scholarly journals 3014 Identification of a Cohort to Study Treatment Patterns in Elderly Patients with Incident Hodgkin Lymphoma (HL) using Surveillance, Epidemiology and End Results (SEER)-Medicare Data

2019 ◽  
Vol 3 (s1) ◽  
pp. 122-123
Author(s):  
Angie Mae Rodday ◽  
Theresa Hahn ◽  
Peter Lindenauer ◽  
Susan Parsons
Keyword(s):  
Initial Treatment ◽  
Older Patients ◽  
Treatment Patterns ◽  
Registry Data ◽  
Medicare Part ◽  
System Level ◽  
Fee For Service ◽  
Factors Associated ◽  
Medicare Data

OBJECTIVES/SPECIFIC AIMS: (1) To define and describe a cohort of patients aged ≥65 years with incident HL from SEER-Medicare data. (2) To identify patient, disease, and system-level factors associated with initial treatment for HL. METHODS/STUDY POPULATION: This retrospective cohort study utilized SEER-Medicare data from 1999-2014. Patients with incident classical HL were identified using SEER registry histology groupings. The cohort was restricted to those with Medicare Part A and B fee-for-service for 3 months prior to and 1 year after diagnosis (or until date of death) in order to fully capture claims for outpatient chemotherapy. Patients were excluded for the following reasons: missing month of HL diagnosis; unknown diagnostic confirmation; reporting from autopsy or death certificate; or another cancer diagnosis +/− 2 years of the HL diagnosis. Demographic and disease characteristics were defined based on SEER registry data. Broad treatment categories were defined using SEER data, while detailed treatment categories will be defined based on Medicare claims. Length of follow-up was defined as the number of months until the earliest of the following: death; end of continuous Medicare Part A and B fee-for-service enrollment; or the end of the available data (12/31/2014). Demographic, disease, and preliminary treatment characteristics were described for the cohort. Future analyses will explore patient and disease factors, including comorbidities and an estimate of frailty, as well as system-level factors associated with initial treatment of HL. RESULTS/ANTICIPATED RESULTS: We identified 2909 patients meeting eligibility for the cohort. The median length of follow-up was 22 months (Q1=5, Q3=62). Median age was 75.9 years (Q1=70, Q3=81), 49.6% were female, and 82.6% were non-Hispanic/White. Only 11.5% of patients were in rural or non-urban areas. 13.8% of patients were dual eligible for both Medicare and Medicaid. Nodular sclerosis was the most common histology (35.2%), followed by mixed cellularity (21.1%); 36.5% had histology that was not otherwise specified. Patients were evenly distributed across Ann Arbor Stage (21.8% with I; 22.3% with II; 25.8% with III; 24.2% with IV; 6% unknown). B symptoms were present in 35.2% of patients, absent in 39.6%, and unknown in 25.2%. Neither tumor bulk nor international prognostic score were available via SEER registry data. According to SEER registry data, most patients received some treatment for their HL (81.9%) and 75% of those patients initiated treatment within one month of diagnosis. 72% of patients died with median time to death of 9 months (Q1=3, Q3=43). DISCUSSION/SIGNIFICANCE OF IMPACT: We successfully identified and described a cohort of 2909 older patients with incident HL from the SEER-Medicare data. This provides a unique opportunity to study this cohort in a large, representative dataset with nearly 15 years of follow up. Future analysis will help us to better understand treatment patterns of HL in older patients and factors associated with treatment. These results can then be used to help improve care decisions and clinical outcomes.

Treatment Patterns and Outcomes of DLBCL after Failure of Front-Line Immunochemotherapy

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2683-2683 ◽  
Author(s):  
Umar Farooq ◽  
Matthew J Maurer ◽  
Stephen M Ansell ◽  
Tasha Lin ◽  
Grzegorz S. Nowakowski ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Research Funding ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Treatment Patterns ◽  
Front Line ◽  
Factors Associated ◽  
Line Therapy ◽  
First Relapse

Abstract Background: Diffuse large B-cell lymphoma (DLBCL) is curable for the majority of patients treated with anthracycline based immunochemotherapy (IC). However, up to 40% of patients will relapse or require retreatment of DLBCL and outcomes are poor in this setting. Here we examine the incidence, treatment patterns and outcomes of relapsed DLBCL in the R-CHOP era. Methods: Patients were prospectively enrolled in the University of Iowa / Mayo Clinic SPORE Molecular Epidemiology Resource (MER) within 9 months of diagnosis and followed for relapse, retreatment, and death. Clinical management at diagnosis and subsequent therapies were per treating physician. This analysis includes patients with DLBCL or primary mediastinal B-cell lymphoma (PMBCL) who underwent front-line anthracycline based IC; patients with primary CNS lymphoma or PTLD were excluded. All relapse and re-treatments were verified by medical record review. Response to front-line therapy was retrospectively classified per 2007 Revised Response Criteria for Malignant Lymphoma from available clinical and radiology records. Unplanned consolidative radiation (RT) without biopsy proven disease after achieving PR from IC (N=21) was not classified as a relapse. Results: 1039 patients with newly diagnosed DLBCL or PMBCL and treated with IC were enrolled in the MER from 2002-2012. Median age at diagnosis was 62 years (range 18-92) and 577 patients (56%) were male. 647 patients (63%) had stage III/IV disease and IPI at diagnosis was 0-1 in 350 patients (34%), 2 in 305 patients (29%), 3 in 250 patients (24%) and 4-5 in 134 patients (13%). At a median follow-up of 59 months (range 1-148), 258 patients had relapse or retreatment of DLBCL of which 184 (71%) died. Incidence of relapse was 21.7% (95% CI: 19.3%-24.4%) at 2 years and 25.5% (95% CI: 22.9%-28.5%) at 5 years. In addition, the incidence of lymphoma related death without documented relapse or retreatment was 4.7% (95% CI: 3.6%-6.2%) at 2 years. At first relapse, 174 patients (67% of relapsed) received platinum based salvage therapy with 90 (52%) subsequently proceeding to autologous stem cell transplant (ASCT). 22 patients received CNS directed systemic therapy at relapse with 9 (41%) proceeding to transplant, and 43 received non-platinum-based salvage systemic therapy with 7 proceeding to transplant (17%), 15 patients received RT only as 2nd line therapy, and 4 were untreated. At a median follow-up of 56 months (range 6-121) post-transplant, 39 of 107 patients who underwent transplant remain in remission with a 2-year post-transplant progression-free survival of 45% (95% CI 37%-56%). Response to front-line IC was predictive of post-relapse outcome. Survival post-relapse was superior in the 162 patients with responsive disease (CR or PR) at the end of front-line IC (median OS 21.0 months) compared to the 88 patients who had stable or progressive disease (median OS 6.8 months, HR = 2.33, 95% CI: 1.73-3.14 p<0.0001). Transient response in midst of front-line IC was similar to no response. Patients achieving a CR or PR to front-line IC were more likely to proceed to ASCT at relapse (55%) compared to patients with either SD or PD at the end of front-line IC (25% and 17% respectively, p<0.0001). Other factors associated with poor survival at first relapse were relapse within 12 months of diagnosis (HR = 2.24, 95% CI: 1.57-3.18, p<0.0001), IPI at diagnosis of 3-5 (HR=1.51, 95% CI: 1.13-2.03, p=0.0058), and age > 60 (HR =1.51, 95% CI: 1.12-2.03, p=0.0064). There was no difference in survival at first relapse by cell of origin (HR = 1.13, 95% CI: 0.74-1.72, p=0.59). Conclusions: Most patients undergo therapy after relapsed/refractory DLBCL but only one-third receive ASCT. Outcomes following all treatments for relapsed/refractory DLBCL remain poor. Factors associated with adverse outcomes include refractory to front-line therapy, early relapse, baseline IPI and advanced age. These outcomes provide relevant historical control for the many novel agents being tested in this unmet need. Figure 1. Figure 1. Disclosures Farooq: Kite Pharma: Research Funding. Maurer:Kite Pharma: Research Funding. Cerhan:Kite Pharma: Research Funding. Link:Genentech: Consultancy, Research Funding; Kite Pharma: Research Funding. Thompson:Kite Pharma: Research Funding.

Treatment patterns in patients with multiple myeloma (MM): A retrospective study using Medicare data.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19506-e19506 ◽  
Author(s):  
Peggy L. Lin ◽  
Dominick Latremouille-Viau ◽  
Medha Sasane ◽  
Patrick Gagnon-Sanschagrin ◽  
Hozefa A. Divan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Stem Cell Transplant ◽  
Response Duration ◽  
Treatment Patterns ◽  
Cell Transplant ◽  
Medicare Data ◽  
Survival Table ◽  
Practice Methods

e19506 Background: MM is characterized by repeated relapses and refractoriness and is managed by successive lines of therapies (LT) each typically resulting in shorter response duration over prior LT. This study describes current MM treatment (tx) landscape in US clinical practice. Methods: Adult MM patients (pts) with continuous Medicare Part A, B, and D coverage initiated on 1st LT (1L), without stem cell transplant, were identified in the Medicare Research Identifiable Files (2012-2016). Claims for any MM tx within 60 days of the 1st tx constituted the tx regimen of an LT. End of LT was defined as a claim for a new MM tx > 60 days post LT initiation (tx augmentation or switch), discontinuation of all tx in a regimen for > 90 consecutive days, end of Medicare coverage/data or death. From 1L to 3L, overall survival (OS), LT duration (DoT), tx regimens and sequences were assessed. Results: 8374 MM pts with 1L (median [med] age = 76 years at 1L; 55% female) were analyzed. Over a med follow-up of 20 months (mos) from 1L (med 1L DoT = 5.6 mos), 2849 pts received a 2L (med 2L DoT = 5.6 mos) and 978 received a 3L (med 3L DoT = 4.7 mos). The most prominent tx regimens were bortezomib/corticosteroids (CS; VD) in 1L, and lenalidomide/CS (RD) in 2L and 3L. The most prevalent tx sequence was 1L VD, 2L RD and 3L VD. The 1- and 2-year OS rates were 81% [95% confidence interval: 81-82] and 68% [67-69] from 1L initiation, 80% [78-82] and 64% [61-66] from 2L, and 73% [69-76] and 55% [51-60] from 3L initiation, respectively. Conclusions: MM Medicare pts mainly cycle through bortezomib- or lenalidomide-based regimens in front LT; newer agents gain more usage in later LT. A better understanding of tx options and sequencing is warranted to prolong survival. [Table: see text]

scholarly journals Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

2019 ◽  
Author(s):  
Samuel Lawrent Mpinganjira ◽  
Timothy Tchereni ◽  
Andrews Gunda ◽  
Victor Mwapasa
Keyword(s):  
Qualitative Study ◽  
Health Facilities ◽  
System Level ◽  
Hiv Care ◽  
Hiv Positive ◽  
Long Distance ◽  
Care Clinic ◽  
Loss To Follow Up ◽  
Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews with them and also with 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, EMTCT, loss to follow up, mother-infant pairs, Option B+

scholarly journals Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study

2020 ◽  
Vol 11 (5) ◽  
pp. 745-751
Author(s):  
Marika Salminen ◽  
Jonna Laine ◽  
Tero Vahlberg ◽  
Paula Viikari ◽  
Maarit Wuorela ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Outpatient Clinic ◽  
Older Patients ◽  
Cox Regression ◽  
Regression Analyses ◽  
Factors Associated ◽  
Follow Up Study ◽  
The Mean ◽  
First Time

Abstract Purpose To examine the effect of predictive factors on institutionalization among older patients. Methods The participants were older (aged 75 years or older) home-dwelling citizens evaluated at Urgent Geriatric Outpatient Clinic (UrGeriC) for the first time between the 1st of September 2013 and the 1st of September 2014 (n = 1300). They were followed up for institutionalization for 3 years. Death was used as a competing risk in Cox regression analyses. Results The mean age of the participants was 85.1 years (standard deviation [SD] 5.5, range 75–103 years), and 74% were female. The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The mean age for institutionalization was 86.1 (SD 5.6) years. According to multivariate Cox regression analyses, the use of home care (hazard ratio 2.43, 95% confidence interval 1.80–3.27, p < 0.001), dementia (2.38, 1.90–2.99, p < 0.001), higher age (≥ 95 vs. 75–84; 1.65, 1.03–2.62, p = 0.036), and falls during the previous 12 months (≥ 2 vs. no falls; 1.54, 1.10–2.16, p = 0.012) significantly predicted institutionalization during the 3-year follow-up. Conclusion Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.

Factors Related to Underuse of Surveillance Mammography Among Breast Cancer Survivors

2006 ◽  
Vol 24 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Nancy L. Keating ◽  
Mary Beth Landrum ◽  
Edward Guadagnoli ◽  
Eric P. Winer ◽  
John Z. Ayanian
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Repeated Measures ◽  
Breast Cancer Survivors ◽  
Geographic Region ◽  
Fee For Service ◽  
Factors Associated ◽  
Follow Up Care ◽  
Surveillance Mammography

Purpose Many older breast cancer survivors do not undergo annual mammography despite guideline recommendations. We identified factors associated with underuse of surveillance mammography and examined whether variation was explained by differences in follow-up care. Patients and Methods We used Surveillance, Epidemiology, and End Results-Medicare data to identify a population-based sample of 44,511 women fee-for-service Medicare enrollees aged ≥ 65 years who were diagnosed with stage I or II breast cancer in 1992 to 1999 who underwent primary surgical therapy. We assessed factors associated with mammography during months 7 to 18, 19 to 30, and 31 to 42 after breast cancer diagnosis using repeated-measures logistic regression; and we examined whether follow-up care with providers of various specialties explained variation in mammography use. Results Only three quarters of women (77.6%) underwent mammography during months 7 to 18 after diagnosis, and only 56.7% had mammography yearly over 3 years. In multivariable analyses, women who were older, black, unmarried, and living in certain regions were less likely than other women to undergo surveillance mammography (all P < .05). Patients with more visits and patients who continued to see a medical oncologist, radiation oncologist, or surgeon were most likely to have mammograms (P < .001); however, adjusting for visits with providers did not explain the lower mammography rates based on age, race, marital status, and geographic region. Conclusion Many elderly breast cancer survivors do not undergo annual surveillance mammography, particularly women who are older, black, and unmarried, and this underuse was not explained by access to follow-up care. New strategies are needed to increase use of surveillance mammography and decrease variations based on nonclinical factors that are likely unrelated to appropriateness of medical care.

scholarly journals Factors Associated with Sarcopenia and 7-Year Mortality in Very Old Patients with Hip Fracture Admitted to Rehabilitation Units: A Pragmatic Study

Nutrients ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 2243 ◽  
Author(s):  
Vincenzo Malafarina ◽  
Concetta Malafarina ◽  
Arantzazu Biain Ugarte ◽  
J. Alfredo Martinez ◽  
Itziar Abete Goñi ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Hospital Stay ◽  
Grip Strength ◽  
Older Patients ◽  
Hand Grip Strength ◽  
Factors Associated ◽  
Hand Grip ◽  
Risk Of Mortality

Background: Admitted bedridden older patients are at risk of the development of sarcopenia during hospital stay (incident sarcopenia). The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Methods: A multicenter, pragmatic, prospective observational study was designed. Older subjects with hip fracture admitted to two rehabilitation units were included. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. The mortality was evaluated after 7 years of follow-up. Results: A total of 187 subjects (73.8% women) age 85.2 ± 6.3 years were included. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index. During follow-up 114 patients died (60.5% sarcopenic vs. 39.5% non-sarcopenic, p = 0.001). Cox regression analyses showed that factors associated to increased risk of mortality were sarcopenia (HR: 1.67, 95% CI 1.11–2.51) and low hand-grip strength (HR: 1.76, 95% CI 1.08–2.88). Conclusions: Older patients with undernutrition have a higher risk of developing sarcopenia during hospital stay, and sarcopenic patients have almost two times more risk of mortality than non-sarcopenic patients during follow-up after hip fracture.

scholarly journals Factors Associated With Loss-to-follow-up Of Hiv-positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

2019 ◽  
Author(s):  
Samuel Lawrent Mpinganjira ◽  
Timothy Tchereni ◽  
Andrews Gunda ◽  
Victor Mwapasa
Keyword(s):  
Qualitative Study ◽  
Health Facilities ◽  
System Level ◽  
Hiv Care ◽  
Hiv Positive ◽  
Long Distance ◽  
Care Clinic ◽  
Loss To Follow Up ◽  
Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) greatly contributes to sub-optimal retention (74%) of HIV-positive (HIV+) women initiated on antiretroviral therapy (ART) during pregnancy under Option B+ strategy. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs (MIP). Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of MIPs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced 19 LTFU women and conducted in-depth interviews (IDIs) with them and also with 30 healthcare workers (HCWs) from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed and translated and, then, analysed using deductive content analysis. Results The following reasons were reported contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; food insecurity; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system level which contribute to poor retention of MIPs in HIV care. Key words PRIME, PMTCT, eMTCT, loss to follow up, mother-infant pairs, Option B+

scholarly journals Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study

2021 ◽  
Vol 9 (1) ◽  
pp. e001585
Author(s):  
Brenda Bongaerts ◽  
Suzanne V Arnold ◽  
Bernard H Charbonnel ◽  
Hungta Chen ◽  
Andrew Cooper ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Older Patients ◽  
Intensive Treatment ◽  
Middle Income ◽  
Glucose Lowering ◽  
Factors Associated ◽  
Middle Income Countries

IntroductionAlthough individualized target glycated hemoglobin (HbA1c) levels are recommended in older people with type 2 diabetes, studies report high levels of potential overtreatment. We aimed to investigate the proportion of older patients (aged ≥65 years) who potentially received an inappropriately intensive treatment (HbA1c level <7.0% (53.0 mmol/mol)) in a global study. Factors associated with intensive glycemic management and using glucose-lowering medications associated with a high risk of hypoglycemia (high-risk medications (insulin, sulfonylureas, and meglitinides)) were also assessed.Research design and methodsDISCOVER is a 3-year observational study program of 15 992 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. Data were collected at baseline (initiation of second-line therapy) and at 6, 12, and 24 months. Factors associated with an inappropriately intensive treatment or using high-risk medications were assessed using a hierarchical regression model.ResultsOf the 3344 older patients with baseline HbA1c data in our analytic cohort, 23.5% received inappropriate treatment intensification. Among those who had follow-up HbA1c data, 55.2%, 54.2%, and 53.5% were inappropriately tightly controlled at 6, 12, and 24 months, respectively, with higher proportions in high-income than in middle-income countries. The proportion of patients receiving high-risk medications was higher in middle-income countries than in high-income countries. Gross national income (per US$5000 increment) was associated with increased odds of inappropriately intensive treatment but with decreased odds of receiving high-risk medications.ConclusionsA large proportion of older DISCOVER patients received an inappropriately intensive glucose-lowering treatment across the 2 years of follow-up, with substantial regional variation. The use of high-risk medications in these patients is particularly concerning.

Medicare Fee-for-Service Enrollees with Acute Myelogenous Leukemia: An Analysis of Treatment Patterns and Patient Survival

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 505-505 ◽  
Author(s):  
Juliana Leah Meyers ◽  
Yanni F Yu ◽  
Keith L Davis
Keyword(s):  
Supportive Care ◽  
Survival Time ◽  
Median Survival ◽  
Patient Survival ◽  
Best Supportive Care ◽  
Treatment Patterns ◽  
Myelogenous Leukemia ◽  
Fee For Service ◽  
Over Time

Abstract Abstract 505 Background: Acute myelogenous leukemia (AML) is the most common type of leukemia among adults in the US. The incidence of AML increases with age. Older AML patients, constituting the majority of the AML population, generally have poor outcomes with median survival less than 3 months. Published information on treatment patterns and survival trends in elderly patients with AML is outdated and newer information on treatment patterns and survival is lacking. Objective: The goal of this retrospective database analysis is to examine treatment patterns, overall patient survival, predictors of which patients are likely to receive chemotherapy, and predictors of mortality among Medicare fee-for-service enrollees diagnosed with AML in the most recent available database. Methods: Medicare patients aged 65+ years in the SEER (Survey, Epidemiology, and End Results) cancer registry with a new AML diagnosis between 1/1/1997 and 12/31/2007 were selected for study inclusion. Patients were required to have at least 6 months of pre-AML Medicare Part A and B benefits and no evidence of managed care (Medicare Part C) enrollment post-AML diagnosis. Patients were excluded from the analysis if they had evidence of another tumor (either solid or hematological) in the SEER registry before the first AML diagnosis. Health care claims in the 6 months pre-index were examined, and patients with any diagnosis of a solid tumor (not specified in SEER) were also excluded. Patients were followed until their date of death or end of observation period (i.e., 12/31/2007). Study measures included AML-directed treatments (i.e., chemotherapy, radiation therapy, hematopoietic stem-cell/bone marrow transplants [HSCT/BMT]), best supportive care received, and post-AML diagnosis survival time. Patient survival time was assessed overall and for patients receiving chemotherapy during follow-up versus patients receiving best supportive care only. Temporal changes in treatment utilization and survival were assessed by evaluating these measures separately for AML cases diagnosed in 1997–1999, 2000–2003, and 2004–2007. Multivariate logistic regressions were undertaken to assess predictors of receipt of chemotherapy, including patient demographics, comorbidities, and year of AML diagnosis. Results: 6,888 patients met the study inclusion criteria. Mean (SD) and median age were 78.3 (7.2) and 78.0 years respectively. Over 43% of patients received chemotherapy at any point post-diagnosis. Chemotherapy use increased slightly over time: 40.7%, 42.3%, and 46.0% of patients diagnosed with AML in the periods in 1997–1999, 2000–2003, and 2004–2007, respectively. Fifty-six percent of patients received only best supportive care post-diagnosis, and the percentage slightly decreased over time. Among patients receiving only best supportive care, rates of hospice care increased substantially over time: 32.9%, 42.7%, and 49.1% in each of the respective time periods. Rates of HSCT/BMT procedures were low with an increase over time: 0.67%, 2.06%, and 2.49%. Nearly all patients (97.1%) died during the observable follow-up, and median survival time was 2.6 months. Among patients who received chemotherapy, 93.9% died during follow-up and the median survival was 6.5 months with 5.7, 6.4, and 7.0 months among patients diagnosed in 1997–1999, 2000–2003, and 2004–2007, respectively. Among patients who received only best-supportive care, 99.5% died during follow-up and median survival was 1.5 months with little change over time. Younger patients (65–74 years vs >= 75 years), patients with fewer comorbidities (Charlson Comorbidity Index [CCI] ≤1 vs > CCI >1), patients with a post-AML secondary cancer diagnosis, and patients diagnosed with AML in more recent years were found to be more likely to receive chemotherapy. Conclusions: Findings from our analysis showed an increasing trend in rates of chemotherapy treatment and utilization of hospice care among Medicare patients with AML. However, a large portion of elderly patients remain untreated. Median survival among patients who received chemotherapy was found to increase over time. Patients who received chemotherapy, when compared to those who did not, had a lower mortality rate and an over 3-fold longer median survival. Disclosures: Yu: Boehringer Ingelheim Pharmaceuticals, Inc.: Employment.

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