scholarly journals Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6085
Author(s):  
Yien Ning Sophia Wong ◽  
Christopher C. T. Sng ◽  
Diego Ottaviani ◽  
Grisma Patel ◽  
Amani Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Treatment ◽  
Mortality Risk ◽  
Metastatic Cancer ◽  
Hospitalized Patients ◽  
Solid Cancer ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
History Of ◽  
University College London

An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.

scholarly journals Cancer History and Systemic Anti-Cancer Therapy Independently Predict COVID-19 Mortality: A UK Tertiary Hospital Experience

2020 ◽  
Vol 10 ◽  
Author(s):  
Christopher C. T. Sng ◽  
Yien Ning Sophia Wong ◽  
Anjui Wu ◽  
Diego Ottaviani ◽  
Neha Chopra ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Tertiary Hospital ◽  
Solid Cancer ◽  
Cancer History ◽  
Asian Ethnicity ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
South Asian Ethnicity ◽  
History Of ◽  
Second Peak

BackgroundThe COVID-19 pandemic remains a pressing concern to patients with cancer as countries enter the second peak of the pandemic and beyond. It remains unclear whether cancer and its treatment contribute an independent risk for mortality in COVID-19.MethodsWe included patients at a London tertiary hospital with laboratory confirmed SARS-CoV-2 infection. All patients with a history of solid cancer were included. Age- and sex-matched patients without cancer were randomly selected. Patients with hematological malignancies were excluded.ResultsWe identified 94 patients with cancer, matched to 226 patients without cancer. After adjusting for age, ethnicity, and co-morbidities, patients with cancer had increased mortality following COVID-19 (HR 1.57, 95% CI:1.04–2.4, p = 0.03). Increasing age (HR 1.49 every 10 years, 95% CI:1.25–1.8, p < 0.001), South Asian ethnicity (HR 2.92, 95% CI:1.73–4.9, p < 0.001), and cerebrovascular disease (HR 1.93, 95% CI:1.18–3.2, p = 0.008) also predicted mortality. Within the cancer cohort, systemic anti-cancer therapy (SACT) within 60 days of COVID-19 diagnosis was an independent risk factor for mortality (HR 2.30, 95% CI: 1.16–4.6, p = 0.02).ConclusionsAlong with known risk factors, cancer and SACT confer an independent risk for mortality following COVID-19. Further studies are needed to understand the socio-economic influences and pathophysiology of these associations.

scholarly journals Sociodemographics and their impacts on risk factor awareness and beliefs about cancer and screening: results from a cross-sectional study in Newfoundland and Labrador

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fuyan Shi ◽  
Lance Garrett Shaver ◽  
Yujia Kong ◽  
Yanqing Yi ◽  
Kris Aubrey-Bassler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Cancer Screening ◽  
Cancer Treatment ◽  
Newfoundland And Labrador ◽  
Online Questionnaire ◽  
Excellent Health ◽  
History Of ◽  
History Of Cancer

Abstract Background Our objective was to examine cancer risk factor awareness and beliefs about cancer treatment, outcomes, and screening, and how these are mediated by sociodemographic variables, among Newfoundland and Labrador residents. Methods Participants aged 35 to 74 were recruited through Facebook advertising, and a self-administered online questionnaire was used to collect data. Descriptive statistics, Spearman rank correlations, and multivariate logistic regression analyses were performed. Results Of the 1048 participants who responded and met the inclusion criteria for this study, 1019 were selected for this analysis. Risk factor recognition was generally good, though several risk factors had poor awareness: being over 70 years old (53.4% respondents aware), having a low-fiber diet (65.0%), and drinking more than 1 unit of alcohol per day (62.8%). Our results showed that the participants’ awareness of risk factors was significantly associated with higher income level (rs = 0.237, P <  0.001), higher education (rs = 0.231, P <  0.001), living in rural regions (rs = 0.163, P <  0.001), and having a regular healthcare provider (rs = 0.081, P = 0.010). Logistic regression showed that among NL residents in our sample, those with higher income, post-secondary education, those in very good or excellent health, and those with a history of cancer all had higher odds of having more positive beliefs about cancer treatment and outcomes. Those with a history of cancer, and those with very good or excellent health, also had higher odds of having more positive beliefs about cancer screening. Finally, compared to Caucasian/white participants, those who were non-Caucasian/white had lower odds of having more positive beliefs about cancer screening. Conclusion Among adults in NL, there was poor awareness that low-fiber diets, alcohol, and age are risk factors for cancer. Lower income and education, rural residence, and not having a health care provider were associated with lower risk factor awareness. We also found a few associations between sociodemographic factors and beliefs about cancer treatment and outcomes or screening. We stress that while addressing awareness is necessary, so too is improving social circumstances of disadvantaged groups who lack the resources necessary to adopt healthy behaviours.

scholarly journals Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes

2019 ◽  
Vol 17 (10) ◽  
pp. 1184-1192 ◽  
Author(s):  
Grace L. Smith ◽  
Maria A. Lopez-Olivo ◽  
Pragati G. Advani ◽  
Matthew S. Ning ◽  
Yimin Geng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Insurance ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Patients With Cancer ◽  
Related Quality ◽  
Financial Burdens ◽  
Cancer Experience

Background: Patients with cancer experience financial toxicity from the costs of treatment, as well as material and psychologic stress related to this burden. A synthesized understanding of predictors and outcomes of the financial burdens associated with cancer care is needed to underpin strategic responses in oncology care. This study systematically reviewed risk factors and outcomes associated with financial burdens related to cancer treatment. Methods: MEDLINE, Embase, PubMed, PsychINFO, and the Cochrane Library were searched from study inception through June 2018, and reference lists were scanned from studies of patient-level predictors and outcomes of financial burdens in US patients with cancer (aged ≥18 years). Two reviewers conducted screening, abstraction, and quality assessment. Variables associated with financial burdens were synthesized. When possible, pooled estimates of associations were calculated using random-effects models. Results: A total of 74 observational studies of financial burdens in 598,751 patients with cancer were identified, among which 49% of patients reported material or psychologic financial burdens (95% CI, 41%–56%). Socioeconomic predictors of worse financial burdens with treatment were lack of health insurance, lower income, unemployment, and younger age at cancer diagnosis. Compared with patients with health insurance, those who were uninsured demonstrated twice the odds of financial burdens (pooled odds ratio [OR], 2.09; 95% CI, 1.33–3.30). Financial burdens were most severe early in cancer treatment, did not differ by disease site, and were associated with worse health-related quality of life (HRQoL) and nearly twice the odds of cancer medication nonadherence (pooled OR, 1.70; 95% CI, 1.13–2.56). Only a single study demonstrated an association with increased mortality. Studies assessing the comparative effectiveness of interventions to mitigate financial burdens in patients with cancer were lacking. Conclusions: Evidence showed that financial burdens are common, disproportionately impacting younger and socioeconomically disadvantaged patients with cancer, across disease sites, and are associated with worse treatment adherence and HRQoL. Available evidence helped identify vulnerable patients needing oncology provider engagement and response, but evidence is critically needed on the effectiveness of interventions designed to mitigate financial burden and impact.

scholarly journals Clinical Determinants Differentiating the Severity of SARS-CoV-2 Infection in Cancer Patients: Hospital Care or Home Recovery

2021 ◽  
Vol 8 ◽  
Author(s):  
Dong D. Lin ◽  
Yunhong Wu ◽  
Sudhamshi Toom ◽  
Niki Sheth ◽  
Kevin Becker ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Older Patients ◽  
Hospital Care ◽  
Performance Status ◽  
Antibody Test ◽  
Hospitalized Patients ◽  
Myelosuppressive Chemotherapy ◽  
Anti Cancer ◽  
At Home

Background: Cancer patients may carry a worse prognosis with SARS-CoV-2 infection. Most of the previous studies described the outcomes of hospitalized cancer patients. We aimed to study the clinical factors differentiating patients requiring hospital care vs. home recovery, and the trajectory of their anti-cancer treatment.Methods: This study was conducted in a community cancer center in New York City. Eligible patients were those who had cancer history and were diagnosed of SARS-CoV-2 infection between March 1 and May 30, 2020, with confirmatory SARs-CoV-2 virus test or antibody test. Four groups were constructed: (A) hospitalized and survived, (B) hospitalized requiring intubation and/or deceased, (C) non-hospitalized, asymptomatic, with suspicious CT image findings, close exposure, or positive antibody test, and (D) non-hospitalized and symptomatic.Results: One hundred and six patients were included in the analysis. Thirty-five patients (33.0%) required hospitalization and 13 (12.3%) died. Thirty (28.3%) patients were asymptomatic and 41 (38.7%) were symptomatic and recovered at home. Comparing to patients who recovered at home, hospitalized patients were composed of older patients (median age 71 vs. 63 years old, p = 0.000299), more who received negative impact treatment (62.9 vs. 32.4%, p = 0.0036) that mostly represented myelosuppressive chemotherapy (45.7 vs. 23.9%, p = 0.0275), and more patients with poorer baseline performance status (PS ≥ 2 25.7 vs. 2.8%, p = 0.0007). Hypoxemia (35% in group A vs. 73.3% in group B, p = 0.0271) at presentation was significant to predict mortality in hospitalized patients. The median cumulative hospital stay for discharged patients was 16 days (range 5–60). The median duration of persistent positivity of SARS-CoV-2 RNA was 28 days (range 10–86). About 52.9% of patients who survived hospitalization and required anti-cancer treatment reinitiated therapy. Ninety-two percent of the asymptomatic patients and 51.7% of the symptomatic patients who recovered at home continued treatment on schedule and almost all reinitiated treatment after recovery.Conclusions: Cancer patients may have a more severe status of SARS-CoV-2 infection after receiving myelosuppressive chemotherapy. Avoidance should be considered in older patients with poor performance status. More than two thirds of patients exhibit minimal to moderate symptoms, and many of them can continue or restart their anti-cancer treatment upon recovery.

Assessment of Clinical Risk Factors for Symptomatic Venous Thromboembolism in Common Cancers: A VERITY Registry Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3826-3826
Author(s):  
Shankaranarayana Paneesha ◽  
Aidan McManus ◽  
Roopen Arya ◽  
Nicholas Scriven ◽  
Tim Nokes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Family History ◽  
Cancer History ◽  
Patients With Cancer ◽  
Thrombosis Risk ◽  
History Of ◽  
Age And Sex

Abstract The association between venous thromboembolism (VTE) and cancer is well-recognised, but the thrombosis risk factor profile of patients with cancer-associated VTE is poorly characterised; it is unclear if additional risk factors contribute to the risk of thrombosis beyond the cancer itself, or if the risk factor profile is tumour-specific. Our aim was to compare the thrombosis risk factor profiles of cancer patients with or without symptomatic VTE enrolled in VERITY, an ongoing UK prospective VTE registry. The VERITY registry records data on patients with VTE and those in whom the diagnosis of VTE is excluded. Between Jun 05 and Mar 08, 49044 patient entries were made. Individual case data for patients with cancer were extracted. Using available risk factor data, univariate analysis of 9 established risk factors for VTE (medical in-patient history/immobilisation >3 days within last 4 weeks; major surgery in the last 4 weeks; hormonal risk factor; previous history of VTE; family history of VTE; known thrombophilia; intravenous drug abuse; current smoking; and leg paralysis), comparing VTE and non-VTE cancer cases, was performed for the 4 most common cancers using SPSS. To account for the potential impact of age and sex on VTE risk, age-adjusted values were calculated for breast and prostate cancer, and age- and sex-adjusted values for colorectal and lung. A nominal level of 5% statistical significance was assumed. Of 2825 cancer cases, 1382 had an objectively confirmed diagnosis of VTE and in 1443 the diagnosis of VTE was excluded. Breast (n=498), prostate (n=374), colorectal (n=343) and lung cancer (n=275) accounted for 53% of cancer cases. Univariate associations between risk factors and symptomatic VTE were found only for prostate cancer: history of VTE (odds ratio [OR] = 3.48; 95% CI, 2.01, 6.02; p < 0.00001), family history of VTE (OR = 2.56; 95% CI, 1.02, 6.44; p = 0.046), hormonal risk factor (OR = 2.22; 95% CI, 1.00, 4.92; p = 0.049). In colorectal cancer, smoking was less likely in VTE cases (OR = 0.54; 95% CI, 0.34, 0.87; p = 0.012). Adjusting for age (and sex), univariate associations between risk factors and symptomatic VTE were again found only for prostate cancer: history of VTE (OR = 3.23; 95% CI, 1.56, 6.68; p = 0.002), with smoking less likely in age-adjusted VTE cases (OR = 0.50; 95% CI, 0.28, 0.91; p = 0.022). Our analysis of a registry population found few associations between known thrombosis risk factors and symptomatic VTE in patients with common cancers, suggesting these factors impact little on thromboembolic risk in these cancers.

Insights Into the Mechanism of Zymogen Protein C Protection Against Cancer Progression

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3350-3350 ◽  
Author(s):  
Julie M Crudele ◽  
Geerte L. Van Sluis ◽  
Paris Margaritis ◽  
Joshua I Siner ◽  
Michael Sliozberg ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Tumor Progression ◽  
Cancer Progression ◽  
Protein C ◽  
Metastatic Cancer ◽  
Dependent Manner ◽  
B16f10 Cells ◽  
Anti Cancer ◽  
Anticoagulant Function ◽  
Dose Dependent

Abstract Abstract 3350 Cancer is frequently associated with activation of coagulation, and a procoagulant state facilitates tumor metastasis. Recent studies have suggested that the activated protein C (aPC) pathway plays a role in modulating tumor metastasis, and this protection likely requires both the anticoagulant and cytoprotective effects of aPC. Notably, our early work revealed that the inactive precursor, zymogen PC (zyPC), can even more effectively protect against metastasis. The aim of this study was therefore to explore mechanisms through which zyPC could prevent metastatic cancer progression in a murine cancer model. A liver gene transfer model using viral vectors was utilized to achieve a wide range of sustained expression of wildtype (WT) or mutant murine zyPCs. C57BL/6 experimental mice expressing stable levels of zyPCs and age and gender matched control mice receiving PBS were injected intravenously with 2.5×105 murine melanoma B16F10 cells, which metastasize to the lungs. After 3 weeks the number of pulmonary tumors was determined. Expression of WT zyPC in C57BL/6s decreased the rates of metastasis in a dose-dependent manner compared to PBS controls (p<0.01; n=8–18/group). These effects were noted even in mice injected with low vector dose (200% zyPC expression). Conversely, when PC-deficient mice (3% of normal, n=7) were administered B16F10s without zyPC-expression, they did not survive the full 3 weeks, while their littermate controls (PC > 50% of normal, n=6) did despite high rates of metastasis. These data clearly demonstrate the protective role of zyPC in tumor progression. We then tested modified zyPCs to identify the critical functions responsible for our observations in this tumor model. Two mutants with minimal anticoagulant function, R15Q and S195A, were generated. zyPC-R15Q is unable to dock to the thrombin-thrombomodulin complex active site and so cannot be converted to aPC. Compared to PBS controls (n=7), mice expressing zyPC-R15Q still showed a significant decrease in the number of tumor foci (p<0.001; 75–99% reduction; n=13) similar to the WT zyPC (p=0.28; n=8). Mice expressing zyPC-S195A (n=12), which has a mutation in the serine protease active site, also showed a significant decrease in the number of tumor foci compared to PBS controls (n=8; p<0.05; 90–99% reduction). As with the R15Q, mutating the S195 did not affect the ability of zyPC to protect against metastasis (p=0.22). Next, we tested the importance of the main PC/aPC cellular receptors in our model. Binding to endothelial protein C receptor (EPCR) enhances activation of PC. We inhibited this binding by injecting anti-EPCR blocking antibody 1560 (J Thromb Haemost. 2005 3:1351) intraperitoneally one hour prior to the B16F10 cells. zyPC-expressing mice that received anti-EPCR antibody (n=22) still had a significant reduction in tumor rates compared to PBS controls (n=10; p<0.01; 45–75% reduction). Moreover, mice expressing zyPC had similar levels of protection whether they received the anti-EPCR antibody or an isotype control (n=22–24; p=0.31). EPCR binding not only increases activation of PC, it also mediates the cytoprotective effect by clustering with and facilitating the activation of the signaling protease-activated receptor 1 (PAR1). PAR1 −/− mice expressing zyPC (n=21) challenged with B16F10 cells still had reduced rates of metastasis compared to PAR1 −/− PBS controls (n=15; p<0.01; 67% reduction). The zyPC protection in PAR1 null mice was comparable to that in PAR1 +/− littermate controls (n=10; p=0.619). Collectively, these findings suggest a distinct mechanism by which zyPC modulates tumor progression independent of EPCR and PAR1, both of which are required for aPC-mediated protection. Despite elevated circulating levels of PC, zyPC-expressing mice did not suffer from increased blood loss following tail clipping or show prolonged activated partial thromboplastin times (aPTTs) compared to hemostatically normal mice. In conclusion, zyPC protects against metastatic cancer progression in a dose-dependent manner. Our data show for the first time that this zyPC effect is independent of its anticoagulant function. Furthermore, protection is not mediated through EPCR or PAR1, suggesting an alternative pathway by which zyPC limits tumor progression. These findings suggest that WT zyPC and variants with little to no anticoagulant function are safe and efficacious in preventing metastatic cancer progression. Disclosures: Van Sluis: PCT patent pending: Protein C: A Zymogen for Anti-Cancer Treatment Patents & Royalties. High:PCT patent pending: Protein C: A Zymogen for Anti-Cancer Treatment Patents & Royalties. Spek:PCT patent pending: Protein C: A Zymogen for Anti-Cancer Treatment Patents & Royalties. Arruda:PCT patent pending: Protein C: A Zymogen for Anti-Cancer Treatment Patents & Royalties.

Assessment of Risk of Thromboprophylaxis Failure in Hospitalized Patients with Cancer (Artic Study)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 588-588
Author(s):  
Martha L Louzada ◽  
Michael J. Kovacs ◽  
FAtimah Al-Ani ◽  
Alejandro Lazo-Langner ◽  
Lenicio Siqueira
Keyword(s):  
Risk Factors ◽  
Respiratory Distress ◽  
Hospital Stay ◽  
Univariate Analysis ◽  
Failure To Thrive ◽  
Hospitalized Patients ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Reason For Admission ◽  
Active Cancer

Abstract Background: Venous thromboembolism (VTE) remains the major cause of morbidity and mortality in hospitalized patients. Three randomized placebo controlled trials have demonstrated the superiority low molecular weight heparin (LMWH) and 1 heparinoid in the prevention of VTE in hospitalized medical patients with a 50% absolute risk reduction in VTE compared to placebo, but an overall failure rate of 5%. Current guidelines suggest that hospitalized cancer patients receive venous thromboprophylaxis with LMWH, if their hospital stay is longer than 3 days. In this study we sought to evaluate the incidence of VTE in hospitalized patients with cancer receiving VTE prophylaxis with subcutaneous 5000 units of dalteparin daily during the admission period. Methods: This is a single centre retrospective cohort study (London, Canada). We collected data from adult patients with active cancer admitted for acute medical reasons who received VTE prophylaxis with LMWH during their hospital stay. We considered failure of prophylaxis if objective diagnosis of pulmonary embolism or deep venous thrombosis occurred: a) during hospitalization; b) within 1 month or 3 months of most recent discharge from hospital. We included patients 18 years old or older; with any type of active cancer (except basal cell and squamous cell carcinoma of the skin) admitted for at least 3 days for treatment of an acute medical reason directly associated to their cancer or not. We did not include patients admitted at the intensive care unit. We need 713 patients to demonstrate a 5 to 7.5% failure rate in VTE prophylaxis (MCID 2.5%) in hospitalized patients with cancer with a 0.025 one-sided alpha and 80% power. Results: Between January 2011 and December 2013 our hospital registered 4262 admissions of patients with active malignancy for treatment of an acute medical illness. 875 patients (total 1132 admissions) fulfilled our eligibility criteria. 434 were males (49.5%), mean age 64.3 (SD= 13.5). There were 180 (20%) hematological and 695 (80%) solid malignancies. The most frequent tumor sites were genitourinary (n=170), lung (n=158), colorectal (n=128) and others (n= 239). 559 (70%) patients with solid tumors had stage III or IV. Reason for admission was failure to thrive (n=232); fever/ infection (n= 202); need for cancer treatment (n= 154); pain control (n=126); respiratory distress (n=108) or CNS symptoms (n=53). Mean hospitalization days were 14.7 (±12). 491 (56%) patients had a single admission. VTE occurred in 70 of 875 patients (8.0%). The incidence of VTE was most frequent during the hospitalization period [34 of 70 patients (48.0%)] compared to 1 month [14 (20.0%)] or 3 months [22 (31.5%)] following the most recent hospitalization. Univariate analysis suggested that being male (OR= 1.69; 95%CI: 1.03 – 2.78; p=0.039); age 65 or older (OR=1.39; 95%CI: 0.4 -1.8; p=0.052); admission due to respiratory distress (OR=2.61; 95%CI: 0.9 – 6.8; p=0.052) or failure to thrive (OR=2.52; 95%CI: 1.1 – 5.9; p=0.036) were significantly associated with VTE risk. Having pancreas or colorectal cancer approached significance (Table). Total bleeding rate was 18 of 875 (2%) with 5 major bleeding events. 175 (20%) patients died during the study period: 125 (75%) due to malignancy progression. Conclusion: Hospitalized patients with active cancer are at high risk for VTE prophylaxis failure (8%). It appears that reason of admission, age and male sex are significant risk factors of VTE prophylaxis failure. Having colorectal or pancreatic cancer may also pose a risk for VTE. New VTE prophylactic strategies for this population should be investigated in future prospective studies. Table. Univariate analysis to assess potential risk factors for LMWH prophylaxis failure in hospitalized patients with cancer Risk Factors Odds Ratio (95% CI) p-value Male 0.95 (0.6 -1.5) 0.808 Age ≥65 1.39 (0.4 -1.8) 0.052 Stage I - II Stage III - IV 1.03 (0.4 -2.5)1.27 (0.7 -2.4) 0.9090.478 Primary tumor site* Lung Colorectal Breast Pancreas Others 1.79 (0.8 - 7.4)2.67(0.9 - 4.7)1.63 (0.9 -10.7)3.11 (0.6 - 3.8)1.33 (0.9 - 5.6) 0.1690.0600.3630.0730.452 Reason for admission^ Fever CNS symptoms Respiratory distress Pain Failure to thrive 1.32 (0.5 - 3.4)1.703 (0.5 - 6.0)2.61 (0.9 - 6.8)1.79 (0.7 - 4.8)2.52 (1.1 - 5.9) 0.5720.4110.0520.2480.036 Number of admissions ** <4 ≥ 4 1.21 (0.7 - 2.0)1.46 (0.4 -5.0) 0.4620.553 Reference: *hematological; ^anticancer treatment ** single admission Disclosures No relevant conflicts of interest to declare.

Impact of quality of life on employment and marital status in long-term cancer survivors treated in a referral center in Mexico.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 122-122
Author(s):  
Yuly Andrea Remolina Bonilla ◽  
Alejandra Armengol Alonso ◽  
Raul Rogelio Trejo rosales
Keyword(s):  
Quality Of Life ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Marital Status ◽  
Financial Burden ◽  
Metastatic Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
History Of

122 Background: Worldwide there is an increasing number of cancer survivors (CS); in the United States in 2016 there were more than 15 million CS and are predicted to increase to 20 million in 2026. In Mexico (GLOBOCAN 2012), new cancer cases were 148.000 and at least 69.000 will survive. Therefore, it is necessary to focus on cancer survivor’s quality of life (QOL) and its effects in social aspects. Methods: A cross-sectional study was performed including 205 CS with history of non-metastatic cancer (aged ≤65 years, ≥ 2 years from diagnosis and off chemo- or radiotherapy). The QOL-CS questionnaire developed by City of Hope Medical Center was used to measure QOL. Participants reported employment and marital status changes during or after cancer treatment. The aim of this study was to evaluate QOL in CS and its association with employment and marital status. A multivariate logistic regression analysis was conducted to estimate odds ratios (OR). Results: Of the 205 CS 70.2% were women and 29.8% men. Median age at the time of the study was 56 years. Median survival time from diagnosis was 83.6 months. 37.1% had history of invasive breast, 18% colorectal and 8.8% testicular cancers. Disease-related marital status changes presented in 15.6%, 26.8% lost or changed work and 36.6% decreased their work hours. Distress about initial diagnosis, cancer treatment, family and financial burden had the worst score in the QOL-CS. We found no differences in QOL between gender, income, age at diagnosis or type of tumor, but having received chemotherapy was associated with worst QOL (OR 7.33 CI 95% 1.99-26.96 p = 0.003) as well as self-reported neuropathy (OR 2.34 CI 95% 1.06-5.19 p = 0.032). Those with low QOL-CS scores (≤6) were more likely to have a disease-related change in employment (OR 2.34 CI 95% 1.19-4.61 p = 0.014). Disease-related marital status changes were higher in who experienced work status variations (OR 3.87 CI 95% 1.21-12.4 p = 0.023). Conclusions: this is one of the first studies in Mexican CS that associate QOL with relevant social roles. In this cohort having received chemotherapy has the greatest impact in QOL. CS with low QOL were more likely to have changes in employment and therefore, in the marital status.

scholarly journals Association of common comorbidities with osteonecrosis: a nationwide population-based case–control study in Denmark

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020680 ◽  
Author(s):  
Alina Dima ◽  
Alma Becic Pedersen ◽  
Lars Pedersen ◽  
Cristian Baicus ◽  
Reimar Wernich Thomsen
Keyword(s):  
General Population ◽  
Population Control ◽  
Metastatic Cancer ◽  
Large Population ◽  
Connective Tissue Diseases ◽  
Population Based ◽  
Solid Cancer ◽  
Chronic Pulmonary Diseases ◽  
History Of ◽  
Severe Liver Disease

ObjectiveTo examine recent time trends in the incidence of osteonecrosis (ON) in Denmark and to investigate different common comorbidities association with ON in a population-based setting.MethodsUsing Danish medical databases, we included all patients with a first-time hospital diagnosis of ON during 1995–2012. Each ON case was matched with 10 randomly selected population control subjects from general population. For all participants, we obtained a complete hospital history of comorbidities included in the CharlsonComorbidity Index 5 years preceding the inclusion date.Results4107 ON cases and 41 063 controls were included. The incidence of ON increased from 3.9 in 1995 to 5.5 in 2012 per 100 000 inhabitants. Solid cancer was the most common comorbidity, associated with an adjusted OR (aOR) for ON of 2.0 (95% CI 1.7 to 2.2). For advanced metastatic cancer, leukaemia and lymphoma, aORs of ON were 3.4 (95% CI 2.5 to 4.5), 4.3 (95% CI 2.7 to 7.0) and 5.8 (95% CI 4.3 to 7.8), respectively. Among other chronic conditions, aORs were 3.5 (95% CI 3.0 to 4.1) for connective tissue diseases and 2.3 (95% CI 2.0 to 2.7) for chronic pulmonary diseases. aORs were also increased at 2.8 (95% CI 1.9 to 4.1) and 4.5 (95% CI 2.5 to 8.2) for mild and moderate-to-severe liver disease, respectively, and 4.2 (95% CI 3.4 to 5.2) for renal disease.ConclusionThis large population-based study provides evidence for an increasing ON incidence in the general population and documents an association between several common comorbid conditions and risk of ON.

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