An Analysis of Treatment Patterns, Receipt of Guideline-Concordant Care, and Survival Outcomes among Elderly Women with Non-Metastatic Breast Cancer Using the SEER-Medicare Linked Dataset

Breast cancer (BC) is the 2nd most commonly diagnosed type of cancer in the United States (US) and the 1st among women, with 57% of incident cases in those age \u3e 60 years. Relative to other cancers, BC has high survival rates, with a 89% 5-year overall survival rate. High survival rates are due to improvements in disease understanding, treatment, and earlier stage at diagnosis from increased routine BC screening. Yet, disparities in treatment and survival outcomes persist. Epidemiologic studies suggest that elderly women experience disparities uniquely associated with increasing age and comorbidity, in addition to those associated with socio-demographic characteristics, access to oncology care resources, and clinical prognostic factors. This sequence of retrospective database studies sought to characterize and examine associations with initial loco-regional treatment for stage I and II BC, receipt of guideline-concordant care (GCC) and individual tests and treatments for stage I-III BC, and overall 5-year survival among using the first two study cohorts and a third, more broadly inclusive cohort of elderly women with stage I-III BC. Cohorts of women age ≥ 66 years diagnosed in 2003--2009 were selected from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) linked dataset. Regarding the 1st study, 55% of women had breast-conserving surgery (BCS) plus radiation therapy (RT), 23% has mastectomy, and 22% had BCS without RT as their initial loco-regional treatment. Compared to women who received BCS plus RT, those who were older, of greater comorbidity, later stage, or non-white race were more likely to have had mastectomy or BCS without RT. Women who were less likely to have had mastectomy or BCS without RT were those treated by an oncology surgeon or both an oncology and general surgeon vs. a general surgeon only, from areas of less education, lower income, or lived in metro areas. Regarding the 2nd study, only 34% received GCC, 61% had RT, and 25% had chemotherapy but, most women had their hormone receptor (HR) statuses and lymph nodes tested. Women who were older, of greater comorbidity, stage II vs. I, lymph node negative, or non-white race were less likely to receive GCC, while those who were HR negative or treated by an oncology surgeon or both an oncology and general surgeon, vs. a general surgeon only were more likely to receive GCC. Regarding the 3rd study, overall 5-year survival ranged from 82%-88% among the three cohorts. The risk of death was greater for women who were older, of greater comorbidity, diagnosed at a later stage, HR negative, treated by mastectomy, BCS without RT, did not received GCC, RT, or chemotherapy, but was lower for women treated by an oncology surgeon or both an oncology and general surgeon vs. a general surgeon only. Despite recommended treatment guidelines, increasing age and comorbidity are strongly associated with less aggressive BC among elderly women. Older women with BC should receive treatment according to guidelines as it would be otherwise given to younger women, health permitting. While the increased risk of death associated with increasing age is inevitable, targeting health behaviors to decrease comorbidity and continued routine BC screening for earlier stage at diagnosis may go a long way to improve survival

A National Study of Health Behaviors and Health-Related Quality of Life Among Survivors of Breast, Prostate, and Colorectal Cancer Compared to Propensity Score Matched Controls, as well as, Comparisons by Cancer Type & Gender

The objectives of this study were to 1) compare the prevalence of specific measures of Health-Related Quality of Life (HRQOL) between breast, prostate, female, and male colorectal cancer survivors to propensity score matched controls, and to compare HRQOL by type of cancer and gender and 2) compare the prevalence of specific health conditions and health behaviors between breast, prostate, female, and male colorectal cancer survivors to propensity score matched controls, and to compare health behaviors by type of cancer and gender. A cross-sectional study was conducted using a sample of breast, prostate, and colorectal cancer survivors 18 years of age and older and \u3e 1 year past diagnosis were selected from the 2009 BRFSS. A greedy algorithm and matching without replacement used propensity scores to match 3 controls to every 1 case on age, gender, race/ethnicity, income, insurance status, and region of the U.S. HRQOL measures compared were life satisfaction, perceived emotional support, activity limitations, perceived general, physical and mental health, and sleep quality. Health conditions compared were arthritis, asthma, heart disease, diabetes, hypertension, high cholesterol, stroke, activity limitations, and perceived general health. Health behaviors compared were flu immunization, physical check-up, cholesterol check, BMI, physical activity, fruit and vegetable consumption, smoking, and alcohol use. Chi-square tests were used to test for covariate balance and compared prevalence of health conditions and behaviors. Binomial and multinomial logistic regression models were used to estimate the probabilities of behaviors for cancer cases compared to controls. The final study sample consisted of 6,393 breast, 3,636 prostate, 1,111 female colorectal, and 824 male colorectal cancer survivors. Compared to matched controls, cancer survivors were up to 3.67 times more likely (95%CI: 2.09, 6.47) at 1 -- 5 years since diagnosis, and up to 1.91 times more likely (95%CI: 1.30, 2.79). Breast, female, and male colorectal cancer survivors were up to 2.62 times more likely (95%CI: 1.72, 3.99) to report activity limitations compared to matched controls. Additionally, colorectal cancer survivors were more likely to report worse physical health than their matched controls. Male colorectal and prostate cancer survivors were more likely to report worse mental health, and prostate cancer survivors were more likely to report a lack of emotional support and not enough sleep compared to their matched controls. Comparisons by cancer type found that male colorectal cancer survivors were more likely to report activity limitations and perceive their general and physical health to be worse than prostate cancer survivors. Gender comparisons found that females were more likely to hold poorer perceptions of their general, physical, and mental health, report not enough sleep, and not receiving enough emotional support, but more likely to be satisfied with life. Breast and prostate cancer survivors reported a greater prevalence of chronic health conditions than matched controls. Breast cancer survivors were more likely to engage in healthier behaviors 1 -- 5 years after diagnosis, but were more likely to be obese at \u3e 5 years after diagnosis than controls. Male colorectal cancer survivors were less likely to engage in clinical preventive care at \u3e 5 years after diagnosis than controls. Female colorectal and breast cancer survivors were less likely be overweight and/or obese, former and/or current smokers, drink any alcohol, and more likely to consume ≥ 5 servings of fruits and vegetables per day, but more likely to engage in none or insufficient levels of physical activity compared to male colorectal and prostate cancer survivors, respectively. All cancer survivor groups reported more limitations and held poorer perceptions of their general health. Differences between matched controls for other HRQOL measure vary by type of cancer, although compared to similar males without cancer, male cancer survivors reported worse outcomes on measures such as mental health, sleep, and emotional support. However, when female survivors were compared to male survivors, females reported worse outcomes for all measures except life satisfaction. Breast and prostate cancer survivors have more chronic health conditions compared to matched controls than do female and male colorectal cancer survivors. Breast cancer survivors are more likely to engage in healthy behaviors than their matched controls. Female cancer survivors engage healthier lifestyle behaviors, with the exception of physical activity, compared to male cancer survivors. (Abstract shortened by UMI.)

Survival and recovery modeling of acute kidney injury in critically ill adults

Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I–III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant (p-value \u3c 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1–22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14–39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention

Burden of Depression among Working-Age Adults with Rheumatoid Arthritis

Objective. Tis study estimated the excess clinical, humanistic, and economic burden associated with depression among workingage adults with Rheumatoid Arthritis (RA). Methods. A retrospective cross-sectional study was conducted among working-age (18 to 64 years) RA patients with depression (� = 647) and without depression (�=2,015) using data from the nationally representative Medical Expenditure Panel Survey for the years 2009, 2011, 2013, and 2015. Results. Overall, 25.8% had depression. In adjusted analyses, adults with RA and depression compared to those without depression were signifcantly more likely to have pain interference with normal work (severe pain: AOR = 2.22; 95% CI = 1.55, 3.18), functional limitations (AOR = 2.17; 95% CI = 1.61, 2.94), and lower mental health HRQoL scores. Adults with RA and depression had signifcantly higher annual healthcare expenditures ($14,752 versus 10,541, � \u3c .001) and out-of-pocket spending burden. Adults with RA and depression were more likely to be unemployed and among employed adults, those with depression had a signifcantly higher number of missed work days annually and higher lost annual wages due to missed work days. Conclusions. Tis study highlights the importance of efectively managing depression in routine clinical practice of RA patients to reduce pain and functional limitations, improve quality of life, and lower direct and indirect healthcare costs

Receipt of Guideline-Concordant Care Among Older Women With Stage I-III Breast Cancer: A Population-Based Study

Background: This study examined receipt of guideline-concordant care (GCC) according to evidence-based treatment guidelines and quality measures and specific types of treatment among older women with breast cancer. Patients and Methods: A total of 142,433 patients aged ≥66 years diagnosed with stage I–III breast cancer between 2007 and 2011 were identified in the SEER-Medicare linked database. Algorithms considering cancer characteristics and the appropriate course of care as per guidelines versus actual care received determined receipt of GCC. Multivariable logistic regression estimated the likelihood of GCC and specific types of treatment for women aged ≥75 versus 66 to 74 years. Results: Overall, 39.7% of patients received GCC. Patients diagnosed at stage II or III, with certain preexisting conditions, and of nonwhite race were less likely to receive GCC. Patients with hormone-negative tumors, higher grade tumors, and greater access to oncology care resources were more likely to receive GCC. Patients aged ≥75 years were approximately 40% less likely to receive GCC or adjuvant endocrine therapy, 78% less likely to have any surgery, 61% less likely to have chemotherapy, and about half as likely to have radiation therapy than those aged 66 to 74 years. Conclusions: Fewer than half of older women with breast cancer received GCC, with the lowest rates observed among the oldest age groups, racial/ethnic minorities, and women with later-stage cancers. However, patients with more aggressive tumor characteristics and greater access to oncology resources were more likely to receive GCC. Considering that older women have the highest incidence of breast cancer and that many are diagnosed at stages requiring more aggressive treatment, efforts to increase rates of earlier stage diagnosis and the development of less toxic treatments could help improve GCC and survival while preserving quality of life