729 The impact of immune and targeted therapies for melanoma in asian populations: a national cancer database analysis 2004–2016

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A773-A773
Author(s):  
Lifen Cao ◽  
Kavin Sugumar ◽  
Ankit Mangla ◽  
Megan Miller ◽  
Luke Rothermel
Keyword(s):  
Targeted Therapies ◽  
Stage Iv ◽  
Advanced Melanoma ◽  
National Cancer Database ◽  
Histologic Subtype ◽  
Asian Populations ◽  
Asian Patients ◽  
Kaplan Meier ◽  
Before And After ◽  
The Impact

BackgroundImmune checkpoint inhibitors (ICI) and targeted therapies (TT) have improved the survival outcomes in patients with advanced melanoma. However, less is known about their impact on Asian patients with melanoma. In this study, we hypothesize that patients of Asian ancestry would have improved survival for advanced melanoma since the introduction of ICI and TT in 2011.MethodsAsian patients with melanoma were identified in the National Cancer Database (NCDB) from 2004–2016. Patient, tumor, and treatment characteristics were compared for populations treated before and after 2011 using Chi-square analyses. Overall survival (OS) was analyzed using Kaplan-Meier estimates.Results1,411 Asian patients with melanoma were identified. Overall, 21% were melanoma in situ, and 79% were invasive melanomas. 62% of patients did not have a documented histologic subtype. The most common reported histologies were superficial spreading (14%) and acral lentiginous (10%) melanomas. Primary locations included 41% lower extremity, 17% upper extremity, and 11% head and neck. The age at diagnosis has increased during the study period - 38% over 60 years old in 2004, to 54% in 2016 (P<0.002). Kaplan-Meier survival estimates were performed for the whole Asian melanoma population and showed worse OS for all patients diagnosed after 2011 compared with patients diagnosed before 2011 - 83% vs 84% at 24 months (P=0.0033), 71% vs 76% at 48 months (P<0.001), respectively. However, the OS for those stage IV melanomas diagnosed after 2011 is better compared to patients diagnosed before 2011 - 52% vs. 26% at 24 months (P<0.001), and 20% vs. 13% at 48 months (P<0.001), respectively. (table 1) The worse OS trend seen for all patients was driven by those with early stage disease and likely does not reflect melanoma specific survival. Utilization rates of ICI and TT in Stage IV melanoma in Asian populations was significantly higher after 2011 (9% versus 30% before and after 2011 respectively, p=0.026). This was comparable to the utilization rates of 12% vs 34% for all patients (all races) with stage IV melanomas captured in the NCDB for the periods from 2004–2011 and 2012–2016.Abstract 729 Table 1Survival for stage IV asian melanoma*Longest follow up time in group 2 (Asian Melanoma diagnosed 2012 and after)ConclusionsAsian patients with melanoma are receiving diagnoses at older ages. Despite decreases in OS for all Asian patients with melanoma, advanced stage IV of the diseases have improved outcomes for the group treated in the era of ICI and TT. Further investigation is warranted to understand the treatment, patient, and tumor characteristics that predict response in this demographic of patients.

The impact of nodal metastasis on survival in stage IV colon cancer: Analysis of National Cancer Database 2004-2014.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15042-e15042
Author(s):  
Sukamal Saha ◽  
Mohamed Elgamal ◽  
Meghan Cherry ◽  
Robin Buttar ◽  
David Wiese ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Stage Iv ◽  
Nodal Metastasis ◽  
Rank Test ◽  
National Cancer Database ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
The Impact

e15042 Background: Lymph node (LN) metastasis (mets) is the strongest prognostic factor in colon cancer (CCa), however, its significance in Stage IV disease remains controversial. We analysed National Cancer Database (NCDB) to determine the impact of nodal mets on survival in Stage IV CCa patients (pts). Methods: From 2004-2014, NCDB pts with pathologic Stage IV CCa were divided into groups based on LN status and No. of +ve LNs. Only Stage IV CCa pts who underwent surgical resection of their primary tumor with available pathologic data as well as chemotherapy data were included. Kaplan-Meier method and log rank test were used to compare 5-year overall survival. Results: A total of 33574 pts data met the criteria of the study. Adenocarcinoma represented 82.3% of the total pts. Majority of the pts (82.61%) had +ve LN status. Mean survival was 36.3 vs 24.2 months in -ve LN vs +ve LN pts respectively. Overall 5yr survival was better in LN -ve pts ( 23.4%) versus LN +ve pts ( 10.2%) Survival for all years was inversely related to the number of +ve LN ( Table). For LN +ve or LN -ve pts, receiving any form of chemotherapy was associated with significantly improved survival when compared to no chemotherapy. Conclusions: LN status and No. of +ve LNs impact the prognosis of CCa, even in stage IV. Receiving some form of chemotherapy improves the prognosis for both pts with +ve or -ve LN status. These findings suggest that separation of Stage IV LN negative versus positive patients may be warranted in staging and treatment. 5 year survival according to LN status and No. of positive LN. [Table: see text]

Organ dysfunction (dys) and clinical outcomes in patients (pts) treated with immune checkpoint inhibitors (ICIs).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 2569-2569
Author(s):  
QI LIU ◽  
Elad Sharon ◽  
Issam Zineh ◽  
Diqiong (Joan) Xie ◽  
Shrujal S. Baxi ◽  
...  
Keyword(s):  
Renal Function ◽  
Liver Function ◽  
Clinical Outcomes ◽  
Checkpoint Inhibitors ◽  
Stage Iv ◽  
Organ Function ◽  
Kaplan Meier ◽  
Level Data ◽  
The Impact

2569 Background: ICIs (anti-PD-L1/PD-1/CTLA-4) are approved in multiple cancers. The impact of organ dys on the pharmacokinetics of ICIs is known, but associated clinical outcomes are not well characterized. We compared real-world (rw) clinical outcomes in ICI-treated pts by liver and renal function. Methods: This retrospective study used longitudinal, patient-level data from community practices in the Flatiron Health electronic-health record (EHR)-derived database. We included pts diagnosed with advanced cancers (NSCLC, renal cell, melanoma, gastric/esophageal, or head and neck) on or after 1/1/2011, treated with an ICI with follow-up through 12/31/2018 and with baseline liver or renal function results in the EHR ≤30 days prior to ICI start. Organ function was stratified as normal, mild, moderate, or severe dys based on NCI CTCAE. We computed unadjusted median estimates for rw time to treatment discontinuation (rwTTD) for any reason and overall survival (OS) across baseline groups using the Kaplan-Meier method. Results: Of 15,979 pts, we identified 12,978/12,840 pts with evaluable renal/liver function, respectively; median follow-up was 5.1 mos and median age was 69.0 yrs (IQR: 61.0, 76.0) for both. Most pts had NSCLC (69.4/69.0%), were men (60.1/60.0%), white (73.5/73.6%), and diagnosed at stage IV (58.7%/58.6%). Most ICI was given in 1st-line (42.3/42.1%) (outcomes in Table). Conclusions: Pts with categorically worse baseline liver function had progressively worse on-treatment outcomes, including shorter OS, which differed from trends in renal dys. Whether baseline dys is prognostic or predictive of ICI outcomes should be further investigated in addition to reasons for discontinuation. Clinical outcomes (unadjusted median times, mos [95% CI]) by organ function. [Table: see text]

Immunotherapy in metastatic melanoma: A sociodemographic analysis of the National Cancer Database.

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 87-87
Author(s):  
Amie Patel ◽  
Justin Moyers ◽  
Gayathri Nagaraj
Keyword(s):  
Metastatic Melanoma ◽  
Checkpoint Inhibitors ◽  
Academic Research ◽  
Stage Iv ◽  
National Cancer Database ◽  
Medicaid Expansion ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Socio Demographic Factors ◽  
Stage Iv Melanoma

87 Background: Metastatic melanoma carries poor prognosis and traditional chemotherapy has limited efficacy, but immune checkpoint inhibitors (ICIs) have drastically improved disease outcomes since first approved in 2011. Access to these costly agents in the real-world setting can be challenging. We aimed to assess the demographic and socioeconomic factors associated with receipt of immunotherapy in Stage IV melanoma using National Cancer Database (NCDB). Methods: NCDB first classified ICIs as immunotherapy agents in 2013, hence we queried the database to identify patients with Stage IV melanoma from 2013 to 2016. Patients were divided into receipt of immunotherapy or no receipt of immunotherapy; those without documentation of either were excluded. Factors compared between the two groups included age, sex, diagnosis year, Charlson-Deyo score, insurance and state Medicaid expansion status, income, treatment region, and facility type. Survival analyses were performed by Kaplan-Meier method. Logistic Regression was used to examine factors associated with immunotherapy receipt. Results: 9512 Stage IV melanoma patients had documented immunotherapy status during 2013 to 2016. 36.0% of patients received immunotherapy. Median overall survival (mOS) for all-comers was 10.1 months with improved survival for those who received immunotherapy compared to those who did not (mOS 18.4 v 7.4 months; p<0.01). Regression analysis revealed increased receipt of immunotherapy was associated with diagnosis in states with Medicaid expansion (OR: 1.16, 95% CI:1.002-0.1.340) compared to non-expansion; west north central (OR:1.433; 95%CI:1.139-1.804) and mountain (OR:1.433; 95%CI:1.132-1.813) regions when compared to pacific; academic/research program (OR:1.923; 95%CI:1.592-2.323) and integrated cancer programs (OR:1.362; 95%CI:1.094-1.695) compared to community program. Charlson-Deyo Scores of 1-3, lower Income, increased age, and less high school graduation were associated with decreased immunotherapy receipt. Conclusions: Improved survival is realized in those who receive immunotherapy for stage IV melanoma. Socio-demographic factors show discrepant receipt of immunotherapy.

Outcomes of appendiceal adenocarcinomas compared to right and left-sided colorectal adenocarcinomas: An analysis from the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 42-42
Author(s):  
Kanika Gupta Nair ◽  
Wei Wei ◽  
Michael Cruise ◽  
Katherine Tullio ◽  
Bassam N. Estfan
Keyword(s):  
Stage Iv ◽  
Stage I ◽  
Disease Stage ◽  
Rank Test ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Stage Iv Disease ◽  
The Difference ◽  
The Right ◽  
Colorectal Adenocarcinomas

42 Background: Appendiceal carcinomas (AC) account for 1-2% of colorectal cancers (CRC) and are generally treated like other CRC. However, there is limited data to guide treatment. While AC originate on the right side of the colon, it is unclear if they behave like as right-sided CRC (R-CRC). We seek to learn how AC differ from right versus left-sided CRC (L-CRC). Methods: We identified histologically confirmed cases of appendiceal and colorectal adenocarcinomas with information about stage and overall survival (OS) diagnosed between 2004 and 2016 from the National Cancer Database. Kaplan-Meier method and log-rank test were used to estimate and compare OS. Results: 833,939 patients met our inclusion criteria: 15,138 (1.8%) AC, 447,551 (53.7%) L-CRC, 308,794 (37.0%) R-CRC, and 62,456 (7.5%) transverse CRC (T-CRC). Median age at diagnosis of all patients was 68 years (range:18-90); AC was lowest at 61 years for stage I-III disease and 58 years for stage IV disease. Stage IV AC was more common in females 3628/5739 (63.22%). AC had the best OS among site groups in stage I-III. Median OS for stage I-III AC was 128.8 months (95% CI: 117.9-139.0), with 5-year OS rate of 0.69 (95% CI: 0.67-0.70); L-CRC median OS was 111.6 months (95% CI: 110.9-112.4), with 5-year OS rate of 0.681 (95% CI: 0.680-0.683); R-CRC median OS was 88.5 months (95% CI: 87.8-89.1), with 5-year OS rate of 0.613 (95% CI: 0.611-0.615); and T-CRC median OS was 86.2 months (95% CI: 84.7-87.6), with 5-year OS rate of 0.608 (95% CI: 0.604-0.613) (p <0.0001) (Table). Similar difference was observed in stage IV patients (Table). Conclusions: Patients with AC had significantly better OS for stages I-III and stage IV compared to patients with L-CRC, R-CRC, and T-CRC, though outcomes were more similar to L-CRC. The difference is more evidence for patients with stage IV disease. T-CRC had similar OS to R-CRC, as anticipated. [Table: see text]

Does pathologic upstaging to PT3A portend a worsened prognosis when compared to non-upstaged PT3A renal cell carcinoma: Analysis of the National Cancer Database.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 624-624
Author(s):  
Devin Patel ◽  
Fady Ghali ◽  
Margaret Meagher ◽  
Aaron Bradshaw ◽  
Sunil Patel ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Clinical Stage ◽  
Cox Proportional Hazards ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Incident Cases ◽  
The Impact

624 Background: Pathological T3a (pT3a) renal cell carcinoma (RCC) is often diagnosed at the time of final pathological analysis, though impact of lack pre-treatment detection on surgical outcomes is unclear. We sought to compare outcomes of pathologically upstaged pT3a RCC with pT3a RCC recognized clinically. Methods: We queried the National Cancer Database for incident cases of pT3a pN0/x pM0/x renal cell carcinoma (RCC) treated with radical (RN) or partial nephrectomy (PN) between 2009-2015. Tumors were staged using the AJCC staging system, 7th edition. Pathologically upstaged tumors were defined as those that had a clinical stage of T1 or T2. Non-upstaged tumors had a clinical stage of T3a. Multivariable Cox proportional hazards and Kaplan-Meier survival analysis were performed to study the impact of clinical to pathological upstaging in pT3a tumors on overall survival (OS) in patients treated with RN and PN. Results: A total of 19,538 pT3a tumors were identified of which 7,231 (37%) had concordant clinical stage (non-upstaged) and 12,307 (63%) had lower clinical stage (upstaged). Patients with upstaged tumors had longer time from diagnosis to surgery (31.5 vs. 23.8 days; p<0.001), smaller tumor size (6.7 vs. 7.4 cm; p<0.001), higher rates of treatment with partial nephrectomy (18% vs. 11%; p<0.001), and higher rates of negative margins (92% vs. 89%; p<0.001). On multivariate analysis, age (HR 1.06; p<0.001), Charlson Comorbidity Index (HR 1.51; p=0.006) and positive margin status (HR 1.55; p<0.001) were associated with worse OS. Pathological upstaging was an independent predictor of improved OS following both PN (HR 0.74; 95% CI 0.59-0.91; p=0.006) and RN (HR 0.87; 95% CI 0.82-0.93; p<0.001). Kaplan-Meier analysis showed higher OS for tumors that were upstaged following both PN (5-year OS 73 vs. 70%; p=0.0083) and RN (5-year OS 67 vs. 64%; p<0.001). Conclusions: Most pT3a RCC are pathologically upstaged. Pathological pT3a tumors that were correctly detected clinically were associated with worsened outcomes. While our findings require further confirmation, they call for consideration and refinement of risk stratification protocols in pT3a RCC.

Doxorubicin and concurrent radiotherapy for anaplastic thyroid cancer: We need to do better

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16506-16506 ◽  
Author(s):  
S. Lim ◽  
N. Y. Lee ◽  
M. G. Fury ◽  
R. A. Ghossein ◽  
A. R. Shaha ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Progression Free Survival ◽  
Anaplastic Thyroid Cancer ◽  
Median Number ◽  
Cancer Center ◽  
Published Data ◽  
Histologic Subtype ◽  
Kaplan Meier ◽  
Prior Surgery ◽  
The Impact

16506 Background: Anaplastic thyroid cancer (ATC) is a rare, aggressive malignancy. The potential for pathologic misclassification complicates the interpretation of published data. One treatment option for locoregionally (LR) advanced disease is weekly low-dose doxorubicin (D) with concurrent radiation therapy (RT), based on reported 2-year local control rates of 68% (ATC)/77% (other TC histologic subtypes) (Cancer 1987;60:2372). We looked to evaluate our experience with this general approach, but in a larger series which included pathologic confirmation of all ATC cases. Methods: Patients (pts) were identified through the Memorial Sloan-Kettering Cancer Center (MSKCC) Radiation Oncology and Pathology Databases. Inclusion criteria: diagnosis of ATC between 1984–2006, with pathology review at MSKCC; LR disease only, able to be encompassed within a RT portal; treatment at MSKCC with planned weekly D (10 mg/m2) and concurrent radiation. Prior surgery was allowed. Documentation of failure was based on clinical/radiographic assessment. Principal outcomes assessed: LR control (LRC: no failure at the primary site, in the neck, or the mediastinum), progression-free survival (PFS), and overall survival (OS). The Kaplan-Meier method was applied. Results: Thirty-seven patients were included in our analysis (median age 64; 54% female, 46% male). Median RT dose 5760 cGy, >4500 cGy in 32 (87%), administered through hyperfractionated or once-daily schedules. Median number of D treatments received 5.5, >4 in 24 (65%). 2-year outcomes: LRC 25%; PFS 8%; OS 18%. 6 patients remain alive at the time of last follow-up with survival durations of 4.1, 11.4, 11.7, 57.3, 58.5, and 140.7 months, respectively. A subset analysis was performed limited to the 24 patients (65%) who completed >4,500 cGy of radiation and >4 doses of D. 2-year outcomes were improved in this latter group, but remained disappointing, even among these more highly selected pts (LRC 30%; PFS 11%; OS 27%). Conclusions: Better therapy is needed for this poor prognostic disease. Future analyses will evaluate the impact of histologic subtype of ATC, radiation technique/dose, and surgical resection on outcome. No significant financial relationships to disclose.

Impact of income in stage IV prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 244-244
Author(s):  
Aabra Ahmed ◽  
Timothy Dean Malouff ◽  
Ryan W Walters ◽  
Sydney Marsh ◽  
Peter T. Silberstein
Keyword(s):  
Prostate Cancer ◽  
Median Survival ◽  
Statistical Significance ◽  
Stage Iv ◽  
Median Income ◽  
High School Degree ◽  
Kaplan Meier ◽  
Survival Differences ◽  
The Impact ◽  
Zip Code

244 Background: There is growing evidence of the impact of socioeconomic status on survival in cancer patients. To our knowledge, this is the largest study to examine demographics and the association between income and survival in patients with stage IV prostate cancer. Methods: Using the National Cancer Database, 50,639 patients diagnosed with stage IV prostate cancer between 2004-2011 were identified. Income was evaluated using the median income of the patient’s zip code. Between-income survival differences were estimated by the Kaplan-Meier method and associated log-rank tests; Tukey-Kramer adjusted p < .05 indicated statistical significance. Results: Survival differences were indicated between all income quartiles. Median survival was highest for patients in zip codes with a median income ≥ $63,000 and lowest for patients in zip codes with an income < $38,000 (46.1 months vs. 31.6 months, respectively; p < .001). As such, 41% of patients in zip codes with a median income ≥ $63,000 were alive five years following diagnosis, compared to 31% of patients in zip codes with median income < $38,000. Additionally, compared to patients in zip codes in which the median income was < $38,000, patients in zip codes with a median income ≥ $63,000 had a higher rate of zero comorbidities (81% vs. 76%), a greater percentage of patients living in an area where >93% people have a high school degree (58% vs 1%), and a lower proportion of African Americans (8% vs 41%). Conclusions: Compared to patients with a median income < $38,000, patients in zip codes with a median income > $63,000 had a median survival nearly 15 months longer, had 10% more patients alive after 5 years, and had fewer comorbidities. [Table: see text]

scholarly journals Dipeptidyl Peptidase-4 Inhibitors as a Third-Line Oral Antihyperglycaemic Agent in Patients with Type 2 Diabetes Mellitus: The Impact of Ethnicity

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
X. Zhang ◽  
B. Brooks ◽  
L. Molyneaux ◽  
E. Landy ◽  
R. Banatwalla ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase 4 ◽  
Asian Patients ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Before And After ◽  
Third Line ◽  
And Gender ◽  
The Impact

Aims. The aim of this study is to examine the efficacy of adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to patients with type 2 diabetes inadequately controlled by metformin and sulphonylurea combination treatment. The response of Asian and non-Asian patients to this regimen was also examined.Methods. The medical and computerized records of 80 patients were examined. These patients had baseline HbA1c levels ranging from 7.0 to 12.5% and had a DPP-4 inhibitor add-on therapy for a minimum period of 12 weeks. The primary endpoint was the change in HbA1c level before and after DPP-4 inhibitor treatment.Results. During oral triple therapy, there was a reduction of HbA1c from 8.3% (7.7–8.9) to 7.2% (6.8–7.6) and 26 patients (32.5%) achieved an HbA1c <7%. Poor baseline glycaemic control, lower BMI, and younger age were associated with a better response, but duration of diabetes and gender did not affect outcome. The HbA1c reduction was not different between Asians and non-Asians group [−1.00% (0.6–1.3) vs −0.90% (0.4–1.6)].Conclusions. DPP-4 inhibitor as a third-line add-on therapy can achieve significant glycaemic improvement in patients with type 2 diabetes inadequately controlled on the combination of metformin and sulphonylurea. The improvement in HbA1c was similar between Asian and non-Asian patients.

scholarly journals The impact of fluid resuscitation via colon on patients with severe acute pancreatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tongtian Ni ◽  
Ying Chen ◽  
Bing Zhao ◽  
Li Ma ◽  
Yi Yao ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Fluid Resuscitation ◽  
Early Stage ◽  
Pure Water ◽  
Complementary Therapy ◽  
Kaplan Meier ◽  
Before And After ◽  
First Onset ◽  
The Impact

AbstractSevere acute pancreatitis (SAP) is a life-threatening disease. Fluid Resuscitation Via Colon (FRVC) may be a complementary therapy for early controlled fluid resuscitation. But its clinical application has not been reported. This study aims to explore the impact of FRVC on SAP. All SAP patients with the first onset within 72 h admitted to the hospital were included from January 2014 to December 2018 through electronic databases of Ruijin hospital and were divided into FRVC group (n = 103) and non-FRVC group (n = 78). The clinical differences before and after the therapy between the two groups were analyzed. Of the 181 patients included in the analysis, the FRVC group received more fluid volume and reached the endpoint of blood volume expansion ahead of the non-FRVC group. After the early fluid resuscitation, the inflammation indicators in the FRVC group were lower. The rate of mechanical ventilation and the incidence of hypernatremia also decreased significantly. Using pure water for FRVC was more helpful to reduce hypernatremia. However, Kaplan–Meier 90-day survival between the two groups showed no difference. These results suggest that the combination of FRVC might benefit SAP patients in the early stage of fluid resuscitation, but there is no difference between the prognosis of SAP patients and that of conventional fluid resuscitation. Further prospective study is needed to evaluate the effect of FRVC on SAP patients.

The impact of the high emergency lung transplantation program in cystic fibrosis in France: insight from a comparison with Canada

2021 ◽  
pp. 2100014
Author(s):  
Adèle Coriati ◽  
Jenna Sykes ◽  
Lydie Lemonnier ◽  
Xiayi Ma ◽  
Sanja Stanojevic ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Transplantation ◽  
Population Based ◽  
Transplant Survival ◽  
Post Transplant ◽  
Kaplan Meier ◽  
Before And After ◽  
Cumulative Incidence Curve ◽  
The Impact ◽  
To Receive

IntroductionFrance implemented a high emergency lung transplantation (HELT) program nationally in 2007. A similar program does not exist in Canada. The objectives of our study were to compare health outcomes within France as well as between Canada and France before and after the HELT program in a population with Cystic Fibrosis (CF).MethodsThis population-based cohort study utilised data from the French and Canadian CF registries. A cumulative incidence curve assessed time to transplant with death without transplant as competing risks. The Kaplan-Meier method was used to estimate post-transplant survival.ResultsBetween 2002 and 2016, there were 1075 (13.0%) people with CF in France and 555 (10.2%) people with CF in Canada who underwent lung transplantation. The proportion of lung transplant increased in France after the HELT program was initiated (4.5% versus 10.1%) whereas deaths pre-transplant decreased from 85.3% in the pre-HELT to 57.1% in the post-HELT period. Between 2008–2016, people in France were significantly more likely to receive a transplant (Hazard Ratio (HR) 1.56, 95% CI 1.37–1.77, p<0.001) than die (HR 0.55, 95% CI 0.46–0.66, p<0.001) compared to Canada. Post-transplant survival was similar between the countries and there was no difference in survival when comparing pre- and post-HELT period in France.ConclusionFollowing the implementation of the HELT program, people living with CF in France were more likely to receive a transplant than die. Post-transplant survival in the post-HELT period in France did not change compared to the pre-HELT period, despite potentially sicker patients being transplanted, and is comparable to Canada.

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