Differences In Treatment Characteristics Research Articles

Gender-affirming surgeries and patient-reported outcomes in gender binary versus non-binary and genderqueer-identifying individuals

Background Approximately 25%–50% of transgender and gender diverse (TGD) individuals identify as non-binary and/or genderqueer (NBGQ), yet understanding of the role of genital gender-affirming surgeries (GAS) and the overall outcomes of gender-affirming treatment in this group is limited. Aim Comparing the choice of gender-affirming surgical treatments and patient-reported outcomes between binary and NBGQ TGD individuals. Methods We conducted a cross-sectional online survey including 171 participants who completed at least 80% of their medical transition and had undergone GAS (based on self-report). Participants were grouped as binary transgender (n = 151) or NBGQ (n = 20) based on self-reported gender identity. Main outcomes included the propensity for genital GAS in NBGQ individuals compared to binary peers. Patient-reported outcomes, such as gender congruence, body satisfaction, life satisfaction, self-esteem, and mental health, were compared between groups. Analyses were conducted accounting for potential confounding factors including age, sex assigned at birth, and level of social support. Results NBGQ individuals reported a lower likelihood of having received genital GAS compared to binary-identifying participants (55.0% vs. 84.1%; OR = 0.23; p = .002), also after correcting for confounding factors, such as sex assigned at birth (OR = 0.28; p = .03; 95% CI 0.09–0.90). Patient-reported outcomes indicated poorer post-treatment body satisfaction and gender recognition, self-esteem, life satisfaction, and mental health in the NBGQ group (small to large effect sizes). Discussion The study emphasizes the differences in treatment characteristics of NBGQ individuals undergoing gender-affirming surgical care, related to both surgeries received and (poorer) patient-reported outcomes. These findings underscore the importance of individualized and equitable care in TGD healthcare to improve overall health outcomes.

Private and public psychotherapy in Israel 5 years after the ‘mental health insurance reform'

Abstract Background In 2015, Israel implemented a mental health insurance reform aiming to increase availability of mental health services in the public sector. However, little is known about the private sector. Aim To characterize the differences between private and public psychotherapy sectors following the reform. Methods Data was collected in December 2020 via an internet survey among a representative sample of 4,688 Israeli adults and included questions about patients’ characteristics, treatment seeking, choice of provider, and patient experience. Results 400 participants (8%) reported receiving psychotherapy treatment in the community in 2020. Of those, 49% were treated privately. Logistic regression showed that ultra-Orthodox Jews (95% CI 1.7-15; OR = 5), individuals with higher education (1.7-4.4; 2.7) and women (1.3-3.4; 2.1) were more likely to be treated privately, while Arabs (0.17-0.95; 0.4), individuals over 60 (0.2-0.6; 0.3), and those receiving psychiatric care (0.2-0.4; 0.3) were less likely. Private treatment was characterized by shorter waiting times (50% waited < 2 weeks vs. 25% in the public sector; p < 0.05), longer treatments (44% treated > 1 year vs. 28%; p < 0.05), and higher patient experience score (9.1 vs. 8.3 out of 10; p < 0.05). The leading causes for choosing private care were the ability to choose the therapist and shorter waiting times. 20% of those treated privately had sought public treatment before opting for private care. Conclusions Following the insurance reform, private psychotherapy is still used by half of the patient population. The study highlights the existence of a population interested in receiving public care but not receiving it, and of differences in quality of care between the two sectors. Other countries considering publicly financed mental health care should consider scenarios where private care remains advantageous, and the public service is not responsive enough. Key messages • Despite the right to publicly funded care, half of the patients in Israel use private care. Patients who sought public care but turned to private providers suggest unmet needs in the public sector. • Differences in treatment characteristics and in patient experience between the private and public sectors suggest differences in quality.

EPID-01. Differences in first-line treatment but comparable survival outcomes for pediatric brainstem and non-brainstem high-grade gliomas in the Netherlands – a population-based study

INTRODUCTION: Pediatric high-grade gliomas (pHGG) are among the most devastating childhood cancers. Due to their limited treatment options and tumor biology, brainstem (BS) pHGG are considered to have worse survival outcomes compared to non-brainstem (NBS) pHGG. METHODS: Detailed clinical data were gathered by trained registrars for all children diagnosed with a pHGG (including radiologically diagnosed brainstem tumors) in the Netherlands for the period 2003-2017. Tumors were grouped into BS and NBS tumors according to the ICD-O-3 topography codes. Differences in treatment characteristics were tested with the Chi-squared, Fisher exact or Mann-Whitney-Wilcoxon test. Median survival time was determined by Kaplan-Meier method. Trends and survival differences were tested with Cox Proportional-Hazards Models. RESULTS: In total, 276 pHGG patients (BS n=166, NBS n=110) were diagnosed during 2003-2017. Differences in first line treatment were found for neurosurgery (25% of BS versus 95% of NBS patients, p<0.001) and systemic therapy (20% of BS versus 70% of NBS, p<0.001). Notable, 10% of BS patients received temozolomide compared to 55% of NBS patients (p<0.001). No significant difference was found for first-line radiotherapy. However, total cumulative dose and number of fractions differed significantly (BS: median 44.8 Gy and 16 fractions; NBS: median 57.4 Gy and 30 fractions, both p<0.001), reflecting hypofractionation regimens in BS pHGG. Survival remained stable over time for both BS (p=0.9) and NBS (p=0.3). Median survival time was comparable between BS (9.7 months) and NBS patients (9.8 months, p=0.6).CONCLUSION: Despite differences in treatment characteristics we found comparable survival outcomes for BS and NBS pHGG. It remains unclear why survival for both BS and NBS pHGG in this retrospective population-based study is substantially inferior to published data. If the underlying reasons can be found in differences in treatment characteristics, data type (hospital-based versus population-based) or incompleteness of non-microscopically verified cases, is subject to further research.

A Comparison of Quit Outcomes for Men and Women in a Smoking Cessation Program Offering Personalized Nicotine Replacement Therapy and Counseling in Primary Care Clinics

Women may have greater difficulty achieving long-term abstinence following a quit attempt compared to men. We sought to determine whether there were differences in treatment characteristics or outcome between female and male primary care patients enrolled in a smoking cessation program providing personalized nicotine replacement therapy (NRT) with counselling support. The sample included 27,601 Ontarians (53% female, 47% male) who enrolled in the Smoking Treatment for Ontario Patients program between 2016 and 2018. Dose, type, and duration of NRT supplied was personalized to need. Thirty-day point prevalence tobacco smoking abstinence was self-reported via online or telephone survey at 6 months post-enrollment. Both female and male participants received a median of 8 weeks of NRT. Types of NRT received were similar, with 80% of both female and male participants receiving patch and short-acting NRT. Total cumulative dose was somewhat higher for men (1373mg vs. 1265mg, p<0.001); but when calculated as dose per day, per cigarette smoked at baseline, dose was slightly higher among women (1.6mg vs. 1.5mg, p<0.001). Quit rates at 6 months were lower for women versus men (24% vs. 27%; AOR = 0.84 [95% CI = 0.78-0.90], p<0.001). There were no significant interactions between gender and dose, type or duration of NRT supplied. Women were slightly less likely to quit than men, despite receiving similar treatment. There was no evidence that women benefitted more or less from variations in dose, type or duration of NRT supply.

Management of meningeal solitary fibrous tumors/hemangiopericytoma; surgery alone or surgery plus postoperative radiotherapy?

Introduction A meningeal solitary fibrous tumor (SFT), also called hemangiopericytoma, is a rare mesenchymal malignancy. Due to anatomic constrains, even after macroscopic complete surgery with curative intent, the local relapse risk is still relatively high, thus increasing the risk of dedifferentiation and metastatic spread. This study aims to better define the role of postoperative radiotherapy (RT) in meningeal SFTs. Patients and methods A retrospective study was performed across seven sarcoma centers. Clinical information was retrieved from all adult patients with meningeal primary localized SFT treated between 1990 and 2018 with surgery alone (S) compared to those that also received postoperative RT (S + RT). Differences in treatment characteristics between subgroups were tested using independent samples t-test for continuous variables and chi-square tests for proportions. Local control (LC) and overall survival (OS) rates were calculated as time from start of treatment until progression or death from any cause. LC and OS in groups receiving S or S + RT were compared using Kaplan–Meier survival curves. Results Among a total of 48 patients, 7 (15%) underwent S and 41 (85%) underwent S + RT. Median FU was 65 months. LC was significantly associated with treatment. LC after S at 60 months was 60% versus 90% after S + RT (p = 0.052). Furthermore, R1 resection status was significantly associated with worse LC (HR 4.08, p = 0.038). OS was predominantly associated with the mitotic count (HR 3.10, p = 0.011). Conclusion This retrospective study, investigating postoperative RT in primary localized meningeal SFT patients, suggests that combining RT to surgery in the management of this patient population may reduce the risk for local failures.

1426P Gender differences in treatment characteristics and outcomes of esophagogastric cancer surgery - Data from the Dutch upper-GI cancer audit

1426P Gender differences in treatment characteristics and outcomes of esophagogastric cancer surgery - Data from the Dutch upper-GI cancer audit

Synchronous Versus Metachronous Colorectal Liver Metastasis Yields Similar Survival in Modern Era

BackgroundSynchronous colorectal cancer liver metastasis (CRLM) has been viewed as being more aggressive and having shorter survival than metachronous disease. Advances in CRLM management led us to examine differences in treatment characteristics of synchronous versus metachronous CRLM patients along with survival and recurrence. Materials and methodsA retrospective review of hepatic resection for CRLM at a tertiary academic medical center was performed for two periods: a historic cohort from 1992 to 2010 (n = 121), and a modern cohort (n = 179) from 2012 to 2018. Clinical variables were compared between the patient groups, and survival outcomes were characterized. ResultsFive-year disease-specific survival for the modern synchronous group compared to the historic synchronous group was 71.7% versus 44.3% (P = 0.02). Modern metachronous versus modern synchronous 5-y disease-specific survival rates were 49.8% versus 71.7% (P = 0.31). Compared to the historic cohort, the modern one had significantly different timing of hepatic resection (P < 0.01) with increased use of liver-first (30.1% versus 7.5%) and simultaneous liver-colon resections (24.1% versus 10.4%), along with greater use of neoadjuvant chemotherapy (96.4% versus 65.6%; P < 0.01). Significantly more patients in the modern synchronous cohort had disease-free or alive-with-disease status at last follow-up, compared to the historic group (P < 0.01), and experienced less disease recurrence (62.7% versus 77.6%; P < 0.05). ConclusionsModern synchronous CRLM patients who underwent hepatic resection experienced significantly improved survival compared to a historic cohort. We postulate that increased use of neoadjuvant chemotherapy and liver-first/simultaneous liver-colon resections in the modern synchronous cohort contributed to improved survival.

Extrameningeal solitary fibrous tumors-surgery alone or surgery plus perioperative radiotherapy: A retrospective study from the global solitary fibrous tumor initiative in collaboration with the Sarcoma Patients EuroNet.

BackgroundSolitary fibrous tumor (SFT) is a rare mesenchymal malignancy. Although surgery is potentially curative, the local relapse risk is high after marginal resections. Given the lack of prospective clinical trial data, the objective of the current study was to better define the role of perioperative radiotherapy (RT) in various SFT presentations by location.MethodsThis was retrospective study performed across 7 sarcoma centers. Clinical information was retrieved from all adult patients with extrameningeal, primary, localized SFT who were treated between 1990 and 2018 with surgery alone (S) compared with those who also received perioperative RT (S+RT). Differences in treatment characteristics between subgroups were tested using analysis of variance statistics and propensity score matching. Local control and overall survival rates were calculated from the start of treatment until progression or death from any cause.ResultsOf all 549 patients, 428 (78%) underwent S, and 121 (22%) underwent S+RT. The median follow‐up was 52 months. After correction for mitotic count and surgical margins, S+RT was significantly associated with a lower risk of local progression (hazard ratio, 0.19: P = .029), an observation further confirmed by propensity score matching (P = .012); however, this association did not translate into an overall survival benefit.ConclusionsThe results from this retrospective study investigating perioperative RT in patients with primary extrameningeal SFT suggest that combining RT with surgery in the management of this patient population is significantly associated with a reduced risk of local failures, especially in patients who have less favorable resection margins and in those who have tumors with a high mitotic count.

154: Buprenorphine for pharmacotherapy of OUD in pregnancy: Does treatment setting matter?

Buprenorphine is now commonly used as the first-line opioid pharmacotherapy for pregnant women with opioid use disorder (OUD), but little is known regarding effects of treatment setting on outcomes. The objective of this study is to determine whether there are differences in treatment characteristics and neonatal outcomes between pregnant women receiving buprenorphine in private practice (PP) versus outpatient treatment programs (OTP). Retrospective cohort study of pregnant women receiving buprenorphine at an urban, academic medical center from 2011 to 2017. Women were divided into two groups by OUD treatment setting: PP versus OTP. Unadjusted and adjusted analyses were performed to assess differences in treatment and neonatal outcomes. Comparison of means was performed using T-test. Hepatitis C status, smoking, maternal age, race/ethnicity, parity, gestational diabetes, pre-eclampsia, dose at delivery and use of buprenorphine at conception were included in the adjusted analyses. 107 pregnant women were included of which 70 (65.4%) received buprenorphine at a PP and 37 (34.6%) received buprenorphine at an OTP. Women treated at a PP were less likely to have been receiving buprenorphine prior to conception than those treated at an OTP (63% versus 83%, p <0.05; Table 1). Buprenorphine dose during first and second trimesters were similar, however women in the PP group received approximately 4mg more buprenorphine in the third trimester and at delivery than women in the OTP group (p<0.01). These differences reflect the tendency for women treated at an OTP to be on lower doses at delivery compared to the first or second trimester. There was no significant difference in neonatal outcomes with the exception of head circumference which was larger in the OTP group even after adjusting for confounding (0.97 cm, adj. p= 0.047; Table 2). There were several differences in treatment characteristics between pregnant women receiving buprenorphine for OUD at a PP versus OTP including higher delivery dose and a lower likelihood of dose reduction during pregnancy. However, neonatal outcomes were similar with the exception of a small difference in head circumference. The reason for the difference in treatment characteristics requires further study.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Radiation Therapy as Sole Management for Solitary Fibrous Tumors (SFT): A Retrospective Study From the Global SFT Initiative in Collaboration With the Sarcoma Patients EuroNet

Solitary fibrous tumors (SFTs) are extremely rare mesenchymal malignancies. Given the lack of large prospective studies on radiation therapy (RT) with definitive and/or palliative intent in SFT patients, this retrospective study aimed to better define the benefit of RT in this disease. A retrospective observational study was performed across 7 sarcoma centers. Clinical information was retrieved from all patients receiving RT without surgery over the course of their locally advanced and/or metastatic disease. Differences in treatment characteristics between subgroups were tested using analysis-of-variance tests. Local control (LC) and overall survival (OS) rates were calculated as time from the start of RT until local progression and death from any cause, respectively. Since 1990, a total of 40 patients were identified. RT was applied with definitive intent in 16 patients and with palliative intent in 24. The median follow-up period was 62months. In patients treated with definitive RT (receiving approximately 60Gy), the objective response rate was 67%. At 5years, the LC rate was 81.3%, and the OS rate was 87.5%. In the case of palliative RT (typically 39Gy), the objective response rate was 38%. The LC and OS rates at 5years were 62.5% and 54.2%, respectively. In both subgroups, RT-associated toxicities were mild with predominantly grade 1 acute and late side effects. This retrospective study suggests a clinically meaningful benefit for RT given with either definitive or palliative intent without surgery in SFT management. Prospective registries potentially in collaboration with patient advocacy groups are warranted to further assess the role of RT in patients with this rare malignancy.

Comparing two tyrosine kinase inhibitors for treatment of advanced renal cell carcinoma in Medicare and commercially insured patients

Objective:The objective of this study was to compare treatment characteristics, survival and costs for sunitinib and pazopanib for advanced renal cell carcinoma (RCC) in a real-world setting.Methods:Using claims data, this observational, retrospective cohort study selected individuals aged 19 to 89 years, with commercial or Medicare insurance, advanced RCC, and at least one pharmacy claim for sunitinib or pazopanib between 1 November 2009 and 31 December 2012. Treatment characteristics (treatment interruption, adherence, duration and discontinuation), survival, and costs were measured up to 12 months. Statistical models were adjusted for age, gender, geographic region, race, and RxRisk-V score.Results:At baseline, pazopanib patients exhibited significantly worse health status indicators (RxRisk-V score, number of pharmacy claims, and pre-index total healthcare costs) than sunitinib patients. There were no differences in treatment characteristics or survival. Index medication costs (mean difference $5580, p = 0.03, adj p = 0.05) and total healthcare costs (mean difference $12,192, p = 0.09, adj p = 0.07) trended higher with sunitinib. Patients non-adherent with sunitinib incurred significantly higher total costs compared to patients non-adherent with pazopanib (mean difference $17,680, p = 0.04, adj p = 0.01).Conclusions:Mortality data and proxy variables for treatment effectiveness indicate comparable clinical value for both medications. Sunitinib treatment trended towards higher index medication and total healthcare costs despite higher pre-index total costs and worse health status indicators at baseline with pazopanib. Non-adherence with sunitinib was associated with significantly higher total healthcare costs, which may indicate differences in tolerability between the two agents and requires further investigation.

Osteoarthritis of the hip and/or knee in Dutch general practice and physiotherapy practice

Purpose: To describe demographic characteristics and the treatment process of patients with hip osteoarthritis (OA) or knee OA treated in Dutch general practice (GP) and/or physiotherapy practice. Additionally, to investigate whether there are differences in characteristics between referred and non-referred patients with hip or knee OA in GP and physiotherapy practice. Methods: Data from two, separate national registration networks were used. Patients who visited their general practitioner and/or physiotherapist between 2006 and 2009 on account of hip or knee OA were included. Demographic data concerned prevalence and incidence rates, gender and age. In GP, prescriptions and referrals were analyzed. In physiotherapy practice, the health problem, the number of treatment sessions, the duration of a treatment episode, the applied interventions and the treatment results were investigated. In case of continue data, two sample t-tests were used to compare between patients with hip OA and patients with knee OA, respectively between referred patients and non-referred patients in GP and in physiotherapy practice. Chi square tests were used to compare categorical variables. Results: In total, 7477 patients were included. Prevalence rates for hip/knee OA comprised 10.4 / 1000 patients in GP and 18.4 / 1000 patients in physiotherapy practice. Both in GP and physiotherapy practice, the OA population included more females than males and more patients with knee OA than hip OA. Forty-five percent of the patients in GP received a medicine, mostly a NSAID. Prescriptions were significantly more common in patients with knee OA than in patients with hip OA. About 5% of the hip/knee population was referred to a physiotherapist. Referred patients were more often treated pharmacologically than non-referred patients. In physiotherapy practice, patients with hip OA were faced significantly longer with complaints than patients with knee OA. There were no significant differences in treatment characteristics between referred patients (68%) and patients who seek help from a physiotherapist on their own initiative (32%). Patients with hip or knee OA in GP who are referred to a physiotherapist were significantly older and more often females in comparison to patients with hip or knee OA in physiotherapy practice who are referred by their GP. Conclusion: In GP, patients with knee OA are more often treated pharmacologically than patients with hip OA. The same applies to patients who are referred for physiotherapy compared to non-referred patients. General practitioners should reconsider the frequent use of NSAID's, because guidelines recommend the use of analgesics as first medicine of choice. In physiotherapy practice, the duration of complaints differs between patients with hip OA and patients with knee OA. There are no differences referred and non-referred patients. At this moment, patient- and treatment characteristics of patients with hip or knee OA are extracted from two separate registration networks. Patient characteristics differed significantly between referred patients in GP and referred patients in physiotherapy practice. Therefore, to enable longitudinal observation of care in patients with hip or knee OA, it is desirable to create a multidisciplinary registration network in which patient oriented data from different care providers is clustered. (aut. ref.)

Individualized smoking cessation treatment in an outpatient setting: Predictors of outcome in a sample with psychiatric and addictions co-morbidity

Objective Patients with psychiatric disorders have higher rates of smoking and greater difficulty quitting smoking. However, few studies have compared patients with schizophrenia or schizoaffective disorders to patients with other psychiatric diagnoses without psychosis, addressing ability to quit and differences in treatment characteristics. Method A retrospective chart review was conducted on a sample of 165 cigarette smokers admitted to an outpatient smoking cessation clinic located in a large inner-city psychiatric hospital. Patients with schizophrenia and schizoaffective disorder ( n = 55) were matched for age and sex at a ratio of 1:2 with a comparison group without psychosis ( n = 110) from the same clinic. Primary outcomes of interest were quit status (7-day point prevalence) and significant reduction in cigarettes per day (≥ 50% but not quit) at final treatment session. Results There were no significant differences between groups for end-of-treatment quit rate or significant reduction (≥ 50%) in cigarettes per day. Patients with schizophrenia made significantly more visits to the clinic and were in treatment for a longer period of time. A greater number of individual treatment sessions and being male were the most significant predictors of cessation. Conclusion Patients with schizophrenia were as likely to quit smoking as a comparison group of patients with a high rate of other psychiatric comorbidities without psychosis. Findings suggest treatment success in this population requires an extended number of clinic visits, group therapy, and possibly higher doses of nicotine replacement.

On‐demand vs. prophylactic treatment for severe haemophilia in Norway and Sweden: differences in treatment characteristics and outcome

Using an 11-year panel of 156 Norwegian and Swedish patients with severe haemophilia, and including retrospective case-book data from birth, we compared the differences in the haemophilia-related resource use between on-demand and prophylactic treatment. Patients treated on-demand had more surgery (arthrodeses, prostheses implantations and synovectomies) and more days lost from work. Median annual factor-concentrate consumption among adults (18+) was 211,000 IU [interquartile range (IQR) 154,000-268,000] or 3,024 IU kg-1 year(-1) for patients on prophylactic treatment and 55,000 IU (IQR 28,000-91,000) for on-demand patients (780 IU kg(-1) year(-1)). This was partly explained by the fact that the median dose per kg body weight was twice as great 28, (IQR 24-32) for prophylaxis compared with 14 (IQR 12-16) for on-demand. Prescribed dose per kg body weight was found to be an important factor explaining the variation in total annual factor-concentrate consumption per patient for both types of treatment. Other variables included in the panel-data regression analysis were the number of weeks on secondary prophylaxis for on-demand patients and age, body weight and type of haemophilia for children (0-17 years) on prophylaxis. Differences were consistently substantial and will affect both costs and benefits of the two treatment strategies.