Evaluation of the effect of care at NCI comprehensive cancer centers (NCICCCs) on disparities in outcome within adolescents and young adults (AYAs) with cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9512-9512
Author(s):  
Julie Anna Wolfson ◽  
Can-Lan Sun ◽  
Heeyoung Kim ◽  
Tongjun Kang ◽  
Smita Bhatia
Keyword(s):  
African Americans ◽  
Older Age ◽  
Age At Diagnosis ◽  
Cancer Center ◽  
Insurance Status ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Race Ethnicity ◽  
The Impact

9512 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21 year-olds, the impact of site of care on survival for vulnerable AYA subpopulations (age at diagnosis or race/ ethnicity) between 22-and 39y at diagnosis remains unstudied. Methods: We constructed a cohort of 10,727 patients newly diagnosed between the ages of 22- and 39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the LA County cancer registry between 1998 and 2008. Multivariable Cox regression analysis was conducted, and included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model; the analysis was stratified by site of care (NCICCC vs. non-NCICCC). Results: A total of 928 (9%) patients received treatment at the 3 NCICCCs (City of Hope, Jonsson Cancer Center and Norris Cancer Center) in LA County, and 9,799 received care elsewhere. Five-year overall survival (5y OS) was significantly worse for patients treated at non-NCICCC (87%) when compared with those treated at NCICCC (84%, p=0.02). In addition, 5y OS was worse for African Americans (71%) vs. non-Hispanic whites (89%, p<0.0001) and for older patients (31-39yo: 84%, vs. 22-30yo: 86%, p=0.0004). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that African Americans (HR=1.4, p=0.0002) and older AYAs (31-39y: HR=1.24, p<0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (African Americans: HR=0.8, p=0.7) and age (31-39yo: HR=1.1, p=0.6) was abrogated. On the other hand, among patients treated at non-NCICCC, these differences in outcome persisted (African Americans: HR=1.45, p =0.0002; 31-39yo: HR=1.25, p<.0001). Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the effects of race and older age on mortality in AYAs with cancer. Barriers to accessing care at NCICCCs are being explored.

The effect of care at NCI comprehensive cancer centers on disparities in outcome in adolescents and young adults (AYAs) with cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 217-217 ◽  
Author(s):  
Julie Anna Wolfson ◽  
Can-Lan Sun ◽  
Heeyoung Kim ◽  
Tongjun Kang ◽  
Smita Bhatia
Keyword(s):  
Overall Survival ◽  
Multivariable Analysis ◽  
Cancer Center ◽  
Insurance Status ◽  
Cancer Centers ◽  
Risk Of Death ◽  
Comprehensive Cancer Centers ◽  
Increased Risk ◽  
Race Ethnicity ◽  
The Impact

217 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21y, impact of site of care on survival for vulnerable AYA subpopulations (race/ethnicity) between 22-39y at diagnosis remains unstudied. Methods: Utilizing a cohort of 10,602 AYAs newly diagnosed between 22-39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the Los Angeles County cancer registry between 1998 and 2008, we aimed to determine the impact of receiving care at NCI Comprehensive Cancer Centers (NCICCC) on overall survival for AYAs, and disparities in survival by race/ethnicity. We further aimed to understand the role of SES and insurance status in accessing care at NCICCC. Multivariable analyses included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model. Results: A total of 904 (9%) patients received treatment at the 3 NCICCC (City of Hope, Jonsson Cancer Center, and Norris Cancer Center) in LA County. Ten-year overall survival (10y OS) was significantly worse for patients treated at non-NCICCC (81%) when compared with those treated at NCICCC (83%, p=0.02). Also, 10y OS was worse for African Americans (AA) (68%) vs. non-Hispanic whites (86%, p<0.0001). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that AA (HR=1.5, p=0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (HR=0.9, p=0.84) was abrogated. However, among patients treated at non-NCICCC, these differences in outcome persisted (HR=1.48, p<0.0001). Independent of SES, insurance and tumor factors, AA (OR=0.44, p<0.001) were less likely to use NCICCC. Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the inferior outcome observed among AA with cancer. AA are less likely to use NCICCC for treatment. Barriers to accessing care at NCICCC are currently being explored.

Equitable application of pancreatic cancer treatment guidelines to mitigate racial and insurance disparities at a comprehensive cancer center.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 119-119
Author(s):  
Andrea M. Schiefelbein ◽  
Amy K Taylor ◽  
John K. Krebsbach ◽  
Jienian Zhang ◽  
Yana Puckett ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Guidelines ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Insurance Status ◽  
Risk Of Death ◽  
Increased Risk ◽  
Race Ethnicity

119 Background: Race and ethnicity-based treatment and survival disparities are documented for pancreatic cancer. Studies cite patient genetic, biological, and social factors and differences across treatment centers and geographical areas that may contribute to disparities. We investigated treatment and survival disparities for a cohort of 1,569 pancreatic cancer (PC) patients at the local level within a National Cancer Institute-designated comprehensive cancer center. Methods: Data from 1,569 PC patients aged over 18 diagnosed with adenocarcinoma, NOS or infiltrating duct carcinoma, NOS from 2004 to 2016 who received some or all of their care at the University of Wisconsin Carbone Cancer Center were included in the study. Sequential models of adjusted Cox proportional hazard regression were performed to describe the association between race/ethnicity and overall survival. Model I included age, sex and race/ethnicity; model II added BMI, Charlson Comorbidity Index and stage; model III added rurality, treatment course and payer. Treatment course, defined as the receipt of chemoradiation, surgery with/without chemoradiation, or no treatment, rurality, and insurance status were factors of interest. Results: 38.6% of patients were diagnosed with metastatic disease. Overall survival was 11.6 months. Non-Hispanic black (NHB) patients experienced an 88% increased risk of death (95% CI: 23%-188%) and patients categorized as other race/ethnicity experienced a 32% (10%-60%) increased risk of death compared to NH white (NHW) patients in model II. After adding treatment course and insurance status, the hazard ratio for NHB patients decreased to 1.41 (0.92-2.17) and other race/ethnicity patients decreased to 1.27 (1.05-1.53) compared to NHW Patients. Medicaid patients had an adjusted hazard ratio of 1.41 (1.01-1.95) and unknown/uninsured patients had an adjusted hazard ratio of 1.62 (1.71-4.02) compared to managed care patients. Incarcerated patients had an adjusted hazard ratio of 1.28 (0.98-1.67) compared to managed care patients. Conclusions: To reduce disparities across race/ethnicity and insurance status, organizations should invest in financial support programs for patients in need and monitor treatment courses for people of color, underinsured or uninsured patients to verify access to treatment, equitable treatment, and adherence to treatment guidelines. Future studies should investigate the contribution of clinician and healthcare system bias to race and ethnicity-based cancer disparities.

Difference in cardiovascular disease incidence by sociodemographic factors in adolescent and young adult (AYA) cancer survivors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6565-6565
Author(s):  
Theresa Keegan ◽  
Lawrence H. Kushi ◽  
Qian Li ◽  
Ann Brunson ◽  
Marcio H. Malogolowkin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Sociodemographic Factors ◽  
Cancer Type ◽  
Cvd Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Race Ethnicity ◽  
The Impact

6565 Background: AYA cancer survivors are at increased risk of developing cardiovascular disease (CVD) compared to AYAs without a history of cancer. In AYA cancer survivors, few population-based studies have focused on CVD risk and none have considered whether the occurrence of CVD differs by sociodemographic factors. Methods: Analyses focused on 64,918 patients aged 15-39 y at diagnosis for one of 14 first primary cancers during 1996-2010 and surviving > 2 years after diagnosis, with follow-up through 2013. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. We estimated the cumulative incidence of developing CVD, accounting for death as a competing risk, stratified by race/ethnicity, neighborhood socioeconomic status (SES) at diagnosis, health insurance status at diagnosis/initial treatment and cancer type. We examined the impact of CVD on mortality using multivariable Cox proportional hazards regression with CVD as a time-dependent covariate. Results: Overall, 2374 (3.7%) patients developed CVD, and 7690 (11.9%) died over the follow-up period. Survivors of acute myeloid leukemia (12.6%), acute lymphoid leukemia (11.1%), central nervous system cancer (9.0%) and non-Hodgkin lymphoma (6.0%) had the highest incidence of CVD at 10-years. Incidence was significantly higher among Blacks (6.7%) at 10-years than non-Hispanic Whites (3.0%), Hispanics (3.7%) and Asian/Pacific Islanders (3.7%) (p < 0.001). AYA survivors with public or no insurance (vs private) had a higher 10-year incidence of CVD (5.8% vs 2.9%; p < 0.001), as did survivors residing in low (vs high) SES neighborhoods (4.1% vs 2.7%; p < 0.001). These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by five-fold or higher among AYAs who developed CVD. Conclusions: AYA cancer survivors who were uninsured or publicly insured, of Black race/ethnicity, or who resided in lower SES neighborhoods are at increased risk for developing CVD and experiencing higher mortality. The proactive management of CVD risk factors in these subgroups may improve patient outcomes.

scholarly journals Sociodemographic Profile and Outcomes of Patients with Non-Diffuse Large B-Cell Lymphoma (non-DLBCL) Treated at Minority-Predominant Facilities in the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4868-4868
Author(s):  
Vivek Kumar ◽  
Taimur Sher ◽  
Vivek Roy ◽  
Prakash Vishnu ◽  
Anne M Hazen ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
B Cell Lymphoma ◽  
The United States ◽  
Racial Minorities ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Race Ethnicity ◽  
Facility Level ◽  
The Impact

Abstract Background: Racial disparities in outcomes of cancer patients have been reported. Access to comprehensive cancer centers is associated with improved overall survival (OS) but racial/ethnic minorities may have a disparate access to such care. While the impact of treatment facility volume on outcomes has been evaluated, outcomes of centers with minority-predominant patient population have not been studied. We compared demographic profiles, facility level data and OS of patients treated at minority-predominant facilities to facilities that treated predominantly non-Hispanic Whites (NHW) with non-DLBCL. Methods: The National Cancer Database (NCDB) was used to identify all non-DLBCL patients diagnosed between 2004 and 2015. "Minority-treating facilities" were defined as facilities in the top decile by proportion for initial treatment of non-Hispanic African-Americans (NHAA), Hispanics and other races. We performed univariate and multivariate analyses to compare sociodemographic and clinical factors influencing outcomes between minority treating and non-minority treating facilities. A subgroup analysis stratified by race/ethnicity was also conducted to study the effect of treating facilities on the outcome of NHWs and minorities separately. Results: Of 1339 total facilities, 123 (9.1%) qualified as minority treating. Of 207,239 eligible patients in NCDB, 18,719 (9.03%) received treatment at the minority-treating facilities and of these, 11,190 (~60%) belonged to the minority races. Overall, 4.5% (6,988/156,664) NHWs and 30% (11,190/37,639) minorities received treatment at the minority-treating facilities. Several demographic and facility level characteristics were significantly different among the patients treated at minority-treating facilities as compared to non-minority treating facilities. Overall, significantly higher number of patients in minority-treating hospitals had lower income and education, had Medicaid coverage or lack of insurance. The OS of patients in minority treating facilities was significantly worse as compared to non-minority facilities (Figures). On multivariate analysis, patients who received treatment at minority-treating facilities were at 10% (HR=1.10, 95% CI: 1.06-1.14 p<0.001) higher risk of mortality as compared to those treated at the non-minority treating facilities. On multivariate analysis, NHAA (30% increased risk) and 'other races' (9% increased risk) were at significantly higher risk of mortality as compared to the NHW (Table 2). To study the effect of treatment at minority-treating facilities on OS among the patients of same race/ethnicity group, a multivariate analysis was also run separately for NHW and racial minorities. The NHWs who received treatment at minority-treating facilities were at 13% higher risk of death (HR=1.13, 95% CI: 1.08-1.19 p<0.001) as compared to NHWs who were treated at non-minority treating facilities. Similarly, the racial minorities who received treatment at minority treating facilities were at 8% higher risk of death (HR=1.08, 95% CI: 1.03-1.19 p=0.003) as compared to those who received treatment at the nonminority treating facilities. Conclusions:Outcomes of patients who received treatment at minority treating facilities was significantly worse than those at non-minority treating facilities. This was true for NHWs and racial minorities separately as well. Several demographic and facility level characteristics were significantly different in the two groups however OS remained worse after adjusting for them. Causes of poor outcomes at minority-treating facilities must be analyzed to mitigate them and improve outcomes for all. Figure. Figure. Disclosures Ailawadhi: Takeda: Consultancy; Celgene: Consultancy; Amgen: Consultancy; Janssen: Consultancy; Pharmacyclics: Research Funding.

scholarly journals The Effect of Autologous Stem Cell Transplant (ASCT) on Survival in Californians with Multiple Myeloma (MM) in the Era of Modern Treatment

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1991-1991
Author(s):  
Aaron S Rosenberg ◽  
Ann M Brunson ◽  
Theresa HM Keegan ◽  
Brian Jonas ◽  
Joseph Tuscano ◽  
...  
Keyword(s):  
African Americans ◽  
Cox Regression ◽  
Age At Diagnosis ◽  
Administrative Databases ◽  
Cell Transplant ◽  
Entire Cohort ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Race Ethnicity ◽  
Over Time

Abstract Background: The use and timing of ASCT on survival after MM in the era of modern therapy remain topics of debate. Using population based data, we evaluated factors associated with the receipt of ASCT and the effect of ASCT on overall survival (OS). Methods: Patients diagnosed with MM during 2000 - 2012 were identified in the California Cancer Registry (CCR) (n=12,714). CCR data were linked to the California Patient Discharge Database (PDD). Logistic regression estimated the odds ratio (OR) of having an early (< 1 year from diagnosis) or late (> 1 year) ASCT (vs. no ASCT). OS was calculated using the Kaplan-Meier (KM) method. To determine the effect of ASCT on OS from diagnosis date, Cox regression models estimated adjusted hazard ratios (aHR) of death treating ASCT as a time dependent covariate. OS time was compared after matching ASCT to no ASCT patients on age, sex, race/ethnicity, neighborhood socioeconomic status (SES), comorbidity at diagnosis, year of diagnosis, and accounting for time to transplant. Results: The majority of MM patients were male (54%) and of non-Hispanic white (58%) race/ethnicity; 19% Hispanic, 12% African American, and 9% Asian. Median age at diagnosis was 67 (range 18 - 104). African Americans and Hispanics were younger than non-Hispanic whites (median age 64 and 65 vs 69). Comorbidity data from the PDD was available in 59% of the patients in the 2 years prior to MM diagnosis: 7.5% had 0, 21% had 1-2, and 31% had ≥3 comorbidities. A total of 2136 (17%) patients underwent ASCT: 1347 < 1 year from and 789 ≥1 year after diagnosis. Time to ASCT did not change over time: among patients diagnosed 2000 - 2003 median time to transplant was 9.2 mo, 10 mo among those diagnosed 2004 - 2007 and 9.7 in those diagnosed 2008 - 2012. Patients who underwent ASCT were younger than those who did not (median age 56 vs 70 respectively). African Americans were less likely to undergo early ASCT (OR 0.7, P<0.001), but not late ASCT (OR 0.8, P=0.07). Patients with ≥3 comorbidities (vs. 0) at diagnosis were less likely to have ASCT (OR 0.42 P<0.001 and OR 0.28 P<0.001 for early and late, respectively), while patients with 1-2 comorbidities were less likely to have late ASCT (OR 0.59 P<0.001). The lowest 2 quintiles of SES was associated with less use of early ASCT (OR 0.62 p<0.001 and 0.65 p<0.001 respectively), but not late ASCT (OR 0.89 p=0.4 and 0.96 p=0.7 respectively). The likelihood of receiving ASCT increased over time: compared to 2000-2003, the ORs for patients diagnosed in 2004 - 2007 were 1.36 for early (P<0.001) and 1.64 (P<0.001) for late ASCT and were 2.64 (P<0.001) for early and 1.80 (P<0.001) for late for those diagnosed in 2008-2012. The median follow-up was 32 months. Median OS from diagnosis for the entire cohort, unadjusted for age, comorbidities, and SES was 37 months. Adjusting for sex, race/ethnicity, age at diagnosis, SES, comorbidities, insurance status and year of diagnosis, OS improved over time: compared to patients diagnosed in 2008 - 2012, aHR of death of those diagnosed 2000-2003 was 1.58 (P<0.001), and 1.35 (P<0.001) for those diagnosed 2004-2007. ASCT at any point was associated with a 23% reduction in the risk of death from all causes (aHR 0.77 P<0.001). Patients who received early ASCT had a 27% reduction (aHR 0.73 P<0.001), while those receiving late ASCT had an 11% decrease (aHR 0.89 P<0.001) in risk of all cause death. In the matched analysis, the median OS from date of transplant, or matched date in the no ASCT cohort, were: no ASCT = 49 mo, early ASCT = 83 mo, and late ASCT 65 mo (P<0.001 Figure 1). The effect of aSCT on OS differed by date of diagnosis (P for interaction <0.001). Improvements in OS due to ASCT were more pronounced in later time periods: aHR for early and late ASCT in 2000-2003 were 0.9 (P = 0.12) and 0.98 (P 0.86) compared with those in 2004-2007 (0.63 P<0.001 and 0.85 P = 0.06) and in 2008-2012 (0.55 P<0.001 and 0.74 P=0.08). Conclusions :ASCT was utilized in 17% of Californians with MM during 2000-2012, and its use increased over time. The use of ASCT, whether within a year of diagnosis or later in the disease course, is associated with improved OS and this effect may be more pronounced in the era of novel agents. Despite the inherent limitations of analyses of administrative databases, the large number of patients and established robust nature of CCR and PDD data makes accurate depiction of results in the community probable. These data support the continued role of ASCT in the management of patients with MM. Disclosures Jonas: Celgene: Honoraria; Incyte: Honoraria; Onyx: Honoraria; GlycoMimetics: Consultancy.

scholarly journals Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

2021 ◽  
Author(s):  
◽  
Mustafa Alsahab ◽  
Lucy Beishon ◽  
Bryony Brown ◽  
Elinor Burn ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Care Needs ◽  
Multi Centre Study ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ordinal Logistic Regression Analysis ◽  
The Impact

Abstract Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (&gt;80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

66 Complex markers of survival from pembrolizumab: the potential predictive role of tumor mutational burden (TMB) and KRAS

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A71-A71
Author(s):  
Yong Hee Lee ◽  
Carrie Hoefer ◽  
Paul DePietro ◽  
Mary Nesline
Keyword(s):  
Overall Survival ◽  
Survival Benefit ◽  
Cox Regression ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
High Status ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Mutational Status ◽  
Increased Risk

BackgroundPembrolizumab, with or without chemotherapy, is NCCN guideline-recommended treatment for NSCLC cancer patients depending on tumor PD-L1 status by IHC. PD-L1 IHC provides guidance for treatment selection for response, but does not accurately predict survival benefit from pembrolizumab. Emerging evidence suggests TMB and other genomic markers (KRAS, STK11, TP53 mutations), may have clinical utility for predicting survival benefit.MethodsWe identified a cohort of metastatic EGFR/ALK wild type NSCLC patients (n=116) whose tumors underwent comprehensive profiling (June 2017-March 2019) for genomic variants, TMB and PD-L1 IHC 22C3 prior to selection of pembrolizumab (n=43), pembrolizumab + chemotherapy (n=41), or chemotherapy only (excluding subsequent targeted therapy or immunotherapy) (n=32) at Roswell Park Comprehensive Cancer Center, with at least one year of follow up. TMB was assessed using a 1.75 Mb capture of 409 oncogenes with full exon coverage (DNA-Seq), with ‘high’ TMB interpreted as ≥10 mutations/Mb. Electronic pharmacy records were curated to create pre and post-test treatment histories for each patient. Cox regression analysis evaluated OS with pembrolizumab monotherapy or pembrolizumab + chemotherapy vs chemotherapy only, adjusting for covariates including oncogenic driver mutations, TMB, PD-L1 IHC demographics, clinicopathologic characteristics, prior treatment, and performance status. Using the same model, we then assessed overall survival for each treatment group by TMB, KRAS, STK11, and TP53 mutant status.ResultsOverall, 47% of tumors were PD-L1 high, 47% TMB high, 34% KRAS mutant (codons 12, 13, 60, 61), 52% TP53 mutant and 16% STK11 mutant. As expected, pembrolizumab with or without chemotherapy significantly improved overall survival (OS) compared to chemotherapy alone; with TMB, smoking, and ECOG status identified as significant covariates. PD-L1 IHC status was not associated with OS for any treatment. TMB high status was significant for OS benefit with pembrolizumab either as monotherapy [HR=0.02; CI=0.01–0.40; p=0.01] or in combination with chemotherapy [HR=0.20; CI=0.04–0.95; p=0.04]. KRAS mutant status was independently significant for OS benefit from pembrolizumab + chemotherapy [HR=0.01; CI=0.01–0.79; p=0.04] but not for pembrolizumab monotherapy or chemotherapy alone. Among patients who received pembrolizumab monotherapy, there was a trend toward increased risk of death in those with STK11 mutations [HR=17.54; CI=0.35–1,000; p=0.15], whereas TP53 mutant status trended toward survival benefit [HR=0.18; CI=0.02–1.53; p=0.11].ConclusionsData comparing pembrolizumab treatments with chemotherapy and independent marker associations suggest TMB has predictive power for determining overall survival benefit from pembrolizumab, while KRAS, STK11, and TP53 mutational status demonstrated potential prognostic relevance for NSCLC.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

scholarly journals Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044384
Author(s):  
Guduru Gopal Rao ◽  
Alexander Allen ◽  
Padmasayee Papineni ◽  
Liyang Wang ◽  
Charlotte Anderson ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Severe Infection ◽  
Older Age ◽  
Cross Sectional ◽  
North West ◽  
Icu Admission ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Increased Risk

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North West Healthcare NHS Trust (LNWH).ParticipantsPatients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measuresDescriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.ResultsThe outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients.ConclusionThe findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.

Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality

2021 ◽  
pp. 088307382110001
Author(s):  
Jody L. Lin ◽  
Joseph Rigdon ◽  
Keith Van Haren ◽  
MyMy Buu ◽  
Olga Saynina ◽  
...  
Keyword(s):  
Severe Pneumonia ◽  
Sensitivity Analyses ◽  
Tube Placement ◽  
Composite Outcome ◽  
Eligibility Criteria ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Neurologic Impairment ◽  
Increased Risk ◽  
The Impact

Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

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