103 Screening for Alcohol and Drugs: Are We Under-testing Older Patients?

Abstract Introduction Only a fraction of trauma patients are being tested for drugs of abuse, despite the evidence that abuse of these substances contributes to traumatic injuries. In the specific trauma patient population of burn victims, drug and alcohol intoxication at the time of the burn may alter prognosis for both morbidity and mortality. Younger populations tend to be thought of at higher risk for drug and alcohol intoxication, and this may bias testing in other age groups. This study examined drug and alcohol testing in burn patients presenting to an ABA-verified burn center to determine if testing biases existed based on age, sex, or burn severity, and what populations were high risk for abuse in order to optimize testing in the high risk populations. Methods The burn center’s inpatient database was queried for all admitted patients from January 2013 to December 2017. Patients whose charts lacked description of the burns or where no burn information could be found were excluded from the study. Age, sex, length of stay (LOS), and total body surface area (TBSA) burned were examined. Statistical analysis was then performed with t-tests and Fisher’s test. Results A total of 1032 patients were included in the study. 159 (15.4%) patients were tested for alcohol use and 146 (14.1%) were tested for drugs. Significant predictors of whether patients were tested or not were TBSA and LOS (P< 0.001 for both). There were no significant differences between sexes in testing positive for drugs or alcohol, although there was a trend for more aggressive screening in males than females. The age group most likely to test positive for drugs and/or alcohol was 51–60 year olds. This age group accounted for 25% and 20% of all burn patients tested for alcohol and substances of abuse, respectively; yet this group accounted for 53% and 23% of all positive alcohol and drug tests. Perhaps surprisingly, individuals in age groups up to 90s tested positive for both alcohol and drugs. Conclusions As expected, age extremes were not tested for drugs or alcohol. Only 15% of patients were screened on arrival. Of these and contrary to expectations, 51–60 year olds were the most likely group of burn patients to test positive for drugs and/or alcohol, and patients up to their 90s were testing positive for substances of abuse. However, these populations are not as rigorously screened as younger populations and the use of these substances may be missed, thus affecting patient outcomes. Age bias may be limiting screening and affecting care in older burn patient populations. Applicability of Research to Practice Older patients (51–60 year olds) when tested are more likely to test positive particularly for alcohol upon presentation. More rigorous testing of older patients for alcohol and drugs of abuse may capture more patients who are using these substances and help to guide early care in these populations.

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Abstract 14804: Complications and Mortality Following CRT-D versus ICD Implants in Older Medicare Beneficiaries

Circulation ◽

10.1161/circ.142.suppl_3.14804 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Emily P Zeitler ◽

Andrea Austin ◽

Daniel J Friedman ◽

Christopher G Leggett ◽

Lauren Gilstrap ◽

...

Keyword(s):

Lower Risk ◽

Older Patients ◽

Proportional Hazards Model ◽

Age Groups ◽

Cox Proportional Hazards Model ◽

Cardiac Resynchronization ◽

Age Group ◽

Medicare Beneficiaries ◽

Icd Implantation ◽

Risk Of Death

Introduction: Despite growing numbers of older HF patients, clinical trials of implantable defibrillators (ICDs) and cardiac resynchronization therapy (CRT) rarely include older patients (≥75 yrs). Hypotheses: (1) Among Medicare beneficiaries, older CRT-D patients have a higher risk of procedure-related complications than older ICD patients. (2) Compared with older ICD patients, older CRT-D patients have lower risk of death. Methods: We identified Medicare beneficiaries with HF and reduced LVEF who underwent ICD or CRT-D implant based on CPT codes (1/2008-8/2015) by age group (65-74, 75-84, and 85+). After matching device groups with inverse probability weighting (IPW), we estimated the comparative hazard ratio (HR) of death by age group and device type using a Cox proportional hazards model. Results: Compared with the ICD group, the CRT-D group was older and more likely to be white and female and have atrial fibrillation; CRT-D patients were less likely to have ischemic heart disease. Use of guideline directed medical therapy was similar between groups. In all age groups, complications were more common in the CRT-D group. IPW was successful, and after matching, the HR for death was lower in the CRT-D versus the ICD group; this finding was most pronounced in the 85+ age group in which the HR for death in the CRT-D versus ICD group was 0.76 (95% CI 0.64-0.88). (Table) Conclusions: Procedure-related complications in older HF patients were higher in CRT-D versus ICD patients and generally increased with age. Overall high post-implant mortality in ICD patients (± CRT) highlights the difficulty in assessing competing mortality risk when considering patients for an ICD especially in the oldest patients in whom clinical trial data are absent. However, in matched Medicare beneficiaries, CRT-D was associated with a lower risk of mortality in all age groups compared with ICD alone. These findings support the use of CRT in eligible older patients undergoing ICD implantation.

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Biologic Features and Clinical Outcomes According to Age Groups In Myelodysplastic Syndrome

Blood ◽

10.1182/blood.v116.21.4963.4963 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4963-4963

Author(s):

Seungbum Lee ◽

Je-Hwan Lee ◽

Jung-Hee Lee ◽

Dae-Young Kim ◽

Sung-Doo Kim ◽

...

Keyword(s):

High Risk ◽

Prognostic Factor ◽

Myelodysplastic Syndrome ◽

Clinical Outcomes ◽

Survival Data ◽

Risk Group ◽

Age Groups ◽

Intensive Treatment ◽

Age Group ◽

Younger Age

Abstract Abstract 4963 Myelodysplastic syndrome (MDS) is a disease of the elderly, but can also affect younger people. Age is known to be an important prognostic factor in MDS but age variable is not included in most prognostic scoring systems because it is not thought as a disease-related variable. Many reports have showed that MDS is seen one to two decades earlier in Far Eastern countries than Western countries. We retrospectively investigated the differences in biologic features and clinical outcomes according to different age groups in Korean patients with MDS. Primary end points of our study were overall survival (OS) and progression-free survival (PFS). PFS was defined as time from diagnosis to AML progression or death. About one third of the patients received intensive treatment including chemotherapy, hypomethylating treatment or hematopoietic cell transplantation. Therefore, all survival data were censored at the start of intensive treatment to eliminate the influence of the treatments on clinical outcomes. A total of 403 patients, 248 males and 155 females, were included in this study. Median age was 54 years. We divided the patients into three age groups: ≤50 years (n=181), 51 to 60 (n=81), and over 60 (n=141). Baseline biologic features were significantly different according to three age groups: with increasing age, more male preponderance (P=0.009), more BM blast percentage (P<0.001), more advanced WHO subtype (P<0.001), higher proportion of high risk cytogenetic features (P=0.052; ≤60 vs. >60, P=0.011), poorer ECOG performance status (P=0.004), higher IPSS risk group (P=0.019). Five-year survival probabilities were significantly different according to age groups (≤ 50 vs. 51–60 vs. > 60; OS, 66.8% vs. 28.5% vs. 12.2%, P<0001; PFS, 58.5% vs. 37.9% vs. 12.3%, P<0.001). Survivals were also significantly different according to age groups in both IPSS Low/INT-1 (P<0.001 for OS, P=0.001 for PFS) and IPSS INT-2/High risk group (P=0.026 for OS, P=0.069 for PFS). Cox proportional hazards models also demonstrated that age group was an independent prognostic factor for survivals: ≤ 50 vs. 51–60 and > 60; OS, RR 2.3 (P=0.037) and RR 4.6 (P<0.001); PFS, RR 1.3 (P=0.449) and RR 2.0 (P=0.012). Conclusion: Biologic features and clinical outcomes were significantly different among age groups in MDS. Clinical outcomes were better in younger age group independently of biologic features. Survivals (OS & PFS) were better in younger age group and survival differences by age groups were observed in both lower and higher risk MDS, suggesting that age stratification should be considered in treatment decision and clinical trial design. Disclosures: No relevant conflicts of interest to declare.

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Survival until First Progression and Post First Progression Survival Equally Contribute to the Overall Survival of Myeloma Patients: Differences in Patients ≤65 Years of Age Compared to Patients >65 Years

Blood ◽

10.1182/blood.v120.21.4030.4030 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4030-4030

Author(s):

Efstathios Kastritis ◽

Evangelos Terpos ◽

Maria Roussou ◽

Maria Gavriatopoulou ◽

Dimitra Gika ◽

...

Keyword(s):

High Risk ◽

Renal Impairment ◽

Initial Phase ◽

Older Patients ◽

Performance Status ◽

Age Groups ◽

First Line ◽

Younger Patients ◽

First Line Therapy ◽

Line Therapy

Abstract Abstract 4030 Age is a major prognostic factor for the outcome of patients with multiple myeloma (MM), due to more intensive treatment in younger vs. older patients, comorbidities and toxicity, resulting in early discontinuation of treatment in older patients or even differences in disease characteristics. It is believed that the longer survival of patients ≤65 years is, to a large extent, due to the receipt of more lines of therapy and thus they can have an extended survival even after relapse to first line therapy. In order to decipher these differences in the outcome of MM patients of different ages, we analyzed 438 consecutive, unselected patients who were treated in a single center (Department of Clinical Therapeutics, University of Athens School of Medicine) from April 1994 to April 2012, and compared the characteristics and outcome of patients ≤65 years (166 patients), which are usually treated with more intensive therapies (including HDT), to that of patients 66–75 years (154 patients) and >75 years of age (118 patients). Some of these patients were included in clinical trials; however, even patients who were ineligible because of poor performance status, renal impairment or comorbidities were also included, thus, being more representative of the general myeloma population. Differences in the characteristics of patients of different age groups are depicted in the table. Younger patients presented less often with ISS-3, severe anemia, renal impairment or impaired PS than older patients. However, there was no difference in the detection of high risk cytogenetics. Response was higher and deeper in younger patients. Early deaths, within 2 months from initiation of therapy, occurred more often in older patients. Median PFS was longer in younger patients. Similar proportion of patients who relapsed have received 2nd line therapy (p=0.365). Post relapse survival (PRS) was 31 months for patients ≤65 years, 20 months for patients 66–75 years and 15 months for patients >75 years (p<0.001). The difference of PRS between patients 66–75 years and patients >75 years was also significant (p=0.004). Median OS was 71 months for patients <65 years, 46 months for patients 66–75 years and 31.5 months for patients >75 years (p<0.001). Thus, it seems that the OS of patients in each age group is distributed almost equally between the initial phase of the disease and post first relapse/progression (see Table). PFS <12 months was observed in 10% of patients ≤65 years vs. 22.5% and 29% of patients 66–75 and >75 years (p=0.003). PRS for patients with a PFS<12 months was 8 months for those ≤65 years, 10 months and 6 months for patients 66–75 and >75 years. Median OS was significantly better for patients who achieved CR or VGPR (58 months) vs. patients who achieved a PR (39 months) (p<0.001). For patients <65 years who achieved a CR/VGPR median OS has not been reached (4-year OS was 79%), for patients 66–75 years was 52 months and 40 months for those >75 years (p<0.001). Among patients with a minimum follow up ≥10 years (76 patients), 5 (6.5%) remained without progression for ≥10 years (4 of them had received HDT). In order to adjust for imbalances in baseline characteristics and depth of response (CR/VGPR vs. PR), we performed a multivariate analysis in which ISS stage (p<0.001), novel agent-based first line therapy (p=0.01), CR/VGPR (p=0.005) and age ≤65 (p<0.001), but not 66–75 vs. >75 years (p=0.092) were independently associated with improved survival. In conclusion, our data indicate that the survival of MM patients is distributed almost equally between the initial phase i.e. before relapse to first line therapy, and to subsequent phases of their disease i.e. post relapse survival. This is observed across all age groups, but in patients ≤65 years the duration of first response is significantly longer, perhaps due to more intensive therapies and to less frequent early deaths. In this unselected series of patients, the 10-year free of progression rate was 6.5%. Table ≤65 years 66–75 years >75 years p-value Males 60% 43.5% 51% 0.015 ISS-1 21% 18% 9% 0.02 ISS-2 50% 46% 47% ISS-3 29% 37% 45% Hb <10 g/dl 40% 45% 53% 0.075 eGFR <60 ml/min 29% 45% 55% <0.001 Performance status ≥2 39% 55% 59% 0.001 High risk cytogenetics (n=194) 50% 48% 41% 0.5 Upfront novel agents 73.5% 63% 81% 0.023 CR 34% 27% 17% 0.005 >VGPR 56% 49% 34% 0.001 ≥PR 81% 79% 64% 0.003 Early deaths 2% 6% 12% 0.005 Median PFS (months) 34 19.5 15 0.001 Median PRS (months) 31 20 15 <0.001 Median OS (months) 71 46 31.5 <0.001 Disclosures: No relevant conflicts of interest to declare.

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Prevalence of high-risk human papillomavirus in uterine cervical lesions among older Japanese women.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5084 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5084-5084

Author(s):

Kazuhiro Takehara ◽

Hiroko Nakamura ◽

Osamu Samura ◽

Tomoya Mizunoe ◽

Akihisa Saito ◽

...

Keyword(s):

High Risk ◽

Age Groups ◽

Hpv Infection ◽

Japanese Women ◽

Older Age ◽

Age Group ◽

Hpv 16 ◽

Younger Age ◽

Hpv Genotypes ◽

High Risk Hpv

5084 Background: To estimate the prevalence and genotypes of high-risk human papillomavirus (HPV) among older Japanese women, using liquid-based cytology (LBC). Methods: ThinPrep LBC specimens were collected from 11,039 Japanese women (age range, 14-98 years). After classifying cytodiagnosis, specimens were analyzed for HPV DNA using the multiplex polymerase chain reaction method. Cervical smear specimens from 1,302 women showed positive results. To examine the prevalence of HPV in women defined as negative for intraepithelial lesion or malignancy (NILM), 2,563 samples were randomly selected from the remaining 9,737 women. Comparisons were made between women ≥50 years of age (older age group) and women <50 years of age (younger age group). Written informed consent was obtained from all patients. In this study, the high-risk HPV genotypes encountered were 16, 18, 31, 33, 35, 45, 52, and 58. Results: In the older age group with abnormal smear findings, HPV genotypes were detected in 49.7% (148/298), including high-risk HPV genotypes in 40.9% (122/298). In the younger age group with abnormal smear findings, HPV genotypes were detected in 71.7% (720/1004), including high-risk HPV genotypes in 58.1% (583/1,004). In NILM, HPV-positive rates were 4.5% (39/873) in the older age group and 11.8% (199/1,690) in the younger age group. In high-grade squamous intraepithelial lesion (HSIL) or more severe cytological findings, HPV genotypes of each group (older age group/younger age group) were detected in 61.7%/83.1%, and high-risk HPV genotypes were detected in 56.4%/74.7% of women. In positive cervical smears, HPV 16 was the most frequently detected (28.5%) in the younger age group, while HPV 52 (31.3%) and 58 (27.2%) were detected more frequently than HPV 16 (18.4%) in the older age group. Conclusions: In Japan, although HPV infection as a cause of abnormal cervical cytology is more frequent among younger age groups than in older age groups, high-risk HPV infection was more highly associated with older individuals (older age group/younger age group: abnormal smear findings, 82.4%/81.0%; HSIL or more severe cytological findings, 91.3%/89.9%). In older age groups, HPV 52 and 58 were more frequent than HPV 16.

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The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-specific Mortality Patterns

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa206 ◽

2020 ◽

Author(s):

Kayhan Gurbuz ◽

Mete Demir

Keyword(s):

Mortality Rate ◽

Descriptive Analysis ◽

Age Groups ◽

Total Body Surface Area ◽

Multivariate Regression Analysis ◽

Inhalation Injury ◽

Burn Patients ◽

Age Group ◽

Specific Mortality ◽

Fire Flame

Abstract The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital (ACTRH). Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into ten sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70-79 years had the highest mortality rate of 33.3%; followed by 60-69, 80+, 18-29, 10-17, and <5 sub-age groups, whose mortality rates were, 13.0%, 7.8%, 7.2%, 2.4%, 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, total body surface area burned ≥20 percent (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (p<0.0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (p<0.0001), whose had 5.84 times more likely death; followed by 29-59, 18-29 sub-age groups, with the ORs of 2.12 (95%CI=1.25-3.61), 2.08 (95%CI=1.90-4.05), respectively. Oppose to these findings; the 0-17 sub-age group was not found to have a statistically significant effect in predicting mortality.

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Cervical artery dissection in patients ≥60 years

Neurology ◽

10.1212/wnl.0000000000003788 ◽

2017 ◽

Vol 88 (14) ◽

pp. 1313-1320 ◽

Cited By ~ 16

Author(s):

Christopher Traenka ◽

Daphne Dougoud ◽

Barbara Goeggel Simonetti ◽

Tiina M. Metso ◽

Stéphanie Debette ◽

...

Keyword(s):

Risk Factors ◽

Older Patients ◽

Age Groups ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Age Group ◽

Presenting Symptoms ◽

Cervical Artery ◽

Secondary Analyses ◽

Study Population

Objective:In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years.Methods:We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients–Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated.Results:Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33–0.66]), headache (ORadjusted 0.58 [0.42–0.79]), mechanical trigger events (ORadjusted 0.53 [0.36–0.77]), and migraine (ORadjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1–2.10]) and hypertension (ORadjusted 3.08 [2.25–4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0–2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]).Conclusion:In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.

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The Impact of Age on the Outcome of Primary Treatment for Classical Hodgkin's Lymphoma: 70 Years of Age Is a Clinical Relevant Cutpoint and the Most Important Predictor of Overall Survival

Blood ◽

10.1182/blood-2019-130282 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1559-1559

Author(s):

Lourdes Calvente ◽

Manjula Maganti ◽

Mary Gospodarowicz ◽

David C. Hodgson ◽

Danielle Rodin ◽

...

Keyword(s):

High Risk ◽

Febrile Neutropenia ◽

Treatment Outcomes ◽

Older Patients ◽

Research Funding ◽

Multivariable Analysis ◽

Advanced Stage ◽

Age Group ◽

Grade 3 ◽

The Impact

Introduction: Classical Hodgkin lymphoma (cHL) typically affects younger patients but 15-35% are >60 years. The age used to define an elderly population has varied but age 60 is frequently used. A clinically relevant definition of older age could be based on the use of alternate treatments due to different efficacy and/or toxicity. Treatment outcomes may also be influenced by tumor biology and patient comorbidity that vary with age. We evaluated the effect of age on treatment outcomes in cHL. Methods: All cHL patients treated at our centre between Jan 1999 and Dec 2015 were retrospectively analyzed. Clinical data were obtained from prospectively collected Lymphoma database and additional data was manually retrieved. Treatment for localized disease was combined modality (2-4 cycles of ABVD and potentially 6 cycles for bulk disease > 10 cm; radiation doses 20-35 Gy) with advanced disease typically receiving chemotherapy alone (ABVD 6-8 cycles). Older patients received individualized treatment. We used the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI), (Sorror Blood 2005) as the elements can be abstracted retrospectively. Results: 607 patients were identified; 14% were >60 years and 6% were age >70. Baseline characteristics are outlined in table 1. Patients >70 presented more frequently with high-risk HCT-CI and worse ECOG PS. Patients > 60 presented more frequently with advanced stage (61-70 age group: 40%; >70 years: 46%). 65% of the patients age >70 presented with an IPS of >3. Chemotherapy alone approaches were used more commonly in older patients (age 61-70: 40%; age 70+: 51%) than in those <60 years (25%). Within the whole cohort 12 patients received non-anthracycline based treatment (<60: n=4; 61-70: n=1; and >70: n=7).For patients <60 and >70 this decision was made due to prior comorbidities that precluded the use of standard treatment, and for the patient in the 61-70 was because of acute toxicity with ABVD-based chemotherapy. Treatment was discontinued in 33% of the patients > 70 (77% due to toxicity), 21% in the 61-70 years group (30% toxicity) and 6% in patients <60 (29% toxicity). Patients > 70 had higher rates of grade 3-5 febrile neutropenia (28% versus 15% [age 61-70] and 7% [age <60]). Bleomycin toxicity was more common in older patients (age >70: grade 3-4 events 12% of the patients with discontinuation in 66%; age 61-70: 13% with discontinuation rate of 20%) compared to a 1% rate of grade 3-5 events in age <60. There was a grade 5 episode of febrile neutropenia in >70 group and 1 death related to bleomycin in age <60. With a median follow up of 8.6 years, the 10-year OS and PFS were 80.5% and 71.2%, respectively. By age-group, the 10-year OS was 88% (<60 years), 57% (61-70 years) and 15% (age >70 years); (p<0.001) (Figure 1a-b). In multivariable analysis for OS, age 61-70 (HR 2.44, p=0.002) and age >70 (HR 5.72, p=0.001), non-anthracycline based chemotherapy (HR 3.69, p<0.001), high-risk HCT-CI (HR 3.03, p=0.001) and ECOG 2-4 (HR 1.8, p=0.017), were significant. Age >70, type of chemotherapy, high-risk HCT-CI, and advanced stage were significant for PFS in the multivariable analysis (Table 2a-b). Death due to disease or toxicity at 10 years was 13.6% (age <60: 9.7%, 61-70 years: 23.2%; and for age > 70: 50.7%; [p=<0.001]) (Figure 2a-b). Multivariable analysis for cause-specific survival identified age >70 years (HR 4.04, p=<0.001), extranodal disease (HR 2.57, p=0.001) and ECOG 2-4 (HR 2.10, p=0.010) as significant predictors(Table 3). Conclusions: Age >70 years is a clinically relevant age cutoff as it has additional prognostic significance and greater rates of treatment discontinuation and toxicity compared to age 60. The HCT-CI is a useful predictor of outcome in cHL and should be validated prospectively. In multivariable analysis, age, type of treatment, comorbidity and ECOG performance status are independent predictors of OS. Further studies are ongoing to validate these findings and assess biologic differences in older versus younger cHL patients. Disclosures Tsang: Nordic Nanovector: Research Funding. Kridel:Gilead Sciences: Research Funding. Kukreti:Celgene: Honoraria; Amgen: Honoraria; Takeda: Honoraria. Prica:Celgene: Honoraria; Janssen: Honoraria. Kuruvilla:Janssen: Research Funding; Roche: Honoraria; Novartis: Honoraria; Merck: Honoraria; Gilead: Honoraria; Seattle Genetics: Consultancy; Roche: Consultancy; Merck: Consultancy; Karyopharm: Consultancy; Celgene: Honoraria; BMS: Honoraria; BMS: Consultancy; Abbvie: Consultancy; Gilead: Consultancy; Astra Zeneca: Honoraria; Janssen: Honoraria; Roche: Research Funding; Amgen: Honoraria; Seattle Genetics: Honoraria; Karyopharm: Honoraria.

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High-risk human papillomavirus detection in self-collected vaginal samples compared with healthcare worker collected cervical samples among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa

Virology Journal ◽

10.1186/s12985-021-01662-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Teboho Amelia Tiiti ◽

Tebogo Loraine Mashishi ◽

Varsetile Varster Nkwinika ◽

Ina Benoy ◽

Selokela Gloria Selabe ◽

...

Keyword(s):

South Africa ◽

Human Papillomavirus ◽

High Risk ◽

Healthcare Worker ◽

Age Groups ◽

Tertiary Hospital ◽

P Value ◽

Age Group ◽

Total Group ◽

Mcnemar Test

Abstract Background In 2017, the South African National Department of Health (NDoH) Cervical Cancer Prevention and Control Policy was revised. Human papillomavirus (HPV) testing on self-collected samples may offer improved screening uptake. The objectives of the study were to compare the positivity of high-risk (hr)-HPV deoxyribonucleic acid (DNA) and hrHPV viral messenger ribonucleic acid (mRNA) between healthcare worker-collected cervical and self-collected vaginal samples and investigate the accuracy of the applicator-tampon-based self-collected samples in detecting hrHPV DNA and hrHPV mRNA. Methods A total of 527 women aged 18 years and older and seeking gynecology services at a tertiary hospital in Pretoria, South Africa, were enrolled. Vaginal samples were self-collected using SelfCerv applicator tampon, followed by cervical samples collected by a healthcare worker using a Cervex Brush® Combi. Both samples were tested with the Abbott m2000 analyzer for 14-hrHPV types and 285 paired samples were tested for hrHPV E6/E7 mRNA using the Aptima HR-HPV mRNA assay. The prevalence of hrHPV DNA and hrHPV E6/E7 mRNA was estimated and the positivity between the two collection methods was compared for the total group as well as per age group. Results HrHPV prevalence was 48.0% (95% CI 43.7–52.4) among healthcare worker collected samples and 47.6% (95% CI 43.3–52.0) among self-collected samples. There was no difference in positivity between healthcare worker collection (48.0%) and applicator-tampon-based self-collection, 47.6% (p-value = 0.90). The proportions of hrHPV were equal between the age groups as shown by the McNemar test (p = 0.9036) results for correlated proportions. The prevalence of hrHPV mRNA was 78.6% (95% CI 73.4–83.2) and 58.6% (95% CI 52.6–64.4) for healthcare worker- and self-collection, respectively. The McNemar test for correlated proportions was highly significant (p < 0.0001), indicating that the hrHPV mRNA proportions are not comparable, although this differed between age groups. Conclusions Applicator-tampon-based self-collection has a comparable hrHPV DNA positivity rate as healthcare worker collection but different positivity rates for hrHPV mRNA. Self-sampling showed high concordance with healthcare worker-collected sampling for hrHPV DNA detection, especially regarding HPV 16/18 detection. HrHPV DNA was equally detected between the total group as well as per age group. Implementation of self-sampling using an applicator tampon as a primary screening tool may be considered.

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Time to Treatment Initiation Predicts Overall Survival in Hospitalized Acute Myeloid Leukemia (AML) Patients: A California Population-Based Study

Blood ◽

10.1182/blood.v128.22.3982.3982 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3982-3982

Author(s):

Tatini Datta ◽

Brian A Jonas ◽

Aaron S Rosenberg ◽

Qian Li ◽

Ann M Brunson ◽

...

Keyword(s):

Clinical Trial ◽

Overall Survival ◽

Older Patients ◽

De Novo ◽

Age Groups ◽

Population Based ◽

Age Group ◽

Younger Age ◽

De Novo Aml ◽

The Impact

Abstract Background: The impact of time from diagnosis to chemotherapy initiation (time to treatment, TTT) for AML has been a topic of ongoing debate. A prior study reported that TTT ≥5 days adversely impacted overall survival in younger (<60 years of age), but not older (≥60 years of age), patients. However, subsequent studies found either no effect of TTT on overall survival, regardless of age, or an adverse impact of TTT on overall survival for both younger (>10 days) and older patients (>5 days). Prior data also showed no impact of TTT on early mortality. Given these conflicting findings, consensus on the impact of TTT on survival is lacking and warrants further study. Using prospectively collected population-based data, we analyzed a large cohort of adult AML patients to examine the effect of TTT on overall survival. Methods: Using data from the California Cancer Registry and Patient Discharge Dataset between 1999-2012, patients≥15years diagnosed with de novo AML and who received inpatient treatment between 1-90 days from diagnosis were identified (n=5337). Multivariable logistic regression was used to determine factors associated with TTT>5 days vs 1-5 days with data presented as odds ratios (OR) and 95% confidence intervals (CI). The effect of TTT on overall and 60-day survival was estimated using multivariable Cox proportional hazards regression with TTT (1-5, 6-10,>10 days)considered as a time-dependent variable. Patients were stratified by age group (<60,≥60 years) for all analyses.Multivariable models accounted for age, race/ethnicity, sex, number of comorbidities, marital status, neighborhood socioeconomic status, health insurance type, treatment at National Cancer Institute designated (NCI) vs non-NCI designated facility, use ofleukapheresis, and year of diagnosis. Results: Of the 2659 patients <60 years of age, 61.0% were treated within 5 days and 79.7% within 10 days of diagnosis, compared to 43.8% and 65.0%, respectively, of the 2678 patients≥60 years of age. Patients≥60 years were more likely to have 3+ comorbidities compared to the younger age group (43.3% vs 25.9%, P<0.001). The likelihood of TTT>5 days increased with age in both younger and older patients. Across both age groups, patients requiringleukapheresis(age<60: OR 0.19, CI 0.10-0.34; age≥60: OR 0.23, CI 0.12-0.45), treated at a non-NCI (vs NCI) center (age<60: OR 0.62, CI 0.52-0.73; age≥60: OR 0.64, CI 0.52-0.78) and with 1-2 (vs 0) comorbidities (age<60: OR 0.81, CI 0.67-0.98; age≥60: OR 0.69, CI 0.54-0.88) or 3+ (vs 0) comorbidities (age<60: OR 0.77, CI 0.62-0.97; age≥60: OR 0.52, CI 0.41-0.66) had a lower odds of TTT>5 days. Younger (age<60) African Americans (vs non-Hispanic whites) had a higher odds of TTT >5 days (OR 1.43, CI 1.04-1.97). Delaying chemotherapy >10 days (vs 1-5 days) adversely impacted overall survival in both age groups (age<60: HR 1.26, CI 1.11-1.43; age≥60: HR 1.17, CI 1.06-1.28) (Table). However, TTT of 6-10 days (vs 1-5 days) affected overall survival in young (age<60: HR 1.15, CI 1.02-1.31), but not older patients. A TTT of 6-10 days (vs 1-5 days) adversely impacted 60-day survival in both age groups (age<60: HR 1.70, CI 1.24-2.33; age≥60: HR 1.27, CI 1.05-1.54); 60-day survival results were similar for a TTT >10 days (vs 1-5 days) (Table). Conclusions: In a large cohort of patients with de novo AML, TTT of up to 10 days did not have a negative impact on overall survival in patients over the age of 60. In younger patients (<age 60), TTT >5 days was associated with decreased overall survival. Delaying chemotherapy over 5 days adversely impacted 60-day survival in both age groups. Our observation that patients were more likely to have a shorter TTT at non-NCI designated hospitals may relate to delays associated with transfer to or clinical trial enrollment at NCI centers. Our results suggest that waiting to get results of ancillary testing, such as cytogenetic and molecular mutation analyses, in order to inform treatment decisions for AML patients, may be feasible in some patients with AML. In an era of rapidly evolving prognostic and treatment landscapes for AML, our findings may have implications for personalized therapy, including novel targeted therapies, and clinical trial design for patients withAML. Disclosures No relevant conflicts of interest to declare.

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An Exploratory of Study of a Text Messaging Intervention to Reduce Problematic Alcohol Use among Adults 50 and Older (Preprint)

10.2196/preprints.16236 ◽

2019 ◽

Author(s):

Alexis Kuerbis ◽

Silke Behrendt ◽

Varnica Aurora ◽

Frederick J. Muench

Keyword(s):

High Risk ◽

Alcohol Use ◽

Text Messaging ◽

Age Groups ◽

Secondary Analysis ◽

Preliminary Evidence ◽

Age Group ◽

End Of Treatment ◽

Text Messaging Intervention ◽

Problematic Alcohol Use

BACKGROUND Given both a worldwide aging population and increasing rates of high-risk alcohol use, rates of adults 50 and older with high-risk alcohol use and associated problems are rapidly growing. Several barriers to prevention, intervention, and treatment persist among this group. Mobile interventions, specifically those who use text messaging (TM), can provide an opportunity for early intervention and prevention of problems. OBJECTIVE This study is a secondary analysis of data from a pilot study of a TM intervention among high-risk drinkers (N=151) with one third of the participants 50 to 65 years old. Feasibility, acceptability and preliminary effectiveness of the intervention for older adults (OA) were explored compared to their younger adult (YA, 21-49 years old) counterparts. METHODS Between age group differences at baseline and end of treatment (12 weeks) were explored. An age group by TM type (loss framed/gain framed, tailored, or assessment only) interaction was tested to determine whether there was a moderating effect of age group on TM type. RESULTS Few baseline differences emerged between age groups, except that OA drank almost daily, while YA drank fewer days but more heavily on the days they drank. Only OA ranked boredom as one of the most challenging situations to not drink heavily. The TM intervention was effective at 12 weeks in reducing drinking among both age groups, though slightly more effective for YA than for OA and with tailored messaging outperforming the other two TM types on drinking outcomes. Among OA, loss and gain framed messages were effective on the additional health outcomes. All participants reported satisfaction with the intervention and two-thirds in both age groups elected to continue receiving TM after the study period concluded. CONCLUSIONS There is preliminary evidence that TM is feasible, acceptable, and effective across age groups. Findings also suggest that further adaptation of TM across age group could enhance its effectiveness.

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