Patterns of care in treating childhood neuroblastoma: Evidence from a population level study (SEER) in the United States.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e22011-e22011
Author(s):  
Diarmuid Coughlan ◽  
Charles Lynch ◽  
Matthew Gianferante ◽  
Jennifer Stevens ◽  
Linda C Harlan
Keyword(s):  
United States ◽  
Clinical Trial ◽  
High Risk ◽  
Cancer Registries ◽  
The United States ◽  
Patterns Of Care ◽  
Treatment Modalities ◽  
High Dose ◽  
High Risk Patients ◽  
Risk Patients

e22011 Background: Childhood neuroblastoma describes a heterogeneous group of extracranial solid tumors. This heterogeneity is reflected in the sequence and variety of treatment modalities administered. We describe the treatment pattern and survival of childhood neuroblastoma patients using population-based data in the United States. Methods: Using the National Cancer Institute’s (NCI) Patterns of Care data, we examined treatment provided to childhood neuroblastoma patients newly diagnosed in 2010 and 2011 and registered to one of 14 Surveillance, Epidemiology, and End Results (SEER) cancer registries. Data were re-abstracted from hospital records and treating physicians were contacted to verify the treatment given. Stratifying by the Children’s Oncology Group (COG)’s 3-level (low, intermediate and high) neuroblastoma risk classification system for therapeutic decision-making, gave a snapshot of community-based treatment patterns. Kaplan-Meier survival analyses were also performed. Results: The majority of 250 patients (76%) were enrolled on an open/active clinical trial. All low-risk patients received surgery with/without chemotherapy. The majority of intermediate-risk patients (77%) received chemotherapy regimen that included carboplatin, etoposide, cyclophosphamide and doxorubicin. High-risk patients received extensive, multimodal treatment consisting of chemotherapy, surgery, high dose chemotherapy with stem cell rescue (transplant), radiation, immunotherapy (dinutuximab), and isotretinoin therapy. Cyclophosphamide was the most utilized chemotherapy agent (94%) in high-risk patients. Survival with a maximum follow-up of 48 months, was lowest (68%) for patients diagnosed with high-risk disease. Conclusions: The majority of childhood neuroblastoma patients are registered on a risk-based open/active clinical trial. Variation in modality, systemic agents and sequence of treatment reflects the heterogeneity of therapy for childhood neuroblastoma patients.

scholarly journals Assessment of statin therapy, LDL-C levels, and cardiovascular events among high-risk patients in the United States

2016 ◽  
Vol 10 (1) ◽  
pp. 63-71.e3 ◽  
Author(s):  
Sudhir K. Unni ◽  
Ruben G.W. Quek ◽  
Joseph Biskupiak ◽  
Vinson C. Lee ◽  
Xiangyang Ye ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
The United States ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Optimizing antiviral treatment for seasonal influenza in the United States: A Mathematical Modeling Analysis

2020 ◽  
Author(s):  
Matan Yechezkel ◽  
Martial Ndeffo-Mba ◽  
Dan Yamin
Keyword(s):  
United States ◽  
High Risk ◽  
Seasonal Influenza ◽  
Antiviral Treatment ◽  
Social Contact ◽  
Population Level ◽  
The United States ◽  
Transmission Model ◽  
High Risk Patients ◽  
Risk Patients

Seasonal influenza remains a major health burden in the United States. Despite recommendations of early antiviral treatment of high-risk patients, the effective treatment coverage remains very low. We developed an influenza transmission model that incorporates data on infectious viral load, social contact, and healthcare-seeking behavior, to evaluate the population-level impact of increasing antiviral treatment timeliness and coverage among high-risk patients in the US. We found that increasing the rate of early treatment among high-risk patients who received treatment more than 48 hours after symptoms onset, would substantially avert infections and influenza-induced hospitalizations. We found that treatment of the elderly has the highest impact on reducing hospitalizations, whereas treating high-risk individuals aged 5-19 years old has the highest impact on transmission. The population-level impact of increased timeliness and coverage of treatment among high-risk patients was observed regardless of seasonal influenza vaccination coverage and the severity of the influenza season.

Difference in Outcome of Adolescents with Acute Lymphoblastic Leukemia (ALL) Enrolled in Pediatric (AIEOP) and Adult (GIMEMA) Protocols.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1954-1954 ◽  
Author(s):  
Anna Maria Testi ◽  
Maria Grazia Valsecchi ◽  
Valentino Conter ◽  
Marco Vignetti ◽  
Francesca Paoloni ◽  
...  
Keyword(s):  
High Risk ◽  
Lymphoblastic Leukemia ◽  
Survival Rates ◽  
Treatment Modalities ◽  
High Dose ◽  
Cranial Radiotherapy ◽  
Childhood All ◽  
High Risk Patients ◽  
Drug Induction ◽  
Risk Patients

Abstract Progress in the treatment of acute lymphoblastic leukaemia (ALL) has led to better survival rates; however, children have had a greater benefit from improved treatment modalities than adolescent who show an overall lower event-free survival (EFS) compared to younger patients. Some differences in the clinical and biologic characteristics of adolescents compared to childhood ALL may partly account for the different outcome, but adolescents treated on pediatric ALL trials seem to have a significantly better EFS than those treated on adult trials. We retrospectively compared the results obtained in a series of 245 patients ranging in age from 14 to 18 years diagnosed and enrolled in specific Italian children and adult ALL trials, between 4/1996 and 10/2003. One hundred and fifty patients, from 30 pediatric centers, underwent the childhood AIEOP ALL 95 and 2000 protocols; the other 95, from 28 adult centers, were enrolled in the GIMEMA ALL 0496 and 2000 protocols. The AIEOP 95 and 2000 trials are BFM-like protocols with a 7 drug induction followed by risk-modulated post-remission therapy that includes high-dose MTX and reinduction for low and intermediate groups, and intensive blocks (high-dose MTX and cytarabine) for high-risk patients. Standard maintenance therapy is administered up to a total of 2 years. Cranial radiotherapy is limited to high-risk patients. Stem cell transplantation is planned for very high-risk patients. The GIMEMA regimens are instead based on an induction with high-dose anthracyclines (cumulative dose 550 mg/m2), high-dose cytarabine as consolidation and do not include high-dose MTX and the reinduction phase. Standard maintenance with vincristine + daunorubicin/cyclophosphamide pulses is given for 2 years. Cranial radiotherapy is administered to all patients. The main patients characteristics at diagnosis, in the two groups under examination, were comparable except for age: median age was 15 and 16 years, respectively in the AIEOP and GIMEMA trials.Poor risk cytogenetic translocations and T-immunophenotype were equally dinstributed. Adolescents in the AIEOP protocols had a higher CR rate (94% vs 89%) and a lower relapse rate (17% vs 45%) compared to the adolescents enrolled in the GIMEMA trials. The 2-year overall survival rate was 80% in the AIEOP protocols and 71% in the GIMEMA trials. Detailed results according to the different clinical and biologic features of the adolescents analyzed will be presented. The results of our comparative study indicate that adolescents enrolled in pediatric trials have a more favourable clinical outcome.

scholarly journals Outcomes and temporal trends among high-risk patients after lung transplantation in the United States

2012 ◽  
Vol 31 (11) ◽  
pp. 1182-1191 ◽  
Author(s):  
Timothy J. George ◽  
Claude A. Beaty ◽  
Arman Kilic ◽  
Pali D. Shah ◽  
Christian A. Merlo ◽  
...  
Keyword(s):  
United States ◽  
High Risk ◽  
Lung Transplantation ◽  
Temporal Trends ◽  
The United States ◽  
High Risk Patients ◽  
Risk Patients

Secondhand Smoke Exposure Among High-Risk Patients in the United States (NHANES 2001–2012): Implications for Clinical Practice

2018 ◽  
Vol 21 (4) ◽  
pp. 551-556 ◽  
Author(s):  
Tahgrid Asfar ◽  
Tulay Koru-Sengul ◽  
Estefania C Ruano-Herreria ◽  
Danielle Sierra ◽  
David J Lee ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
High Risk ◽  
Secondhand Smoke ◽  
The United States ◽  
Smoke Exposure ◽  
Secondhand Smoke Exposure ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals PCV39 HEALTH STATUS IN HIGH-RISK PATIENTS UNDERGOING NONCARDIAC VASCULAR SURGERY IN THE UNITED STATES

2004 ◽  
Vol 7 (3) ◽  
pp. 330
Author(s):  
S Sheikh ◽  
S Haider ◽  
CC Joseph ◽  
WC Lee ◽  
KF Gold ◽  
...  
Keyword(s):  
United States ◽  
Health Status ◽  
High Risk ◽  
Vascular Surgery ◽  
The United States ◽  
High Risk Patients ◽  
Risk Patients

Effect of Lesion Segmentation in Melanoma Diagnosis for a Mobile Health Application

2017 ◽  
Author(s):  
Nasim Alamdari ◽  
Nicholas MacKinnon ◽  
Fartash Vasefi ◽  
Reza Fazel-Rezai ◽  
Minhal Alhashim ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
High Risk ◽  
Skin Cancer ◽  
Mobile Device ◽  
The United States ◽  
Care Providers ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Cost

In 2016, more than 76,380 new melanoma cases were diagnosed and 10,130 people were expected to die from skin cancer in the United States (one death per hour) [1]. A recent study demonstrates that the economic burden of skin cancer treatment is substantial and, in the United States, the cost was increased from $3.6 billion in 2002–2006 to $8.1 billion in 2007–2011 [2]. Monitoring moderate and high-risk patients and identifying melanoma in the earliest stage of disease should save lives and greatly diminish the cost of treatment. In this project, we are focused on detection and monitoring of new potential melanoma sites with medium/high risk patients. We believe those patients have a serious need and they need to be motivated to be engaged in their treatment plan. High-risk patients are more likely to be engaged with their skin health and their health care providers (physicians). Considering the high morbidity and mortality of melanoma, these patients are motivated to spend money on low-cost mobile device technology, either from their own pocket or through their health care provider if it helps reduce their risk with early detection and treatment. We believe that there is a role for mobile device imaging tools in the management of melanoma risk, if they are based on clinically validated technology that supports the existing needs of patients and the health care system. In a study issued in the British Journal of Dermatology [2] of 39 melanoma apps [2], five requested to do risk assessment, while nine mentioned images for expert review. The rest fell into the documentation and education categories. This seems like to be reliable with other dermatology apps available on the market. In a study at University of Pittsburgh [3], Ferris et al. established 4 apps with 188 clinically validated skin lesions images. From images, 60 of them were melanomas. Three of four apps tested misclassified +30% of melanomas as benign. The fourth app was more accurate and it depended on dermatologist interpretation. These results raise questions about proper use of smartphones in diagnosis and treatment of the patients and how dermatologists can effectively involve with these tools. In this study, we used a MATLAB (The MathWorks Inc., Natick, MA) based image processing algorithm that uses an RGB color dermoscopy image as an input and classifies malignant melanoma versus benign lesions based on prior training data using the AdaBoost classifier [5]. We compared the classifier accuracy when lesion boundaries are detected using supervised and unsupervised segmentation. We have found that improving the lesion boundary detection accuracy provides significant improvement on melanoma classification outcome in the patient data.

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