Time from diagnosis to treatment initiation in advanced non-small cell lung cancer (NSCLC): Time trends and racial differences

6037 Background: Historical survival evaluation of clinical trials for advanced NSCLC suggests that median survival improved by 0.4 months over a 22 year period. Survival in clinical trails is evaluated from treatment initiation and not from diagnosis. If treatment is initiated earlier over time, this may create a lead-time effect on survival analysis and thus may explain the apparent discrepancy between trial findings and outcomes in the community. Objective: Investigate if, over time, there has been a shortening of the time between the diagnosis of NSCLC and the initiation of chemotherapy. Methods: We evaluated patients with NSCLC stages IIIB and IV between 01/01/1994 and 12/31/1999. Date of diagnosis was obtained from Surveillance, Epidemiology, and End Results (SEER). Treatment data was obtained from Medicare claims and is restricted to patients above age 65. Differences were compared using analysis of variance (ANOVA). Results: A total of 11,995 patients were identified. Patient’s characteristics: median age 74 years; 57% of patients were males; racial distribution: white (82.4%), black (9.4%), Asian (3.2%), Hispanics (1.2%), others (3.8%); stage distribution: IIIB (38%), IV (62%). Chemotherapy was given to 3,377 (28%) patients. There was an increase in chemotherapy utilization over time: 10% in 1994 to 35% in 1999. Over time there was a shortening from diagnosis to chemotherapy initiation from 1.6 months in 1994 to 1.3 months in 1999 (p = 0.0004). Among those receiving chemotherapy, median survival from diagnosis did not change over this time period. Black patients had a longer time between diagnosis and treatment initiation: 1.7 months vs. 1.4 months (p < 0.01). Conclusions: Over time, there has been a shortening of the time between diagnosis and chemotherapy initiation. This difference, although small, seems to account for much of the apparent historical survival benefit observed. This finding puts additional limitation on the historical comparisons of survival between trials. Racial differences may help explain, in part, observed differences in outcome. No significant financial relationships to disclose.

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Narrowing of the Racial Disparities Gap in Survival of Patients with Mycosis Fungoides: A Longitudinal Analysis of the SEER Database (1988 to 2011)

Blood ◽

10.1182/blood-2021-151820 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1392-1392

Author(s):

Noha Soror ◽

Hamid D. Ismail ◽

Catherine Chung ◽

Basem M. William

Keyword(s):

Racial Disparities ◽

Research Funding ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

P Value ◽

Time Period ◽

Black Patients ◽

Over Time

Abstract I ntroduction: Mycosis Fungoides (MF) is the most common subtype of cutaneous T-cell lymphomas. Prior Studies have identified Black race as a risk factor for earlier age at diagnosis, more advanced stages at time of diagnosis and poor prognosis in patients with MF. Data examining differences in racial disparities outcomes over time are limited. Objective: This retrospective analysis aims to examine if the racial disparities in survival outcomes of MF patients have improved over time. Subjects and Methods: Using the United States Surveillance, Epidemiology and End Results (SEER) 1988-2011 public use database, we examined survival patterns for patients with MF (with the code of 9700) between 1988 and 2011. Cases were divided into three cohorts based on the year of diagnosis; "1988 - 1995", "1996 - 2003", and "2004 - 2011". Univariable and multivariable analysis were conducted to assess for factors significantly associated with the overall survival. The nonparametric estimates of the survival distribution function, Kaplan and Meier survival curves, and Cox proportional hazards model were used to investigate the factors affecting the survival time. Results: From 1988 to 2011, a total of 2896 cases of MF were identified with a median follow-up of 60 months. The difference in the survival time between the years of diagnosis 1988-1995 and 2004-2011 is significant (p-value=0.05). The parameter estimate of the Cox proportional hazards model for the "1988-1995" and the "2004-2011" period as a reference is also significant (p-value = 0.024) and the hazard ratio (HR) is 1.407, which means that patients diagnosed in 1988-1995 were 1.4 times likely to die from the disease compared to the patients diagnosed in 2004-2011 (i.e. patients in 1988-1995 were more likely to not survive than in 2004-2011) (Table 1 and 2). There is no significant difference in the survival of the patients between "1996-2003" and "2004-2011" (p-value 0.998), Cox model estimate is not significant (p-value = 0.178), and the HR is 0.94 (Table 1 and 2). For the time period 1988-1995, the survival of Black patients was inferior to White (p= 0.0339), Asians (p=0.001), and other races (p=0.0011); Figure 2 and Table 3. For the time period 1996-2003, there was no difference in survival across races (p-value=0.7599); Figure 3 and Table 3. For the time period of 2004-2011, survival of Black patients was similar to White (p-value=1) but again inferior to Asian (p-value=0.05) and other races (p-value=0.09); Figure 4 and Table 3. Across the entire time period of 1998-2011, the survival of Black patients was inferior to White (Chi-square=6.59 and p-value=0.0084); Figure 5. The survival gap between Black and White patients seems to be obliterated in subsequent; "1996 - 2003" and "2004 - 2011" vs 1988-1995 (Figures 3 and 4) due to improvements in survival of Black patients over time (Figure 6) while the survival of White patients remained rather steady over time (Figure 7). Conclusions: Our study demonstrated that Black race was significantly correlated with poorer survival in patients with MF. The etiology of this poorer prognosis can be related to access to medical care, socioeconomic disparities, or possibly difference in disease biology and immune response. Despite the persistent pattern of lower survival across all time periods, the gap in survival between White and Black races seems to be narrowing overtime. Figure 1 Figure 1. Disclosures William: Dova Pharmaceuticals: Research Funding; Incyte: Research Funding; Kyowa Kirin: Consultancy; Merck: Research Funding; Guidepoint Global: Consultancy.

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Misclassification of Gleason grade and tumor stage in Asian-American patients with low-risk prostate cancer: A SEER-Based Analysis

10.21203/rs.3.rs-1012252/v1 ◽

2021 ◽

Author(s):

Xiao Li ◽

Zicheng Xu ◽

Wenbo Xu ◽

Feng Qi ◽

Qing Zou

Keyword(s):

Prostate Cancer ◽

Racial Differences ◽

Asian Americans ◽

Asian American ◽

Low Risk ◽

Gleason Grade ◽

Black Patients ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer ◽

Over Time

Abstract Background This study aimed to investigate the misclassification rates of Asian-American patients with low-risk prostate cancer who underwent radical prostatectomy (RP). Methods Patients diagnosed with low-risk PCa treated with RP between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Then, basic characteristics and pathological outcomes of enrolled patients were retrospectively extracted. We compared the rates of upgrading and/or upstaging between Asian-American patients and White/Black patients. Moreover, temporal trend analyses were performed to explore the changes in upgrading and upstaging rates in each race over time. Finally, logistic regression models were constructed to explore the role of Asian race in upgrading and upstaging and to screen out potential risk factors for predicting upgrading and upstaging in Asian-American patients. Results In patients with low-risk PCa, Asian-Americans had significantly higher rate of upgrading than Whites (51.25% vs. 45.18%, P<0.001), while no statistical difference was found in the comparison of upstaging rate (10.01 vs. 10.01, P=0.536). Moreover, Asian-Americans were more likely to upgrade to diseases with higher ISUP grade than Whites (P=0.010). The rate of upgrading increased significantly over time in White and Black patients, but not in Asian-American patients. Finally, race seemed to be an independent risk factor for predicting upgrading, while the racial differences seemed to be more pronounced between White and Black patients. Conclusion Asian-American patients had a significantly higher rate of upgrading than White patients. Moreover, Asian-American patients were more likely to upgrade to diseases with higher ISUP grade. Further risk assessment before clinical decision for low-risk PCa patients with the help of significant clinical variables is required.

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Morquio A syndrome and effect of enzyme replacement therapy in different age groups of Turkish patients: a case series

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01761-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Sebile Kılavuz ◽

Sibel Basaran ◽

Deniz Kor ◽

Fatma Derya Bulut ◽

Sevcan Erdem ◽

...

Keyword(s):

Enzyme Replacement Therapy ◽

Replacement Therapy ◽

Clinical Data ◽

Treatment Initiation ◽

Case Series ◽

Enzyme Replacement ◽

Morquio A ◽

Over Time ◽

Morquio A Syndrome

Abstract Background This case series includes longitudinal clinical data of ten patients with Morquio A syndrome from south and southeastern parts of Turkey, which were retrospectively collected from medical records. All patients received enzyme replacement therapy (ERT). Clinical data collected included physical appearance, anthropometric data, neurological and psychological examinations, cardiovascular evaluation, pulmonary function tests, eye and ear-nose-throat examinations, endurance in the 6-min walk test and/or 3-min stair climb test, joint range of motion, and skeletal investigations (X-rays, bone mineral density). Results At the time of ERT initiation, two patients were infants (1.8 and 2.1 years), five were children (3.4–7.1 years), and three were adults (16.5–39.5 years). Patients had up to 4 years follow-up. Most patients had classical Morquio A, based on genotypic and phenotypic data. Endurance was considerably reduced in all patients, but remained relatively stable or increased over time in most cases after treatment initiation. Length/height fell below normal growth curves, except in the two infants who started ERT at ≤ 2.1 years of age. All patients had skeletal and/or joint abnormalities when ERT was started. Follow-up data did not suggest improvements in skeletal abnormalities, except in one of the younger infants. Nine patients had corneal clouding, which resolved after treatment initiation in the two infants, but not in the other patients. Hepatomegaly was reported in seven patients and resolved with treatment in five of them. Other frequent findings at treatment initiation were coarse facial features (N = 9), hearing loss (N = 6), and cardiac abnormalities (N = 6). Cardiac disease deteriorated over time in three patients, but did not progress in the others. Conclusions Overall, this case series with Morquio A patients confirms clinical trial data showing long-term stabilization of endurance after treatment initiation across ages and suggest that very early initiation of ERT optimizes growth outcomes.

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Divergent poststroke outcomes for black patients

Neurology ◽

10.1212/wnl.0000000000008391 ◽

2019 ◽

Vol 93 (18) ◽

pp. e1664-e1674 ◽

Cited By ~ 6

Author(s):

James F. Burke ◽

Chunyang Feng ◽

Lesli E. Skolarus

Keyword(s):

Racial Differences ◽

Care Setting ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Fee For Service ◽

Primary Analysis ◽

Skilled Nursing ◽

Black Patients ◽

Postacute Care ◽

White Patients

ObjectiveTo explore racial differences in disability at the time of first postdischarge disability assessment.MethodsThis was a retrospective cohort study of all Medicare fee-for-service beneficiaries hospitalized with primary ischemic stroke (ICD-9,433.x1, 434.x1, 436) or intracerebral hemorrhage (431) diagnosed from 2011 to 2014. Racial differences in poststroke disability were measured in the initial postacute care setting (inpatient rehabilitation facility, skilled nursing facility, or home health) with the Pseudo-Functional Independence Measure. Given that assignment into postacute care setting may be nonrandom, patient location during the first year after stroke admission was explored.ResultsA total of 390,251 functional outcome assessments (white = 339,253, 87% vs black = 50,998, 13%) were included in the primary analysis. At the initial functional assessment, black patients with stroke had greater disability than white patients with stroke across all 3 postacute care settings. The difference between white and black patients with stroke was largest in skilled nursing facilities (black patients 1.8 points lower than white patients, 11% lower) compared to the other 2 settings. Conversely, 30-day mortality was greater in white patients with stroke compared to black patients with stroke (18.4% vs 12.6% [p < 0.001]) and a 3 percentage point difference in mortality persisted at 1 year. Black patients with stroke were more likely to be in each postacute care setting at 30 days, but only very small differences existed at 1 year.ConclusionsBlack patients with stroke have 30% lower 30-day mortality than white patients with stroke, but greater short-term disability. The reasons for this disconnect are uncertain, but the pattern of reduced mortality coupled with increased disability suggests that racial differences in care preferences may play a role.

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Changes in survival characteristics ofDiplostomum spathaceumcercariae emerged from cadmium-exposedLymnaea stagnalis

Journal of Helminthology ◽

10.1079/joh2004271 ◽

2005 ◽

Vol 79 (1) ◽

pp. 55-59 ◽

Cited By ~ 7

Author(s):

N.J. Morley ◽

M. Crane ◽

J.W. Lewis

Keyword(s):

Life Span ◽

Lymnaea Stagnalis ◽

Control Population ◽

Survival Period ◽

Parasite Transmission ◽

Tail Loss ◽

Diplostomum Spathaceum ◽

Time Period ◽

Potential Indicator ◽

Over Time

AbstractThe effect of exposingLymnaea stagnalis(Gastropoda: Pulmonata), infected withDiplostomum spathaceum(Trematoda: Diplostomatidae), to 100 μg l−1cadmium for 7 days on survival characteristics (survival, tail loss, decaudized cercarial life-span) of emerged cercariae was investigated. Exposure ofL. stagnalisto cadmium resulted in significantly increasedD. spathaceumcercarial survival and an inhibited tail loss compared to controls. The normal parallel relationship which exists over time between decreasing cercarial survival and increasing tail loss in controls was changed in cercariae from cadmium-exposed hosts with an increased proportion of cercarial deaths occurring without tail loss. The decaudized cercarial life-span over the survival period of the cercarial population did not significantly change. However comparisons between individuals decaudized during the initial 24 h time period with those which were decaudized during the final period of cercarial survival showed a significantly altered life span which did not occur in the control population. As a potential indicator of penetration ‘fitness’ comparisons were also undertaken between control and exposed cercariae decaudized during the initial 24 h time period, which revealed that the decaudized cercarial life-span from the exposed hosts was significantly different from controls. This may have important implications for the ability of cercariae to migrate through the tissues of their target host. The importance and relevance of these results to parasite transmission are discussed.

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Faculty Publishing Productivity: Comparisons over Time

College & Research Libraries ◽

10.5860/crl.67.3.230 ◽

2006 ◽

Vol 67 (3) ◽

pp. 230-239 ◽

Cited By ~ 16

Author(s):

John M. Budd

Keyword(s):

Academic Librarians ◽

Tenure Track ◽

Data Set ◽

Part Time Faculty ◽

Time Period ◽

Rate Of Increase ◽

Part Time ◽

Per Capita ◽

Time Faculty ◽

Over Time

Concerns about higher education abound, and these include concerns about productivity. The present study extends two previous examinations of faculty publishing productivity covering the years 1991 to 1993 and 1995 to 1997. Both members of ARL and a group of institutions included in ACRL’s data set are included. For both groups there are some increases in mean total numbers of publications, although the rate of increase has decreased since the second time period. Per capita rates of publication demonstrate an even flatter pattern. In recent years, there have been some changes in the dynamics of universities’ faculties; there are more part-time faculty and more faculty who are not on the tenure track. These factors, coupled with the publishing data, point to activities that all academic librarians should be aware of.

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Creating relationship continuity across projects in the construction industry

IMP Journal ◽

10.1108/imp-07-2016-0015 ◽

2017 ◽

Vol 11 (2) ◽

pp. 207-229 ◽

Cited By ~ 2

Author(s):

Malena Ingemansson Havenvid ◽

Elsebeth Holmen ◽

Åse Linné ◽

Ann-Charlott Pedersen

Keyword(s):

Construction Industry ◽

Empirical Studies ◽

Mutual Orientation ◽

Content Type ◽

Construction Firms ◽

Relationship Continuity ◽

Time Period ◽

Strategy Types ◽

The Relationship ◽

Over Time

Purpose The purpose of this paper is to investigate the relationship continuity across projects among actors in the construction industry, and to discuss why and how such continuity takes place. Design/methodology/approach The authors draw on the results from four in-depth case studies illustrating different strategies for pursuing relationship continuity. The results are analysed and discussed in light of the oft-mentioned strategies suggested by Mintzberg (1987): emergent, deliberate and deliberately emergent strategies. Furthermore, the ARA-model is used to discuss why the relationship continuity strategies are pursued, and which factors might enable and constrain the relationship continuity. Findings The main findings are twofold. First, the authors found that the strategy applied for pursuing relationship continuity may, in one-time period, contain one type of strategy or a mix of strategy types. Second, the type of strategy may evolve over time, from one type of strategy being more pronounced in one period, to other strategies being more pronounced in later periods. The strategies applied by construction firms and their counterparts can thus contain elements of emergent, deliberate and deliberately emergent strategies, in varying degrees over time. It is also shown that the strategies of the involved actors co-evolve as a result of interaction. Also, the main reasons for pursuing continuity appear to lie in the re-use and development of important resources and activities across projects to create efficiency and the possibility to develop mutual orientation, commitment and trust over time, and thus reduce uncertainty. Research limitations/implications Further empirical studies are needed to support the findings. For managers, the main implication is that relationship continuity can arise as part of an emerging interaction pattern between firms or as part of a planned strategy, but that elements of both might be needed to sustain it. Originality/value The authors combine Mintzberg’s strategy concepts with the ARA-model to bring new light to the widely debated issue of discontinuity and fragmentation in the construction industry.

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Association between ibrutinib treatment and hypertension

Heart ◽

10.1136/heartjnl-2021-319110 ◽

2021 ◽

pp. heartjnl-2021-319110

Author(s):

Dae Hyun Lee ◽

Fahad Hawk ◽

Kieun Seok ◽

Matthew Gliksman ◽

Josephine Emole ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Repeated Measures ◽

Treatment Initiation ◽

Kinase Inhibitor ◽

Pressure Change ◽

Exact Test ◽

N 93 ◽

Pressure Changes ◽

Over Time

BackgroundIbrutinib is a tyrosine kinase inhibitor most commonly associated with atrial fibrillation. However, additional cardiotoxicities have been identified, including accelerated hypertension. The incidence and risk factors of new or worsening hypertension following ibrutinib treatment are not as well known.MethodsWe conducted a retrospective study of 144 patients diagnosed with B cell malignancies treated with ibrutinib (n=93) versus conventional chemoimmunotherapy (n=51) and evaluated their effects on blood pressure at 1, 2, 3 and 6 months after treatment initiation. Descriptive statistics were used to compare baseline characteristics for each treatment group. Fisher’s exact test was used to identify covariates significantly associated with the development of hypertension. Repeated measures analyses were conducted to analyse longitudinal blood pressure changes.ResultsBoth treatments had similar prevalence of baseline hypertension at 63.4% and 66.7%, respectively. There were no differences between treatments by age, sex and baseline cardiac comorbidities. Both systolic and diastolic blood pressure significantly increased over time with ibrutinib compared with baseline, whereas conventional chemoimmunotherapy was not associated with significant changes in blood pressure. Baseline hypertensive status did not affect the degree of blood pressure change over time. A significant increase in systolic blood pressure (defined as more than 10 mm Hg) was noted for ibrutinib (36.6%) compared with conventional chemoimmunotherapy (7.9%) at 1 month after treatment initiation. Despite being hypertensive at follow-up, 61.2% of patients who were treated with ibrutinib did not receive adequate blood pressure management (increase or addition of blood pressure medications). Within the ibrutinib group, of patients who developed more than 20 mm Hg increase in systolic blood pressure, only 52.9% had hypertension management changes.ConclusionsIbrutinib is associated with the development of hypertension and worsening of blood pressure. Cardiologists and oncologists must be aware of this cardiotoxicity to allow timely management of blood pressure elevations.

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Visualizing Belief in Meritocracy, 1930–2010

Socius Sociological Research for a Dynamic World ◽

10.1177/2378023118811805 ◽

2018 ◽

Vol 4 ◽

pp. 237802311881180 ◽

Cited By ~ 1

Author(s):

Jonathan J. B. Mijs

Keyword(s):

Survey Data ◽

Representative Sample ◽

Western World ◽

Birth Cohorts ◽

Popular Belief ◽

Time Period ◽

Level Data ◽

Two Measures ◽

Time Periods ◽

Over Time

In this figure I describe the long trend in popular belief in meritocracy across the Western world between 1930 and 2010. Studying trends in attitudes is limited by the paucity of survey data that can be compared across countries and over time. Here, I show how to complement survey waves with cohort-level data. Repeated surveys draw on a representative sample of the population to describe the typical beliefs held by citizens in a given country and period. Leveraging the fact that citizens surveyed in a given year were born in different time-periods allows for a comparison of beliefs across birth cohorts. The latter overlaps with the former, but considerably extends the time period covered by the data. Taken together, the two measures give a “triangulated” longitudinal record of popular belief in meritocracy. I find that in most countries, popular belief in meritocracy is (much) stronger for more recent periods and cohorts.

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Neglecting Decline: Remembered and Predicted Personal Development Diverge from Actual Longitudinal Change.

10.31234/osf.io/43qvh ◽

2019 ◽

Author(s):

Sarah Molouki ◽

Daniel Bartels ◽

Oleg Urminsky

Keyword(s):

Longitudinal Study ◽

Personal Development ◽

Absolute Magnitude ◽

Longitudinal Change ◽

Personal Change ◽

Future Change ◽

Change Over Time ◽

Time Period ◽

One Year ◽

Over Time

A one-year longitudinal study was conducted to investigate the accuracy of people’s assessmentsof their own personal change over time. We compared people’s predicted, actual, and recalledchange in their personality, values, and preferences over this time period. On average,participants underestimated the absolute magnitude of their personal change, yet simultaneouslyoverestimated their net improvement, in both prediction and recall. This effect was due to anasymmetry whereby people selectively neglected negative changes, especially prospectively.Although participants in our sample both improved and declined over the year, they were morelikely to remember past improvements than declines, and made nearly uniformly positivepredictions of future change. We discuss how the current findings reconcile researchdemonstrating expectations of personal improvement (e.g., Wilson & Ross, 2001; Kanten &Teigen, 2008) with other research that suggests people overpredict their personal stability(Quoidbach, Gilbert, & Wilson, 2013).

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