Mengyang Di1,2, Tamra Keeney3,4,5, Emmanuelle Belanger3,4, Orestis A Panagiotou3,4,6, Adam J Olszewski1,7. 1. Department of Medicine, Alpert Medical School of Brown University, Providence, RI. 2. Division of Hematology/Oncology, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT. 3. Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA. 4. Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI. 5. Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI. 6. Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI. 7. Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI.
Abstract
PURPOSE: To examine the impact of global risk, a measure comprising age, comorbidities, function, and cognitive statuses, on treatment selection and outcomes among older home care recipients with diffuse large B-cell lymphoma. METHODS: From SEER-Medicare, we selected home care recipients diagnosed with diffuse large B-cell lymphoma in 2011-2015, who had pretreatment Outcome and Assessment Information Set (OASIS) evaluations. We created a global risk indicator categorizing patients as low-, moderate-, or high-risk on the basis of OASIS assessments. We examined the association of global risk with receipt of therapy and among chemotherapy recipients, with mortality, emergency department visits, hospitalization, and intensive care unit admission within 30 days from first treatment in logistic models, reporting adjusted odds ratios (OR) with 95% CI. We compared overall survival across risk groups estimating adjusted hazard ratios. RESULTS: Of the 1,232 patients (median age, 80 years), 65% received chemotherapy. High-risk patients (v moderate-risk) were less likely to receive any chemotherapy (OR, 0.50; 95% CI, 0.39 to 0.64) and curative regimens (OR, 0.59; 95% CI, 0.40 to 0.86) if treated, although even in the moderate-risk group, only 61% received curative regimens. High-risk patients were more likely to experience acute mortality (OR, 2.24; 95% CI, 1.43 to 3.52), emergency department visits (OR, 1.35; 95% CI, 1.00 to 1.83), hospitalization (OR, 1.60; 95% CI, 1.19 to 2.17), or intensive care unit admission (OR, 1.52; 95% CI, 1.04 to 2.22) and had inferior overall survival (hazard ratio, 1.41; 95% CI, 1.11 to 1.78). CONCLUSION: Global risk on the basis of OASIS is easily available, suggesting a potential way to improve patient selection for curative treatment and institution of preventive measures.
PURPOSE: To examine the impact of global risk, a measure comprising age, comorbidities, function, and cognitive statuses, on treatment selection and outcomes among older home care recipients with diffuse large B-cell lymphoma. METHODS: From SEER-Medicare, we selected home care recipients diagnosed with diffuse large B-cell lymphoma in 2011-2015, who had pretreatment Outcome and Assessment Information Set (OASIS) evaluations. We created a global risk indicator categorizing patients as low-, moderate-, or high-risk on the basis of OASIS assessments. We examined the association of global risk with receipt of therapy and among chemotherapy recipients, with mortality, emergency department visits, hospitalization, and intensive care unit admission within 30 days from first treatment in logistic models, reporting adjusted odds ratios (OR) with 95% CI. We compared overall survival across risk groups estimating adjusted hazard ratios. RESULTS: Of the 1,232 patients (median age, 80 years), 65% received chemotherapy. High-risk patients (v moderate-risk) were less likely to receive any chemotherapy (OR, 0.50; 95% CI, 0.39 to 0.64) and curative regimens (OR, 0.59; 95% CI, 0.40 to 0.86) if treated, although even in the moderate-risk group, only 61% received curative regimens. High-risk patients were more likely to experience acute mortality (OR, 2.24; 95% CI, 1.43 to 3.52), emergency department visits (OR, 1.35; 95% CI, 1.00 to 1.83), hospitalization (OR, 1.60; 95% CI, 1.19 to 2.17), or intensive care unit admission (OR, 1.52; 95% CI, 1.04 to 2.22) and had inferior overall survival (hazard ratio, 1.41; 95% CI, 1.11 to 1.78). CONCLUSION: Global risk on the basis of OASIS is easily available, suggesting a potential way to improve patient selection for curative treatment and institution of preventive measures.
Authors: L Decoster; K Van Puyvelde; S Mohile; U Wedding; U Basso; G Colloca; S Rostoft; J Overcash; H Wildiers; C Steer; G Kimmick; R Kanesvaran; A Luciani; C Terret; A Hurria; C Kenis; R Audisio; M Extermann Journal: Ann Oncol Date: 2014-06-16 Impact factor: 32.976
Authors: Supriya G Mohile; William Dale; Mark R Somerfield; Mara A Schonberg; Cynthia M Boyd; Peggy S Burhenn; Beverly Canin; Harvey Jay Cohen; Holly M Holmes; Judith O Hopkins; Michelle C Janelsins; Alok A Khorana; Heidi D Klepin; Stuart M Lichtman; Karen M Mustian; William P Tew; Arti Hurria Journal: J Clin Oncol Date: 2018-05-21 Impact factor: 44.544
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