Investigating the prevalence and risk of chemotherapy-induced neuropathy among cancer patients.

12078 Background: Neuropathy is a common side effect of some chemotherapies. Clinical and other factors may confer neuropathy risk, but rates and risk factors across neuropathy-causing chemotherapies are incompletely understood. Methods: We examined 15 chemotherapy drugs known to confer neuropathy. Within a broad population of cancer patients who underwent treatment with these agents at the University of Chicago Medicine between 2012-2018, we determined prevalence of chemotherapy-induced neuropathy, defined as patients with initiation of a neuropathy treatment medication (amitriptyline, carbamazepine, duloxetine, gabapentin, or pregabalin) after starting chemotherapy. We then analyzed chemotherapy-induced neuropathy risk for different drugs and based on clinical demographic factors. Results: We analyzed 7,866 patients (65.3% White, 53.7% Female, 27.6% Black/African-American, 5.6% Hispanic or Latino, 3.1% Asian/Mideast Indian, 2.4% More than one Race, 0.2% American Indian or Alaska Native, 0.2% Native Hawaiian/Other Pacific Islander). The overall prevalence of chemotherapy-induced neuropathy was 24.3% across our patient population. Black/African-American patients had an increased risk of chemotherapy-induced neuropathy compared to the rest of the patient cohort (OR 1.4, 95% CI 1.3-1.6, P = 1.6e-10). Females also exhibited an increased risk of chemotherapy-induced neuropathy compared to males (OR 1.2, 95% CI 1.1-1.3, P = 1.5e-3). Conclusions: Certain chemotherapy agents confer substantial risk of chemotherapy-induced neuropathy, and risk is increased in Blacks and females. Future work will investigate additional risk-modifying factors including the potential role of germline polymorphisms on chemotherapy neuropathy risk.[Table: see text]

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Differences in COVID-19 Testing and Test Positivity Among Veterans, United States, 2020

Public Health Reports ◽

10.1177/00333549211009498 ◽

2021 ◽

pp. 003335492110094

Author(s):

Jacqueline M. Ferguson ◽

Hoda S. Abdel Magid ◽

Amanda L. Purnell ◽

Mathew V. Kiang ◽

Thomas F. Osborne

Keyword(s):

United States ◽

African American ◽

Low Income ◽

The United States ◽

Positive Test ◽

Health Administration ◽

Positive Test Result ◽

Black African ◽

Increased Risk ◽

Test Result

Objective COVID-19 disproportionately affects racial/ethnic minority groups in the United States. We evaluated characteristics associated with obtaining a COVID-19 test from the Veterans Health Administration (VHA) and receiving a positive test result for COVID-19. Methods We conducted a retrospective cohort analysis of 6 292 800 veterans in VHA care at 130 VHA medical facilities. We assessed the number of tests for SARS-CoV-2 administered by the VHA (n = 822 934) and the number of positive test results (n = 82 094) from February 8 through December 28, 2020. We evaluated associations of COVID-19 testing and test positivity with demographic characteristics of veterans, adjusting for facility characteristics, comorbidities, and county-level area-based socioeconomic measures using nested generalized linear models. Results In fully adjusted models, veterans who were female, Black/African American, Hispanic/Latino, urban, and low income and had a disability had an increased likelihood of obtaining a COVID-19 test, and veterans who were Asian had a decreased likelihood of obtaining a COVID-19 test. Compared with veterans who were White, veterans who were Black/African American (risk ratio [RR] = 1.23; 95% CI, 1.19-1.27) and Native Hawaiian/Other Pacific Islander (RR = 1.13; 95% CI, 1.05-1.21) had an increased likelihood of receiving a positive test result. Hispanic/Latino veterans had a 43% higher likelihood of receiving a positive test result than non-Hispanic/Latino veterans did. Conclusions Although veterans have access to subsidized health care at the VHA, the increased risk of receiving a positive test result for COVID-19 among Black and Hispanic/Latino veterans, despite receiving more tests than White and non-Hispanic/Latino veterans, suggests that other factors (eg, social inequities) are driving disparities in COVID-19 prevalence.

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The Patient–Provider Relationship: Predictors of black/African American Cancer Patients’ Perceived Quality of Care and Health Outcomes

Health Communication ◽

10.1080/10410236.2019.1625006 ◽

2019 ◽

Vol 35 (10) ◽

pp. 1289-1294 ◽

Cited By ~ 2

Author(s):

Matthew Asare ◽

Christina Fakhoury ◽

Nealey Thompson ◽

Eva Culakova ◽

Amber S. Kleckner ◽

...

Keyword(s):

African American ◽

Quality Of Care ◽

Health Outcomes ◽

Cancer Patients ◽

Perceived Quality ◽

Black African ◽

Perceived Quality Of Care

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Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing

Blood ◽

10.1182/blood-2021-148846 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4170-4170

Author(s):

Tom Adamkiewicz ◽

Mohamed Mubasher ◽

Folashade Omole ◽

Melvin R. Echols ◽

Jason Payne ◽

...

Keyword(s):

African American ◽

Respiratory Failure ◽

Conflicts Of Interest ◽

Care Facility ◽

Memorial Hospital ◽

Beta Thalassemia ◽

Separate Analysis ◽

Black African ◽

Medicine Service ◽

Increased Risk

Abstract A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA; 960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Hair loss associated with aromatase inhibitor treatment among breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21619 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21619-e21619

Author(s):

Lisa Gallicchio ◽

Carla Calhoun ◽

Kathy J. Helzlsouer

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Aromatase Inhibitor ◽

Cancer Patients ◽

Hair Loss ◽

Side Effect ◽

Common Side Effect ◽

Breast Cancer Patients ◽

Increased Risk

e21619 Background: Hair loss and thinning have been reported by breast cancer patients treated with aromatase inhibitors (AIs); these side effects are documented to be reasons that patients discontinue their AI therapy and have been shown to be associated with a decrease in quality of life. Despite this knowledge, there is a paucity of detailed data on hair changes over the course of AI therapy. The purpose of this study was to examine hair changes and risk factors for hair loss among breast cancer patients initiating aromatase inhibitor therapy and followed for one year. Methods: Data were analyzed from a cohort of 146 breast cancer patients initiating AI therapy and followed over the first year of their AI treatment. At baseline (prior to AI therapy) and at 1-year, a questionnaire was administered that ascertained data on demographics, health behaviors, and symptoms. Detailed hair loss questions, including those pertaining to family history and specific location of hair loss, were added during the study period when study staff noticed that hair loss and thinning were commonly being reported on the symptom checklist after initiation of AI therapy. Multivariable logistic regression analysis was conducted to examine factors related to AI-attributed hair loss. Results: Among the 86 breast cancer patients who completed the detailed hair loss survey at 1-year (mean age = 63y), 43% reported experiencing hair loss after the initiation of AI therapy. The most frequently reported time period of onset of the AI-attributed hair loss was between 3 and 6 months post-AI initiation (43.2%), with 67.6% of patients noting hair loss in the mid-scalp (top of head). Factors significantly associated with AI-related hair loss at 1-year were: hair loss prior to AI therapy, having a BMI > 30 kg/m2(odds ratio (OR) = 6.5), being a current smoker (OR = 7.8), and maternal history of hair loss or hair thinning (OR = 9.1). ORs were similar when patients with prior chemotherapy were excluded. Conclusions: Hair loss is a common side effect of AI therapy that can negatively affect a patient’s quality of life and potentially lead to treatment discontinuation. Treatment options for this AI-related side effect should be explored, especially for patients who are at increased risk.

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Ozone therapy in the management of cancer-treatment toxicity [abstract]

Journal of Ozone Therapy ◽

10.7203/jo3t.3.4.2019.15399 ◽

2019 ◽

Vol 3 (4) ◽

Author(s):

Bernardino Clavo ◽

Norberto Santana-Rodríguez ◽

Pedro Llontop ◽

Charlin Méndez ◽

Keila Zerecero ◽

...

Keyword(s):

Side Effects ◽

Cancer Patients ◽

Ozone Therapy ◽

Cancer Treatments ◽

Beneficial Effects ◽

Chemotherapy Drugs ◽

Increased Risk ◽

Delayed Healing ◽

Radiation Induced ◽

After Cancer

PURPOSE: This presentation will be focused to show clinical and preclinical works using Ozone therapy in the management of side effects related to cancer treatments. MATERIAL AND METHODS: Published articles and our experience about the potential beneficial effects of Ozone therapy in different adverse events related with cancer treatments. RESULTS: 1. Clinical experiences have shown that Ozone therapy can decrease or avoid delay in the commencement of Radiotherapy and Chemotherapy in patients with delayed wound-healing after cancer surgery. These delays could lead to increased risk of tumor relapse. 2. Clinical studies have shown the success of Ozone therapy to treat different side effects of Radiotherapy, Chemotherapy and Surgery. In our institution Ozone therapy was used to treat: delayed healing after chemotherapy extravasation, radiation-induced dermatitis, fistula and fibrosis after cancer treatments, radiation-induced side effects such as: delayed-healing, vaginitis, cystitis, proctitis, brain injury. Other institutions have also described beneficial effects of Ozone therapy in the treatment of mucositis, wound infections or bisphosphonate-related jaw osteonecrosis in cancer patients 3. Finally, several preclinical studies have shown "protective" effect of Ozone preconditioning against selective toxicity induced by different chemotherapy drugs and radiation. These works suggest potential clinical application to prevent toxicity. DISCUSSION AND CONCLUSIONS: Several studies support the potential role of Ozone therapy as complementary treatment to avoid delay in the commencement of Radio-Chemotherapy and prevent or treat some side effects of cancer-treatments. However, as it happens with hyperbaric chambers and other more accepted therapies, well addressed clinical trials are required for a definitive demonstration. Meanwhile, our work with Ozone therapy looking for the improvement of quality of life and/or symptom management has to follow an appropriate information to cancer-patients.

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Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry

10.1101/2020.11.06.20226035 ◽

2020 ◽

Author(s):

Christian Kirkup ◽

Colin Pawlowski ◽

Arjun Puranik ◽

Ian Conrad ◽

John C. O’Horo ◽

...

Keyword(s):

African American ◽

Mortality Rate ◽

Unfractionated Heparin ◽

Risk Ratio ◽

Cardiac Injury ◽

Kidney Injury ◽

Respiratory Illness ◽

P Value ◽

Black African ◽

Increased Risk

AbstractCOVID-19 patients are at an increased risk of thrombosis and various anticoagulants are being used in patient management without an established standard-of-care. Here, we analyze hospitalized and ICU patient outcomes from the Viral Infection and Respiratory illness Universal Study (VIRUS) registry. We find that severe COVID patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (311 deceased patients out of 760 total patients = 41%) compared to patients administered enoxaparin but not unfractionated heparin (214 deceased patients out of 1,432 total patients = 15%), presenting a risk ratio of 2.74 (95% C.I.: [2.35, 3.18]; p-value: 1.4e-41). This difference persists even after balancing on a number of covariates including: demographics, comorbidities, admission diagnoses, and method of oxygenation, with an amplified mortality rate of 39% (215 of 555) for unfractionated heparin vs. 23% (119 of 522) for enoxaparin, presenting a risk ratio of 1.70 (95% C.I.: [1.40, 2.05]; p-value: 2.5e-7). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to those administered enoxaparin, including acute kidney injury (227 of 642 [35%] vs. 156 of 608 [26%] respectively, adjusted p-value 0.0019), acute cardiac injury (40 of 642 [6.2%] vs. 15 of 608 [2.5%] respectively, adjusted p-value 0.01), septic shock (118 of 642 [18%] vs. 73 of 608 [12%] respectively, adjusted p-value 0.01), and anemia (81 of 642 [13%] vs. 46 of 608 [7.6%] respectively, adjusted p-value 0.02). Furthermore, a higher percentage of Black/African American COVID patients (375 of 1,203 [31%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (595 of 2,488 [24%]), for a risk ratio of 1.3 (95% C.I.: [1.17, 1.45], adjusted p-value: 1.6e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (272 of 959 [28%] for Black/African American vs. 213 of 959 [22%] for White/Caucasian, adjusted p-value: 0.01, relative risk: 1.28, 95% C.I.: [1.09, 1.49]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research in order to elucidate potential socioeconomic, racial, or other disparities underlying the use of anticoagulants to treat severe COVID patients.

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Chemotherapeutic drugs that penetrate the blood–brain barrier affect the development of hyperactive delirium in cancer patients

Palliative & Supportive Care ◽

10.1017/s1478951514000765 ◽

2014 ◽

Vol 13 (4) ◽

pp. 859-864 ◽

Cited By ~ 11

Author(s):

Hiromichi Matsuoka ◽

Kazuhiro Yoshiuchi ◽

Atsuko Koyama ◽

Masatomo Otsuka ◽

Kazuhiko Nakagawa

Keyword(s):

Cancer Patients ◽

Blood Brain Barrier ◽

Multiple Logistic Regression Analysis ◽

Brain Barrier ◽

Psychiatric Disease ◽

Antineoplastic Drugs ◽

Chemotherapy Drugs ◽

Blood Brain ◽

Medical Oncologists ◽

Increased Risk

AbstractObjective:Delirium is a frequently encountered psychiatric disease in terminal cancer patients. However, the mechanism of delirium is unclear. The aim of our study was to investigate the relationship between administration of chemotherapy drugs that penetrate the blood–brain barrier (BBB) and the development of delirium in cancer patients.Method:We retrospectively analyzed 166 cancer patients (97 males, 69 females) continuously who died between September of 2007 and January of 2010 using a review of medical charts. Multiple logistic regression analysis was employed to investigate the effects of antineoplastic drugs penetrating the BBB on development of delirium in cancer patients with control for other risk factors.Results:In multivariate analysis, antineoplastic drugs that penetrated the BBB were significantly associated with development of delirium (OR = 18.92, CI95 = 1.08–333.04, p < 0.001).Significance of results:The use of chemotherapy drugs that penetrate the BBB may be a risk factor for delirium. This information may allow palliative care doctors and medical oncologists to predict which patients are at increased risk for delirium.

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Exploring Racial and Age Disproportionalities in COVID-19 Positive Pediatric Cohort

Proceedings of IMPRS ◽

10.18060/24605 ◽

2020 ◽

Vol 3 ◽

Author(s):

Emily Freeman ◽

Yiqiang Song ◽

Katie Allen ◽

Siu Hui ◽

Eneida Mendonca

Keyword(s):

African American ◽

Disease Severity ◽

Alaska Native ◽

Race And Ethnicity ◽

Inpatient Care ◽

Pediatric Patients ◽

Epidemiological Data ◽

Age Group ◽

Patients Âgés ◽

Increased Risk

Background: Social and health inequities place marginalized populations at increased risk of contracting the novel coronavirus 2019 (COVID-19). While COVID-19 literature continues to accumulate, there remains a lack of comprehensive epidemiological data on COVID-19 in children. The study aims to identify demographic trends in disease severity amongst COVID-19 positive pediatric patients. Methods: We analyzed the medical records of 2217 laboratory-confirmed COVID-19 pediatric patients, ages 0-18, across Indiana. Working with Regenstrief Institute Center of Biomedical Informatics, data was extracted from the databases of Indiana Network for Patient Care, Indiana University Health, and Eskenazi Health from February 28th, 2020 to July 13th, 2020. Factors of interest were age, race, and ethnicity. The study assessed the clinical outcome of disease severity which was defined by one of the following clinical designations: outpatient management exclusively, emergency care without hospital admission, non-pediatric intensive care unit (PICU) hospitalization, PICU hospitalization, and death. Results: The laboratory confirmed COVID-19 pediatric cohort was composed of 12.2% (N= 270) Black or African American, 49.3% (N=1094) white, and 3.2% (N= 71) American Indian/Alaska Native, Asian/Pacific Islander, and Multiracial combined group. 34.4% of Black or African American patients required emergency (12.2%) or inpatient care (22.2%) while 24.4% white patients required emergency (7.0%) or inpatient care (17.3%). 17.6% of the cohort was 0-5 years old, 24.8% was 6-12 years old, and 57.6% was 13-18 years old. 30.9% of the 0-5 age group required emergency or inpatient care while the percentages of the 6-12 age group and 13-18 age group requiring emergency or inpatient care were 20.6% and 18.9%, respectively. Conclusion: While our data is preliminary and requires additional validation, our exploration of racial and age disproportionalities in pediatric coronavirus severity serves to expand on the current COVID-19 literature and understanding of this virus.

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