Self-reported health and survival in older patients diagnosed with multiple myeloma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6582-6582
Author(s):  
Nadia Azmi Nabulsi ◽  
Ali Alobaidi ◽  
Brian Talon ◽  
Alemseged Ayele Asfaw ◽  
Jifang Zhou ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Medical Condition ◽  
Self Report ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Reported Health ◽  
Risk Of Cancer ◽  
The Impact

6582 Background: The strength of associations between pre-diagnosis self-reported health (SRH) and mortality differ by medical condition, with a moderately strong association reported among cancer patients. Less is known about the impact of SRH on survival among patients diagnosed with multiple myeloma (MM). We aimed to evaluate pre-diagnosis SRH in relation to survival in a cohort of older MM patients. Methods: We analyzed a prospective cohort from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database of patients 65 years and older diagnosed with first primary MM. Survey responses to a single general health question (asking patients to self-report their health as excellent, very good, good, fair, or poor) were used to determine pre-diagnosis SRH, grouped as high (excellent/very good/good) or low (fair/poor). We used multivariable Cox proportional hazards models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between SRH and risks of all-cause and cancer-specific mortality. Results: Of 521 MM patients with pre-diagnosis SRH data, the mean (SD) age at diagnosis was 76.8 (6.1) years with 60% of patients identifying as white, 18% as black, and 32% reporting low SRH. Compared to patients reporting high SRH, patients reporting low SRH were older, had lower education levels, more comorbidities, and lower Veterans-RAND 12 physical health and mental health component summary scores. In multivariable analyses, MM patients with low SRH had a 28% increased risk of all-cause mortality (HR = 1.28, 95% CI = 1.00, 1.64) and a non-statistically significant 19% increased risk of cancer-specific mortality (HR = 1.19, 95% CI = 0.87, 1.61) compared to MM patients reporting high SRH. Conclusions: Our findings suggest that lower SRH is highly prevalent among MM patients prior to diagnosis and is associated with modestly increased all-cause mortality. At a minimum, low SRH deserves clinical attention to determine how older MM patients’ quality of life may be compromised. The mechanism by which SRH affects mortality in MM should be further assessed and efforts should be made to identify whether any of the underlying mechanisms linking SRH and mortality in MM are mutable.

scholarly journals Hormone replacement therapy in women with cancer and risk of cancer-specific mortality and cardiovascular disease: a protocol for a cohort study from Scotland and Wales

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Úna McMenamin ◽  
Blánaid Hicks ◽  
Carmel Hughes ◽  
Peter Murchie ◽  
Julia Hippisley-Cox ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Hormone Replacement Therapy ◽  
Venous Thromboembolism ◽  
Replacement Therapy ◽  
Cancer Diagnosis ◽  
Hormone Replacement ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

Abstract Background Hormone replacement therapy (HRT) is widely used and has proven benefits for women with menopausal symptoms. An increasing number of women with cancer experience menopausal symptoms but the safety of HRT use in women with cancer is unclear. There are particular concerns that HRT could accelerate cancer progression in women with cancer, and also that HRT could increase the risk of cardiovascular disease in such women. Therefore, our primary aim is to determine whether HRT use alters the risk of cancer-specific mortality in women with a range of common cancers. Our secondary objectives are to investigate whether HRT alters the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. Methods The study will utilise independent population-based data from Wales using the SAIL databank and Scotland based upon the national Prescribing Information System. The study will include women newly diagnosed with common cancers from 2000 to 2016, identified from cancer registries. Women with breast cancers will be excluded. HRT will be ascertained using electronic prescribing in Wales or dispensing records in Scotland. The primary outcome will be time to cancer-specific mortality from national mortality records. Time-dependent cox regression models will be used to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer specific death in HRT users compared with non-users after cancer diagnosis after adjusting for relevant confounders, stratified by cancer site. Analysis will be repeated investigating the impact of HRT use immediately before cancer diagnosis. Secondary analyses will be conducted on the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. Analyses will be conducted within each cohort and pooled across cohorts. Discussion Our study will provide evidence to inform guidance given to women diagnosed with cancer on the safety of HRT use and/or guide modifications to clinical practice.

Allostatic Load in Cancer: A Systematic Review and Mini Meta-Analysis

2020 ◽  
pp. 109980042096989
Author(s):  
Asha Mathew ◽  
Ardith Z. Doorenbos ◽  
Hongjin Li ◽  
Min Kyeong Jang ◽  
Chang Gi Park ◽  
...  
Keyword(s):  
Cancer Research ◽  
Allostatic Load ◽  
Meta Analysis ◽  
Cancer History ◽  
Tumor Pathology ◽  
Post Traumatic Growth ◽  
Increased Risk ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

Background: Individuals with cancer experience stress throughout the cancer trajectory. Allostatic load (AL), a cumulative multi-system measure, may have a greater value in stress assessment and the associated biological burden than individual biomarkers. A better understanding of the use of AL and its operationalization in cancer could aid in early detection and prevention or alleviation of AL in this population. Purpose: To consolidate findings on the operationalization, antecedents, and outcomes of AL in cancer. Methods: Seven databases (CINAHL, Ovid MEDLINE, Web of Science, APA PsycInfo, Scopus, Embase, and Cochrane CENTRAL) were searched for articles published through April 2020. The NIH tools were used to assess study quality. Results: Twelve studies met inclusion criteria for this review. Although variability existed in the estimation of AL, biomarkers of cardiovascular, metabolic, and immune systems were mostly used. Associations of AL with cancer-specific variables were examined mostly utilizing population-databases. Significant associations of AL with variables such as cancer-related stress, positive cancer history, post traumatic growth, resilience, tumor pathology, and cancer-specific mortality were found. Mini meta-analysis found that a one-unit increase in AL was associated with a 9% increased risk of cancer-specific mortality. Conclusion: This review reveals heterogeneity in operationalization of AL in cancer research and lack of clarity regarding causal direction between AL and cancer. Nevertheless, AL holds a significant promise in cancer research and practice. AL could be included as a screening tool for high-risk individuals or a health outcome in cancer. Optimal standardized approaches to measure AL would improve its clinical utility.

Low-dose aspirin use and cancer-specific mortality: a meta-analysis of cohort studies

2019 ◽  
Author(s):  
Xianmin Wang ◽  
Yupeng Luo ◽  
Tingting Chen ◽  
Kui Zhang
Keyword(s):  
Cohort Studies ◽  
Low Dose ◽  
Meta Analysis ◽  
Cancer Type ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

ABSTRACT Background Considering the increased risk of bleeding caused by aspirin, and the observed benefit in all-cause mortality may be due to an improvement in cardiovascular-related mortality. We carried out this meta-analysis to estimate the association of low-dose aspirin use and risk of cancer-specific mortality. Methods We searched the PubMed and China National Knowledge Infrastructure (CNKI) databases for all articles within a range of published years from 1980 to 2018. Results Finally, 13 published cohort studies with 65 768 patients were available for estimating overall risk of cancer-specific mortality associating with post-diagnosis low-dose aspirin use, and 4 cohort studies were available for pre-diagnosis low-dose aspirin use with 16 654 patients. Overall, statistical evidence of significantly decreased cancer-specific mortality was found to be associated with post-diagnosis low-dose aspirin use (OR = 0.84, 95% CI = 0.75–0.93), but not with pre-diagnosis low-dose aspirin use. In terms of subgroup analyses by cancer type, post-diagnosis low-dose aspirin use was significantly with decreased cancer-specific mortality for digestive tract cancer including colorectal cancer, esophageal cancer and gastric cancer. Conclusion Our meta-analysis indicated that post-diagnosis but not pre-diagnosis low-dose aspirin use may reduce cancer-specific mortality.

Lung cancer chemotherapy and radiotherapy toxicity in patients with HIV.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13616-e13616
Author(s):  
Tinaye Mutetwa ◽  
Deborah Catherine Marshall ◽  
Sadiq Rehmani ◽  
Paz Polak ◽  
Keith Magnus Sigel
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Stage I ◽  
People Living With Hiv ◽  
Cancer Specific Survival ◽  
Early Stage Lung Cancer ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

e13616 Background: Lung cancer is the leading cause of cancer death for people living with HIV (PWH), and this group experiences lung cancer outcome disparities for unclear reasons. To better understand these disparities, we explored potential differences in adverse events since the start of chemotherapy, or radiation therapy (RT), among PWH with stage I-IIIA non-small cell lung cancer (NSCLC). Methods: Our matched case-cohort study used data from SEER-Medicare data on stage I-IIIA NSCLC diagnosed between 2000 and 2013. We identified 809 early stage NSCLC patients with HIV; 40 were treated with chemotherapy and 60 with RT. For each therapy type, a PWH case was matched, by age, sex, and cancer stage to 10 controls with no evidence of HIV infection. Outcome Measures: Acute severe chemotherapy or RT toxicity ascertained by a relevant inpatient diagnosis within 6 months of chemotherapy initiation or chronic toxicities from outpatient diagnostic codes within 24 months. We also evaluated overall (all-cause) and lung cancer-specific survival. Results: Among hematologic toxicities, PWH treated with chemotherapy were more than twice as likely to develop severe anemia [odds ratio [OR] = 2.3 (95% confidence interval [95% CI]: 1.2-4.6)]; but not neutropenia or thrombocytopenia (both p > 0.06). Among patients receiving chemotherapy, HIV was not associated with any other severe acute toxicities including fever, infection, nausea, renal dysfunction, and septicemia. For chronic complications, PWH had increased risk of neuropathy (OR 4.2; 95% CI: 1.3-13.6). Overall, HIV was associated with an increased count of chemotherapy complications seen per patient [p = 0.02]. PWH receiving chemotherapy had worse all-cause mortality (hazard ratio (HR) = 1.7; 95% CI: 1.2-2.4) and higher lung cancer-specific mortality (HR 1.8; 95% CI: 1.2-2.7) compared to uninfected persons after adjusting for treatment with surgery. In contrast, HIV was not significantly associated with severe RT complications (esophagitis, pneumonitis or hemoptysis), although all-cause mortality (HR 1.5; 95% CI: 1.1-2.0) and lung-cancer specific mortality (HR 1.5; 95% CI: 1.1-2.0) were higher among PWH receiving RT after adjusting for treatment with surgery. Conclusions: Antiretroviral-era PWH with early stage lung cancer experienced more frequent complications after chemotherapy but not radiotherapy compared to matched uninfected persons. These toxicities may have led to treatment alterations potentially contributing to outcome disparities seen in this high-risk group.

scholarly journals Competing Risks of Cancer and Non-Cancer Mortality When Accompanied by Lifestyle-Related Factors—A Prospective Cohort Study in Middle-Aged and Older Adults

2020 ◽  
Vol 10 ◽  
Author(s):  
Pawel Macek ◽  
Malgorzata Biskup ◽  
Malgorzata Terek-Derszniak ◽  
Marta Manczuk ◽  
Halina Krol ◽  
...  
Keyword(s):  
Cancer Mortality ◽  
Vigorous Physical Activity ◽  
Competing Risk ◽  
Cancer Death ◽  
Related Factors ◽  
Risk Of Death ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer ◽  
The Impact

BackgroundThe study aimed to identify the association between the lifestyle-related factors and the cancer-specific, or non-cancer-specific mortality, when accompanied by a competing risk. Two statistical methods were applied, i.e., cause-specific hazard (CSH), and sub-distribution hazard ratio (SHR). Their respective key advantages, relative to the actual study design, were addressed, as was overall application potential.MethodsSource data from 4,584 residents (34.2% men), aged 45–64 years, were processed using two different families of regression models, i.e., CSH and SHR; principal focus upon the impact of lifestyle-related factors on the competing risk of cancer and non-cancer mortality. The results were presented as hazard ratios (HR) with 95% confidence intervals (95% CI).ResultsAge, smoking status, and family history of cancer were found the leading risk factors for cancer death; the risk of non-cancer death higher in the elderly, and smoking individuals. Non-cancer mortality was strongly associated with obesity and hypertension. Moderate to vigorous physical activity decreased the risk of death caused by cancer and non-cancer causes.ConclusionsSpecific, lifestyle-related factors, instrumental in increasing overall, and cancer-specific mortality, are modifiable through health-promoting, individually pursued physical activities. Regular monitoring of such health-awareness boosting pursuits seems viable in terms of public health policy making.

scholarly journals Association of Allostatic Load with All-Cause and Cancer Mortality by Race and Body Mass Index in the REGARDS Cohort

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1695 ◽  
Author(s):  
Tomi Akinyemiju ◽  
Lauren E Wilson ◽  
April Deveaux ◽  
Stella Aslibekyan ◽  
Mary Cushman ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Allostatic Load ◽  
Baseline Risk ◽  
Targeted Interventions ◽  
Black And White ◽  
Increased Risk ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

Among 29,701 Black and White participants aged 45 years and older in the Reasons for Geographic and Racial Difference in Stroke (REGARDS) study, allostatic load (AL) was defined as the sum score of established baseline risk-associated biomarkers for which participants exceeded a set cutoff point. Cox proportional hazard regression was utilized to determine the association of AL score with all-cause and cancer-specific mortality, with analyses stratified by body-mass index, age group, and race. At baseline, Blacks had a higher AL score compared with Whites (Black mean AL score: 2.42, SD: 1.50; White mean AL score: 1.99, SD: 1.39; p < 0.001). Over the follow-up period, there were 4622 all-cause and 1237 cancer-specific deaths observed. Every unit increase in baseline AL score was associated with a 24% higher risk of all-cause (HR: 1.24, 95% CI: 1.22, 1.27) and a 7% higher risk of cancer-specific mortality (HR: 1.07, 95% CI: 1.03, 1.12). The association of AL with overall- and cancer-specific mortality was similar among Blacks and Whites and across age-groups, however the risk of cancer-specific mortality was higher among normal BMI than overweight or obese participants. In conclusion, a higher baseline AL score was associated with increased risk of all-cause and cancer-specific mortality among both Black and White participants. Targeted interventions to patient groups with higher AL scores, regardless of race, may be beneficial as a strategy to reduce all-cause and cancer-specific mortality.

scholarly journals Survival after Abdominoperineal and Sphincter-Preserving Resection in Nonmetastatic Rectal Cancer: A Population-Based Time-Trend and Propensity Score-Matched SEER Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Rene Warschkow ◽  
Sabrina M. Ebinger ◽  
Walter Brunner ◽  
Bruno M. Schmied ◽  
Lukas Marti
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Procedure ◽  
Time Trend ◽  
Patient Characteristics ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer ◽  
The Impact

Background.Abdominoperineal resection (APR) has been associated with impaired survival in nonmetastatic rectal cancer patients. It is unclear whether this adverse outcome is due to the surgical procedure itself or is a consequence of tumor-related characteristics.Study Design.Patients were identified from the Surveillance, Epidemiology, and End Results database. The impact of APR compared to coloanal anastomosis (CAA) on survival was assessed by Cox regression and propensity-score matching.Results.In 36,488 patients with rectal cancer resection, the APR rate declined from 31.8% in 1998 to 19.2% in 2011, with a significant trend change in 2004 at 21.6% (P<0.001). To minimize a potential time-trend bias, survival analysis was limited to patients diagnosed after 2004. APR was associated with an increased risk of cancer-specific mortality after unadjusted analysis (HR = 1.61, 95% CI: 1.28–2.03,P<0.01) and multivariable adjustment (HR = 1.39, 95% CI: 1.10–1.76,P<0.01). After optimal adjustment of highly biased patient characteristics by propensity-score matching, APR was not identified as a risk factor for cancer-specific mortality (HR = 0.85, 95% CI: 0.56–1.29,P=0.456).Conclusions.The current propensity score-adjusted analysis provides evidence that worse oncological outcomes in patients undergoing APR compared to CAA are caused by different patient characteristics and not by the surgical procedure itself.

scholarly journals Chemotherapy and radiation therapy in locally advanced oropharyngeal cancer

2020 ◽  
pp. 262-263
Author(s):  
N.M. Seriogina
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced ◽  
Survival Rates ◽  
Dose Intensity ◽  
Chemoradiation Therapy ◽  
Hpv Status ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

Background. About 650,000 new cases of head and neck cancer are diagnosed worldwide each year. About 66 % of these patients already have a common stage of the disease. Mortality up to one year is 38.8-44.4 %. The male/female ratio is 3.4:1. Smoking, alcohol consumption, human papillomavirus (HPV) infection, and herpes viruses are the main risk factors for the developing oropharyngeal cancer (OPC). Objective. To identify the features and to describe the treatment of OPC. Materials and methods. Analysis of literature data on this issue. Results and discussion. HPV-associated OPC is characterized by the favorable survival rates. 60-80 % of patients with such OPC are non-smokers and do not abuse alcohol, the average age is 45-55 years. The main principles of diagnosis and treatment of locally advanced forms of OPC include the use of modern imaging methods, staging depending on HPV status, definitive chemoradiation therapy, dose escalation (66-72 Gray), the use of integrated boosts on the tumor and affected lymph nodes, radiation therapy (RT) without a break, the use of the adaptive RT method. It has been shown that RT split courses reduce local tumor control by 13 %, while increasing the risk of late radiation complications by 18-40 %. RT with modulated dose intensity is accompanied by the reduction in the risk of all-cause mortality by 21 %, as well as the risk of cancer-specific mortality, and by the reduction of the number of aspiration pneumonia cases. Adaptive RT is a modern RT technology that involves adjusting the radiation plan during the course of treatment due to the changes in the anatomy of the tumor and surrounding tissues. The main stages of adaptive RT are obtaining the current data from the megavolt computed tomography, recalculation of the dose distribution, comparison with the plan before treatment, and adaptation of the plan. The results of chemotherapy should be evaluated no earlier than 12 weeks after its completion. Rehabilitation after chemoradiation therapy (prevention of trismus) involves massage and training of the jaw muscles, maintaining proper posture, oral hygiene. Conclusions. 1. HPV status is an important parameter in predicting the course of OPC. 2. HPV-associated OPC is characterized by the favorable survival rates. 3. The planned RT must be held without an interruption. 4. RT with modulated dose intensity is accompanied by the reduction in all-cause mortality by 21 %, as well as the risk of cancer-specific mortality. 5. The main area of research in HPV-associated OPC is the de-escalation of treatment regimens.

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