Characteristics, management and outcome of prehospital pediatric emergencies by a Dutch HEMS

Abstract Background In prehospital care, the Helicopter Emergency Medical Service (HEMS) can be dispatched for critically injured or ill children. However, little detail is known about dispatches for children, in terms of the incidence of prehospital interventions and overall mortality. The primary objective of this study is to provide an overview of pediatric patient characteristics and incidence of interventions. Methods A retrospective chart review of all patients ≤ 17 years who received medical care by Rotterdam HEMS from 2012 until 2017 was carried out. Results During the study period, 1905 pediatric patients were included. 59.1% of patients were male and mean age was 6.1 years with 53.2% of patients aged ≤ 3 years. 53.6% were traumatic patients and 49.7% were non-traumatic patients. 18.8% of patients were intubated. Surgical procedures were performed in 0.9%. Medication was administered in 58.1% of patients. Cardiopulmonary resuscitation (CPR) was necessary in 12.9% of patients, 19.9% were admitted to the intensive care unit and 14.0% needed mechanical ventilation. Overall mortality was 9.5%. Mortality in trauma patients was 5.5% and in non-trauma group 15.3%. 3.9% of patients died at the scene. Conclusions Patients attended by HEMS are at high risk of prehospital interventions like CPR or intubation. EMS has little exposure to critically ill or injured children. Hence, HEMS expertise is required to perform critical procedures. Trauma patients had higher survival rates than non-traumatic patients. This may be explained by underlying illnesses in non-traumatic patients and CPR as reason for dispatch. Further research is needed to identify options for improving prehospital care in the non trauma pediatric patients.

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369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.564 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S254-S254

Author(s):

Victoria Bengualid ◽

Maria Martinez ◽

Zhenisa Hysenaj ◽

Debra M Willner ◽

Judith Berger

Keyword(s):

Oxygen Saturation ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Altered Mental Status ◽

Channel Blockers ◽

First Case ◽

Overall Mortality

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

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Chief Complaints, Diagnoses, and Medications Prescribed Seven Weeks Post-Katrina in New Orleans

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00005549 ◽

2008 ◽

Vol 23 (1) ◽

pp. 41-47 ◽

Cited By ~ 10

Author(s):

Erica Howe ◽

David Victor ◽

Eboni G. Price

Keyword(s):

Hurricane Katrina ◽

New Orleans ◽

Healthcare Delivery ◽

Retrospective Chart Review ◽

Central Business District ◽

Patient Characteristics ◽

Primary Objective ◽

Urgent Care ◽

Chief Complaints ◽

Post Disaster

AbstractBackground:In the aftermath of Hurricane Katrina, widespread flooding devastated the New Orleans healthcare system. Prior studies of post-hurri-cane healthcare do not consistently offer evidence-based recommendations for re-establishing patient care post-disaster. The primary objective of this study is to examine associations between patient characteristics, chief com-plaints, final diagnoses, and medications prescribed at a post-Katrina clinic to better inform strategic planning for post-disaster healthcare delivery (e.g., charitable donations of medications and medical supplies).Methods:This study is a retrospective chart review of 465 patient visits from 02 September 2005 to 22 October 2005 at a post-Katrina clinic in New Orleans, Louisiana that was open for seven weeks, providing urgent care services in the central business district. Using logistic regression, the relationships between patient characteristics (date of visit, gender, age, evacuation status), type of chief complaint, final diagnosis, and type of medication prescribed was examined.Results:Of 465 patients, 49.2% were middle-aged, 62.4% were men, 35% were relief workers, and 33.3% were evacuees; 35% of visits occurred in week five. Of 580 chief complaints, 71% were illnesses, 21% were medication refill requests, and 8.5% were injuries. Among 410 illness complaints, 25% were ears, nose, and throat (ENT)/dental, 17% were dermatologic, and 11% were cardiovascular. Most requested classes of medication refills for chronic medical conditions (n = 121) were cardiovascular (52%) and endocrine (24%).Most illness-related diagnoses (n = 400) were ENT/dental (18.2%), dermatologic (14.8%), cardiovascular (10.2%), and pul-monary (10.2%). Thirty-six percent of these diagnoses were infectious. Among 667 medications prescribed, 21% were cardiac agents, 13% pulmonary, 13% neurologic/musculoskeletal/pain, 11% antibiotics, 10% endocrine, and 9.3% anti-allergy. The likelihood of certain chief complaints, diagnoses, and medica-tions prescribed varied with patient characteristics.Conclusions:Donations of certain classes of medications were more useful than others. Prevalence of select co-morbidities, the nature of patient involve-ment in recovery activities in the disaster area, and post-disaster health haz-ards may explain variations in chief complaints, diagnoses, and medications prescribed by patient characteristics.

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Opioid Infusions in the Neonatal Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-15.2.142 ◽

2010 ◽

Vol 15 (2) ◽

pp. 142-146

Author(s):

Amanda Suarez ◽

David C. Knoppert ◽

David S. C. Lee ◽

Donna Pletsch ◽

Jamie A. Seabrook

Keyword(s):

Pain Assessment ◽

Neonatal Intensive Care ◽

Assessment Tool ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Primary Objective ◽

Procedural Pain ◽

Opioid Use ◽

Neonatal Pain ◽

Scale Scores

ABSTRACT OBJECTIVES The primary objective of this study was to compare the use of opioid infusions to that proposed in guidelines published in an in-house medication handbook. Secondary objectives were to assess the documented use of a standardized neonatal pain assessment tool and to describe the supplemental use of opioids concurrent with an opioid infusion. METHODS A retrospective chart review was performed for all patients in the NICU who received opioid infusions between November 1, 2005, and November 30, 2006. Data collected included patient characteristics, opioid infusion dosing and duration, supplemental opioid use, and pain assessment documentation. RESULTS Of the110 neonates who received morphine or fentanyl during the study period, 65 patients met inclusion criteria. Reasons for starting an opioid infusion included nonsurgical sedation and/or analgesia (51%), postoperative pain (17%), and procedural pain (1%). No reason was documented for 31% of patients. Thirtyeight percent of neonates received a loading dose of opioid before initiation of the infusion. The median dose was 100 mcg/kg (IQR=48.2) for morphine and and 1 mcg/kg (IQR=0.8) for fentanyl. The mean ± SD starting rates of morphine and fentanyl infusions were 12.3 ± 4.7 mcg/kg/hr and 1.5 ± 1.7 mcg/kg/hr, respectively. Supplemental opioid doses were given to 46% of neonates during the infusion period. Supplemental doses were given for procedures (69%) and pain/agitation/sedation (26%). No reason was documented for 5% of patients. The Neonatal Pain, Agitation and Sedation Scale scores were only documented 9% of the time for each day that the patient received an opioid infusion. CONCLUSIONS Dosing of opioids generally was within the recommendations that are described in the in-house medication handbook. A substantial percentage of neonates received supplemental opioid doses while on opioid infusions, mostly for procedural pain management. Documentation of the reason for using opioid infusions and the assessment of neonatal pain was poor.

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Safety and efficacy of fosaprepitant in pediatric patients for prevention of chemotherapy induced nausea and vomiting.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22023 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22023-e22023 ◽

Cited By ~ 1

Author(s):

Karissa N Kusick ◽

Madeline Waldron ◽

Anthony Zembillas ◽

Maya Wai ◽

Rabi Hanna ◽

...

Keyword(s):

Pediatric Patients ◽

Safety Evaluation ◽

Cost Savings ◽

Retrospective Chart Review ◽

Cost Effective ◽

Marrow Transplant ◽

Primary Objective ◽

Nausea And Vomiting ◽

Patients Âgés ◽

Cycle Basis

e22023 Background: Aprepitant is an antiemetic that antagonizes the substance P neurokinin-1 receptor. Fosaprepitant is an intravenous prodrug of aprepitant and is FDA-approved for the prevention of chemotherapy-induced nausea and vomiting (CINV) in adults. Although the FDA extended approval of oral aprepitant to children and adolescents for CINV, pediatric patients have challenges obtaining aprepitant due to insurance or have difficulty taking oral medications during chemotherapy. Fosaprepitant is a logical alternative but data are lacking for safe and effective dosing in children. In 2015, fosaprepitant was added to our hospital formulary for pediatric patients receiving moderate to highly emetogenic chemotherapy. The fosaprepitant dose established was 150mg for weight ≥30kg or 3mg/kg/dose for < 30kg. There is also potential for overall cost savings to our institution. Fosaprepitant is about half the cost of aprepitant using equivalent adult doses. Methods: This retrospective chart review was considered exempt from IRB.All pediatric patients who received fosaprepitant between April 2015 and October 2016 while inpatient were included.Patients undergoing bone marrow transplant were excluded from the study.The primary objective was to determine safety of fosaprepitant. To evaluate safety, incidence of infusion related reactions related to fosaprepitant administration were assessed. Secondary objectives include efficacy of fosaprepitant in pediatric patients and evaluation of cost savings. To evaluate efficacy, the use of breakthrough antiemetics, documented emesis, and Adapted Rhodes Index for Nausea and Vomiting score were collected. Descriptive statistics were used for all data analyses on a per cycle basis. Results: A preliminary safety evaluation of 20 patients ages 9 months through 16 years received 87 doses of fosaprepitant for CINV prophylaxis.Six patients < 30kg received weight-based dosing; the other 14 patients received a dose of 150mg.One patient experienced an infusion related reaction from fosaprepitant but symptoms resolved after the infusion was stopped. Conclusions: Fosaprepitant appears to be safe and cost-effective to prevent CINV in children.

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Outcomes of Elderly Patients with AML in the Hamilton Area: How Are We Doing?

Blood ◽

10.1182/blood.v112.11.4690.4690 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4690-4690

Author(s):

Sadiya Kukaswadia ◽

Tina Hsu ◽

Parveen Wasi

Keyword(s):

Elderly Patients ◽

Median Survival ◽

Myeloid Leukemia ◽

Survival Rates ◽

Age Groups ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Optimal Management ◽

Hematological Disorders ◽

One Year

Abstract Acute myeloid leukemia (AML) is the most common form of leukemia amongst adults. Elderly patients (i.e. over the age of 60) with AML consistently have poorer outcomes than their younger counterparts and very few guidelines exist on the optimal management of AML in this population. A retrospective chart review of patients 60 years of age or older diagnosed with AML was conducted to better define this population, identify biological and patient characteristics that predict outcomes with treatment, and determine factors influencing management decisions. A total of 142 patients diagnosed with AML between April 2002 and April 2007 were included. Patients were analyzed together, as well as in pre-specified age groups (60–65, 66–75, and >75 years). Patients ranged from 60 to 92 years old, with a median of 70 years. Very few patients had a favorable cytogenetic profile (3.5%) at the time of diagnosis (Table 1). In addition, 41.5% of patients had a preceding hematologic diagnosis. Of these, 61.0% had pre-existing myelodysplastic syndrome and 16.9% had chronic myeloid leukemia. The proportion of patients with secondary transformation increased with age (age 60–65 −25%; 65–75 −39%; >75 – 51.3%). Over 60% of patients were induced, with younger patients opting for induction more often (age 60–65 − 88.6%; 65–75 − 66.1%; >75 – 20.5%). The most commonly cited reasons for not treating were the presence of comorbidities (32.1%), patient preference (26.8%), age (17.9%), and preceding hematological conditions (16.1%). Only 25% of those treated were able to complete the entire course of treatment. Despite this, more than half (58.1%) of patients were able to attain remission. As expected, overall survival was dismal across all age groups with 10.6% surviving to one year. Median survival was 2 months with survival decreasing with increasing age (Table 2). With treatment one year survival increased to 15.1% with a median survival of 3.75 months (treated vs. untreated - 15.1% vs. 3.6%, p <0.005). This result was largely driven by survival in the 60–65 year age group, in whom those treated did significantly better than those who were not (1 year survival 20.5% vs. 0%, p <0.005; median 6 vs. 0.18 months). In terms of economic resources, patients who were induced had significantly more outpatient appointments (22.2 vs. 6.4, p <0.0001), hospital days (58.8 vs. 11.6, p <0.0001), and used more blood products (65.7 vs. 12.1, p <0.001), presumably due to increased survival in those who were treated. This dramatic difference between those treated and those who were palliated was seen both in patients age 60–65 and 66–75, but was markedly attenuated in patients older than 75. Our findings are consistent with previous studies. Elderly patients with AML do poorly, with worsening outcomes with increasing age, and survival that is measured in months. This may be due to the increasing prevalence of patients with preceding hematological disorders and secondary transformation with age, as well as poor cytogenetic profiles of this population. In addition, as age and comorbidities increase, more patients opt out of induction chemotherapy. Further research is needed to establish optimal management and improve outcomes of elderly patients with AML. Table 1: Cytogenetics All patients (n; % of patients) Age 60–65 years (n; % of patients) Age 66–75 years (n; % of patients) Age 76 years and greater (n; % of patients) No of Patients 142 44 59 39 Cytogenetics Unknown 40 (28.2%) 10 (22.7%) 11 (18.6%) 19 (48.7%) Favourable 5 (3.5%) 1 (2.3%) 2 (3.5%) 2 (5.1%) 12 Intermediate 59 (41.5%) 23 (52.3%) 24 (40.7%) (30.8%) 6 Unfavourable 38 (26.8%) 10 (22.7%) 22(37.3%) (15.4%) Table 2: Survival Rates All patients (n; % of patients) Age 60–65 years (n; % of patients) Age 66–75 years (n; % of patients) Age 76 years and greater (n; % of patients 1 year survival 15 (10.6%) 8 (18.2%) 5 (8.5%) 2 (5.1%) All 2/56 (3.6%) 0/5 (0%) 1/20 (5.0%) 1/31 (3.2%) Untreated 13/86 (15.1%) 8/39 (20.5%) 4/39 (10.3%) 1/8 (12.5%) Treated (p = 0.004) (p = 0.003) (p = 0.41) (p = 0.23) Median survival (months) 2 3 2 1 All 1 5.5 days 1.5 1 Untreated 3.75 2 6 2.9 Treated Lost to Follow Up 52 (36.3%) 17 (38.6%) 24 (40.7%) 11 (28.2%)

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Dexamethasone Use in the Treatment of Pediatric Deep Neck Space Infections

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419890349 ◽

2019 ◽

Vol 129 (4) ◽

pp. 376-379 ◽

Cited By ~ 1

Author(s):

James B. Tansey ◽

John Hamblin ◽

Madhu Mamidala ◽

Jerome Thompson ◽

Jennifer Mclevy ◽

...

Keyword(s):

Chart Review ◽

Primary Outcome ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

P Value ◽

Surgical Drainage ◽

Dexamethasone Group ◽

Deep Neck Space Infections

Objectives: Assess the outcome of Intravenous (IV) dexamethasone in the treatment of pediatric deep neck space infections (DNSI) in combination with IV antibiotics. Methods: Retrospective chart review of pediatric patients admitted for a DNSI from March 2014 to June 2016. Patient characteristics including demographics, abscess type, antibiotic, dexamethasone, surgery, culture, and length of stay (LOS) were obtained. Patients treated with antibiotics alone versus antibiotics and dexamethasone were compared. Primary outcome measures were rate of surgical drainage and LOS. Results: Overall 153 patients with DNSI were identified, including 62 lateral neck, 18 parapharyngeal, 40 peritonsillar, 32 retropharyngeal, and 1 submandibular. All patients received antibiotics. Dexamethasone was used in 35% of patients. The rate of surgical drainage in the dexamethasone and non-dexamethasone group was 36% and 53% respectively ( P = .043). LOS was shorter for the dexamethasone group (2.9 days) compared to the non-dexamethasone group (3.8 days) but was non-significant, P-value-.09. The most common microorganisms cultured were MRSA (25), MSSA (11), and Streptococcus pyogenes (10). Conclusion: Dexamethasone use was associated with a decreased rate of surgical drainage in pediatric patients with DNSI. Further prospective study is needed to determine the role of dexamethasone in treatment.

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Survival rates for adult trauma patients who require cardiopulmonary resuscitation

CJEM ◽

10.1017/s1481803500009234 ◽

2004 ◽

Vol 6 (04) ◽

pp. 263-265 ◽

Cited By ~ 7

Author(s):

Khaled Alanezi ◽

Farhan Alanzi ◽

Samir Faidi ◽

Sheila Sprague ◽

Margeritta Cadeddu ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Injury Severity ◽

Cardiopulmonary Arrest ◽

Survival Rates ◽

Vital Signs ◽

Hospital Setting ◽

Pulseless Electrical Activity ◽

Consecutive Series ◽

Trauma Patients ◽

Overall Mortality

ABSTRACTObjectives:To determine survival rates in adult trauma patients requiring cardiopulmonary resuscitation (CPR).Methods:We used 1992–2002 trauma registry data to identify all adult trauma patients over the age of 16 who required CPR in the pre-hospital setting or within 24 hours of arriving at the hospital. Demographic information, mechanism of injury, injury severity score (ISS), vital signs at the scene and in the hospital, and mortality were obtained from patient charts. Patients were stratified into 2 groups: those with absent vital signs in the field who required prehospital CPR, and those who lost vital signs within 24 hours of arriving at the trauma suite.Results:Of 50 eligible patients, 28 (58%) were male and 46 (92%) sustained blunt trauma. Mean age was 44.8 ± 20 years and mean ISS was 38 ± 18. Overall mortality was 96% (48/50), and all patients who required prehospital CPR died. The only 2 survivors were patients who arrived with vital signs and developed pulseless electrical activity while in the trauma suite.Conclusion:In this consecutive series of trauma victims with cardiopulmonary arrest there were no survivors among those who lost vital signs and required CPR prior to arriving at the hospital.

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Helicopter Emergency Medical Service and Hospital Treatment Levels Affect Survival in Pediatric Trauma Patients

Journal of Clinical Medicine ◽

10.3390/jcm10040837 ◽

2021 ◽

Vol 10 (4) ◽

pp. 837

Author(s):

Felix Marius Bläsius ◽

Klemens Horst ◽

Jörg Christian Brokmann ◽

Rolf Lefering ◽

Hagen Andruszkow ◽

...

Keyword(s):

Emergency Medical Service ◽

Medical Service ◽

Pediatric Patients ◽

Pediatric Trauma ◽

Helicopter Emergency Medical Service ◽

Trauma Patients ◽

Trauma Centers ◽

Emergency Medical ◽

Level Ii ◽

Level I

(1) Background: Data on the effects of helicopter emergency medical service (HEMS) transport and treatment on the survival of severely injured pediatric patients in high-level trauma centers remain unclear. (2) Methods: A national dataset from the TraumaRegister DGU® was used to retrospectively compare the mortality rates among severely injured pediatric patients (1–15 years) who were transported by HEMS to those transported by ground emergency medical service (GEMS) and treated at trauma centers of different treatment levels (levels I–III). (3) Results: In total, 2755 pediatric trauma patients (age: 9.0 ± 4.8 years) were included in this study over five years. Transportation by HEMS resulted in a significant survival benefit compared to GEMS (odds ratio (OR) 0.489; 95% confidence interval (CI): 0.282–0.850). Pediatric trauma patients treated in level II or III trauma centers showed 34% and fourfold higher in-hospital mortality risk than those in level I trauma centers (level II: OR 1.34, 95% CI: 0.70–2.56; level III: OR 4.63, 95% CI: 1.33–16.09). (4) Conclusions: In our national pediatric trauma cohort, both HEMS transportation and treatment in level I trauma centers were independent factors of improved survival in pediatric trauma patients.

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Association between Mode of Transportation and Survival in Adult Trauma Patients with Blunt Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000510 ◽

2021 ◽

pp. 1-9

Author(s):

Fouad A. Sakr ◽

Rana H. Bachir ◽

Mazen J. El Sayed

Keyword(s):

Cohort Study ◽

Survival Rate ◽

Blunt Trauma ◽

Survival Rates ◽

Trauma Patients ◽

Matched Cohort ◽

Matched Cohort Study ◽

Blunt Injuries ◽

Ground Ambulance ◽

Mode Of Transportation

Abstract Introduction: Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently. Study Objective: This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance). Methods: A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation. Results: Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000). Conclusion: In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.

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Real-World Palbociclib Use in HR+/HER2− Advanced Breast Cancer in Canada: The IRIS Study

Current Oncology ◽

10.3390/curroncol28010066 ◽

2021 ◽

Vol 28 (1) ◽

pp. 678-688

Author(s):

Katie Mycock ◽

Lin Zhan ◽

Gavin Taylor-Stokes ◽

Gary Milligan ◽

Debanjali Mitra

Keyword(s):

Breast Cancer ◽

Real World ◽

Medical Records ◽

Survival Rates ◽

Growth Factor Receptor ◽

Metastatic Breast ◽

Retrospective Chart Review ◽

Hormone Receptor Positive ◽

Kaplan Meier ◽

Epidermal Growth

Background: Palbociclib is a selective cyclin-dependent kinase (CDK) 4/6 inhibitor used in combination with aromatase inhibitors or fulvestrant for patients with hormone receptor-positive (HR+) human epidermal growth factor receptor 2 (HER2)-negative advanced/metastatic breast cancer (ABC/MBC). Palbociclib was the first CDK 4/6 inhibitor approved for HR+/HER2− ABC/MBC treatment in Canada in combination with letrozole (P+L) as an initial endocrine-based therapy (approved March 2016), or with fulvestrant (P+F) following disease progression after prior endocrine therapy (approved May 2017). The Ibrance Real World Insights (IRIS) study (NCT03159195) collected real-world outcomes data for palbociclib-treated patients in several countries, including Canada. Methods: This retrospective chart review included women with HR+/HER2− ABC/MBC receiving P+L or P+F in Canada. Physicians reviewed medical records for up to 14 patients, abstracting demographic and clinical characteristics, treatment patterns, and clinical outcomes. Progression-free rates (PFRs) and survival rates (SRs) at 6, 12, 18, and 24 months were estimated via Kaplan–Meier analysis. Results: Thirty-three physicians examined medical records for 247 patients (P+L, n = 214; P+F, n = 33). Median follow-up was 8.8 months for P+L and 7.0 months for P+F. Most patients were initiated on palbociclib 125 mg/d (P+L, 90.2%; P+F, 84.8%). Doses were reduced in 16.6% of P+L and 14.3% of P+F patients initiating palbociclib at 125 mg/d. The PFR for P+L was 90.3% at 12 months and 78.2% at 18 months; corresponding SRs were 95.6% and 93.0%. For P+F, 6-month PFR was 91.0%; 12-month SR was 100.0%. Conclusions: Dose reduction rates were low and PFR and SR were high in this Canadian real-world assessment of P+L and P+F treatments, suggesting that palbociclib combinations are well tolerated and effective.

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