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Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

ABSTRACT: BACKGROUND:To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). METHODS:Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ?18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute-designated cancer center (NCI-CC). Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ?60 days from diagnosis). RESULTS:Of the 7007 patients with AML, 1762 (25%) were treated at an NCI-CC. Patients with AML who were treated at NCI-CCs were more likely to be aged ?65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI-CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38-0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non-NCI-CCs. CONCLUSIONS:The initial treatment of adult patients with AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938-45. © 2018 American Cancer Society.

SUBMITTER: Ho G

PROVIDER: S-EPMC6911353 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

Ho Gwendolyn G Wun Ted T Muffly Lori L Li Qian Q Brunson Ann A Rosenberg Aaron S AS Jonas Brian A BA Keegan Theresa H M THM

Cancer 20180216 9

<h4>Background</h4>To the authors' knowledge, few population-based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML).<h4>Methods</h4>Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999-2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity scor ...[more]

PMID: 29451695

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Project description:PurposeThe use of integrative approaches for symptom management is highly prevalent among patients undergoing cancer treatment and among cancer survivors and is increasingly endorsed by clinical practice guidelines. However, access to and implementation of integrative oncology (IO) approaches are hindered by barriers at multiple levels, including logistic, geographic, financial, organizational, and cultural barriers. The goal of this mixed-method study was to examine oncology provider and patient knowledge, beliefs, and preferences in IO to identify facilitators, barriers, and recommendations for implementation of IO modalities.Materials and methodsData sources included patient surveys and provider semistructured interviews. Patients were in active treatment (n = 100) and survivors (n = 100) of heterogeneous cancer types. Patient and survivor surveys interrogated: (1) interest in types of IO approaches; and (2) preferences for delivery modality, frequency, and location. Providers (n = 18) were oncologists and nurse navigators working with diverse cancer types. Interviews queried their knowledge of and attitudes about IO, about their patients' needs for symptom management, and for recommendations for implementation of IO approaches in their clinic. We used the Consolidated Framework for Implementation Research framework to systematically analyze provider interviews.ResultsThe primary interests reported among actively treated patients and survivors were massage therapy, acupuncture, and wellness/exercise. Most patients expressed interest in both group and individual sessions and in telehealth or virtual reality options. Emergent themes from provider interviews identified barriers and facilitators to implementing IO approaches in both the internal and external settings, as well as for the implementation process.ConclusionThe emphasis on mind-body interventions as integrative rather than alternative highlights the importance of interventions as evidence-based, comprehensive, and integrated into health care. Gaining simultaneous perspectives from both patients and physicians generated insights for the implementation of IO care into complex clinical systems within a comprehensive cancer center.

Project description:BackgroundFormaldehyde exposure is associated with leukemia in some epidemiological studies. In the National Cancer Institute's formaldehyde cohort, previously followed through December 31, 1979, and updated through December 31, 1994, formaldehyde exposure was associated with an increased risk for leukemia, particularly myeloid leukemia, that increased with peak and average intensity of exposure.MethodsWe extended follow-up through December 31, 2004 (median follow-up = 42 years), for 25 619 workers employed at one of 10 formaldehyde-using or formaldehyde-producing plants before 1966. We used Poisson regression to calculate relative risk (RR) estimates and 95% confidence intervals (CIs) to examine associations between quantitative formaldehyde exposure estimates (peak exposure, average intensity and cumulative exposure) and death from lymphohematopoietic malignancies. All statistical tests were two-sided and considered to be significant at P = .05.ResultsWhen follow-up ended in 2004, there were statistically significant increased risks for the highest vs lowest peak formaldehyde exposure category (> or =4 parts per million [ppm] vs >0 to <2.0 ppm) and all lymphohematopoietic malignancies (RR = 1.37; 95% CI = 1.03 to 1.81, P trend = .02) and Hodgkin lymphoma (RR = 3.96; 95% CI = 1.31 to 12.02, P trend = .01). Statistically nonsignificant associations were observed for multiple myeloma (RR = 2.04; 95% CI = 1.01 to 4.12, P trend > .50), all leukemia (RR = 1.42; 95% CI = 0.92 to 2.18, P trend = .12), and myeloid leukemia (RR = 1.78; 95% CI = 0.87 to 3.64, P trend = .13). There was little evidence of association for any lymphohematopoietic malignancy with average intensity or cumulative exposure at the end of follow-up in 2004. However, disease associations varied over time. For peak exposure, the highest formaldehyde-related risks for myeloid leukemia occurred before 1980, but trend tests attained statistical significance in 1990 only. After the mid-1990s, the formaldehyde-related risk of myeloid leukemia declined.ConclusionsEvaluation of risks over time suggests a possible link between formaldehyde exposure and lymphohematopoietic malignancies, particularly myeloid leukemia but also perhaps Hodgkin lymphoma and multiple myeloma. Observed patterns could be due to chance but are also consistent with a causal association within the relatively short induction-incubation periods characteristic of leukemogenesis. Further epidemiological study and exploration of potential molecular mechanisms are warranted.

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Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

Publications

Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute-designated cancer centers in California.

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