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Schwartz JL, Lasser EC, Kitchen C, Gwynn KB, Pandya C, Weiner JP, Gudzune KA. Prevalence of lifestyle-related behavioral information in claims data in the U.S. Prev Med 2024; 178:107826. [PMID: 38122938 DOI: 10.1016/j.ypmed.2023.107826] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Given their association with varying health risks, lifestyle-related behaviors are essential to consider in population-level disease prevention. Health insurance claims are a key source of information for population health analytics, but the availability of lifestyle information within claims data is unknown. Our goal was to assess the availability and prevalence of data items that describe lifestyle behaviors across several domains within a large U.S. claims database. METHODS We conducted a retrospective, descriptive analysis to determine the availability of the following claims-derived lifestyle domains: nutrition, eating habits, physical activity, weight status, emotional wellness, sleep, tobacco use, and substance use. To define these domains, we applied a serial review process with three physicians to identify relevant diagnosis and procedure codes within claims for each domain. We used enrollment files and medical claims from a large national U.S. health plan to identify lifestyle relevant codes filed between 2016 and 2020. We calculated the annual prevalence of each claims-derived lifestyle domain and the proportion of patients by count within each domain. RESULTS Approximately half of all members within the sample had claims information that identified at least one lifestyle domain (2016 = 41.9%; 2017 = 46.1%; 2018 = 49.6%; 2019 = 52.5%; 2020 = 50.6% of patients). Most commonly identified domains were weight status (19.9-30.7% across years), nutrition (13.3-17.8%), and tobacco use (7.9-9.8%). CONCLUSION Our study demonstrates the feasibility of using claims data to identify key lifestyle behaviors. Additional research is needed to confirm the accuracy and validity of our approach and determine its use in population-level disease prevention.
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Affiliation(s)
- Jessica L Schwartz
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elyse C Lasser
- Center for Population Health IT, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Christopher Kitchen
- Center for Population Health IT, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kendrick B Gwynn
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Community Physicians, Baltimore, MD, USA
| | - Chintan Pandya
- Center for Population Health IT, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan P Weiner
- Center for Population Health IT, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Population Health IT, Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ruderman SA, Odden MC, Webel AR, Fitzpatrick AL, Crane PK, Nance RM, Drumright LN, Whitney BM, Mixson LS, Ma J, Willig AL, Haidar L, Eltonsy S, Mayer KH, O'Cleirigh C, Cropsey KL, Eron JJ, Napravnik S, Greene M, McCaul M, Chander G, Cachay E, Lober WB, Kritchevsky SB, Austad S, Landay A, Pandya C, Cartujano-Barrera F, Saag MS, Kamen C, Hahn AW, Kitahata MM, Delaney JAC, Crane HM. Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV. J Acquir Immune Defic Syndr 2023; 94:135-142. [PMID: 37368939 PMCID: PMC10527292 DOI: 10.1097/qai.0000000000003242] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Tobacco smoking increases frailty risk among the general population and is common among people with HIV (PWH) who experience higher rates of frailty at younger ages than the general population. METHODS We identified 8608 PWH across 6 Centers for AIDS Research Network of Integrated Clinical Systems sites who completed ≥2 patient-reported outcome assessments, including a frailty phenotype measuring unintentional weight loss, poor mobility, fatigue, and inactivity, and scored 0-4. Smoking was measured as baseline pack-years and time-updated never, former, or current use with cigarettes/day. We used Cox models to associate smoking with risk of incident frailty (score ≥3) and deterioration (frailty score increase by ≥2 points), adjusted for demographics, antiretroviral medication, and time-updated CD4 count. RESULTS The mean follow-up of PWH was 5.3 years (median: 5.0), the mean age at baseline was 45 years, 15% were female, and 52% were non-White. At baseline, 60% reported current or former smoking. Current (HR: 1.79; 95% confidence interval: 1.54 to 2.08) and former (HR: 1.31; 95% confidence interval: 1.12 to 1.53) smoking were associated with higher incident frailty risk, as were higher pack-years. Current smoking (among younger PWH) and pack-years, but not former smoking, were associated with higher risk of deterioration. CONCLUSIONS Among PWH, smoking status and duration are associated with incident and worsening frailty.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, WA, USA
| | | | - Lara Haidar
- University of Manitoba, Winnipeg, Manitoba, CA
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Hatef E, Kitchen C, Pandya C, Kharrazi H. Assessing Patient and Community-Level Social Factors; The Synergistic Effect of Social Needs and Social Determinants of Health on Healthcare Utilization at a Multilevel Academic Healthcare System. J Med Syst 2023; 47:95. [PMID: 37656284 DOI: 10.1007/s10916-023-01990-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
We investigated the role of both individual-level social needs and community-level social determinants of health (SDOH) in explaining emergency department (ED) utilization rates. We also assessed the potential synergies between the two levels of analysis and their combined effect on patterns of ED visits. We extracted electronic health record (EHR) data between July 2016 and June 2020 for 1,308,598 unique Maryland residents who received care at Johns Hopkins Health System, of which 28,937 (2.2%) patients had at least one documented social need. There was a negative correlation between median household income in a neighborhood with having a social need such as financial resource strain, food insecurity, and residential instability (correlation coefficient: -0.05, -0.01, and - 0.06, p = 0, respectively). In a multilevel model with random effects after adjusting for other factors, living in a more disadvantaged neighborhood was found to be significantly associated with ED utilization statewide and within Baltimore City (OR: 1.005, 95% CI: 1.003-1.007 and 1.020, 95% CI: 1.017-1.022, respectively). However, individual-level social needs appeared to enhance the statewide effect of living in a more disadvantaged neighborhood with the OR for the interaction term between social needs and SDOH being larger, and more positive, than SDOH alone (OR: 1.012, 95% CI: 1.011-1.014). No such moderation was found in Baltimore City. To our knowledge, this study is one of the first attempts by a major academic healthcare system to assess the combined impact of patient-level social needs in association with community-level SDOH on healthcare utilization and can serve as a baseline for future studies using EHR data linked to population-level data to assess such synergistic association.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA.
| | - Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
| | - Chintan Pandya
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
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Ruderman SA, Nance RM, Drumright LN, Whitney BM, Hahn AW, Ma J, Haidar L, Eltonsy S, Mayer KH, Eron JJ, Greene M, Mathews WC, Webel A, Saag MS, Willig AL, Kamen C, McCaul M, Chander G, Cachay E, Lober WB, Pandya C, Cartujano-Barrera F, Kritchevsky SB, Austad SN, Landay A, Kitahata MM, Crane HM, Delaney JAC. Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV. AIDS 2023; 37:967-975. [PMID: 36723488 PMCID: PMC10079563 DOI: 10.1097/qad.0000000000003501] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Frailty is common among people with HIV (PWH), so we developed frail risk in the short-term for care (RISC)-HIV, a frailty prediction risk score for HIV clinical decision-making. DESIGN We followed PWH for up to 2 years to identify short-term predictors of becoming frail. METHODS We predicted frailty risk among PWH at seven HIV clinics across the United States. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and five-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had a greater than 45% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots. RESULTS Among 3170 PWH (training set), 7% developed frailty, whereas among 1510 PWH (validation set), 12% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed antiretroviral therapy, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95% confidence interval: 0.73-0.79) and sensitivity of 80% and specificity of 61% at a 5% frailty risk cutoff. CONCLUSIONS Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.
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Affiliation(s)
| | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | - Lara Haidar
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kenneth H Mayer
- Harvard Medical School, Fenway Institute, Boston, Massachusetts
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Michael S Saag
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Mary McCaul
- Johns Hopkins University, Baltimore, Maryland
| | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA
- Johns Hopkins University, Baltimore, Maryland
| | - Edward Cachay
- University of California San Diego, San Diego, California
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Ruderman SA, Webel AR, Willig AL, Drumright LN, Fitzpatrick AL, Odden MC, Cleveland JD, Burkholder G, Davey CH, Fleming J, Buford TW, Jones R, Nance RM, Whitney BM, Mixson LS, Hahn AW, Mayer KH, Greene M, Saag MS, Kamen C, Pandya C, Lober WB, Kitahata MM, Crane PK, Crane HM, Delaney JAC. Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States. J Assoc Nurses AIDS Care 2023; 34:158-170. [PMID: 36652200 PMCID: PMC10088432 DOI: 10.1097/jnc.0000000000000389] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ABSTRACT Modifications to Fried's frailty phenotype (FFP) are common. We evaluated a self-reported modified frailty phenotype (Mod-FP) used among people with HIV (PWH). Among 522 PWH engaged in two longitudinal studies, we assessed validity of the four-item Mod-FP compared with the five-item FFP. We compared the phenotypes via receiver operator characteristic curves, agreement in classifying frailty, and criterion validity via association with having experienced falls. Mod-FP classified 8% of PWH as frail, whereas FFP classified 9%. The area under the receiver operator characteristic curve for Mod-FP classifying frailty was 0.93 (95% CI = 0.91-0.96). We observed kappa ranging from 0.64 (unweighted) to 0.75 (weighted) for categorizing frailty status. Both definitions found frailty associated with a greater odds of experiencing a fall; FFP estimated a slightly greater magnitude (i.e., OR) for the association than Mod-FP. The Mod-FP has good performance in measuring frailty among PWH and is reasonable to use when the gold standards of observed assessments (i.e., weakness and slowness) are not feasible.
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Affiliation(s)
- Stephanie A Ruderman
- Stephanie A. Ruderman, MPH, is a PhD candidate, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Allison R. Webel, RN, PhD, is an Associate Dean for Research, School of Nursing, University of Washington, Seattle, Washington, USA. Amanda L. Willig, PhD, RD, is an Associate Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Lydia N. Drumright, PhD, MPH, is a Clinical Assistant Professor, School of Nursing, University of Washington, Seattle, Washington, USA. Annette L. Fitzpatrick, PhD, is a Research Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Michelle C. Odden, PhD, is an Associate Professor, Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA. John D. Cleveland, MS, is a Statistician, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. Greer Burkholder, MD, is an Assistant Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Christine H. Davey, RN, PhD, is a Postdoctoral Fellow, School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Julia Fleming, MD, is an Infectious Disease Specialist, Harvard Medical School, Fenway Institute, Boston, Massachusetts, USA. Thomas W. Buford, PhD, is a Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA. Raymond Jones, PhD, is an Assistant Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Robin M. Nance, PhD, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Bridget M. Whitney, PhD, MPH, is a Senior Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. L. Sarah Mixson, MPH, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Andrew W. Hahn, MD, is a Clinical Assistant Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Kenneth H. Mayer, MD, is a Professor, Harvard Medical School, Fenway Institute, Boston, Massachusetts, USA. Meredith Greene, MD, is an Associate Professor, Department of Medicine, University of California San Francisco, San Francisco, California, USA. Michael S. Saag, MD, is a Professor and Associate Dean, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Charles Kamen, PhD, MPH, is an Associate Professor, Department of Surgery, University of Rochester, Rochester, New York, USA. Chintan Pandya, PhD, is an Assistant Scientist, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. William B. Lober, MD, MS, is a Professor, School of Nursing, University of Washington, Seattle, Washington, USA. Mari M. Kitahata, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Paul K. Crane, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Heidi M. Crane, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Joseph A. C. Delaney, PhD, is an Associate Professor, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, California, USA
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Crane HM, Ruderman SA, Whitney BM, Nance RM, Drumright LN, Webel AR, Willig AL, Saag MS, Christopoulos K, Greene M, Hahn AW, Eron JJ, Napravnik S, Mathews WC, Chander G, McCaul ME, Cachay ER, Mayer KH, Landay A, Austad S, Ma J, Kritchevsky SB, Pandya C, Achenbach C, Cartujano-Barrera F, Kitahata M, Delaney JA, Kamen C. Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment. Drug Alcohol Depend 2022; 240:109649. [PMID: 36215811 PMCID: PMC10088427 DOI: 10.1016/j.drugalcdep.2022.109649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine associations between frailty and drug, alcohol, and tobacco use among a large diverse cohort of people with HIV (PWH) in clinical care in the current era. METHODS PWH at 7 sites across the United States completed clinical assessments of patient-reported measures and outcomes between 2016 and 2019 as part of routine care including drug and alcohol use, smoking, and other domains. Frailty was assessed using 4 of the 5 components of the Fried frailty phenotype and PWH were categorized as not frail, pre-frail, or frail. Associations of substance use with frailty were assessed with multivariate Poisson regression. RESULTS Among 9336 PWH, 43% were not frail, 44% were prefrail, and 13% were frail. Frailty was more prevalent among women, older PWH, and those reporting current use of drugs or cigarettes. Current methamphetamine use (1.26: 95% CI 1.07-1.48), current (1.65: 95% CI 1.39-1.97) and former (1.21:95% CI 1.06-1.36) illicit opioid use, and former cocaine/crack use (1.17: 95% CI 1.01-1.35) were associated with greater risk of being frail in adjusted analyses. Current smoking was associated with a 61% higher risk of being frail vs. not frail (1.61: 95% CI 1.41-1.85) in adjusted analyses. CONCLUSIONS We found a high prevalence of prefrailty and frailty among a nationally distributed cohort of PWH in care. This study identified distinct risk factors that may be associated with frailty among PWH, many of which, such as cigarette smoking and drug use, are potentially modifiable.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Stephanie A Ruderman
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Bridget M Whitney
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Robin M Nance
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Lydia N Drumright
- Department of Biobehavioral Nursing and Health Informatics, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Allison R Webel
- Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Building, Box 357260, 1959 NE Pacific Ave, Seattle, WA, USA.
| | - Amanda L Willig
- Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Michael S Saag
- Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Katerina Christopoulos
- School of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Meredith Greene
- School of Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA.
| | - Andrew W Hahn
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, USA.
| | - Sonia Napravnik
- Department of Epidemiology, 130 Mason Farm Rd, 2101 Bioinformatics Building, Chapel Hill, NC 27599-7215, USA.
| | | | - Geetanjali Chander
- Department of Medicine, 600N. Wolfe Street, Carnegie, Baltimore, MD 21287, USA.
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 3400N. Charles St. Baltimore, MD 21218-2683, USA.
| | - Edward R Cachay
- Owen Clinic, University of California San Diego, UC San Diego Health System, USA.
| | - Kenneth H Mayer
- Fenway Health/The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA.
| | - Alan Landay
- Rush University, 1735 W. Harrison St, Chicago, IL 60612, USA.
| | - Steven Austad
- Department of Biology, Campbell Hall, 1300 University Blvd, University of Alabama Birmingham, Birmingham, AL, USA.
| | - Jimmy Ma
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Gerontology & Geriatric Medicine, Stricht Center for Healthy Aging and Alzheimer's Prevention, 475 Vine Street, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Chintan Pandya
- Center for Population Health Information Technology, Wolfe Street, Baltimore, MD 21205, Johns Hopkins University, Baltimore, MD, USA.
| | - Chad Achenbach
- Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave # 1, Chicago, IL 60611, USA.
| | | | - Mari Kitahata
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Joseph Ac Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.
| | - Charles Kamen
- Department of Surgery University of Rochester Medical Center Rochester, NY, USA.
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Patel V, Pandya C, Patel Z, Patel D, Pandya A. Isocratic RP-UHPLC method development and validation of stability-indicating for simultaneous determination of teneligliptin and metformin in fixed-dose combination. 10 5267/j ccl 2021. [DOI: 10.5267/j.ccl.2021.4.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pharmaceutical combination of Teneligliptin Hydrobromide hydrate (TEN) and Metformin Hydrochloride (MET) drugs is used in the treatment of type 2 diabetes mellitus. A new analytical method: QuEChERS (Quick, Easy, Cheap, Effective, Rugged, Safe) has been developed for the quantification of Teneligliptin (TEN) and Metformin (MET) in bulk and tablet dosage forms. The analysis was performed on Agilent symmetry analytical column Eclipse plus C18 (150 mm × 4.6 mm, 5 μm) ultra- performance liquid chromatography-Diode Array Detectors (UHPLC-DAD), while the detection was performed on 233 nm using Diode Array Detectors. Buffer and acetonitrile (65:35 v/v) were the mobile phase, run at a flow rate of 0.7 mL min−1 for isocratic elution. The buffer used in the mobile phase contained 50 mM potassium di-hydrogen phosphate, pH adjusted to 3.5±0.02 with orthophosphoric acid. The mean values of recovery were found to be 100.50% and 99.81%. The proposed method could be ideal for quantitative evaluation in pharmaceutical preparations of these drugs and also for their quality control in bulk manufacturing. Stress test covers: acid, base, peroxide, thermal and photolytic degradation; were conducted to show the specificity of the method and degradation.
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Arastu A, Patel A, Mohile SG, Ciminelli J, Kaushik R, Wells M, Culakova E, Lei L, Xu H, Dougherty DW, Mohamed MR, Hill E, Duberstein P, Flannery MA, Kamen CS, Pandya C, Berenberg JL, Aarne V, Liu Y, Loh KP. Assessment of Financial Toxicity Among Older Adults With Advanced Cancer. JAMA Netw Open 2020; 3:e2025810. [PMID: 33284337 PMCID: PMC8184122 DOI: 10.1001/jamanetworkopen.2020.25810] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Importance Financial toxicity (FT), unintended and unanticipated financial burden experienced by cancer patients undergoing cancer care, is associated with negative consequences and increased risk of mortality. Older patients (≥70 years) with cancer are at risk for FT, yet data are limited on FT and whether oncologists discuss FT with their patients. Objective To examine the prevalence of FT in older adults with advanced cancer, its association with health-related quality of life (HRQoL), and cost conversations between oncologists and patients. Design, Setting, and Participants This cross-sectional secondary analysis was performed on baseline data from the Improving Communication in Older Cancer Patients and Their Caregivers study, a cluster randomized trial from 31 community oncology practices across the US that was conducted from October 29, 2014, to April 28, 2017. Participants included 536 patients with advanced cancer who answered 3 questions regarding financial toxicity. Data were analyzed from September 1, 2019, to May 1, 2020. Exposure Older patients undergoing cancer care treatments. Main Outcomes and Measures The main outcome looked at FT and its association with HRQoL. Three questions were used to identify patients 70 years or older experiencing FT. Multivariable linear regression models were used to assess the independent associations of FT with HRQoL. A single audio-recorded clinic transcript was analyzed within 4 weeks of enrollment for patients with FT. The framework method was used to identify frequency and themes related to cost conversations. Results This study evaluated 536 patients 70 years or older with advanced cancer. Ninety-eight patients (18.3%) reported FT; mean (SD) age was 76.4 (5.4) years; 59 (60.2%) were female, 14 (14.3%) were Black/African American, 91 (92.9%) were not employed, and 29 (29.6%) had Medicare as their sole insurance coverage. On multivariate regression analyses, FT was associated with higher levels of depression (β = 0.81; 95% CI, 0.15-1.48), anxiety (β = 1.67; 95% CI, 0.74-2.61), and distress (β = 0.73; 95% CI, 0.08-1.39) and lower HRQoL (β = -5.30; 95% CI, -8.92 to -1.69). Among those who reported FT, 49% had a conversation with their health care professional about costs. Most conversations (79%) were initiated by oncologists or patients. Four themes were generated from cost conversations: statements regarding cost of care, ability to afford medical prescriptions, indirect consequences associated with inability to work and provide for family, and cost burden in nontreatment domains. Conclusions and Relevance In this study, among older adults with advanced cancer, FT is associated with worse HRQoL. Almost half of conversations among patients reporting FT demonstrated costs are being actively discussed. Resources and interventions are needed to manage FT.
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Affiliation(s)
- Asad Arastu
- Department of Medicine, Oregon Health and Science University Hospital, Portland, Oregon, USA
| | - Arpan Patel
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Supriya Gupta Mohile
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Joseph Ciminelli
- Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ramya Kaushik
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Megan Wells
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Eva Culakova
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Lianlian Lei
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Huiwen Xu
- Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Mostafa R. Mohamed
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Elaine Hill
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Marie Anne Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Charles Stewart Kamen
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Chintan Pandya
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jeffrey L. Berenberg
- Hawaii National Cancer Institute Community Oncology Research Program (MU-NCORP), Honolulu, Hawaii, USA
| | - Valerie Aarne
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Yang Liu
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Kah Poh Loh
- James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Pandya C, Mwesigwa S, Dougherty DW. Racial differences in hospitalizations associated with COVID-19 in patients with cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.122] [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
122 Background: Reports concerning possible racial disparities in Covid-19 illness severity and health consequences for U.S. minority population have been emerging. Similar data for patients with cancer diagnosis have been scant. We aimed to evaluate the effect of race on primary outcome of hospitalization in patients with cancer who tested positive for Covid-19. Methods: Retrospective observational quality of care study of electronic health records for patients with cancer who tested positive for Covid-19 between March 1 and June 10, 2020 and had at least one visit in the past 1-year at the cancer center. Demographics, non-cancer comorbidities, cancer type and treatment were captured. Primary outcome of hospitalization and secondary outcome of emergency department (ED) visits were assessed from index event up to 30 days after index event, which is laboratory-confirmed diagnosis of Covid-19. Logistic regression analysis was performed to evaluate the association of race with outcomes after adjusting for confounding factors. Results: 557 patients tested positive for Covid-19 and had at least one visit at the cancer institute in past one year. Of the total positive patients, 325 (58%) were females, 79 (14%) were blacks, and 225 (40%) had 2 or more comorbidities. The most common cancers were gastrointestinal (N=105) and other cancers (N=194); 47 had any systemic cancer treatment in the past 30 days before Covid-19 test. 56 patients had ED visit out of which 26% were blacks (p=0.002) and 96 had inpatient hospital visit out of which blacks were 19% (p=0.13). The mean length of hospital stay (LOS) was 7.86±11.6 days. On multivariate analysis, after controlling for demographics, comorbidities, and cancer variables, black race was independently associated with higher odds of hospitalization (Odds Ratio=2.19, confidence interval=1.2 to 3.8). Conclusions: In a large cohort of patients with cancer who tested positive for Covid-19, while 14% were blacks, they contributed to 17% hospitalizations and 26% ED visits associated with Covid-19. Black race was independently associated with higher odds of hospitalization due to Covid-19 than white race, after adjusting for confounding factors.
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Hardy S, Pandya C, Mohile N, Janelsins M, Milano M. QOLP-26. PATIENT REPORTED SOCIAL FUNCTION AND SURVIVAL IN GLIOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.846] [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: 11/14/2022] Open
Abstract
Abstract
PURPOSE
Research among patients with cancer suggests that health related quality of life (HRQOL) may be more predictive of survival than performance status. Social function is a HRQOL outcome influenced by both physical and mental health. To our knowledge, no work has analyzed the potential association between survival and social function in patients with brain tumors.
METHODS
In the SEER Medicare Health Outcomes Survey, 158 patients were identified with 1) diagnosis of glioma between 1976 and 2013 2) no other cancer diagnosis 3) at least one post-diagnosis HRQOL survey. We examined the relationship between social function and mortality using a multivariable Cox proportional hazard model. We also examined factors correlated with social function score using linear regression.
RESULTS
At last follow up, 48% of the patients had died, 53% were female, 59% had trouble with ≥1 ADL, 53% were married, 27% had glioblastoma, 74% were white, and 32% had no reported comorbidities. Median time from cancer diagnosis to survey was 79 months and median age at survey was 60 years. For patients alive at last follow-up, there was a difference of >5 points for the social function subscale (38.2 vs 30.6) compared to those who died during the median 163 month follow up interval. On multivariable Cox proportion hazard model adjusting for covariates, higher social function scores were significantly associated with improved survival (5 point increase in score, HR 0.86, p = 0.0029). Worse social function was associated with patient-reported neurologic deficits in vision and speech and report of depression, but not marital status, sex, race, or patient-reported income.
DISCUSSION
Patient-reported social function score on post-diagnosis surveys, even after accounting for important clinical factors, was significantly associated with survival. The impact of patient reported social function in those with glioma should be further examined in confirmatory longitudinal studies.
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Affiliation(s)
- Sara Hardy
- University of Rochester, Rochester, NY, USA
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11
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Mohile SG, Magnuson A, Pandya C, Velarde C, Duberstein P, Hurria A, Loh KP, Wells M, Plumb S, Gilmore N, Flannery M, Wittink M, Epstein R, Heckler CE, Janelsins M, Mustian K, Hopkins JO, Liu J, Peri S, Dale W. Community Oncologists' Decision-Making for Treatment of Older Patients With Cancer. J Natl Compr Canc Netw 2019. [PMID: 29523669 DOI: 10.6004/jnccn.2017.7047] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: This study's objectives were to describe community oncologists' beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods: Community oncologists were recruited to participate in 2 multisite geriatric oncology trials. Participants shared their beliefs about and confidence in caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs single-agent vs no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly chosen vignette that varied on 3 variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist/vignette-patient characteristics and treatment decisions. Results: Oncologist response rate was 61% (n=305/498). Most oncologists agreed that "the care of older adults with cancer needs to be improved" (89%) and that "geriatrics training is essential" (72%). However, <25% were "very confident" in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted odds ratio [aOR], 5.01; 95% CI, 2.73-9.20), normal cognition (aOR, 5.42; 95% CI, 3.01-9.76), and being functionally intact (aOR, 3.85; 95% CI, 2.12-7.00). Accounting for all vignettes across all scenarios, 161 oncologists (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: aOR, 3.22; 95% CI 1.43-7.25, impaired cognition: aOR, 3.13; 95% CI, 1.36-7.20, impaired function: aOR, 2.48; 95% CI, 1.12-5.72). Oncologists' characteristics were not associated with decisions about providing chemotherapy. Conclusion: Geriatric-relevant information, when available, strongly influences community oncologists' treatment decisions.
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Affiliation(s)
- Supriya G Mohile
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Allison Magnuson
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Chintan Pandya
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Carla Velarde
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Paul Duberstein
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Arti Hurria
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Kah Poh Loh
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Megan Wells
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Sandy Plumb
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Nikesha Gilmore
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Marie Flannery
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Marsha Wittink
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Ronald Epstein
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Charles E Heckler
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Michelle Janelsins
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Karen Mustian
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Judith O Hopkins
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Jane Liu
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - Srihari Peri
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
| | - William Dale
- From James Wilmot Cancer Center, University of Rochester, Rochester, New York; City of Hope Cancer Center, Duarte, California; Southeast Clinical Oncology Research (SCOR) Consortium NCI Community Oncology Research Program (NCORP), Winston-Salem, North Carolina; Heartland Cancer Research NCORP, Decatur, Illinois; and Delaware/Christiana Care NCORP, Newark, Delaware
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Dougherty DW, Leblebjian H, Duperrault M, Awad MM, Bartel S, McDonnell A, Bunnell CA, Wagner AJ, Pandya C, Hamel LM, Glotzbecker B. Outcomes of immunotherapy administration for hospitalized cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.98] [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
98 Background: With approvals across multiple cancer types and favorable toxicity profiles, oncologists may consider using immunotherapy (IMT) while their patients are hospitalized. Inpatient IMT may be cost-prohibitive to administer for most institutions due to high cost and inpatient payment structure, but little data are available to evaluate outcomes for IMT in hospitalized patients. We investigated the survival benefit of administering IMT to hospitalized patients with cancer at an NCI-designated cancer center. Methods: We conducted a retrospective chart review of all patients receiving ipilimumab, nivolumab, or pembrolizumab during inpatient admission at Dana-Farber Cancer Institute/Brigham & Women’s Hospital in 2017. For each patient, we assessed: total dose, indication for dosing, cancer type, time between dose and discharge, time between discharge and death, and total cost (average wholesale price). Study follow up was January 1, 2017 to July 1, 2018. Results: Fifty doses of IMT were administered to 44 patients. Most patients (40) received 1 dose, 2 patients received 3 doses, 1 patient received 2 doses, and 1 patient received a combination of ipilimumab/nivolumab. The most common cancer types were lung (41%), gastrointestinal (18%), and head and neck (16%). Indications for IMT administration were: patient due for next dose (48%), disease progression (42%), and new diagnosis (11%). The majority of doses (70%) were received within 7 days prior to discharge, with 32% of doses within 1 day of discharge. The majority of patients (86%) died in the study period; 14% of patients died during admission. Average survival between discharge and death was 54 days (range: 0-444 days). Total cost of inpatient IMT administration was $413,370, an average of $9,395 per patient. Conclusions: To our knowledge, this is the largest analysis of outcomes for patients receiving IMT during a hospitalization. Inpatient use of IMT in cancer patients is associated with high cost and poor clinical outcomes. Dosing within one week prior to hospital discharge was common. Clinical factors such as PD-L1 status, disease status, and reason for admission, which may be important to understand which patients may benefit most from inpatient IMT, should be examined.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Chintan Pandya
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
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Doucette C, Hardy S, Pandya C, Milano M. Health-Related Quality of Life in Early Stage Lung Cancer: A SEER-MHOS Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1193] [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] [Indexed: 10/26/2022]
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14
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Pandya C, Clarke T, Scarsella E, Alongi A, Amport SB, Hamel L, Dougherty D. Ensuring Effective Care Transition Communication: Implementation of an Electronic Medical Record-Based Tool for Improved Cancer Treatment Handoffs Between Clinic and Infusion Nurses. J Oncol Pract 2019; 15:e480-e489. [PMID: 30946643 PMCID: PMC9797242 DOI: 10.1200/jop.18.00245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Ineffective handoffs contribute to gaps in patient care and medication errors, which jeopardize patient safety and lead to poor-quality care. The project aims are to develop and implement a standardized handoff process using an electronic medical record (EMR)-based tool to ensure optimal communication of treatment-related information for patients receiving cancer treatment between oncology nurses. METHODS A multidisciplinary team convened to develop a standard and safe treatment handoff process. The intervention was developed over a series of phases using Plan-Do-Study-Act methodology, including current workflow process mapping; identifying gaps, limitations, and potential causes of ineffective handoffs; and prioritizing these using a Pareto chart. An EMR-based tool incorporating a standardized treatment handoff process was developed. Study outcomes included proportion of handoff-related medication errors, tool utilization, handoff completion, patient waiting time, and nurse satisfaction with tool. All outcomes were evaluated before and after the intervention over a 1-year period. RESULTS The proportion of medication errors as a result of ineffective handoffs was reduced from 10 of 17 (60%) pre-intervention to 11 of 34 (32%) postintervention (P = .07). The EMR-based handoff tool was used in 9,274 of 10,910 (85%) patient treatment visits, and the handoff completion rate increased from 32% pre-intervention to 86% postintervention. Patient waiting time showed an average reduction of 2 minutes/patient/month. A majority of nurses reported that the new tool conveyed necessary information (85% of nurses) and was effective in preventing errors (81% of nurses). CONCLUSION Multidisciplinary stakeholders guided the development and implementation of a standard handoff process and an EMR-based tool to optimize communication between nurses during patient transition. The intervention was associated with a reduction in the proportion of medication errors as the result of ineffective handoffs. In addition, the intervention improved communication between nurses.
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Affiliation(s)
- Chintan Pandya
- University of Rochester Medical Center, Rochester, NY,Chintan Pandya, PhD, James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Ave, Box 704, Rochester, NY 14642; e-mail:
| | - Tammy Clarke
- University of Rochester Medical Center, Rochester, NY
| | | | - Alex Alongi
- University of Rochester Medical Center, Rochester, NY
| | | | - Lauren Hamel
- Wayne State University School of Medicine, Detroit, MI
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Pandya C, Magnuson A, Flannery M, Zittel J, Duberstein P, Loh KP, Ramsdale E, Gilmore N, Dale W, Mohile SG. Association Between Symptom Burden and Physical Function in Older Patients with Cancer. J Am Geriatr Soc 2019; 67:998-1004. [PMID: 30848838 DOI: 10.1111/jgs.15864] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 08/31/2018] [Revised: 12/21/2018] [Accepted: 02/07/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the independent association between symptom burden and physical function impairment in older adults with cancer. DESIGN Cross-sectional. SETTING Two university-based geriatric oncology clinics. PARTICIPANTS Patients with cancer aged 65 years or older who underwent evaluation with geriatric assessment (GA). MEASUREMENTS Symptom burden was measured as a summary score of severity ratings (range = 0-10) of 10 commonly reported symptoms using a Clinical Symptom Inventory (CSI). Functional impairment was defined as the presence of one or more impairments of instrumental activities of daily living (IADLs), any significant physical activity limitation on the Medical Outcomes Survey (MOS), one or more recent falls in the previous 6 months, or a Short Physical Performance Battery (SPPB) score of 9 or less. Multivariate analysis evaluated the association between symptom burden and physical function impairment, adjusting for other clinical and sociodemographic variables. RESULTS From 2011 to 2015, 359 patients with cancer and a median age of 81 years (range = 65-95 y) consented. The mean CSI score was 23.2 ± 20.5 with an observed range of 0 to 90. Patients in the highest quartile of symptom burden (N = 91; CSI score 52 ± 13) had a higher prevalence of IADL impairment (91% vs 51%), physical activity limitation (93% vs 65%), falls (55% vs 21%), and SPPB score of 9 or less (92% vs 69%) (all P values <.01) when compared with those in the bottom quartile (N = 81; CSI score: 2 ± 2). With each unit increase in CSI score, the odds of having IADL impairment, physical activity limitations, falls, and SPPB scores of 9 or less increased by 4.8%, 4.4%, 2.9%, and 2.5%, respectively (P < .05 for all results). CONCLUSIONS In older patients with cancer, higher symptom burden is associated with functional impairment. Future studies are warranted to evaluate if improved symptom management can improve function in older cancer patients. J Am Geriatr Soc 67:998-1004, 2019.
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Affiliation(s)
- Chintan Pandya
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Marie Flannery
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York.,School of Nursing, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jason Zittel
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Erika Ramsdale
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Nikesha Gilmore
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - William Dale
- City of Hope National Medical Center, Department of Supportive Care Medicine, Duarte, California
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Pandya C, Sabatka S, Kettinger M, Alongi A, Hamel LM, Guancial EA, Dougherty DW. Using electronic medical record system to improve compliance with national guidelines for comprehensive distress screening in cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
309 Background: Psychosocial distress screening (DS) and management is associated with improved quality of life and outcomes in cancer patients and is required for accreditation by the American College of Surgeons Commission on Cancer. Comprehensive distress screening (CDS) consists of routine distress screening, evaluation, referral to appropriate psychosocial services, and follow-up to ensure adequate care. Electronic medical record (EMR) systems can be leveraged to facilitate and document CDS as part of clinical care and to evaluate the CDS process as a quality standard. The aim of this study is to develop and implement an EMR-based tool to document and evaluate the CDS process as part of routine oncology care. Methods: An EMR-based tool with structured data fields is developed for social workers to document risk factors for distress, assessment, management plan including psychosocial service referrals, and time spent delivering care following DS using the NCCN distress thermometer (DT). Evaluation of CDS process is done in cancer patients who have documented psychosocial care in the EMR-system from 1/2017-5/2018. Results: During the study period, 1327 cancer patients underwent 2480 distress screening evaluations. The average distress score was 3.2 (median = 2) on the DT scale of 0-10, with 855 (64%), 326 (25%), and 146 (11%) patients reporting on average mild (0-3), moderate (4-6), and severe (7-10) distress respectively. 400/1327 (30%) patients accounted for 1177 documented social work contact/visits, of which financial (40%) and emotional (15%) were the most common concerns. 89% (1047) of the visits had follow-up plans and 77% of encounters resulted in referrals, of which financial support (26%) and pharmacy assistance (22%) were the most common referral services. The average time spent on each psychosocial care visit was reported to be 21 minutes. Conclusions: EMR-based forms with structured data fields can be used to document and promote improved adherence to national guidelines for CDS as part of routine oncology care by facilitating data collection. Such tools can be leveraged to capture relevant data on impact of CDS on social work resource utilization.
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Affiliation(s)
- Chintan Pandya
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | - David W. Dougherty
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
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Pandya C, An A, Duberstein P, Dougherty DW, Noel MS. Using Best Practice Advisory alert to increase early advanced care planning discussion and palliative care referral in advanced cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
320 Background: Patients with advanced cancer can benefit from early initiation of palliative care (PC) and advanced care planning (ACP). In theory, the Medical Order for Life-Sustaining Treatments (MOLST), which provides a vehicle for end-of-life discussion, could lead to improved uptake of ACP and PC. In order for MOLST forms to influence these care process outcomes, methods are needed to help clinicians introduce the forms to patients in a compassionate manner. The objective of this study is to develop a best practice advisory (BPA) alert in the electronic medical record (EMR) to help oncologists identify appropriate patients for ACP and PC referral and evaluate its impact on improving MOLST form and palliative referral order documentation in EMR for these patients. Methods: BPA alert criteria included Lung and GI cancer patients with stage IV disease or undergoing treatment with palliative intent. The oncologists could act on the alert by either acknowledging it with action statement (I have already discussed ACP, I intend to discuss ACP in this or next visit, Patient unlikely to die in next 12 months, other) or dismiss it. We examined the rates of MOLST form and PC referral orders in the EMR 12-months before and after the BPA was implemented in 03/2018. Results: The BPA fired in 424 patients who met the criteria over a period of 9 weeks. It was acknowledged in 409 and cancelled in 15 patients. Following the alert, 40 (9%) patients had a MOLST form added to the chart compared to only 9 (2%) patients before the alert and 17 (4%) patients had palliative care referral order placed vs. 10 (2%) patients before the alert. Physicians acknowledged discussing ACP in 145 patients, most of whom (25/30) initiated these conversations after the BPA was implemented. Data collection is ongoing to capture BPA effect for longer follow-up. Conclusions: The BPA alert intervention resulted in significant increase in documentation of ACP and palliative referral order suggesting the potential of this tool in improving adherence to national guidelines calling for early initiation of palliative care and advance care planning in patients with advanced cancers.
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Affiliation(s)
- Chintan Pandya
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
| | - Amy An
- University of Rochester, Rochester, NY
| | | | - David W. Dougherty
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Marcus Smith Noel
- University of Rochester James P. Wilmot Cancer Institute, Strong Memorial Hospital, Rochester, NY
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Arastu A, Ciminelli J, Culakova E, Lei L, Xu H, Dougherty DW, Mohamed MR, Wells M, Duberstein P, Flannery MA, Morrow GR, Kamen CS, Pandya C, Berenberg JL, Aarne V, Mohile SG. The impact of financial toxicity on quality of life in older patients with cancer: Baseline data from the University of Rochester NCI Community Oncology Research Program (NCORP). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.87] [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
87 Background: Financial toxicity (FT), or the stress and strain patients (pts) experience as a result of paying for cancer care, can have profound negative impacts on pts’ overall quality of life (QoL). This study examined associations of FT with anxiety, depression, and QoL in older pts with advanced cancer. Methods: This is a secondary analysis of baseline data from a Geriatric Assessment intervention study conducted by UR NCORP across 31 practice sites (PI: Mohile). Pts were categorized as experiencing FT if they reported any one of the following: delaying medications due to cost, insufficient income in a typical month for food and housing, or insufficient income in a typical month for other basic needs. Pts also completed the Generalized Anxiety Disorder-7 (GAD7, score 0-21) to evaluate anxiety, the Geriatric Depression Scale (GDS, score 0-15) to assess depression, and the Functional Assessment of Cancer Therapy- Generation (FACT-G, score 0-108), to measure overall QoL. Associations of FT with anxiety, depression, and QoL were assessed in separate multivariate linear regression models controlling for covariates at p < 0.1. Results: Among 542 pts (mean age 77; range 70-96, 49% female), 18% (98 pts) experienced FT. In separate regression analysis, FT was significantly associated with all 3 outcome measures. On average, pts experiencing FT scored 1.76 higher (p < 0.01) on the GAD7 (indicating greater anxiety severity), 0.76 points higher (p = 0.02) on the GDS (indicating greater depression severity), and 5.16 points lower (p < 0.01) on the FACT-G (indicating lower QoL). Conclusions: Older pts with advanced cancer who experience income and cost-related barriers to quality cancer care reported worse anxiety, depression, and QoL than those without FT. Given the association between FT and these outcomes, these 3 FT questions may help identify vulnerable older pts and allow providers to intervene sooner and thereby enhance the quality of care pts receive.
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Affiliation(s)
- Asad Arastu
- University of Rochester Medical Center, Rochester, NY
| | | | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY
| | - Lianlian Lei
- University of Rochester Medical Center, Rochester, NY
| | - Huiwen Xu
- University of Rochester Medical Center, Rochester, NY
| | - David W. Dougherty
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Megan Wells
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Chintan Pandya
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
| | | | - Valerie Aarne
- University of Rochester Medical Center, Rochester, NY
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19
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Dunne RF, Roussel B, Culakova E, Pandya C, Fleming FJ, Hensley B, Magnuson AM, Loh KP, Gilles M, Ramsdale E, Maggiore RJ, Jatoi A, Mustian KM, Dale W, Mohile SG. Characterizing cancer cachexia in the geriatric oncology population. J Geriatr Oncol 2018; 10:415-419. [PMID: 30196027 DOI: 10.1016/j.jgo.2018.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 04/04/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Cancer cachexia, characterized by weight loss and sarcopenia, leads to a decline in physical function and is associated with poorer survival. Cancer cachexia remains poorly described in older adults with cancer. This study aims to characterize cancer cachexia in older adults by assessing its prevalence utilizing standard definitions and evaluating associations with components of the geriatric assessment (GA) and survival. MATERIALS AND METHODS Patients with cancer older than 65 years of age who underwent a GA and had baseline CT imaging were eligible in this cross-sectional study. Cancer cachexia was defined by the international consensus definition reported in 2011. Sarcopenia was measured using cross-sectional imaging and utilizing sex-specific cut-offs. Associations between cachexia, sarcopenia, and weight loss with survival and GA domains were explored. RESULTS Mean age of 100 subjects was 79.9 years (66-95) and 65% met criteria for cancer cachexia. Cachexia was associated with impairment in instrumental activities of daily living (IADL) (p = .017); no significant association was found between sarcopenia or weight loss and IADL impairment. Cachexia was significantly associated with poorer survival (median 1.0 vs 2.1 years, p = .011). CONCLUSIONS Cancer cachexia as defined by the international consensus definition is prevalent in older adults with cancer and is associated with functional impairment and decreased survival. Larger prospective studies are needed to further describe cancer cachexia in this population.
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Affiliation(s)
- Richard F Dunne
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States.
| | - Breton Roussel
- Department of Medicine, Brown University, Providence, RI, United States
| | - Eva Culakova
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Chintan Pandya
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Fergal J Fleming
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Bradley Hensley
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Allison M Magnuson
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Kah Poh Loh
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Maxence Gilles
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Erika Ramsdale
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - Ronald J Maggiore
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Aminah Jatoi
- Mayo Clinic, Department of Oncology, Rochester, MN, United States
| | - Karen M Mustian
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
| | - William Dale
- City of Hope, Department of Supportive Care Medicine, Duarte, CA, United States
| | - Supriya G Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; University of Rochester NCI Community Oncology Research Program (UR NCORP), Rochester, NY, United States
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20
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Arastu A, Ciminelli J, Culakova E, Lei L, Xu H, Dougherty DW, Mohamed MR, Wells M, Duberstein P, Flannery MA, Morrow GR, Kamen CS, Pandya C, Berenberg JL, Aarne V, Mohile SG. Association of financial toxicity (FT) with depression, anxiety, and quality of life (QoL) in older patients with advanced cancer: An analysis of 544 patients from 31 practices in the University of Rochester NCI Community Oncology Research Program (UR NCORP). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e22037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Asad Arastu
- University of Rochester Medical Center, Rochester, NY, US
| | | | - Eva Culakova
- University of Rochester Medical Center, Rochester, NY
| | | | - Huiwen Xu
- University of Rochester Medical Center, Rochester, NY
| | - David W. Dougherty
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | - Megan Wells
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Chintan Pandya
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
| | | | - Valerie Aarne
- University of Rochester Medical Center, Rochester, NY
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21
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Loh KP, Zittel J, Kadambi S, Pandya C, Xu H, Flannery M, Magnuson A, Bautista J, McHugh C, Mustian K, Dale W, Duberstein P, Mohile SG. Elucidating the associations between sleep disturbance and depression, fatigue, and pain in older adults with cancer. J Geriatr Oncol 2018; 9:464-468. [PMID: 29506921 DOI: 10.1016/j.jgo.2018.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/05/2018] [Accepted: 02/20/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Sleep disturbance is prevalent and often coexists with depression, fatigue, and pain in the cancer population. The aim of this study was to describe the prevalence of sleep disturbance with co-existing depression, fatigue, and pain in older patients with cancer. We also examined the associations of several socio-demographic and clinical variables with sleep disturbance. METHODS This cross-sectional study consisted of 389 older patients with solid and hematologic malignancies who were referred to the Specialized Oncology Care & Research in the Elderly (SOCARE) clinics at the Universities of Rochester and Chicago between May 2011 and October 2015 and completed a sleep and geriatric assessment (that inquires about fatigue, pain, and depression). Multivariate logistic regression was used to identify variables associated with sleep disturbance. RESULTS The prevalence of sleep disturbance was 40%. Of those with sleep disturbance (n = 154), 84% also had at least one of the other three symptoms (25% had one symptom, 38% had two symptoms, and 21% had three symptoms). Sleep disturbance was more likely to be reported in those with comorbidities (45% vs. 28%, P = 0.002), depression (49% vs. 36%, P = 0.015), fatigue (49% vs. 23%, P < 0.001), and pain (45% vs. 31%, P = 0.010). On multivariable analysis, only fatigue (adjusted odds ratio (AOR) 1.90, 95% CI 1.10-3.30, P = 0.020) was independently associated with sleep disturbance. CONCLUSIONS Sleep disturbance is prevalent and often co-occurs with depression, fatigue, or pain in older patients with cancer. Fatigue was significantly associated with sleep disturbance and future studies should explore interventions that target sleep disturbance and fatigue.
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Affiliation(s)
- Kah Poh Loh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Jason Zittel
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Sindhuja Kadambi
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Chintan Pandya
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, United States
| | - Marie Flannery
- School of Nursing, University of Rochester School of Medicine and Dentistry, United States
| | - Allison Magnuson
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Javier Bautista
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Colin McHugh
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Karen Mustian
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - William Dale
- Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago Medical Center, United States
| | - Paul Duberstein
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States
| | - Supriya G Mohile
- James P Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, United States.
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22
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Termer NK, Richardson M, Adams MJ, Alongi A, Bellohusen P, Bruckner LB, Cowen R, Fritsch S, Hettler D, Kerns SL, Pandya C, Williams A, Constine LS. Meeting requirements for survivorship visits: Interventions for patient identification. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.59] [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
59 Background: A major challenge in providing quality survivorship care to cancer patients is efficiently and effectively identifying and scheduling patients who need a Survivorship Visit (SV). While the Commission on Cancer (CoC) Standard 3.3 defines which patients require a Survivorship Care Plan (SCP), staff need to operationalize the definition and search the clinic’s patient records on a regular basis to accurately identify eligible patients. This is a challenge for a busy cancer center. Methods: In July 2017 the Judy DiMarzo Cancer Survivorship Program instituted a full time Data Analyst (DA) to assist in identifying survivors using the OncoLog Cancer Registry and the Electronic Medical Record (EMR). Previously the identification process was limited to the EMR, and the Survivorship Program Nurse Coordinator (NC) was a combined role overseeing metrics, identifying patients and assisting with SVs. Currently the DA has piloted a method extracting data monthly from OncoLog and the EMR to assess eligibility of Standard 3.3. The data is compiled and sent to the NC who assists the cancer-specific service lines responsible for the patients identified to ensure SVs occur in a timely manner. Results: Our pilot intervention resulted in a 283% increase in SVs per month, from an average of 30 SVs to 115 SVs per month. The overall achievement for the CoC SV delivery requirement increased from 16% prior to the intervention to 33% in just 3 months. GI increased from 5% to 20%. Lung increased from 16% to 39%. The average SV was 3 months after the end of treatment. Approximately 60 hours was dedicated to establishing this method and 35 hours per month in the eligibility, identification process. Conclusions: By adding a DA role, extracting data from Oncolog and the EMR, as well as increasing accountability at the service line level to improve identification and scheduling of eligible patients, the delivery of SCPs to eligible patients substantially increased. Nevertheless this process is time consuming and will likely not be sufficient to ensure that all eligible survivors receive appropriate care. Consequently, additional, systematic improvements in this process should be explored such as EMR methodologies to automate patient identification.
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Affiliation(s)
| | | | - M Jacob Adams
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Richard Cowen
- University of Rochester Medical Center, Rochester, NY
| | - Susan Fritsch
- University of Rochester Medical Center, Rochester, NY
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23
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Magnuson A, Lemelman T, Pandya C, Goodman M, Noel M, Tejani M, Doughtery D, Dale W, Hurria A, Janelsins M, Lin FV, Heckler C, Mohile S. Geriatric assessment with management intervention in older adults with cancer: a randomized pilot study. Support Care Cancer 2018; 26:605-613. [PMID: 28914366 PMCID: PMC5887127 DOI: 10.1007/s00520-017-3874-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 03/01/2017] [Accepted: 09/07/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Older adults receiving cancer therapy have heightened risk for treatment-related toxicity. Geriatric assessment (GA) can identify impairments, which may contribute to vulnerability and adverse outcomes. GA management interventions can address these impairments and have the potential to improve outcomes when implemented. METHODS We conducted a randomized pilot study comparing GA with management interventions versus usual care in patients with stage III/IV solid tumor malignancies (N = 71). In all patients, a trained coordinator conducted and scored a baseline GA with pre-determined cutoffs for impairment. For patients randomized to the intervention arm, an algorithm was used to identify GA management recommendations based upon identified impairments. Recommendations were relayed to the primary oncologist for implementation. GA was repeated at 3 months. The primary outcome was grade 3-5 chemotherapy toxicity. Secondary outcomes included feasibility, hospitalizations, dose reductions, dose delays, and early treatment discontinuation. RESULTS The mean participant age was 76 (70-89). The total number of GA management recommendations relayed was 409, of which 35.4% were implemented by the primary oncologist. Incidence of grade 3-5 chemotherapy toxicity did not differ between the two groups. Prevalence of hospitalization, dose reductions, dose delays, and early treatment discontinuation also did not differ between the two groups. CONCLUSIONS An algorithm can be used to guide GA management recommendations in older adults with cancer. However, reliance upon the primary oncologist for execution resulted in a low prevalence of implementation. Future work should aim to understand barriers to implementation and explore alternate models of implementing geriatric-focused care for older adults with cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Supriya Mohile
- University of Rochester, Rochester, NY, USA.
- Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY, 14642, USA.
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24
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Pandya C, Nielsen G, Hu J, Ram J, Rozario C, Wallace D, Hamel LM, Dougherty DW. Palliative care utilization in oncology patients with 30-day hospital readmission. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.31_suppl.110] [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
110 Background: Reducing the rate of hospital readmissions is an important aspect of improving quality of life and cost of care for patients with advanced cancer. Early Palliative Care (PC) has been shown to improve quality of life and downstream healthcare utilization in patients with advanced cancer. The aim of this study was to examine palliative care (PC) utilization and factors associated with 30-day readmission in cancer patients. Methods: All patients with 30 day readmissions to the inpatient oncology service at the Wilmot Cancer Institute from July 2015-June 2016 were identified. Chart reviews were conducted to determine primary cancer stage and type; reason for, length of stay and discharge disposition (e.g. discharged on hospice, deceased) for index and readmission; potential preventability of readmission; and if and when the patient had met with PC. Results: A total of thirty-nine patients experienced a 30-day readmission, with 95% of patients having stage IV disease and 77% having a primary lung or GI malignancy. Most patients (74%) had not met with PC at the time of the index admission and 49% of patients had not met with PC by the time of readmission. Forty one percent (N = 17) of patients either died during readmission or were discharged on hospice. Forty one percent (N = 7) of those that died during readmission or were discharged on hospice did not meet with palliative care. Forty four percent of readmissions were classified as potentially preventable. Conclusions: Nearly half of all advanced cancer patients had not met with PC by the time of their readmission. Upon readmission, many patients were either discharged to hospice or died, suggesting that patients with advanced cancer could benefit from earlier PC. Increased and improved patient-oncologist PC communication, including referrals to PC specialists, may reduce readmission rates for patients with advanced cancer.
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Affiliation(s)
- Chintan Pandya
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
| | - Gradon Nielsen
- University of Rochester Department of Medicine, Rochester, NY
| | - John Hu
- University of Rochester Department of Medicine, Rochester, NY
| | - Jodi Ram
- University of Rochester Department of Medicine, Rochester, NY
| | - Cheryl Rozario
- University of Rochester Department of Medicine, Rochester, NY
| | | | - Lauren M. Hamel
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - David W. Dougherty
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
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25
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Pandya C, Alongi A, Dougherty DW. Effect of physician-level performance feedback on pattern of structured cancer stage entry. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.141] [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
141 Background: In contrast to unstructured free text, structured entry of cancer type and stage facilitates easy utilization of this clinically important data to accurately identify patient population, measure and report performance on outcomes and quality of care as well as for various clinical decision support systems. There is significant variation in physician utilization of Electronic Medical Record based staging modules which capture the data in structured form. The aim of study is to increase structured cancer staging by providing performance feedback to individual physicians. Methods: An EPIC based physician performance feedback report was developed consisting of staging tool utilization performance captured by percentage of staged patients out of all the patients seen by the provider as well as the MRN link (to act upon) of the un-staged patients with stageable cancer diagnosis using criteria: 1) un-staged cancer on the problem list 2) active treatment plan and 3) seen by provider in last one year. Reports were sent monthly to the providers starting 11/1/2015. Pre-intervention structured staging rates were compared with 6- and 12-month post-intervention rates. Results: EPIC patient data was used to determine the number of patients eligible for staging. In 12 months prior to the intervention, 36% (n = 414/1164) of patients eligible for staging were staged in the structured staging module. After the intervention, the 6- and 12-month staging rates were 60% (n = 836/1387) and 68% (n = 1084/1585), respectively, suggesting an absolute improvement of 89% in structured stage entry. Conclusions: Performance feedback to oncology providers resulted in behavior change and dramatically improved rates of structured cancer staging. Availability of such structured data is essential for development, implementation and evaluation of various quality improvement interventions and strategies such as quality reporting, outcomes analysis, practice patterns, and other population health initiatives. Incremental and large-scale improvement in care processes and outcomes may be achieved through such individual-level feedback mechanisms and contribute to learning health care systems.
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Affiliation(s)
| | | | - David W. Dougherty
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
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26
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Dougherty DW, Scarsella E, Clarke T, Alvino E, Rich L, Goonan S, Mietus K, Wade N, Alongi A, Bobry M, Guancial EA, Blaney M, Amport SB, Pandya C. Improving cancer treatment handoffs: Wilmot Cancer Institute’s (WCI) ASCO Quality Training Program experience. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.139] [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
139 Background: Ineffective handoffs contribute to gaps in patient care and medication errors, jeopardizing patient safety and leading to poor quality of care. Ineffective handoffs accounted for 59% of reported medication events at WCI Infusion Center. The completion rate of WCI’s existing electronic medical record (EMR) based free text handoff note for patients treated with anti-cancer therapy on the same day as a clinic visit was 32%. The project aim is to create an effective EMR integrated treatment handoff tool and establish standard workflow processes to ensure optimal communication among WCI providers for improved patient safety and quality of care. Methods: We convened a multidisciplinary team to develop an efficient and safe treatment handoff tool. WCI nurses were surveyed to evaluate the baseline state of the handoff process. Tool development was performed over a series of phases, including creation of a project charter and aim statement, outlining current workflow process, identifying gaps and limitations in the process, identifying potential causes of ineffective hand-off and using a Pareto chart to prioritize them. Utilizing the Situation-Background-Assessment-Recommendation framework, an EMR-integrated handoff tool with standardized workflow process was developed, along with an educational plan for the tool. Results: 52% (N = 22/42) of nurses found the current handoff note to be ineffective at preventing errors and 48% (N = 20/42) identified incomplete or missing information as a significant factor for ineffective communication. Other barriers identified included poor note design, lack of standardization in workflow and variation in note use. During the 1 week implementation of the new handoff tool, the utilization rate was 100% (N = 32) with completion rate of 41% (13 of 32). Further data collection is ongoing and nursing perception of the new tool will be evaluated at 3 months. Conclusions: Multidisciplinary stakeholders’ guided development and implementation of an EMR-integrated treatment handoff tool to optimize the communication between cancer care providers during patient transition is associated with improvement in handoff tool utilization and communication.
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Affiliation(s)
- David W. Dougherty
- Wilmot Cancer Institute/University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Lynn Rich
- Wilmot Cancer Institute, Rochester, NY
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Lowenstein LM, Mohile SG, Gil HH, Pandya C, Hemmerich J, Rodin M, Dale W. Which better predicts mortality among older men, a prostate cancer (PCa) diagnosis or vulnerability on the Vulnerable Elders Survey (VES-13)? A retrospective cohort study. J Geriatr Oncol 2016; 7:437-443. [PMID: 27480793 DOI: 10.1016/j.jgo.2016.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/19/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Older men with a prostate cancer (PCa) diagnosis face competing mortality risks. Little is known about the prevalence of vulnerability and predictors of mortality in this population compared to men without a PCa diagnosis. We examined the predictive utility of the Vulnerable Elders Survey (VES-13) for mortality in older men with a PCa diagnosis as compared to controls. MATERIALS AND METHODS Men aged ≥65years from an urban geriatrics clinic completed the VES-13 between 2003 and 2008. Each patient with a PCa diagnosis was matched by age to five controls, resulting in 59 patients with a PCa diagnosis and 318 controls. Cox proportional hazard models were used to determine the association of a PCa diagnosis and vulnerability on the VES-13 with mortality. RESULTS AND CONCLUSIONS The mean age for men with a PCa diagnosis and controls was 77.9years and 76.1years, respectively. Of those with a PCa diagnosis, 74.6% had no active disease or a rising PSA only. Regardless of PCa diagnosis, vulnerable individuals on the VES-13 were more likely to die during the study period (VES-13≥3: HR=4.46, p<0.01; VES13≥6: HR=3.77, p<0.01). Men with a PCa diagnosis were not more likely to die compared to age-matched controls (VES-13≥3: HR=1.14, p=0.59; VES13≥6: HR=1.06, p=0.83). Vulnerability for men with a PCa diagnosis was more predictive of mortality. Therefore, the assessment of vulnerability is important for establishing goals of care.
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Affiliation(s)
- Lisa M Lowenstein
- James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA.
| | - Supriya G Mohile
- James Wilmot Cancer Center, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA
| | - Heather Hopkins Gil
- Division of Geriatrics and Aging, University of Rochester, 435 East Henrietta Road, Rochester, NY 14620, USA
| | - Chintan Pandya
- Department of Public Health Sciences, University of Rochester, 265 Crittenden Blvd., Rochester, NY 14642, USA
| | - Joshua Hemmerich
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, 5841 South Maryland Ave., MC, 6098, Chicago, IL, USA
| | - Miriam Rodin
- Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd., St. Louis, MO. 63104, USA
| | - William Dale
- Department of Medicine, Section of Geriatrics and Palliative Medicine, University of Chicago, 5841 South Maryland Ave., MC, 6098, Chicago, IL, USA
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Magnuson A, Pandya C, Lemelman T, Goodman M, Dale W, Mohile SG. A Randomized Study of Geriatric Assessment with Management (GAM) in Older Adults with Cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Loh KP, Magnuson A, Dale W, Velarde C, Pandya C, Heckler CE, Hurria A, Mustian KM, Hopkins JO, Liu J, King DM, Peri S, Morrow GR, Mohile SG. Association of patient age, function and cognition with cancer treatment decisions: A University of Rochester NCORP study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kah Poh Loh
- University of Rochester Medical Center, Rochester, NY
| | | | | | - Carla Velarde
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Judith O. Hopkins
- NRG Oncology/NSABP, and SCOR NCORP and the Forsyth Regional Cancer Center, Winston Salem, NC
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Pandya C, Magnuson A, Dale W, Lowenstein L, Fung C, Mohile SG. Association of falls with health-related quality of life (HRQOL) in older cancer survivors: A population based study. J Geriatr Oncol 2016; 7:201-10. [PMID: 26907564 DOI: 10.1016/j.jgo.2016.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 09/08/2015] [Revised: 12/04/2015] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association between falls and health-related quality of life (HRQOL) in older cancer survivors. MATERIALS AND METHODS Using the 2006-2011 Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey (SEER-MHOS) linkage database, a cross-sectional analysis was performed including 17,958 older cancer survivors. Multivariable regression models were used to evaluate the association of falls with HRQOL measured by the physical component summary (PCS) and mental component summary (MCS) scores on the Veteran RAND 12-item health survey after controlling for demographic, health- and cancer-related factors. A longitudinal analysis using the analysis of covariance (ANCOVA) models was also conducted comparing changes in HRQOL of older cancer survivors who fell with HRQOL of older patients with cancer who did not fall. RESULTS In the cross-sectional analysis, 4524 (25%) cancer survivors who fell reported a significantly lower PCS (-2.18; SE=0.16) and MCS (2.00; SE=0.17) scores compared to those who did not (N=13,434). In the longitudinal analysis, after adjusting for baseline HRQOL scores and covariates, patients who fell reported a decline in mean HRQOL scores of both PCS (-1.54; SE=0.26) and MCS (-1.71; SE=0.27). Presence of depression, functional impairment and comorbidities was significantly associated with lower HRQOL scores. CONCLUSION Falls are associated with lower HRQOL scores and are associated with a significant prospective decline in HRQOL in older cancer survivors. Further research is necessary to determine if assessment and intervention programs can help improve HRQOL by reducing the likelihood of falls.
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Affiliation(s)
- Chintan Pandya
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Allison Magnuson
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - William Dale
- Division of Geriatrics and Palliative Care, University of Chicago, Chicago, IL, USA
| | - Lisa Lowenstein
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Chunkit Fung
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Supriya G Mohile
- Division of Medical Oncology, James Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA.
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Kilari D, Iczkowski KA, Pandya C, Robin AJ, Messing EM, Guancial E, Kim ES. Copper Transporter-CTR1 Expression and Pathological Outcomes in Platinum-treated Muscle-invasive Bladder Cancer Patients. Anticancer Res 2016; 36:495-501. [PMID: 26851002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND/AIM Platinum (Pt)-based neoadjuvant chemotherapy (NAC) is the standard-of-care for muscle-invasive bladder cancer (MIBC). However, the survival benefit with NAC is driven by patients with pathological response at cystectomy. Non-responders are subject to adverse effects of Pt, with delay in definitive treatment. Copper transporter receptor 1 (CTR1) plays an important role in Pt uptake and the level of expression may influence Pt sensitivity. We hypothesized that tumor CTR1 expression correlated with pathological outcome. PATIENTS AND METHODS We identified matched paraffin-embedded tissues from pre-NAC transurethral bladder tumor resection (TURBT) and post-NAC radical cystectomy (RC) specimens in 47 patients with MIBC who received Pt-based NAC. Tumor and adjacent normal tissues were stained with CTR1 antibody. CTR1 expression was determined through immunohistochemistry by two pathologists blinded to the outcome (0=undetectable; 1+=barely detectable; 2+=moderate; and 3+=intense staining). Pathological response was defined as either down-staging to non-MIBC (≤pT1N0M0) or complete pathological response (pT0). Pathological outcome was compared between the CTR1 expression groups. RESULTS Forty-three percent of TURBT and 41% of RC specimens expressed a CTR1 score of 3+. Forty-four percent of patients had a pathological response to NAC, and 17% had pT0 disease at cystectomy. In both pre-NAC TURBT and post-NAC RC specimens, a CTR1 expression score of 3+ correlated with pathological response (p=0.0076 and p=0.023, respectively). CONCLUSION This is the first study to demonstrate a correlation between CTR1 tumor expression and pathological outcome in Pt-treated MIBC. These findings suggest that CTR1 expression may be a biomarker for Pt sensitivity.
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Affiliation(s)
- Deepak Kilari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
| | | | - Chintan Pandya
- Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Adam J Robin
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, U.S.A
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Elizabeth Guancial
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - Eric S Kim
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
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Gewandter JS, Dale W, Magnuson A, Pandya C, Heckler CE, Lemelman T, Roussel B, Ifthikhar R, Dolan J, Noyes K, Mohile SG. Associations between a patient-reported outcome (PRO) measure of sarcopenia and falls, functional status, and physical performance in older patients with cancer. J Geriatr Oncol 2015; 6:433-41. [PMID: 26365897 DOI: 10.1016/j.jgo.2015.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 03/04/2015] [Revised: 06/13/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In older patients with cancer, we aimed to investigate associations between a patient-reported outcome measure for sarcopenia (SarcoPRO) and the Short Physical Performance Battery (SPPB), self-reported falls, and limitations in instrumental activities of daily living (IADLs). MATERIALS AND METHODS Assessments were conducted as part of the initial evaluation of older, often frail, patients with cancer seen in the Specialized Oncology Care and Research in the Elderly (SOCARE) clinic. Univariate associations were evaluated using Spearman's correlation and Wilcoxon sign ranked tests. Logistic regressions were used to identify associations of clinical factors and SarcoPRO scores or SPPB scores with falls and IADL limitations. RESULTS In total, 174 older patients with cancer were evaluated. A moderate correlation was found between the SarcoPRO and the SPPB (ρ=0.62). After adjusting for multiple clinical factors, neither the SarcoPRO nor the SPPB were associated with falls. In contrast, both higher SarcoPRO (i.e., worse) and lower SPPB (i.e., worse) scores were associated with limitations in IADLs (odds ratio for one unit change in predictor: SarcoPRO: 1.06, p<0.0001; SPPB: 0.71, p=0.003, respectively). Models using the SarcoPRO and SPPB explained similar amounts of variability in association with IADL limitations (AUC: 0.88 vs. 0.87, respectively). CONCLUSIONS The SarcoPRO was moderately associated with the SPPB, an objective measure of physical performance, and was associated with limitations in IADLs. Thus, older patients with cancer who present with IADL limitations should be screened for sarcopenia. The SarcoPRO shows promise as a measure for screening as well as outcome assessment for research on sarcopenia.
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Affiliation(s)
- Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester, Box 601 Elmwood Ave, Rochester, NY 14642, USA.
| | - William Dale
- Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Allison Magnuson
- James Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
| | - Chintan Pandya
- Department of Public Health Sciences, University of Rochester, Rochester, NY 14642, USA
| | - Charles E Heckler
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA
| | - Tatyana Lemelman
- James Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
| | - Breton Roussel
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
| | | | - James Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY 14642, USA
| | - Katia Noyes
- Departments Surgery and of Public Health Sciences, University of Rochester, Rochester, NY 14642, USA
| | - Supriya G Mohile
- James Wilmot Cancer Institute, University of Rochester, Rochester, NY 14642, USA
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Mohile SG, Velarde C, Hurria A, Magnuson A, Lowenstein L, Pandya C, O’Donovan A, Gorawara-Bhat R, Dale W. Geriatric Assessment-Guided Care Processes for Older Adults: A Delphi Consensus of Geriatric Oncology Experts. J Natl Compr Canc Netw 2015; 13:1120-30. [PMID: 26358796 PMCID: PMC4630807 DOI: 10.6004/jnccn.2015.0137] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Structured care processes that provide a framework for how oncologists can incorporate geriatric assessment (GA) into clinical practice could improve outcomes for vulnerable older adults with cancer, a growing population at high risk of toxicity from cancer treatment. We sought to obtain consensus from an expert panel on the use of GA in clinical practice and to develop algorithms of GA-guided care processes. METHODS The Delphi technique, a well-recognized structured and reiterative process to reach consensus, was used. Participants were geriatric oncology experts who attended NIH-funded U13 or Cancer and Aging Research Group conferences. Consensus was defined as an interquartile range of 2 or more units, or 66.7% or greater, selecting a utility/helpfulness rating of 7 or greater on a 10-point Likert scale. For nominal data, consensus was defined as agreement among 66.7% or more of the group. RESULTS From 33 invited, 30 participants completed all 3 rounds. Most experts (75%) used GA in clinical care, and the remainder were involved in geriatric oncology research. The panel met consensus that "all patients aged 75 years or older and those who are younger with age-related health concerns" should undergo GA and that all domains (function, physical performance, comorbidity/polypharmacy, cognition, nutrition, psychological status, and social support) should be included. Consensus was met for how GA could guide nononcologic interventions and cancer treatment decisions. Algorithms for GA-guided care processes were developed. CONCLUSIONS This Delphi investigation of geriatric oncology experts demonstrated that GA should be performed for older patients with cancer to guide care processes.
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Affiliation(s)
- Supriya Gupta Mohile
- James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620
| | - Carla Velarde
- James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620
| | - Arti Hurria
- City of Hope Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010
| | - Allison Magnuson
- James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620
| | - Lisa Lowenstein
- James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620
| | - Chintan Pandya
- James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620
| | | | - Rita Gorawara-Bhat
- Section of Geriatrics and Palliative Medicine, University of Chicago, MC6098, 5841 S. Maryland Avenue, Chicago, IL 60637
| | - William Dale
- Section of Geriatrics and Palliative Medicine, University of Chicago, MC6098, 5841 S. Maryland Avenue, Chicago, IL 60637
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Kilari D, Iczkowski K, Pandya C, Robin A, Guancial E, Kim E. 417 Association between copper transporter CTR1 expression and pathologic response in cisplatin (pt)-treated muscle invasive bladder cancer (MIBC) patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30251-9] [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] [Indexed: 10/22/2022]
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Magnuson A, Pandya C, Dale W, Lowenstein L, Fung C, Mohile SG. Association of falls with health related quality of life (HRQOL) in older cancer patients: A population based longitudinal study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Chunkit Fung
- Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
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Abstract
The leaf and stem of cordia macleodii plant were investigated for evaluating antibacterial and antifungal properties.Different extracts of leaf and stem viz. double distilled water, methanol, ethyl acetate ane n-hexane were collectedand content was optimized for the maximum amount of extraction with varying time of 6 and 12 h. The extracts weretested for their antimicrobial activities against gram-positive bacteria (B. sutilis), gram-negative bacteria (E. coli) andfungi (A. niger). The extracts were found to be more active against bacteria as compared to fungi. It was also observedthat the antibacterial and antifungal potential of the water extracts were found to be excellent as 1A (38 mm) and 1B (22mm) compared to the other extracts.
Graphical Abstract:
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Flannery MA, Pandya C, Tejani MA, Kamen CS, Magnuson A, Dale W, Morrow GR, Mohile SG. Palliative care needs: Symptom reporting during geriatric oncology evaluation. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.31_suppl.184] [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
184 Background: Although extensive descriptive work has been conducted on the symptom experience in cancer, relatively little is known about the specific palliative care needs for geriatric oncology populations. When all age groups are studied older individuals report less symptoms and the symptom experience of older cancer patients is minimized. Utilizing data collected from two geriatric oncology referral clinics the primary aim of this study was to identify geriatric oncology patients’ symptom reports, the number of symptoms experienced, and interference reported from symptoms. Methods: Patients referred to a geriatric oncology consult clinic were asked to complete the MD Anderson Symptom Inventory (MDASI) total of 13 items. In addition all patients underwent comprehensive geriatric assessment with a battery of tests. Results: 192 patients completed the symptom inventory with a median age of 81 years (range 65-95). 94% of patients reported at least one symptom, >45% reported experiencing 10 of the 13 symptoms (mean number of symptoms =5.7, SD= 3.7). Most frequently reported symptoms were in order: drowsiness, trouble remembering, dry mouth, disturbed sleep, pain, distress, decreased appetitive, dyspnea, and sadness. Severity ratings for individual symptoms M’s= 0.3-2.5, although the complete range of 0-10 was reported. 67% of patients reported that symptoms were interfering with their quality of life, general activity level and walking ability. Conclusions: In contrast to the myth that older cancer patients have minimal symptoms, at time of referral to a geriatric oncology consultation patients report on average experiencing six symptoms which interfere with their quality of life. There is an intersection between geriatric oncology and palliative care and these descriptive findings highlight the importance of systematic symptom assessment for older individuals with cancer to identify needed symptom relief strategies.
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Affiliation(s)
| | | | | | | | | | - William Dale
- University of Chicago Medical Center, Chicago, IL
| | - Gary R. Morrow
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
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Magnuson A, Pandya C, Dale W, Wallace J, Flannery M, Mohile S. Higher symptom burden is associated with functional impairment and falls in older adults with cancer. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.108] [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] [Indexed: 11/26/2022]
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Pandya C, Hashmi S, Khera N, Gertz MA, Dispenzieri A, Hogan W, Siddiqui M, Noyes K, Kumar SK. Cost-effectiveness analysis of early vs. late autologous stem cell transplantation in multiple myeloma. Clin Transplant 2014; 28:1084-91. [PMID: 25040732 DOI: 10.1111/ctr.12421] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autologous stem cell transplant (ASCT) is the current standard of care for most patients with multiple myeloma (MM) who are transplant eligible, yet the timing of ASCT is disputed due to a similar overall (OS) and progression-free survival with an early ASCT (eASCT) or a delayed ASCT (dASCT) approach. OBJECTIVE We developed a decision analytic model to perform cost-effectiveness analysis of the two commonly used treatment strategies for MM. METHODS Data on disease progression and treatment effectiveness came from 2001 to 2008 cohort treated at the Mayo Clinic and from published studies. Cost analysis was performed from a third-party payer perspective. RESULTS The Consumer Price Index adjusted 2012 costs of eASCT and dASCT were $249 236 and $262 610, respectively. eASCT cohort had a benefit of 1.96 quality-adjusted life years (QALYs), 0.23 QALYs more than dASCT, implying that eASCT is preferred (dominant) over dASCT. The most critical variables in one-way sensitivity analysis were treatment-related mortality and OS associated with eASCT strategy. CONCLUSIONS We conclude that eASCT could potentially be a relatively cost-effective treatment option for appropriate patients with MM, and these results would help patients, providers, and payers in decision making for timing of ASCT.
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Affiliation(s)
- Chintan Pandya
- Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
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Kilari D, Iczkowski K, Robin A, Pandya C, Bylow KA, Langenstroer P, Messing EM, Guancial EA, Kim ES. Association between copper transporter receptor 1(CTR1) expression and pathologic outcomes in cisplatin (Pt)-treated bladder cancer (BC) patients. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Adam Robin
- Medical College of Wisconsin, MILWAUKEE, WI
| | | | | | | | | | | | - Eric S. Kim
- University of Rochester Medical Center, Rochester, NY
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Magnuson A, Pandya C, Mohile SG. Factors associated with falls in older patients with cancer: A cross-sectional study of Medicare beneficiaries. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20514] [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: 11/20/2022] Open
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Fung C, Pandya C, Guancial E, Noyes K, Sahasrabudhe DM, Messing EM, Mohile SG. Impact of bladder cancer on health related quality of life in 1,476 older Americans: a cross-sectional study. J Urol 2014; 192:690-5. [PMID: 24704007 DOI: 10.1016/j.juro.2014.03.098] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The impact of bladder cancer diagnosis on health related quality of life is poorly understood. We compared health related quality of life measures in patients before and after bladder cancer diagnosis. MATERIALS AND METHODS We performed a cross-sectional study in 1,476 patients 65 years old or older with bladder cancer in the SEER-MHOS linkage database between 1998 and 2007 to assess differences in physical and mental component summary scores in 620 and 856 who completed a survey before and after bladder cancer diagnosis, respectively. To determine differences in physical and mental scores in the prediagnosis and post-diagnosis cohorts, we used ANOVA adjusting for baseline covariates. RESULTS There were statistically significant differences in physical and mental component summary scores between the prediagnosis and post-diagnosis groups (-2.7, 95% CI -3.8, -1.7 vs -1.4, 95% CI -2.6, -0.3). In patients with nonmuscle invasive bladder cancer the physical and mental score differences were -1.9 (p <0.01) and -1.4 (p = 0.01), respectively. In those with muscle invasive bladder cancer there was a statistically and clinically significant difference in the physical but not the mental score (-5.3, p <0.01 vs -2.7, p = 0.07). This difference in the physical domain persisted up to 10 years after the diagnosis of muscle invasive bladder cancer. Patients with bladder cancer who had 4 or more comorbid medical conditions and 1 or more deficits in daily living activity were most at risk for low physical component summary scores. CONCLUSIONS Future research into interventions to improve health related quality of life and methods to incorporate health related quality of life into decision making models are critical to improve outcomes in older patients with bladder cancer.
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Affiliation(s)
- Chunkit Fung
- Division of Medical Oncology, University of Rochester Medical Center, Rochester, New York.
| | - Chintan Pandya
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Elizabeth Guancial
- Division of Medical Oncology, University of Rochester Medical Center, Rochester, New York
| | - Katia Noyes
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Deepak M Sahasrabudhe
- Division of Medical Oncology, University of Rochester Medical Center, Rochester, New York
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Supriya G Mohile
- Division of Medical Oncology, University of Rochester Medical Center, Rochester, New York
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Fung C, Pandya C, Guancial EA, Noel S, Noyes K, Sahasrabudhe DM, Messing EM, Scosyrev E, Mohile SG. Changes in health-related quality of life (HRQL) after bladder cancer (BC) diagnosis (DX): A longitudinal population-based study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.317] [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
317 Background: Few studies have examined longitudinal changes in HRQL among BC patients. To our knowledge, this is the largest prospective population-based study to quantify HRQL changes from before to after BC DX and to compare their HRQL with a non-cancer cohort. Methods: Our sample included 179 BC patients (≥ age 65) and 376,986 non-cancer subjects within the SEER-Medicare Health Outcomes Survey database (1998-2007). We assessed HRQL as measured by physical (PCS) and mental (MCS) component summary scores of the veterans RAND 12-item health survey. An analysis of covariance model was used to estimate changes in HRQL scores for patients after BC DX relative to control subjects with adjustment for baseline HRQL scores and covariates. Results: 84.4% (N=151) of BC patients had non-muscle invasive BC (NMIBC) and 15.6% (N=28) had muscle invasive BC (MIBC). 49.2% and 39.1% of BC patients had ≥2 comorbid conditions and ≥1 activities of daily living (ADL) deficit, respectively. Compared to the control subjects, more BC patients were men (67.0% vs 38.5%; P<0.01), current or former smokers (58.7% vs 37.3%; P<0.01), and had income ≥ $50,000(15.1% vs 8.8%; P=0.02). Other baseline demographic and socioeconomic characteristics were similar (P>0.05). After DX, BC patients reported a significant decline in PCS (1.9; 95% CI 0.1, 3.7) score compared to non-cancer controls whereas the decrease in MCS score (1.4; 95% CI -0.1, 3.0) was not statistically significant. For those with NMIBC, HRQL was not significantly different than that of the non-cancer cohort (P>0.05) after DX. However, the PCS and MCS scores of MIBC patients decreased by 5.3 (95% CI 0.9, 9.8) and 3.8 points (95% CI -0.1, 7.7) after DX, respectively. Older age at BC DX, lower educational and income levels, smoking history, and higher numbers of comorbid conditions and ADL deficits were significantly associated with inferior PCS and MCS scores after BC DX (P<0.01). Conclusions: Treatment-related side effects and/or symptoms due to BC adversely affect HRQL of BC patients, especially in those with MIBC, and should be consistently assessed by health care providers. Future research that examines interventions to improve HRQL is critical to improve BC care.
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Affiliation(s)
- Chunkit Fung
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | | | - Shri Noel
- University of Rochester Medical Center, Rochester, NY
| | - Katia Noyes
- Department of Surgery and Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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Fung C, Pandya C, Noyes K, Scosyrev E, Sahasrabudhe DM, Messing EM, Mohile SG. Impact of bladder cancer (BC) on health-related quality of life (HRQL) in 1,476 older Americans. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.9549] [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
9549 Background: The impact of BC on HRQL is poorly understood. To our knowledge, this is the first and largest cross-sectional study that compares HRQL of patients before and after BC diagnosis (DX). Methods: Our sample included 1,476 BC patients (≥ age 65) within the SEER-Medicare Health Outcomes Survey linkage database (1998-2007). We assessed differences in HRQL as measured by SF-36 physical (PCS) and mental (MCS) summary scores in patients who had a survey >1 yr before BC DX (n=620) and those who had a survey after BC DX (n=856). We compared groups by year from BC DX using regression analyses and results were adjusted for cancer stage, race, gender, age at BC DX, marital status, education, income, smoking status, activity of daily living (ADLs), and non-cancer comorbidities. Results: Patients who had a survey after BC DX were diagnosed with BC at an older age than those with a survey before BC DX (55.9% at age ≥75 yr vs. 36.8%; P<0.01). Other baseline demographic and socioeconomic characteristics were similar. Baseline HRQL were poor in patients before DX (PCS mean=40.1; MCS mean=51.1) with 50.6% and 31.9% of them having comorbidity score ≥2 and impairment of ≥1 ADLs, respectively. After BC DX, significant decreases in PCS (-2.7; 95% CI -3.8,-1.7) and MCS (-1.4; 95% CI -2.6, -0.3) were observed, with HRQL being lowest in those who had BC DX within 1 yr (PCS mean= 36.6; MCS mean=49.7). Declines in PCS during the <1, 1-3, 3-5, 5-10, and 10+ yr periods after BC DX compared to before BC DX were -3.8 (P<0.01), -2.5 (P<0.01), -2.2 (P=0.01), -1.1 (P=0.19) and -0.8 (P=0.57) whereas decreases in MCS were -2.0 (P=0.01), -2.2 (P<0.01), -1.2 (P=0.21), -0.1 (P=0.92), -0.8 (P=0.62) respectively. More advanced BC, lower educational level, higher comorbidity score, and impaired ADLs were significantly associated with both worse PCS and MCS after BC DX (P<0.05). Lower income and older age at BC DX showed significant association with low PCS (P<0.05). Conclusions: Older BC patients are a vulnerable population with poor baseline HRQL. HRQL of patients after BC DX is significantly worse than HRQL of patients before DX, possibly due to therapy and/or disease progression. Future research that evaluates interventions to improve HRQL in older patients with BC is critical.
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Affiliation(s)
- Chunkit Fung
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Katia Noyes
- Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY
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Kilari D, Pandya C, Fung C, Sahasrabudhe DM, Brasacchio RA, Messing EM, Sievert L, Mohile SG. Characteristics and outcomes of elderly patients with systemic prostate cancer (PCa) treated with peripheral androgen blockade (PAB). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.226] [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
226 Background: The side effect profile of androgen deprivation (ADT) warrants exploration of alternative options for elderly patients with systemic PCa. In phase 2 trials, the combination of anti-androgen and 5 alpha reductase inhibitor (PAB) demonstrated efficacy with low morbidity in the fit population. The objective of this retrospective study was to evaluate the characteristics and outcomes of elderly patients treated with PAB in lieu of ADT. Methods: We reviewed records of patients ≥65 yrs who received PAB in the geriatric oncology program from 2007-2012. Patients were evaluated with a validated comprehensive geriatric assessment (CGA) prior to PAB. Descriptive statistics were used to evaluate PAB type, characteristics of patients and their cancers, as well as PCa –specific and overall outcomes Results: Twenty-one asymptomatic PCa patients received PAB (bicalutamide alone-57%, or bicalutamide and finasteride-43%) in lieu of ADT. Indications for treatment were metastatic disease (53%) or biochemical relapse with PSA doubling time≤ 6 months (47%). Median age at the initiation of PAB was 86 years (range 65-94) and 76 % had ECOG PS≥ 2. By CGA, 57 % were vulnerable, 33% frail and 10% fit. 76% had contraindications for standard ADT (e.g., dementia, falls, etc.); the rest declined ADT due to concern about adverse effects (AE). The median PSA at PAB initiation was 14.78 (range 0.9-165.8). PSA nadir (i.e. 1st of 3 consecutive PSA levels where values were within 90%) was reached in 57% of patients at the time of analysis with the remainder demonstrating a continuing decline. Median PSA at nadir was 0.86(range 0.02-11.24). The median follow up time was 11 months (range 1-30). The median time to PSA nadir was 5 months; (range 1-19). PSA nadir was maintained for median of 10.5 months (range 3-24).The median % decline in PSA was 92 % (range 13-99%).No patients reported AE or required treatment interruption. Two fit patients of the 4 who progressed on PAB responded to subsequent ADT. Conclusions: These results provide evidence that PAB is feasible, active and well tolerated in patients for whom ADT may be contraindicated. A prospective phase II study for an older vulnerable patient population is planned.
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Affiliation(s)
| | | | - Chunkit Fung
- University of Rochester Medical Center, Rochester, NY
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Hashmi S, Pandya C, Khera N, Gertz M, Dispenzieri A, Hogan W, Siddiqui M, Noyes K, Kumar S. Cost Effectiveness Decision Tree Analysis of Early Versus Late Autologous Stem Cell Transplantation (ASCT) in Multiple Myeloma (MM) in the United States (US). Biol Blood Marrow Transplant 2013. [DOI: 10.1016/j.bbmt.2012.11.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaphingst KA, Goodman M, Pandya C, Garg P, Stafford J, Lachance C. Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population. Patient Educ Couns 2012; 88:291-7. [PMID: 22197261 PMCID: PMC3443406 DOI: 10.1016/j.pec.2011.11.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 11/07/2011] [Accepted: 11/27/2011] [Indexed: 05/04/2023]
Abstract
OBJECTIVE Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information. METHODS 1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors. RESULTS Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p =.012) and heart disease (p < .001), seek health information frequently in newspapers (p < .001) and in general (p < .001), and be female (p < .001). Patients who talked frequently with doctors about FHH were more likely to report a family history of heart disease (p = .011), meet physical activity recommendations (p = .022), seek health information frequently in newspapers (p < .001) and in general (p < .001), be female (p < .001), and not have experienced racial discrimination in healthcare (p < .001). CONCLUSION Patients with a family history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions. PRACTICE IMPLICATIONS Interventions are needed to encourage providers to update patients' family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control.
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Affiliation(s)
- Kimberly A Kaphingst
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
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Pillai P, Pandya C, Bhatt N, Gupta SS. Biochemical and reproductive effects of gestational/lactational exposure to lead and cadmium with respect to testicular steroidogenesis, antioxidant system, endogenous sex steroid and cauda-epididymal functions. Andrologia 2011; 44:92-101. [DOI: 10.1111/j.1439-0272.2010.01109.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pandya C, Pillai P, Nampoothiri LP, Bhatt N, Gupta S, Gupta S. Effect of lead and cadmium co-exposure on testicular steroid metabolism and antioxidant system of adult male rats. Andrologia 2011; 44 Suppl 1:813-22. [PMID: 21933223 DOI: 10.1111/j.1439-0272.2010.01137.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The mechanism of testicular toxicity of lead (Pb) and cadmium (Cd) is poorly understood. Previous studies focused on single metal-related changes in testicular toxicity. This study points towards the possible involvement of Pb- and Cd-induced oxidative stress in the suppression of steroidogenesis. The oxidative status of testis of adult male rats exposed to Pb acetate and cadmium acetate either alone or in combination at a dose of 0.025 mg kg(-1) body weight of metal intraperitoneally for 15 days was studied. Pb and Cd caused an increase in reactive oxygen species (ROS) by elevating testicular malondialdehydes (MDA) and decrease in activities of testicular antioxidant enzymes superoxide dismutase (SOD), catalase, glucose 6 phosphate dehydrogenase (G6PDH) and glutathione-S-transferase (GST) in mitochondrial and/or post-mitochondrial fraction. Activities of steroidogenic enzymes 3β and 17β-hydroxysteroid dehydrogenase also decreased significantly leading to altered testosterone production. Metal-exposed groups showed significantly decreased testicular and epididymal sperm count. Epididymal sperm motility and viability was also decreased on Pb and Cd exposure. Cd exposure showed more toxic effect than lead exposure, while combined exposure demonstrated least toxicity. In vitro experiments showed that vitamin C restores steroidogenic enzyme activities, suggesting that Pb- and Cd-induced ROS inhibits the testicular steroidogenesis.
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Affiliation(s)
- C Pandya
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
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Ashida S, Goodman M, Pandya C, Koehly LM, Lachance C, Stafford J, Kaphingst KA. Age differences in genetic knowledge, health literacy and causal beliefs for health conditions. Public Health Genomics 2010; 14:307-16. [PMID: 20829577 PMCID: PMC3136390 DOI: 10.1159/000316234] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study examined the levels of genetic knowledge, health literacy and beliefs about causation of health conditions among individuals in different age groups. METHODS Individuals (n = 971) recruited through 8 community health centers in Suffolk County, New York, completed a one-time survey. RESULTS Levels of genetic knowledge were lower among individuals in older age groups (26-35, p = 0.011; 36-49, p = 0.002; 50 years and older, p<0.001) compared to those in the youngest age group (18-25). Participants in the oldest age group also had lower health literacy than those in the youngest group (p <0.001). Those in the oldest group were more likely to endorse genetic (OR = 1.87, p = 0.008) and less likely to endorse behavioral factors like diet, exercise and smoking (OR = 0.55, p = 0.010) as causes of a person's body weight than those in the youngest group. Higher levels of genetic knowledge were associated with higher likelihood of behavioral attribution for body weight (OR = 1.25, p <0.001). CONCLUSIONS Providing additional information that compensates for their lower genetic knowledge may help individuals in older age groups benefit from rapidly emerging genetic health information more fully. Increasing the levels of genetic knowledge about common complex diseases may help motivate individuals to engage in health promoting behaviors to maintain healthy weight through increases in behavioral causal attributions.
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Affiliation(s)
- S Ashida
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, USA.
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