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

Associations of multimorbidity and patient‐reported experiences of care with conservative management among elderly patients with localized prostate cancer

Abstract Background Many elderly localized prostate cancer patients could benefit from conservative management (CM). This retrospective cohort study examined the associations of patient‐reported access to care and multimorbidity on CM use patterns among Medicare Fee‐for‐Service (FFS) beneficiaries with localized prostate cancer. Methods We used linked Surveillance, Epidemiology, and End Results cancer Registry, Medicare Claims, and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey files. We identified FFS Medicare Beneficiaries (age ≥ 66; continuous enrollment in Parts A & B) with incident localized prostate cancer from 2003 to 2013 and a completed MCAHPS survey measuring patient‐reported experiences of care within 24 months after diagnosis (n = 496). We used multivariable models to examine MCAHPS measures (getting needed care, timeliness of care, and doctor communication) and multimorbidity on CM use. Results Localized prostate cancer patients with multimorbidity were less likely to use CM (adjusted odds ratio (AOR)=0.42 (0.27‐ 0.66), P < .001); those with higher scores on timeliness of care (AOR = 1.21 (1.09, 1.35), P < .001), higher education attainment (3.21 = AOR (1.50,6.89), P = .003), and impaired mental health status (4.32 = AOR (1.86, 10.1) P < .001) were more likely to use CM. Conclusion(s) Patient‐reported experience with timely care was significantly and positively associated with CM use. Multimorbidity was significantly and inversely associated with CM use. Addressing specific modifiable barriers to timely care along the cancer continuum for elderly localized prostate cancer patients with limited life expectancy could reduce the adverse effects of overtreatment on health outcomes and costs