to identify factors that associated with COVID-19 severity among patients with melanoma, particularly assessing outcomes of patients on active targeted or immune therapy. METHODS Using the COVID-19 and Cancer Consortium (CCC19) registry, we identified 307 patients with melanoma diagnosed with COVID-19. We used multivariable models to assess demographic, cancer-related, and treatment-related factors associated with COVID-19 severity on a 6-level ordinal severity scale. We assessed whether treatment was associated with increased cardiac or pulmonary dysfunction among hospitalized patients and assessed mortality among patients with a history of melanoma compared with other cancer survivors. RESULTS Of 307 patients, 52 received immunotherapy (17%), and 32 targeted therapy (10%) in the previous 3 months. Using multivariable analyses, these treatments were not associated with COVID-19 severity (immunotherapy OR 0.51, 95% CI 0.19 - 1.39; targeted therapy OR 1.89, 95% CI 0.64 - 5.55). Among hospitalized patients, no signals of increased cardiac or pulmonary organ dysfunction, as measured by troponin, brain natriuretic peptide, and oxygenation were noted. Patients with a history of melanoma had similar 90-day mortality compared with other cancer survivors (OR 1.21, 95% CI 0.62 - 2.35). CONCLUSIONS Melanoma therapies did not appear to be associated with increased severity of COVID-19 or worsening organ dysfunction. Patients with history of melanoma had similar 90-day survival following COVID-19 compared with other cancer survivors.
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Affiliation(s)
| | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | | | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, USA
| | | | | | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Sunny R K Singh
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | | | | | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - James J Yoon
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Brandon Hayes-Lattin
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | | | | | - Sumit A Shah
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Michael J Glover
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | | | | | - Anup Kasi
- The University of Kansas Cancer Center, Lawrence, KS, USA
| | - Saqib H Abbasi
- The University of Kansas Cancer Center, Lawrence, KS, USA
| | | | - Kendra Viera
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Elizabeth J Klein
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
| | | | | | | | | | - Daniel Y Reuben
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Benjamin French
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Jeremy L Warner
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
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15
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Nagaraj G, Vinayak S, Khaki AR, Sun T, Kuderer NM, Aboulafia DM, Acoba JD, Awosika J, Bakouny Z, Balmaceda NB, Bao T, Bashir B, Berg S, Bilen MA, Bindal P, Blau S, Bodin BE, Borno HT, Castellano C, Choi H, Deeken J, Desai A, Edwin N, Feldman LE, Flora DB, Friese CR, Galsky MD, Gonzalez CJ, Grivas P, Gupta S, Haynam M, Heilman H, Hershman DL, Hwang C, Jani C, Jhawar SR, Joshi M, Kaklamani V, Klein EJ, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Labaki C, Lammers PE, Lathrop KI, Lewis MA, Li X, de Lima Lopes G, Lyman GH, Makower DF, Mansoor AH, Markham MJ, Mashru SH, McKay RR, Messing I, Mico V, Nadkarni R, Namburi S, Nguyen RH, Nonato TK, O’Connor TL, Panagiotou OA, Park K, Patel JM, Patel KG, Peppercorn J, Polimera H, Puc M, Rao YJ, Razavi P, Reid SA, Riess JW, Rivera DR, Robson M, Rose SJ, Russ AD, Schapira L, Shah PK, Shanahan MK, Shapiro LC, Smits M, Stover DG, Streckfuss M, Tachiki L, Thompson MA, Tolaney SM, Weissmann LB, Wilson G, Wotman MT, Wulff-Burchfield EM, Mishra S, French B, Warner JL, Lustberg MB, Accordino MK, Shah DP. Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study. medRxiv 2023:2023.03.09.23287038. [PMID: 37205429 PMCID: PMC10187350 DOI: 10.1101/2023.03.09.23287038] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations. Methods This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity. Results 1,383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32 - 1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70 - 6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83 - 12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63 - 3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20 - 2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66 - 3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89 - 22.6]). Hispanic ethnicity, timing and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status. Conclusions Using one of the largest registries on cancer and COVID-19, we identified patient and BC related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to Non-Hispanic White patients.
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Affiliation(s)
| | - Shaveta Vinayak
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
| | | | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, TN
| | - Nicole M. Kuderer
- University of Washington, Seattle, WA
- Advanced Cancer Research Group, Kirkland, WA
| | | | | | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH
| | | | | | - Ting Bao
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Sibel Blau
- Northwest Medical Specialties, Tacoma, WA
| | - Brianne E. Bodin
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY
| | - Hala T. Borno
- UCSF Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA
| | | | - Horyun Choi
- University of Hawaii Cancer Center, Honolulu, HI
| | | | | | | | | | | | | | - Matthew D. Galsky
- Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Petros Grivas
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
| | | | - Marcy Haynam
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI
| | | | - Sachin R. Jhawar
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Virginia Kaklamani
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | | | - Natalie Knox
- Stritch School of Medicine at Loyola University, Maywood, IL
| | - Vadim S. Koshkin
- UCSF Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA
| | - Amit A. Kulkarni
- Masonic Cancer Center at the University of Minnesota, Minneapolis, MN
| | - Daniel H. Kwon
- UCSF Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA
| | | | | | - Kate I. Lathrop
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | | | - Xuanyi Li
- Vanderbilt University Medical Center, Nashville, TN
| | - Gilberto de Lima Lopes
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, FL
| | - Gary H. Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
| | - Della F. Makower
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Merry-Jennifer Markham
- University of Florida, Division of Hematology and Oncology, UF Health Cancer Center, Gainesville, FL
| | | | - Rana R. McKay
- Moores Cancer Center, University of California, San Diego, CA
| | - Ian Messing
- Division of Radiation Oncology, George Washington University, Washington, DC
| | - Vasil Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | | | | | - Ryan H. Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago, IL
| | | | | | | | - Kyu Park
- Loma Linda University Cancer Center, Loma Linda, CA
| | | | | | | | | | | | - Yuan James Rao
- Division of Radiation Oncology, George Washington University, Washington, DC
| | - Pedram Razavi
- Moores Cancer Center, University of California, San Diego, CA
| | | | - Jonathan W. Riess
- UC Davis Comprehensive Cancer Center at the University of California at Davis, CA
| | - Donna R. Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - Mark Robson
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Suzanne J. Rose
- Carl & Dorothy Bennett Cancer Center at Stamford Hospital, Stamford, CT
| | - Atlantis D. Russ
- University of Florida, Division of Hematology and Oncology, UF Health Cancer Center, Gainesville, FL
| | | | - Pankil K. Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
| | | | - Lauren C. Shapiro
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Daniel G. Stover
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Lisa Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
- Seattle Cancer Care Alliance, Seattle, WA
| | | | | | | | - Grace Wilson
- Masonic Cancer Center at the University of Minnesota, Minneapolis, MN
| | - Michael T. Wotman
- Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | | | - Dimpy P. Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX
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16
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Burns L, Jani C, Radwan A, Omari OA, Patel M, Oxnard GR, Tapan U. Implementation Challenges and Disparities in Molecular Testing for Patients With Stage IV NSCLC: Perspectives from an Urban Safety-Net Hospital. Clin Lung Cancer 2023; 24:e69-e77. [PMID: 36464575 DOI: 10.1016/j.cllc.2022.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
The advent of next-generation sequencing (NGS), including both tissue assays and circulating tumor DNA (ct-DNA), has been pivotal in improving outcomes for patients with non-small cell lung cancer (NSCLC). Although molecular testing is standard of care for advanced NSCLC, challenges still exist in its implementation. This Perspective examines barriers to the widespread implementation of NGS from the vantage point of a single urban safety-net institution, with a particular focus on examining racial disparities in NGS completion. We conducted a review of patients at our institution from January 2015 through January 2022 and examined molecular testing patterns before and after the publication of updated molecular testing guidelines from the International Association for the Study of Lung Cancer (IASLC), Association for Molecular Pathology (AMP), and College of American Pathologists (CAP) in March of 2018. While NGS increased over time, we found that 43% of patients in the March 2018 through January 2022 group still did not receive NGS, and the most common reasons for the absence of testing included a lack of physician ordering and insufficient tissue on biopsy. We did not note any racial disparities in completion or time-to-adoption of NGS. Patients with squamous cell carcinoma (SCC) histology were noted to receive liquid NGS markedly less often than patients with non-squamous histology in the March 2018 through January 2022 period. Based on our own data and a review of findings from colleagues in the field, we advocate for additional physician educational programming, increased use of ct-DNA biopsy, automated (reflexive) NGS tissue testing on receipt of biopsy, and consideration for the broader molecular profiling of patients with SCC histology.
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Affiliation(s)
- Laura Burns
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA.
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Amr Radwan
- Section of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
| | - Mohini Patel
- Boston University School of Public Health and Boston Medical Center, Boston, MA
| | - Geoffrey R Oxnard
- Section of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Umit Tapan
- Section of Hematology & Medical Oncology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA
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17
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Choueiri TK, Labaki C, Bakouny Z, Hsu CY, Schmidt AL, de Lima Lopes G, Hwang C, Singh SR, Jani C, Weissmann LB, Griffiths EA, Halabi S, Wu U, Berg S, O'Connor TE, Wise-Draper TM, Panagiotou OA, Klein EJ, Joshi M, Yared F, Dutra MS, Gatson NTN, Blau S, Singh H, Nanchal R, McKay RR, Nonato TK, Quinn R, Rubinstein SM, Puc M, Mavromatis BH, Vikas P, Faller B, Zaren HA, Del Prete S, Russell K, Reuben DY, Accordino MK, Singh H, Friese CR, Mishra S, Rivera DR, Shyr Y, Farmakiotis D, Warner JL. Breakthrough SARS-CoV-2 infections among patients with cancer following two and three doses of COVID-19 mRNA vaccines: a retrospective observational study from the COVID-19 and Cancer Consortium. Lancet Reg Health Am 2023; 19:100445. [PMID: 36818595 PMCID: PMC9925160 DOI: 10.1016/j.lana.2023.100445] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 01/03/2023] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Background Breakthrough SARS-CoV-2 infections following vaccination against COVID-19 are of international concern. Patients with cancer have been observed to have worse outcomes associated with COVID-19 during the pandemic. We sought to evaluate the clinical characteristics and outcomes of patients with cancer who developed breakthrough SARS-CoV-2 infections after 2 or 3 doses of mRNA vaccines. Methods We evaluated the clinical characteristics of patients with cancer who developed breakthrough infections using data from the multi-institutional COVID-19 and Cancer Consortium (CCC19; NCT04354701). Analysis was restricted to patients with laboratory-confirmed SARS-CoV-2 diagnosed in 2021 or 2022, to allow for a contemporary unvaccinated control population; potential differences were evaluated using a multivariable logistic regression model after inverse probability of treatment weighting to adjust for potential baseline confounding variables. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. The primary endpoint was 30-day mortality, with key secondary endpoints of hospitalization and ICU and/or mechanical ventilation (ICU/MV). Findings The analysis included 2486 patients, of which 564 and 385 had received 2 or 3 doses of an mRNA vaccine prior to infection, respectively. Hematologic malignancies and recent receipt of systemic anti-neoplastic therapy were more frequent among vaccinated patients. Vaccination was associated with improved outcomes: in the primary analysis, 2 doses (aOR: 0.62, 95% CI: 0.44-0.88) and 3 doses (aOR: 0.20, 95% CI: 0.11-0.36) were associated with decreased 30-day mortality. There were similar findings for the key secondary endpoints of ICU/MV (aOR: 0.60, 95% CI: 0.45-0.82 and 0.37, 95% CI: 0.24-0.58) and hospitalization (aOR: 0.60, 95% CI: 0.48-0.75 and 0.35, 95% CI: 0.26-0.46) for 2 and 3 doses, respectively. Importantly, Black patients had higher rates of hospitalization (aOR: 1.47, 95% CI: 1.12-1.92), and Hispanic patients presented with higher rates of ICU/MV (aOR: 1.61, 95% CI: 1.06-2.44). Interpretation Vaccination against COVID-19, especially with additional doses, is a fundamental strategy in the prevention of adverse outcomes including death, among patients with cancer. Funding This study was partly supported by grants from the National Cancer Institute grant number P30 CA068485 to C-YH, YS, SM, JLW; T32-CA236621 and P30-CA046592 to C.R.F; CTSA 2UL1TR001425-05A1 to TMW-D; ACS/FHI Real-World Data Impact Award, P50 MD017341-01, R21 CA242044-01A1, Susan G. Komen Leadership Grant Hunt to MKA. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).
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Affiliation(s)
| | | | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Chih-Yuan Hsu
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | | | | | - Clara Hwang
- Division of Hematology and Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Sunny R.K. Singh
- Division of Hematology and Medical Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
| | - Lisa B. Weissmann
- Department of Internal Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
| | | | | | - Ulysses Wu
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Stephanie Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Timothy E. O'Connor
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | | | - Orestis A. Panagiotou
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Elizabeth J. Klein
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Fares Yared
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Sibel Blau
- Northwest Medical Specialties, PLLC, Puyallup, WA, USA
| | | | | | - Rana R. McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Taylor K. Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Ryann Quinn
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Praveen Vikas
- Holden Comprehensive Cancer Center, Iowa City, IA, USA
| | - Bryan Faller
- Missouri Baptist Medical Center Cancer Center/Heartland NCORP, St Louis, MO, USA
| | | | | | - Karen Russell
- Tallahassee Memorial Healthcare, Tallahassee, FL, USA
| | | | - Melissa K. Accordino
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Harpreet Singh
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | - Sanjay Mishra
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Dimitrios Farmakiotis
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Jeremy L. Warner
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
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18
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Tseng AS, Patel HP, Kumar A, Jani C, Patel K, Jaswaney R, Thakkar S, Kowlgi NG, Dani SS, Arora S, Mulpuru SK, Madhavan M, Killu AM, Cha YM, DeSimone CV, Deshmukh A. One-year outcomes of catheter ablation for atrial fibrillation in young patients. BMC Cardiovasc Disord 2023; 23:83. [PMID: 36774486 PMCID: PMC9921413 DOI: 10.1186/s12872-022-03017-6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 12/16/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is relatively less frequent in younger patients (age < 50). Recently, studies have suggested that early restoration of sinus rhythm may lead to improved outcomes compared with rate control, however the efficacy of catheter ablation for AF in young is scarce. METHODS We included all hospitalized patients between 18 and 50 years with a diagnosis of AF from the Nationwide Readmission Database 2016-2017 from the Healthcare Cost and Utilization Project. Demographic and comorbidity data were collected and analyzed. Outcomes assessed included one-year AF readmission rates, all-cause readmission, ischemic stroke, and all-cause mortality. Subgroup analyses were performed for all demographic and comorbidity variables. RESULTS Overall, 52,598 patients (medium age 44, interquartile range 38-48, female 25.7%) were included in the study, including 2,146 (4.0%) who underwent catheter ablation for AF. Patients who underwent catheter ablation had a significantly lower rate of readmission for AF or any cause at one year (adjusted hazard ratios (HR) of 0.52 [95% confidence interval (CI): 0.43-0.63] and HR of 0.81 [95% CI: 0.72-0.89], respectively). There was no difference in 1-year readmission for stroke or all-cause mortality between the two groups. Subgroup analyses showed a consistent reduction in the risk of AF readmission among major demographic and comorbidity subgroups. CONCLUSION Catheter ablation in young patients with AF was associated with a reduction in 1-year AF related and all-cause readmissions. These data merit further prospective investigation for validation, through dedicated registries and multicenter collaborations to include young AF from diverse population.
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Affiliation(s)
- Andrew S. Tseng
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Harsh P. Patel
- grid.280418.70000 0001 0705 8684Department of Cardiovascular Disease, Southern Illinois University School of Medicine, Springfield, IL USA
| | - Ashish Kumar
- grid.239578.20000 0001 0675 4725Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH USA
| | - Chinmay Jani
- grid.38142.3c000000041936754XDepartment of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA USA
| | - Kirtenkumar Patel
- grid.240382.f0000 0001 0490 6107Department of Cardiology, North Shore University Hospital, Manhasset, NY USA
| | - Rahul Jaswaney
- grid.67105.350000 0001 2164 3847Department of Medicine, Case Western Reserve University, Cleveland, OH USA
| | - Samarthkumar Thakkar
- grid.416016.40000 0004 0456 3003Department of Internal Medicine, Rochester General Hospital, Rochester, NY USA
| | - Narayan G. Kowlgi
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Sourbha S. Dani
- grid.415731.50000 0001 0725 1353Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA USA
| | - Shilpkumar Arora
- grid.443867.a0000 0000 9149 4843Department of Cardiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH USA
| | - Siva K. Mulpuru
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Malini Madhavan
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Ammar M. Killu
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Yong-mei Cha
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Christopher V. DeSimone
- grid.66875.3a0000 0004 0459 167XDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA. .,Mayo Clinic College of Medicine, 200 1St St SW, Rochester, MN, 55905, USA.
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Yang DD, Borsky K, Jani C, Crowley C, Rodrigues JN, Matin RN, Marshall DC, Salciccioli JD, Shalhoub J, Goodall R. Trends in keratinocyte skin cancer incidence, mortality and burden of disease in 33 countries between 1990 and 2017. Br J Dermatol 2023; 188:237-246. [PMID: 36763862 DOI: 10.1093/bjd/ljac064] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/02/2022] [Accepted: 10/18/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Keratinocyte cancers (KCs) are the most common type of cancer in the White population worldwide, with associated high healthcare costs. Understanding the epidemiological trends for KCs, namely basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (SCCs), is required to assess burden of disease, project future trends and identify strategies for addressing this pressing global health issue. OBJECTIVES To report trends in BCC and SCC incidence, and SCC mortality and disability-adjusted life-years (DALYs). METHODS An observational study of the Global Burden of Disease (GBD) database between 1990 and 2017 was performed. European Union countries and other selected high-income countries, including the UK and the USA, classified as having high-quality mortality data, were included. Annual age-standardized incidence rates (ASIRs), age-standardized death rates (ASDRs) and DALYs for each country were obtained from the GBD database. Trends were described using joinpoint regression analysis. RESULTS Overall, 33 countries were included. For both BCC and SCC in 2015-2017, the highest ASIRs were observed in the USA and Australia. Males had higher ASIRs than females at the end of the observation period in all countries for SCC, and in all countries but two for BCC. In contrast, the highest ASDRs for SCC were observed in Australia and Latvia for males, and in Romania and Croatia for females. The highest DALYs for SCC for both sexes were seen in Australia and Romania. Over the observation period, there were more countries demonstrating decreasing trends in mortality than in incidence, and disparities were observed between which countries had comparatively high mortality rates and which had high incidence rates. Overall reductions in SCC DALYs were observed in 24 of 33 countries for males, and 25 countries for females. CONCLUSIONS Over the past 27 years, although trends in SCC incidence have risen in most countries, there is evidence that mortality rates have been decreasing. Burden of disease as assessed using DALYs has decreased in the majority of countries. Future work will explore potential explanatory factors for the observed disparity in trends in SCC incidence and mortality.
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Affiliation(s)
| | - Kim Borsky
- Medical Data Research Collaborative, London, UK
| | - Chinmay Jani
- Medical Data Research Collaborative, London, UK.,Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Conor Crowley
- Medical Data Research Collaborative, London, UK.,Division of Pulmonary and Critical Care Medicine, Lahey Hospital, Burlington, MA, USA
| | | | - Rubeta N Matin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dominic C Marshall
- Medical Data Research Collaborative, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Justin D Salciccioli
- Medical Data Research Collaborative, London, UK.,Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK.,Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Goodall
- Medical Data Research Collaborative, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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20
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Zuzek Z, Arora S, Helmy I, Jani C, Jaswaney R, Patel K, Patel HP, Patel M, Osman MN, Li J, Shishehbor MH. Underutilization of Drug-Eluting Stents in Infrapopliteal Intervention for Chronic Limb-Threatening Ischemia. J Endovasc Ther 2023; 30:45-56. [PMID: 35075941 DOI: 10.1177/15266028211068763] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Multiple randomized clinical trials have shown superiority of drug-eluting stents (DES) over bare-metal stents (BMS) for infrapopliteal disease. However, real-world data on DES utilization and outcomes in infrapopliteal chronic limb-threatening ischemia (CLTI) patients are unknown. MATERIALS AND METHODS We utilized the Nationwide Readmission Database (NRD) from 2016 to 2017 to extract patients undergoing infrapopliteal intervention with stents (BMS and DES) for CLTI using appropriate ICD-10 codes. Multilevel logistic regression with hospital ID as random effect was used to assess DES utilization. Primary outcome was the composite of target limb major amputation (TLmajA) and target limb revascularization (TLR). Multivariate Cox-proportional hazard regression was used to adjust for confounders. RESULTS Our study included a total of 1817 patients. Of these patients, 1056 patients (58.1%) received DES; DES utilization was stable (relative change: +2.5%, p-trend: 0.867) between 2016 and 2017 and was higher in teaching hospitals (adjusted odds ratio [aOR] = 1.28, 95% CI = 1.03-1.61, p=0.029] and medium (aOR = 3.13, 95% CI = 2.17-4.55, p≤0.001) and large (aOR = 1.56, 95% CI = 1.14-2.17, p=0.005) bed-sized hospitals. Inter-class correlation was 0.44 suggesting ~44% variation in DES utilization between any 2 random hospitals; DES was associated with lower rate of the primary composite outcome (aHR = 0.75, 95% CI = 0.62-0.92, p=0.004) compared with BMS. CONCLUSION In patients undergoing infrapopliteal intervention for CLTI, DES demonstrated significant underutilization despite supportive evidence of their superiority compared with BMS; DES was associated with improvement in the primary composite outcome compared with BMS.
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Affiliation(s)
- Zachary Zuzek
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Shilpkumar Arora
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Irfan Helmy
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Chinmay Jani
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Rahul Jaswaney
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Mohini Patel
- Boston University School of Public Health, Boston, MA, USA
| | - Mohammed Najeeb Osman
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jun Li
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mehdi H Shishehbor
- Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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21
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Shayeb AM, McManus HD, Urman D, Jani C, Zhang T, Dizman N, Meza L, Sivakumar A, Gan CL, Barata P, Bilen MA, Gao X, Heng D, Pal S, Narra R, Kilari D, Kaymakcalan MD, McGregor B, Choueiri TK, McKay RR. Cabozantinib Safety With Different Anticoagulants in Patients With Renal Cell Carcinoma. Clin Genitourin Cancer 2023; 21:55-62. [PMID: 36411184 DOI: 10.1016/j.clgc.2022.10.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients with renal cell carcinoma (RCC) on cabozantinib, venous thromboembolism (VTE) management remains challenging due to limited safety data regarding direct oral anticoagulants (DOACs) use in conjunction with cabozantinib. We investigated the safety of cabozantinib with different anticoagulants in patients with RCC. METHODS In this retrospective multicenter study (9 sites), patients with advanced RCC were allocated into 4 groups: (1) cabozantinib without anticoagulation, cabozantinib with concomitant use of (2) DOACs, (3) low molecular weight heparin (LMWH), or (4) warfarin. The primary safety endpoint was the proportion of major bleeding events (defined per International Society on Thrombosis and Hemostasis criteria). The primary efficacy endpoint was the proportion of new/recurrent VTE while anticoagulated. RESULTS Between 2016 and 2020, 298 patients with RCC received cabozantinib (no anticoagulant = 178, LMWH = 41, DOAC = 64, and warfarin = 15). Most patients had clear cell histology (78.5%) and IMDC intermediate/poor disease (78.2%). Cabozantinib was first, second, or ≥ third line in 21.8%, 31.9%, 43.3% of patients, respectively. Overall, there was no difference in major bleeding events between the no anticoagulant, LMWH, and DOAC groups (P = .088). Rate of new/recurrent VTE was similar among anticoagulant groups. Patients with a VTE had a statistically significantly worse survival than without a VTE (HR 1.48 [CI 95% 1.05-2.08, P = .02]). CONCLUSION This real-world cohort provides first data on bleeding and thrombosis complications in patients with RCC treated with cabozantinib with or without concurrent anticoagulation. DOACs appear safe for VTE treatment for patients with RCC on cabozantinib, but optimized anticoagulation management, including individualized risk-benefit discussion, remains important in clinical practice.
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Affiliation(s)
| | | | | | - Chinmay Jani
- Mount Auburn Hospital - Harvard Medical School, Cambridge, MA
| | | | | | | | | | - Chun L Gan
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | - Pedro Barata
- University Hospitals Seidman Cancer Center, Cleveland, OH
| | | | - Xin Gao
- Massachusetts General Hospital, Boston, MA
| | - Daniel Heng
- Tom Baker Cancer Center, Calgary, Alberta, Canada
| | | | - Ravi Narra
- Medical College of Wisconsin, Milwaukee, WI
| | | | | | | | | | - Rana R McKay
- University of California San Diego, La Jolla, CA.
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22
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Egan PC, Jani C, Singh H, Mishra S, Warner JL. The Importance of Recency of Cancer Diagnosis in Patients Hospitalized with COVID-19-Glimpses from an EHR-based Study. Cancer Epidemiol Biomarkers Prev 2023; 32:3-5. [PMID: 36620898 DOI: 10.1158/1055-9965.epi-22-0876] [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] [Received: 09/12/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 01/10/2023] Open
Abstract
Multiple prior studies have shown an increased risk of severe disease and death from SARS-CoV-2 infection in patients with cancer. Nolan and colleagues conducted a multi-institution, electronic health record (EHR)-based study of adults hospitalized with COVID-19 delineating the difference in outcomes when stratified by current versus former cancer diagnosis and found that only a current diagnosis appears to confer an increased risk of severe COVID-19 and death.We review these findings in the context of other studies examining outcomes for individuals with cancer diagnoses and COVID-19. We also address questions raised by this type of study about the significant challenges of EHR-based studies and discuss potential avenues for future research in this arena. See related article by Nolan et al., p. 12.
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Affiliation(s)
- Pamela C Egan
- Lifespan Cancer Institute, Providence, Rhode Island.,Brown University, Providence, Rhode Island
| | | | | | | | - Jeremy L Warner
- Lifespan Cancer Institute, Providence, Rhode Island.,Vanderbilt University Medical Center, Nashville, Tennessee
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23
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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Jaroenlapnopparat A, Banankhah P, Khoory J, Jani C, Sehra S. A Diagnostic Dilemma of a Case of Granulomatosis With Polyangiitis (GPA) Presenting With Thrombotic Vasculopathy. Cureus 2023; 15:e34479. [PMID: 36874702 PMCID: PMC9981548 DOI: 10.7759/cureus.34479] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Granulomatosis with polyangiitis (GPA) is a rare disease with a prevalence of about three in 100,000 persons in the United States. GPA is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis affecting predominantly small-sized vessels. It can present with localized or systemic symptoms with multiple organ involvement, thus making diagnosis challenging. Common skin lesions in GPA are palpable purpura, petechiae, ulcers, and livedo reticularis. These lesions usually have underlying vasculitis with or without granuloma on histology findings. To date, there have been no previous reports about thrombotic vasculopathy in GPA before. We present a case of a 25-year-old female who presented with intermittent joint pain for weeks, purpuric rash, and mild hemoptysis for a few days. A review of systems was notable for a 15-pound weight loss in one year. Physical examination was significant for a purpuric rash on the left elbow and toe, and left knee swelling and erythema. Presenting laboratory results were notable for anemia, indirect hyperbilirubinemia, mildly elevated D-dimers, and microscopic hematuria. Chest radiograph revealed confluent airspace disease. Extensive infectious workup was negative. A skin biopsy of her left toe revealed dermal intravascular thrombi without evidence of vasculitis. The thrombotic vasculopathy did not favor vasculitis but raised concern for a hypercoagulable state. However, extensive hematologic workup was negative. Bronchoscopy findings were consistent with diffuse alveolar hemorrhage. Later, cytoplasmic ANCA (c-ANCA) and anti-proteinase 3 (PR3) antibody titers were positive. Her diagnosis was unclear since both skin biopsy and bronchoscopy were nonspecific and inconsistent with her positive antibody results. The patient eventually underwent a kidney biopsy, which showed pauci-immune necrotizing and crescentic glomerulonephritis. Finally, a diagnosis of granulomatosis with polyangiitis was made based on the kidney biopsy and positive c-ANCA. The patient was treated with steroids and IV rituximab and discharged home with outpatient rheumatology follow-up. Due to multiple signs and symptoms including thrombotic vasculopathy, there was a diagnostic dilemma requiring a multidisciplinary approach. This case highlights the importance of pattern recognition for the diagnostic framework of rare disease entities and the multidisciplinary collaborative efforts required to reach the final diagnosis.
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Affiliation(s)
| | - Peymaan Banankhah
- Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Joseph Khoory
- Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Chinmay Jani
- Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Shiv Sehra
- Rheumatology, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
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25
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Jani C, Lotz M, Keates S, Gupta Y, Walker A, Al Omari O, Parvez A, Patel D, Gnata M, Perry J, Khorashadi L, Weissmann L, Pories SE. Management of Lobular Neoplasia Diagnosed by Core Biopsy. Breast J 2023; 2023:8185446. [PMID: 37114120 PMCID: PMC10129432 DOI: 10.1155/2023/8185446] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023]
Abstract
Lobular neoplasia (LN) involves proliferative changes within the breast lobules. LN is divided into lobular carcinoma in situ (LCIS) and atypical lobular hyperplasia (ALH). LCIS can be further subdivided into three subtypes: classic LCIS, pleomorphic LCIS, and LCIS with necrosis (florid type). Because classic LCIS is now considered as a benign etiology, current guidelines recommend close follow-up with imaging versus surgical excision. The goal of our study was to determine if the diagnosis of classic LN on core needle biopsy (CNB) merits surgical excision. This is a retrospective, observational study conducted at Mount Auburn Hospital, Cambridge, MA, from May 17, 2017, through June 30, 2020. We reviewed the data of breast biopsies conducted at our hospital over this period and included patients who were diagnosed with classic LN (LCIS and/or ALH) and excluded patients having any other atypical lesions on CNB. All known cancer patients were excluded. Of the 2707 CNBs performed during the study period, we identified 68 women who were diagnosed with ALH or LCIS on CNB. CNB was performed for an abnormal mammogram in the majority of patients (60; 88%) while 7(10.3%) had an abnormal breast magnetic resonance imaging study (MRI), and 1 had an abnormal ultrasound (US). A total of 58 patients (85%) underwent excisional biopsy, of which 3 (5.2%) showed malignancy, including 2 cases of DCIS and 1 invasive carcinoma. In addition, there was 1 case (1.7%) with pleomorphic LCIS and 11 cases with ADH (15.5%). The management of LN found on core biopsy is evolving, with some advocating surgical excision and others recommending observation. Our data show a change in diagnosis with excisional biopsy in 13 (22.4%) of patients with 2 cases of DCIS, 1 invasive carcinoma, 1 pleomorphic LCIS, and 9 cases of ADH, diagnosed on excisional biopsy. While ALH and classic LCIS are considered benign, the choice of ongoing surveillance versus excisional biopsy should be made with shared decision making with the patient, with consideration of personal and family history, as well as patient preferences.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Margaret Lotz
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Division of Hematology-Oncology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Sarah Keates
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Division of Hematology-Oncology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Yasha Gupta
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Department of Radiology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Alexander Walker
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Omar Al Omari
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Arshi Parvez
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
| | - Dipesh Patel
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Department of Radiology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Maria Gnata
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - John Perry
- Department of Pathology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Leila Khorashadi
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Department of Radiology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Lisa Weissmann
- Department of Internal Medicine, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Division of Hematology-Oncology, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
| | - Susan E. Pories
- Harvard Medical School, 25 Shattuck St, Boston 02115, MA, USA
- Hoffman Breast Center, Department of Surgery, Mount Auburn Hospital, 300 Mount Auburn St., Cambridge, MA, USA
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26
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Singh H, Kurman JS, Jani C, Abdalla M, DePaul B, Benn BS. Off-label use of intrabronchial valves for persistent air leak is safe and effective: a retrospective case analysis. J Thorac Dis 2022; 14:4725-4732. [PMID: 36647468 PMCID: PMC9840033 DOI: 10.21037/jtd-22-824] [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: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Background Persistent air leak (PAL) is a challenging clinical problem associated with prolonged hospital stay and increased morbidity. Historically, treatment options were limited to thoracostomy tube drainage, pleurodesis, and surgical repair. The development of one-way airway valves has represented a paradigm shift in PAL management. We present our experience using intrabronchial valves (IBVs) for PAL management looking at both on-label (post-thoracic surgery) and off-label (all other) indications. Methods We performed a retrospective review of our single-center experience. Data collected included demographics, primary pathology leading to PAL, comorbidities, time to chest tube removal, complications, mortality, need for any additional procedure, and time to IBV removal. Results During the study period, 15 patients underwent IBV insertion for PAL. The on-label cohort contained three patients (post lobectomy or segmentectomy). The off-label cohort had 12 patients (6 empyema, 4 secondary spontaneous pneumothorax, 1 penetrating trauma, and 1 post percutaneous lung nodule biopsy). In the on-label cohort, chest tube was removed after a mean duration of 4.0±1.0 days for all patients. In the off-label cohort, 83.3% (10/12) had chest tube removal 16.2±5.7 days (P=0.396) after IBV placement. One patient developed hypoxic respiratory failure shortly after IBV insertion, necessitating removal of 2 out of 5 valves. Conclusions IBVs are a minimally invasive, well tolerated treatment modality for patients with PAL and a viable alternative to invasive surgical interventions. Procedure or valve-related complications are uncommon. Valves can be removed and do not preclude surgical intervention. Updated guidelines are necessary to formalize PAL management.
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Affiliation(s)
- Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan S Kurman
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mohammed Abdalla
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brandon DePaul
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bryan S Benn
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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27
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Ahmed A, Rupal A, Walker A, Al Omari O, Jani C, Singh H, Nanchal RS. Patent Foramen Ovale and Ascending Aortic Dilatation Causing Platypnea-Orthodeoxia Syndrome. Cureus 2022; 14:e26953. [PMID: 35989814 PMCID: PMC9381869 DOI: 10.7759/cureus.26953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Platypnea-orthodeoxia syndrome (POS) is an underdiagnosed clinical syndrome characterized by dyspnea (platypnea) and hypoxemia (orthodeoxia) in the upright position that resolves when recumbent. POS is often due to an underlying right-to-left shunt. Four broad mechanisms for the shunt have been described: intracardiac shunts, intrapulmonary shunts, hepatopulmonary syndrome, and pulmonary ventilation-perfusion mismatch. A 68-year-old male with a past medical history of chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, ascending aortic dilation (3.9 cm), myelofibrosis, and status post stem cell transplant complicated by graft versus host disease was found hypoxemic (oxygen saturation: 82%) on routine visit prompting hospitalization. Hypoxemia initially responded to 40% FiO2 but subsequently progressed to refractory hypoxemia on 100% FiO2. A chest computed tomography (CT) scan showed evidence of multiple segmental pulmonary emboli with patent central pulmonary arteries. Hypoxemia out of proportion to pulmonary embolism clot burden and examination findings consistent with orthodeoxia prompted further investigations. Nuclear medicine scan showed radiotracer activity in both brain and kidneys consistent with a small right-to-left shunt (5.9%). Transesophageal echocardiography (TEE) revealed a patent foramen ovale (PFO) with a right-to-left shunt across the atrial septum, with a maximum opening of 3.5 mm and tunnel length of 25 mm. Right heart catheterization (RHC) is consistent with the right-to-left shunt and normal right heart pressures. The degree of the shunt was not significant enough to explain the degree of hypoxemia, but all the diagnostic studies were performed in a supine position, possibly underestimating the degree of the shunt. PFO closure with transcatheter 30-mm Gore device (GORE® CARDIOFORM, Arizona, USA) decreased supplemental oxygen requirement from 75% high-flow nasal cannula (NC) to room air (RA) immediately after the procedure. The patient was subsequently discharged home on a baseline oxygen requirement of 2 L NC at nighttime. POS should be suspected when a patient develops severe hypoxemia after changing from a recumbent position to a sitting or standing position. The identification and correction of the shunting or mismatch often allow complete resolution of POS. Transthoracic echocardiography with agitated saline, TEE, and RHC are the diagnosis modalities of choice. Left heart cardiac catheterization remains the gold standard, which would demonstrate a mismatch in oxygen saturation between the pulmonary vein and the aorta. Our patient’s PFO was successfully closed by a percutaneous transcatheter closure device leading to the complete resolution of hypoxemia immediately.
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Kulkarni A, Hennessy C, Wilson G, Ramesh V, Hwang C, Awosika J, Bakouny Z, Vilar-Compte D, Khan H, McKay RR, Jani C, Puc M, Kasi A, Berg SA, Castillo DR, Hayes-Lattin BM, Hosmer W, Flora DB, Duma N. Smoking and COVID-19 in patients with cancer: Novel analysis from CCC19 registry. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18766] [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: 11/20/2022] Open
Abstract
e18766 Background: Patients (pts) with thoracic cancers have a high rate of hospitalization and death from COVID-19. Smoking has been associated with increased risk for severe COVID-19. However, there is limited data evaluating the impact of smoking recency on COVID-19 severity in pts with cancer. We aimed to characterize the clinical outcomes of COVID-19 based on the recency of smoking in pts with thoracic cancers (TC) and all other cancers (OC). Methods: Adult pts with cancer and lab-confirmed SARS-CoV-2 and smoking history recorded in the CCC19 registry (NCT0435470) were included. Pts were stratified by cancer type (TC or OC) and further stratified into subgroups based on the recency of smoking cessation: current smoker; former smokers who quit < 1 yr. ago; 1-5 yr. ago; 6-10 yr. ago; quit > 10 yr. ago; and never smoker. 30-day all-cause mortality was the primary endpoint. Secondary endpoints were any hospitalization; hospitalization with supplemental O2; ICU admission; and mechanical ventilation. Results: From January 2020 to December 2021, 752 pts from TC group and 8,291 pts from OC group met the inclusion criteria. 78% of patients in TC group ever smoked compared to 36% patients in the OC group. In both groups, the majority of never-smokers were females (70% and 60% in TC and OC respectively). The burden of smoking and the rate of pulmonary comorbidities (PC) was higher in the TC group (PC 22-69%) compared to OC group (PC 12-26%) across all smoking strata. Overall, 30-day all-cause mortality was 21% and 11% in pts with TC and OC respectively. Former smokers who quit < 1 year ago in TC group had the highest rate of mortality and severe COVID-19 outcomes. However, in the OC group, there was no consistent trend of higher mortality or severe COVID-19 outcomes in specific subgroups based on smoking recency. Conclusions: To our knowledge this is the largest study evaluating the effect of granular phenotypes of smoking recency on COVID-19 outcomes in pts with cancer. Recent smokers who quit < 1 year ago in TC group had the highest rate of mortality and severe COVID-19. Further analysis exploring the factors (e.g., smoking pack years) associated with severe outcomes in this subgroup is planned.[Table: see text]
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Affiliation(s)
| | | | | | | | | | - Joy Awosika
- University of Cincinnati Cancer Institute, Cincinnati, OH
| | - Ziad Bakouny
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Hina Khan
- Lifespan Cancer Institute, Cancer Center at Brown University, Providence, RI
| | - Rana R. McKay
- University of California San Diego Health, La Jolla, CA
| | | | | | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | - Wylie Hosmer
- Cancer Ctr Central Connecticut, West Hartford, CT
| | | | - Narjust Duma
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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29
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Beeghly-Fadiel A, Prescott LS, Ruiz-Garcia E, Hwang C, Heilman H, McKay RR, Saliby RM, Lau S, Nagaraj G, Puc M, Zsiros E, Shah S, Jani C, Cosin J, Nakasone E, O'Cearbhaill RE, Crispens MA, Brown AJ. COVID-19 in patients with gynecologic cancer: A preliminary report from the COVID-19 and Cancer Consortium (CCC19). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5508] [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: 11/20/2022] Open
Abstract
5508 Background: Limited information exists regarding the severity of short-term outcomes among patients with gynecologic cancer who are infected with SARS-CoV-2. Methods: Patients with gynecologic cancer and laboratory confirmed SARS-CoV-2 infection were identified from the international CCC19 registry. We estimated odds ratios (OR) from ordinal logistic regression for associations with severity of COVID-19 outcomes, defined from least to most severe as hospitalization, intensive care unit (ICU) admittance, mechanical ventilation, and 30-day mortality. Results: Of 842 patients identified, 48% had endometrial cancer, 24% had ovarian cancer, 22% had cervical cancer, and 6% had dual primary/other gynecologic cancers. The majority were from the United States (86%), most were non-Hispanic White (46%), and the median age was 62 years (IQR 52-72). The majority were diagnosed with localized disease (68%); only 18 (2%) and 15 (2%) were fully or partially vaccinated, respectively. In the 3 months prior to COVID-19, 36% had any cancer treatment, with chemotherapy the most common (23%). When diagnosed with COVID-19, most patients were in remission (50%), while 37% had active disease, including 22% with metastatic disease. Most patients presented with typical COVID-19 symptoms (76%); few had a poor ECOG performance status (PS ≥2, 14%). Outcomes included hospitalization (50%), ICU admittance (12%), mechanical ventilation (8%), and death within 30 days of testing positive for SARS-CoV-2 (10%). In unadjusted models, increasing age (OR: 1.03 1.02-1.04) and Black race (OR 1.91, 1.31-2.77) were associated with increased severity of COVID-19 outcomes. Compared to patients in remission for ≥5 years, those with progressive disease had increased severity (OR 1.88, 1.25-2.82), while those in remission for < 5 years or with stable disease had decreased severity of COVID-19 outcomes (OR 0.55, 0.39-0.76). In multivariable models that included adjustment for age, race, and cancer status, additional factors associated with increased COVID-19 outcome severity included cardiac (OR 1.57, 1.13-2.19) and renal (OR 2.00, 1.33-3.00) comorbidities, an ECOG PS ≥2 (OR 5.15, 3.21-8.27), having pneumonia or pneumonitis (OR 4.08, 2.94-5.66), venous thromboembolism (OR 4.67, 2.49-8.75), sepsis (OR 14.2, 9.05-22.1), or a co-infection within ±2 weeks of SARS-CoV-2 (OR: 4.40, 2.91-6.65); asymptomatic SARS-CoV-2 infection was associated with decreased severity of outcomes (OR: 0.25, 0.16-0.38). The overall case fatality rate was 15.7%. Conclusions: Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, co-morbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes, along the continuum from least to most, of hospitalization, ICU admittance, mechanical ventilation, and 30-day mortality.
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Affiliation(s)
| | | | | | | | | | - Rana R. McKay
- University of California San Diego Health, La Jolla, CA
| | | | - Suzie Lau
- Jewish General, Montréal, QC, Canada
| | | | | | - Emese Zsiros
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Sumit Shah
- Stanford University Medical Center, Stanford, CA
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30
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Warner JL, Pinato DJJ, Mishra S, Saliby RM, Hwang C, Gulati S, McKay RR, Labaki C, Griffiths EA, Jani C, Yu PP, Portuguese AJ, Puc M, Egan P, Shah S, Kasi A, Berg SA, Flora DB, Accordino MK, Shah DP. Post-acute sequelae of SARS-CoV-2 infection in patients with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18746] [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: 11/20/2022] Open
Abstract
e18746 Background: Most patients with cancer and COVID-19 will survive the acute illness. The longer-term impacts of COVID-19 on patients with cancer remain incompletely described. Methods: Using COVID-19 and Cancer Consortium registry data thru 12/31/2021, we examined outcomes of long-term COVID-19 survivors with post-acute sequelae of SARS-CoV-2 infection (PASC aka “long COVID”). PASC was defined as having recovered w/ complications or having died w/ ongoing infection 90+ days from original diagnosis; absence of PASC was defined as having fully recovered by 90 days, with 90+ days of follow-up. Patients with SARS-CoV-2 re-infection and records with low quality data were excluded. Results: 858 of 3710 of included patients (23%) met PASC criteria. Median follow-up (IQR) for PASC and recovered patients was 180 (98-217) and 180 (90-180) days, respectively. The PASC group had a higher rate of baseline comorbidities and poor performance status (Table). Cancer types, status, and recent anticancer treatment were similar between the groups. The PASC group experienced a higher illness burden, with more hospitalized (83% vs 48%); requiring ICU (29% vs 6%); requiring mechanical ventilation (17% vs 2%); and experiencing co-infections (19% vs 8%). There were more deaths in the PASC vs recovered group (8% vs 3%), with median (IQR) days to death of 158 (120-272) and 180 (130-228), respectively. Of these, 9% were attributed to COVID-19; 15% to both COVID-19 and cancer; 15% to cancer; and 23% to other causes. Conversely, no deaths in the recovered group were attributed to COVID-19; 57% were attributed to cancer; and 24% to other causes (proximal cause of death unknown/missing in 38% and 19%, respectively). Cancer treatment modification was more common in the recovered group (23% vs 18%). Conclusions: Patients with underlying comorbidities, worse ECOG PS, and more severe acute SARS-CoV-2 infection had higher rates of PASC. These patients suffered more severe complications and incurred worse outcomes. There was an appreciable rate of death in both PASC and non-PASC, with cancer the dominant but not only cause in fully recovered patients. Further study is needed to understand what factors drive PASC, and whether longer-term cancer-specific outcomes will be affected.[Table: see text]
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Affiliation(s)
| | | | | | | | | | - Shuchi Gulati
- University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rana R. McKay
- University of California San Diego Health, La Jolla, CA
| | | | | | | | | | | | | | | | | | - Anup Kasi
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | - Dimpy P Shah
- University of Texas Health Science Center San Antonio, San Antonio, TX
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31
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Jani C, Jani RT, Kurman J, Singh H. Temporal trends of lung cancer burden in India in comparison to global burden from 1990 to 2019: An observation analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21081] [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: 11/20/2022] Open
Abstract
e21081 Background: Lung cancer is the leading cause of cancer-related deaths worldwide and remains a significant health concern globally. There is limited understanding of the lung cancer epidemiology trends in India. This study compares lung cancer incidence, disability-adjusted life years (DALYs), and mortality in the Indian population with the global burden. Methods: The lung cancer incidence, DALYs, and mortality data were analyzed for males and females from 1990-2019 using the Global Burden of Disease (GBD) database. GBD is an open-source data repository managed by the Institute for Health Metrics and Evaluation research center, University of Washington. International Classification of Diseases (ICD) code C34 were used for data extraction. Temporal trends in lung cancer were evaluated using descriptive statistics. Results: India had a lower lung cancer-related disease burden than the global population. Incidence trends: In India, lung cancer age-standardized incidence rates (ASIRs) increased from 6.62/100,000 in 1990 to 7.7/100,00 in 2019. ASIRs increased from 10.36 to 11.16 in males and 2.68 to 4.49 in females. In contrast, overall and male ASIRs decreased globally from 28.39 to 27.66 and 46.22 to 40.44, respectively. But global lung cancer incidence in females increased from 13.77 to 16.83, mirroring the trends in the Indian female population. DALYs trends: In India, DALYs increased uniformly from 1990 to 2019. The overall DALYs (including males and females) increased from 166.66 to 190.16. In males, DALYs increase from 258.05 to 271.30, and in females DALYs increase from 68.80 to 112.90. Similarly, at the global level, DALYs in females increased from 311.7 to 327.57. However, overall and male’s global DALYs improved from 657.97 to 551.58 and 1053.25 to 802.86, respectively. Mortality trends: In the Indian population, there was only a slight overall increase in age-standardized mortality rates (ASMRs) from 7.04 to 8.06. A similar slight increase in mortality rates was observed in males (11.04 to 11.73). However, in females, there was a substantial increase from 2.85 to 4.70. In contrast, overall and male ASMRs decreased globally from 27.39 to 25.18 and 45.08 to 37.38, respectively. Similar females’ mortality trends in India, globally, females ASMRs increased from 13.04 to 14.96. Conclusions: Our study reports a lower lung cancer-associated health burden in the Indian population. However, there is an increase in the incidence, DALYs, and mortality in both males and females in the Indian population from 1990 to 2019. Similar worsening trends are observed in females at the global level. In contrast, there is a hint towards improvement in the incidence, DALYs, and mortality at the global level in general, primarily due to improvement in males’ disease burden. There is also a persistent gap in males and females epidemiology, where males have a higher lung cancer burden than females.
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Affiliation(s)
| | | | | | - Harpreet Singh
- Froedtert and Medical College of Wisconsin, Milwaukee, WI
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Bhatt PS, Jani C, Shah D, Ahmed A, Mariano M, Singh H, Graber JJ, Salciccioli JD. Trends in incidence and mortality of brain cancer: An observational study of the Global Burden of Disease database from 1990 to 2019. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18720] [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: 11/20/2022] Open
Abstract
e18720 Background: Brain cancer is relatively rare accounting for approximately 1.3% of all cancer diagnoses in the US annually, however it has a particularly poor prognosis with 5-year survival at 33%. The morbidity and mortality associated with brain cancer is high, while global epidemiological data relating to it remains scarce. This study investigates brain cancer incidence, mortality and disability-adjusted life years (DALYs) in the EU 15+ countries and six WHO world regions. Methods: We extracted data for 19 countries, including the EU nations as well as other selected high-income countries including the UK and USA from the Global Burden of Disease (GBD) database. This data included age-standardized incidence ratio (ASIR), age-standardized mortality ratio (ASMR) and DALY from brain cancer (ICD 10 codes C70-C72, D42-D43.9, D44.3-D44.5) between 1990 and 2019. Joinpoint analyses were used to describe trends further. Results: Greece was noted to have the highest DALY for both sexes with 252/100,000 and 174/100,000 respectively for males and females. The majority of countries saw a drop in DALY during the study period (14/19 for males and 19/19 for females). Greece also reported the highest ASMR over the study period for both sexes at 7.8/100,000 and 5.3/100,000 respectively for males and females. The majority of countries also saw a decline in ASMR (12/19 for males and 16/19 for females) with Belgium noting the largest decline for males and females at -27.2% and -34.3% respectively. Denmark was noted to have the highest ASIR in 2019 for both sexes with 17.9/100,000 and 16.4/100,000 respectively for males and females. Most countries reported an increase in ASIR over the study period (17/19 for males and 15/19 for females). Denmark displayed the greatest increase in incidence for both sexes with an 84.5% and 64.3% increase, respectively, for males and females. Notably, the countries with the highest incidences and DALYs, Denmark, Luxembourg, and Greece, also had the highest mortality. All countries saw a decline in the mortality-to-incidence ratio over the study period, with Denmark and Ireland showing the greatest drop for both sexes. Conclusions: Over the study period, the burden of brain cancer has decreased in most countries as measured by DALY, ASMR, and mortality-to-incidence ratios. However, incidence rates have increased. The reduced disease burden may be due to the use of temazolamide which has improved outcomes in MGMT methylated and IDH mutated gliomas, with PCV chemotherapy with radiation therapy having similar effects for high risk low grade gliomas. The preferential use of bevacizumab may explain some of the differing trends between European and other developed countries. Future work is required to delineate the diverging trends between global disease burden and incidence while highlighting the etiology of these changes.
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Affiliation(s)
| | | | - Darshil Shah
- Temple University School of Medicine, Philadelphia, PA
| | | | - Melissa Mariano
- University of New England College of Osteopathic Medicine, Portland, ME
| | - Harpreet Singh
- Froedtert and Medical College of Wisconsin, Milwaukee, WI
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Hanbury GH, Jani C, Abdallah N, Shalhoub J, Salciccioli JD, Marshall DC. Trends in oncological disease burden: A comparative study between higher and lower-middle-income countries. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10560] [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: 11/20/2022] Open
Abstract
10560 Background: Cancer is a major cause of morbidity and mortality worldwide. Ten million cancer-related deaths were recorded in 2020, a rise of 66% over the preceding two decades. Malignancies of the breast, lung, prostate and colon account for over 40% of new cancer diagnoses worldwide. This study observes trends in oncological disease burden among higher (HIC’s) and lower-middle-income countries (LMIC’s) between 2000 and 2019. Methods: Mortality to incidence ratios (MIR) were calculated using the Global Burden of Disease database by extracting age standardized mortality and incidence rates per 100 000 for breast, lung, prostate and colorectal cancer for the years 2000-2019. The European Union (EU) 15+ countries were taken to represent HIC’s. 8 of the LMIC’s in the World Bank group were included as their data quality rating was 3/5 or higher. This cohort comprised Egypt, Sri Lanka, Ukraine, El Salvador, Republic of Moldova, Philippines, Kyrgyzstan and Nicaragua. Breast, lung, colorectal and prostate cancer were included as the tumor types with highest global incidence. Median MIR (with interquartile range) were computed for each LMIC and EU15+ groups for males and females for each of the four tumor types. Results: Between 2000 and 2019 median MIR for the LMIC group was higher than for EU15+ group for all four cancer types in males and females. Wilcoxon rank sum of the 2019 data showed a statistically significant difference (p <0.001) in MIR between HIC’s and LMIC’s (table 1). For breast, prostate and colorectal cancer the difference in median MIR between LMIC group and EU15+ decreased over the observation period, for lung cancer the difference increased. Conclusions: Globally there are wide geographical variations in MIR. Cancer outcomes appear consistently worse in LMIC’s compared to HIC’s. Availability of cancer screening, access to treatment and risk-factor prevalence may contribute to the above trends. Identifying these regional disparities provides an opportunity to target resource allocation to regions that would derive the greatest benefit. [Table: see text]
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Affiliation(s)
| | | | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Joseph Shalhoub
- Imperial College of London & Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Dominic C Marshall
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Sharma R, Jani C. Mapping incidence and mortality of leukemia and its subtypes in 21 world regions in last three decades and projections to 2030. Ann Hematol 2022; 101:1523-1534. [PMID: 35536353 DOI: 10.1007/s00277-022-04843-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
This study examines the burden of leukemia and its subtypes at the global, regional, and national levels in 21 world regions and 204 countries in the last three decades. The estimates of incidence, deaths, and age-standardized rates of leukemia for 21 regions and 204 countries for 1990-2019 were extracted from the Global Burden of Disease 2019 study. Average annual percentage change in 1990-2019 for 21 regions was utilized for projecting leukemia burden in 2030. Globally, there were 643,579 [586,980-699,729] incident cases and 334,592 [306,818-360,214] deaths in 2019 due to leukemia, up from 474,924 [388,559-560,550] cases and 263,263 [233,664-298,696] deaths in 1990. Between 1990 and 2019, the age-standardized incidence rate (ASIR) decreased from 9.6 [8.1-11.0] in 1990 to 8.2 [7.5-8.9] per 100,000 person-years in 2019, and the age-standardized mortality rate (ASMR) decreased from 5.8/100,000 [5.2-6.4] in 1990 to 4.3/100,000 [3.9-4.6] in 2019. Between 1990 and 2019, the ASIR decreased in majority of regions except Western Europe and high-income Asia Pacific, whereas the ASMR decreased in all 21 regions. In 2019, country-wise, the ASIR varied from 3.0/100,000 [2.3-3.7] in Palau to 35.1/100,000 [26.4-47.2] in San Marino and the ASMR spanned from 2.3/100,000 [1.7-2.8] in San Marino to 15.8/100,000 [12.0-20.4] in Syria. As per our projections, globally, there will be 720,168 incident cases and 367,804 deaths due to leukemia in 2030. Substantial improvements have been witnessed in leukemia mortality rates in all regions, especially high-income regions and countries. Health care policies focusing on diagnostic improvements, cancer registration, and newer therapeutics at reduced cost or with insurance coverage are needed in low and middle-income countries.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entreprenuership, Delhi Technological University, East Delhi Campus, Room No. 305, Vivek Vihar Phase II, Delhi, 110095, India.
| | - Chinmay Jani
- Mount Aubrun Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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Singhal A, Nanda M, Sharma R, Jani C. The Burden of Chronic Kidney Disease in Asia, 1990-2019: Examination of Estimates from Global Burden of Disease 2019 Study. Nephrology (Carlton) 2022; 27:610-620. [PMID: 35506615 DOI: 10.1111/nep.14051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/07/2022] [Revised: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a global public health issue, with Asia accounting for one of the highest CKD prevalence worldwide. This study examines the burden of CKD in Asian continent in the last three decades. DATA AND METHODS The estimates of age, sex and year wise burden of CKD for forty-nine countries in Asia for 1990 to 2019 were procured from the Global Burden of Disease 2019 study. FINDINGS In 2019, there were 9.8 million [9.0 - 10.6 million] new cases and 763,024 [696,050 - 823,829] deaths due to CKD in Asia. Between 1990 and 2019, CKD prevalence doubled from 202.4 million [186.5-219.1 million] to 431.2 [400.3-462.0 million]. Although age-standardized incidence rate (ASIR) of CKD increased from 170.6 [156.7 - 186.2] in 1990 to 206.3 [190.4 - 223.4] per 100,000 person-years in 2019, the age-standardized mortality rate (ASMR) witnessed a modest reduction from 18.4/100,000 [17.0 - 20.1] to 17.3/100,000 [15.7 - 18.7]. In 2019, the ASIR spanned from 141.9 /100,000 [126.2 - 159.2] in Tajikistan to 561.4/100,000 [524.6 - 598.6] in Saudi Arabia, and ASMR varied from 8.9/100,000 [7.2-9.8] in Japan to Saudi Arabia (52.9[42.8-63.1]). Between 1990 and 2019, absolute count of CKD incident cases, deaths, prevalent cases and DALYs increased 100% or more in 48/49, 32/49, 43/49 and 23/49 countries, respectively. INTERPRETATION CKD is widespread in the Asian region, with an alarming burden in resource-constrained countries. Strategies such as promoting awareness, screening among high-risk individuals, provision of cost-effective therapies, and increased healthcare coverage could help deal with the CKD epidemic in Asia.
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Affiliation(s)
- Aashima Singhal
- University School of Management and Entrepreneurship; Delhi Technological University, New Delhi, India
| | - Mehak Nanda
- University School of Management and Entrepreneurship; Delhi Technological University, New Delhi, India
| | - Rajesh Sharma
- University School of Management and Entrepreneurship; Delhi Technological University, New Delhi, India
| | - Chinmay Jani
- Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
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Patel P, Shah D, Jani C, Shah J, Jani R, Kelaiya A, Pandya J, Singh H, Al Omari O, Roy D, Behlau I, Parikh A. Outcomes of patients presenting with Guillain-Barre Syndrome at a tertiary care center in India. BMC Neurol 2022; 22:151. [PMID: 35459157 PMCID: PMC9027043 DOI: 10.1186/s12883-022-02676-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Guillain-Barre Syndrome (GBS), also known as acute idiopathic polyneuritis, is a critical acquired condition associated with preceding nonspecific infection or triggering factors like trauma, surgery, or vaccination. GBS is currently the most frequent cause of acute flaccid paralysis in India. This study evaluates the short-term and in-hospital outcomes in different subtypes of GBS. Methods A prospective observational study was conducted at V.S. Hospital, Ahmedabad, from September 2015 to December 2017. Patients above the age of 12 were included. Patients having other underlying neurological conditions, as well as immunodeficiency disorders, were excluded. The patients were classified into different subtypes of GBS, and functional outcomes were recorded on admission and discharge according to Hughes Scoring System. All statistical analyses were performed by using SPSS software. Results Out of 50 patients, 35 (70%) were males. The mean age was of 37.18 +/− 18.35 years. 25 (50%) patients had a preceding infection. 88% of patients presented with cranial nerve (CN) involvement had a Hughes Score of >/= 3 (p = 0.0087). They had less improvement of Hughes Score on discharge (0.13 +/− 0.04) as compared to the patients without cranial nerve involvement (0.38 +/− 0.08) (p = 0.008). Respiratory involvement was associated with a higher Hughes Score (p = 0.005) on admission. 85% of patients diagnosed with an axonal subtype of GBS had a Hughes Score of >/= 3 (p = 0.06) compared to 74% patients with demyelinating subtype. Axonal subtype required double period (11 +/− 2.34) to show improvement as compared to demyelinating subtype (6 +/− 1.2) (p = 0.020). Irrespective of the subtypes, in two different treatment cohorts (PLEX vs IVIG), there was no difference in short term functional outcomes measured by improvement in the Hughes scores (p = 0.89). Conclusions Early cranial nerve and respiratory involvement in patients presenting with GBS are associated with poor outcomes warranting immediate critical care involvement. In our study, amongst all the subtypes, axonal had poor clinical outcomes. Further clinical trials on the Indian subpopulation will help us evaluate the impact of different treatment modalities on this disease.
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Affiliation(s)
- Priyank Patel
- Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Darshil Shah
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, 19140, USA.
| | - Chinmay Jani
- Harvard Medical School, Boston, MA, USA.,Division of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA, USA
| | - Jui Shah
- Medical Student, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Ruchi Jani
- Medical Student, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Arjun Kelaiya
- GCS Medical College, Hospital & Research Centre, Ahmedabad, Gujarat, India
| | - Jinal Pandya
- Department of Physiology, Dr. M K Shah Medical College, Ahmedabad, Gujarat, India
| | - Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Omar Al Omari
- Harvard Medical School, Boston, MA, USA.,Division of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA, USA
| | - Dhara Roy
- Harvard Medical School, Boston, MA, USA
| | - Irmgard Behlau
- Harvard Medical School, Boston, MA, USA.,Division of Medicine, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA, USA.,Department of Infectious Disease, Mount Auburn Hospital, Beth-Israel Lahey Health, Cambridge, MA, USA.,Molecular Biology & Microbiology, Tufts Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA
| | - Ami Parikh
- Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India
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Punjwani S, Khanna P, Jani C, Waston J, Behlau I. Aortic Mural Thrombosis Diagnosed After a Second Dose of mRNA-1273 SARS-CoV-2 Vaccine. Am J Ther 2022; 29:e358-e361. [DOI: 10.1097/mjt.0000000000001498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schuster-Bruce J, Jani C, Goodall R, Kim D, Hughes W, Salciccioli JD, Marshall D, Shalhoub J. A Comparison of the Burden of Thyroid Cancer Among the European Union 15+ Countries, 1990-2019: Estimates From the Global Burden of Disease Study. JAMA Otolaryngol Head Neck Surg 2022; 148:350-359. [PMID: 35266977 PMCID: PMC8914910 DOI: 10.1001/jamaoto.2021.4549] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/10/2022] [Indexed: 01/14/2023]
Abstract
Importance The global incidence of thyroid cancer has been increasing rapidly, and this increase has had an attendant burden on health systems. However, it is unclear how the burden of this disease differs among the pre-2004 countries of the European Union (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the UK), US, Australia, Canada, and Norway (EU15+). Objective To assess the trends in mortality, incidence, and disability-adjusted life-years (DALYs) associated with thyroid cancer between 1990 and 2019 in EU15+ nations. Data analysis was conducted from July 11 to October 11, 2021. Design, Setting, and Participants Observational cross-sectional analysis of the incidence of thyroid cancer was conducted using data obtained from the Global Burden of Disease Study database. Nineteen countries of the EU15+ were included. Exposures Thyroid cancer. Main Outcomes and Measures Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs) and DALYs were extracted for individual EU15+ countries per sex for each of the years from 1990 to 2019, and mortality-to-incidence indexes were computed. Joinpoint regression analysis was used to describe the trends. Results Thirteen of 19 countries (68%) showed an average annual percentage change increase in ASIR across the study period (range, 0.2%-2.5%). Joinpoint regression analysis revealed largely plateauing ASIR trends in recent years across most EU15+ nations since 1990. Between 2011 and 2019, the estimated annual percentage change in the US was 0. Australia, Denmark, and the US were the only countries with increasing ASMR trends with positive average annual percentage changes: Australia, 0.6 (95% CI, 0.2-1.0); Denmark, 1.0 (95% CI, 0.8-1.3); and US, 0.4 (95% CI, 0.4-0.5); the remaining 16 countries showed negative trends (range, -0.2 to -2.1). Disability-adjusted life-years decreased in all EU15+ countries except Australia, Denmark, and the US. Conclusions and Relevance This cross-sectional analysis found that overall, the burden of thyroid cancer across EU15+ countries appears to be decreasing, evidenced by plateauing incidence rates and reductions in mortality and DALYs over the 30-year study period. However, the US and Australia appear to have increasing ASMR and DALY trends. Ongoing observation is required to monitor how changes in international clinical practice guidelines affect thyroid cancer DALYs and mortality.
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Affiliation(s)
- James Schuster-Bruce
- Department of Ear, Nose and Throat and Head & Neck Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Richard Goodall
- Department of Plastic Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Dae Kim
- Department of Ear, Nose and Throat and Head & Neck Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - William Hughes
- St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom
| | - Justin D. Salciccioli
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominic Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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DeLago AJ, Singh H, Jani C, Rupal A, Shalhoub J, Goodall R, Shah D, Hartley A, Hammond-Haley M, Marshall DC, Gizzi M, AbdelRazek M, Salciccioli JD. An observational epidemiological study to analyze intracerebral hemorrhage across the United States: Incidence and mortality trends from 1990 to 2017. J Stroke Cerebrovasc Dis 2022; 31:106216. [DOI: 10.1016/j.jstrokecerebrovasdis.2021.106216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022] Open
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Ahmed A, Jani C, Bhatt P, Singh H, Jani R, Shalhoub J, Marshall D, Lam P, Salciccioli J. EPR22-104: A Comparison of the Burden of Leukemia Amongst Various Regions of the World, 1990-2019. J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Alaaeldin Ahmed
- 1 Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- 2 Harvard Medical School, Boston, MA
| | - Chinmay Jani
- 1 Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- 2 Harvard Medical School, Boston, MA
| | - Padmanabh Bhatt
- 1 Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- 2 Harvard Medical School, Boston, MA
| | | | - Ruchi Jani
- 4Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Joseph Shalhoub
- 5College London, UK and Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Dominic Marshall
- 6 National Heart and Lung Institute, Imperial College London, UK
| | - Prudence Lam
- 1 Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
- 2 Harvard Medical School, Boston, MA
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Mariano M, Jani C, Khanna P, Patel D, Perry J, Yalamarti B, Abner A. Eccrine Carcinoma With an Unknown Primary: Managing Occult Cancer Through Multidisciplinary Tumor Board Collaboration. Cureus 2022; 14:e23183. [PMID: 35444869 PMCID: PMC9009997 DOI: 10.7759/cureus.23183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/05/2022] Open
Abstract
Eccrine carcinomas are rare cutaneous cancers that tend to be locally aggressive. Here we report a rare case of a mucinous eccrine carcinoma presenting in axillary lymph nodes without an identifiable primary lesion. This is a 69-year-old male with a past medical history of benign prostatic hyperplasia, melanoma, basal cell carcinoma, hypercholesterolemia, hypertension, and arthritis who was found to have an elevated prostate-specific antigen. Transrectal prostate biopsies confirmed adenocarcinoma of the prostate. A chest CT scan performed for further staging of prostate cancer identified new left axillary lymphadenopathy and positron emission tomography (PET)-CT imaging showed moderate fluorodeoxyglucose (FDG) uptake in the lymph nodes of the left axilla and left subpectoral regions. Lymph node tissue obtained by core needle biopsy demonstrated high-grade carcinoma with a nonspecific immunohistochemical profile. Complete left axillary lymphadenectomy was performed, revealing mucinous eccrine carcinoma. He was started on hormonal therapy for prostate cancer and radiation therapy for axillary eccrine carcinoma at the same time. Based on our literature review, this appears to be the first case of eccrine carcinoma in axillary lymph nodes with an unknown primary. This case is further complicated by synchronous primary prostate cancer. After a multidisciplinary tumor board review, it was decided that his axillary disease should be treated as a primary mucinous carcinoma with complete lymphadenectomy followed by localized radiation. The patient had stable disease at the six-month follow-up. Cancers with unknown primary lesions pose unique challenges in disease management. Without established recommendations or guidelines, multidisciplinary discussions and a collaborative approach are needed.
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Singh H, Benn BS, Jani C, Abdalla M, Kurman JS. Photodynamic therapy for treatment of recurrent adenocarcinoma of the lung with tracheal oligometastasis. Respir Med Case Rep 2022; 37:101620. [PMID: 35330589 PMCID: PMC8938912 DOI: 10.1016/j.rmcr.2022.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/06/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
- Corresponding author. Medical College of Wisconsin, 8701 W Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Bryan S. Benn
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mohammed Abdalla
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan S. Kurman
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
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Abdallah N, Jani C, Mouchati C, Jani RT, Bhatt P, Salciccioli J, Khanna P, Singh H, Shalhoub J, McKay RR, Marshall DC. Trends of kidney cancer burden from 1990 to 2019 in European Union 15+ countries. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.393] [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: 11/20/2022] Open
Abstract
393 Background: Kidney cancer is among the most common cancers worldwide and is increasing in incidence. During 2020, around 400,000 new cases of kidney cancer were reported, with 180,000 estimated deaths. In recent decades, significant variability in the incidence and mortality of kidney cancer has been universally reported. This study aimed to compare geographical trends in incidence, mortality, and disability-adjusted life years from kidney cancer between European Union (EU) 15+ countries from 1990 to 2019. Methods: The mortality data of kidney cancer were extracted from the Global Burden of Disease Study database. Versions 10 and 9 of the International Classification of Diseases were adopted. Age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and disability-adjusted life years (DALYs) were collected, per year and per country of the EU15+ group. Mortality-to-incidence ratios (MIR) were calculated. Data was then dichotomized into males and females. Joinpoint regression was done for analysis of trends. Results: From 1990 to 2019, ASIRs increased in most of the countries except for Luxembourg for males, the United States of America (USA) for females, and Austria and Sweden for both sexes. The largest rises of ASIRs were in Denmark for males and females (+89.3% and +82.8%, respectively). ASDRs increased in 10/19 countries for males and 9/19 in females, with the highest rise in Denmark for males and females (+41.7% and +37.7% respectively), and the largest drop in Austria for males and females (-33.8% and -35.8% respectively). MIRs decreased in all countries, for both sexes, with the widest declines in Portugal for males (-29.0%) and in Ireland for females (-26.6%). Trends in DALYs were variable, with the highest rise in Denmark for males and females (+38.6% and +30.2% respectively) and the largest drop in Austria for males and females (-39.5% and -41.2%, respectively). In 2019, the highest ASIR was observed in the USA for males (16.7/100,000) and in Finland for females (8.3/100,000), the highest ASDR in the Netherlands for males (6.1/100,000) and Finland for females (3.0/100,000), highest MIR in Sweden for both genders (0.6/100,000 each), and highest DALYs in the Netherlands for males (132.3/100,000) and in Finland for females (62.6/100,000). Conclusions: The incidence and mortality from kidney cancer rose in most EU15+ countries from 1990 to 2019. Interestingly, an improvement in the outcomes is predicted by the drop in MIR in all countries.[Table: see text]
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Affiliation(s)
- Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Christian Mouchati
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Padmanabh Bhatt
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA
| | | | | | - Harpreet Singh
- Froedtert and Medical College of Wisconsin, Milwaukee, WI
| | - Joseph Shalhoub
- Imperial College of London & Imperial College Healthcare NHS Trust, London, United Kingdom
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Jani C, Mouchati C, Abdallah N, Mariano M, Jani RT, Salciccioli JD, Marshall DC, Singh H, Shalhoub J, McKay RR. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: Estimates from the Centers for Disease Control WONDER database. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.030] [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: 11/20/2022] Open
Abstract
30 Background: In the United States of America (USA), prostate cancer is the most common cancer in men, and it remained the second leading cause of cancer related mortality. It has a disproportionate burden of disease among minorities. In particular, African American (AA) men have a higher incidence and more aggressive disease course. Our study compares trends in prostate cancer mortality in the United States of America (USA) by race and state from 1999 to 2019. Methods: We used the Center for Disease Control (CDC) WONDER database using ICD-10 code C61 to extract mortality data for malignant prostate cancer. Age standardized death rates (ASDRs) are reported per 100,000 population using the USA standard population. ASDRs were divided into American Indian or Alaskan Native, Asian, Black or African American and, Whites and reported by year for each state. Due to the lack of available data in many states, state-wise analyses were done for white and African American men only. We used Joinpoint regression analysis for trends comparison. Results: Between 1999 and 2019, data was analyzed from 50 states of the USA, of which four started collecting data from 2000, one from 2001, one from 2008, and one from 2009. Three states had data until 2018 only. Data was missing for African American men in 17 states. In 2019, ASDR in African American (13.4/100,000) was significantly higher than Whites (7.3/100,000) (p<0.001). The highest ASDR for African American was observed in Nebraska (33.5/100,000), followed by Wisconsin (17.7/100,000). In contrast, the highest ASDR for whites was observed in Alaska (11/100,000), followed by Utah (10.5/100,000) ASDR decreased by 31.8% in White men at the national level, compared to a decline of 44.6% in African American men. ASDR decreased in all states for both races. For White men, the widest drops were in South Dakota (-45.9%) and Kentucky (-47.0%), and the lowest declines in New Hampshire (-11.5%) and Alaska (-16.0%). For African American men, the largest decreases were in Delaware (-57.8%) and Nevada (-55.3%), and the smallest declines were in Kentucky (-14.9%) and Wisconsin (-20.3%). Conclusions: During the last 20 years, the mortality rate from prostate cancer has consistently dropped in all the states of the USA and for all races. Even though a higher decrease in ASDR was observed in the African American and Asian racial groups, ASDR is still higher in African Americans as compared to Whites.[Table: see text]
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Christian Mouchati
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA
| | | | | | | | - Harpreet Singh
- Froedtert and Medical College of Wisconsin, Milwaukee, WI
| | - Joseph Shalhoub
- Imperial College of London & Imperial College Healthcare NHS Trust, London, United Kingdom
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Mouchati C, Abdallah N, Jani C, Mariano M, Jani RT, Marshall DC, Singh H, Shalhoub J, Salciccioli J, McKay RR. Trends in disease burden from prostate cancer amongst different regions of the world and extensively the European Union 15+ countries, from 1990 to 2019: Estimates from the Global Burden of Disease study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.187] [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: 11/20/2022] Open
Abstract
187 Background: Prostate cancer was the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide. Global variations in the burden of prostate cancer have been observed in the past decades. This study aimed to assess the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Health Organization (WHO) regions and extensively in the European Union (EU) 15+ countries from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract the mortality data of prostate cancer, based on the International Classification of Diseases versions 10 and 9. Data acquired for different WHO regions and each country of the EU15+ nations, per year from 1990 to 2019, included age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and disability-adjusted life years (DALYs). Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased worldwide (+13.16%), except in the American region, with the largest growth in the Eastern Mediterranean Region (EMR) (+72.43%). While ASDRs and DALYs increased in Africa, South-East Asia, and EMR, they decreased in the Americas, Europe, and Western Pacific Region (WPR). MIRs decreased universally (-25.52%), mainly in the WPR (-43.49%). In EU15+ countries, ASIRs increased in all countries, except for Canada (-11.27%) and the United States of America (USA) (-10.37%), with the largest rise in Finland (+75.11%). ASDRs decreased in all countries, with the widest drop in Luxembourg (-41.89%) and the lowest in Denmark (-13.96%). MIRs decreased in all countries, with the highest drop in Finland (-55.37%). Similarly, DALYs decreased in all countries, with the highest decrease in Luxembourg (-40.56%). In 2019, the highest ASIR was in the USA (118.24/100,000), whereas Denmark had the highest ASDR (31.35/100,000), MIR (0.38/100,000), and DALY (498.03/100,000). Conclusions: Over the 30 years, the incidence of prostate cancer has been rising worldwide, excluding Canada and the USA. However, the universal decrease of MIRs highlights improved outcomes and efficient screening and therapeutic strategies. All indices are represented per 100,000 population.[Table: see text]
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Affiliation(s)
- Christian Mouchati
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA
| | | | | | - Harpreet Singh
- Froedtert and Medical College of Wisconsin, Milwaukee, WI
| | - Joseph Shalhoub
- Imperial College of London & Imperial College Healthcare NHS Trust, London, United Kingdom
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Satyanarayana G, Enriquez KT, Sun T, Klein EJ, Abidi M, Advani SM, Awosika J, Bakouny Z, Bashir B, Berg S, Bernardes M, Egan PC, Elkrief A, Feldman LE, Friese CR, Goel S, Gomez CG, Grant KL, Griffiths EA, Gulati S, Gupta S, Hwang C, Jain J, Jani C, Kaltsas A, Kasi A, Khan H, Knox N, Koshkin VS, Kwon DH, Labaki C, Lyman GH, McKay RR, McNair C, Nagaraj G, Nakasone ES, Nguyen R, Nonato TK, Olszewski AJ, Panagiotou OA, Puc M, Razavi P, Robilotti EV, Santos-Dutra M, Schmidt AL, Shah DP, Shah SA, Vieira K, Weissmann LB, Wise-Draper TM, Wu U, Wu JTY, Choueiri TK, Mishra S, Warner JL, French B, Farmakiotis D. Coinfections in Patients with Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Study. Open Forum Infect Dis 2022; 9:ofac037. [PMID: 35198648 PMCID: PMC8860152 DOI: 10.1093/ofid/ofac037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 12/22/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The frequency of coinfections and their association with outcomes have not been adequately studied among patients with cancer and coronavirus disease 2019 (COVID-19), a high-risk group for coinfection. Methods We included adult (≥18 years) patients with active or prior hematologic or invasive solid malignancies and laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, using data from the COVID-19 and Cancer Consortium (CCC19, NCT04354701). We captured coinfections within ±2 weeks from diagnosis of COVID-19, identified factors cross-sectionally associated with risk of coinfection, and quantified the association of coinfections with 30-day mortality. Results Among 8765 patients (hospitalized or not; median age, 65 years; 47.4% male), 16.6% developed coinfections: 12.1% bacterial, 2.1% viral, 0.9% fungal. An additional 6.4% only had clinical diagnosis of a coinfection. The adjusted risk of any coinfection was positively associated with age >50 years, male sex, cardiovascular, pulmonary, and renal comorbidities, diabetes, hematologic malignancy, multiple malignancies, Eastern Cooperative Oncology Group Performance Status, progressing cancer, recent cytotoxic chemotherapy, and baseline corticosteroids; the adjusted risk of superinfection was positively associated with tocilizumab administration. Among hospitalized patients, high neutrophil count and C-reactive protein were positively associated with bacterial coinfection risk, and high or low neutrophil count with fungal coinfection risk. Adjusted mortality rates were significantly higher among patients with bacterial (odds ratio [OR], 1.61; 95% CI, 1.33–1.95) and fungal (OR, 2.20; 95% CI, 1.28–3.76) coinfections. Conclusions Viral and fungal coinfections are infrequent among patients with cancer and COVID-19, with the latter associated with very high mortality rates. Clinical and laboratory parameters can be used to guide early empiric antimicrobial therapy, which may improve clinical outcomes.
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Affiliation(s)
| | | | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Klein
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Maheen Abidi
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shailesh M Advani
- Cancer Prevention and Control, Department of Oncology, Georgetown University School of Medicine, Georgetown University, Washington DC, USA
| | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephanie Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | - Marilia Bernardes
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Pamela C Egan
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Lawrence E Feldman
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | | | - Shipra Goel
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Keith L Grant
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | | | - Shuchi Gulati
- University of Cincinnati Cancer Center, Cincinnati, OH, USA
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jayanshu Jain
- The University of Kansas Cancer Center, Overland Park, KS, USA
| | | | - Anna Kaltsas
- Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Anup Kasi
- The University of Kansas Cancer Center, Overland Park, KS, USA
| | - Hina Khan
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Natalie Knox
- Stritch School of Medicine at Loyola University, Maywood, IL, USA
| | - Vadim S Koshkin
- Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA, USA
| | - Daniel H Kwon
- Helen Diller Family Comprehensive Cancer Center at the University of California at San Francisco, San Francisco, CA, USA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington Seattle, WA, USA
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Christopher McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Elisabeth S Nakasone
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington Seattle, WA, USA
| | - Ryan Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Taylor K Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Adam J Olszewski
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | - Orestis A Panagiotou
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | - Pedram Razavi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Dimpy P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Sumit A Shah
- Stanford Cancer Institute at Stanford University, Stanford, CA, USA
| | - Kendra Vieira
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
| | | | | | - Ulysses Wu
- Hartford HealthCare Cancer Institute, Hartford, CT, USA
| | - Julie Tsu-Yu Wu
- Stanford Cancer Institute at Stanford University, Stanford, CA, USA
| | | | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Dimitrios Farmakiotis
- The Warren Alpert Medical School of Brown University and Lifespan Cancer Institute, Providence, RI, USA
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Walker A, Rupal A, Jani C, Al Omari O, Singh H, Patel D, Perrino C, McCannon J. Longstanding Phenytoin Use as a Cause of Progressive Dyspnea. Chest 2022; 161:e91-e96. [DOI: 10.1016/j.chest.2021.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/16/2021] [Accepted: 08/27/2021] [Indexed: 10/19/2022] Open
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Singh H, Koster M, Jani C, Rupal A, Walker A, Khoory J, Tewari A, Casasola M, Ranker LR, Thomson C. Nodule net: A centralized prospective lung nodule tracking and safety-net program. Respir Med 2022; 192:106737. [PMID: 35051877 DOI: 10.1016/j.rmed.2022.106737] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inadequate follow-up of suspicious lung nodules can result in diagnostic delays and potential progression to advanced lung cancer. In 2015, a multidisciplinary lung nodule management program, Nodule Net, was implemented to increase the timely follow-up rate. In this study, we sought to evaluate the effectiveness of the program. METHODS 2398 chest CT reports were reviewed for the presence of a lung nodule. Baseline demographics, nodule characteristics, and follow-up recommendations were collected. For reports that did not include structured recommendations, Fleischner Society guidelines were applied if appropriate. The rate of follow-up imaging was recorded and compared with historical rates. RESULTS Lung nodules were reported on 1367 (57%) of scans. Of the 632 participants with recommendations for follow-up, the Nodule Net nurse navigator was notified on 523 (83%). Of these, 408 (78%) completed follow-up, compared to 57/109 (52%) in those who were not reported to Nodule Net tracking system (risk ratio: 1.49, 95% CI: 1.24-1.79, p-value < 0.05). Out of these 408, nodule net outreach was required to prompt the follow-up in 116 (28%). Of these, a lung malignancy was diagnosed in 4 (4%). CONCLUSIONS Management of lung nodules is a complex process. Implementation of a lung nodule tracking program led to a significant increase in the completion of recommended follow-up imaging compared with usual care. Developing a comprehensive lung nodule program using an automated software system rather than manual processes to refer and track incidental findings may further reduce barriers to completion of follow-up.
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Affiliation(s)
- Harpreet Singh
- Department of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Megan Koster
- Department of Pulmonary and Critical Care, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Arashdeep Rupal
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alexander Walker
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Joseph Khoory
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Arti Tewari
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Marcel Casasola
- Department of Pulmonary and Critical Care, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | | | - Carey Thomson
- Department of Pulmonary and Critical Care, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA
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Jani C, Al Omari O, Singh H, Walker A, Patel K, Mouchati C, Radwan A, Pandit Z, Hanbury G, Crowley C, Marshall DC, Goodall R, Shalhoub J, Salciccioli JD, Tapan U. Trends of HIV-Related Cancer Mortality between 2001 and 2018: An Observational Analysis. Trop Med Infect Dis 2021; 6:tropicalmed6040213. [PMID: 34941669 PMCID: PMC8707967 DOI: 10.3390/tropicalmed6040213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
The burden of AIDS-defining cancers has remained relatively steady for the past two decades, whilst the burden of non-AIDS-defining cancer has increased. Here, we conduct a study to describe mortality trends attributed to HIV-associated cancers in 31 countries. We extracted HIV-related cancer mortality data from 2001 to 2018 from the World Health Organization Mortality Database. We computed age-standardized death rates (ASDRs) per 100,000 population using the World Standard Population. Data were visualized using Locally Weighted Scatterplot Smoothing (LOWESS). Data for females were available for 25 countries. Overall, there has been a decrease in mortality attributed to HIV-associated cancers among most of the countries. In total, 18 out of 31 countries (58.0%) and 14 out of 25 countries (56.0%) showed decreases in male and female mortality, respectively. An increasing mortality trend was observed in many developing countries, such as Malaysia and Thailand, and some developed countries, such as the United Kingdom. Malaysia had the greatest increase in male mortality (+495.0%), and Canada had the greatest decrease (−88.5%). Thailand had the greatest increase in female mortality (+540.0%), and Germany had the greatest decrease (−86.0%). At the endpoint year, South Africa had the highest ASDRs for both males (16.8/100,000) and females (19.2/100,000). The lowest was in Japan for males (0.07/100,000) and Egypt for females (0.028/100,000).
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Correspondence: ; Tel.: +1-857-284-3042
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
| | - Harpreet Singh
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Alexander Walker
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Kripa Patel
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Smt NHL Municipal Medical College, Ahmedabad 380006, Gujarat, India
| | - Christian Mouchati
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Amr Radwan
- Department of Internal Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA 02118, USA; (A.R.); (U.T.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Zuha Pandit
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA 02138, USA; (O.A.O.); (A.W.); (Z.P.)
- Harvard Medical School, Boston, MA 02115, USA;
| | - Georgina Hanbury
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Conor Crowley
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Division of Pulmonary and Critical Care, Lahey Hospital, Burlington, MA 01805, USA
| | - Dominic C. Marshall
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Richard Goodall
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Joseph Shalhoub
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA 02115, USA;
- MDR Collaboration, London W2 1NY, UK; (H.S.); (K.P.); (C.M.); (G.H.); (C.C.); (D.C.M.); (R.G.); (J.S.)
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Umit Tapan
- Department of Internal Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA 02118, USA; (A.R.); (U.T.)
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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Elkrief A, Wu JT, Jani C, Enriquez KT, Glover M, Shah MR, Shaikh HG, Beeghly-Fadiel A, French B, Jhawar SR, Johnson DB, McKay RR, Rivera DR, Reuben DY, Shah S, Tinianov SL, Vinh DC, Mishra S, Warner JL. Learning through a Pandemic: The Current State of Knowledge on COVID-19 and Cancer. Cancer Discov 2021; 12:303-330. [PMID: 34893494 DOI: 10.1158/2159-8290.cd-21-1368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
The ongoing COVID-19 pandemic has left patients with current or past history of cancer facing disparate consequences at every stage of the cancer trajectory. This comprehensive review offers a landscape analysis of the current state of the literature on COVID-19 and cancer including the immune response to COVID-19, risk factors for severe disease, and impact of anticancer therapies. We also review the latest data on treatment of COVID-19 and vaccination safety and efficacy in patients with cancer, as well as impact of the pandemic on cancer care, including the urgent need for rapid evidence generation and real-world study designs.
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Affiliation(s)
- Arielle Elkrief
- Hemato-Oncology, University of Montreal Research Center (CRCHUM)
| | | | | | - Kyle T Enriquez
- Medical Scientist Training Program, Vanderbilt University School of Medicine
| | | | - Mansi R Shah
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey
| | | | | | | | - Sachin R Jhawar
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center
| | | | | | | | - Daniel Y Reuben
- Hematology and Oncology, Medical University of South Carolina
| | | | | | | | - Sanjay Mishra
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center
| | - Jeremy L Warner
- Medicine and Biomedical Informatics, Vanderbilt University Medical Center
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