Effect of advanced age, elevated bilirubin, and disease extent on outcomes of unresectable pancreatic cancer (UPC) patients receiving first-line chemotherapy: A population-based study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 325-325 ◽  
Author(s):  
Hannah Marie Cherniawsky ◽  
Ying Wang ◽  
Sunita Ghosh ◽  
Winson Y. Cheung ◽  
Maria Yi Ho
Keyword(s):  
Metastatic Disease ◽  
Real World ◽  
Population Based ◽  
Advanced Age ◽  
Disease Extent ◽  
Population Based Study ◽  
The Real ◽  
Real World Setting ◽  
Elevated Bilirubin ◽  
The Impact

325 Background: Superiority of FOLFIRINOX (FFN) and nab-paclitaxel plus gemcitabine (NG) over standard gemcitabine (GEM) monotherapy for UPC was shown in the PRODIGE and MPACT trials, respectively. However, both trials either excluded or limited enrollment of patients with locally advanced disease, elevated bilirubin and advanced age. We sought to determine the impact of age, bilirubin and disease extent on treatment outcomes in the real-world setting. Methods: We identified all patients newly diagnosed with UPC who received palliative chemotherapy at any 1 of 6 British Columbia Cancer Centers and the Cross Cancer Institute in Alberta from January 2014 to April 2016. Receipt of at least one cycle of chemotherapy represented treatment with group assignment based on the initial regimen delivered. Outcomes were compared while adjusting for age, bilirubin, extent of disease, and other measured confounders. Results: A total of 292 consecutive patients were identified of whom 161 (55%) were aged > = 65 years, 164 (56%) were male, 74 (25%) had elevated bilirubin, and 205 (70%) had metastatic disease at the time of presentation. Patients who received FFN or NG had a longer median overall survival (OS) than those treated with GEM alone after adjusting for age, ECOG, bilirubin and extent of metastatic disease (11 vs 10 vs 4 months, respectively; FFN: HR 0.297, 95% CI 0.199-0.445, p < 0.0001, and NG: HR 0.338, 95% CI 0.236 – 0.485, p < 0.0001). Similarly, FFN and NG patients also had longer progression-free survival (PFS) in comparison to GEM alone (8.8 vs 6.9 vs 2.9 months, respectively; FFN: HR 0.33, 95% CI 0.22-0.499, p < 0.0001, and NG: HR 0.47, 95% CI 0.33 – 0.67, p < 0.0001). Advanced age and elevated bilirubin were not significantly associated with OS and PFS (p > 0.05). Conclusions: The efficacy of FFN and NG were superior when compared to GEM alone for patients with UPC in the real-world setting. This population-based study showed that the benefits of FFN and NG persisted regardless of advanced age and hyperbilirubinemia.

scholarly journals Real-World Data on Outcomes in Metastatic Castrate-Resistant Prostate Cancer Patients Treated With Abiraterone or Enzalutamide: A Regional Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Rachel Raju ◽  
Arvind Sahu ◽  
Myron Klevansky ◽  
Javier Torres
Keyword(s):  
Prostate Cancer ◽  
Real World ◽  
Burden Of Disease ◽  
Eastern Cooperative Oncology Group ◽  
Response Rates ◽  
The Real ◽  
Real World Setting ◽  
Psa Response ◽  
Visceral Metastases ◽  
The Impact

BackgroundBoth abiraterone and enzalutamide have shown to improve overall survival (OS), progression-free survival (PFS) and prostate-specific antigen (PSA) response in patients with metastatic castration-resistant prostate cancer (mCRPC) regardless of previous treatment with chemotherapy (COU-AA3011, COU-AA3022, AFFIRM3 and PREVAIL4). The data regarding the impact of these treatments in the real world setting is scarce. This study assessed the real world survival and disease outcomes in mCRPC patients in a regional health service in Victoria with the use of abiraterone and enzalutamide.MethodsThis retrospective clinical audit included 75 patients with diagnosis of mCRPC treated with either abiraterone or enzalutamide between January 1, 2014, and December 31, 2019, at Goulburn Valley Health. Patients were stratified according to the drug received, Eastern Cooperative Oncology Group (ECOG) performance status, Gleason score, burden of disease at diagnosis, presence of visceral metastases and use of previous chemotherapy. The primary end point was PSA response (defined as a reduction in the PSA level from baseline by 50% or more). The secondary outcomes were PSA PFS, radiographic PFS, and OS.ResultsThirty-seven patients received enzalutamide, and the other 38 received abiraterone. Only 20% of patients in either group had visceral metastases. 32% of patients receiving enzalutamide had a high burden of disease, compared to 53% receiving abiraterone. 38% of patients in the enzalutamide group and 53% in the abiraterone group had received prior chemotherapy. PSA response rates were higher in the enzalutamide group than abiraterone group (70.3% vs 37.8%). Both PSA and radiographic PFS were longer in the enzalutamide group than abiraterone group; 7 months vs 5 months for both end points. OS was also found to be longer in patients receiving enzalutamide; 30 months compared to only 13 months in patients receiving abiraterone.ConclusionBoth abiraterone and enzalutamide have shown to result in significant PSA response rates, as well as PFS and OS benefit in mCRPC patients in the real world setting. The difference in responses and survival benefit are probably impacted by the unbalanced burden of disease.

scholarly journals Real‐world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population‐based study

2020 ◽  
Vol 86 (12) ◽  
pp. 2349-2361 ◽  
Author(s):  
Renata Cristina Rezende Macedo do Nascimento ◽  
Tanja Mueller ◽  
Brian Godman ◽  
Sean MacBride Stewart ◽  
Simon Hurding ◽  
...  
Keyword(s):  
Real World ◽  
Population Based ◽  
Population Based Study ◽  
Scottish Population ◽  
The Impact

Epidemiology and survival of neuroendocrine tumors in Ontario: A 15-year population-based study.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 184-184 ◽  
Author(s):  
Moises Cukier ◽  
Calvin Law ◽  
Ning Liu ◽  
Refik Saskin ◽  
Simron Singh
Keyword(s):  
Overall Survival ◽  
Metastatic Disease ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Anatomical Site ◽  
Discharge Abstract Database ◽  
Population Based Study ◽  
Absolute Increase ◽  
The Impact

184 Background: A recent study of the SEER database in the United States showed a 5-fold increase in neuroendocrine tumours (NETs) over the last 30 years. An increasing incidence has also been reported in Norway, Sweden, England, Holland, Italy and Japan, but interestingly not in Denmark and Switzerland. The objective of our study is to describe the incidence, anatomical distribution and survival of NETs in Ontario. Methods: A population based study was initiated using the Ontario Cancer Registry, cross-linked with the Registered Persons Database and the Canadian Institute of Health Information Discharge Abstract Database. All cases of NETs were identified in Ontario (> 13 million persons) from 1994 to 2009. Baseline demographic, clinical and outcomes data were abstracted to allow for an analysis of annual incidence rates, and overall survival. Results: A total of N = 5619 cases were identified. The incidence rate increased from 2.46/ 100,000 (95% CI, 2.13-2.83) in 1994 to 5.86/ 100,000 (95% CI, 5.40 – 6.35) in 2009. The median age was 62 with 50.5% female cases. When divided by site, bronchopulmonary NETs where the most common (22%), then jejunum/ileum (17%) and rectal (16%) NETs, while pancreatic NETs (pNETs) and gastric NETs were 10% and 5% respectively. The absolute increase in the study period was most pronounced for pNETs (6-fold), rectal (5-fold) and gastric (5-fold) NETs. Metastatic disease was documented in 45% of the cases; 20% at diagnosis and 25% during follow-up. The 5-and 10-year overall survival (OS) was 61% and 46% respectively, for the entire population. Site specific 5-year OS were: rectal (87.0%), small bowel (73.4%), gastric (67.4%), colon (64.3%) and pancreas (48.8%). 5-year OS was compared for patients with and without metastatic disease after diagnosis (69.0% vs 40.1%, p<0.0001). Conclusions: There appears to be a significant increase of reported cases of NETs in Ontario, Canada, particularly pNETs, rectum NETs and gastric NETs. This supports much of the population-based reports worldwide. Survival appears to vary significantly according to anatomical site and extent of disease. Further research is required to understand the impact of this cancer previously perceived to be rare but clearly increasing.

scholarly journals Diagnosis to Treatment Interval in DLBCL Is Predictive of Overall Survival in a Large, Population-Based Registry

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1700-1700 ◽  
Author(s):  
Danielle N. Blunt ◽  
Liam Smyth ◽  
Evgenia Gatov ◽  
Chenthila Nagamuthu ◽  
Rena Buckstein ◽  
...  
Keyword(s):  
Overall Survival ◽  
Real World ◽  
Cox Regression ◽  
Treatment Time ◽  
Median Number ◽  
Population Based ◽  
Aggressive Disease ◽  
Real World Setting ◽  
Treatment Centre ◽  
The Impact

Abstract Despite advances in treatment for diffuse large B cell lymphoma (DLBCL), approximately one third of patients will relapse, with known risk factors largely limited to the biology of the disease. Recently, patient selection bias has been highlighted as a concern in patients enrolled in DLBCL trials, as the need to categorize patients by cell-of-origin necessitates a prolonged screening period that might exclude patients with a need for urgent treatment and thus more aggressive biology (Maurer et al., JCO 2018). Whether an abbreviated diagnosis to treatment interval represents a surrogate for more aggressive disease and adverse prognosis is unclear in a "real-world" setting. We evaluated the time from diagnosis to treatment (and other pre-treatment time intervals) and additional socioeconomic and system-based variables and their impact on lymphoma outcomes. Methods : Using population-based health administrative databases held at the Institute of Clinical and Evaluative Sciences, Ontario, Canada, we identified adults ≥18 years with DLBCL or transformed lymphoma. We explored the impact of timelines prior to commencing treatment and socio-economic status, distance to treating hospital, inpatient/outpatient status, and type of treatment centre on overall survival (OS) and progression-free survival (PFS). Patients were followed from index (first rituximab treatment) until death, occurrence of a new primary cancer, or March 31, 2017. Cox regression analyses were completed to evaluate the impact of predictor variables on OS. Results: In the population evaluated (n=9446), the median age was 66 years and 54% were of male gender. Forty-four percent were from the top two income quintiles and 86% from urban settings. Educational attainment was evenly distributed. Median number of co-morbidities using the John Hopkins aggregated diagnostic groups (ADGs) was 11 (IQR 9-14) with 61% of patients having a high AGD score (≥10). Patients waited a median of 37 days from diagnosis to treatment (IQR 39), with 25% waiting > 60 days. From diagnosis, patients waited a median of 19 days to see a hematologist/oncologist (diagnosis to consult time; IQR 24), followed by a further 15 days before chemotherapy was initiated (consult to treatment time; IQR 22). The first cycle was delivered as an inpatient in 4%. Median number of cycles was 6 (IQR 2) with 61% of patients completing ≥ 6. Most patients lived within 20 km of the treating centre (64%); however, 13% travelled > 60 km. At the conclusion of study follow-up, 57% of the cohort were alive with median OS not yet reached (Figure 1). Of the 3499 patients with the cause of death available, 73% had DLBCL listed as primary cause with 9.3% of patients dying on active treatment. In Cox regression analysis, an extended time from diagnosis to treatment was associated with improvement in overall survival. Compared to patients who required treatment within 30 days of diagnosis, patients who were treated within 30 - 60 days of diagnosis (HR 0.72; CI 95% 0.67 - 0.78) and > 60 days from diagnosis (HR 0.78; CI 95% 0.71 - 0.85) experienced improved survival (Figure 2). Compared to patients who lived close to the initial treatment centre (< 20 km), the survival of those patients who travelled more significant distances (> 60 km was not meaningfully impacted (HR 0.91; CI 95% 0.82-1.01). Conclusion:An abbreviated diagnosis to treatment time in newly-diagnosed DLBCL predicts for inferior overall survival in a "real-world" setting, and is potentially reflective of more aggressive disease biology or clinical behaviour. Clinical trials that require extended screening periods may be inadvertently enriched with patients with lymphomas that exhibit less aggressive clinical behaviour (and improved prognosis). In daily practice, patients with less clinically aggressive presentations should be reassured that their outcome should not be adversely impacted by a reasonable wait time. Forthcoming multivariable analyses will be presented to evaluate the impact of additional socioeconomic and system based variables on survival. Disclosures Buckstein: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Acute myeloid leukemia in the real world: why population-based registries are needed

Blood ◽  
2012 ◽  
Vol 119 (17) ◽  
pp. 3890-3899 ◽  
Author(s):  
Gunnar Juliusson ◽  
Vladimir Lazarevic ◽  
Ann-Sofi Hörstedt ◽  
Oskar Hagberg ◽  
Martin Höglund
Keyword(s):  
Acute Myeloid Leukemia ◽  
Real World ◽  
Myeloid Leukemia ◽  
Remission Rate ◽  
Performance Status ◽  
Population Based ◽  
Dynamic Graph ◽  
The Real ◽  
The Impact ◽  
Acute Myeloid

Abstract Population-based registries may provide data complementary to that from basic science and clinical intervention studies, all of which are essential for establishing recommendations for the management of patients in the real world. The same quality criteria apply for the evidence-based label, and both high representation and good data quality are crucial in registry studies. Registries with high coverage of the target population reduce the impact of selection on outcome and the subsequent problem with extrapolating data to nonstudied populations. Thus, data useful for clinical decision in situations not well covered by clinical studies can be provided. The potential clinical impact of data from population-based studies is exemplified with analyses from the Swedish Acute Leukemia Registry containing more than 3300 acute myeloid leukemia (AML) patients diagnosed between 1997 and 2006 with a median follow-up of 6.2 years on (1) the role of intensive combination chemotherapy for older patients with AML, (2) the impact of allogeneic stem cell transplantation on survival of younger patients with AML, and (3) the continuing problem with early deaths in acute promyelocytic leukemia. We also present the first Web-based dynamic graph showing the complex interaction between age, performance status, the proportion of patients given intensive treatment, early death rate, complete remission rate, use of allogeneic transplants, and overall survival in AML (non-AML).

Trends in Insulin Therapy—A1C and Age at the Time of Insulin Initiation in the Real-World Setting

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2328-PUB
Author(s):  
RAJIV KOVIL ◽  
MANOJ S. CHAWLA ◽  
PURVI M. CHAWLA ◽  
MIKHIL C. KOTHARI ◽  
AMBARI F. SHAIKH
Keyword(s):  
Insulin Therapy ◽  
Real World ◽  
Insulin Initiation ◽  
The Real ◽  
Real World Setting
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