scholarly journals 787Multistate modelling to investigate the impact of recurrent malaria episodes on hospital admissions and mortality

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Saber Dini ◽  
Nicholas Douglas ◽  
Jeanne Rini Poespoprodjo ◽  
Enny Kenangalem ◽  
Paulus Sugiarto ◽  
...  
Keyword(s):  
Vivax Malaria ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Early Death ◽  
Morbidity And Mortality ◽  
Radical Cure ◽  
Liver Stage ◽  
Recurrent Malaria ◽  
The Impact ◽  
Malaria Episodes

Abstract Background Inadequate prevention and treatment of malaria can lead to reinfections and recurrent episodes, and for vivax malaria, further recurrences from the dormant liver stage. This study quantified the impact of recurrent malaria episodes on morbidity and mortality. Methods Routinely collected data were available from 68,381 malaria patients presenting to the primary referral hospital in Papua, Indonesia. A multi-state modelling framework, with Cox regression for transition rates, was employed to determine the risks of re-presentation to hospital, receiving in-patient treatment, and early (≤14 days post treatment)/late death following multiple malaria episodes. Results The risk of re-presentation to hospital increased from 34.7% (95%CI: 34.4%–35.1%) at first episode to 58.6% (57.5%–59.6%) following the third episode. Infection with vivax malaria increased the rate of re-presentation to hospital by 1.48-fold (Hazard Ratio 1.48; 95%CI 1.44–1.51) and late hospital in-patient admission by 1.17-fold (1.11–1.22), compared to falciparum. Falciparum malaria caused a higher overall rate of early death (1.54 (1.25–1.92)), however, after multiple episodes, there was a trend towards a greater rate of early death for vivax infection (1.91 (0.73–4.97)). Conclusions Recurrent episodes of malaria can cause substantial morbidity and mortality, highlighting the importance of prevention and effective treatments for both falciparum and vivax malaria. Key messages To achieve elimination of malaria in South-East Asia, where prevalence of vivax malaria is high, we must prioritise the radical cure of vivax to eliminate the liver-stage of this species that causes relapses of infection.

scholarly journals Cardiovascular risk after hospitalisation for unexplained syncope and orthostatic hypotension

Heart ◽  
2017 ◽  
Vol 104 (6) ◽  
pp. 487-493 ◽  
Author(s):  
Ekrem Yasa ◽  
Fabrizio Ricci ◽  
Martin Magnusson ◽  
Richard Sutton ◽  
Sabina Gallina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Orthostatic Hypotension ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Cox Regression ◽  
All Cause Mortality ◽  
Unexplained Syncope ◽  
The Impact

ObjectiveTo investigate the relationship of hospital admissions due to unexplained syncope and orthostatic hypotension (OH) with subsequent cardiovascular events and mortality.MethodsWe analysed a population-based prospective cohort of 30 528 middle-aged individuals (age 58±8 years; males, 40%). Adjusted Cox regression models were applied to assess the impact of unexplained syncope/OH hospitalisations on cardiovascular events and mortality, excluding subjects with prevalent cardiovascular disease.ResultsAfter a median follow-up of 15±4 years, 524 (1.7%) and 504 (1.7%) participants were hospitalised for syncope or OH, respectively, yielding 1.2 hospital admissions per 1000 person-years for each diagnosis. Syncope hospitalisations increased with age (HR, per 1 year: 1.07, 95% CI 1.05 to 1.09), higher systolic blood pressure (HR, per 10 mm Hg: 1.06, 95% CI 1.01 to 1.12), antihypertensive treatment (HR: 1.26, 95% CI 1.00 to 1.59), use of diuretics (HR: 1.77, 95% CI 1.31 to 2.38) and prevalent cardiovascular disease (HR: 1.59, 95% CI 1.14 to 2.23), whereas OH hospitalisations increased with age (HR: 1.11, 95% CI 1.08 to 1.12) and prevalent diabetes (HR: 1.82, 95% CI 1.23 to 2.70). After exclusion of 1399 patients with prevalent cardiovascular disease, a total of 473/464 patients were hospitalised for unexplained syncope/OH before any cardiovascular event. Hospitalisation for unexplained syncope predicted coronary events (HR: 1.85, 95% CI 1.49 to 2.30), heart failure (HR: 2.24, 95% CI 1.65 to 3.04), atrial fibrillation (HR: 1.84, 95% CI 1.50 to 2.26), aortic valve stenosis (HR: 2.06, 95% CI 1.28 to 3.32), all-cause mortality (HR: 1.22, 95% CI 1.09 to 1.37) and cardiovascular death (HR: 1.72, 95% CI 1.23 to 2.42). OH-hospitalisation predicted stroke (HR: 1.66, 95% CI 1.24 to 2.23), heart failure (HR: 1.78, 95% CI 1.21 to 2.62), atrial fibrillation (HR: 1.89, 95% CI 1.48 to 2.41) and all-cause mortality (HR: 1.14, 95% CI 1.01 to 1.30).ConclusionsPatients discharged with the diagnosis of unexplained syncope or OH show higher incidence of cardiovascular disease and mortality with only partial overlap between these two conditions.

scholarly journals Combined healthy lifestyle factors and risk of all-cause and cardiovascular first hospitalization

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Bonaccio ◽  
A Di Castelnuovo ◽  
S Costanzo ◽  
M Persichillo ◽  
A De Curtis ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Cox Regression ◽  
Healthy Lifestyle ◽  
Adult Population ◽  
Population Based ◽  
Lifestyle Factors ◽  
Inflammatory Biomarkers ◽  
Healthy Lifestyles ◽  
Italian Population ◽  
The Impact

Abstract Background We aimed to explore the association of combined healthy lifestyles with risk of first hospitalization for all-cause, cardiovascular disease (CVD), ischemic heart disease (IHD) and stroke in a southern Italian population-based cohort. We also investigated several biological mechanisms possibly on the pathway between lifestyles and health outcomes. Methods Longitudinal analysis on 23,161 men and women (aged≥35 y) recruited in the Moli-sani Study (2005-2010). We defined 4 healthy lifestyle factors as abstention from smoking; high adherence to Mediterranean diet; physical activity; absence of abdominal obesity. First hospital admissions for any and CVD-related causes were recorded by direct linkage with hospital discharge form registry. Hazard ratios (HR) with 95% confidence interval (95%CI) were calculated by multivariable Cox-regression. Results Over a median follow up of 7.2 y, we ascertained a total of 9,482 hospitalizations, 3,556 CVD, 939 IHD and 589 stroke-related hospital admissions. Adherence to all four healthy lifestyles, compared with none or 1, was associated with lower risk of hospitalization for any cause (HR = 0.82; 0.74-0.90), CVD (HR = 0.81;0.69-0.95) and IHD (HR = 0.63; 0.44-0.90) and, to a less extent, with stroke hospitalizations. Inflammatory biomarkers (e.g. C-reactive protein) were likely to partly explain the association between lifestyles and all-cause (14%) or CVD (15%) hospitalizations, while inflammation played a leading role towards risk of IHD (30%) and stroke-related hospital admissions (21%). Conclusions The impact of combined 4 healthy lifestyles on first hospitalization risk was considerable. Inflammatory biomarkers explained a large proportion of this association. Key messages Improvements to lifestyle reduce the risk of hospitalizations in a general adult population. Achieving a greater number of healthy behaviours has the potential to reduce the burden of hospitalizations and the associated healthcare costs.

scholarly journals Changes in tobacco-related morbidity and mortality in French women: worrying trends

2019 ◽  
Vol 30 (2) ◽  
pp. 380-385 ◽  
Author(s):  
Valérie Olié ◽  
Anne Pasquereau ◽  
Frank A G Assogba ◽  
Pierre Arwidson ◽  
Viet Nguyen-Thanh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lung Cancer ◽  
Hospital Admissions ◽  
Population Attributable Fraction ◽  
Morbidity And Mortality ◽  
National Database ◽  
Attributable Mortality ◽  
Chronic Obstructive ◽  
Strong Impact ◽  
The Impact

Abstract Background The high prevalence of smoking among French women since the 1970s has been reflected over the past decade by a strong impact on the health of women. This paper describes age and gender differences in France of the impact of smoking on morbidity and mortality trends since the 2000s. Methods Smoking prevalence trends were based on estimates from national surveys from 1974 to 2017. Lung cancer incidence were estimated from 2002–12 cancer registry data. Morbidity data for chronic obstructive pulmonary disease (COPD) exacerbation and myocardial infarction were assessed through hospital admissions data, 2002–15. For each disease, number of deaths between 2000 and 2014 came from the national database on medical causes of death. The tobacco-attributable mortality (all causes) was obtained using a population-attributable fraction methodology. Results The incidence of lung cancer and COPD increased by 72% and 100%, respectively, among women between 2002 and 2015. For myocardial infarction before the age of 65, the incidence increased by 50% between 2002 and 2015 in women vs. 16% in men and the highest increase was observed in women of 45–64-year-olds. Mortality from lung cancer and COPD increased by 71% and 3%, respectively, among women. The estimated number of women who died as a result of smoking has more than doubled between 2000 and 2014 (7% vs. 3% of all deaths). Conclusions The increase in the prevalence of smoking among women has a major impact on the morbidity and mortality of tobacco-related diseases in women and will continue to increase for a number of years.

Mortality, Morbidity, and Prognostic Factors in the Surgical Resection of Brain Metastases: A Contemporary Cohort Study

2020 ◽  
Vol 81 (04) ◽  
pp. 279-289
Author(s):  
Helder Picarelli ◽  
Marcelo de Lima Oliveira ◽  
Gustavo Nader Marta ◽  
Davi J. Fontoura Solla ◽  
Manoel Jacobsen Teixeira ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Causes Of Death ◽  
Cox Regression ◽  
Morbidity And Mortality ◽  
Carcinomatous Meningitis ◽  
Primary Tumor Site ◽  
Risk Of Death ◽  
Prognostic Indices ◽  
The Impact

Abstract Objective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due to neurologic causes, NSR may be controversial in other situations. Many aspects related to NSR have not yet been well established, and the primary prognostic indices were proposed only in the last decade. This study evaluates the survival and the morbidity, causes of death, prognostic factors, and the impact of RT in patients with BMs treated by NSR in the current era. Methods A total of 200 patients with BMs who were treated by NSR were evaluated sequentially and followed prospectively. We used logistic regression and Cox regression models to identify independent factors associated with mortality at 4 weeks and at 1 year, respectively. Clinical features, morbidity, recurrence, and causes of death were also studied. Results Lung cancer was the most prevalent cancer (36.5%); the median Karnofsky Performance Status (KPS) score was 60. Total resection was achieved in 89%, and adjuvant RT was applied in 63% of the cases. The rates of surgical mortality, morbidity, and mortality at 4 weeks were 1.5%, 17%, and 7.5%, respectively. Systemic infections were the leading cause of death in 62.5% of the cases. The median survival was 5 months, and 34.5% of patients lived > 1 year. The postoperative KPS (KPSpo) score remained unchanged or improved in 94.5% of the cases. In the multivariate analysis, a KPSpo score ≥ 80 and the application of adjuvant RT were associated with a lower risk of death at 12 weeks and at 1 year. Interestingly, the variables of primary tumor site, number of BMs, and presence of carcinomatous meningitis were not significant. Conclusion Morbidity and mortality were high, a third of the patients lived > 1 year, and the KPS score improved or remained unchanged in most cases. Prognostic indices and health conditions were important predictive factors, but the KPSpo score and adjuvant RT were independent variables for survival at 12 weeks and at 1 year. Therefore, new studies are needed to assess the influence of new therapies and specific molecular profiles.

scholarly journals The influence of changes in activity-based financing on hospital readmissions for the elderly

2016 ◽  
Vol 4 (2) ◽  
pp. 72-81 ◽  
Author(s):  
Jun Yin ◽  
Fredrik A. Dahl ◽  
Terje P. Hagen ◽  
Hilde Lurås
Keyword(s):  
Readmission Rate ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Average Length ◽  
Hospital Readmissions ◽  
Random Effect ◽  
The Elderly ◽  
Patient Specific ◽  
Readmission Rates ◽  
The Impact

Activity-based financing of Norwegian hospitals was implemented in 1997. An earlier study shows that when the activity-based component increases, the average length of stay for the elderly is reduced. If this reduction entails premature discharge, an increased activity-based component may have the undesirable side effect of increasing readmission rates. Yearly the Norwegian government decides the size of the activity-based component, and all hospitals face the same size. In this paper, we investigate whether the level of activity-based financing is associated with the readmission rates for acute-care patients above 70 years of age. The sample consisted of 468 010 hospital admissions among elderly patients in the period from 2000 to 2007. Using repeated cross-sectional data extracted from the Norwegian Patient Registry, a Cox regression model was used to estimate factors that may influence the hazard rate of a readmission within 30 days. The overall 30-day readmission rate was 6.6%. The results demonstrate that the activity-based component had no significant effect on the readmission rate. Patient-specific factors such as age, gender, diagnoses, comorbidities, as well as the time trend, were important predictors of readmission rates. We also found a statistically significant random effect of hospitals, although this effect was less substantial than the impact of patient characteristics. Our results show that the effect of the activity-based component on the readmission rate was negligible when it varied between 40% and 60%.Published: Online May 2016. In print August 2016.

scholarly journals The risk of adverse clinical outcomes following treatment of Plasmodium vivax malaria with and without primaquine in Papua, Indonesia

2020 ◽  
Vol 14 (11) ◽  
pp. e0008838
Author(s):  
Kamala Thriemer ◽  
Jeanne-Rini Poespoprodjo ◽  
Enny Kenangalem ◽  
Nicholas M. Douglas ◽  
Paulus Sugiarto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
G6pd Deficiency ◽  
Cox Regression ◽  
Artemisinin Combination Therapy ◽  
Morbidity And Mortality ◽  
Radical Cure ◽  
Drug Induced ◽  
Routine Administration ◽  
Plasmodium Vivax Malaria ◽  
Glucose 6 Phosphate Dehydrogenase

The widespread use of primaquine (PQ) radical cure for P. vivax, is constrained by concerns over its safety. We used routinely collected patient data to compare the overall morbidity and mortality in patients treated with and without PQ without prior testing of Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency in Papua, Indonesia, where there is a low prevalence of G6PD deficiency. Records were collated from patients older than 1 year, with P. vivax infection, who were treated with an artemisinin combination therapy (ACT). The risks of re-presentation, hospitalization, major fall in haemoglobin and death within 30 days were quantified and compared between patients treated with and without PQ using a Cox regression model. In total 26,216 patients with P. vivax malaria presented to the hospital with malaria during the study period. Overall 27.56% (95% Confidence Interval (95%CI): 26.96–28.16) of 21,344 patients treated with PQ re-presented with any illness within 30 days and 1.69% (1.51–1.88) required admission to hospital. The corresponding risks were higher in the 4,872 patients not treated with PQ; Adjusted Hazard Ratio (AHR) = 0.84 (0.79–0.91; p<0.001) and 0.54 (0.41–0.70; p<0.001) respectively. By day 30, 14.15% (12.45–16.05) of patients who had received PQ had a fall in haemoglobin (Hb) below 7g/dl compared to 20.43% (16.67–24.89) of patients treated without PQ; AHR = 0.66 (0.45–0.97; p = 0.033). A total of 75 (0.3%) patients died within 30 days of treatment with a mortality risk of 0.27% (0.21–0.35) in patients treated with PQ, compared to 0.38% (0.24–0.60) without PQ; AHR = 0.79 (0.43–1.45; p = 0.448). In Papua, Indonesia routine administration of PQ radical cure without prior G6PD testing, was associated with lower risk of all cause hospitalization and other serious adverse clinical outcomes. In areas where G6PD testing is not available or cannot be delivered reliably, the risks of drug induced haemolysis should be balanced against the potential benefits of reducing recurrent P. vivax malaria and its associated morbidity and mortality.

Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment

2021 ◽  
pp. 104990912110383
Author(s):  
Maria Elena Iriarte Moncho ◽  
Vicente Palomar-Abril ◽  
Teresa Soria-Comes
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Medical Department ◽  
The Impact ◽  
At Home

Introduction: Advanced cancer is accompanied by a substantial burden of symptoms, and palliative care (PC) plays an essential role, especially at the end of life (EOL). In fact, a comprehensive PC through Home Palliative Care Units (HPCU) has been associated with reducing potentially aggressive care at the EOL. We aim to study the impact of HPCU on the quality of assistance of cancer patients at Alcoy Health Department. Methods: A retrospective study was conducted including patients diagnosed with terminal cancer at the Medical Department of Hospital Virgen de los Lirios who died between January 2017 and December 2018. The Multivariate Cox regression model was used to assess the impact of HPCU assistance on the quality of life indicators. Results: 388 patients were included. The median age was 71 years; 65% patients were male, and 68% presented with a 0-2 score on the ECOG scale. On the multivariate analysis, a lack of assistance by HPCU was associated with a higher risk of consulting in the emergency department (OR = 1.29, 95% CI: 1.02-1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45-9.09), a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44-4.67), and a greater probability of dying in hospital (OR = 6.52, 95% CI: 3.78-11.27). Conclusions: Patients receiving HPCU assistance have a lower number of emergency room visits and hospital admissions, and are more likely to die at home. Taken together, these results support the relevance of HPCU providing a high quality attention of cancer patients.

scholarly journals Aortic atherosclerotic plaques: the role of anticoagulation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Silverio Antonio ◽  
T Rodrigues ◽  
N Cunha ◽  
S Couto Pereira ◽  
J Brito ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Cox Regression ◽  
Lower Limbs ◽  
Atherosclerotic Plaques ◽  
High Morbidity ◽  
Supraventricular Arrhythmia ◽  
Bleeding Events ◽  
Therapeutic Implications ◽  
The Impact

Abstract Introduction Aortic atherosclerotic plaques (AAPs) are one of the major causes of spontaneous and iatrogenic stroke and peripheral emboli, carrying an high morbidity and mortality. Transoesophageal echocardiography (TOE) plays a key rule on detecting AAP. The therapeutic approach of this patients (pts) is not well stablished. Purpose To evaluate the impact of anticoagulation (ACO) therapy on major events in asymptomatic pts with AAP detected in TOE. Methods Single-center retrospective study of consecutive patients submitted to TOE between 2010 and 2019 with documentation of AAP. Plaques were described as complex (1) &gt;4mm, (2) ulcerated and (3) mobile thrombi. The plaque location was also documented. We consulted pts data charts for clinical characterization and events recording during the follow up. Major events were defined as stroke, bleeding, hospital admissions (either cardiovascular (CV) and non-CV) and death. Statistical analysis was performed using Cox regression and Chi-square tests. Results We enrolled 177 pts with a mean age of 70±10.5 years, 63.8% males, 31.1% diabetic, 73.4% hypertensive, 54.2% with dyslipidaemia, 62.7% obese, 25.4% with peripheral arterial disease, 25.9% with previous stroke and 55.4% with supraventricular arrhythmia. Most of pts had plaques &gt;4mm (80.8%), mobile thrombi in 11.9% and ulcerated plaques in 7.3%; most of the plaques were located in proximal descending aorta (50.3%) and aortic cross (38.4%). Regarding baseline therapy, 52% were under ACO and 50.3% under statin. The main indication of ACO was atrial fibrillation (45.8%). During follow up (mean time: 1613±1255 days), 61.5% pts died (10.7% from CV causes, 13% with unknown cause), 17.5% had a stroke, 5.7% had other embolic event (lower limbs emboli, unilateral amaurosis and ischemic colitis). Bleeding occurred in 18.3% pts; 47% pts were hospitalized (28.3% from CV cause). Adjusting for age and comorbidities, there were no significant differences between the group with and without ACO. ACO therapy prevented death from any cause, being also an independent predictor (p=0.08, OR 0.489, IC 95% 0.288–0.831) when adjusted for comorbidities and age. ACO was associated with bleeding events (p=0.003), but not with stroke or hospitalization from any cause (p=NS). Conclusion In this subset of pts, ACO therapy prevented death from any cause in pts with AAP. This may have therapeutic implications when approaching this pts, although larger studies to confirm these results are needed. FUNDunding Acknowledgement Type of funding sources: None. Non-CV death and anticoagulation

Quantifying the impact of the COVID-19 pandemic on gastrointestinal cancer care delivery.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 30-30
Author(s):  
Nicholas Perkons ◽  
Casey Kim ◽  
Chris Boedec ◽  
Charles John Schneider ◽  
Ursina R. Teitelbaum ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Radiation Oncology ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Care Delivery ◽  
Morbidity And Mortality ◽  
Specific Effects ◽  
Chemotherapy Infusion ◽  
Future Work ◽  
The Impact

30 Background: Changes in healthcare utilization and delivery during the first months of the COVID-19 pandemic have altered the presentation, treatment, and management of patients with gastrointestinal (GI) malignancies. We hypothesize this has contributed to diagnostic and treatment delays that will increase disease morbidity and mortality. Methods: We performed a retrospective cohort study comparing healthcare utilization of patients with diagnosed GI malignancy (ICD10:C15-C26) during and prior to the COVID-19 pandemic within our health system. Deidentified patient encounter parameters were collected for the first 20 weeks of both 2019 and 2020, including the number of: new patient visits (NPVs), hospital admissions, and specialty encounters. Difference-in-difference analyses adjusted for week-specific and year-specific effects quantified the impact of the COVID-19 pandemic on care delivery, with week 11 of 2020 marking the start of the pandemic period. Results: The 2019 and 2020 cohorts of patients had similar demographic compositions on the basis of sex and ethnicity (2019: n = 23,536, 56.8% M, 70.4/16.3/1.9% White/Black/Hispanic; 2020: n = 25,773, 57.0% M, 70.3/16.3/2.0% White/Black/Hispanic). Across all GI malignancies, the COVID-19 pandemic period was associated with a significant decrease in NPVs (-50.0/week, -45% from 2019, p < 1e-3). Colorectal cancer (CRC) had the largest decrease in NPVs among GI malignancies (-25.3/week, -53% from 2019, p < 1e-4). Of note, there was a parallel decrease in colonoscopies during this time (-682/week, -91% from 2019, p < 1e-11). For patients with diagnosed GI malignancies, the COVID-19 pandemic was associated with statistically significant declines in hospital admissions (-31.7/week, -37% from 2019, p < 1e-5), radiology encounters (-177/week, -38% from 2019, p < 1e-6), radiation oncology encounters (-18.2/week, -12% from 2019, p < 0.01), chemotherapy infusion visits (-62.2/week, -17% from 2019, p < 1e-4), and surgery encounters (-71.1/week, -15.7% from 2019, p < 0.01). Subgroup analyses revealed these reductions were most significant in patients with CRC (radiology encounters, surgery encounters, hospital admissions), anal cancer (radiation oncology encounters), and pancreatic cancer (chemotherapy infusion visits). Conclusions: These data demonstrate that the COVID-19 pandemic is associated with significant disruptions to care delivery. While these effects were appreciated broadly across GI malignancies, CRC—diagnosed and managed by periodic screening—has been affected most acutely. The precipitous drop in screening colonoscopies likely contributed to the decline in NPVs, specialty encounters and hospital admissions. These findings underscore the importance of reinstating regular GI cancer screening and management. Future work will assess the impact of these and other changes to cancer care delivery on long term morbidity and mortality.

Correlation of short telomeres (ST) with vulnerability, toxicity, and early death in elderly AOC patients receiving carboplatin: A multicenter GINECO trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9011-9011 ◽  
Author(s):  
Claire Falandry ◽  
Béatrice Horard ◽  
Jerome Alexandre ◽  
Gael Deplanque ◽  
Oana Cojocarasu ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Elderly Women ◽  
Significant Risk ◽  
Early Death ◽  
Premature Death ◽  
Significant Risk Factor ◽  
Figo Stage ◽  
Telomere Attrition ◽  
Unplanned Hospital Admissions ◽  
The Impact

9011 Background: Age induces a progressive decline in the functional reserve and interferes with cancer treatments. As aging is heterogeneous, this decline has to be assessed individually. Telomere attrition leads to tissue senescence. We tested the hypothesis that telomere lenght (TL) could predict pts vulnerability and outcome during cancer treatment. Methods: This study was performed in the “Elderly women” GINECO trial designed to evaluate the impact of geriatric covariates on survival in AOC pts over 70 receiving 6 courses of carboplatin. TL was estimated in duplicate using standard Terminal Restriction Fragment analysis from peripheral blood cells at inclusion and tested for its correlation with geriatric covariates and pts outcomes (TC and tolerance, overall survival: OS). Results: TL (in base pair) was estimated for 109/111 pts (median 5997; extremes [4517-8333]). No significant correlation was found with any pts characteristics. With a cutoff of 5770 bp, TL discriminated two groups with significantly different Treatment Completion (TC) rates: 0.80 (95CI[0.71-0.89]) and 0.59 (95CI[0.41-0.76]), OR=2.8, p=0.02 for long telomere (LT) and short telomere groups, respectively . ST pts were at higher risk of severe adverse events (SAE, OR=2.7; p<0.02) and tended to have more unplanned hospital admissions (OR=2.1; p<0.08). Considering OS, after adjustment on FIGO stage, TL shorter than the median was a nearly significant risk factor of premature death (HR=1.57; p=0.06. Finally, we addressed if TL correlated with our previously validated geriatric vulnerability score (GVS)c including ADL score<6, IADL score<25, albuminemia<35g/l, lymphopenia<1G/L, HADS score£15 as risk factors of poorer survival. Despite no significant correlation with any of these factors, GVS³3) and ST tended to be correlated (OR=2.1; p=0.08). Conclusions: This exploratory study identifies TL as predictive factor of decreased TC, SAE risk, unplanned hospital admissions and OS after adjustment on FIGO stage.

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