Patterns and Outcomes Of First-Line Management Strategies In Older Adults With Low-Grade Follicular Lymphoma (FL)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1805-1805
Author(s):  
Ashish Rai ◽  
Loretta J. Nastoupil ◽  
Joseph Lipscomb ◽  
Kevin Ward ◽  
David H. Howard ◽  
...  
Keyword(s):  
Older Adults ◽  
Management Strategies ◽  
The United States ◽  
Stage I ◽  
Stage Iii ◽  
Treatment Modalities ◽  
Low Grade ◽  
First Line ◽  
The Impact ◽  
Line Management

Abstract Background Therapeutic decision making for patients with low-grade (grade 1 and 2) FL involves deciding whether to treat, when to treat, and which among the numerous treatment modalities to administer. The lack of trials comparing outcomes of these treatment modalities makes it a complex process. This study seeks to examine the evolving treatment paradigm and evaluate the outcomes of first-line management strategies for low-grade FL in adults aged ≥ 66. Methods We used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 4,233 low grade FL patients (pts) aged 66 years and older diagnosed between 1995 and 2009. We ascertained first-line management strategies from Medicare claims made within 90 days of diagnosis. We used Kaplan-Meier estimators stratified by stage to evaluate survival functions for first-line management strategies. We used multivariate Cox proportional hazards models—stratified by stage and adjusted for patient demographics, comorbidity index, and year of diagnosis—to compare the impact of first-line management strategies on overall survival (OS). Results Of the 4,233 pts, 57% were female, 3% were African American, 93% were White, 51% resided in big metropolitan areas, 70% were diagnosed after 2000, 44% had stage III/IV disease, and 38% had extranodal involvement. The median age at diagnosis was 74 years (interquartile range 70-80). Common first-line management strategies were: observation (obs), 47%; chemotherapy (chemo) plus rituximab (R), 20%; chemo alone, 12%; R alone, 9%; and radiotherapy (XRT) alone, 9%. Among pts receiving chemo plus R (R-chemo), the most commonly used regimens were: R-CHOP (R, cyclophosphamide, doxorubicin, vincristine, and prednisone; 36%), R-CVP (R, cyclophosphamide, vincristine, and prednisone; 47%), R-Fludarabine based (9%), and R-other (7%). The table displays median survival and hazard ratios (HRs) for first-line management strategies. Among stage I/II cases, most favorable outcomes were observed in cases receiving XRT alone, whereas among stage III/IV cases most favorable outcomes were observed in the group that received R-chemo. In the subset of stage III/IV pts that received R-chemo, R-CHOP was associated with the most favorable outcomes. HRs decreased steadily with increasing years of diagnosis. Conclusion First-line R-chemo is commonly used in older adults with low-grade FL in the United States and is associated with most favorable survival outcomes. XRT is associated with very favorable outcomes in stage I/II pts. Outcomes have improved steadily in the past 10 years. CVP–cyclophosphamide, vincristine, prednisone; CHOP- cyclophosphamide, doxorubicin, vincristine, prednisone Disclosures: No relevant conflicts of interest to declare.

Patterns Of Care and Outcomes Of Anthracyclines In Grade 3 Follicular Lymphoma (FL)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4401-4401
Author(s):  
Loretta J. Nastoupil ◽  
Ashish Rai ◽  
Joseph Lipscomb ◽  
Jessica N Williams ◽  
Kevin Ward ◽  
...  
Keyword(s):  
Management Strategies ◽  
The United States ◽  
Patterns Of Care ◽  
Stage Iii ◽  
First Line ◽  
Disease Characteristics ◽  
Multiple Variable ◽  
Comorbidity Index ◽  
Grade 3 ◽  
Line Management

Abstract Background The role of anthracyclines in the management of Grade 3 (G3) FL is unclear. Furthermore, the patterns of care and outcomes of first-line treatment strategies for G3 FL in older adults are not clearly established. We describe the patterns of use, determinants of treatment, and survival outcomes of first-line management strategies for G3 FL with emphasis on four common first-line regimens: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), rituximab (R) plus CHOP (R-CHOP), cyclophosphamide, vincristine, and prednisone (CVP), and R plus CVP (R-CVP). Methods We used the linked Surveillance, Epidemiology, and End Results -Medicare database to identify 1,308 G3 FL patients (pts) diagnosed between 1995 and 2009 and focused on pts diagnosed between 1999 and 2009 when claims with R appear. We ascertained first-line management strategies from Medicare claims made within 90 days of diagnosis. We used multiple variable logistic regression models to evaluate the relationship between pt characteristics and the use of first-line R-CHOP. We used Kaplan-Meier estimators stratified by FL stage to evaluate survival functions for first-line management strategies and performed multiple variable Cox proportional hazards regressions adjusted for pt demographics, comorbidity index, disease characteristics, and year of diagnosis to compare the impact of first-line management strategies on survival. Results Of the 1,308 G3 FL pts, 59% were female, 91% were Caucasian, 3% were African American, 44% had stage III/IV disease, 6% had B-symptoms, and 36% had extranodal involvement. The median age at diagnosis was 75 (interquartile range 70-80). Common first-line management strategies were: observation (obs), 29%; R-CHOP, 26%; CHOP, 9%; radiotherapy alone (XRT), 8%; R alone, 8%; R-CVP, 7%; and CVP, 5%. The use of R-CVP and R-CHOP increased over time (Figure 1). In the cohort of pts diagnosed between 1999 and 2009 the use of R-CHOP was less commonly associated with age >80 years (ref. age 66-70 years; OR 0.19; 95% CI 0.11-0.31), comorbidity index ≥ 2 (ref. index =0; OR 0.54; 95% CI 0.31-0.92), and more commonly associated with stage III/IV FL (OR 1.46; 95% CI 1.05-2.02), and year of diagnosis (ref. years 1999-2001; OR for 2002 3.68; 95% CI 1.77-7.64; steady increase thereafter). The table displays median survival and hazard ratios (HRs) for first-line management strategies. The most favorable outcomes were associated with first-line R-chemotherapy (R-Chemo). Among first-line R-chemo regimens, R-CHOP was associated with the most favorable outcomes (Figure 2). Conclusion R-CHOP is the most commonly used first-line regimen in the United States for older adult pts with FL G3. Even after controlling for disease characteristics and comorbidity, R-CHOP was associated with the most favorable survival outcome. Disclosures: No relevant conflicts of interest to declare.

Disease Characteristics, Patterns Of Care, and Outcomes Of Follicular Lymphoma (FL) In The Oldest Old

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1817-1817
Author(s):  
Loretta J. Nastoupil ◽  
Ashish Rai ◽  
Joseph Lipscomb ◽  
Chadi Nabhan ◽  
Jessica N Williams ◽  
...  
Keyword(s):  
Oldest Old ◽  
Management Strategies ◽  
Patterns Of Care ◽  
Stage Iii ◽  
First Line ◽  
Disease Characteristics ◽  
Comorbidity Index ◽  
Grade 3 ◽  
The Impact ◽  
Line Management

Abstract Background The oldest old constitute a large proportion of the total patient (pt) population with FL. Therapeutic decision making in this group is limited by comorbidities, adverse disease and pts' characteristics, potential treatment toxicity, and limited life expectancy. Further, randomized clinical trials have rarely included this pt population. Whether current practice patterns for these pts affect their outcome remains unanswered. Therefore, we aimed to determine treatment selections, patterns of care, prognostic factors, and survival outcomes of first-line management strategies in a large United States (US) based cohort of the oldest old (pts aged > 80 years at diagnosis). Methods We used the linked Surveillance, Epidemiology, and End Results -Medicare database to identify 1,878 FL cases in pts > 80 years diagnosed between 1995 and 2009 and focused on the period when rituximab (R) claims occurred. We ascertained first-line management strategies from Medicare claims made within 90 days of diagnosis. We used multiple variable logistic regression models to evaluate the relationship between pt characteristics and the use of two common first-line management strategies—observation (obs) and treatment with R, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). We used Kaplan-Meier estimators stratified by stage to evaluate survival functions for first-line management strategies and Cox proportional hazards models adjusted for pt demographics, comorbidity index, disease characteristics, and year of diagnosis to compare the impact of first-line management strategies on survival. Results Of the 1,878 oldest adult pts, 63% were female, 95% were white, 2% were African American, 52% had stage III/IV FL, 17% had grade 3 FL, 5 % had B-symptoms, 35% had extranodal involvement, and 14% had a comorbidity index ≥ 2. Common first-line management strategies were: obs, 46%; R, 17%; chemotherapy (chemo) plus R, 11%; chemo, 11%; and radiotherapy (XRT), 11%. In the cohort of pts diagnosed between 1995 and 2009, obs was more commonly associated with urban pts (ref. less urban/rural pts; OR 1.91; 95% CI 1.15-3.18), and comorbidity index of ≥ 1 (ref. index=0; OR 1.28; 95% CI 1.00-1.64). Obs was less commonly associated with stage III/IV FL (ref. stage I/II; OR 0.67; 95% CI 0.54-0.84), grade 3 FL (ref. grade 1/2; OR 0.35; 95% CI 0.26-0.47), and year of diagnosis (ref. year 1995; OR for 1997 0.23; 95% CI 0.07-0.75; steady decrease thereafter). In the cohort of pts diagnosed between 1999 and 2009, the use of R-CHOP was associated with grade3 FL (ref. grade 1/2; OR 8.20; 95% CI 3.83-17.55) and presence of B-symptoms (ref. absent; OR 4.18; 95% CI 1.81-9.62). R-CHOP use did not vary with year of diagnosis. The table displays median survival and hazard ratios (HRs) for first-line management strategies. Most favorable outcomes were associated with first-line R-Chemo. Among stage III/IV cases, the least favorable outcomes were observed in the group that received chemo without R. The HRs did not vary with more recent years of diagnosis. Conclusion In this largest retrospective analysis of the oldest old US-based FL pts, we demonstrate that first-line R-Chemo is associated with improved survival. Confirmatory prospective studies specifically designed for this pt population are warranted. CVP-cyclophosphamide, vincristine, prednisone; CHOP- cyclophosphamide, doxorubicin, vincristine, prednisone; R-CVP- rituximab, cyclophosphamide, vincristine, prednisone. Disclosures: No relevant conflicts of interest to declare.

Patterns Of First-Line Management Strategies In Older Adults With Follicular Lymphoma (FL)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2983-2983
Author(s):  
Ashish Rai ◽  
Loretta J. Nastoupil ◽  
Jessica N Williams ◽  
Joseph Lipscomb ◽  
Kevin Ward ◽  
...  
Keyword(s):  
African American ◽  
Management Strategies ◽  
Single Agent ◽  
Stage I ◽  
Stage Iii ◽  
First Line ◽  
White Race ◽  
Grade 3 ◽  
African American Race ◽  
Line Management

Abstract Background The treatment paradigm for FL has evolved greatly since the advent of rituximab (R) in 1997. However, a standard of care for first-line management of FL is yet to emerge (Friedberg, JCO 2009). This study seeks to describe the determinants of and temporal patterns in the use of first-line management strategies. Methods We used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 7,931 FL patients (pts) aged ≥ 66 years diagnosed between 1995 and 2009. We ascertained first-line management strategies from Medicare claims made within 90 days of diagnosis. Pts with no FL related treatment claims were classified as observation (obs). We used multiple variable logistic regression models to evaluate the relationship between pt characteristics and the use of two common first-line management strategies—obs and immunochemotherapy with R, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Results Of the 7,931 pts, 57% were female, 3% were African American, 93% were White, 51% resided in big metropolitan areas, 52% were diagnosed after the year 2000, 44% had stage III/IV disease, 17% had grade 3 disease, and 39% had extranodal involvement. The median age at diagnosis was 75 years (interquartile range 70-80). Common first-line management strategies were: obs, 41%; chemotherapy (chemo) plus R, 26%; chemo alone, 11%; R alone, 10%; and radiotherapy (rad) alone, 9%. Among pts receiving chemo plus R the most commonly used regimens were: R-CHOP (50%), R-CVP (R, cyclophosphamide, vincristine, and prednisone, 35%), R-Fludarabine based (7%), R-Other (7%). Trends in the use of first-line management strategies are displayed in the figure. Obs was more commonly associated with age ≥81 years (ref. age 66-70 years; OR 1.41; 95% CI 1.22-1.62) and African American race (ref. White race; OR 1.77; 95% CI 1.33-2.37), and less commonly associated with stage III/IV FL (ref. stage I/II FL; OR 0.84; 95% CI 0.76-0.93); grade 3 FL (ref. grade 1/2 FL; OR 0.37; 95% CI 0.32-0.43), presence of B symptoms (ref. absent; OR 0.54; 95% CI 0.41-0.71), and year of diagnosis (ref. year 1995; OR for 2002 0.57; 95% CI 0.35-0.94; steady decrease thereafter). In the cohort of patients diagnosed between 1999 and 2000, first-line R-CHOP was more commonly associated with stage III/IV FL (ref. stage I/II; OR 1.53; 95% CI 1.27-1.83), grade 3 FL (ref. grade 1/2; OR 7.30; 95% CI 5.86-9.09), presence of B symptoms (ref. absent; OR 1.46; 95% CI 1.04-2.04), and year of diagnosis (ref. years 1999-2001; OR for 2002 3.74; 95% CI 2.38-5.87; steady increase thereafter), and less commonly associated with age 76-80 years (ref. age 66-70 years; OR 0.65; 95% CI 0.51-0.82), age ≥81 years (OR 0.20; 95% CI 0.15-0.27), African American race (ref. White race; OR 0.46; 95% CI 0.25-0.85) and comorbidity index ≥2 (ref. index 0; OR 0.55; 95% CI 0.41-0.76). Conclusions As anticipated, the use of chemo plus R and single-agent R increased steadily after the introduction of R in1997, while that of obs and chemo alone decreased over the same period. Disclosures: No relevant conflicts of interest to declare.

Trends in diagnosis and treatment of early breast cancer (eBC) in the United States (US) during the COVID-19 era.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 227-227
Author(s):  
Benjamin Ackerman ◽  
Catherine Keane ◽  
Julia A. Beaver ◽  
Paul Gustav Kluetz ◽  
Donna Rivera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Systemic Therapy ◽  
Initial Treatment ◽  
The United States ◽  
Stage I ◽  
Treatment Modalities ◽  
Research Database ◽  
Cancer Outcomes ◽  
The Impact

227 Background: Recent studies have demonstrated a decline in cancer screening and diagnosis during the COVID-19 pandemic. This study explored trends in the diagnosis and management of eBC at a sample of cancer clinics across the US early on in the pandemic. Methods: Patients were selected from the Flatiron Health Research Database (FHRD), an electronic health record-derived de-identified database comprising approximately 280 US cancer clinics (̃800 sites of care). Eligible patients had an ICD code for breast cancer, at least two clinical encounters, and a confirmed eBC (Stage I-III) diagnosis from unstructured documents. Patients were selected into two cohorts based on diagnosis date: a) COVID-19 era cohort diagnosed between February 1, 2020 through June 30, 2020 and b) pre-COVID-19 era cohort diagnosed from February 1, 2019 through June 30, 2019. Descriptive statistics were used to assess diagnosis trends in each time frame. Initial treatment received following eBC diagnosis was categorized as surgery, radiation or systemic therapy and was compared between the two cohorts. Initial treatment modalities for each cohort were further stratified by clinical stage and biomarker subtype (HER2+, HR+/HER2-, triple negative [TN] or unknown). Results: A total of 278 and 253 patients were selected for the pre-COVID-19 era and COVID-19 era cohorts, with a median age at diagnosis of 65 and 64 years, respectively. A 35% decrease in the number of eBC diagnoses was observed in April/May 2020 compared to March 2020, yet this reduction in diagnoses was not observed during the equivalent months in the pre-COVID-19 era cohort. Compared to the pre-COVID-19 era, a greater proportion of patients diagnosed with eBC during the COVID-19 era initiated systemic therapy as their first treatment modality (16.5% vs 29.6%) including patients with HER2+ (27.5% vs. 60%), HR+/HER2- (13.5% vs. 24.9%) and TN (30.8% vs. 40.0%) disease. This trend was observed in patients with stage I (11.7% vs. 24.1%) or II (55.9% vs. 73.0%) but not in patients with stage III (81.2% vs. 77.3%) eBC. Notably, among patients with HR+/HER2- eBC who received systemic therapy as their first treatment, endocrine therapy was most commonly used in keeping with recent recommendations from professional societies due to COVID-related anticipated surgical delays. Conclusions: This study demonstrates that COVID-19 was associated with a decreased incidence of eBC which could be, at least in part, attributed to previously reported delays in routine screening and pandemic healthcare utilization. Further efforts are required to understand who was affected by these delays and the impact on cancer outcomes. Follow-up data are needed to understand if the observed trends in cancer screening and treatment persist and their impact on long-term cancer outcomes.

scholarly journals The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America

2021 ◽  
Vol 35 ◽  
pp. 100848
Author(s):  
Ganesh M. Babulal ◽  
Valeria L. Torres ◽  
Daisy Acosta ◽  
Cinthya Agüero ◽  
Sara Aguilar-Navarro ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Latin America ◽  
Well Being ◽  
The United States ◽  
The Impact

scholarly journals Food Insecurity in the United States: Identification, Treatment, and Implications

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 772-773
Author(s):  
Rose Ann DiMaria-Ghalili ◽  
Connie Bales ◽  
Julie Locher
Keyword(s):  
United States ◽  
Older Adults ◽  
At Risk ◽  
Food Insecurity ◽  
Well Being ◽  
The United States ◽  
Health Clinic ◽  
High Risk Population ◽  
Geriatric Syndrome ◽  
The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

Cyber Place Management and Crime Prevention: The Effectiveness of Cybersecurity Awareness Training Against Phishing Attacks

2021 ◽  
pp. 104398622110016
Author(s):  
Sinchul Back ◽  
Rob T. Guerette
Keyword(s):  
Crime Prevention ◽  
Research University ◽  
Management Strategies ◽  
Large Body ◽  
The United States ◽  
Place Management ◽  
Online Setting ◽  
Using Data ◽  
Virtual Domain ◽  
The Impact

Criminologists and crime prevention practitioners recognize the importance of geographical places to crime activities and the role that place managers might play in effectively preventing crime. Indeed, over the past several decades, a large body of work has highlighted the tendency for crime to concentrate across an assortment of geographic areas, where place management tends to be absent or weak. Nevertheless, there has been a paucity of research evaluating place management strategies and cybercrime within the virtual domain. The purpose of this study was to investigate the effectiveness of place management techniques on reducing cybercrime incidents in an online setting. Using data derived from the information technology division of a large urban research university in the United States, this study evaluated the impact of an anti-phishing training program delivered to employees that sought to increase awareness and understanding of methods to better protect their “virtual places” from cybercrimes. Findings are discussed within the context of the broader crime and place literature.

Does the second wave of COVID-19 undermine corporate immunity? International evidence

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Huy Viet Hoang ◽  
Cuong Nguyen ◽  
Khanh Hoang
Keyword(s):  
Stock Returns ◽  
Stock Price ◽  
Fixed Effects ◽  
Management Strategies ◽  
The United States ◽  
Least Square ◽  
Content Type ◽  
The Impact ◽  
Second Wave ◽  
Practical Implications

PurposeThis study compares the impact of the COVID-19 pandemic on stock returns in the first two waves of infection across selected markets, given built-in corporate immunity before the global outbreak.Design/methodology/approachThe data are collected from listed firms in five markets that have experienced the second wave of COVID-19 contagion, namely the United States (US), Australia, China, Hong Kong and South Korea. The period of investigation in this study ranges from January 24 to August 28, 2020 to cover the first two COVID-19 waves in selected markets. The study estimates the research model by employing the ordinary least square method with fixed effects to control for the heterogeneity that may confound the empirical outcomes.FindingsThe analysis reveals that firms with larger size and more cash reserves before the COVID-19 outbreak have better stock performance under the first wave; however, these advantages impede stock resilience during the second wave. Corporate governance practices significantly influence stock returns only in the first wave as their effects fade when the second wave emerges. The results also suggest that in economies with greater power distance, although stock price depreciation was milder in the first wave, it is more intense when new cases again surge after the first wave was contained.Practical implicationsThis paper provides practical implications for corporate managers, policymakers and governments concerning crisis management strategies for COVID-19 and future pandemics.Originality/valueThis study is the first to evaluate built-in corporate immunity before the COVID-19 shock under successive contagious waves. Besides, this study accentuates the importance of cultural understanding in weathering the ongoing pandemic across different markets.

Determining the Long-Term Effectiveness of a Group-Based Physical Activity Program

2018 ◽  
Vol 20 (3) ◽  
pp. 401-408
Author(s):  
Anamica Batra ◽  
Richard C. Palmer ◽  
Elena Bastida ◽  
H. Virginia McCoy ◽  
Hafiz M. R. Khan
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Healthy Aging ◽  
Population Level ◽  
The United States ◽  
South Florida ◽  
Community Based ◽  
Evidence Based Programs ◽  
The Impact

Objective. In 2015, only half (48%) of older adults in the United States (≥60 years) reported engaging in any kind of physical activity. Few studies examine the impact of evidence-based programs when adopted in community-based settings. The purpose of this study is to assess the effectiveness of EnhanceFitness (EF) upto 12-months. Method. EF was offered to older adults in South Florida. A total of 222 EF classes were offered between October 2008 and December 2014. Program consisted of a 1-hour session held three times a week. Even though participation was required for 4 months, 1,295 participants continued the program for at least 1 year. Results. All participants showed significant improvement in outcome measures. A mean change of 1.5, 1.7, and 1.9 was seen in number of chair stands at 4, 8, and 12 months (p < .001), respectively. The number of arm curls performed improved from 16.8 at baseline to 18.8, 18.8, and 19.2 at 4-, 8-, and 12-months, respectively. Participants improved their up-and-go time by decreasing from 9.1 (baseline) to 8.7 (4 months) to 8.6 (12 months; p = .001). Discussion. Randomized controlled trials are commonly used to determine the efficacy of an intervention. These interventions when disseminated at the population level have the potential to benefit large masses. EF is currently offered at more than 700 locations. This tremendous success of EF brings attention to an important question of continuous monitoring of these programs to ensure program consistency and intended outcomes. The model used by the Healthy Aging Regional Collaborative could be replicated by other communities.

Impact of gender on treatment and survival of patients with esophageal cancer in the United States.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 173-173
Author(s):  
Camille Baumrucker ◽  
Dido Franceschi ◽  
Alan S Livingstone ◽  
Francis Igor Macedo
Keyword(s):  
Esophageal Cancer ◽  
The United States ◽  
Small Sample ◽  
Stage I ◽  
Disease Stage ◽  
Cancer Data ◽  
Female Patients ◽  
White Males ◽  
Chi Square Analysis ◽  
The Impact

173 Background: Esophageal cancer (EC) is historically a male-predominant disease. Current available evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institutional series. Methods: Patients with EC (stage I-III) were identified in the National Cancer Data Base (NCDB, 2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Overall survival (OS) was estimated using Kaplan-Meier method and Cox proportional hazards regression. Results: Of 62,893 patients included, male gender was predominant (77.7% vs 22.3%). Adenocarcinoma was the most common subtype (66.7%); however, squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were significantly older (68.5 vs. 66.1 years; p<0.001) and more likely African American (AA) (14% vs. 8.1%; p<0.001). Females were more likely to present with local disease (stage I, 19.6% vs. 18.2%; p<0.001), while males presented more likely with locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Females had worse OS compared to males (18.1 vs. 19.7 mo; p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; cII/III: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001), while AA females had better OS (13.5 vs. 12.6mo, p=0.001). Among patients with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (28% vs. 40.5%, p<0.001). Females who underwent esophagectomy had improved OS over males (40.3 vs. 32.7mo; p<0.001). More specifically, white females who underwent esophagectomy had improved OS over white males (47.6 vs 38mo, p<0.001); however, AA males and females who underwent esophagectomy had similar OS (33.8 vs 32.6mo, p=0.452). Female gender, advanced age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and esophagectomy were independent predictors of mortality (Table). Conclusions: Females with EC seem to have less access to CT, RT and esophagectomy, which is associated with worse OS compared to males. Healthcare policies should be implemented to increase access to standard of care treatment for female patients with EC. [Table: see text]

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