Non-cancer Mortality Research Articles

The healthy eating index may not be an appropriate indicator for assessing dietary quality in breast cancer survivors: results from NHANES 2005-2018.

Evidence on the relationship between the Healthy Eating Index (HEI) and mortality in breast cancer (BC) survivors remains inconclusive. Moreover, rare studies have explored the effect of individual HEI components on survival in this population. This study explored the association between the HEI-2020, including total and 13 component scores, and mortality in BC survivors. This cross-sectional study included data of 481 female BC survivors (representing a 3.3 million population) obtained from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. The HEI-2020 total and component scores (higher scores indicating superior dietary quality) were calculated based on the 24 h dietary recall interview. Data on mortality until December 31, 2019, were obtained from the NHANES Public-Use Linked Mortality File. The weighted Cox proportional hazards models were used to assess the association between HEI-2020 and mortality outcomes. After fully adjusting for confounders, a qualified total HEI-2020 score (≥60) was significantly associated with reduced non-cancer mortality (HR 0.59, 95%CI: 0.35-0.99), but not with all-cause or cancer-specific mortality. Among the 13 HEI components, a lower intake of added sugars (with a qualified component score) was linked to a decreased risk of both all-cause and non-cancer mortality (HR 0.44 and 0.25, 95%CI: 0.25-0.77 and 0.13-0.48, respectively, all p < 0.05). Conversely, higher consumption of seafood and plant proteins (with a qualified component score) correlated with an increased risk of cancer-specific mortality (HR 3.64, 95%CI: 1.57-8.45), and a higher intake of dairy was associated with an elevated risk of both all-cause and non-cancer mortality (HR 2.12 and 2.81, 95%CI: 1.36-3.29 and 1.56-5.07, respectively). Higher total and component scores of the HEI-2020 do not uniformly confer a lower mortality risk for BC survivors. The HEI-2020 may not be an appropriate indicator for post-diagnosis dietary assessment or recommendations for BC survivors.

Combined effects of nutrition, inflammatory status, and sleep quality on mortality in cancer survivors

BackgroundCancer survivors face many challenges in long-term health management, including malnutrition, systemic inflammation, and sleep issues, which significantly affect their survival and quality of life.MethodsA prospective cohort study was derived from the National Health and Nutrition Examination Survey from 2005–2018 harboring 1,908 cancer survivors (weighted population, 11,453,293), of whom 688 deaths (220 from cancer mortality, 468 from non-cancer mortality). The Advanced Lung Cancer Inflammation Index (ALI) was used as a measure of nutritional status and systemic inflammation in cancer patients. Weighted multivariable Cox proportional hazards regression models were utilized to explore the independent and combined effects of ALI and sleep quality on mortality outcomes.ResultsThe participants with a high ALI were more likely to be female, aged 40 to 64 years, non-Hispanic white, and have a higher BMI. We observed that elevated ALI levels were associated with decreased risks of all-cause mortality (Hazard ratio [HR] = 0.601, 95% Confidence interval [CI] = 0.521–0.695, P < 0.001), cancer-specific mortality (HR = 0.659, 95% CI = 0.497–0.870, P = 3.34 × 10–3) and non-cancer-specific mortality (HR = 0.579, 95% CI = 0.478–0.701, P < 0.001). Similarly, better sleep quality (e.g., without sleep troubles) was associated with lower risks of all-cause mortality (HR = 0.761, 95% CI = 0.620–0.933, P = 8.79 × 10–3) and non-cancer-specific mortality (HR = 0.713, 95% CI = 0.572–0.890, P = 2.80 × 10–3). Notably, the joint analysis showed that cancer survivors with higher ALI levels and better sleep quality (e.g., standard sleep duration) had the lowest risks of all-cause (HR = 0.468, 95% CI = 0.352–0.622, P < 0.001), cancer-specific mortality (HR = 0.631, 95% CI = 0.333–0.672, P = 7.59 × 10–3) and non-cancer-specific mortality (HR = 0.440, 95% CI = 0.315–0.615, P < 0.001).ConclusionsThis study suggests that better nutritional and inflammatory status, combined with good sleep quality, may contribute to improved survival among cancer survivors. These results underscore the potential clinical importance of integrating nutritional and sleep quality assessments into the long-term care of cancer survivors to enhance their overall prognosis.

Cancer incidence and competing mortality risk following 15 presenting symptoms in primary care: a population-based cohort study using electronic healthcare records

·ObjectivesAssessment of age, sex and smoking-specific risk of cancer diagnosis and non-cancer mortality following primary care consultation for 15 new-onset symptoms.Methods and analysisData on patients aged 30–99 in 2007–2017 were...

Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study

ObjectiveTo prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years).DesignProspective cohort studySettingThe Nurses’ Health Study II, United States...

Correlation between environmental DEET exposure and the mortality rate of cancer survivors: a large-sample cross-sectional investigation

BackgroundN, N-Diethyl-meta-toluamide (DEET) is the predominant active ingredient found in insect repellents utilized by consumers. Exposure to DEET has been associated with notable risks to human health. Nonetheless, there is a scarcity of extensive cohort studies investigating the precise correlation between DEET exposure and mortality rates among cancer survivors. The objective of this study is to thoroughly evaluate the connection between DEET exposure and mortality rates in cancer survivors.MethodsThis study employed individual samples obtained from the National Health and Nutrition Examination Survey (NHANES). Utilizing data from NHANES spanning 2007 to 2016, this study incorporated a cohort of 5,859 cancer survivors for subsequent analysis, following the exclusion of incomplete datasets. Through subgroup analysis, the research examined the impact of quartile levels of 3-diethyl-carbamoyl benzoic acid (DCBA), the primary metabolite of DEET, on cancer survivors across various subgroups within the broader population. Furthermore, the research utilized a multivariable Cox proportional hazards regression model and Kaplan-Meier (KM) curves to investigate the relationship between 3-diethyl-carbamoyl benzoic acid (DCBA), a principal metabolite of DEET, and mortality rates in individuals who have survived cancer.ResultsThe study identified an association between specific quartiles of DCBA concentration and a decreased risk of all-cause mortality among cancer survivors, specifically in the second (Q2: 0.665–1.95) and third quartiles (Q3: 1.95–6.845). Furthermore, a significant correlation was observed between the third quartile and cancer-specific mortality (Q3: 1.95–6.845), as well as between the second quartile and non-cancer mortality (Q2: 0.665–1.95). The quartiles of DCBA concentration exhibit a statistically significant correlation with total deaths (P < 0.001), cancer-specific deaths (P = 0.009), and non-cancer deaths (P < 0.001) among cancer survivors. The correlation between DCBA and reduced mortality risk in cancer survivors is particularly notable among females and individuals of non-Hispanic Black descent.ConclusionThe detection of DCBA in the urine of adult cancer survivors is strongly associated with increased mortality risks, particularly among females and non-Hispanic Black individuals, warranting further investigation and targeted interventions.

Abstract 4136040: Wearable Device-Measured Physical Activity and Incident Cardiovascular Diseases In Cancer Survivors

Background: Cardiovascular diseases (CVD) is the leading cause of non-cancer mortality among cancer survivors. Despite the known benefits of physical activity on cardiovascular health in the general population, evidence regarding post-diagnosis physical activity and CVD risk among cancer survivors is limited. Objectives: To explore the associations of wearable device-measured moderate-to-vigorous intensity physical activity (MVPA) with CVD risk in long-term cancer survivors. Methods: The retrospective analysis involved a prospective cohort of 6109 cancer survivors without CVD from the UK Biobank accelerometry subsample. Cancer diagnoses were obtained from national cancer registries (International Classification of Diseases-10 [ICD-10], C00-C97, except for non-melanoma skin cancer, in situ, and non-well-defined cancers), and participants were followed up through December 31, 2022. A machine-learning algorithm was utilized to categorize MVPA into four groups based on guideline-recommend MVPA duration (0-75 min/week, 75-150 min/week, 150-300 min/week, ≥300 min/week). Results: Over a median follow-up of 7.88 years, there were 539 incident CVD events, including 361 incident CAD events, 155 incident HF events, and 109 incident stroke events. A clear inverse linear dose-response relationship between MVPA volume and the incidence of CVD was observed (P for nonlinear=0.49), with no maximal threshold for the benefits. Adjusted CVD incidence rates (95% confidence intervals [CIs]) across MVPA groups (0-75 min/week, 75-150 min/week, 150-300 min/week, ≥300 min/week) were 15.30 (12.90, 18.10), 13.50 (11.00, 16.40), 12.00 (10.20, 14.10), and 9.86 (8.35, 11.60) per 1000 person-years, respectively. Adjusted hazard ratios (95% CI) for CVD, CAD, HF, and stroke in the highest MVPA group (≥300 min/week) compared with those with the lowest MVPA group (0-75 min/week) were 0.63 (0.49, 0.80), 0.68 (0.51, 0.91), 0.66 (0.42,1.06), 0.72 (0.42, 1.23), respectively. Conclusions: Findings from the UK Biobank study suggest that longer durations of MVPA are associated with reduced incident CVD risk in cancer survivors, particularly in CAD risk reduction, underscoring the potential for physical activity to serve as a key component in cardio-oncology care.

Commercial prices and their influence on urology practices: Prostate cancer care among men with Medicare.

For men with prostate cancer, there is substantial variation in the use of conservative management, such as active surveillance. Commercial prices, which vary across urology practices, may afford incentives that foster physician behaviors associated with utilization. Such behaviors may "spillover" to the Medicare population and affect quality. This study evaluated the effects of practice-level commercial prices on health care utilization and quality in men with prostate cancer insured by traditional Medicare. From a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer between 2014-2019 (n=44,653). Using commercial payments from the MarketScan database, they developed a practice-level commercial price index (ratio of commercial prices to Medicare prices). They examined the association of the price index with price standardized spending, overtreatment (treatment among those with >50% noncancer mortality within 10 years), and underuse of diagnostic testing in active surveillance (at least one prostate-specific antigen test and one confirmatory test-MRI, prostate biopsy, genomic test-within 12 months of diagnosis). Practice-level commercial price indices varied from 1.34 (134% of Medicare prices), for practices in the bottom decile, to 3.00, for practices in the top decile. Increasing price index was associated with lower odds of overtreatment (odds ratio, 0.86; 95% confidence interval, 0.76-0.97; p=.01), but not price standardized spending or underuse of diagnostic testing in active surveillance. Commercial prices vary markedly across urology practices. Among newly diagnosed men with traditional Medicare, those managed by practices with higher commercial price indices had lower odds of overtreatment, suggesting improved prostate cancer care quality.

Suitable temperature indicator for adverse health impacts in sub-tropical cities: a case study in Hong Kong from 2010-2019

Heat-health warning systems and services are important preventive actions for extreme heat, however, global evidence differs on which temperature indicator is more informative for heat-health outcomes. We comprehensively assessed temperature predictors on their summer associations with adverse health impacts in a high-density subtropical city. Maximum, mean, and minimum temperatures were examined on their associations with non-cancer mortality and hospital admissions in Hong Kong during summer seasons 2010–2019 using Generalized Additive Models and Distributed Lag Non-linear Models. In summary, mean and minimum temperatures were identified as strong indicators for mortality, with a relative risk(RR) and 95% confidence interval(CI) of 1.037 (1.006–1.069) and 1.055 (1.019–1.092), respectively, at 95th percentile vs. optimal temperature. Additionally, minimum temperatures captured the effects of hospital admissions, RR1.009 (95%CI: 1.000- 1.018). In stratified analyses, significant associations were found for older adults, female sex, and respiratory-related outcomes. For comparison, there was no association between maximum temperature and health outcomes. With climate change and projected increase of night-time warming, the findings from this comprehensive assessment method are useful to strengthen heat prevention strategies and enhance heat-health warning systems. Other locations could refer to this comprehensive method to evaluate their heat risk, especially in highly urbanized environments and subtropical cities.

Association of Life's Essential 8 metrics with mortality outcomes in US cancer survivors

Abstract Aims The increased in global cancer survivors and treatment complications has created an unmet need for effective long-term health strategies. This study aimed to evaluate the relationship between LE8 and all-cause, cancer-specific, and non-cancer mortality in cancer survivors in the US. Methods A prospective cohort study was conducted using a nationally representative sample of cancer survivors, age 40 years or older (n = 2205), derived from the US. Cancer diagnoses were determined through face-to-face interviews, while health status was gauged using the LE8 score on a scale of 0-100. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations of overall and individual component of LE8 with overall, cancer-specific, and noncancer mortality, respectively. Result Among the 2205 participants (mean [SE] age, 66.4 [0.4] years; 54.1% females; 87.4% non-Hispanic White ethnicity), the average LE8 score was 65.5 ± 0.4, with diet having the lowest (45.5 ± 1.0) and the highest scores attributed to sleep (85.1 ± 0.7). During the up to 5.7 years follow-up period, 526 deaths were documented, comprising 174 cancer-related, 123 cardiovascular disease-related, and 229 from other causes. A high LE8 score was linked to a 71% reduction in all-cause mortality risk (HR: 0.29, 95% CI: 0.16-0.54) as well as significant reduction in the risk of cancer deaths (HR: 0.34, 95% CI: 0.13-0.88) and non-cancer deaths (HR: 0.26, 95% CI: 0.13-0.52). Higher LE8 scores were still correlated with reduced mortality in cancer survivors without cardiovascular conditions, while adherence to certain health behaviors was tied to a lower death risk. Conclusions In this study, high LE8 scores, especially the health behaviors component, were strongly associated with extended life expectancy and lower mortality rates.

Sleep characteristics in relation to cardiovascular disease incidence and mortality in individuals with diabetes

Abstract Background/Introduction Evidence regarding the potential health effects of sleep characteristics among individuals with type 2 diabetes (T2D) is limited. Purpose We aimed to examine sleep characteristics in relation to subsequent risk of cardiovascular disease (CVD), including coronary heart disease (CHD), and stroke, and all-cause and cause-specific mortality among individuals with T2D. Methods We prospectively followed 21,902 men and women with T2D at baseline or diagnosed during follow-up (Nurses' Health Study: 1986-2018, Health Professionals Follow-Up Study: 1986-2018). Sleep characteristics, including sleep duration, snoring, sleep apnea, and sleep quality, were repeatedly assessed using self-reported questionnaires at baseline and follow-up. Associations of sleep characteristics with CVD risk and mortality were assessed using Cox proportional hazards models with adjustments for demographic, dietary and lifestyle factors, and medical history. Results During 170,355 and 196,458 person-years of follow-up in participants with T2D, there were 2,486 incident CVD events and 3,922 deaths, respectively. Compared with sleeping for 7-8 h/day, the multivariable-adjusted hazard ratios (HRs) of sleeping for ≤5 h/day were 1.21 (1.02, 1.45) for CVD incidence, 1.24 (1.20, 1.51) for CHD incidence, 1.40 (1.24, 1.58) for total mortality, 1.52 (1.20, 1.92) for CVD mortality, and 1.27 (1.01, 1.61) for other non-CVD and non-cancer mortality, while the HRs of ≥10 h/day were 1.42 (1.21, 1.66) for total mortality, and 1.63 (1.20, 2.10) for other non-CVD and non-cancer mortality. Furthermore, compared with participants without habitual snoring, those with habitual snoring had a 21%, 24%, 18%, and 33% higher risk for CVD incidence, CHD incidence, CVD mortality, and total mortality, respectively. Compared with participants without diagnosed sleep apnea, those with sleep apnea had a 27%-58% higher risk for CVD incidence, CVD mortality, and total mortality. In addition, lower habitual sleep quality, including sleep difficulties and restless sleep, was associated with a substantially higher risk of CVD, CHD, or CVD mortality. No associations were observed between sleep characteristics with risk of stroke and cancer mortality in individuals with T2D. Conclusions Short and long sleep durations as well as habitual snoring, sleep apnea, and lower sleep quality were independently associated with higher risks of CVD incidence and mortality, particularly CVD mortality in individuals with T2D.

Relative burden of cancer and noncancer mortality among long-term survivors of differentiated thyroid cancer in the US.

Limited information is available regarding the relative risks of cancer-specific mortality and noncancer-specific mortality among long-term survivors with differentiated thyroid cancer (DTC). In this retrospective study, nationwide data from the Surveillance, Epidemiology, and End Results database (1992-2020) were utilized. The Accelerated Failure Time Model was applied to calculate Survival Time Ratios (TR), with the primary focus on mortality resulting from DTC. The competing risks model was employed to investigate the relative risks of various outcomes in DTC patients with a survival duration of 5 years or more. In our cohort, 279 patients succumbed to DTC, while 748 died from other diseases. Notably, in DTC cohorts, noncancer-specific mortality rates were consistently higher than DTC-specific mortality rates across different age groups and genders. The risk of DTC and noncancer-specific mortality varied based on the TNM stage. With more advanced disease stages, the risk of DTC and other cancer-specific mortality gradually increased. The cumulative mortality from other cancer-specific causes was consistently the lowest. In long-term surviving DTC patients, noncancer-specific mortality outweighed DTC-specific mortality irrespective of age and gender. For stage I and II patients, increased attention should be directed toward noncancer-specific mortality in postoperative follow-ups. Conversely, for stage III and IV patients, greater consideration should be given to DTC-related causes of death. In addition, for stage III and IV DTC patients, the risk of death from other cancers was significantly higher than for stages I and II.

608. ASSOCIATION BETWEEN SYSTEMIC IMMUNE-INFLAMMATION INDEX (SII) AND THE RISK OF ALL-CAUSE, CANCER, AND NON-CANCER MORTALITY IN THE GENERAL POPULATION

Abstract Background The system immune-inflammation index (SII), based on the counts of platelet, neutrophil and lymphocyte, was recognized as an accurate immunoinflammatory predictor. In order to identify the association between SII with all-cause, cancer and non-cancer mortality among general population, we conducted this prospective cohort study. Methods 25955 participants (≥ 18 years) were included from 2005-2018 National Health and Nutrition Examination Survey (NHANES) and grouped according to the SII quartiles. The association between SII and mortality was identified by multivariate Cox regression and restricted cubic spline (RCS) analyses. Survival outcomes were assessed using Kaplan-Meier analyse. Results In fully adjusted model, the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) of individuals in Q4 of SII were 1.24 (1.09, 1.41) for all-cause mortality and 1.41 (1.23, 1.63) for non-cancer mortality compared with Q1. The aHR and 95% CIs in Q2 of SII were 0.70 (0.50, 0.99) and in Q3 were 0.68 (0.52, 0.87) compared with Q1 for cancer mortality. In RCS analyses, J-shaped curves were observed in the association between SII with all-cause and non-cancer mortality. Additionally, a U-shaped curve was identified between SII and cancer mortality with a threshold SII value of 445.22. Conclusion Therefore, our findings imply that SII can serve as a potential prognosis indicator among general population. Elevated SII is associated with higher all-cause and non-cancer mortality. Besides, both lower and higher SII can serve as predictive factors for cancer mortality.

Mortality follow-up of Fernald Feed Materials Production Center workers exposed to uranium from 1951 to 1985

ObjectiveThis follow-up study of uranium processing workers at the Fernald Feed Materials Production Center examines the relationship between radiation exposure and cancer and non-cancer mortality among 6403 workers employed for...

225. LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED VERSUS CONVENTIONAL OPEN ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: PROPENSITY-SCORE MATCHED ANAYLSIS

Abstract Background This study aimed to compare the long-term oncologic outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) with those of conventional open esophagectomy (OE) for esophageal cancer. Methods Between January 2006 and December 2021, 1,745 consecutive patients underwent esophagectomy for esophageal cancer at our institution. Among them, we retrieved 1,133 patients (mean age 63.1±7.8 years, 86 [7.6%] women, 1,100 [97.1%] squamous cell carcinomas), who were operated by a single surgeon. These patients were categorized into following two groups based on their surgical approaches: RAMIE (n = 497) and OE (n = 636). The RAMIE and OE groups were matched in a 1:1 ratio using propensity scores. Results Median follow-up was 51.8 months. Five-year overall survival (OS, 70.7% vs. 55.0%) and recurrence-free survival (RFS, 63.3% vs. 50.1%) rates were significantly higher in RAMIE than in OE group (P &amp;lt; 0.01). Following propensity-score matching, 886 patients (443 pairs) were successfully matched, demonstrating no significant intergroup differences. The RAMIE group consistently demonstrated enhanced OS (70.4% vs. 61.8%, P &amp;lt; 0.01) and RFS (62.8% vs. 55.8%, P=0.04) after five years, even after adjustment (Figure). The rate of noncancer mortality was significantly higher in the OE group (P &amp;lt; 0.01), whereas the esophageal cancer-related mortality showed no significant differences (P = 0.25). Conclusions RAMIE could be a safer and more feasible option for patients compared with conventional open esophagectomy with favorable long-term oncologic outcomes.

A competing risks machine learning study of neutron dose, fractionation, age, and sex effects on mortality in 21,000 mice

This study explores the impact of densely-ionizing radiation on non-cancer and cancer diseases, focusing on dose, fractionation, age, and sex effects. Using historical mortality data from approximately 21,000 mice exposed to fission neutrons, we employed random survival forest (RSF), a powerful machine learning algorithm accommodating nonlinear dependencies and interactions, treating cancer and non-cancer outcomes as competing risks. Unlike traditional parametric models, RSF avoids strict assumptions and captures complex data relationships through decision tree ensembles. SHAP (SHapley Additive exPlanations) values and variable importance scores were employed for interpretation. The findings revealed clear dose–response trends, with cancer being the predominant cause of mortality. SHAP value dose–response shapes differed, showing saturation for cancer hazard at high doses (> 2 Gy) and a more linear pattern at lower doses. Non-cancer responses remained more linear throughout the entire dose range. There was a potential inverse dose rate effect for cancer, while the evidence for non-cancer was less conclusive. Sex and age effects were less pronounced. This investigation, utilizing machine learning, enhances our understanding of the patterns of non-cancer and cancer mortality induced by densely-ionizing radiations, emphasizing the importance of such approaches in radiation research, including space travel and radioprotection.

Racial and ethnic disparities in mortality among World Trade Center Health Registry enrollees with post-9/11 cancer.

There are well-documented racial and ethnic disparities in mortality after cancer in the general population, but less is known about whether disparities also exist in disaster-exposed populations. We conducted a longitudinal cohort study of 4341 enrollees in the World Trade Center Health Registry (WTCHR) with a first-ever primary invasive cancer diagnosis after 9/11/2001 and followed through 2020. We examined associations of race and ethnicity with all-cause mortality risk and cause-specific mortality risk using multivariable Cox proportional hazards regression models and Fine and Gray's proportional sub-distribution hazards models, respectively. Models were adjusted for baseline characteristics and tumor characteristics. We also examined models further adjusted for socioeconomic status (SES), and we used inverse odds weighting to formally test for mediation by SES. Compared to non-Hispanic White enrollees with cancer, non-Hispanic Blacks had higher risks for all-cause mortality (adjusted hazard ratio (aHR) = 1.20, 95% CI = 1.02-1.41) and non-cancer mortality (aHR = 1.48, 95% CI = 1.09-2.01) in the full model. In the model without SES, Hispanic enrollees with cancer had higher risks for all-cause mortality (aHR = 1.32, 95% CI = 1.09-1.60) and cancer mortality (aHR = 1.31, 95% CI = 1.05-1.64) compared to non-Hispanic Whites; these associations became not statistically significant in the full model. In the inverse odds weighting analysis, SES explained 24% and 29% of the disparity in all-cause mortality risk observed in non-Hispanic Blacks and Hispanics, respectively, compared to non-Hispanic Whites. This study found that there are racial and ethnic disparities in mortality after cancer in the WTCHR. Additional studies are needed to further explore the factors mediating these disparities.

Recommendations for broadening eligibility criteria in esophagus cancer clinical trials: the mortality disparity of esophagus cancer as a first or second primary malignancy.

Esophagus cancer as a second primary malignancy (esophagus-2) is increasingly common, but its prognosis is poorly understood. This study aims to examine the overall, non-cancer related and cancer-specific survival of patients diagnosed with esophagus-2 compared to the first primary esophagus cancer (esophagus-1). We included primary esophagus cancer patients diagnosed from 1975 to 2019 in the Surveillance, Epidemiology, and End Results program. Esophagus-2 was identified in patients with a previous diagnosis of non-esophageal primary malignancy. Hazard ratios of overall, esophagus cancer-specific and non-cancer related mortality were estimated among patients with esophagus-2 compared to esophagus-1, adjusting for age, gender, tumor stage and other demographic and clinical characteristics. A total of 74,521 and 14,820 patients were identified as esophagus-1 and esophagus-2 respectively. Esophagus-2 patients suffered lower risk of esophagus cancer-specific mortality in initial 5 years but with similar risk thereafter, independent of tumor characteristics and treatment. In the first 5 years after diagnosis, patients with esophagus-2 had similar risk of overall mortality with those with esophagus-1 but increased risk thereafter. As for non-cancer related mortality, esophagus-2 patients had higher risk all along. Esophagus-2 patients should not be entirely excluded from clinical trial and a 3-year exclusion window is suggested. A conservative approach to manage esophagus-2 solely based on malignancy history is not supported but effort should be put into surveillance, prevention and management of the comorbidities and complications for the first malignancy.

The 340B Program and High-Risk Prescribing of Oral Targeted Therapies for Advanced Prostate Cancer.

The use of expensive oral targeted agents for advanced prostate cancer can be influenced by those who stand to gain from their use. The 340B drug pricing program allows eligible hospitals to purchase medications at steep discounts, generating millions of dollars in savings. The extent to which hospitals engage in higher-risk prescribing due to program incentives is unclear. Medicare claims were used to perform a retrospective study of men with advanced prostate cancer. The primary outcome was targeted therapy use in men with high noncancer mortality risk. Secondary outcomes included androgen biosynthesis inhibitor use in men with cardiovascular history, androgen receptor inhibitor use in men with neurocognitive history, and therapy within 14 days of death. Proportional hazards models were used to assess time-to-event outcomes, while logistic regression was used for binary outcomes. In men with high noncancer mortality risk, targeted therapy use did not differ at 340B participating compared to nonparticipating hospitals (hazard ratio [HR] 1.1, 95% CI 0.67-1.5). There was no difference in androgen biosynthesis inhibitor use in men with a prior cardiac event (HR 0.96, 95% CI 0.70-1.3) or androgen receptor inhibitor use in men with a prior neurocognitive event (HR 1.5, 95% CI 0.65-3.4) in those treated at 340B participating compared to nonparticipating hospitals. Therapy use in the last 14 days of life did not vary by 340B participation (odds ratio 1.3, 95% CI 0.86-1.9). In men with advanced prostate cancer, high-risk prescribing and futility measures did not vary by participation in the 340B drug pricing program.

Cardiovascular Risk in Cancer Patients Treated with Immune Checkpoint Inhibitors: Challenges and Future Directions.

Cardiovascular disease is the leading cause of non-cancer related mortality and morbidity among people living with or cured from cancer. Immune checkpoint inhibitors (ICIs) are systemic anti-cancer therapies that have revolutionised the treatment of numerous cancers, even achieving durable long-term responses among patients with metastatic disease. However, the pro-inflammatory effects of ICIs have been postulated to increase the risk of atherosclerotic cardiovascular disease (ASCVD) in cancer survivorship. Standard modifiable cardiovascular risk factors can further contribute to ASCVD risk during cancer survivorship but are not routinely screened and are often untreated in patients with cancer. With the expanding use of ICIs leading to improved cancer survivorship, cardiovascular risk identification and prevention will be paramount in the care of patients with cancer. This review highlights the practical challenges associated with ASCVD prevention among the growing number of patients treated with ICIs for cancer, including balancing competing mortality risks from cancer and ASCVD, the lack of ICI-specific cardiovascular risk stratification tools, potential interactions between cardiovascular and oncological therapies, and barriers to implementation of cardiovascular screening and prevention within existing healthcare systems.

Geriatric nutritional risk index and mortality from all-cause, cancer, and non-cancer in US cancer survivors: NHANES 2001-2018.

Malnutrition is strongly correlated with worsened treatment outcomes, reduced standard of living, and heightened mortality rates among individuals with cancer. Our research explores how the Geriatric Nutritional Risk Index (GNRI), a measure of nutritional status, relates to all-cause mortality, cancer-specific, and non-cancer mortality among middle-aged and older adult cancer patients. We enrolled 3,253 participants aged 40 and above who were diagnosed with cancer. The data was obtained from the National Health and Nutrition Examination Survey (NHANES) dataset covering the period from 2001 to 2018, with a median follow-up duration of 83 months. According to the GNRI levels, patients in the study were classified into two distinct groups: the group with a low GNRI (<98) and the group with a high GNRI (≥ 98). We conducted a Kaplan-Meier survival analysis to assess how survival rates vary with different nutritional conditions. Multivariable Cox regression analyses were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality, as well as cancer-specific and non-cancer-related mortality. Restricted cubic spline (RCS) analyses and subgroup evaluations were performed to augment the robustness and validity of our findings. A total of 1,171 deaths were documented, with 383 attributed to cancer, and 788 from other causes. After adjusting for potential confounders, the analysis demonstrated that, within a specified range, an elevation in the GNRI is inversely associated with mortality from all causes, cancer-specific, and non-cancer causes. Moreover, Kaplan-Meier survival curves for all-cause, cancer-specific, and non-cancer mortality distinctly showed a more pronounced decrease in survival rates among individuals in the low GNRI group (<98). Notably, the restricted cubic spline regression model (RCS) revealed statistically significant non-linear associations between GNRI scores and mortality rates. The P-values were ≤0.001 for both all-cause and non-cancer mortality, and 0.024 for cancer-specific mortality. Our study conclusively demonstrated a robust correlation between GNRI scores and mortality rates among cancer patients, encompassing all-cause mortality as well as specific mortality related to both cancerous and non-cancerous causes. The GNRI may be a valuable prognostic tool for predicting cancer mortality outcomes, offering insights that may inform nutritional management and influence the clinical treatment strategies for cancer survivors.