scholarly journals EPID-16. COMPARATIVE ANALYSIS OF OVERALL SURVIVAL AND ADVERSE EVENTS BY ADJUVANT TREATMENT MODALITIES IN ELDERLY PATIENTS WITH GLIOBLASTOMA USING THE SEER-MEDICARE DATABASE

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi77-vi78
Author(s):  
Ping Zhu ◽  
Xianglin Du ◽  
Jay-Jiguang Zhu
Keyword(s):  
Overall Survival ◽  
Adjuvant Therapy ◽  
Elderly Patients ◽  
Cohort Analysis ◽  
Cox Proportional Hazards ◽  
Competing Risk ◽  
Treatment Modalities ◽  
Risk Models ◽  
Risk Of Death ◽  
Competing Risk Models

Abstract OBJECTIVES Few studies have investigated the frequency of adverse event (AE) by adjuvant therapy modalities in elderly patients with glioblastoma (GBM) in “real-world” setting. We conducted a retrospective cohort analysis to compare survival differences and incidences of AE with different treatment modalities. METHODS A total of 3100 elderly GBM patients were derived from the Surveillance, Epidemiology and End Results (SEER)-Medicare dataset (2004–2013). Adjuvant therapy modalities were either chemoradiation (CRT) followed by maintenance chemotherapy with temozolomide or RT alone. Primary outcomes include overall survival (OS) and cumulative incidences of 6-month and 1-year AEs with adjuvant therapies. Kaplan-Meier method and Cox proportional hazards regression were applied for survival analysis. Fine-Gray competing risk models were performed to estimate the risk of incident AEs over time with death as the competing risk event. RESULTS Superior OS was observed among GBM patients treated with CRT compared to RT alone (median OS: 6.9 vs. 2.9 months, P< 0.001). In multivariable Cox proportional hazard model, the risk of death was decreased by 52% for patients in the CRT group over the RT alone group (P< 0.001). Based on the multivariable competing risk models, the receipt of CRT was associated with higher risk of incident 6-month AEs with nausea/vomiting [sub-hazard ratio (SHR): 1.82, P=0.003] and constipation (SHR: 1.47, P=0.022); and 1-year AEs with neutropenia (SHR: 1.63, P=0.002), anemia (SHR: 1.64, P< 0.002), DVT (SHR: 1.25, P=0.035), seizure/epilepsy (SHR: 1.47, P=0.001), nausea/vomiting (SHR: 2.08, P< 0.001), diarrhea (SHR: 1.70, P=0.034), gastroenteritis/colitis (SHR: 2.77, P=0.024), constipation (SHR: 1.62, P=0.001), and dehydration (SHR: 1.27, P=0.020). CONCLUSION Comparing to the RT alone group, elderly GBM patients received CRT had 4-month median OS benefit, but experienced significantly higher incidences of AEs.

scholarly journals Impact of Hydroxyurea on Survival and Risk of Thrombosis Among Older Patients With Essential Thrombocythemia

2019 ◽  
Vol 17 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Nikolai A. Podoltsev ◽  
Mengxin Zhu ◽  
Amer M. Zeidan ◽  
Rong Wang ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Essential Thrombocythemia ◽  
Lower Risk ◽  
Older Patients ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Competing Risk Models ◽  
Medicare Database ◽  
The Impact

ABSTRACTBackground: Current guidelines recommend hydroxyurea (HU) as frontline therapy for patients with high-risk essential thrombocythemia (ET) to prevent thrombosis. However, little is known about the impact of HU on thrombosis or survival among these patients in the real-world setting. Patients and Methods: A retrospective cohort study was conducted of older adults (aged ≥66 years) diagnosed with ET from 2007 through 2013 using the linked SEER-Medicare database. Multivariable Cox proportional hazards regression models were used to assess the effect of HU on overall survival, and multivariable competing risk models were used to assess the effect of HU on the occurrence of thrombotic events. Results: Of 1,010 patients, 745 (73.8%) received HU. Treatment with HU was associated with a significantly lower risk of death (hazard ratio [HR], 0.52; 95% CI, 0.43–0.64; P<.01). Every 10% increase in HU proportion of days covered was associated with a 12% decreased risk of death (HR, 0.88; 95% CI, 0.86–0.91; P<.01). Compared with nonusers, HU users also had a significantly lower risk of thrombotic events (HR, 0.51; 95% CI, 0.41–0.64; P<.01). Conclusions: Although underused in our study population, HU was associated with a reduced incidence of thrombotic events and improved overall survival in older patients with ET.

Outcomes of Chemotherapy Treatment in Elderly Patients with Hodgkin Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3545-3545
Author(s):  
Theodore Thomas ◽  
Patrick M. Reagan ◽  
Suhong Luo ◽  
Kenneth R Carson
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
The United States ◽  
Chemotherapeutic Agents ◽  
Cox Proportional Hazards ◽  
Chemotherapy Treatment ◽  
Poor Prognostic Factor ◽  
Younger Patients ◽  
Risk Of Death

Abstract Introduction: Hodgkin lymphoma (HL) is a common lymphoid malignancy accounting for approximately 10 percent of all lymphomas. In the United States (US), the incidence of HL has a bimodal distribution curve with peaks at age 20 years and a second peak at approximately age 65 years. Age of diagnosis is an important prognostic marker in HL with younger patients having superior outcomes. Patients diagnosed at greater than age 60 years are considered elderly. Prior analyses of HL treatment in elderly patients have revealed worse outcomes in this population with reported 5-year progression free survival (PFS) and overall survival (OS) from 30-45% and 40-60% ranges, respectively (Evens, Blood 2012). The most common first line treatment for HL is doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Elderly patients are thought to have higher risk of bleomycin toxicity and worse outcomes with treatment in comparison to younger patients. Omission of bleomycin or doxorubicin from chemotherapy regimens administered to elderly patients is not uncommon. This study evaluated treatment outcomes of HL in an elderly U.S. Veteran population. Methods: The VHA database was used to identify patients diagnosed with HL using ICD-03 codes C000-C8099, 9651, 9652, 9653-9655, 9663-9667, 9650, 9661-9662, and 9659. Data was available from the Veterans Affairs Central Cancer Registry (VACCR) from October 1st, 2001-December 31st 2013. Data was obtained on patient demographics, weight, height, other clinical characteristics, date of diagnosis and HL directed treatments. Chemotherapeutic agents patients received were collected from the VACCR data and missing data was abstracted using chart review. Patients who received at least one dose of any chemotherapy for HL were considered to have received chemotherapy. Of patients who received chemotherapy, those who received at least one dose of bleomycin or doxorubicin were included in the bleomycin and doxorubicin groups respectively. Patients less than age 60 years were excluded. Patients greater than age 60 years were stratified by age into age groups 61-69 and ≥70 years. Overall survival was measured from date of diagnosis to date of death. Kaplan-Meier method for overall survival was used to evaluate each treatment group. Cox proportional hazard model was used to evaluate risk of death after adjusting for age (61-69 years used as reference) and chemotherapy used (bleomycin or doxorubicin). Results: There were 1,135 unique HL patients [632 (56%) patients ≤ age 60 years, 503 (44%) patients >age 60 years] identified in the VHA database. For patients age years >60, 389 patients (77%) received chemotherapy; with 226 (58%) patients age years 61-69 and 163 (42%) age years ≥70. Bleomycin was administered to 177 (78%) patients age years 61-69 and 106 (65%) patients age years ≥70 (p=0.037). Doxorubicin was administered to 198 (88%) patients age years 61-69 and to 122 (75%) patients age years ≥70 (p=0.0012). Cox proportional hazards analysis demonstrated that patients ≥70 years had a worse overall survival (HR = 1.71; 95% CI 1.276-2.293) in comparison patients age 61-69 years. After adjusting for age and chemotherapy, treatment with doxorubicin (HR 0.67; 95% CI 0.416-1.084) or bleomycin (HR 0.77; 95% CI 0.512-1.192) was associated with an improved survival. Conclusions: This retrospective analysis represents the largest cohort of elderly HL patients with detailed treatment information reported to date. Advanced age (age ≥70 years) was confirmed to be a poor prognostic factor. The chemotherapy agents used in elderly patients also differed by age with less doxorubicin and bleomycin administered to patients age ≥70 years in comparison to those age years 61-69. While not statistically significant, this study demonstrated improved survival in patients receiving bleomycin or doxorubicin regardless of age. Further analyses adjusting for patient comorbidities, evaluating for treatment related toxicity (i.e. pulmonary toxicity) and accounting for cause specific mortality are pending. Disclosures Reagan: Seattle Genetics: Research Funding. Carson:Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.

Estimation of Distribution Function in Bivariate Competing Risk Models

2006 ◽  
Vol 48 (3) ◽  
pp. 399-410 ◽  
Author(s):  
P. G. Sankaran ◽  
J. F. Lawless ◽  
B. Abraham ◽  
Ansa Alphonsa Antony
Keyword(s):  
Distribution Function ◽  
Competing Risk ◽  
Risk Models ◽  
Estimation Of Distribution ◽  
Competing Risk Models

The risk and prognosis of secondary primary malignancy in lung cancer: a population-based study

2021 ◽  
Author(s):  
Jia Hong ◽  
Rongrong Wei ◽  
Chuang Nie ◽  
Anastasiia Leonteva ◽  
Xu Han ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Population Based ◽  
Second Primary ◽  
Second Primary Malignancy ◽  
Risk Models ◽  
Primary Malignancy ◽  
Population Based Study ◽  
Competing Risk Models

Aim: To assess and predict risk and prognosis of lung cancer (LC) patients with second primary malignancy (SPM). Methods: LC patients diagnosed from 1992 to 2016 were obtained through the Surveillance, Epidemiology, and End Results database. Standardized incidence ratios were calculated to evaluate SPM risk. Cox regression and competing risk models were applied to assess the factors associated with overall survival, SPM development and LC-specific survival. Nomograms were built to predict SPM probability and overall survival. Results & conclusion: LC patients remain at higher risk of SPM even though the incidence declines. Patients with SPM have a better prognosis than patients without SPM. The consistency indexes for nomograms of SPM probability and overall survival are 0.605 (95% CI: 0.598–0.611) and 0.644 (95% CI: 0.638–0.650), respectively.

scholarly journals Evaluation of risk factors in patients with breast cancer in stages III and IV: comparison of Cox and Fine-Grey competing risk regression models

2018 ◽  
Vol 5 (02) ◽  
pp. 2022-2033
Author(s):  
Monireh Dehghani Arani ◽  
Alireza Abadi ◽  
Aarvin Yavari ◽  
Yousef Bashiri ◽  
Liley Mahmudi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Cox Model ◽  
Parametric Model ◽  
Hazard Ratio ◽  
Competing Risk ◽  
Age Group ◽  
Risk Models ◽  
Cancer Data ◽  
Competing Risk Models

Introduction: The aim of this study is to fit Fine-Grey competing risk model and compare its results with stratified Cox model and to examine its application in breast cancer data. Methods: The study was conducted on 15830 women diagnosed with breast cancer in British Columbia, Canada. They were divided into four groups according to patients' stage of disease then for patients with stage III and IV breast cancer was fitted Cox's model and Fine-Grey competing risk flexible models to each group. Results: The data show that Out of 1888 patients, 578 lied in the age group of below 50 years old, while 1310 were above 50 years of age. The results obtained from fitting stratified Cox regression model indicate that the variables of age and surgery are significant. The patients in the age group of below 50 years old have 70% less hazard in comparison with people older than 50 years of age (HR=0.83). Further, the patients receiving surgery have 38% less hazard in comparison with the patients not receiving surgery (HR=0.62). Then we fit Fine-Grey competing risk models. the variable of chemotherapy is significant in both parametric and semi-parametric competing risk models, and its hazard ratio is HR=1.15 and HR=1.14 in the two models, respectively. On the other hand, the variable of age has not become significant in any of the models, and its hazard ratio is HR=0.92 and HR=0.93, respectively. The variable of surgery in the competing risk parametric model is significant with an HR of 0.67. In Cox model, the variable of surgery is also significant with HR=0.62. Moreover, the variable of age in the competing risk parametric model has not become significant (HR=0.92), and in contrast the variable of age in the Cox model is significant (HR=0.83). Conclusion: The results of this study show that Considering the comparison of the two models, it is observed that regardless of the properties of competing risk data, estimations of hazard ratio and the extent of significance resulting from Cox models are different from those of competing risk models.   

Lobar versus Sublobar Resection in the Elderly for Early Lung Cancer: A Meta-Analysis

2021 ◽  
Author(s):  
Josiah Ng ◽  
Yoshio Masuda ◽  
Jun Jie Ng ◽  
Lowell Leow ◽  
Andrew M. T. L. Choong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Cancer Recurrence ◽  
Disease Free Survival ◽  
The Elderly ◽  
Sublobar Resection ◽  
Cell Lung Carcinoma ◽  
Risk Of Death ◽  
Stage 1

Abstract Objectives We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC). Methods We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied. Results Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy. Conclusion Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.

scholarly journals Identification of a class of index models: A topological approach

2020 ◽  
Author(s):  
Mogens Fosgerau ◽  
Dennis Kristensen
Keyword(s):  
Competing Risk ◽  
Nonparametric Identification ◽  
Random Utility ◽  
Risk Models ◽  
Topological Approach ◽  
Novel Approach ◽  
Support Conditions ◽  
Competing Risk Models ◽  
Weaker Conditions ◽  
Proof Strategy

Summary We establish nonparametric identification in a class of so-called index models by using a novel approach that relies on general topological results. Our proof strategy requires substantially weaker conditions on the functions and distributions characterising the model than those required by existing strategies; in particular, it does not require any large-support conditions on the regressors of our model. We apply the general identification result to additive random utility and competing risk models.

scholarly journals Traumatic brain injury associated with dementia risk among people with type 1 diabetes

Neurology ◽  
2018 ◽  
Vol 91 (17) ◽  
pp. e1611-e1618 ◽  
Author(s):  
Paola Gilsanz ◽  
Kathleen Albers ◽  
Michal Schnaider Beeri ◽  
Andrew J. Karter ◽  
Charles P. Quesenberry ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Type 1 Diabetes ◽  
Brain Injury ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Competing Risk ◽  
Middle Aged ◽  
Risk Of Death ◽  
Dementia Risk

ObjectiveTo examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D).MethodsWe evaluated 4,049 members of an integrated health care system with T1D ≥50 years old between January 1, 1996, and September 30, 2015. Dementia and TBI diagnoses throughout the study period were abstracted from medical records. Cox proportional hazards models estimated associations between time-dependent TBI and dementia adjusting for demographics, HbA1c, nephropathy, neuropathy, stroke, peripheral artery disease, depression, and dysglycemic events. Fine and Gray regression models evaluated the association between baseline TBI and dementia risk accounting for competing risk of death.ResultsA total of 178 individuals (4.4%) experienced a TBI and 212 (5.2%) developed dementia. In fully adjusted models, TBI was associated with 3.6 times the dementia risk (hazard ratio [HR] 3.64; 95% confidence interval [CI] 2.34, 5.68). When accounting for the competing risk of death, TBI was associated with almost 3 times the risk of dementia (HR 2.91; 95% CI 1.29, 5.68).ConclusionThis study demonstrates a marked increase in risk of dementia associated with TBI among middle-aged and elderly people with T1D. Given the complexity of self-care for individuals with T1D, and the comorbidities that predispose them to trauma and falls, future work is needed on interventions protecting brain health in this vulnerable population, which is now living to old age.

Comparative effectiveness of treatment options in elderly patients with colon cancer receiving adjuvant chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 470-470
Author(s):  
Sacha Satram-Hoang ◽  
Devi Ramanan ◽  
Luen F. Lee ◽  
Shui Yu ◽  
Carolina M. Reyes ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Trials ◽  
Propensity Score ◽  
Elderly Patients ◽  
Older Patients ◽  
Randomized Clinical Trials ◽  
Cohort Analysis ◽  
Risk Of Death ◽  
Morbidity Score ◽  
Co Morbidity

470 Background: While colon cancer (CC) is predominantly a disease of the elderly, older patients are underrepresented in clinical trials. We sought to evaluate whether the treatment patterns and benefits realized by trial participants pertain to older patients in the real-world setting. Methods: Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort analysis of 3390 stage II and III CC patients diagnosed between 1/1/ 2004 to 12/31/2007, who were >66 years, enrolled in Medicare Parts A and B, and received adjuvant treatment with 5FU/LV (n=1368), FOLFOX (n=1398), CAP (capecitabine; n=507), and CAPOX (CAP + oxaliplatin; n=117) within 3 months after surgery. Date of last follow-up was 12/31/2007. Chi-square test and ANOVA or t-test assessed differences in patient and disease characteristics by treatment. Propensity score weighted Cox regression assessed the relative risk of death by treatment. Results: Patients treated with CAP were older (mean age 77 years; p<.0001), more likely female (61%; p<.05), more likely non-white (19%; p<.05) and had higher co-morbidity score (p<.0001) compared to the other treatment groups. The mean time to chemo initiation after surgery were similar between the groups (mean 46-49 days) while mean duration of treatment were longer for 5FU/LV (149 days) and FOLFOX (144 days), compared to CAP (121 days) and CAPOX (111 days); p<.0001. The incidence of adverse events (AEs) within 180 days after initiation of treatment were higher in patients treated with FOLFOX (82%) and 5FU/LV (78%) compared to CAP (74%) and CAPOX (71%); p=0.0002. Propensity score adjusted multivariate analysis demonstrated comparable survival for CAP-based regimens vs. 5-FU/LV- based regimens ( table ). Conclusions: Treatment outcomes for elderly patients observed in routine clinical practice were comparable between CAP-based and 5FU/LV-based regimens and consistent with results reported in randomized clinical trials. AEs associated with medical resource utilization were less frequent with CAP-based regimens. [Table: see text]

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