Tobacco retail availability and tobacco cessation in lung and head and neck (HN) cancer survivors.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11559-11559
Author(s):  
Lawson Eng ◽  
Jie Su ◽  
Steven Habbous ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Dose Effect ◽  
Location Data ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Retail Location ◽  
Time Distance ◽  
One Year ◽  
The Impact ◽  
Walking Time

11559 Background: Continued smoking after a cancer diagnosis is associated with poorer outcomes. Tobacco retail availability is negatively associated with cessation in non-cancer patients (pts), but has not been explored in cancer survivors. We evaluated the impact of tobacco retail availability on cessation in lung and HN cancer pts. Methods: Lung and HN cancer pts (Princess Margaret Cancer Centre, Toronto) completed questionnaires evaluating changes in tobacco use with a median of 26 months apart. Validated tobacco retail location data were obtained from Ministry of Health and pt home addresses were geocoded using ArcGIS 10.6.1, which calculated walking time/distance to nearest vendor, and vendor density within 250 meters (m) and 500m from pts. Multivariable logistic regression and Cox proportional hazard models evaluated the impact of vendor availability on cessation and time to quitting after diagnosis respectively, adjusting for significant clinico-demographic and tobacco covariates. Results: 242/721 lung and 149/445 HN pts smoked at diagnosis; subsequent overall quit rates were 66% and 49% respectively. Mean distance and walking time to a vendor was 1 km (range 0-13) and 11 min (range 0-156). On average, there was one vendor (range 0-19) within 250m and four vendors (range 0-40) within 500m from pts; 37% and 61% of pts lived within 250m and 500m from at least one vendor respectively. Greater distance (aOR 1.18 per 1000m [95% CI 1.00-1.38] p = 0.05) and increased walking time (aOR 1.01 per minute [1.00-1.02] p = 0.05) were associated with quitting at one year. Living within 250m (aOR 0.52 [0.32-0.84] p = 0.008) or 500m (aOR 0.57 [0.35-0.92] p = 0.02) to at least one vendor reduced quitting at one year. Living near more vendors within 500m had an increasing dose effect on reducing cessation rates at one year (aOR 0.96 per vendor [0.93-1.00] p = 0.05). Living within 500m to a vendor reduced chance of quitting at any time (aHR 0.66 [0.48-0.91] p = 0.01). HN and lung subgroups revealed similar associations. Conclusions: Close access to tobacco retail outlets is associated with reduced cessation rates for lung and HN cancer survivors. Reducing density of tobacco vendors is a cessation strategy that can positively impact cancer pt outcomes.

scholarly journals The Fact of Return to Work in Cervical Cancer Survivors and the Impact of Survival Rate: An 11-Year Follow-Up Study

2021 ◽  
Vol 18 (20) ◽  
pp. 10703
Author(s):  
Yu-Shan Sun ◽  
Wei-Liang Chen ◽  
Wei-Te Wu ◽  
Chung-Ching Wang
Keyword(s):  
Cervical Cancer ◽  
Return To Work ◽  
Cancer Survivors ◽  
Research Database ◽  
Cox Proportional Hazard ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Models ◽  
Returning To Work ◽  
The Impact

The aim of the current cohort study was to explore the relationship between return to work (RTW) after cervical cancer treatment and different medical and occupational covariates. We also investigated the effect of RTW on all-cause mortality and survival outcomes of cervical cancer survivors. Data were collected between 2004 and 2015 from the database of the Taiwan Cancer Registry, Labor Insurance Database, and National Health Insurance Research Database. The associations between independent variables and RTW were analyzed by Cox proportional hazard models. A total of 4945 workers (82.3%) who returned to work within 5 years after being diagnosed with cervical cancer. Patients who underwent surgical treatment were more likely to RTW by the 5th year compared to other groups, with a hazard ratio (HR) of 1.21 (95% CI: 1.01~1.44). Small company size and a monthly income greater than NT 38,200 were inversely associated with RTW (HR = 0.91, 95% CI: 0.84~0.98 and HR = 0.48, 95% CI: 0.44~0.53). Furthermore, RTW showed a statistically significant decrease in the risk of all-cause mortality in the fully adjusted HR, (HR = 0.42, p < 0.001). Some medical and occupational factors are associated with RTW in cervical cancer survivors. Returning to work may have a beneficial effect on the survival of patients with cervical cancer.

Heart Transplantation for Pediatric and Congenital Cardiac Disease: A Comparison of Two Eras over 23 Years and 188 Transplants at a Single Institution

2021 ◽  
Vol 12 (1) ◽  
pp. 17-26
Author(s):  
Genevieve C. Tuite ◽  
James A. Quintessenza ◽  
Alfred Asante-Korang ◽  
Sharon R. Ghazarian ◽  
Bethany L. Wisotzkey ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Multivariable Analysis ◽  
Immunosuppressive Agent ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Congenital Cardiac Disease ◽  
Cox Proportional Hazard Models ◽  
One Year ◽  
Patterns Of Practice ◽  
First Time

Background: To assess changes in patterns of practice and outcomes over time, we reviewed all patients who underwent heart transplantation (HTx) at our institution and compared two consecutive eras with significantly different immunosuppressive protocols (cohort 1 [80 HTx, June 1995-June 2006]; cohort 2 [108 HTx, July 2006-September 2018]). Methods: Retrospective study of 180 patients undergoing 188 HTx (June 1995-September 2018; 176 first time HTx, 10 second HTx, and 2 third HTx). In 2006, we commenced pre-HTx desensitization for highly sensitized patients and started using tacrolimus as our primary postoperative immunosuppressive agent. The primary outcome was mortality. Survival was modeled by the Kaplan-Meier method. Univariable and multivariable Cox proportional hazard models were created to identify prognostic factors for survival. Results: Our 188 HTx included 18 neonates, 85 infants, 83 children, and 2 adults (>18 years). Median age was 260.0 days (range: 5 days-23.8 years). Median weight was 7.5 kg (range: 2.2-113 kg). Patients in cohort 1 were less likely to have been immunosensitized preoperatively (12.5% vs 28.7%, P = .017). Nevertheless, Kaplan-Meier analysis suggested superior survival in cohort 2 ( P = .0045). Patients in cohort 2 were more likely to be alive one year, five years, and ten years after HTx. Multivariable analysis identified the earlier era (hazard ratio [HR] [95% confidence interval] for recent era = 0.32 [0.14-0.73]), transplantation after prior Norwood operation (HR = 4.44 [1.46-13.46]), and number of prior cardiac operations (HR = 1.33 [1.03-1.71]) as risk factors for mortality. Conclusions: Our analysis of 23 years of pediatric and congenital HTx reveals superior survival in the most recent 12-year era, despite the higher proportion of patients with elevated panel reactive antibody in the most recent era. This improvement was temporally associated with changes in our immunosuppressive strategy.

Second-Hand Smoke As a Predictor of Smoking Cessation Among Lung Cancer Survivors

2014 ◽  
Vol 32 (6) ◽  
pp. 564-570 ◽  
Author(s):  
Lawson Eng ◽  
Jie Su ◽  
Xin Qiu ◽  
Prakruthi R. Palepu ◽  
Henrique Hon ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Smoking Cessation ◽  
Cancer Survivors ◽  
Second Hand Smoke ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Peer Smoking ◽  
After Cancer

Purpose Second-hand smoke (SHS; ie, exposure to smoking of friends and spouses in the household) reduces the likelihood of smoking cessation in noncancer populations. We assessed whether SHS is associated with cessation rates in lung cancer survivors. Patients and Methods Patients with lung cancer were recruited from Princess Margaret Cancer Centre, Toronto, ON, Canada. Multivariable logistic regression and Cox proportional hazard models evaluated the association of sociodemographics, clinicopathologic variables, and SHS with either smoking cessation or time to quitting. Results In all, 721 patients completed baseline and follow-up questionnaires with a mean follow-up time of 54 months. Of the 242 current smokers at diagnosis, 136 (56%) had quit 1 year after diagnosis. Exposure to smoking at home (adjusted odds ratio [aOR], 6.18; 95% CI, 2.83 to 13.5; P < .001), spousal smoking (aOR, 6.01; 95% CI, 2.63 to 13.8; P < .001), and peer smoking (aOR, 2.49; 95% CI, 1.33 to 4.66; P = .0043) were each associated with decreased rates of cessation. Individuals exposed to smoking in all three settings had the lowest chances of quitting (aOR, 9.57; 95% CI, 2.50 to 36.64; P < .001). Results were similar in time-to-quitting analysis, in which 68% of patients who eventually quit did so within 6 months after cancer diagnosis. Subgroup analysis revealed similar associations across early- and late-stage patients and between sexes. Conclusion SHS is an important factor associated with smoking cessation in lung cancer survivors of all stages and should be a key consideration when developing smoking cessation programs for patients with lung cancer.

scholarly journals Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

Gut ◽  
2019 ◽  
Vol 69 (5) ◽  
pp. 852-858 ◽  
Author(s):  
Julien Kirchgesner ◽  
Nynne Nyboe Andersen ◽  
Fabrice Carrat ◽  
Tine Jess ◽  
Laurent Beaugerie
Keyword(s):  
Incidence Rates ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Cox Proportional Hazard Models ◽  
Inflammatory Bowel ◽  
Artery Disease ◽  
The Impact ◽  
Necrosis Factor

ObjectivePatients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.DesignPatients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.ResultsAmong 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn’s disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).ConclusionExposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

The role of immunotherapy on the survival of pancreatic cancer patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 714-714
Author(s):  
Saber Ali Amin ◽  
Michael Baine ◽  
Jane L. Meza ◽  
Chi Lin
Keyword(s):  
Pancreatic Cancer ◽  
Multivariable Analysis ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Surgery Group ◽  
Age Of Diagnosis ◽  
Cox Proportional Hazard Models ◽  
Definitive Surgery ◽  
The Impact

714 Background: Immunotherapy has revolutionized the treatment landscape of many malignancies, but its therapeutic role in pancreatic cancer (PC) remains unclear. The objective of this study is to investigate the impact of immunotherapy on the overall survival of PC patients stratified by definitive surgery of the pancreas using the National Cancer Database (NCDB). Methods: Patients with pancreatic adenocarcinoma were identified from NCDB. Cox proportional hazard models were employed to assess the impact of immunotherapy on survival after being stratified by surgery and adjusted for age of diagnosis, race, sex, place of living, income, education, treatment facility type, insurance status, year of diagnosis, and treatment types such as chemotherapy and radiation therapy. Results: Of 252,280 patients who were analyzed, 214,632 (85.08%) had definitive surgery, and 37,638 (14.92%) did not get definitive surgery of the pancreas. In the surgery group, 351 (0.93%) received immunotherapy and 37,287 (99.07%) did not while in the no surgery group, 838 (0.39%) received immunotherapy and 213,804 (99.61%) did not. In the multivariable analysis, patients who received immunotherapy had significantly improved OS both in the no surgery group (HR: 0.886, CI: 0.655-0.714; P < 0.0001) and in the surgery group (HR: 0.846, CI: 0.738-0.971; P < 0.0001) compared to patients who did not receive immunotherapy. Treatment with chemotherapy plus immunotherapy was associated with significantly improved OS (HR: 0.871, CI: 0.784-0.967; P < 0.009) compared to chemotherapy without immunotherapy in the no surgery group, while it was not significant in the surgery group. Chemoradiation plus immunotherapy was associated with significantly improved OS (HR: 0.787, CI: 0.684-0.906; P < 0.0009) in the no surgery group and (HR: 0.799, CI: 0.681-0.938) in the surgery group compared to chemoradiation alone. Conclusions: In this study, the addition of immunotherapy to chemoradiation therapy was associated with significantly improved OS in PC patients with or without definitive surgery. The study warrants further future clinical trials of immunotherapy in PC.

scholarly journals PATH-13. SEX-LINKED TUMORAL MGMT STATUS AND OUTCOMES IN NEWLY DIAGNOSED GLIOBLASTOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi145-vi145
Author(s):  
Addison Barnett ◽  
Anas Saeed Bamashmos ◽  
Assad Ali ◽  
Hong Li ◽  
David Bosler ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Progression Free Survival ◽  
Primary Objective ◽  
Newly Diagnosed ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Newly Diagnosed Glioblastoma ◽  
Cox Proportional Hazard Models ◽  
Tertiary Care Institution ◽  
The Impact

Abstract INTRO/OBJECTIVE Glioblastoma (GBM) and MGMT have been reported to have sexual dimorphism. The primary objective of this study was to analyze the impact and association between sex and MGMT status on progression-free survival (PFS) and overall survival (OS) in patients with newly diagnosed GBM. METHODS 582 patients with newly diagnosed GBM who underwent first surgical intervention at a single tertiary care institution between 2012 and 2018 were reviewed. Adults with documented methylated (≥ 12) and un-methylated (≤ 7) MGMT status were included. A Kaplan-Meier and Cox proportional hazard models were used to analyze the association between sex and MGMT status on PFS and OS. RESULTS 464 adult patients (median age 63.4, 36.6% female) had documented MGMT status. Overall rate of MGMT methylated patients was 42.5%, while females were more often methylated than males (52.1% vs 37.4%, p=0.004). MGMT methylated compared to un-methylated females (median: 12.8 vs 7.4 months; 1-yr: 53% vs 27%) had a greater PFS benefit than males (median: 9.6 vs 6.8 months; 1-yr: 44% vs 23%). OS was significantly improved in MGMT methylated compared to un-methylated patients among females (p=0.001) but not among males (p=0.22). Among MGMT methylated patients, females had significantly better OS compared to males (median: 18.7 vs 12.4 months; 2-yr OS: 36.8% vs 24.3%, p=0.03). Although statistically not significant, a similar pattern was observed on PFS (median: 12.8 vs 9.6 months; 1-yr PFS: 52.6% vs 44.4%). Compared to MGMT methylated females, MGMT methylated males had a PFS HR=1.22 (95% CI=0.80 – 1.85, p=0.36), and an OS HR=1.45 (95% CI=1.03 – 2.04, p=0.032). CONCLUSION MGMT methylation is more common in females and methylation had a larger impact on both PFS and OS in females compared to males. These analyses highlight the need to further investigate sex differences that can inform clinical management of GBM.

scholarly journals Impact of concomitant use of DMARDs on the persistence with anti-TNF therapies in patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register

2011 ◽  
Vol 70 (4) ◽  
pp. 583-589 ◽  
Author(s):  
Moetaza M Soliman ◽  
Darren M Ashcroft ◽  
Kath D Watson ◽  
Mark Lunt ◽  
Deborah P M Symmons ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
British Society ◽  
Concomitant Disease ◽  
Treatment Persistence ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Observational Cohort ◽  
One Year ◽  
Biologics Register

ObjectiveTo evaluate the effect of different concomitant disease modifying antirheumatic drugs (DMARDs) on the persistence with antitumour necrosis factor (anti-TNF) therapies in patients with rheumatoid arthritis (RA).MethodThis analysis included 10 396 patients with RA registered with the British Society for Rheumatology Biologics Register, a prospective observational cohort study, who were starting their first anti-TNF therapy and were receiving one of the following DMARD treatments at baseline: no DMARD (n=3339), methotrexate (MTX) (n=4418), leflunomide (LEF) (n=610), sulfasalazine (SSZ) (n=308), MTX+SSZ (n=902), MTX+ hydroxychloroquine (HCQ) (n=401) or MTX+SSZ+HCQ (n=418). Kaplan–Meier survival analysis was used to study the persistence with anti-TNF therapy in each DMARD subgroup up to 5 years. Multivariate Cox proportional hazard models, stratified by anti-TNF used and start year and adjusted for a number of potential confounders, were used to compare treatment persistence overall and according to the reason for discontinuation between each of the DMARD subgroups, using MTX as reference.ResultsOne-year drug survival (95% CI) for the first anti-TNF therapy was 71% (71% to 72%) but this dropped to 42% (41% to 43%) at 5 years. Compared with MTX, patients receiving no DMARD, LEF or SSZ were more likely to discontinue their first anti-TNF therapy while patients receiving MTX in combination with other DMARDs showed better treatment persistence.ConclusionsThese results support the continued use of background DMARD combinations which include MTX. Consideration should be given to the discontinuation of LEF and SSZ monotherapy at the time anti-TNF therapies are started, with the possible exception of the SSZ+ETN combination.

scholarly journals Consequences of infant adoption in Taiwan, 1906-1945: The impact of regional context and household composition on child mortality

2019 ◽  
Author(s):  
Tim Riswick
Keyword(s):  
Child Mortality ◽  
Household Composition ◽  
Adopted Children ◽  
Regional Context ◽  
Mortality Risks ◽  
Cox Proportional Hazard ◽  
Negative Effect ◽  
Cox Proportional Hazard Models ◽  
The Impact ◽  
Reallocation Of Resources

Little is known about health outcomes after adoption in historical non-Western settings and previous studies have found contradictory results of the influence of adoption on mortality risks. This study investigates if, and how, adoption of infants increased child mortality risks compared to non-adopted children. Moreover, it goes further than existing studies by investigating if, and how, after adoption, household composition and regional context influenced child mortality risks of these adopted children in Taiwan during the period 1906-1945. It uses the Taiwan Historical Household Register Database to answer these questions, estimating univariate and multivariate Cox proportional hazard models. The study demonstrates that child mortality risks of both male and female adopted children were much higher compared to non-adopted children. After adoption, household composition was especially important for adopted girls. In particular, similarly aged siblings increased child mortality risks of girls, indicating that the adoptees suffered the consequences of a reallocation of resources. The negative effect of infant adoption on child mortality was the same in all regional contexts. In sum, household composition and regional context should be taken into account when investigating child mortality risks, or other indicators of health inequalities, of adopted children.

Survival outcomes in marginal zone lymphomas in the rituximab era: Analysis of the Surveillance, Epidemiology, and End Results (SEER) database.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8045-8045
Author(s):  
Jorge J. Castillo ◽  
Adam J. Olszewski
Keyword(s):  
Marginal Zone ◽  
Primary Site ◽  
Prognostic Models ◽  
Seer Database ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Disparate Treatment ◽  
Cox Proportional Hazard Models ◽  
Different Characteristics ◽  
The Impact

8045 Background: Despite prognostic models developed for marginal zone lymphoma (MZL), the impact of different characteristics and treatments on survival in the population is largely unknown. We studied survival of MZL patients included in the SEER database. Methods: Records of MZL adult cases diagnosed between 1989-2008 were studied using descriptive methods and analysis of overall (OS) and lymphoma-specific (LSS) survival based on Kaplan-Meier function, stratified log-rank tests and Cox proportional hazard models. Results: 13,957 patients with MZL were identified and classified as splenic (SMZL; n=1,111, 8%), nodal (NMZL; n=4,101, 29%) or extranodal MALT-type MZL (MALT; n=8,745, 63%). The median age was 68 years, 74% of patients were white and 55% were women. Median follow-up was 40 months. MALT was more common in non-Caucasians (p<10-27). B-symptoms were more common in SMZL (p<10-5). Both LSS and OS were significantly better for MALT (p<10-60) with no difference between SMZL and NZML (p=0.30). 10-year LSS estimates were 67% for SMZL, 67% for NMZL, 84% for MALT. There was evidence for improved LSS since 2000 in MALT (HR 0.69, 95% CI 0.59-0.82, p=0.0003) and NMZL (HR 0.64, 95% CI 0.54-0.77, p<10-5), but not for SMZL (HR 0.85, 95% CI 0.56-1.28, p=0.43). Similar results were found for OS. There were differences in survival in MALT subtypes depending on primary site (p<10-12; Table). Conclusions: In the rituximab era, survival has improved for MALT and NMZL, but not for SMZL, possibly due to disparate treatment paradigms. The prognosis of MALT is different depending on primary site of involvement. [Table: see text]

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