Elderly Americans Research Articles

Comparing Framingham risk score and cognitive performance in a Mexican American cohort

ObjectiveMexican-Americans have a higher prevalence of modifiable cardiovascular risk factors as compared to Non-Hispanic whites. This study aims to elucidate the utility of the Framingham Cardiovascular Disease Risk Score (FCVDRS) as a predictor of cognitive performance on a cohort of Mexican Americans elders. Participants and Setting429 Mexican-Americans (338 female and 91 male) from a longitudinal study conducted at The University of North Texas Health Science Center were studied. Main outcome measuresDemographic and clinical data relevant to Framingham Cardiovascular Disease 10-year Risk Score (FCVDRS) were assessed. FCVDRS was calculated based on Body Mass Index (BMI) and categorized as Low if <10, Moderate if between 10 and 20, and High if >20. Cognitive performance on Trails B, Wechsler Logical Memory I and II, Mini Mental State Examination (MMSE), and Animal Naming (AN) tests. Demographic data was analyzed using t-tests and chi-square tests as appropriate. Pearson correlation tests and ANOVAs were used to compare FCVDRS, as a continuous variable and as a categorical variable, against cognitive performance. ResultsBoth Pearson correlation tests and linear regression analysis, showed significant correlations between FCVDRS and performance on 4 of the 8 measures of cognitive performance. ANOVAs with Post-Hoc analysis also showed that the difference in cognitive performance was more pronounced between groups with greater differences in FCVDRS. In all analyses, the strength of the relationship was stronger in females. ConclusionThe results show that FCDVRS has high predictive utility in measures of cognitive function. Gender specific analysis between FCVDRS and cognitive performance indicate a stronger association in females.

Comparing Pathological Risk Factors for Dementia between Cognitively Normal Japanese and Americans.

The Alzheimer’s Disease Neuroimaging Initiative showed that Japanese had significantly lower brain Aβ burden than Americans among a cognitively normal population. This cross-sectional study aimed to compare vascular disease burden, Aβ burden, and neurodegeneration between cognitively normal elderly Japanese and Americans. Japanese and American participants were matched for age (±4-year-old), sex, and Apolipoprotein E (APOE) genotype. Brain vascular disease burden and brain Aβ burden were measured using white matter lesions (WMLs) and 11C-labeled Pittsburgh Compound B (PiB) retention, respectively. Neurodegeneration was measured using hippocampal volumes and cortical thickness. A total of 95 Japanese and 95 Americans were recruited (50.5% men, mean age = 82). Compared to Americans, Japanese participants had larger WMLs, and a similar global Aβ standardized uptake value ratio (SUVR), cortical thickness and hippocampal volumes. Japanese had significantly lower regional Aβ SUVR in the anterior ventral striatum, posterior cingulate cortex, and precuneus. Cognitively normal elderly Japanese and Americans had different profiles regarding vascular disease and Aβ burden. This suggests that multiple risk factors are likely to be involved in the development of dementia. Additionally, Japanese might have a lower risk of dementia due to lower Aβ burden than Americans. Longitudinal follow-up of these cohorts is warranted to ascertain the predictive accuracy of these findings.

Differences in Subjective Memory Impairment, Depressive Symptoms, Sleep, and Physical Activity in African American and Asian American Elderly.

Background: Subjective memory impairment (SMI) is associated with negative health outcomes including mild cognitive impairment and Alzheimer’s disease. However, ethnic differences in SMI and disparities in risk factors associated with SMI among minority populations are understudied. The study examined the ethnic differences in SMI, whether SMI was associated with depressive symptoms, sleep, and physical activity (PA), and whether the associations vary across racial/ethnic groups. Methods: Participants included 243 African and Asian Americans (including Chinese, Vietnamese, and Korean Americans) aged 50 or older. Demographic information, SMI, depressive symptoms, daily sleeping hours, and PA levels were assessed. Results: Vietnamese Americans reported the highest SMI score. Depressive symptoms, sleeping hours, and PA levels were significantly associated with SMI. Depressive symptoms were the only significant factor across all ethnic groups. Significant interaction effects were found between ethnicity and health behaviors in predicting SMI. In particular, Vietnamese American participants with greater depressive symptoms and physical inactivity were significantly more likely to experience SMI compared to other ethnic groups Conclusions: Our findings demonstrate ethnic differences in SMI and its association with depressive symptoms, sleep, and PA, which highlight the importance of considering the unique cultural and historical backgrounds across different racial/ethnic groups when examining cognitive functioning in elderly.

The Great Unequalizer: Initial Health Effects of COVID-19 in the United States

We measure inequities from the COVID-19 pandemic on mortality and hospitalizations in the United States during the early months of the outbreak. We discuss challenges in measuring health outcomes and health inequality, some of which are specific to COVID-19 and others that complicate attribution during most large health shocks. As in past epidemics, preexisting biological and social vulnerabilities profoundly influenced the distribution of disease. In addition to the elderly, Hispanic, Black and Native American communities were disproportionately affected by the virus, particularly when assessed using the years of potential life lost metric. We provide a conceptual framework and initial empirical analysis that seek to shed light on contributors to pandemic-related health inequality, and we suggest areas for future research.

Immunizing Against Hate: Overcoming Asian American and Pacific Islander Racism.

* Abbreviations: AAP — : American Academy of Pediatrics COVID-19 — : coronavirus disease 2019 SARS-CoV-2 — : severe acute respiratory syndrome-coronavirus 2 It has been more than a year since Immediate Past President of the American Academy of Pediatrics (AAP), Sally Goza, MD, FAAP, warned against the threat severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) posed to children and families, including the harm coronavirus disease 2019 (COVID-19)–fueled racism and xenophobia could cause the Asian American community. Sadly, as the COVID-19 pandemic spread, racism and violent attacks on Asian Americans spread along with it. Since March 2020, increases in racist rhetoric have coincided with increases in racist abuse, bullying, and attacks. According to Human Rights Watch,1 an organization that investigates abuses happening throughout the world, reports of discrimination and violence against Asians and people of Asian descent have surged both in the United States and worldwide. A new study of police department statistics2 from 16 of America’s largest cities reveals that hate crimes against Asian Americans rose nearly 150% in 2020, despite overall hate crimes dropping by 7%. Stop AAPI Hate,3 a national coalition that tracks incidents of violence and harassment against Asian Americans and Pacific Islanders in the United States, reported nearly 3800 instances of discrimination against Asians between March 19, 2020, and February 28, 2021. Although these reports may represent only a fraction of the hate incidents that occur, it is an indication of how vulnerable Asian Americans have become to racial attacks and discrimination. Widespread media coverage of violence committed against elderly Asian Americans in cities across the country is stirring up fear and a sense of … Address correspondence to Lee Savio Beers, MD, FAAP. E-mail: president{at}aap.org

Calcitonin (FORTICAL, MIACALCIN) for the treatment of vertebral compression fractures.

Osteoporosis is a common condition affecting the musculoskeletal system. It carries with it increased risks of fracture in many areas of the body, leading to reduced quality of life, limited mobility, and other long-term implications such as chronic pain. Vertebral compression fractures are a common development in patients with osteoporosis. Current treatment options focus on reducing pain; preventative methods are somewhat limited and focus on minimizing risk factors for the development of osteoporosis. In this review, we explore the use of calcitonin (FORTICAL, MIACALCIN) to treat vertebral compression fractures (VCFs). Osteoporosis had a prevalence of more than 10% in the United States in 2010. The CDC estimates that nearly 25% of women over age 65 have findings of osteoporosis, which include low spinal bone mass. The condition is highly prevalent and, in an aging U.S. population, quite clinically relevant. Risk factors for development include advanced age, cigarette smoking, medications, reduced physical activity, and low calcium and vitamin D intake. Family history may also play a role. Diagnosis is made based on bone mineral density.Standard therapy for VCFs in osteoporosis includes analgesic medications, such as NSAIDs and biphosphonates, and surgical intervention. NSAIDs address the chronic pain that is a common long-term effect of VCFs. Biphosphonates have recently been used to attempt to halt the progression and provide prevention. Surgical interventions such as balloon kyphoplasty and vertebroplasty are typically reserved for patients who have failed other methods.Calcitonin is a peptide naturally produced by the human body, released from the parathyroid gland. It binds to osteoclasts, inhibiting them from inducing bone resorption. By relatively unknown mechanisms, it also appears to cause endorphin release and mitigate pain. Clinical data has shown safety and efficacy for exogenous calcitonin in reducing bone turnover and reducing VCF-induced pain. Osteoporosis is a common condition that can lead to complications such as vertebral compression fractures. It can significantly impact the quality of life in many elderly Americans. There is currently no singular treatment, but calcitonin has recently been explored as a possible option for minimizing pain and reducing disease progression. Further studies are needed to understand its preventative benefits fully.

Association with Longevity of Phosphatidylinositol 3-Kinase Regulatory Subunit 1 Gene Variants Stems from Protection against Mortality Risk in Men with Cardiovascular Disease

Introduction: Genetic variation in the phosphatidylinositol 3-kinase reregulatory subunit 1 gene (PIK3R1) is associated with longevity. Objective: The aim of the study was to determine whether cardiovascular disease (CVD) affects this association. Methods: We performed a longitudinal study of longevity-associated PIK3R1 single-nucleotide polymorphism rs7709243 genotype by CVD status in 3,584 elderly American men of Japanese ancestry. Results: At baseline (1991–1993), 2,254 subjects had CVD and 1,314 did not. The follow-up until Dec 31, 2019 found that overall, men with a CVD had higher mortality than men without a CVD (p = 1.7 × 10⁻⁵). However, survival curves of CVD subjects differed according to PIK3R1 genotype. Those with longevity-associated PIK3R1 TT/CC had survival curves similar to those of subjects without a CVD (p = 0.11 for TT/CC, and p = 0.054 for TC), whereas survival curves for CVD subjects with the CT genotype were significantly attenuated compared with survival curves of subjects without a CVD (p = 0.0000012 compared with TT/CC, and p = 0.0000028 compared with TC). Men without CVD showed no association of longevity-associated genotype with life span (p = 0.58). Compared to subjects without any CVD, hazard ratios for mortality risk were 1.26 (95% CI, 1.14–1.39; p = 0.0000043) for CT subject with CVD and 1.07 (95% CI 0.99–1.17; p = 0.097) for CC/TT subjects with CVD. There was no genotypic effect on life span for 1,007 subjects with diabetes and 486 with cancer. Conclusion: Our study provides novel insights into the basis for PIK3R1 as a longevity gene. We suggest that the PIK3R1 longevity genotype attenuates mortality risk in at-risk individuals by protection against cellular stress caused by CVD.

In Memoriam: Ernest Marcus Whiteman, Tei’eihi Beh’eih (Strong Old Man), February 10, 1947–December 13, 2019

ABSTRACTThis is a tribute to a wonderful Native American elder who generously shared his wisdom at the Annual Conferences on Native American Nutrition, held in 2017, 2018, and 2019 at Mystic Lake Center in Prior Lake, Minnesota. Ernie Whiteman's kindness, sense of humor, brilliant storytelling, and many talents are difficult to capture in words. In addition to being an artist, he was a passionate advocate for Native American food sovereignty, working to pass on his deep knowledge and experience of Native culture and the significance of traditional foods to youth in Minnesota.

SC1 Increases in the Share of Spending on Pharmaceuticals Met with Decrease in Overall Spending for Elderly Americans with Diabetes

High and rising drug prices are a central focus of United States health policy. Individuals with diabetes, in particular, have experienced increases in the list price for prescription medications and insulin. With the increasing prevalence of the disease and the growing reliance on drug therapies, we estimated the changes in utilization and spending for diabetes treatment over time for elderly Americans.

Association of growth hormone receptor gene variant with longevity in men is due to amelioration of increased mortality risk from hypertension.

The single nucleotide polymorphism (SNP) rs4130113 of the growth hormone receptor gene (GHR) is associated with longevity. Here we explored whether longevity-associated genotypes protect against mortality in all individuals, or only in individuals with aging-related diseases. Rs4130113 genotypes were tested for association with mortality in 3,557 elderly American men of Japanese ancestry. At baseline (1991–1993), 1,000 had diabetes, 730 had coronary heart disease (CHD), 1,901 had hypertension, 485 had cancer, and 919 lacked these diseases. The men were followed from baseline until Dec 31, 2019 or death (mean 10.8 ± 6.5 SD years, range 0.01–28.8 years; 99.0% deceased by that date). In a heterozygote disadvantage model, longevity-associated genotypes were associated with significantly lower mortality risk in individuals having hypertension (covariate-adjusted hazard ratio [HR] 0.83 [95% CI: 0.76–0.93, p = 4.3 x10–4]. But in individuals with diabetes, CHD, and cancer there was no genotypic difference in lifespan. As expected, normotensive men outlived men with hypertension (p = 0.036). There was no effect, however, of genotypic difference on lifespan in normotensive men (p = 0.11). We found that SNP rs4130113 potentially influenced the binding of transcription factors E2A, MYF, NRSF, TAL1, and TCF12 so as to alter GHR expression. We propose that in individuals with hypertension, longevity-associated genetic variation in GHR enhances cell resilience mechanisms to help protect against cellular stress caused by hypertension. As a result, hypertension-affected men who possess the longevity-associated genetic variant of GHR live as long as normotensive men.

Cancer treatment among the elderly in the United States: Examining the interplay of race/ethnicity and comorbidities.

e18547 Background: As the life expectancy of Americans continues to increase, so does the number of individuals who are diagnosed with cancer and other comorbidities. Management of these patients can become increasingly complicated as physicians administer multiple combinations of interventions and drug therapies. To further complicate this issue, the average number of comorbidities among racial/ethnic minority patients is higher than non-Hispanic (NH) white patients, and this disparity could adversely affect receipt of curative cancer treatment among these minority groups. Therefore, we explored the association between race/ethnicity, comorbidities, and curative cancer treatment among elderly Americans diagnosed with the four most common cancer types. Methods: SEER-Medicare linked data was used to identify 727,136 individuals over 65 years old diagnosed with breast, colorectal, lung, or prostate cancer from 1992-2011. Comorbidity burden was measured using the Charlson Comorbidity Index (CCI) and analyzed as tertiles (T1: lowest CCI score to T3: highest CCI score). Treatment with curative intent was defined as receipt of any cancer-type-specific surgery, chemotherapy, radiation, hormone, or immune therapy within 6 months of cancer diagnosis. Modified Poisson regression models were used to assess the joint association between comorbidities and race/ethnicity on cancer treatment. Results: For all cancers, the percentage of patients receiving treatment declined rapidly with increasing age, CCI scores, number of comorbidities, and advanced cancer stage. In addition, variability in receipt of treatment by race/ethnicity was observed: 76% for NH-White patients, 75% for Hispanic patients, and 68% for NH-Black patients. Taking into account age, genders (for colorectal, lung cancer), year of diagnosis, stage at diagnosis, and socioeconomic status, we found that treatment proportions among NH-Black and Hispanic patients with low CCI score (T1) were 2%-15% lower than NH-White patients with the same CCI score (all p &lt; 0.001). Although treatment proportions decreased with increasing CCI among NH White patients (ranging from 2.5-11.3%; p &lt; 0.01), there was little difference in treatment by CCI among NH Black and Hispanic patients (ranging from 0.5%-2%; p &gt; 0.05). Conclusions: Our findings suggested that racial disparities may exist in cancer treatment among patients with low comorbidities. This finding was unexpected as these patients are less likely than highly comorbid patients to experience drug interactions and other complications due to concurrent disease management therapies.

Protecting the sacred tree: Conceptualizing spiritual abuse against Native American elders.

Protecting the sacred tree: Conceptualizing spiritual abuse against Native American elders.

The Rising Tide of Elderly African-American Suicides: A Call for Action

Suicides are among the leading causes of death in elderly Americans. The problem is expected to grow with an aging population in the U.S. Suicides in African-American elderly are not well studied. This article enumerates the risk factors for suicidal behaviors in elderly African-Americans; presents an epidemiological assessment of suicides in elderly African-Americans from 2010 to 2018 with gender-specific differences, and explores public health considerations for helping to reduce the growing numbers of suicides in elderly African-Americans. Currently, there are very limited evidence-based interventions to reduce or prevent suicides in older African-Americans. This article also provides implications and recommendations for prevention practice and research that is needed to help alleviate suicides in older African-Americans.

Financial Maltreatment of Chinese American Elders: An Inquiry through a Cultural Lens

ABSTRACT This study examined financial maltreatment from the perspectives of Chinese American elders via a mixed method approach. Three focus groups of Chinese American elders and one group of service professionals recruited from Phoenix metropolitan areas shared their insights of financial maltreatment and contributed to the refinement of questions in the followed survey that included 325 elders (Mage = 75.6, SD = 7.00). Two types of financial maltreatment: Financial exploitation and financial neglect were identified from focus group discussions. About 9.2% experienced financial exploitation and 1.5% experienced financial neglect. Both financial exploitation and neglect were related to higher vulnerability scores for abuse assessed using the H-S/EAST elder abuse screening scale. Financial maltreatment needs to be understood in legal, cultural, and family contexts, incorporating the perspectives of older adults. Prevention of financial maltreatment hinges on increased awareness and knowledge of this issue among elders, families and service professionals, and the collaborative efforts of stakeholders from ethnic communities.

Macro- and meso-level contextual influences on health care inequities among American Indian elders

BackgroundAmerican Indian elders, aged 55 years and older, represent a neglected segment of the United States (U.S.) health care system. This group is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other aging populations in the country. Despite the U.S. government’s federal trust responsibility to meet American Indians’ health-related needs through the Indian Health Service (IHS), elders are negatively affected by provider shortages, limited availability of health care services, and gaps in insurance. This qualitative study examines the perspectives of professional stakeholders involved in planning, delivery of, and advocating for services for this population to identify and analyze macro- and meso-level factors affecting access to and use of health care and insurance among American Indian elders at the micro level.MethodsBetween June 2016 and March 2017, we undertook in-depth qualitative interviews with 47 professional stakeholders in two states in the Southwest U.S., including health care providers, outreach workers, public-sector administrators, and tribal leaders. The interviews focused on perceptions of both policy- and practice-related factors that bear upon health care inequities impacting elders. We analyzed iteratively the interview transcripts, using both open and focused coding techniques, followed by a critical review of the findings by a Community Action Board comprising American Indian elders.ResultsFindings illuminated complex and multilevel contextual influences on health care inequities for elders, centering on (1) gaps in elder-oriented services; (2) benefits and limits of the Affordable Care Act (ACA); (2) invisibility of elders in national, state, and tribal policymaking; and (4) perceived threats to the IHS system and the federal trust responsibility.ConclusionsFindings point to recommendations to improve the prevention and treatment of illness among American Indian elders by meeting their unique health care and insurance needs. Policies and practices must target meso and macro levels of contextual influence. Although Medicaid expansion under the ACA enables providers of essential services to elders, including the IHS, to enhance care through increased reimbursements, future policy efforts must improve upon this funding situation and fulfill the federal trust responsibility.

Functional Disability with Systematic Trends and Uncertainty: A Comparison between China and the U.S.

China and the U.S. are two contrasting countries in terms of functional disability and long-term care. China is experiencing declining family support for long-term care and developing private long-term care insurance. The U.S. has a more developed public aged care system and private long-term care insurance market than China. Changes in the demand for long-term care are driven by the levels, trends and uncertainty in mortality and functional disability. To understand the future potential demand for long-term care, we compare mortality and functional disability experiences in China and the U.S., using a multi-state latent factor intensity model with time trends and systematic uncertainty in transition rates. We estimate the model with the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the U.S. Health and Retirement Study (HRS) data. The estimation results show that if trends continue, both countries will experience longevity improvement with morbidity compression and a declining proportion of the older population with functional disability. Although the elderly Chinese have a shorter estimated life expectancy, they are expected to spend a smaller proportion of their future lifetime functionally disabled than the elderly Americans. Systematic uncertainty is shown to be significant in future trends in disability rates and our model estimates higher uncertainty in trends for the Chinese elderly, especially for urban residents.

Lifespan extension conferred by mitogen-activated protein kinase kinase kinase 5 (MAP3K5) longevity-associated gene variation is confined to at-risk men with a cardiometabolic disease.

Genetic variants of the kinase signaling gene MAP3K5 are associated with longevity. Here we explore whether the longevity-association involves protection against mortality in all individuals, or only in individuals with aging-related diseases. We tested the strongest longevity associated single nucleotide polymorphism (SNP), rs2076260, for association with mortality in 3,516 elderly American men of Japanese ancestry. At baseline (1991–1993), 2,461 had either diabetes (n=990), coronary heart disease (CHD; n=724), or hypertension (n=1,877), and 1,055 lacked any of these cardiometabolic diseases (CMDs). The men were followed from baseline until Dec 31, 2019. Longevity-associated genotype CC in a major allele homozygote model, and CC+TT in a heterozygote disadvantage model were associated with longer lifespan in individuals having a CMD (covariate-adjusted hazard ratio [HR] 1.23 [95% CI: 1.12–1.35, p=2.5x10–5] in major allele homozygote model, and 1.22 [95% CI: 1.11–1.33, p=1.10x10–5] in heterozygote disadvantage model). For diabetes, hypertension and CHD, HR p-values were 0.019, 0.00048, 0.093, and 0.0024, 0.00040, 0.0014, in each respective genetic model. As expected, men without a CMD outlived men with a CMD (p=1.9x10–6). There was, however, no difference in lifespan by genotype in men without a CMD (p=0.21 and 0.86, respectively, in each genetic model). In conclusion, we propose that in individuals with a cardiometabolic disease, longevity-associated genetic variation in MAP3K5 enhances resilience mechanisms in cells and tissues to help protect against cardiometabolic stress caused by CMDs. As a result, men with CMD having longevity genotype live as long as all men without a CMD.

Cyanogenic Glycoside Analysis in American Elderberry.

Cyanogenic glycosides (CNGs) are naturally occurring plant molecules (nitrogenous plant secondary metabolites) which consist of an aglycone and a sugar moiety. Hydrogen cyanide (HCN) is released from these compounds following enzymatic hydrolysis causing potential toxicity issues. The presence of CNGs in American elderberry (AE) fruit, Sambucus nigra (subsp. canadensis), is uncertain. A sensitive, reproducible and robust LC-MS/MS method was developed and optimized for accurate identification and quantification of the intact glycoside. A complimentary picrate paper test method was modified to determine the total cyanogenic potential (TCP). TCP analysis was performed using a camera-phone and UV-Vis spectrophotometry. A method validation was conducted and the developed methods were successfully applied to the assessment of TCP and quantification of intact CNGs in different tissues of AE samples. Results showed no quantifiable trace of CNGs in commercial AE juice. Levels of CNGs found in various fruit tissues of AE cultivars studied ranged from between 0.12 and 6.38 µg/g. In pressed juice samples, the concentration range measured was 0.29–2.36 µg/mL and in seeds the levels were 0.12–2.38 µg/g. TCP was highest in the stems and green berries. Concentration levels in all tissues were generally low and at a level that poses no threat to consumers of fresh and processed AE products.

The Mediating Role of Pain Catastrophizing on the Association Between Depression and Pain Severity and Interference Among Elderly Asian Immigrants with Chronic Pain.

PurposeThe association between depression and chronic pain is well established. However, few studies have examined the pathways from depression to chronic pain. The present cross-cultural study aimed to test the mediating effects of pain catastrophizing on associations between depression and chronic pain (eg, pain severity, pain intensity) among Korean American elderly.Patients and MethodsA total of 132 elderly Korean Americans with chronic pain were recruited from elderly daycare centers and Korean ethnic churches in the community. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis.ResultsThe results indicated that the proportion of comorbid depression and chronic pain was 45.7%. Elderly Korean Americans with depression scored higher in pain severity, pain interference, and pain catastrophizing than those without depression. Pain catastrophizing was found to have a significant mediating effect on the relationship between depression and pain severity (indirect effect = 0.147, Bootstrap 95% CI = [0.079, 0.226]), controlling for demographic covariates, comorbidities and pain area. Pain catastrophizing also mediated the relationship between depression and pain interference (indirect effect =0.164, Bootstrap 95% CI = [0.097, 0.244]), controlling for the covariates.ConclusionThese findings add to the literature by providing evidence that pain catastrophizing plays a role in high levels of pain severity and pain interference comorbid chronic pain and depression in Asian elderly immigrants. Appropriate culturally tailored programs to redirect pain catastrophizing cognitive process should be developed and provided for elderly Asian Americans to reduce chronic pain disparity.

Abstract PS13-37: Effectiveness of eribulin in poor prognosis subgroups of metastatic breast cancer (mBC) patients (elderly, African Americans, and patients with liver metastases) in the United States

Abstract Background: Eribulin mesylate was approved in the United States (US) in 2010 as third-line or later treatment (after an anthracycline and a taxane) of mBC. Multiple patient demographic and clinical characteristics have been reported to impact clinical outcomes in mBC patients. The objective of these analyses was to assess real-world clinical outcomes of eribulin therapy in three subgroups that generally have poorer prognoses: elderly (≥65 years), African American, and those with liver metastases in clinical practice in the US. Methods: A retrospective chart review study was conducted across community oncology practices in the US. Adult female patients with mBC who initiated treatment with eribulin as per US prescribing information between 2011 and 2017 were included. Data were extracted by prescribing physicians from individual patient’s electronic health records and captured via an electronic case report form. All patient data were de-identified prior to analyses. Clinical outcomes including objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were assessed in patients who were elderly, African American, or who had liver metastases. Results: Current analyses were based on data from 278 patients including 175 (63%) patients with liver metastases, 98 (35%) elderly patients, and 73 (26%) African American patients. Mean age at initiation of eribulin in each group was: liver metastases, 59; elderly, 71; and African American, 58. Proportion of patients with ECOG-PS ≥2 at initiation of eribulin was: liver metastases, 46%; elderly, 52%; and African American, 47%. The majority of patients received eribulin in 3rd line: liver metastases, 80%; elderly, 87%; and African American, 85%. ORR to eribulin was 34% in patients with liver metastases, 35% in elderly, and 48% in African Americans. Median PFS from initiation of eribulin was 5.2 months in patients with liver metastases, 5.8 months in elderly, and 7.6 months in African Americans. Landmark OS from initiation of eribulin at 6, 12 and 24 months were 71%, 36% and 18%, respectively, in patients with liver metastases, 72%, 35% and 23% in elderly, and 78%, 46%, and 28% in African Americans. Conclusion: Effectiveness of eribulin in clinical practice in patients with liver metastases, elderly, and African Americans was confirmed within this real-world study in the US. Citation Format: Sarah S. Mougalian, Jonathan K. Kish, Jingchuan Zhang, Djibril Liassou, Bruce A. Feinberg. Effectiveness of eribulin in poor prognosis subgroups of metastatic breast cancer (mBC) patients (elderly, African Americans, and patients with liver metastases) in the United States [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS13-37.