Effects of Statins on the Incidence and Mortality of Sepsis in Patients with New Cancer Diagnosis

Statins have been associated with improved survival in cancer patients and with decreased incidence and mortality of sepsis in different populations. Our objective was to assess whether newly diagnosed cancer patients on statins had decreased incidence and mortality of sepsis. We analyzed a US database and included 119,379 patients with a new cancer diagnosis (age 55 (50–60) years, 61% female), 19,468 of them (16%) receiving statins. Statins users were older and presented more comorbidities. After adjustment for baseline characteristics, statin use was associated with decreased death hazard (HR 0.897, 95% CI 0.851–0.945, p < 0.0001). The cumulative incidence of sepsis reached 10% at 5 years but statin use was not significantly associated with sepsis hazard (subdistribution hazard ratio 0.990, 95% CI 0.932–1.050, p = 0.73), including in sensitivity analyzes in patients with hematological malignancy or sepsis within 1 year. In patients subsequently hospitalized with sepsis, hospital mortality was 23% and statin use was not associated with mortality (odds ratio 0.952, 95% CI 0.829–1.091, p = 0.48), including in sensitivity analyzes in patients with septic shock and use of statins at the time of sepsis. In summary, treatment with statin at the time of new cancer diagnosis is not associated with a decreased incidence and mortality of sepsis.

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Correction: The Association of Statin Use after Cancer Diagnosis with Survival in Pancreatic Cancer Patients: A SEER-Medicare Analysis

PLoS ONE ◽

10.1371/journal.pone.0128730 ◽

2015 ◽

Vol 10 (5) ◽

pp. e0128730 ◽

Cited By ~ 3

Author(s):

Christie Y. Jeon ◽

Stephen J. Pandol ◽

Bechien Wu ◽

Galen Cook-Wiens ◽

Roberta A. Gottlieb ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Cancer Diagnosis ◽

After Cancer ◽

Statin Use

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Psychological Impact of Cancer Diagnosis in Newly Diagnosed Breast Cancer Patients

Indian Journal of Public Health Research & Development ◽

10.5958/0976-5506.2017.00167.x ◽

2017 ◽

Vol 8 (3) ◽

pp. 91

Author(s):

C H Shejila ◽

Mamatha Shivananda Pai ◽

Donald J Fernandes ◽

Stanley Mathew ◽

Jyothi Chakrabarty ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Psychological Impact ◽

Newly Diagnosed ◽

Breast Cancer Patients

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Thrombin Generation and D-Dimer Significantly Predict for Early Disease Progression and Mortality in Patients with Gastrointestinal Cancer

Blood ◽

10.1182/blood-2020-136631 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 32-32

Author(s):

Marina Pesenti ◽

Marina Marchetti ◽

Cinzia Giaccherini ◽

Cristina Verzeroli ◽

Laura Russo ◽

...

Keyword(s):

Disease Progression ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Cox Regression ◽

Newly Diagnosed ◽

Early Disease ◽

Gi Cancer ◽

Independent Risk Factors ◽

Ecog Ps ◽

D Dimer

Background: Abnormalities of laboratory coagulation tests are common in cancer patients, underlying a subclinical hypercoagulable state. Due to the reciprocal interaction between coagulation and cancer, the biomarkers of hemostatic system activation are under evaluation as a tool for predicting cancer outcomes, disease progression, and mortality. Aim: In this analysis of a prospective cohort of patients with newly diagnosed metastatic gastro-intestinal (GI) cancer, we wanted to evaluate whether the pre-chemotherapy abnormalities of hemostatic biomarkers may predict for early-disease progression (E-DP), i.e. within 6 months from cancer diagnosis, and for 1-year overall survival (1-year OS). Methods: The study cohort included 304 newly diagnosed metastatic GI cancer patients, candidate to chemotherapy associated or not with immunotherapy, enrolled from March 2012 to March 2019 in the HYPERCAN study (ClinicalTrials.gov, ID# NCT02622815), an ongoing Italian prospective, multicenter, observational study; 191 healthy subjects acted as a control group. At diagnosis, before starting any curative chemotherapy, plasma samples were collected and tested for the following hypercoagulation biomarkers: D-dimer and fibrinogen by an automated coagulometer analyzer (ACL TOP500, Werfen Group), and prothrombin fragment 1+2 (F1+2) by ELISA (Siemens). In addition, thrombin generation (TG) potential was evaluated by Calibrated Automated Thrombogram (CAT) assay at 5 pM tissue factor and endogenous thrombin potential (TG ETP) and TG peak were analyzed. Clinical data [i.e. age, sex, BMI, ECOG Performance Status (ECOG-PS), relevant comorbidies] and the hemochromocytometric parameters were recorded at enrollment, whereas E-DP was clinically monitored every 3 chemotherapy cycles and during follow-up. Results: A cohort of 304 (205M/99F) metastatic GI cancer patients (206 colorectal and 98 gastric cancers) with a median age of 66 years (min-max: 29-85) was available for analysis. At enrollment, patients presented with a hypercoagulable state, as shown by significantly higher (p<0.001) plasma levels of D-dimer, fibrinogen and F1+2, and significantly higher (p<0.01) TG peak and TG ETP values than controls. After 6 months from the start of chemotherapy, E-DP had occurred in 80 patients, providing a cumulative incidence of 29.6% (CI 95% 24.1-35.1). E-DP subjects had significantly (p<0.05) higher baseline D-dimer levels and TG ETP value than non-E-DP patients. Correlation analyses showed that pre-chemotherapy fibrinogen (β = -0.127; p=0.048), D-dimer (β = -0.198; p=0.002) and TG ETP (β = -0.133; p=0.034) levels were significantly and inversely associated with time to E-DP. By Multivariate Cox regression analysis, gastric cancer diagnosis (HR=1.546), pre-chemotherapy D-dimer (HR=1.001) and TG ETP values (HR=1.001) were identified as independent risk factors for E-DP. After 1 year from the start of chemotherapy, 228 patients were dead and the OS was 66.6% (CI 95% 61.3-71.9). Patients who died within 1 year showed higher baseline D-dimer, F1+2, fibrinogen, TG peak and TG ETP values compared to the remaining subjects. Multivariate Cox regression identified independent risk factors for 1-year OS the followings: gastric cancer diagnosis (HR=2.237), D-Dimer (HR=1.001) and TG ETP (HR=1.001) levels, white blood cell count (HR=1.094), ECOG-PS>1 (HR=3.858), and chemotherapy plus immunotherapy treatment (HR=2.274). Conclusion: Our results show that, in newly diagnosed metastatic gastrointestinal cancer patients, before the start of antitumor treatment, a procoagulant state exists. Among the different hemostatic parameters evaluated, D-dimer and TG ETP appear as candidate biomarkers to predict for 6-month DP and 1-year OS. In particular, in this setting, the role of TG as a prognostic biomarker emerges for the first time in a large prospective cohort of GI cancer patients. Project funded by "5xMILLE" n. 12237 grant from the "Italian Association for Cancer Research (AIRC)" Disclosures Santoro: Bristol-Myers Squibb, SERVIER, Gilead Sciences, Pfizer, Eisai, Bayer, MSD, Sanofi, ArQule: Consultancy; Arqule, Sanofi: Consultancy; Takeda, Roche, Abbvie, Amgen, Celgene, AstraZeneca, ArQule, Lilly, Sandoz, Novartis, Bristol-Myers Squibb, Servier, Gilead Sciences, Pfizer, Eisai, Bayer, MSD: Speakers Bureau; Takeda, Roche, Abbvie, Amgen, Celgene, AstraZeneca, ArQule, Lilly, Sandoz, Novartis, Bristol-Myers Squibb, Servier, Gilead Sciences, Pfizer, Eisai, Bayer, MSD: Speakers Bureau; Bristol Myers Squibb, Servier, Gilead, Pfizer, Eisai, Bayer, MSD: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb, SERVIER, Gilead Sciences, Pfizer, Eisai, Bayer, MSD, Sanofi, ArQule: Consultancy, Speakers Bureau; Bristol-Myers Squibb, SERVIER, Gilead Sciences, Pfizer, Eisai, Bayer, MSD, Sanofi, ArQule: Consultancy.

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Case study of an autoantibody panel for early detection of lung cancer and ground-glass nodules

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-020-03309-4 ◽

2020 ◽

Vol 146 (12) ◽

pp. 3349-3357

Author(s):

Yunli Huo ◽

Zijian Guo ◽

Xuehui Gao ◽

Zhongjuan Liu ◽

Ruili Zhang ◽

...

Keyword(s):

Lung Cancer ◽

Lung Disease ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Predictive Value ◽

Positive Test ◽

Test Results ◽

Newly Diagnosed ◽

Lung Cancer Patients ◽

Lung Cancer Diagnosis

Abstract Purpose Increasing lung cancer incidence in China with a high death rate due to late diagnosis highlights the need for biomarkers, such as panels of autoantibodies (AAbs), for prediction and early lung cancer diagnosis. We conducted a study to further evaluate the clinical performance of an AAb diagnostic kit. Methods Using enzyme-linked immunosorbent assay, levels of seven AAbs in serum samples from 121 patients with newly diagnosed lung cancer, 84 controls (34 healthy individuals and 50 patients with benign lung disease), and 100 indeterminate solid nodules, were measured. Participants were followed up until 6 months after a positive test result to confirm lung cancer diagnosis. Results The seven AAb concentration was significantly higher in lung cancer patients than in controls (P < 0.05). The seven AAb sensitivity and specificity for newly diagnosed lung cancer were 45.5% and 85.3%, respectively, while the seven AAb combined area under the curve (in lung cancer patients versus controls) was 0.660. Of the 28 patients with solid nodules with positive test results, 8 and 3 were diagnosed with lung cancer and benign lung disease, respectively, during follow-up. The positive predictive value of the experiment was 72.7%. Conclusion Positive AAb test results were associated with a high risk of lung cancer. The seven-AAb panel also had a high predictive value for detecting lung cancer in patients with solid nodules. Our seven lung cancer autoantibody types can provide an important early warning sign in the clinical setting.

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The Association of Statin Use after Cancer Diagnosis with Survival in Pancreatic Cancer Patients: A SEER-Medicare Analysis

PLoS ONE ◽

10.1371/journal.pone.0121783 ◽

2015 ◽

Vol 10 (4) ◽

pp. e0121783 ◽

Cited By ~ 33

Author(s):

Christie Y. Jeon ◽

Stephen J. Pandol ◽

Bechien Wu ◽

Galen Cook-Wiens ◽

Roberta A. Gottlieb ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Cancer Diagnosis ◽

After Cancer ◽

Statin Use

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Effects of the Timing of Venous Thromboembolic Events on Survival of Patients with Uterine Cancer

Blood ◽

10.1182/blood.v124.21.1534.1534 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1534-1534

Author(s):

Heera Remasankar ◽

Xiao Zhou ◽

Saroj Vadhan-Raj

Keyword(s):

Survival Time ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Uterine Cancer ◽

Hazard Ratio ◽

Newly Diagnosed ◽

Venous Thromboembolic ◽

Uterine Cancers ◽

The Impact

Abstract Background: Cancer patients are at high risk for venous thromboembolic event (VTE), and the occurrence of VTE can affect the prognosis. However, it is unclear if the timing of VTE can influence the prognosis. The purpose of this study was to evaluate the incidence and impact of the timing of VTE (early vs late) on the survival of patients with uterine cancers. Methods: A retrospective cohort study was conducted. The study population included all uterine cancer patients who had newly diagnosed episode of VTE from January 1st 2006 to December 31st2007 at MD Anderson Cancer Center. Medical records of these patients were reviewed for cancer diagnosis, patient demographics, metastasis, date of diagnosis of VTE, type of VTE, the site of VTE, and any recurrences during the follow up period of 2 years since the first VTE. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was defined as the time from the date of cancer diagnosis to the date of death, or to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models. Results: Of the 2151 patients with newly diagnosed VTEs within the 2 years study period, 33 patients were found to have uterine cancers. The median age was 60 years (range 41-84 years). Among all the primary VTEs, 42% were pulmonary embolus (PE); 45% were deep vein thrombosis (DVT), and 12% were concurrent PE/DVT (diagnosed on the same day). The median time of VTE from the date of cancer diagnosis was 8 months (range 0 - 88 months). The majority of these VTE events (55%) were found to occur within 1 year from the date of cancer diagnosis. A total of 8 patients had 10 recurrent episodes of VTE (2 patients had 2 recurrent VTE episodes) during the follow up period. The median survival time was 33 months (range 2.6-121.6 months); 82% of these patients had a metastatic disease. Multivariate proportional hazards model showed that the diagnosis of VTE within 6 months from the cancer diagnosis [Hazard ratio: 3.8, 95% CI (1.1-12.9), p=0.03] and the presence of baseline white blood cell (WBC) count of greater than 11,000/uL [Hazard ratio: 3.5, 95% CI (1.0-12.2), p=0.045] were statistically significant independent predictors for 2 year survival adjusting for age, presence of central venous catheter (CVC), and the baseline platelet count of greater than 350,000/uL. Conclusion: These findings suggest that the timing of VTE is an important indicator of prognosis in patients with uterine cancer; patients who had VTE within 6 months from cancer diagnosis had a shorter 2 year survival. Future larger studies may better define the impact of timing of VTE on survival of patients with Uterine Cancers. Disclosures No relevant conflicts of interest to declare.

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Pre-Chemotherapy Levels of Hemostatic Biomarkers and Prediction of Prognosis in Newly Diagnosed Metastatic Cancer Patients from the Hypercan Study

Blood ◽

10.1182/blood-2018-99-118374 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3795-3795

Author(s):

Anna Falanga ◽

Cinzia Giaccherini ◽

Cristina Verzeroli ◽

Marina Marchetti ◽

Laura Russo ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Plasma Levels ◽

Cox Regression ◽

Metastatic Cancer ◽

Newly Diagnosed ◽

Cox Regression Analysis ◽

Gi Cancer ◽

D Dimer

Abstract Introduction Patients with cancer commonly present with laboratory evidence of hypercoagulability. The HYPERCAN study (ClinicalTrials.gov, ID# NCT02622815) is an ongoing Italian prospective, multicenter, observational study, evaluating the predictive value of thrombotic markers for early cancer diagnosis in healthy subjects and for cancer prognosis and venous thromboembolism in patients with newly diagnosed cancer disease (Thromb Res, 2016). In this analysis of the HYPERCAN study, in a subcohort of consecutive patients with newly diagnosed metastatic non-small cell lung (NSCL) or gastrointestinal (GI) cancers, we aimed to assess whether the pre-chemotherapy levels of thrombotic biomarkers may be predictive of early disease progression (EDP, i.e. within 6 months) and early deaths (i.e. within 1 year). Methods The study cohort included 401 patients [median age: 65 (34-88) years] with metastatic NSCL (n=241) or GI (n=160) cancer. Clinical data were recorded at enrollment and during follow-up visits, disease progression being monitored by imaging. Fibrinogen (Clauss method, IL Werfen, Italy), d-dimer (immuneturbidimetric assay, IL Werfen, Italy), and thrombin generation (TG) potential (CAT assay, Stago, France) were measured in plasma samples collected at patient enrollment, before starting any curative chemotherapy and from a control group of 108 healthy subjects. The study protocol is approved by the local Ethics Committee. Informed written consent is obtained from all study subjects. Data are expressed as median (5th-95th percentile). Results Significantly higher plasma levels of fibrinogen, D-dimer and TG potential were observed in the cohort of cancer patients compared to healthy controls (p<0.01). Among cancer types, fibrinogen levels were significantly greater in NSCL as compared to GI cancer patients [479 (258-934) vs 402 (220-668) mg/dl), p<0.001]. After two year follow up, the cumulative incidence of EDP was 31% (CI 95% 27-36). Of interest, patients with EDP (n=125) vs those without EDP were characterized by significantly (p<0.05) greater pre-chemotherapy levels of leucocytes [9.1 (5.6-21.4) vs 8.4 (4.6-18.2) x109/L], platelets [305 (131-586) vs 283 (148-513) x109/L], fibrinogen [475 (290-913) vs 421 (226-814) mg/dl], and TG endogenous thrombin potential (ETP) [1,919 (1,137-3,086) vs 1,752 (1,264-2,559) nM*min]. In GI cancer, but not in lung cancer patients, multivariate Cox regression analysis according to site of primary tumor identified d-dimer and TG ETP plasma levels, together with GI cancer diagnosis, as independent risk factors for EDP. Concerning mortality, after two year follow-up, the cumulative incidence of overall survival at one year was 63% (CI 95% 58-67), early deaths = 37%. The group of patients who deceased during the first year (n=145) showed significantly (p<0.01) higher leucocyte count [9.7 (5.4-21.6) vs 8 (4.6-16.1) x109/L], plasma fibrinogen [486 (250-846) vs 402 (223-816) mg/dl] and d-dimer [515 (97-3,174) vs 286 (55-1,456) ng/ml] levels. In GI cancer, multivariate Cox regression analysis identified d-dimer and TG ETP plasma levels, leucocytes and platelet counts, and GI cancer diagnosis, as independent risk factors for mortality within 1 year. Differently, none of the hemostatic biomarkers were predictive for mortality in NSCL cancer patients. Conclusions The current analysis of prospectively collected data shows the utility of detecting circulating thrombotic biomarkers in specific cancer types. In particular, in GI metastatic cancer, the levels of D-dimer and TG before starting chemotherapy, together with having a GI cancer, could predict EDP (within 6 months) and early deaths (within 12 months). This was not the case for NSCL cancer. Currently, new tests involving other coagulation biomarkers are ongoing and will be evaluated. Project funded by AIRC "5xMILLE" n. 12237 grant from the "Italian Association for Cancer Research (AIRC)". * On behalf of the HYPERCAN investigators. Disclosures No relevant conflicts of interest to declare.

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Patients preference in receiving phone call from oncologist after cancer diagnosis and before in person consultation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18044 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18044-e18044

Author(s):

Amit Arora ◽

Tatjana Kolevska ◽

Jose Jiminez

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Quality Care ◽

Phone Call ◽

Sensitive Period ◽

Newly Diagnosed ◽

Kaiser Permanente ◽

Diagnosis Of Cancer ◽

After Cancer ◽

The Impact

e18044 Background: Diagnosis of cancer creates an emotionally challenging time for patients. Waiting period between receiving diagnosis, and formal consultation with an Oncologist is associated with fear, shock, and uncertainty. Understanding patients’ preferences during this sensitive period is essential in providing high quality care. We hypothesized that receiving a call from an Oncologist, while waiting for a formal consultation, would help patients cope with cancer diagnosis. Methods: To assess our hypothesis, we surveyed 171 patients across five Kaiser Permanente medical centers. All patients received a call from an Oncology navigator to onboard them, and assure completion of necessary tests before in-person consultation with Oncologist. Of the 171 patients surveyed, 61 patients received an additional call from their assigned Oncologist before a formal in-person consultation. To understand the impact of the call made by the Oncologist, a survey was administered to patients within a few weeks of consultation. The remaining 110 patients who only received a call from an Oncology navigator were also surveyed to determine if a call from an Oncologist before their consultation could have helped them cope better with their cancer diagnosis. Results: Approximately 45 % of surveyed patients (n = 171) preferred a call from an Oncologist before the formal consultation. Conclusions: Brief telephone contact by Oncologist before in-person consultation supports newly diagnosed cancer patients with high-levels of uncertainty and shock. A substantial portion of newly diagnosed cancer patients prefers to speak with an Oncologists in the days after receiving a cancer diagnosis, and those who do receive an Oncologist call, find it beneficial in coping with their diagnosis.[Table: see text]

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Venous thromboembolism in cancer patients: a population-based cohort study

Blood ◽

10.1182/blood.2020007338 ◽

2020 ◽

Cited By ~ 1

Author(s):

Frits I. Mulder ◽

Erzsébet Horvàth-Puhó ◽

Nick van Es ◽

Hanneke van Laarhoven ◽

Lars Pedersen ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

General Population ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Index Date ◽

Cox Regression ◽

Protein Kinase Inhibitors ◽

Subdistribution Hazard ◽

Hazard Ratios

The incidence of venous thromboembolism in cancer patients may have changed in the past decade, possibly due to novel cancer therapies, improved survival, and high-resolution imaging. Danish medical registries were used to identify 499,092 patients with a first-time cancer diagnosis between 1997 and 2017, who were matched to 1,497,276 comparison individuals without cancer from the general population. We computed cumulative incidences of venous thromboembolism 6 and 12 months after the diagnosis/index date. Hazard ratios (HRs) were calculated using Cox regression. Risk factors were examined by computing subdistribution hazard ratios (SHRs) in a competing risk analysis. Cumulative incidence of venous thromboembolism 12 months after the cancer diagnosis/index date was 2.3% (95% confidence interval (CI), 2.2%-2.3%) in the cancer cohort and 0.35% (95% CI, 0.34%-0.36%) in the comparison cohort (HR, 8.5; 95% CI, 8.2-8.8). Important risk factors for cancer patients were prior venous thromboembolism (SHR, 7.6; 95% CI, 7.2-8.0), distant metastasis (SHR, 3.2; 95% CI, 2.9-3.4), and use of chemotherapy (SHR, 3.4; 95% CI, 3.1-3.7), protein kinase inhibitors (SHR, 4.1; 95% CI 3.4-4.9), anti-angiogenic therapy (SHR, 4.4; 95% CI, 3.8-5.2), and immunotherapy (SHR, 3.6; 2.8-4.6). Twelve-month incidence in the cancer cohort increased from 1.0% (95% CI, 0.9%-1.2%) in 1997 to 3.4% (95% CI, 2.9%-4.0%) in 2017, which was paralleled by improved 12-month survival and increased use of computed tomography (CT) scans, chemotherapy, and targeted therapies. In conclusion, the risk of venous thromboembolism in cancer patients is increasing steadily and is 9-fold higher than in the general population.

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