Long-term central venous catheters and infections in older adults with cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 125-125
Author(s):  
Allison Nicole Lipitz Snyderman ◽  
Kent Sepkowitz ◽  
Elena B. Elkin ◽  
Laura C. Pinheiro ◽  
Peter Bach
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Population Based ◽  
Infection Risk ◽  
Central Venous Catheters ◽  
Care Quality ◽  
Central Venous ◽  
Increased Risk ◽  
The Impact

125 Background: Long-term central venous catheters (CVCs) facilitate venous access to administer intravenous fluids and treatments such as chemotherapy. However, CVCs can also be a source of harmful bloodstream infections, a risk that may be underappreciated. Our objective was to assess the impact of long-term CVC use on the risk of infections in a population-based cohort of cancer patients. Methods: Retrospective analysis using the population-based SEER-Medicare dataset for patients over age 65, diagnosed from 2005 to 2007 with invasive colorectal cancer (n = 36,272), head and neck cancers (n = 8,459), lung cancer (n = 56,770), pancreatic cancer (n = 10,536), or non-Hodgkin lymphoma (n = 14,432), or invasive or non-invasive breast cancer (n = 42,271). Cox proportional hazards regression was used to examine the impact of CVC use on infection risk, with CVC exposure treated as a time-varying predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results: Adjusting for demographic and disease characteristics, long-term CVCs significantly increased the risk of infection by at least 40%, across all cancer types (Table). The greatest effect of CVCs on infection risk was in patients with breast cancer. Conclusions: Long-term CVC use is associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs, and targeted strategies to reduce infections for patients requiring their use, are critical to improving cancer care quality. [Table: see text]

scholarly journals Long-Term Central Venous Catheter Use and Risk of Infection in Older Adults With Cancer

2014 ◽  
Vol 32 (22) ◽  
pp. 2351-2356 ◽  
Author(s):  
Allison Lipitz-Snyderman ◽  
Kent A. Sepkowitz ◽  
Elena B. Elkin ◽  
Laura C. Pinheiro ◽  
Camelia S. Sima ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Older Adults ◽  
Pancreatic Cancer ◽  
Infection Risk ◽  
Care Quality ◽  
Central Venous ◽  
Patients With Cancer ◽  
Increased Risk ◽  
The Impact

Purpose Long-term central venous catheters (CVCs) are often used in patients with cancer to facilitate venous access to administer intravenous fluids and chemotherapy. CVCs can also be a source of bloodstream infections, although this risk is not well understood. We examined the impact of long-term CVC use on infection risk, independent of other risk factors such as chemotherapy, in a population-based cohort of patients with cancer. Patients and Methods We conducted a retrospective analysis using SEER-Medicare data for patients age > 65 years diagnosed from 2005 to 2007 with invasive colorectal, head and neck, lung, or pancreatic cancer, non-Hodgkin lymphoma, or invasive or noninvasive breast cancer. Cox proportional hazards regression was used to examine the relationship between CVC use and infections, with CVC exposure as a time-dependent predictor. We used multivariable analysis and propensity score methods to control for patient characteristics. Results CVC exposure was associated with a significantly elevated infection risk, adjusting for demographic and disease characteristics. For patients with pancreatic cancer, risk of infections during the exposure period was three-fold greater (adjusted hazard ratio [AHR], 2.93; 95% CI, 2.58 to 3.33); for those with breast cancer, it was six-fold greater (AHR, 6.19; 95% CI, 5.42 to 7.07). Findings were similar when we accounted for propensity to receive a CVC and limited the cohort to individuals at high risk of infections. Conclusion Long-term CVC use was associated with an increased risk of infections for older adults with cancer. Careful assessment of the need for long-term CVCs and targeted strategies for reducing infections are critical to improving cancer care quality.

Chemotherapy and Cardiotoxicity in Older Breast Cancer Patients: A Population-Based Study

2005 ◽  
Vol 23 (34) ◽  
pp. 8597-8605 ◽  
Author(s):  
John J. Doyle ◽  
Alfred I. Neugut ◽  
Judith S. Jacobson ◽  
Victor R. Grann ◽  
Dawn L. Hershman
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Primary Tumors ◽  
Increased Risk

Purpose Adjuvant chemotherapy, especially with anthracyclines, is known to cause acute and chronic cardiotoxicity in breast cancer patients. We studied the cardiac effects of chemotherapy in a population-based sample of breast cancer patients aged ≥ 65 years with long-term follow-up. Patients and Methods In the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we analyzed treatments and outcomes among women ≥ 65 years of age who were diagnosed with stage I to III breast cancer from January 1, 1992 to December 31, 1999. Propensity scores were used to control for baseline heart disease (HD) and other known predictors of chemotherapy, and Cox proportional hazards models were used to estimate the risk of cardiomyopathy (CM), congestive heart failure (CHF), and HD after chemotherapy. Results Of 31,748 women with stage I to III breast cancer, 5,575 (18%) received chemotherapy. Chemotherapy was associated with younger age, fewer comorbidities, hormone receptor negativity, multiple primary tumors, and advanced disease. Patients who received chemotherapy were less likely than other patients to have pre-existing HD (45% v 55%, respectively; P < .001). The hazard ratios for CM, CHF, and HD for patients treated with doxorubicin (DOX) compared with patients who received no chemotherapy were 2.48 (95% CI, 2.10 to 2.93), 1.38 (95% CI, 1.25 to 1.52), and 1.35 (95% CI, 1.26 to 1.44), respectively. The relative risk of cardiotoxicity among patients who received DOX compared with untreated patients remained elevated 5 years after diagnosis. Conclusion When baseline HD was taken into account, chemotherapy, especially with anthracyclines, was associated with a substantially increased risk of CM. As the number of long-term survivors grows, identifying and minimizing the late effects of treatment will become increasingly important.

scholarly journals Transitions to Long-Term Residential Care Settings

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 223-223
Author(s):  
Bram de Boer ◽  
Hilde Verbeek ◽  
Joseph Gaugler
Keyword(s):  
Older Adults ◽  
Residential Care ◽  
Transitional Care ◽  
Care Transitions ◽  
Theory And Practice ◽  
Term Care ◽  
Residential Care Facility ◽  
Increased Risk ◽  
The Impact

Abstract During their life course, many older adults encounter a transition between care settings, for example, a permanent move into long-term residential care. This care transition is a complex and often fragmented process, which is associated with an increased risk of negative health outcomes, rehospitalisation, and even mortality. Therefore, care transitions should be avoided where possible and the process for necessary transitions should be optimised to ensure continuity of care. Transitional care is therefore a key research topic. The TRANS-SENIOR European Joint Doctorate (EJD) network builds capacity for tackling a major challenge facing European long-term care systems: the need to improve care for an increasing number of care-dependent older adults by avoiding unnecessary transitions and optimising necessary care transitions. During this symposium, four presenters from the Netherlands and Switzerland will present different aspects of transitions into long-term residential care. The first speaker presents the results of a co-creation approach in developing an intervention aimed at preventing unnecessary care transitions. The second speaker presents an overview of interventions aiming to improve a transition from home to a nursing home, highlighting the clear mismatch between theory and practice. The third speaker presents the impact of the COVID-19 pandemic on transitions into long-term residential care using an ethnographic study in a long-term residential care facility in Switzerland. The final speaker discusses the results of a recent Delphi study on key factors influencing implementing innovations in transitional care. The discussant will relate previous findings on transitional care with a U.S. perspective.

scholarly journals Long-Term Blood Pressure Variability and Risk of Cardiovascular Disease Events Among Community-Dwelling Elderly

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1945-1952
Author(s):  
Michael E. Ernst ◽  
Enayet K. Chowdhury ◽  
Lawrence J. Beilin ◽  
Karen L. Margolis ◽  
Mark R. Nelson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Blood Pressure Variability ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Link Type ◽  
Increased Risk ◽  
The Impact

High office blood pressure variability (OBPV) in midlife increases the risk of cardiovascular disease (CVD), but the impact of OBPV in older adults without previous CVD is unknown. We conducted a post hoc analysis of ASPREE trial (Aspirin in Reducing Events in the Elderly) participants aged 70-years and older (65 for US minorities) without history of CVD events at baseline, to examine risk of incident CVD associated with long-term, visit-to-visit OBPV. CVD was a prespecified, adjudicated secondary end point in ASPREE. We estimated OBPV using within-individual SD of mean systolic BP from baseline and first 2 annual visits. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% CI for associations with CVD events. In 16 475 participants who survived to year 2 without events, those in the highest tertile of OBPV had increased risk of CVD events after adjustment for multiple covariates, when compared with participants in the lowest tertile (HR, 1.36 [95% CI, 1.08–1.70]; P =0.01). Similar increased risk was observed for ischemic stroke (HR, 1.56 [95% CI, 1.04–2.33]; P =0.03), heart failure hospitalization, or death (HR, 1.73 [95% CI, 1.07–2.79]; P =0.02), and all-cause mortality (HR, 1.27 [95% CI, 1.04–1.54]; P =0.02). Findings were consistent when stratifying participants by use of antihypertensive drugs, while sensitivity analyses suggested the increased risk was especially for individuals whose BP was uncontrolled during the OBPV estimation period. Our findings support increased OBPV as a risk factor for CVD events in healthy older adults with, or without hypertension, who have not had such events previously. Registration— URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01038583; URL: https://www.isrctn.com ; Unique identifiers: ISRCTN83772183.

scholarly journals Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer

2015 ◽  
Vol 11 (6) ◽  
pp. 505-510 ◽  
Author(s):  
Allison Lipitz-Snyderman ◽  
Qinli Ma ◽  
Michael F. Pollack ◽  
John Barron ◽  
Elena B. Elkin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Evidence Based ◽  
Central Venous ◽  
Evidence Based Guidelines

Long-term central venous catheter (CVC) use is associated with increased morbidity. Evidence-based guidelines tools may help decrease discretionary use of long-term CVCs resulting from provider- or institution-driven variations in practice.

scholarly journals Long‐Term Blood Pressure Variability and Risk of Cognitive Decline and Dementia Among Older Adults

2021 ◽  
Author(s):  
Michael E. Ernst ◽  
Joanne Ryan ◽  
Enayet K. Chowdhury ◽  
Karen L. Margolis ◽  
Lawrence J. Beilin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Blood Pressure Variability ◽  
Link Type ◽  
Incident Dementia ◽  
Increased Risk ◽  
The Impact

Background Blood pressure variability (BPV) in midlife increases risk of late‐life dementia, but the impact of BPV on the cognition of adults who have already reached older ages free of major cognitive deficits is unknown. We examined the risk of incident dementia and cognitive decline associated with long‐term, visit‐to‐visit BPV in a post hoc analysis of the ASPREE (Aspirin in Reducing Events in the Elderly) trial. Methods and Results ASPREE participants (N=19 114) were free of dementia and significant cognitive impairment at enrollment. Measurement of BP and administration of a standardized cognitive battery evaluating global cognition, delayed episodic memory, verbal fluency, and processing speed and attention occurred at baseline and follow‐up visits. Time‐to‐event analysis using Cox proportional hazards regression models were used to calculate hazard ratios (HR) and corresponding 95% CI for incident dementia and cognitive decline, according to tertile of SD of systolic BPV. Individuals in the highest BPV tertile compared with the lowest had an increased risk of incident dementia and cognitive decline, independent of average BP and use of antihypertensive drugs. There was evidence that sex modified the association with incident dementia (interaction P =0.02), with increased risk in men (HR, 1.68; 95% CI, 1.19–2.39) but not women (HR, 1.01; 95% CI, 0.72–1.42). For cognitive decline, similar increased risks were observed for men and women (interaction P =0.15; men: HR, 1.36; 95% CI, 1.16–1.59; women: HR, 1.14; 95% CI, 0.98–1.32). Conclusions High BPV in older adults without major cognitive impairment, particularly men, is associated with increased risks of dementia and cognitive decline. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01038583; isrctn.com . Identifier: ISRCTN83772183.

Incidence and Predictors of Mental Health Outcomes Among Survivors of Adolescent and Young Adult Cancer: A Population-Based Study Using the IMPACT Cohort

2021 ◽  
pp. JCO.20.02019
Author(s):  
Riddhita De ◽  
Rinku Sutradhar ◽  
Paul Kurdyak ◽  
Suriya Aktar ◽  
Jason D. Pole ◽  
...  
Keyword(s):  
Mental Health ◽  
Young Adult ◽  
Health Outcomes ◽  
Psychotic Disorder ◽  
Population Based ◽  
Mental Health Outcomes ◽  
Adolescent And Young Adult ◽  
Increased Risk ◽  
The Impact

PURPOSE Risk and predictors of long-term mental health outcomes in survivors of adolescent and young adult (AYA) cancers are poorly characterized. Mental health is consequently neglected in long-term follow-up. METHODS We identified all AYA in Ontario, Canada age 15-21 years when diagnosed with one of six common cancers between 1992-2012 using a population-based database, and compared them with matched controls. Linkage to provincial healthcare data allowed analysis of rates of outpatient (family physician and psychiatrist) visits for psychiatric indications and time to severe psychiatric events (emergency room visit, hospitalization, and suicide). Demographic-, disease-, and treatment-related predictors of adverse outcomes, including treatment setting (adult v pediatric), were examined. RESULTS Among 2,208 survivors and 10,457 matched controls, 5-year survivors experienced higher rates of outpatient mental health visits than controls (671 visits per 1,000 person-years v 506; adjusted rate ratio [RR] 1.3; 95% CI, 1.1 to 1.5; P = .006). Risk of a severe psychiatric episode was also increased among survivors (adjusted hazard ratio [HR], 1.2; 95% CI, 1.1 to 1.4, P = .008). Risk of a psychotic disorder–associated severe event was doubled in survivors (HR, 2.0, 95% CI, 1.3 to 2.4; P = .007) although absolute risk remained low (15-year cumulative incidence 1.7%; 95% CI, 1.0 to 2.7). In multivariable analysis, survivors treated in adult centers experienced substantially higher outpatient visit rates compared with those treated in pediatric settings (RR 1.8; 95% CI, 1.0 to 3.1; P = .04). CONCLUSION Survivors of AYA cancer are at substantially increased risk of adverse mental health outcomes, with those treated in adult centers at particular risk. Although absolute incidence was low, survivors were at increased risk of psychotic disorder–associated severe events. Long-term mental health surveillance is warranted, as is research into effective interventions during or after cancer treatment.

scholarly journals Herpes zoster in older adults in Ontario, 2002–2016: Investigating incidence and exploring equity

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246086
Author(s):  
Sarah A. Buchan ◽  
Nick Daneman ◽  
Jun Wang ◽  
Sarah E. Wilson ◽  
Gary Garber ◽  
...  
Keyword(s):  
Older Adults ◽  
Herpes Zoster ◽  
Age Groups ◽  
Population Based ◽  
Income Quintile ◽  
Increased Risk ◽  
Neighbourhood Level ◽  
Before And After ◽  
Future Work ◽  
The Impact

Older adults are at increased risk of herpes zoster (HZ) and post-herpetic neuralgia (PHN) and HZ vaccines are available to help prevent infection. The objective of our study was to provide updated data on incidence of HZ and PHN related to clinical and demographic factors in older adults to inform immunization practices. We conducted a population-based, retrospective cohort study and included all cases of HZ seen in outpatient, emergency department, and hospital settings for adults aged 65 years and over between April 1, 2002 to August 31, 2016 in Ontario, Canada. We calculated the incidence of HZ and PHN, and estimated the proportion within each subgroup that developed PHN. We also assessed incidence by neighbourhood-level income quintile before and after the availability of vaccine for private purchase. The average annual incidence of HZ in any setting was 59.0 per 10,000 older adults, with higher incidence in outpatient as opposed to hospital settings. Incidence was higher in the oldest age groups, females, and those classified as immunocompromised or frail. Relative to the pre-vaccine era, the disparities in incidence of HZ by neighbourhood-level income increased, with higher rates of HZ and PHN seen in those residing in lower income quintiles. Additional prevention efforts should be targeted toward adults who are immunocompromised, frail, and those living in lower socioeconomic quintiles. Future work should assess the impact of the zoster vaccine program with a particular focus on equity in the publicly-funded era.

The impact of arm lymphedema on healthcare utilization during long-term breast cancer survivorship: a population-based cohort study

2020 ◽  
Vol 14 (3) ◽  
pp. 347-355 ◽  
Author(s):  
Andrea Cheville ◽  
Minji Lee ◽  
Timothy Moynihan ◽  
Kathryn H. Schmitz ◽  
Mary Lynch ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Healthcare Utilization ◽  
Cancer Survivorship ◽  
Population Based ◽  
Breast Cancer Survivorship ◽  
Arm Lymphedema ◽  
The Impact

scholarly journals Impact of Hurricane Sandy on Hospital Admissions 2 Years Later

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 236-236
Author(s):  
Laura Sands ◽  
Pang Du ◽  
Quyen Do ◽  
Yunnan Xu ◽  
Rachel Pruchno
Keyword(s):  
Older Adults ◽  
Hospital Admissions ◽  
Prognostic Significance ◽  
Hurricane Sandy ◽  
Health Consequences ◽  
Social Risks ◽  
Increased Risk ◽  
The Impact ◽  
Disaster Exposure

Abstract Disaster exposure is often followed by acute illness and injuries requiring hospital admission in the weeks after the disaster. It is not known whether disaster exposure is associated with hospitalization in the years after the disaster. We examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. Older adults (n=909) who participated in a longitudinal panel study provided data before and after Hurricane Sandy. These data were linked with Medicare inpatient files to assess the impact of Hurricane Sandy on hospital admissions after the post-hurricane interview. Those who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized in the second or third years after the hurricane [Hazard Ratio=1.81 (1.15 – 2.85)]. Findings held after controlling for pre-hurricane demographics, social risks, chronic conditions, and decline in physical functioning after the hurricane. These findings are the first to show that disaster exposure increases risk for hospital admissions two years after a disaster, and that older adults’ appraisal of their emotional distress during the disaster has prognostic significance that is not explained by known risks for hospital admissions. The findings suggest that interventions during the storm and after the storm, may reduce long-term health consequences of disaster exposure among older adults.

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