Practice Patterns In Treatment Research Articles

Neurointerventional surveys between 2000 and 2023: a systematic review

BackgroundSurveys are increasingly used in neurointervention to gauge physicians’ and patients’ attitudes, practice patterns, and ‘real-world’ treatment strategies, particularly in conditions for which few, or no evidence-based, recommendations exist. While...

Stereotactic radiosurgery practice patterns for treatment of brain metastases: A large national cancer database study.

123 Background: Brain metastases (BM) portend high mortality rates. While whole brain radiation therapy (WBRT) is a commonly used treatment strategy for BM, stereotactic radiosurgery (SRS) has less neurocognitive toxicity with comparable survival. The objective of this study was to compare treatment practice patterns for SRS vs WBRT using a large national hospital database. Methods: The National Cancer Database (NCDB) was queried for patients ≥18 years treated with radiotherapy (RT) for a BM diagnosis between 2004-2020 and with known follow-up. Twelve cancers were included based on highest prevalence: breast, colorectal, kidney/bladder, liver, lung, lymphoma, melanoma, oral cavity, pancreas, prostate, and thyroid. Patients were grouped by first course RT modality (SRS vs WBRT) confirmed by fraction number (SRS: 1-5; WBRT: 5-15). Multivariable logistic regression assessed predictors of SRS as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Analyses were adjusted for patient and cancer characteristics. Results: Of 112,232 patients with BM, 30,805 (27%) received SRS. Median age was 64 years. Most patients were White (84%), diagnosed in 2012-2020 (64%), with a higher income (56%), more education (55%), and Medicare/Medicaid (60%). The most common cancer treated with RT for BM was lung (85%). Patients were less likely to be treated with SRS if they were Korean (aOR=0.68; 95%CI=0.47-0.95), lower income (aOR=0.88; 95%CI=0.84-0.91), lower education (aOR=0.88; 95%CI=0.85-0.91), with Medicare/Medicaid (aOR=0.86; 95%CI=0.83-0.89) or no insurance (aOR=0.48; 95%CI=0.44-0.53), at a Midwest hospital (aOR=0.79; 95%CI=0.76-0.83; vs Northeast), and at a community (aOR=0.31; 95%CI=0.28-0.33; vs academic) or comprehensive community cancer program (aOR=0.56; 95%CI=0.54-0.58). Patients were more likely to be treated with SRS if they were Asian Indian or Pakistani (aOR=1.41; 95%CI =1.08-1.85), older (aOR=1.01; 95%CI=1.01-1.01), diagnosed in 2012-2020 (aOR=3.92; 95%CI=3.78-4.07; vs 2004-2011), lived farther from the hospital (aOR=1.00; 95%CI=1.00-1.00), and received chemotherapy (aOR=1.17; 95%CI=1.13-1.21). Conclusions: In one of the largest BM studies with over 110,000 US patients, disparities in SRS treatment patterns were identified. On adjusted analysis, SRS was less likely to be used for patients who were lower income, lower educational attainment, without private insurance, and treated at community centers. The data highlight populations with cancer and BM who may benefit from increased access to SRS.

Disparities in stereotactic radiosurgery practice patterns for treatment of brain metastases: A large national cancer database study.

11094 Background: Brain metastases (BM) portend high mortality rates. While whole brain radiation therapy (WBRT) is a commonly used treatment strategy for BM, stereotactic radiosurgery (SRS) has less neurocognitive toxicity with comparable survival. The objective of this study was to compare treatment practice patterns for SRS vs WBRT using a large national hospital database. Methods: The National Cancer Database (NCDB) was queried for patients ≥18 years treated with radiotherapy (RT) for a BM diagnosis between 2004-2017 and with known follow-up. 12 cancers were included based on highest prevalence including: breast, colorectal, kidney/bladder, liver, lung, lymphoma, melanoma, oral cavity, pancreas, prostate, and thyroid. Patients were grouped by first course RT modality (SRS vs WBRT) confirmed by fraction number (SRS: 1-5; WBRT: 5-15). Multivariable logistic regression assessed predictors of SRS as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). Analyses were adjusted for patient and cancer characteristics. Results: Of 88,539 patients with BM, 17,734 (18%) received SRS. Median age was 64 years. Most patients were White (84%), diagnosed in 2011-2017 (58%), with a higher income (55%), more education (55%), and Medicare/Medicaid (58%). The most common cancer treated with RT for BM was lung (86%). Patients were less likely to be treated with SRS if they were Hispanic (aOR=0.85; 95%CI=0.76-0.96), lower income (aOR=0.90; 95%CI=0.86-0.95), lower education (aOR=0.87; 95%CI=0.83-0.91), with Medicare/Medicaid (aOR=0.83; 95%CI=0.79-0.87) or no insurance (aOR=0.46; 95%CI=0.41-0.51), at a Midwest hospital (aOR=0.74; 95%CI=0.71-0.78; vs Northeast), and at a community (aOR=0.28; 95%CI=0.25-0.30; vs academic) or comprehensive community cancer program (aOR=0.50; 95%CI=0.47-0.52). Patients were more likely to be treated with SRS if they were older (aOR=1.01; 95%CI=1.01-1.01), diagnosed in 2011-2017 (aOR=2.39; 95%CI=2.30-2.49; vs 2004-2010), lived farther from the hospital (aOR=1.09; 95%CI=1.07-1.11), and received chemotherapy (aOR=1.41; 95%CI=1.35-1.47). SRS was most often used to treat BM from primary colorectal cancer (aOR=1.99; 95%CI=1.65-2.40), endometrial cancer (aOR=1.52; 95%CI=1.08-2.10), kidney/bladder cancer (aOR=3.09; 95%CI=2.68-3.55), and melanoma (aOR=2.74; 95%CI=2.39-3.14), while less often used to treat BM from lymphoma (aOR=0.18; 95%CI=0.11-0.30), vs breast primary cancers. Conclusions: In one of the largest BM studies with nearly 90,000 US patients, disparities in SRS treatment patterns were identified. On adjusted analysis, SRS was less likely to be used for patients who were of Hispanic ethnicity, lower income, lower educational attainment, without private insurance, and treated at community centers. The data highlight populations with cancer and BM who may benefit from increased access to SRS.

#2205 Varying practice patterns in prevention, screening and treatment of diabetes early after kidney transplantation: a European survey

Abstract Background and Aims Although post-transplant diabetes mellitus (PTDM) is a common complication after kidney transplantation, there is no consensus on preventive measures, nor on the optimal screening and treatment strategy. Method The European Renal Association—DESCARTES working group—distributed a web-based survey to transplant centers across Europe to gather information on the risk assessment, screening procedures and management practices for the prevention and treatment of PTDM in kidney-transplant recipients. Results Answers were obtained from 121 transplant centers across 15 European countries. Screening practices for pre-existing diabetes during the transplant work-up varied considerably, with only 13% of centers using the recommended oral glucose tolerance test (OGTT), while 14% did not screen at all. At transplantation, 19% (n = 23) of centers tailored the immunosuppressive regimen based on perceived PTDM risk, employing strategies like cyclosporin use (12/23), or early steroid withdrawal (2/23). Fifty-two percent adopted strict glycemic control with long-acting insulin in the first days post-transplant. Sixty-eight percent had defined screening protocols for early PTDM (45 days—six months), mostly based on fasting glycemia and/or HbA1c, while only 8/82 incorporated an OGTT. Changes in immunosuppression were considered by 41% in cases of early hyperglycemia (<45 days) and by 58% in established PTDM (>45 days). Besides insulin therapy, dipeptidyl peptidase-4 (DPP4) inhibitors and metformin were most frequently used to manage early hyperglycemia (<45 days) and PTDM (>45 days). Conclusion This European survey underscores significant variation in PTDM prevention, screening, and treatment practices, emphasizing the imperative for clearer guidance in approaching this complication.

Clinical Practice Patterns in Sickle Cell Disease Treatment: Disease-modifying and Potentially Curative Therapies.

Therapeutic options for sickle cell disease (SCD) have increased recently as well as the development of updated national guidelines. It is not known how these options are being offered or to what degree guidelines are incorporated into clinical practice. This study aimed to describe practice patterns for pediatric hematologists regarding the use of disease-modifying and potentially curative therapies for SCD. A 9-section, cross-sectional electronic survey was disseminated during a 3-month period via SurveyMonkey, to members of the American Society of Pediatric Hematology/Oncology Hemoglobinopathy Special Interest Group (ASPHO HSIG). A total of 88 physician members of the ASPHO HSIG were surveyed. Ninety percent of respondents (72/80) start hydroxyurea routinely in patients with HbSS and HbSβ 0 thalassemia, regardless of disease severity. Laboratory monitoring was recommended every 3 months for stable dosing in 63.8% (51/80). New therapies were recommended for patients on hydroxyurea who were still experiencing SCD complications: L-glutamine 68.5% (37/54) or crizanlizumab 93.1% (54/58). Voxelotor was recommended for patients on hydroxyurea with low hemoglobin in 65.1% (43/66) of cases. Matched sibling transplant was considered for any disease severity by 55.1% (38/69). Gene therapy trials are offered on-site by 29% (20/69). Our study demonstrated the enhanced utilization of hydroxyurea while revealing the unexplored potential of other disease-modifying therapies in SCD. These findings underscore the importance of continued knowledge acquisition about the long-term efficacy of new medical therapies and addressing barriers to the use of proven therapies and guide the development of future studies of optimal SCD management.

Demographic Disparities in Uterine Fibroid Incidence Are Not Reflected in Treatment Practice Patterns Among U.S. Women: A Systematic Review and Meta-analysis [ID 2683522

INTRODUCTION: Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UF) and experience severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than hysterectomy and may improve UF outcomes. We reviewed demographic characteristics associated with UAE utilization compared to hysterectomy for symptomatic UF among U.S. women. METHODS: Systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051). 1,350 articles (January 1, 1995, to July 15, 2023) outlining demographic characteristics of UAE versus hysterectomy patients were identified. Two readers screened for inclusion criteria, yielding 11 full-text U.S.-based cohort and randomized controlled-trial studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed (STATA v18.0). Egger’s regression test was used to quantify publication bias. RESULTS: Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio [OR] 3.35; p50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. CONCLUSION: Current knowledge of demographic characteristics of UF patients receiving UAE versus hysterectomy is sparse (n=11 studies). Among these studies, racial disparities in UF incidence do not appear to affect UAE utilization; rather, Black race may predict utilization of UAE compared to hysterectomy. Further research is warranted to determine the effects of clinical and demographic covariates on UF treatment outcomes.

Japanese clinical practice patterns of rituximab treatment for minimal change disease in adults 2021: A web-based questionnaire survey of certified nephrologists.

In Japan, rituximab (RTX) for adult-onset frequently relapsing (FR)/steroid-dependent (SD) minimal change disease (MCD) is not explicitly reimbursed by insurance, and its standard regimen has not been established. We conducted a cross-sectional web-based survey between November and December 2021. The participants were nephrologists certified by the Japanese Society of Nephrology and answered 7 items about RTX for adult MCD. Factors related to the experience of RTX administration at their facilities were estimated by generalized estimating equations. Of 380 respondents, 181 (47.6%) reported the experience of RTX use for adult MCD at their current facilities. Those who worked at university hospitals (vs. non-university hospitals, proportion difference 13.7%) and at facilities with frequent kidney biopsies (vs. 0 cases/year, 19.2% for 1-40 cases/year; 37.9% for 41-80 cases/year; 51.9% for ≥ 81 cases/year) used RTX more frequently. Of 181 respondents, 28 (15.5%) answered that there was no insurance coverage for RTX treatment. Of 327 respondents who had the opportunity to treat MCD, which was a possible indication for RTX, 178 (54.4%) indicated withholding of RTX administration. The most common reason was the cost due to lack of insurance coverage (141, 79.2%). Regarding RTX regimens for FR/SD MCD, introduction treatment with a single body surface area-based dose of 375 mg/m2 and maintenance treatment with a 6-month interval were the most common. This survey revealed the nephrologists' characteristics associated with RTX use, the barriers to RTX use, and the variation in the regimens for adult MCD in Japan.

89 Frequency and Impact of PANDAS/PANS Diagnosis in Canada

Abstract Background Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS/PANS) are defined by abrupt onset and episodic course of neuropsychiatric symptoms associated with infection. There are challenges in the application of published diagnostic criteria, and the frequency of diagnosis is unknown. To date, there is little data on clinical practice patterns in diagnosis, assessment and treatment. Objectives The aim of this study was to estimate and characterize the frequency and impact of the diagnostic label of PANDAS/PANS in Canada. Design/Methods Through established CPSP methodology, over 2,800 paediatricians and subspecialists were surveyed for children seen in the previous month who had received the diagnostic label of PANDAS/PANS. Respondents completed a detailed questionnaire on demographics, clinical presentation, diagnostic evaluation and interventions. Results Between December 1, 2019 and November 30, 2021, 84 reported cases received the diagnosis of PANDAS/PANS. The majority were female (48/84, 57%), with mean age of symptom onset 9.4 years (range 3 to 16 years). Of the 84 cases, 82% (69/84) had OCD and/or acute food refusal, 39% (33/84) had tics and 32% (27/84) had both OCD and tics. Symptom onset was described as sudden in 22% of cases. The vast majority of cases had at least two neuropsychiatric symptoms (80/84, 95%). Infection was associated with symptom onset (22/84, 26%) or exacerbation (25/84, 30%) in less than one-third of cases. Healthcare utilization included emergency-department visits (29/84, 35%) and inpatient admissions, both medical (8/84, 10%) and psychiatric (8/84, 10%). Three quarters (52/68, 76%) of cases had five or more health care visits since symptom onset and 31% (24/78, 31%) accessed more than five health care providers. Medical treatments were provided in 95% (80/84; antibiotics, NSAIDS, steroids, IVIG or rituximab), 95% (80/84) received psychological and/or psychiatric treatments, and more than 50% (42/84) of patients saw a complementary/alternative health provider. Almost all cases (84/85) experienced significant negative impacts, including family stress, mental health concerns, or conflict (54/84, 64%); school absences (43/84, 51%); and withdrawal from activities/friends (33/84, 39%). In forty-one percent (33/81) of cases, there was a significant discrepancy in the certainty of diagnosis, with families significantly more certain than reporting physicians. Conclusion PANDAS/PANS are rare diagnoses, associated with a significant burden on children, families and the healthcare system. In reported cases, there was significant practice variation in diagnosis, assessment and treatment, with frequent uncertainty about the diagnosis. Education and clinical practice guidelines are needed, targeting a range of practitioners.

Plasma cell leukemia: A multicenter retrospective study of 150 patients.

8014 Background: Despite the use of novel induction regimens, stem cell transplantation (SCT), and maintenance therapy, plasma cell leukemia (PCL) remains a challenging disease with a dismal prognosis. Currently, there is no agreed standard of care management for PCL. We conducted a multicenter retrospective analysis of the clinical presentation, treatment, and outcomes of 150 patients with PCL. Methods: Data of patients diagnosed with pPCL or sPCL between 01/2010 and 01/2021 were entered into a study-specific REDCap database from 7 different U.S. academic sites. PCL was defined as ≥ 5% circulating plasma cells. Clinical data included baseline patient characteristics, clinical presentation, treatment, therapeutic response, and survival outcomes. Overall survival (OS) curves were plotted using the Kaplan-Meier method. Cox proportional hazards regression tested associations between patient characteristics and OS, generating hazard ratios (HR) and 95% confidence intervals (CI), adjusted for PCL type (primary or secondary) and SCT. Results: The analytical cohort included 93 pPCL and 57 sPCL patients. Median age at diagnosis was 60 years. High-risk cytogenetics were found in 56.7% of the patients where it was documented. Of the 79 patients with a documented induction regimen, 58.2% received a proteasome inhibitor triplet, 22.8% received a VTD-Pace like conventional chemotherapy, and 3% received a daratumumab quadruplet regimen. SCT (autologous or allogeneic) was done in 56.1% of the patients. The median OS for all patients, those with pPCL, and those with sPCL was 20.3, 36.6, and 3.2 months, respectively. Secondary PCL was associated with worse survival outcomes compared with pPCL (HR, 2.46; 95% CI, 1.51-3.98; p<0.001) (Table). Median OS was better in patients treated with a proteasome inhibitor triplet regimen vs VTD PACE-like combination (28.2 versus 12.6 months). OS was prolonged among patients who underwent any type of SCT compared with those who did not undergo SCT (44.0 versus 5.7 months, p<0.001). Conclusions: This multicenter retrospective study is one of the largest PCL analyses performed to date and reveals the clinical practice patterns of treatment and survival of PCL patients across the U.S. in the novel treatment era. The survival analysis reinforces the poor prognosis in sPCL patients and the continued need for novel treatment approaches in this patient population. While limited by retrospective design, this analysis suggests prolonged survival with transplantation in both pPCL and sPCL. [Table: see text]

Is access to adjuvant treatments prioritized over therapies for metastatic cancer? The Israeli experience.

e18599 Background: The Israeli National Insurance Law determines a uniform benefits package ('the Health Basket') for all residents. A public committee advises each year on which new medications should be added to the Health Basket, subject to the fixed annum budget allocated by the government for this purpose. The clinical benefit of the proposed health technologies is the committee's prime consideration; however, the committee also considers the professional medical societies' prioritizations, the expected budget impact, and other social and ethical aspects. Towards the annual discussions for 2023, 63 new indications for 41 cancer drugs were proposed for the annual update. Of those, 8 were for novel neo-adjuvant/ adjuvant indications, all given high priority ranks by the Israeli Oncologists Society based on the significant disease-free survival (DFS) figures from the phase III clinical trials. Varying the adjuvant treatment practice patterns based solely on DFS figures without available overall survival (OS) data has been in much debate recently between global key opinion leaders. We, therefore, aimed to evaluate whether the Israeli decision-makers have de-facto accepted the attitude of prioritizing budgets for adjuvant/neo-adjuvant therapies as the Israeli Oncologists Society recommended. Methods: We collected data on all cancer therapies proposed for inclusion in the 2023 Health Basket update; drug name, indication, treatment setting (curative intent vs. metastatic disease therapy), ESMO-MCBS grade, and whether or not accepted for reimbursement. All data were extracted from the official Israeli Ministry of Health website publications and press releases. Results: 20% of the allocated budget for updating the National Health basket for 2023 was provided to treat solid tumor cancers. 7 out of the 8 candidate therapies in the neo-adjuvant/adjuvant settings received reimbursement approval (88%) vs. 11 out of 55 therapies for advanced/ metastatic stages of disease (20%). 13 of the 16 candidate metastatic disease therapies that had a high ESMO-MCBS score (4 or 5) were not approved for reimbursement in the 2023 annual committee discussions. Conclusions: Our retrospective evaluation of the Israeli reimbursement prioritization process reveals that decision-makers have accepted the approach of prioritizing potentially curative adjuvant therapies over treatments for patients with incurable cancer. In an era of prosperity of adjuvant therapies in a range of tumor types, concerns might arise regarding restrictions on access to novel therapies for metastatic cancer, even those with proven benefits of significantly improving patients' OS and quality of life. Future analysis should determine the impact of this trend adopted by decision-makers in Israel on disease progression and overall survival in the real-world setting.

Variability in Swallowed Topical Corticosteroid Practice Patterns for Treatment of Pediatric Eosinophilic Esophagitis.

Given the variety of preparations and lack of standardization of swallowed topical corticosteroids (STC) for treatment of eosinophilic esophagitis (EoE), we sought to better understand STC prescribing practices of pediatric gastroenterologists. A 12-question survey was distributed to members of NASPGHAN Eosinophilic Gastrointestinal Disease Special Interest Group (EGID SIG) and responses were analyzed. Forty-two of 68 physicians responded. Oral viscous budesonide (OVB) was overall first choice STC in 31 (74%) survey respondents, with OVB most frequently utilized in patients under 5 years-old and fluticasone propionate (FP) in patients 13-18 years-old. Nineteen types of mixing vehicles were used for OVB preparation, the three most frequent being sucralose, honey, and artificial maple syrup. Insurance coverage, cost, and patient compliance were most frequently cited barriers to STC use. Highly variable STC prescribing practices reported by this group highlights the need for standardization of STC treatment in EoE.

Opioid Use Disorder Practice by Licensure Category in North Carolina

Background Nurse practitioners, physician assistants, and certified nurse midwives, collectively known as advanced practice providers (APPs), are critical members of the opioid use disorder (OUD) treatment workforce. Few studies compare the OUD treatment practice patterns of APPs relative to physicians. Methods In this cross-sectional study, we distributed a survey examining general substance use disorder (SUD) and OUD-specific treat­ment practices to all licensed physicians and APPs in North Carolina, resulting in a sample of 332 respondents. Respondents were asked about screening, referrals, and Drug Enforcement Administration (DEA) X-waiver status. Waivered providers were asked about prescribing buprenorphine. Differences in practice patterns by provider type were examined using descriptive statistics and chi-squared tests. Results Practice patterns were similar between APPs and physicians; however, more APPs reported screening their patients for SUDs (83.3% versus 69.4%, p = .0045). Of the providers who were waivered to prescribe buprenorphine, APPs and physicians were equally likely to be currently prescribing buprenorphine (75.8% versus 77.1%, p = .8900). Limitations This was a descriptive cross-sectional study using self-report data from a purposive sample and may not be representative of all providers. Conclusions Our results describe practice patterns for APPs and physicians and differences that may be reflective of regulations and therapeutic approaches. Similarities in obtaining an X-waiver and prescribing buprenorphine suggest that reducing restrictions on APPs may result in a larger treatment workforce.

Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States.

Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA-non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.

National Trends of Cerebral Venous Sinus Stenting for the Treatment of Idiopathic Intracranial Hypertension.

Cerebral venous sinus stenting (VSS) has emerged as a new surgical procedure for the treatment of severe idiopathic intracranial hypertension (IIH), and its popularity has been anecdotally on the rise. This study explores recent temporal trends of VSS and other surgical IIH treatments in the United States. Adult patients with IIH were identified from the 2016-2020 National Inpatient Sample databases, and surgical procedures and hospital characteristics were recorded. Temporal trends of procedure numbers for VSS, CSF shunts, and optic nerve sheath fenestrations (ONSFs) were assessed and compared. A total of 46,065 (95% CI 44,710-47,420) patients with IIH were identified, of whom 7,535 patients (95% CI 6,982-8,088) received surgical IIH treatments. VSS procedures increased 80% (150 [95% CI 55-245] to 270 [95% CI 162-378] per year, p < 0.001). Concurrently, the number of CSF shunts decreased by 19% (1,365 [95% CI 1,126-1,604] to 1,105 [95% CI 900-1,310] per year, p < 0.001), and ONSF procedures decreased by 54% (65 [95% CI 20-110] to 30 [95% CI 6-54] per year, p < 0.001). Practice patterns for surgical IIH treatment in the United States are rapidly evolving, and VSS is becoming increasingly common. These findings highlight the urgency of randomized controlled trials to investigate the comparative effectiveness and safety of VSS, CSF shunts, ONSF, and standard medical treatments.

Evolving Treatment Patterns in Diabetic Macular Edema Between 2015 and 2020.

Purpose: To explore the recent evolution of diabetic macular edema (DME) treatment practice patterns over 5 years among retina specialists in the United States. Methods: This retrospective analysis assessed 306 700 eyes with newly diagnosed DME from the Vestrum Health database between January 2015 and October 2020. The year-over-year and cumulative 5-year distributions of eyes treated with antivascular endothelial growth factor (anti-VEGF) agents, steroids, focal laser, or any combination and those of untreated eyes were calculated. Changes from baseline visual acuity were assessed. Results: Yearly treatment patterns changed significantly from 2015 (n = 18056) to 2020 (n = 11042). The proportion of untreated patients declined over time (32.7% vs 27.7%; P < .001), the use of anti-VEGF monotherapy increased (43.5% vs 61.8%; P < .001), the use of focal laser monotherapy declined (9.7% vs 3.0%; P < .001), and the use of steroid monotherapy remained stable (0.9% vs 0.7%; P = 1.000). Of eyes that maintained follow-up for 5 years (from 2015 to 2020), 16.3% were untreated while 77.5% were treated with anti-VEGF agents (as monotherapy or combination therapy). Vision gains in treated patients remained approximately stable from 2015 (3.6 letters) to 2020 (3.5 letters). Conclusions: From 2015 to 2020, treatment patterns for DME evolved toward greater anti-VEGF monotherapy, stable steroid monotherapy, less laser monotherapy, and fewer untreated eyes.

Patient and disease characteristics, treatment practices and oncologic outcomes among patients with colorectal cancer: a population-based analysis.

The incidence of colorectal cancer (CRC) is increasing among young adults. We sought to report on patient and disease characteristics, treatment practice patterns and outcomes in this population. We conducted a retrospective cohort study using administrative health data from the Alberta Cancer Registry (2004-2015), including demographic and tumour characteristics, and treatment received. Outcome measures included overall and cancer-specific deaths. We used Cox regression and Kaplan-Meier curves to assess for factors associated with survival. We included 18 070 patients with CRC (n = 1583 [8.8%] < 50 yr, n = 16 487 [91.2 %] ≥ 50 yr). Younger patients were more likely to present with locally advanced disease (21.0% v. 18.0%, p < 0.0001), stage III (16.4 % v. 14.6%, p < 0.0001) or metastatic (16.7% v. 13.8%, p < 0.0001) involvement. Younger patients were more likely to receive surgery (87.2% v. 80.9%, p < 0.0001), chemotherapy (59.6% v. 34.1%, p < 0.0001) or radiation therapy (49.5% v. 37.2%, p < 0.001). At 5 years, overall and cancer-specific survival was better among younger patients than older patients (30.6% v. 51.5% overall deaths, 27.5% v. 38.4% cancer-specific deaths, p < 0.0001). Despite higher stage and higher grade disease, young patients with CRC had more favourable oncologic outcomes than stage-matched older patients, which may be related to younger patients receiving more aggressive treatment. Further investigation should focus on optimal treatment patterns for young patients with CRC.

Single Institution Observational Study of Risk-Adapted Therapy for Children with Newly Diagnosed Core-Binding Factor Acute Myeloid Leukemia

Background: Pediatric acute myeloid leukemia (AML) with core-binding factor (CBF) rearrangements (RUNX1-RUNX1T1/CBFβ-MYH11) have favorable outcomes. Therefore, hematopoietic stem cell transplantation (HSCT) is usually not offered to these patients during their first remission (CR1). However, more than one third of patients experienced relapse. Objective: To explore whether HSCT in CR1 for pediatric CBF-AML would benefit this subgroup. Design and Methods: We describe the outcomes of 68 cases with RUNX1-RUNX1T1 and 21 with the CBFβ-MYH11 consecutively treated in a single institution between 2012 and 2018. Practice patterns in pediatric CBF-AML treatment varied according to the presumed risk of relapse or treatment abandonment. Remission induction consisted of two courses of a low-intensity or standard-intensity regimen. Post-remission treatment consisted of two or three courses of standard AML therapy. Hematopoietic stem cell transplantation (HSCT) was offered in first complete remission (CR1) for selected patients. Results: Eighty-nine patients received two courses of a low-intensity or standard-intensity regimen for remission induction and two or three courses of standard AML therapy for post-remission. C-KIT mutations were present in 49.4% of the cases. Eight-three of 87 (95.4%) children attained CR, and two patients were not evaluable. Twenty-nine patients at high risk of relapse underwent HSCT in CR1. The 5-year event-free survival (EFS), overall survival (OS), and relapse rates were 74.8%, 85.0%, and 13.9%, respectively. There was a significant difference in 5-year OS (100% vs. 81.5%, P = 0.016), EFS (96.4% vs. 67.1%, P = 0.003), and relapse-free survival (RFS) (96.4% vs. 68.8%, P = 0.005) between patients who underwent HSCT in CR1 and those treated with chemotherapy alone. Conclusion: Our data suggest a potential benefit of HSCT for selected patients with CBF-AML and reveal a need to improve risk stratification for pediatric CBF-AML.

Incidence of atrial fibrillation/flutter, one-year re-admission rates, and practice patterns among patients &amp;lt;65 years of age: a Danish nationwide study

Abstract Background/Introduction The general atrial fibrillation/flutter (AF) population is well explored and described, but there is sparse data on temporal changes in the incidence, AF-readmission rates, and practice patterns in patients with AF under 65 years of age from unselected cohorts. Purpose To investigate temporal changes, AF readmission rates, and practice patterns in patients under 65 years of age with first-time AF diagnosed between 2000–2018. Methods Using Danish nationwide registries, we identified patients &amp;gt;18 years and &amp;lt;65 years with a first-time AF-diagnosis from 2000–2018. The cohort was categorized according to calendar periods; 2000–2002, 2003–2006, 2007–2010, 2011–2014 and 2015–2018. Incidence rate (IR) of AF per 100,000 person years (PY), AF-readmission, and practice patterns of medical treatment, electrical cardioversion, and catheter ablation was investigated in the first year following AF-diagnosis. Results In this study 60,917 patients were included; 8,150 patients (13.4%) in 2000–2002, 11,898 (19.5%) in 2003–2006, 13,560 (22.3%) in 2007–2010, 14,167 (23.3%) in 2011–2014 and 13,142 (21.6%) in 2015–2018. No major differences were seen in patient characteristics according to calendar period. A stepwise increase, as seen in the Table, in the crude IR of AF per 100,000 PY was observed across calendar periods, except for 2015–2018 (Crude IR [95% CI]: 2000–2002: 78.7 [77.0; 80.4], 2003–2006: 86.3 [84.7; 87.8], 2007–2010: 97.9 [96.3; 99.6], 2011–2014: 102.3 [100.7; 104.0], 2015–2018: 93.6 [92.0; 95.2], while no difference in AF readmission was identified (AF-readmissions: 2000–2002: 32.7%, 2003–2006: 31.1%, 2007–2010: 32.2%, 2011–2014: 32.1% and 2015–2018: 31.7%), as seen in the Figure, right panel. In the first year following AF-diagnosis, the cumulative incidence of catheter ablation increased stepwise from 1.2% in 2000–2002 to 7.6% in 2015–2018 and electrical cardioversion from 2.0% in 2000–2002 to 8.7% in 2015–2018 (Figure, left panel). Treatment with oral anticoagulant therapy (OAC) increased from 28.5% in 2000–2002 to 47.8% in 2015–2018, while there was no change in treatment with rhythm or rate medication therapy. Conclusion From 2000–2018, we found an increase in the incidence of atrial fibrillation/flutter (AF) in patients &amp;lt;65 years from 78.7/100,000 person years (PY) to 93.6/100,000 PY and an increase in the use of catheter ablation, electrical cardioversion and OAC in the first year following first-time AF-diagnosis. AF readmission rates were stable over calendar periods. Funding Acknowledgement Type of funding sources: None.

Association of clinic type with receipt of neoadjuvant therapy among patients with localized pancreatic cancer: Value of multidisciplinary clinic.

63 Background: Patients with localized pancreatic adenocarcinoma (PDAC) generally benefit from multi-modality therapy, which may be best coordinated through a pancreas multi-disciplinary clinic (PMDC). Whether treatment practice patterns vary based on whether a patient was seen through PMDC versus individual specialty-specific clinics is unclear. Methods: Using institutional Pancreatic Cancer Registry, we identified patients who came to Johns Hopkins Hospital through either PMDC or one of the individual surgical, medical, or radiation oncology clinics for localized PDAC between 2018-2020 and eventually underwent resection. During this time, it was standard practice for borderline resectable (BRPC) patients to undergo at least 4 months of neoadjuvant chemotherapy, with or without radiation, before transitioning to exploration, while locally advanced (LAPC) patients were treated with 4-6 months of chemotherapy, followed by radiation, followed by potential exploration. The primary outcome was completion of neoadjuvant therapy as per the above stage-specific institutional standards. Multivariable analyses were performed to find association between PMDC visit and completion of neoadjuvant therapy, controlling for age, sex, race, stage, baseline performance status and type of chemotherapy. Results: A total of 240 patients met inclusion criteria. Of these, 157 (65.4%) had PMDC visits. Distribution of stage across the cohort included 81 (34.3%), 91 (38.5%), and 64 (27.1%) patients with resectable PDAC, BRPC and LAPC, respectively. Patients in the PMDC group received radiation therapy more commonly (59.7% vs 34.9%, p = 0.004), as compared to patients seen through individual specialty-specific clinics. Mean duration of chemotherapy was higher for patients seen through PMDC (4.4 (SD: 1.7) vs 3.9 (SD: 2.0) months) compared with individual clinics. Completion of neoadjuvant therapy per institutional stage-specific standards was seen in 46% (n = 24) of the patients visiting individual specialty-specific clinics compared to 71% (n = 85) of patients who were seen through PMDC (p = 0.002). The adjusted odds ratio of completion of neoadjuvant therapy per institutional standards for patients seen through PMDC visit was 3.35 times the odds for patients seen through individual clinics (95% CIs 1.46-7.07; p = 0.004). Of note, a higher proportion of patients who were seen through PMDC enrolled in a clinical trial (n = 26, 16.6%) compared with patients seen through individual clinics (n = 6; 7.2%) (p = 0.043). Conclusions: Provision of care through a multi-disciplinary clinic was associated with significantly higher odds of completing neoadjuvant therapy per institutional standards as compared to care through individual specialty-specific clinics. In addition, care through a PMDC may also be associated with increased trial enrollment.

POS-050 SEPSIS-ASSOCIATED ACUTE KIDNEY INJURY REQUIRING RENAL REPLACEMENT THERAPY IN SOUTH INDIA: THE PREDICTORS OF OUTCOME

Sepsis is common in critically ill patients occurring in up to 40% of patients admitted to the intensive care unit (ICU) and patients with septic shock carry high hospital mortality of up to 40%. Sepsis-associated Acute Kidney Injury (SA-AKI) requiring renal replacement therapy (RRT) carries an additional increased risk of poor outcome. The demography, the practice patterns of treatment, and outcomes in AKI vary widely across the world. The risk factors for SA-AKI are not sufficiently studied in developing countries such as India.