Prediction of hospitalizations in patients with cancer age 70 and older receiving chemotherapy.

216 Background: Chemotherapy is one of the main treatments for cancer and is associated in many cancers with significant benefits in overall and disease-free survival. Nevertheless, it is also associated with adverse effects that may lead to hospitalizations in older patients with comorbidities or decreased general status. We aimed to identify factors associated with hospital admissions in this population. Methods: Records of cancer patients 70 years-old or older who received adjuvant chemotherapy or first line chemotherapy for a cancer in a single center were retrospectively reviewed. Demographic, disease and treatment data were extracted. Factors associated with hospitalizations during chemotherapy treatment were evaluated in a univariate analysis with the x2 or the Fisher’s exact test. Factors identified were fitted in a multivariate regression model. Results: Among the 276 patients included in the study, 117 (42.4%) were male and 159 (57.6%) were female. Most patients (53.6%) were 70 to 75 years-old, but there were also significant proportions of patients that were 76 to 80 years-old and above age 80 (29.0% and 17.4% respectively). Chemotherapy was given in the adjuvant setting in 51.1% of patients and in the first line metastatic setting in 48.9% of patients. Treatment was with single chemotherapy drug in 22.8% of patients and poly-chemotherapy was given in 77.2% of patients. One hundred and six patients (38.4%) had a hospital admission during or up to a month after their chemotherapy treatment. Factors associated with admission in the multivariate analysis included ECOG PS > 1 (p = 0.04, odds ratio 1.4, 95% CI: 1.0-1.9) and hypoalbuminemia (p = 0.03, odds ratio 0.94, 95% CI: 0.88-0.99). Among the 174 patients that had a good PS (ECOG PS = 0 or 1) and normal albumin, only 28.7% had been hospitalized during treatment, while 62.3% of the 77 patients with PS of 2 or 3, hypoalbuminemia or both were hospitalized during or within the month after completion of treatment. Conclusions: Good ECOG PS in combination with a normal albumin is predictive of lower hospitalization rate in cancer patients 70 years-old and older receiving chemotherapy.

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Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution

Future Oncology ◽

10.2217/fon-2020-0425 ◽

2020 ◽

Vol 16 (32) ◽

pp. 2635-2643

Author(s):

Samantha L Freije ◽

Jordan A Holmes ◽

Saleh Rachidi ◽

Susannah G Ellsworth ◽

Richard C Zellars ◽

...

Keyword(s):

Cancer Patients ◽

Odds Ratio ◽

Regression Models ◽

Tumor Patients ◽

Logistic Regression Models ◽

Factors Associated ◽

Follow Up Care ◽

Risk Patients ◽

African American Race

Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African–American race (odds ratio [OR] 1.33; 95% CI: 1.17–1.51), Medicaid insurance (OR 1.59; 1.36–1.87), no insurance (OR 1.66; 1.32–2.10) and rural residence (OR 1.78; 1.49–2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.

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Treatment of Relapse of Clinical Stage I Nonseminomatous Germ Cell Tumors on Surveillance

Journal of Clinical Oncology ◽

10.1200/jco.18.01250 ◽

2019 ◽

Vol 37 (22) ◽

pp. 1919-1926 ◽

Cited By ~ 13

Author(s):

Robert J. Hamilton ◽

Madhur Nayan ◽

Lynn Anson-Cartwright ◽

Eshetu G. Atenafu ◽

Philippe L. Bedard ◽

...

Keyword(s):

Germ Cell ◽

Odds Ratio ◽

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Line Treatment ◽

First Line ◽

Factors Associated ◽

Nonseminomatous Germ Cell Tumors ◽

First Line Treatment

PURPOSE Active surveillance (AS) for testicular nonseminomatous germ cell tumors (NSGCT) is widely used. Although there is no consensus for optimal treatment at relapse on surveillance, globally patients typically receive chemotherapy. We describe treatment of relapses in our non–risk-adapted NSGCT AS cohort and highlight selective use of primary retroperitoneal lymph node dissection (RPLND). METHODS From December 1980 to December 2015, 580 patients with clinical stage I NSGCT were treated with AS, and 162 subsequently relapsed. First-line treatment was based on relapse site and extent. Logistic regression was used to explore factors associated with need for multimodal therapy on AS relapse. RESULTS Median time to relapse was 7.4 months. The majority of relapses were confined to the retroperitoneum (66%). After relapse, first-line treatment was chemotherapy for 95 (58.6%) and RPLND for 62 (38.3%), and five patients (3.1%) underwent other therapy. In 103 (65.6%), only one modality of treatment was required: chemotherapy only in 58 of 95 (61%) and RPLND only in 45 of 62 (73%). Factors associated with multimodal relapse therapy were larger node size (odds ratio, 2.68; P = .045) in patients undergoing chemotherapy and elevated tumor markers (odds ratio, 6.05; P = .008) in patients undergoing RPLND. When RPLND was performed with normal markers, 82% required no further treatment. Second relapse occurred in 30 of 162 patients (18.5%). With median follow-up of 7.6 years, there were five deaths (3.1% of AS relapses, but 0.8% of whole AS cohort) from NSGCT or treatment complications. CONCLUSION The retroperitoneum is the most common site of relapse in clinical stage I NSGCT on AS. Most are cured by single-modality treatment. RPLND should be considered for relapsed patients, especially those with disease limited to the retroperitoneum and normal markers, as an option to avoid chemotherapy.

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Implant R100 Predicts Rectal Bleeding in Prostate Cancer Patients Treated with IG-IMRT to 45 Gy and Pd-103 Implant

Journal of Radiotherapy ◽

10.1155/2014/130652 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6

Author(s):

Matthew Packard ◽

Vladimir Valakh ◽

Russell Fuhrer

Keyword(s):

Rectal Bleeding ◽

Odds Ratio ◽

Prostate Volume ◽

Univariate Analysis ◽

Prostate Adenocarcinoma ◽

Seminal Vesicles ◽

Risk Category ◽

Factors Associated ◽

Individual Source ◽

Grade 3

Purpose. To define factors associated with rectal bleeding in patients treated with IG-IMRT followed by Pd-103 seed implant. Methods and Materials. We retrospectively reviewed 61 prostate adenocarcinoma patients from 2002 to 2008. The majority (85.2%) were of NCCN intermediate risk category. All received IG-IMRT to the prostate and seminal vesicles followed by Pd-103 implant delivering a mean D90 of 100.7 Gy. Six patients received 45 Gy to the pelvic nodes and 10 received androgen deprivation. Results. Ten patients (16.4%) developed rectal bleeding: 4 were CTCAE v.3 grade 1, 5 were grade 2, and 1 was grade 3. By univariate analysis, age, stage, Gleason sum, PSA, hormonal therapy, pelvic radiation, postoperative prostate volume, D9, V100, individual source activity, total implanted activity per cm3, and duration of interval before implant did not impact rectal bleeding. Implant R100 was higher in patients with rectal bleeding: on average, 0.885 versus 0.396 cm3, P=.02, odds ratio of 2.26 per .5 cm3 (95% CI, 1.16–4.82). A trend for significance was seen for prostate V200 and total implanted activity. Conclusion. Higher implant R100 was associated with development of rectal bleeding in patients receiving IG-IMRT to 45 Gy followed by Pd-103 implant. Minimizing implant R100 may reduce the rate of rectal bleeding in similar patients.

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Oral Presentation VI

World Journal of Endocrine Surgery ◽

10.5005/wjoes-8-1-34 ◽

2016 ◽

Vol 8 (1) ◽

pp. 34-39

Author(s):

Woo Young Kim ◽

Jeonghun Lee ◽

Euy-Young Soh

Keyword(s):

Braf Mutation ◽

Odds Ratio ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Male Gender ◽

University Hospital ◽

Capsular Invasion ◽

Papillary Thyroid ◽

Factors Associated ◽

Clinicopathologic Factors

ABSTRACT BACKGROUND AND AIMS Papillary thyroid cancer (PTC) is the most frequent subtype among thyroid cancers. Lymph node (LN) metastases are frequent in PTC and the incidence is 60% on average. Recent studies have shown that there has been an increase in the mortality or recurrence with LN metastases and that more than 5 metastatic LNs are clinically important. Therefore, we investigated clinicopathologic factors associated with clinically important LN metastases. METHODS From January 2010 to October 2013, we retrospectively enrolled 2,628 PTC patients who underwent thyroidectomy at Ajou University Hospital. Among 1,425 patients with LN metastasis, 325 had ≥ 5 LN metastases. RESULTS In univariate analysis, young age (< 45 year), male gender, capsular invasion, multiplicity, tumor size, and lymphovascular invasion (p < 0.001) were statistically associated with both LN metastasis and ≥ 5 LN metastases. However, Braking Action Fair (BRAF) mutation was not important to predict LN metastasis (p > 0.05). In multivariate analysis, lymphovascular invasion was the most important factor (odds ratio: 4.7, 4.0) among other clinicopathologic factors (odds ratio:< 2.1). CONCLUSION Braking Action Fair (BRAF) mutation was not useful to predict the LN metastasis. However, lymphovascular invasion was the most important factor to predict more than five cervical LN metastasis which is very important clinically.

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The pattern of distant metastasis and clinicopathological factors associated with de-novo metastatic cervical cancer: a retrospective analysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20215053 ◽

2021 ◽

Vol 10 (1) ◽

pp. 191

Author(s):

J. Kannan ◽

Amit Saklani ◽

Srigopal Mohanty ◽

Kiranmayee Narapaneni ◽

Deepak George ◽

...

Keyword(s):

Cervical Cancer ◽

Multivariate Analysis ◽

Cancer Patients ◽

Distant Metastasis ◽

Primary Tumor ◽

De Novo ◽

Univariate Analysis ◽

High Grade ◽

Newly Diagnosed ◽

Factors Associated

Background: Metastatic cervical cancer carries poor prognosis. The factors associated with distant metastasis in newly diagnosed cervical cancer patients are not clear.Methods: A retrospective analytical study was performed to study the pattern of distant metastasis, and to evaluate the factors associated with de-novo metastatic cervical cancer. Univariate and multivariate analysis (by MANOVA) were used to evaluate the association. P≤0.05 was considered significant.Results: Out of 1321 newly diagnosed cervical cancer patients, 54 (4.1%) had de-novo metastatic disease and most of which (81%) were found at single site. Common sites of distant metastasis were non-regional nodes, followed by liver, lung, peritoneum and bone. Univariate analysis showed the factors associated with de-novo metastasis were non squamous subtype, high grade histology, bulky primary tumor (>4 cm), pelvic/para-aortic lymphadenopathy, and hydroureteronephrosis. Multivariate analysis revealed the factors associated with de-novo metastasis were bulky primary tumor (>4 cm), high grade histology, pelvic/para aortic lymphadenopathy, hydroureteronephrosis.Conclusions: Newly diagnosed cervical cancer patients with bulky primary tumor, high grade histology, pelvic or para aortic lymphadenopathy, hydroureteronephrosis are associated with higher risk of de-novo distant metastasis.

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Analysis of prognostic factors in advanced pancreatic cancer (APDAC) patients (pts) undergoing to first-line nab-paclitaxel (Nab-P) and gemcitabine (G) treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.412 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 412-412 ◽

Cited By ~ 3

Author(s):

Guido Giordano ◽

Vanja Vaccaro ◽

Eleonora Lucchini ◽

Paola Bertocchi ◽

Francesca Bergamo ◽

...

Keyword(s):

Prognostic Factors ◽

Primary Tumor ◽

Cox Regression ◽

Univariate Analysis ◽

Advanced Pancreatic Cancer ◽

Prognostic Impact ◽

First Line ◽

Primary Tumor Site ◽

Clinical Records ◽

Ecog Ps

412 Background: Nab-P + G combination represents an optimal first line therapeutic option in APDAC. Actually we have no parameters to predict prognosis in pts receiving this regimen. Here we present data of a multicentre retrospective analysis evaluating prognostic impact of clinical or biological factors in a cohort of APDAC pts treated with Nab-P + G first line CT. Methods: Clinical records of 118 APDAC pts receiving first line Nab-P + G were retrospectively reviewed. Overall survival (OS) and progression free survival (PFS) were evaluated with Kaplan Meier method with 95% CI and curves were compared with log-rank test. Cox-regression model was applied to the data with univariate and multivariate approach. Variables included in analysis were age, gender, ECOG PS, primary tumor site, liver metastases, multiple metastatic sites, baseline CA19-9, bilirubin levels, neutrophil/lymphocyte ratio (NLR), CA19-9 decrease > 50%, biliary stent and symptomatic disease. Results: Median age was 66 (37 - 83), M/F:65/53, ECOG PS 0/1/2: 51/46/21 respectively. 4 complete and 27 partial responses were observed with 26% response rate (RR). Median OS and PFS were 11 months (95% CI 9.58 – 12.41) and 7 months ( 95% CI 5.96 – 8.03) respectively. When considered at univariate analysis primary tumor location to the head, ECOG PS of 2, bilirubin levels higher than median and NLR ≥ 5 had a bad prognostic impact both on PFS and OS. Differently, CA19-9 decrease > 50% was considered a positive prognostic factor for PFS and OS. Multivariate analysis confirmed the negative role of NLR ≥ 5 respect of PFS (HR 3.21; 95%CI 1.61 – 5.68, p = 0.002) and OS (HR 3.38; 95%CI 1.88 – 5.79, p = 0.001) and positive impact of CA19-9 decrease > 50% on PFS (HR 0.37; 95% CI 0.11 – 0.68, p=0.006) and OS (HR 0.53; 95% CI 0.15 – 0.97, p=0.005), as independent prognostic factors. Conclusions: This analysis suggest that in APDAC pts receiving first line Nab-P + G, high NLR value (≥5) could be considered an easy detectable, independent parameter to predict poor outcomes in terms of PFS and OS. Furthermore CA19-9 reduction > 50% from baseline may be, in absence of other clinical and molecular parameters, an early marker of good prognosis.

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Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study

Einstein (São Paulo) ◽

10.1590/s1679-45082015ao3189 ◽

2015 ◽

Vol 13 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Renato Melli Carrera ◽

Miguel Cendoroglo Neto ◽

Paulo David Scatena Gonçales ◽

Flavio Rocha Brito Marques ◽

Camila Sardenberg ◽

...

Keyword(s):

Medical Education ◽

Multivariate Analysis ◽

Surgical Procedures ◽

Education Program ◽

Continuing Medical Education ◽

Odds Ratio ◽

Hospital Admissions ◽

Univariate Analysis ◽

Medical Education Program ◽

Education Requirements

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. Conclusion The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program.

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Joint dysfunction associated with venous malformations of the limbs: Which patients are at high risk?

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517693101 ◽

2017 ◽

Vol 33 (2) ◽

pp. 89-96 ◽

Cited By ~ 3

Author(s):

Li Hu ◽

Hui Chen ◽

Xi Yang ◽

Ming Liu ◽

Mengning Yan ◽

...

Keyword(s):

High Risk ◽

Odds Ratio ◽

Analogue Scale ◽

Adjusted Odds Ratio ◽

Univariate Analysis ◽

Preliminary Evidence ◽

Venous Malformations ◽

Factors Associated ◽

Scale Scores ◽

Pain Duration

Objectives Joint dysfunction occurs frequently in patients with venous malformations of the extremities. This study aims to describe the risk factors of joint dysfunction in these patients. Method We retrospectively collected clinical and radiological aspects of 168 patients with extremity venous malformations from January 2013 to August 2015. Patients were categorized into “with joint dysfunction” or “without joint dysfunction” groups according to the symptoms. Results Forty-four (26%) patients were assigned into with joint dysfunction group. Univariate analysis showed that the significant variables were age (P = 0.008), location (P = 0.005), size (P < 0.001), involved tissue (P < 0.001), visual analogue scale scores of pain (P = 0.004), pain duration (P = 0.018), and therapy history (P < 0.001). Multivariate analysis showed that the factors associated with joint dysfunction were age below 10 years (adjusted odds ratio = 2.70, P = 0.004), lower limb (adjusted odds ratio = 2.72, P = 0.042), pain duration over 1 year (adjusted odds ratio = 3.47, P = 0.001) and therapy history (yes) (adjusted odds ratio = 3.71, P = 0.004). Conclusion This study provides preliminary evidence indicating which patients are at high risk for joint dysfunction associated with limb venous malformations.

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Gene Expression Signature in Advanced Colorectal Cancer Patients Select Drugs and Response for the Use of Leucovorin, Fluorouracil, and Irinotecan

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.4187 ◽

2007 ◽

Vol 25 (7) ◽

pp. 773-780 ◽

Cited By ~ 118

Author(s):

Maguy Del Rio ◽

Franck Molina ◽

Caroline Bascoul-Mollevi ◽

Virginie Copois ◽

Frédéric Bibeau ◽

...

Keyword(s):

Gene Expression ◽

Colorectal Cancer ◽

Cancer Patients ◽

Advanced Colorectal Cancer ◽

Support Vector ◽

Cancer Tissue ◽

Chemotherapy Response ◽

First Line ◽

Metastatic Setting ◽

Colorectal Cancer Patients

Purpose In patients with advanced colorectal cancer, leucovorin, fluorouracil, and irinotecan (FOLFIRI) is considered as one of the reference first-line treatments. However, only about half of treated patients respond to this regimen, and there is no clinically useful marker that predicts response. A major clinical challenge is to identify the subset of patients who could benefit from this chemotherapy. We aimed to identify a gene expression profile in primary colon cancer tissue that could predict chemotherapy response. Patients and Methods Tumor colon samples from 21 patients with advanced colorectal cancer were analyzed for gene expression profiling using Human Genome GeneChip arrays U133. At the end of the first-line treatment, the best observed response, according to WHO criteria, was used to define the responders and nonresponders. Discriminatory genes were first selected by the significance analysis of microarrays algorithm and the area under the receiver operating characteristic curve. A predictor classifier was then constructed using support vector machines. Finally, leave-one-out cross validation was used to estimate the performance and the accuracy of the output class prediction rule. Results We determined a set of 14 predictor genes of response to FOLFIRI. Nine of nine responders (100% specificity) and 11 of 12 nonresponders (92% sensitivity) were classified correctly, for an overall accuracy of 95%. Conclusion After validation in an independent cohort of patients, our gene signature could be used as a decision tool to assist oncologists in selecting colorectal cancer patients who could benefit from FOLFIRI chemotherapy, both in the adjuvant and the first-line metastatic setting.

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