Lower Charlson Score Research Articles

The safety and efficacy of low dose BCG intravesical instillation for the treatment of uremic or kidney transplant patients with recurrent urothelial carcinoma of the bladder

RFA. In this cohort, local recurrence-free survival (p 1⁄4 0.76) and metastases-free survival (p 1⁄4 0.51) were similar between PN and RFA. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p < 0.001 for all). In the RFA group, all patients have been biopsy before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated RFA treatment without recurrence. CONCLUSIONS: For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy. However, the long-term efficacy of these approaches remains to be established.

LB-S&T-28 GLYCINE TRANSPORTER TYPE 2 (GLYT2) INHIBITOR AMELIORATES AUTONOMIC DYSREFLEXIA DURING BLADDER HYDRODISTENTION AND DETRUSOR OVERACTIVITY IN IC/BPS RAT MODEL

RFA. In this cohort, local recurrence-free survival (p 1⁄4 0.76) and metastases-free survival (p 1⁄4 0.51) were similar between PN and RFA. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p < 0.001 for all). In the RFA group, all patients have been biopsy before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated RFA treatment without recurrence. CONCLUSIONS: For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy. However, the long-term efficacy of these approaches remains to be established.

Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy.

The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP). We retrospectively analyzed 1008 older patients (>70years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI<2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan-Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal 'Cut off' for CCI. The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan-Meier curve between two groups for non-cancer death and survival estimations for 5 and 10years shows significant worst outcomes for patients with CCI≥2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test. Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP.

Postoperative radiotherapy for pathologic N2 non-small-cell lung cancer treated with adjuvant chemotherapy: a review of the National Cancer Data Base.

To investigate the impact of modern postoperative radiotherapy (PORT) on overall survival (OS) for patients with N2 non-small-cell lung cancer (NSCLC) treated nationally with surgery and adjuvant chemotherapy. Patients with pathologic N2 NSCLC who underwent complete resection and adjuvant chemotherapy from 2006 to 2010 were identified from the National Cancer Data Base and stratified by use of PORT (≥ 45 Gy). A total of 4,483 patients were identified (PORT, n = 1,850; no PORT, n = 2,633). The impact of patient and treatment variables on OS was explored using Cox regression. Median follow-up time was 22 months. On univariable analysis, improved OS correlated with younger age, treatment at an academic facility, female sex, urban population, higher income, lower Charlson comorbidity score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT. On multivariable analysis, improved OS remained independently predicted by younger age, female sex, urban population, lower Charlson score, smaller tumor size, multiagent chemotherapy, resection with at least a lobectomy, and PORT (hazard ratio, 0.886; 95% CI, 0.798 to 0.988). Use of PORT was associated with an increase in median and 5-year OS compared with no PORT (median OS, 45.2 v 40.7 months, respectively; 5-year OS, 39.3% [95% CI, 35.4% to 43.5%] v 34.8% [95% CI, 31.6% to 38.3%], respectively; P = .014). For patients with N2 NSCLC after complete resection and adjuvant chemotherapy, modern PORT seems to confer an additional OS advantage beyond that achieved with adjuvant chemotherapy alone.

Comparison of Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses

BackgroundPartial nephrectomy (PN) is a preferred treatment for cT1 renal masses, whereas thermal ablation represents an alternative nephron-sparing option, albeit with higher reported rates of recurrence. ObjectiveTo review our experience with PN, percutaneous radiofrequency ablation (RFA), and percutaneous cryoablation for cT1 renal masses. Design, setting, and participantsA total of 1803 patients with primary cT1N0M0 renal masses treated between 2000 and 2011 were identified from the prospectively maintained Mayo Clinic Renal Tumor Registry. InterventionPN compared with percutaneous ablation. Outcome measurements and statistical analysisLocal recurrence-free, metastases-free, and overall survival rates were estimated using the Kaplan-Meier method and compared with log-rank tests. Results and limitationsOf the 1424 cT1a patients, 1057 underwent PN, 180 underwent RFA, and 187 underwent cryoablation. In this cohort, local recurrence-free survival was similar among the three treatments (p=0.49), whereas metastases-free survival was significantly better after PN (p=0.005) and cryoablation (p=0.021) when compared with RFA. Of the 379 cT1b patients, 326 patients underwent PN, and 53 patients were managed with cryoablation (8 RFA patients were excluded). In this cohort, local recurrence-free survival (p=0.81) and metastases-free survival (p=0.45) were similar between PN and cryoablation. In both the cT1a and cT1b groups, PN patients were significantly younger, with lower Charlson scores and had superior overall survival (p<0.001 for all). Limitations include retrospective review and selection bias. ConclusionsIn a large cohort of sporadic cT1 renal masses, we observed that recurrence-free survival was similar for PN and percutaneous ablation patients. Metastases-free survival was superior for PN and cryoablation patients when compared with RFA for cT1a patients. Overall survival was superior after PN, likely because of selection bias. If these results were validated, an update to clinical guidelines would be warranted. Patient summaryPartial nephrectomy and percutaneous ablation for small (<7-cm) and localized renal masses are associated with similar rates of local recurrence.

MP60-15 PATTERNS OF URINARY DIVERSION AFTER RADICAL CYSTECTOMY OVER THE PAST 20 YEARS: A POPULATION-BASED ANALYSIS

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 2014MP60-15 PATTERNS OF URINARY DIVERSION AFTER RADICAL CYSTECTOMY OVER THE PAST 20 YEARS: A POPULATION-BASED ANALYSIS Dustin Hyatt, Oluwakayode Adejoro, Sean Elliott, and Joel Slaton Dustin HyattDustin Hyatt More articles by this author , Oluwakayode AdejoroOluwakayode Adejoro More articles by this author , Sean ElliottSean Elliott More articles by this author , and Joel SlatonJoel Slaton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1769AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Over the past twenty years, there has been a large push within the urological community towards the greater use of catheterizable urinary pouches and neobladders when compared to ileal conduits. We performed a population-based analysis to determine current patterns of use and factors associated with choice of specific urinary diversions. Methods We interrogated the SEER-Medicare Database from the years 1992-2009 to identify all patients undergoing radical cystectomy for urothelial cancer and for specific choice of urinary diversion used. Parameters including age, race, gender, income, education, and stage of cancer were correlated with choice of urinary diversion. Results Among the 5892 cystectomy and urinary diversions that were performed, Continent urinary diversion (CUD) vs ileal diversions were performed in 14% in 1992. This percentage rose to 23-25% for the rest of the 1990’s but has gradually fallen off to 16-18% in the 2000’s. Receiving a CUD had a significant effect (Tis, Ta, T1 – 27%; T2 -21%; 19%) As might be expected the percentage of patients undergo a CUD decreased with age (65-69, 29%; 70-74, 22%; 75-79, 14%; and >80, 9%). With respect to gender, 21% of men had a CUD and 14% of women with the number in the latter group rising over the past 20 years. Race played a minimal part in decision making (Caucasian 18% vs nonwhite 22%). Regionally, the West perform 50% higher number of CD. The patients with the highest income (22% vs 13%), higher education (26% vs 17%) and lower Charlson score (0 vs 1, 21% vs 15%)had a higher change of obtaining a CUD. Conclusions Despite a large push among the urologic community over the past two decades, continent diversions appear to have peaked in the 1990’s and modestly fell off into the 2000’s. Patients receiving CUD were more likely to be male, young, better education, and higher income. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e638 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Dustin Hyatt More articles by this author Oluwakayode Adejoro More articles by this author Sean Elliott More articles by this author Joel Slaton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The prevalence of laparoscopy and patient safety outcomes: an analysis of colorectal resections

Although laparoscopic colorectal surgery is associated with faster postoperative recovery and shorter hospital stays than open surgery, perioperative patient safety analyses using process-focused, validated measures have yet to be performed. This study analyzed the U.S. Nationwide Inpatient Sample, a 20% weighted sample of inpatient hospital discharges, from 1998 to 2009. The study included patients who underwent open or laparoscopic colorectal resections and excluded those younger than 18years and those who underwent emergent or multiple colorectal operations. The primary outcome measure was surgery-specific patient safety indicators (PSIs). Uni- and multivariate regression methods were used to estimate associations of surgery type with PSIs. A total of 2,936,641 patients were identified, and 177,547 (6%) of these patients underwent laparoscopic colorectal resections. The laparoscopic patients were younger (p<0.001) and more likely to be Caucasian (p=0.005) and male (p<0.001), to have lower Charlson scores (p<0.001), and to undergo surgery in teaching hospitals (p<0.001) located in urban areas (p<0.001). The prevalence of laparoscopic surgery has increased rapidly in recent years, from 5 to 29% of all colorectal procedures performed in 2007 and 2009, respectively. The prevalence of any PSI was lower in the laparoscopic group (4.2 vs. 8.3%; p<0.001). Multivariate analyses showed that the likelihood of any PSI for laparoscopic colorectal resection was 57% lower than for open resections (odds ratio, 0.43; 95% confidence interval, 0.40-0.46; p<0.001). Laparoscopic colorectal surgery was associated with a lower risk of adverse patient safety events, a difference that became more pronounced as the prevalence of laparoscopy increased. Future studies should focus on factors that promote the safe adoption of innovative surgical techniques and optimize surgical outcomes.

Risk Models for Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP)

We investigated which variables independently associated with protection against or development of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and severity of PEP. Subsequently, we derived predictive risk models for PEP. In a case-control design, 6505 patients had 8264 ERCPs, 211 patients had PEP, and 22 patients had severe PEP. We randomly selected 348 non-PEP controls. We examined 7 established- and 9 investigational variables. In univariate analysis, 7 variables predicted PEP: younger age, female sex, suspected sphincter of Oddi dysfunction (SOD), pancreatic sphincterotomy, moderate-difficult cannulation (MDC), pancreatic stent placement, and lower Charlson score. Protective variables were current smoking, former drinking, diabetes, and chronic liver disease (CLD, biliary/transplant complications). Multivariate analysis identified seven independent variables for PEP, three protective (current smoking, CLD-biliary, CLD-transplant/hepatectomy complications) and 4 predictive (younger age, suspected SOD, pancreatic sphincterotomy, MDC). Pre- and post-ERCP risk models of 7 variables have a C-statistic of 0.74. Removing age (seventh variable) did not significantly affect the predictive value (C-statistic of 0.73) and reduced model complexity. Severity of PEP did not associate with any variables by multivariate analysis. By using the newly identified protective variables with 3 predictive variables, we derived 2 risk models with a higher predictive value for PEP compared to prior studies.

Automated peritoneal dialysis in Hong Kong: There are two distinct groups of patients

To compare the clinical outcome between continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) in specific subgroups of patients. We reviewed the clinical outcome of 90 consecutive incident APD patients and 180 CAPD patients in our centre. The median follow up was 21.9 months (inter-quartile range, 9.5 to 46.5 months). The APD group was younger and had a lower Charlson's score than the CAPD group. Furthermore, the APD group had a highly skewed distribution of the Charlson's score, indicating the possibility of two different groups of patients. Multivariate analysis showed that in addition to the treatment mode (APD vs CAPD) and Charlson's score, there was a significant interaction between the two (P = 0.043) on patient survival. For patients with Charlson's score ≤6, the APD group had a significantly better patient survival than the CAPD group (78.3% vs. 65.4% at 5 years, P = 0.039), while for patients with Charlson's score ≥7, the APD group had a worse patient survival than the CAPD group (16.3% vs. 48.4% at 5 years, P = 0.028). Similarly, Charlson's score and its interaction with treatment mode, but not the APD group per se, were independent predictors of technique survival (P = 0.013). For patients with Charlson's score ≥7, the APD group had a significantly lower technique survival than the CAPD group (8.8% vs. 34.3%, P = 0.001), while for patients with Charlson's score ≤6, the technique survival was similar (44.4% vs. 42.5%, P = 0.15). Peritonitis-free survival was 35.2% and 32.2% for APD and CAPD groups, respectively (P = 0.021), and the difference was not affected by Charlson's score. Comorbid diseases had a significant interaction with the mode of PD on patient and technique survival of incident PD patients. Our result suggests that APD may offer benefit in, and only in, young patients with minimal comorbid diseases.

Clinical findings of vertebral osteomyelitis: Brucella spp. versus other etiologic agents

We aimed to evaluate patients with vertebral osteomyelitis (VO) in our region and to compare the clinical and laboratory parameters of brucellar and non-brucellar VO patients (NBVO). This retrospective study included 80 patients with VO followed in our hospital between August 2004 and September 2010. The distribution of gender was 43 females (53.8%) and 37 males (46.2%) with average age of 52.5. Patients with brucellar vertebral VO (BVO; n = 30) accounted for 37.5% of all patients, and the rest (n = 50) were with NBVO. Co-morbidities existed in 32.5% of patients. In statistical comparison of VO patients who had the Brucella spp. as the infectious agent with patients of VO by non-brucellar pathogens, the following factors were found out to be significantly associated with BVO; low Charlson score (P = 0.0001), lower co-incidence with chronic renal failure (P = 0.001), high frequency of constitutional symptoms (P = 0.006), fever (P = 0.005), low-level inflammatory markers (WBC; Neutrophil; ESR; CRP, P values 0.006; 0.001; 0.022; 0.002, respectively), low-rate surgical treatment (P = 0.02) and culture positivity (P = 0.0001) and higher hemoglobin, total protein, albumin values (P = 0.002; 0.032; 0.016, respectively). VO may be strongly associated with brucellosis in patients presenting with fever and symptoms, low Charlson score and indistinct inflammatory markers.

Who Doesn’t Authorize the Linking of Survey and Administrative Health Data? A General Population-based Investigation

To determine the extent of authorization bias in a study linking survey and medical record data in a general population-based investigation. Authorization status (authorized data linkage vs. not) was ascertained through a sequential mixed mode mail and telephone survey conducted in Olmsted County, MN. Respondents (regardless of authorization status) were linked to the Rochester Epidemiology Project (REP), the medical record system for health care providers in Olmsted County. The REP provided data on gender, age, race, health status (co-morbid conditions), and health care utilization (ER admission, hospital admission, clinical office visits and procedures). Authorizers (n=1357) are compared to non-authorizers (n=217) with respect to these demographic and clinical characteristics. 86.2% of respondents authorized data linkage. Non-authorizers were younger, healthier (lower Charlson score), and less likely to have 3 or more recent clinical office visits. In multivariate analysis, Charlson score was no longer a significant predictor of authorization while an ER visit did predict authorization. Younger subjects are less likely to authorize data linkages. As such, researchers should be aware of this source of potential bias when analyzing population-based linked survey and administrative data. The presence of bias with respect to health care use is more complicated. It is dependent on how the concept is operationalized with heavy clinical users more likely to authorize and those with ER visits less so.

Disparities in Utilization of High-Volume Hospitals for Cancer Surgery: Results of a Korean Population-Based Study

Referral to high-volume hospitals has been recommended for cancer procedures with a demonstrated volume-outcome relationship. However, little is known about the factors associated with use of high-volume hospitals for cancer procedures. The purpose of this study was to determine patient characteristics associated with receipt of oncologic surgery at high-volume hospitals. Data were obtained from claims submitted to the Korean National Health Insurance System. We identified patients who underwent the following procedures between 2002 and 2005: esophagectomy, pancreatectomy, gastrectomy, colectomy, lung resection, mastectomy, and cystectomy. Each hospital volume was divided into tertiles. Patient demographic, socioeconomic, and clinical variables were investigated as factors that may affect use of high- or low-volume hospitals. A total of 49,897 patients received one of the seven procedures. Trends toward lower operative risks at high-volume hospitals were observed for all procedures. Patients who were older [odds ratio (OR), 0.60-0.69], lived in a rural area (OR, 0.79), had emergent surgeries (OR, 0.39-0.85), and had lower Charlson score were less likely to go to high-volume hospitals. For all procedures, patients having the lowest income level were significantly less likely to be treated at high-volume hospitals, compared with patients having the highest income level (OR, 0.45-0.58). We identified substantial demographic and socioeconomic disparities in use of high-volume hospitals for the seven procedures examined. The policy for selective referral to high-volume hospitals should include explicit efforts to identify patient and system factors required to reduce current inequities.

Comparing the Characteristics, Utilization, Efficiency, and Outcomes of VA and Non-VA Inpatient Care Provided to VA Enrollees

To compare the characteristics, utilization, and outcomes of Veterans Health Administration (VA) and non-VA inpatient care provided to VA enrollees in New York. Using VA and New York State administrative and clinical databases, we conducted a retrospective study examining 110,716 residents of New York State who were enrolled in the VA and had 266,869 inpatient admissions in VA and non-VA hospitals in New York. For each admission, we determined the system of care used (VA or non-VA), patient demographics, and characteristics of the admission, and we calculated VA patients' relative reliance on the VA for inpatient care. For each Major Diagnostic Category (MDC), we examined reliance, patient characteristics, and lengths-of-stay for 2 groups: veterans who were younger than age 65 and those age 65 or older. Fifty-three percent of younger patients' inpatient admissions were in the VA, whereas 32% of older patients' were; however, relative reliance on the VA varied dramatically across the 19 MDCs examined. Across age groups, patients admitted to VA hospitals were younger, less likely to be white, and less likely to live in a rural setting. Those using VA hospitals had lower Charlson scores and received less complex care. For both age groups and across all MDCs, admissions to VA hospitals had substantially higher diagnosis related group-specific observed-to-expected lengths-of-stay. Younger and older veterans use VA and non-VA hospitals differently for inpatient services. Comprehensive inpatient datasets could inform planners about VA's service market and VA managers about achievable performance benchmarks that are relevant to VA's service population.

Comprehensive Geriatric Assessment (CGA): Reliable tool for tailored oncologic treatment

20679 Background: Aging is a process different from person to person, which is influenced by several factors. Comprehensive Geriatric Assessment (CGA) should lead to a more scientific approach to the elderly cancer patient, aimed to the identification and sometimes treatment of oncological and medical problems. Methods: We have ideated GONG model for CGA with the purpose of selecting patients eligible for oncological treatment or supportive care only, and then used it to evaluate 351 patients from April 2004 to 0ctober 2007. Results: Their mean age was 76.4 years old (22.81% were older than 80), male/female ratio was 1.2. Distinguish three categories of patients: frail; border-line (frail patients with a good functional status but Charlson Index > 8, or a bad functional status with a low Charlson score); and not frail. Our evaluation included also nutritional, psychological and cognitive assessment. 39 patients were classified as frail (11.11%), 77 as border-line (21.94%), 235 as not frail (66.9%). In the...

A retrospective analysis of patient characteristics and the treatment experience of elderly oncology patients in Kingston, Ontario, Canada

20628 Background: A 2005 study of treatment practices of elderly patients diagnosed before 2000 in Ontario, concluded that age remains a cause of disparity in cancer delivery and that this has remained unchanged over a 30 year period (Journal of Clinical Oncology 23:3802–10). Methods: We performed a retrospective chart review of all elderly patients (age ≥ 75 yrs) referred to the Cancer Centre of Southeastern Ontario in 2006. Patients were identified by a computer search. We collected data on patient demographics (age, gender, marital status, Charlson comorbidity score, cancer type, stage) and treatment (type, intent, acceptance/refusal). Results: A total of 454 patients, representing 17% of all new referrals, were identified. Patient characteristics were as follows: median age 80.0 yrs (75–99), males 49%, married 44.3%, patients with Charlson comorbidity score ≥5 41%. The commonest cancer sites were: gastrointestinal (22%), breast (17%), genitourinary (16%) and lung (15%). 39% of patients had undergone surgery with curative intent; 35% were referred for consideration of palliative treatments. Treatment was discussed and/or recommended as follows: chemotherapy 44%, hormonal therapy 22%, radiation 62%. Acceptance rates were highest for hormonal therapy (92%), intermediate for radiation (77%) and lowest for chemotherapy (47%). 21% of patients did not receive any cancer treatment. In bivariate analysis, the following factors were associated with a higher probability of accepting therapy: chemotherapy - non-palliative intent (p< 0.001), lower Charlson score (≤5) (p=0.003), type of cancer (p<0.001); hormonal therapy - male gender (p=0.036); radiation - married status (p=0.056), age <80 yrs ((p=0.04). Conclusions: We conclude: 1) elderly patients represent a significant proportion of all new referrals to our centre; 2) a substantial portion are referred for consideration of palliative treatments for advanced disease; 3) although hormonal therapy and radiation are associated with high acceptance rates, acceptance rates for chemotherapy are substantially lower, especially in pts with higher Charlson comorbidity scores and in the palliative setting. No significant financial relationships to disclose.

Impact of Comorbidity on Colorectal Cancer Screening in the Veterans Healthcare System

The quality assessment measure of colorectal cancer screening in the veteran's health system reports the proportion of patients aged 52-80 years who were tested. This approach does little to assess for comorbid illnesses, which might limit the utility of screening. Our aim was to determine the relationship between patient comorbidity and screening by fecal occult blood test in a national sample of veterans. We examined the Veterans Health Administration's national databases (October 2003-February 2005) for a random sample of primary care patients, aged > or = 50 years. The Charlson score, a validated measure of comorbidity burden, was calculated from diagnosis codes by the Deyo method. The association between Charlson score and colorectal cancer screening was assessed with logistic regression. The sample of 77,268 was 97% men; mean age was 67 years. Charlson score distribution was 0, 45%; 1, 24%; 2, 14%; 3, 7%; 4, 4%; 5, 2%; 6, 1%; 7, 0.8%; 8, 0.6%; 9, 0.4%; > or = 10, 1%. Overall there was no consistent significant association between Charlson score and use of fecal occult blood testing except in the sickest 1%. There was a strong and incremental relationship between Charlson score and 1-year mortality. Although there was a strong relationship in the veteran population between the Charlson score and survival, colorectal cancer screening utilization was not impacted by Charlson score. Instead, resources were expended evenly throughout the population, rather than directed toward screening the patients with the most life-years at stake. The quality measure for colorectal cancer screening should be modified to account for patient comorbidity.

A Tale of Two Time Periods: Ovarian Cancer Trends in Ontario

We assessed population-based trends in incidence and survival rates for epithelial ovarian cancer in Ontario in two time periods. Our population-based study cohort included all women with epithelial ovarian cancer treated initially with abdominal surgery in Ontario for January 1996 through December 2001. Incident surgical cases were documented by hospital contact data and the Ontario Cancer Registry. Patient characteristics (age, for example) were obtained from electronic administrative data records. Regression analyses were used to assess the influence of time period on survival while controlling for age, comorbidity, and other factors associated with this outcome.A total of 3825 women met the inclusion criteria. We found that the age-standardized incidence of ovarian cancer remained stable during 1996-2001. A shift to a younger age at diagnosis was found between the two time periods being compared. The univariate analysis revealed a clear difference in death rate, to which age at diagnosis, Charlson comorbidity score, and treatment period contributed. Earlier time period (p < 0.0001), advancing age (p < 0.0001), higher Charlson score (p < 0.0001), and lower income quartile score (p = 0.03) were significantly associated with poorer survival in the univariate analysis. Younger age, lower Charlson score, and more recent time period of diagnosis and treatment (p < 0.0001) were associated with improved survival in the proportional hazards model.We conclude that age-standardized incidence and mortality rates for ovarian cancer in Ontario have remained stable. For women initially treated with surgery, advances in management have led to an improvement in survival.

Systemic therapy (ST) in cancer patients ≥ 80 years of age: A Manitoba population-based assessment

6090 Background: Little is known about the cancer characteristics, treatment options and outcomes in the oldest subset of the elderly, those ≥ 80, who develop cancer. Methods: We employed a population-based, cross-sectional design utilizing the provincial cancer registry and administrative data augmented by clinic-specific retrospective chart review to study the demographics, treatment and outcomes of patients ≥ 80 diagnosed with cancer in the years 2002–2003 in Manitoba, Canada. We assessed treatment patterns for various subgroups (analyzed using chi-square and Fisher’s exact tests to determine association, as appropriate) and associated survival. Results: Our cohort included 2,194 patients. This represented 20.8% of all incident cases. The median age was 84 (range: 80–102), with a slight preponderance of females (53%). As expected, prostate, lung, and colorectal cancers were most common for males with breast, lung, and colorectal cancer being most common for females. Only 241 (10.9%) of the cohort were referred to the central cancer centre for consideration of ST which was less than the overall referral rate of 33%. Of those referred, 57% did not receive ST, 20% received palliative ST, and 23% received adjuvant/curative ST. The two year survival rates were statistically significant by treatment categories (not referred = 39%, referred but who did not receive ST = 39%, palliative ST = 27%, and adjuvant/curative ST = 76%,) (p&lt;0.0001). The Charlson score for those patients referred who received ST was lower than those who did not receive ST (p&lt;0.0001) Conclusions: Our data indicate that in patients ≥ 80 years of age with cancer, few are referred to the central cancer clinic for ST. Of those referred, patients who receive adjuvant/curative intent ST live longer then those not receiving ST. Lower Charlson scores (indicative of fewer comorbidities and better general health) were found more often in patients receiving ST. No significant financial relationships to disclose.