scholarly journals Subjective survival expectations and morbidity patterns of European citizens aged 50 years and older

2021 ◽  
Author(s):  
Απόστολος Παπαχρήστος
Keyword(s):  
Survival Expectations

Οι προσδοκίες των ανθρώπων για την μελλοντική επιβίωση τους μεταβάλλονται κατά τη διάρκεια της ζωής τους. Κάποιοι είναι σταθερά πιο αισιόδοξοι και πιστεύουν ότι οι πιθανότητες της μελλοντικής επιβίωσης τους είναι υψηλές. Η συστηματική διερεύνηση των χαρακτηριστικών τόσο των αισιόδοξων όσο και των απαισιόδοξων ανθρώπων μπορεί να αποκαλύψει τους λόγους διαφορών της αναμενόμενης Υποκειμενικής Επιβίωσης.Τα αποτελέσματα αυτής της διατριβής δείχνουν ότι υπάρχουν κοινοί παράγοντες που επηρεάζουν τις Υποκειμενικές Πιθανότητες Επιβίωσης. Αφενός, παράγοντες όπως ένας μεγάλος αριθμός παιδιών, υψηλότερη κοινωνικό-οικονομική κατάσταση, συχνή σωματική δραστηριότητα, συχνή κατανάλωση φρούτων ή λαχανικών και αυγών ή οσπρίων καθώς και καλύτερη ποιότητα ζωής σχετίζονται με υψηλότερες Υποκειμενικές Πιθανότητες Επιβίωσης, νεανική Βιολογική Ηλικία καθώς και μακροζωία. Από την άλλη πλευρά, παράγοντες όπως κακή υγείας, περισσότεροι περιορισμοί στις Δραστηριότητες της καθημερινής ζωής, μεγαλύτερος αριθμός χρόνιων ασθενειών, κακή μνήμη, κακές δεξιότητες γραφής και κατάθλιψη σχετίζονται με χαμηλότερες Υποκειμενικές Πιθανότητες Επιβίωσης, εξελιγμένη Βιολογικής Ηλικίας και υψηλότερη θνησιμότητα.Ένας από τους ερευνητικούς στόχους της παρούσας διατριβής είναι η εξέλιξη μιας καινοτόμου μεθόδου για την εκτίμηση της «Υποκειμενική Ηλικία Επιβίωσης», με βάση τις Υποκειμενικές Πιθανότητες Επιβίωσης και τους πινάκες θνησιμότητας του γενικού πληθυσμού. Τα αποτελέσματα της διατριβής δείχνουν σαφώς ότι τόσο οι Υποκειμενικές Πιθανότητες Επιβίωσης όσο και η «Υποκειμενική Ηλικία Επιβίωσης» είναι ανεξάρτητοι παράγοντες που προβλέπουν θνησιμότητα. Αυτό συνεπάγεται ότι οι δύο ποσότητες αυτές περιλαμβάνουν «πληροφορίες επιβίωσης» σημαντικές για την πρόβλεψη της πραγματικής επιβίωσης και μπορούν να χρησιμοποιηθούν για την εκτίμηση Δεικτών Γήρανσης του πληθυσμού. Τέλος, τα πρότυπα της «Υποκειμενικής Ηλικίας Επιβίωσης» είναι επίσης συγκρίσιμα με τα πρότυπα της Βιολογικής Ηλικίας και της Υποκειμενικής Ηλικίας.Η εισαγωγή της έννοιας «Υποκειμενική Ένταση Θνησιμότητας» επιτρέπει τον επαν-υπολογισμό των Υποκειμενικών Πιθανοτήτων Επιβίωσης για μικρότερο χρονικό ορίζοντα εκτίμησης. Για παράδειγμα οι συμμετέχοντες στο SHARE Wave 6 εκτιμούν την πιθανότητα επιβίωσης τους για τα επόμενα 14 έτη, κατά μέσο όρο. Ωστόσο, για την εκτίμηση της ακρίβειας των Υποκειμενικών Πιθανοτήτων Επιβίωσης μικρότεροι χρονικοί ορίζοντες εκτίμησης απατούνται (π.χ. 2 έτη μέχρι το επόμενο SHARE Wave). Οι Υποκειμενικές Πιθανότητες Επιβίωσης με μικρότερο χρονικό ορίζοντα εκτιμώνται με την χρήση της «Υποκειμενική Ένταση Θνησιμότητας».Τα αποτελέσματα δείχνουν ότι αφενός οι Υποκειμενικές Πιθανότητες Επιβίωσης που αντιστοιχούν σε χρονικό ορίζονται 2 ετών (μέχρι το SHARE Wave 7) και αφετέρου η «Υποκειμενική Ηλικία Επιβίωσης», είναι ανεξάρτητοι παράγοντες που προβλέπουν θνησιμότητα και περιλαμβάνουν πληροφορίες σημαντικές για την πρόβλεψη της πραγματικής επιβίωσης.

scholarly journals Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Deborah Carr
Keyword(s):  
Life Expectancy ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Risk Of Death ◽  
Advance Care ◽  
Survival Expectations ◽  
The Impact

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

Accuracy incentives and framing effects to minimize the influence of cognitive bias among advanced cancer patients

2021 ◽  
pp. 135910532110256
Author(s):  
Eric A Finkelstein ◽  
Yin Bun Cheung ◽  
Maurice E Schweitzer ◽  
Lai Heng Lee ◽  
Ravindran Kanesvaran ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Cognitive Biases ◽  
Survey Design ◽  
Framing Effects ◽  
Advanced Cancer Patients ◽  
Advanced Illness ◽  
Treatment Benefits ◽  
Hypothetical Treatment ◽  
Survival Expectations

Many patients with advanced illness have unrealistic survival expectations, largely due to cognitive biases. Studies suggests that when people are motivated to be accurate, they are less prone to succumb to these biases. Using a randomized survey design, we test whether offering advanced cancer patients ( n = 200) incentives to estimate their prognosis improves accuracy. We also test whether presenting treatment benefits in terms of a loss (mortality) rather than a gain (survival) reduces willingness to take up a hypothetical treatment. Results are not consistent with the proposed hypotheses for either accuracy incentives or framing effects.

scholarly journals M6a Regulator-Associated Methylation Modification Patterns Shape Tumor Microenvironment Characteristics in Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Bobin Ning ◽  
Yonggan Xue ◽  
Hongyi Liu ◽  
Hongyu Sun ◽  
Baoqing Jia
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Microenvironment ◽  
Single Cell ◽  
Signaling Pathways ◽  
Principal Component ◽  
Unsupervised Clustering ◽  
Survival Prediction ◽  
Multiple Perspectives ◽  
Single Cell Sequencing ◽  
Survival Expectations

Abstract Although substantial achievements in the tumor microenvironment (TME) of hepatocellular carcinoma (HCC) have led to fundamental improvements both in the basic research and clinical management, the potential mechanisms and regulatory relationships between m6A regulators and the TME are still unknown. We first conducted unsupervised clustering on the samples according to the core m6A expression, and then compared the signaling pathways, differential genes (DEGs), and TME between the m6A phenotypes, and re-validated the relationship between m6A regulators and TME by single cell sequencing. Then, the geneCluster was obtained by another unsupervised clustering of the DEGs, and the clinical as well as TME traits were evaluated among the geneClusters. Finally, the m6A scores of individual patients were calculated by principal component analysis (PCA) to verify the correlation from multiple perspectives, including survivals, clinical characters, mutations, TME, immunotherapy, and chemotherapy. Through a comprehensive analysis of 729 samples, we classified HCC patients into three m6A clusters and three geneClusters. Each group exhibited remarkable variations in terms of signaling pathways, clinical traits, and survival expectations. Notably, the m6A phenotypes corresponded to three different types of TME, namely immune-inflamed, immune-excluded, and immune-desert, respectively. In addition, the m6A regulator can accurately reflect the individualized microenvironment in HCC, and present supreme expression levels in the stromal microenvironment. However, the m6A score system is able to make accurate predictions not only in terms of clinical traits, survival prediction, and TME mentioned above, but also in the sensitivity of HCC patients to immunotherapy and chemotherapy. This study revealed the uniqueness and pluripotency of m6A regulators in the TME of HCC by combining single-cell sequencing and bulk sequencing. The quantified m6A modification indices were able to accurately predict patient survival expectations, clinical traits, TME, and sensitivity to immunotherapy and chemotherapy.

scholarly journals Mixture survival models methodology: an application to cancer immunotherapy assessment in clinical trials

2019 ◽  
Author(s):  
Lizet Sanchez ◽  
Patricia Lorenzo-Luaces ◽  
Claudia Fonte ◽  
Agustin Lage
Keyword(s):  
Lung Cancer ◽  
Clinical Trials ◽  
Parametric Models ◽  
Survival Models ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Term Survival ◽  
Survival Expectations ◽  
Multimodality Test

Abstract Progress in immunotherapy revolutionized the treatment landscape for advanced lung cancer, raising survival expectations beyond those that were historically anticipated with this disease. In the present study, we describe the methods for the adjustment of mixture parametric models of two populations for survival analysis in the presence of long survivors. A methodology is proposed in several five steps: first, it is proposed to use the multimodality test to decide the number of subpopulations to be considered in the model, second to adjust simple parametric survival models and mixture distribution models, to estimate the parameters and to select the best model fitted the data, finally, to test the hypotheses to compare the effectiveness of immunotherapies in the context of randomized clinical trials. The methodology is illustrated with data from a clinical trial that evaluates the effectiveness of the therapeutic vaccine CIMAvaxEGF vs the best supportive care for the treatment of advanced lung cancer. The mixture survival model allows estimating the presence of a subpopulation of long survivors that is 44% for vaccinated patients. The differences between the treated and control group were significant in both subpopulations (population of short-term survival: p = 0.001, the population of long-term survival: p = 0.0002). For cancer therapies, where a proportion of patients achieves long-term control of the disease, the heterogeneity of the population must be taken into account. Mixture parametric models may be more suitable to detect the effectiveness of immunotherapies compared to standard models.

CheckMate 8KX: Phase 1/2 multitumor preliminary analyses of a subcutaneous formulation of nivolumab (± rHuPH20).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2575-2575
Author(s):  
Sara Lonardi ◽  
Iwona Lugowska ◽  
Christopher G. C. A. Jackson ◽  
Anne O'Donnell ◽  
Rastilav Bahleda ◽  
...  
Keyword(s):  
De Novo ◽  
Phase 1 ◽  
Geometric Mean ◽  
Primary Objective ◽  
Tumor Type ◽  
Part D ◽  
Part C ◽  
Local Site ◽  
Survival Expectations ◽  
Grade 3

2575 Background: Immunotherapy has transformed cancer survival expectations. Nivolumab (NIVO), a programmed death-1 inhibitor, is approved for intravenous (IV) administration across multiple cancers. BMS is developing a subcutaneous (SC) NIVO formulation with a permeation enhancer, recombinant human hyaluronidase PH20 enzyme (rHuPH20), to allow for more rapid delivery and the potential to decrease treatment burden. We report the first data on pharmacokinetics (PK), pharmacodynamics, safety, and immunogenicity for SC NIVO + rHuPH20. Methods: CheckMate 8KX is a phase 1/2 study in checkpoint inhibitor-naïve patients (pts) who were ≥ 18 years of age, ECOG PS 0–1, with metastatic/unresectable solid tumors and measurable disease. The primary objective was to describe SC NIVO PK; secondary objectives were safety and immunogenicity. Additional analyses compared exposures to historical IV NIVO (Zhao X, et al. J Clin Oncol 2020;31:302–309). In cycle 1, pts in Part A received SC NIVO 720 mg + rHuPH20, and pts in Part B received SC NIVO 720 mg, SC NIVO 960 mg + rHuPH20, or SC NIVO 960 mg. For cycles 2+, pts in Parts A and B received IV NIVO 480 mg every 4 weeks (Q4W). Pts still on study switched to Part C, SC NIVO 1200 mg + rHuPH20 until end of therapy. In Part D, pts received de novo SC NIVO 1200 mg + rHuPH20 Q4W. Results: Patient characteristics varied by age, weight, tumor type, and prior treatment. NIVO exposures increased with increasing SC dose (Table). For 960 mg and 1200 mg NIVO + rHuPH20, Cavg and Ctau were above geometric mean exposures for IV NIVO 3 mg/kg every 2 weeks (Q2W), and Cmax was below IV NIVO 10 mg/kg Q2W. In Part C (n = 28), 13 (46.4%) pts experienced any-grade TRAEs with no new/worsening grade 3+ TRAEs or TRAEs leading to discontinuation/death; 7 (25.0%) reported grade 1 local site reactions. In Part D (n = 36), 27 (75.0%) pts experienced any-grade TRAEs, 4 (11.1%) grade 3/4 TRAEs, 2 (5.6%) serious grade 3/4 TRAEs with 1 leading to discontinuation, and no treatment-related deaths; 10 (27.8%) reported grade 1 local site reactions. Anti-NIVO antibodies (Ab) were observed with SC NIVO but not associated with altered PK/safety, or neutralizing Ab. Exploratory biomarker data found increased CD8+ tumor-infiltrating lymphocytes and PD-L1 tumor expression in post-treatment biopsies, similar to IV NIVO. Conclusions: Exposures associated with SC NIVO + rHuPH20 doses investigated in CheckMate 8KX were well tolerated, with a safety profile consistent with IV NIVO. Data support evaluation of SC NIVO + rHuPH20 in a phase 3 study. Clinical trial information: NCT03656718. [Table: see text]

scholarly journals Survival Expectations of the Obese: Is Excess Mortality Reflected in Perceptions?

2005 ◽  
Vol 13 (4) ◽  
pp. 754-761 ◽  
Author(s):  
Tracy A. Falba ◽  
Susan H. Busch
Keyword(s):  
Excess Mortality ◽  
Survival Expectations

Ten Years’ Experience with Capd in a Nursing Home Setting

1997 ◽  
Vol 17 (3) ◽  
pp. 255-261 ◽  
Author(s):  
John E. Anderson
Keyword(s):  
Nursing Home ◽  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Survival Rates ◽  
Home Setting ◽  
Technical Problems ◽  
Logistic Analysis ◽  
Survival Expectations ◽  
Home Placement ◽  
Esrd Patients

Objective We reviewed our experience with end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) in a nursing home with the aims of describing their demographic and clinical characteristics, evaluating CAPD technique success and patient outcomes. Setting University-based, teaching nursing home. Design Retrospective review of patients in our nursing home treated with CAPD between 1 June 1986 and 1 June 1996. Patients One hundred and nine patients: 66 (60.5%) were female and 59 (54%) were white. Their mean age was 62.7 years ± 12.8 SD (range 31 -88). Females were significantly older than males (64.9 years ± 10.7 SD vs 59.1 years ± 14.6 SD, p < 0.05). Sixty-eight (62.4%) were diabetics. Main outcomes studied:Cox -adjusted patient survival. Cause of death. Peritonitis and hospitalization rates. Logistic analysis of predictors of discharge home. Results Six and 12-month survival rates were 51.7% and 37.2%, respectively. Age greater than 75, poor functional status, coronary artery disease (CAD), and decubitus ulcers were significant mortality risks. Vascular disease was the leading cause (41.7%) of death. The peritonitis rate in the nursing home was 1.19 episodes per patient year. Gram-positive organisms predominated. The hospitalization rate was 22.4 days per patient year. Gangrene/ stump infections and peritonitis accounted for 14% and 10% of admissions. Those patients admitted for rehabilitation and with higher activity of daily living (ADL) scores were more likely, and those with diabetes, age ≥75, and CAD less likely to be discharged. Conclusions We continue to believe that peritoneal dialysis is a reasonable option for ESRD patients placed in nursing homes. Technical problems do not limit its use, but overall poor patient outcomes are an important issue. Patients, their families, and referring physicians should be informed of the limited survival expectations particularly for the very old and/or severely functionally impaired patient. Patients whose discharge is anticipated on admission are those most likely to return to the community and are the most likely to truly benefit from nursing home placement.

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