Predicted Life Expectancy Research Articles

Type 2 Diabetes Mellitus Strongly Impacts Survival in Patients with Diffuse Large B Cell Lymphoma

▪Introduction: Accumulating evidence in the past decade suggested that type 2 diabetes mellitus (T2DM) is correlated with elevated cancer risks and cancer mortality via possible underlying mechanisms of hyperglycemia, hyperinsulinemia and chronic inflammation. However, no literature to date has focused on the relation between diffuse large B cell lymphoma (DLBCL) and T2DM. The objective of this study was to assess the prognostic impact of T2DM on diffuse large B cell lymphoma (DLBCL) survival.Methods: Three hundred and sixty-one newly-diagnosed DLBCL patients whose treatments included rituximab between June 2006 and March 2015 were recruited. Pre-existing T2DM was defined as having a medical record of T2DM or elevated fasting glucose level (≥7.0mmol/L) at diagnosis of DLBCL. Pre-diabetes referred to being diagnosed as impaired fasting glucose or impaired glucose tolerance, or fasting blood glucose level ≥6.1 mmol/L and <7.0 mmol/L at enrollment. Multivariate Cox regression analyses screened the prognostic risk factors associated with progression free survival (PFS) and overall survival (OS). Receiver-operator characteristic curves and the corresponding areas under the curve (AUC) assessed the predictive accuracy of International Prognostic Index (IPI) and T2DM.Results: In total, 61 patients (16.90%) had pre-existing T2DM and 57 (15.79%) patients had pre-diabetes. Diabetic patients were more likely to have old age, poor Eastern Cooperative Oncology Group (ECOG) performance status (PS) and low IPI score. T2DM was associated with unfavorable PFS and OS in rituximab era (Figure 1a and b), and it was an independent risk factor for inferior OS (HR=1.930; 95% CI: 1.092−3.411; p=0.024), especially in patients with the IPI 0−2, age under 60 years, early stage disease, ECOG PS 0−1 and Hans classification of germinal center B-cell. Pre-diabetics also shared inferior PFS and OS compared with patients with no T2DM tendency (Figure 1c and d). Additionally, we introduced a novel Prognostic Index (PI) which was calculated as the sum of IPI and one additional point for having T2DM weighed by their Cox regression coefficients. PI demonstrated significantly larger AUCs than IPI alone and could accurately differentiate the survival outcomes of DLBCL patients. Adding the criterion of T2DM could improve the prognostic capacity of IPI for OS prediction (Figure 1g). Moreover, diabetic DLBCL patients on oral anti-diabetic drugs (primarily metformin) presented better PFS and OS in comparison with those on insulin and non-medication after multivariable adjustments including diabetic duration and fasting glucose level (Figure 1e and f).Conclusion: Our findings suggested that pre-existing T2DM could serve as an important prognostic factor for survival in DLBCL patients. Clinicians' attention of T2DM at DLBCL diagnosis should be aroused to help predict life expectancy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Cancer-Specific Outcomes in the Elderly with Triple-Negative Breast Cancer: A Systematic Review.

Triple-negative breast cancer (TNBC) is more common among young women, although it frequently presents in older patients. Despite an aging population, there remains a paucity of data on the treatment of TNBC in elderly women. We conducted a systematic review of the peer-reviewed and unpublished literature that captures the management and breast-cancer-specific survival (BCSS) of women ≥70 years old with TNBC. Out of 739 papers, five studies met our inclusion criteria. In total, 2037 patients with TNBC treated between 1973 and 2014 were captured in the analysis. Women ≥70 years old were less likely to undergo surgical resection compared to those <70 (92.8% vs. 94.6%, p = 0.002). Adjuvant therapy, including radiation and chemotherapy, was also less likely to be utilized in women ≥70 years of age. These treatment differences were associated with more than a doubling of cancer-specific mortality in the elderly cohort (5.9% vs. 2.7% in ≤70 years old, p < 0.0001). Two of the five studies showed improved BCSS with adjuvant treatment while others showed no difference. Our systemic review questions the appropriateness of therapeutic de-escalation in this cohort and highlights the significant gap in our understanding of the optimal management for elderly patients with TNBC. Until more data are available, multidisciplinary treatment decision-making should carefully balance the available clinical evidence as well as the patient’s predicted life expectancy and goals-of-care preferences.

Increased Hemoglobin A1c Time in Range Reduces Adverse Health Outcomes in Older Adults With Diabetes.

Short- and long-term glycemic variability are risk factors for diabetes complications. However, there are no validated A1C target ranges or measures of A1C stability in older adults. We evaluated the association of a patient-specific A1C variability measure, A1C time in range (A1C TIR), on major adverse outcomes. We conducted a retrospective observational study using administrative data from the Department of Veterans Affairs and Medicare from 2004 to 2016. Patients were ≥65 years old, had diabetes, and had at least four A1C tests during a 3-year baseline period. A1C TIR was the percentage of days during the baseline in which A1C was in an individualized target range (6.0-7.0% up to 8.0-9.0%) on the basis of clinical characteristics and predicted life expectancy. Increasing A1C TIR was divided into categories of 20% increments and linked to mortality and cardiovascular disease (CVD) (i.e., myocardial infarction, stroke). The study included 402,043 veterans (mean [SD] age 76.9 [5.7] years, 98.8% male). During an average of 5.5 years of follow-up, A1C TIR had a graded relationship with mortality and CVD. Cox proportional hazards models showed that lower A1C TIR was associated with increased mortality (A1C TIR 0 to <20%: hazard ratio [HR] 1.22 [95% CI 1.20-1.25]) and CVD (A1C TIR 0 to <20%: HR 1.14 [95% CI 1.11-1.19]) compared with A1C TIR 80-100%. Competing risk models and shorter follow-up (e.g., 24 months) showed similar results. In older adults with diabetes, maintaining A1C levels within individualized target ranges is associated with lower risk of mortality and CVD.

Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults

Guidelines recommend against routine breast and prostate cancer screenings in older adults with less than 10 years' life expectancy. One study using a claims-based prognostic index showed that receipt of cancer screening itself was associated with lower mortality, suggesting that the index may misclassify individuals when used to inform cancer screening, but this finding was attributed to residual confounding because the index did not account for functional status. To examine whether cancer screening remains significantly associated with all-cause mortality in older adults after accounting for both comorbidities and functional status. This cohort study included individuals older than 65 years who were eligible for breast or prostate cancer screening and who participated in the 2004 Health and Retirement Study. Data were linked to Medicare claims from 2001 to 2015. Data analysis was conducted from January to November 2020. A Cox model was used to estimate the association between all-cause mortality over 10 years and receipt of screening mammogram or prostate-specific antigen (PSA) test, adjusting for variables in a prognostic index that included age, sex, comorbidities, and functional status. Potential confounders (ie, education, income, marital status, geographic region, cognition, self-reported health, self-care, and self-perceived mortality risk) of the association between cancer screening and mortality were also tested. The breast cancer screening cohort included 3257 women (mean [SD] age, 77.8 [7.5] years); the prostate cancer screening cohort included 2085 men (mean [SD] age, 76.1 [6.8] years). Receipt of screening mammogram was associated with lower hazard of all-cause mortality after accounting for all index variables (adjusted hazard ratio [aHR], 0.67; 95% CI, 0.60-0.74). A weaker, but still statistically significant, association was found for screening PSA (aHR 0.88; 95% CI, 0.78-0.99). None of the potential confounders attenuated the association between screening and mortality except for cognition, which attenuated the aHR for mammogram from 0.67 (95% CI, 0.60-0.74) to 0.73 (95% CI, 0.64-0.82) and the aHR for PSA from 0.88 (95% CI, 0.78-0.99) to 0.92 (95% CI, 0.80-1.05), making PSA screening no longer statistically significant. In this study, cognition attenuated the observed association between cancer screening and mortality among older adults. These findings suggest that existing mortality prediction algorithms may be missing important variables that are associated with receipt of cancer screening and long-term mortality. Relying solely on algorithms to determine cancer screening may misclassify individuals as having limited life expectancy and stop screening prematurely. Screening decisions need to be individualized and not solely dependent on life expectancy prediction.

ID: 3524153 PREDICTED LIFE EXPECTANCY AMONG OLDER ADULTS ATTENDING COLONOSCOPY: AN ANALYSIS OF THE NEW HAMPSHIRE COLONOSCOPY REGISTRY

The USPSTF recommends colorectal cancer screening through age 75, with individualization for ages 76-85 based on factors including life expectancy greater than 10 years. There are no specific guidelines on when to stop surveillance colonoscopy. The objective of this study was to evaluate the predicted life expectancy among older adults presenting for colonoscopy by indication as a potential measure of appropriateness.

Impact of the geriatric assessment on clinical treatment decision in older Indian persons with cancer.

e24015 Background: The geriatric assessment (GA) is a multidimensional evaluation of an older person. Identification of the non-oncologic vulnerabilities, estimation of life expectancy and chemotherapy risk prediction aid the clinicians in the therapeutic risk-benefit ratio analysis. Globally, GA leads to changes in oncologic decisions in 28% of patients. Methods: An observational study with a retrospective and prospective cohort of patients who underwent a GA in the geriatric oncology clinic at the Tata Memorial Hospital in Mumbai, India. The study was approved by the institutional ethics committee (IEC) and registered with Clinical Trials Registry of India-CTRI/2020/04/024675. Written informed consent was obtained from the patients enrolled in the prospective part of the study; the IEC granted a consent waiver for the retrospective portion of the study. Patients aged 60 years and older with a diagnosis of malignancy were evaluated in the geriatric oncology clinic. The results of the GA were entered in the electronic medical records (EMR). The systemic therapy plan prior to the GA and the actual therapy plan made were retrospectively captured from the EMR. The primary objective was to determine the proportion of patients in whom the systemic therapy plan was changed following the GA. Results: Between June 2018 and Feb 2021, 340 patients were evaluated in the geriatric oncology clinic for whom the pre-GA and post-GA systemic therapy plans were available. The median age was 70 years (range, 60-100); 264 (78%) were men. The common malignancies were lung cancer in 134 (39.4%) and gastrointestinal in 119 (35%). The intent of therapy was palliative in 190 (56%) patients. Following the GA, the systemic therapy plan was changed in 125 (36.8%) patients. The most common change was deintensification of therapy in 106 patients (31.2%), including dose reduction in 41 (12%), decrease in the number of chemotherapy medicines in 8 (2.4%), substitution of chemotherapy by targeted therapy (4, 1.2%)/oral hormonal therapy (4, 1.2%)/oral TKI (11, 3.2%)/immunotherapy (2, 0.6%) and withholding systemic therapy in 36 (10.6%) patients. Withholding systemic therapy consisted of a change from chemoradiotherapy to radical radiation alone in 17 (5%), withholding neoadjuvant or adjuvant chemotherapy in 5 (1.5%) and a change to best supportive care in 14 (4.1%). Conclusions: The results of the GA led to a change in the management plan in over one-third of older Indian patients with cancer. GA is an important tool in the oncologic decision-making process for older persons with cancer. Clinical trial information: CTRI/2020/04/024675.

Life expectancy in metastatic prostate cancer patients according to racial/ethnic groups.

To quantify the magnitude of differences between observed overall survival and respective, age-adjusted Social Security Administration life tables-derived life expectancy in Caucasian, African American, Hispanic/Latino and Asian metastatic prostate cancer patients. Furthermore, to test for differences in cancer-specific mortality and other-cause mortality according to race/ethnicity. We relied on the 2004-2006 Surveillance, Epidemiology and End Results database to identify Caucasian, African American, Hispanic/Latino and Asian metastatic prostate cancer patients. Social Security Administration life tables were used to compute 10-year life expectancy for comparisons with observed overall survival. Poisson regression plots showed cancer-specific mortality relative to other-cause mortality for each race/ethnicity. A total of 2574 (64.2%) patients were Caucasian, 753 (18.8%) were African American, 453 (11.3%) were Hispanic/Latino and 227 (5.7%) were Asian, respectively. The median age at diagnosis was 72years in Caucasian patients, 68years in African American patients, 70years in Hispanic/Latino patients and 72years in Asian patients. Observed overall survival rates were always lower compared with respective predicted life expectancy. The magnitude of the difference between observed overall survival and predicted life expectancy at 10years was highest in African American patients (-52.2%), followed by Caucasian patients (-48.3%), Hispanic/Latino patients (-46.1%) and Asian patients (-37.4%). African American patients showed the highest cancer-specific mortality rates (71.1%) and second-highest other-cause mortality rates (17.4% vs highest 18.4% in Caucasian patients), despite having the youngest age at diagnosis. Asian patients showed the lowest cancer-specific mortality rates (65.5%, P<0.0001) and lowest other-cause mortality rates (13.3%, P=0.04), despite having the oldest age at diagnosis. Despite having the youngest age at diagnosis, African American patients show the least favorable survival profile in metastatic prostate cancer. Conversely, Asian patients show the most favorable survival profile in metastatic prostate cancer, despite having the oldest age at diagnosis.

Light-Intensity Physical Activity and Life Expectancy: National Health and Nutrition Survey

Quantifying the years of life gained associated with light-intensity physical activity may be important for risk communication in public health. Because no studies have examined the role of light-intensity physical activity in life expectancy, this study aims to quantify the years of life gained from light-intensity physical activity in a population-based U.S. This study used data from 6,636 participants in the National Health and Nutrition Examination Survey (2003-2006). Analyses were conducted in 2020. Light-intensity physical activity was categorized into low, medium, and high on the basis of tertiles, and survival models were applied to estimate the years of life gained from each light-intensity physical activity group. Analyses were repeated in participants with moderate-to-vigorous physical activity above or below the median. During a mean follow-up of 11 years and at 55,520 person-years, 994 deaths were recorded. At age 20 years, participants with low, medium, and high light-intensity physical activity had a predicted life expectancy of 53.92 (95% CI=46.66, 61.18), 58.16 (95% CI=52.10, 65.22), and 58.44 (95% CI=51.29, 65.60) years, suggesting significant years of life gained from medium and high levels of light-intensity physical activity of 2.89 (95% CI=0.90, 4.12) and 3.07 (95% CI=0.84, 5.30) years. The corresponding years of life gained at age 45 years and 65 years were 2.51 (95% CI=0.40, 5.47) and 1.52 (95% CI=0.54, 2.50) years for the medium light-intensity physical activity group and 2.66 (95% CI=0.80, 4.52) and 1.62 (95% CI=0.49, 52.75) years for the high light-intensity physical activity group. This association was significant in participants with moderate-to-vigorous physical activity below the median but not for those with moderate-to-vigorous physical activity above the median. Light-intensity physical activity may extend life expectancy. Given the low prevalence of moderate-to-vigorous physical activity in populations, physical activity promotion efforts may capitalize on emerging evidence on light-intensity physical activity, particularly among the most inactive groups.

Greenness and education inequalities in life expectancy in Latin American cities: an ecological study

BackgroundGreenness has been found to be associated with reduced mortality and morbidity and improved wellbeing, with recent evidence further linking it to narrower health inequalities. However, results come mostly from high-income countries and thus might not be generalisable to other settings. In this preliminary analysis, we address this gap by examining whether education inequalities in life expectancy in Latin American cities vary by area-level greenness. MethodsWe used data from the Salud Urbana en America Latina (SALURBAL) study. The analysis sample included 28 large cities in nine Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, Panama, and El Salvador), comprising 671 sub-city units (>10 per city), for the period 2012–16. We used sub-city data on life expectancy, education (percentage of residents with high school or university education, as an indicator for socioeconomic status), and greenness (as calculated by the satellite image-derived normalised difference vegetation index). We used multilevel linear models of sub-cities nested within cities, with country fixed effects to predict life expectancy by education, greenness, and their interaction, while accounting for covariates at the city and sub-city levels. FindingsHigher education was associated with higher life expectancy in both sexes (men: standardised regression coefficient b=0·51 [95% CI 0·36–0·65]; women: 0·34 [0·23–0·45]), whereas increased area-level greenness was associated with higher life expectancy among men (0·39 [0·03–0·75]). The educational gradient in life expectancy was steeper in greener areas for both sexes (men: b for interaction=0·20 [0·08–0·32]; women: 0·15 [0·05–0·24]). InterpretationContrary to evidence from high-income countries, our initial results from Latin America suggest education disparities in life expectancy might increase with greater levels of green space. Given the already wide intra-urban inequalities in Latin American cities, and the sparse and unequal distribution of urban green spaces, greening policies need to make a concerted effort to ensure that unequal access to green spaces does not exacerbate existing health inequalities. FundingWellcome Trust (205177/Z/16/Z).

Improving the accuracy of estimating paper permanence for accelerated degradation in closed vials

To more accurately predict the permanence of paper during natural aging, we studied cellulose aging according to closed vial setup, which compared to alternative paper aging methods is closer to natural aging with regard to predictions of paper life expectancy. To improve kinetic evaluation, not only cellulose degradation by hydrolysis and oxidation, but also the moisture content in the closed vial were measured during the aging process. This allowed to eliminate the long-known errors of the method caused by vial leakage which falsely produce different aging rates for different aging periods. With the aim of predicting paper permanence more accurately, several ways of considering the moisture changes and the influences of paper moisture and vial leakage were considered and an improved protocol was elaborated that corrects the rate of cellulose chain scission based on the average moisture content in the paper. Based on this hydrolysis rate, the expected half-life DP becomes independent of the aging period and thus less error-prone and more reliable. We hope that this improvement of the very common closed-vial aging method will quickly be accepted and welcomed by the paper conservation community.

Salvage Radical Prostatectomy: Baseline Prostate Cancer Characteristics and Survival Across SEER Registries.

To test for baseline prostate cancer characteristics and survival differences after salvage radical prostatectomy (SRP) across 18 Surveillance, Epidemiology and End Results (SEER) registries from 2004 to 2016. We tabulated prostate-specific antigen (PSA), cT stage, age, and SRP rates across individual SEER registries. Kaplan-Meier and competing risks regression methodologies depicted cancer-specific mortality and other cause mortality. Finally, overall mortality was compared with predicted life expectancy. Overall, 428 SRP patients (2004-2016) were identified in the SEER database. Median follow-up duration was 74 months (interquartile range [IQR], 31-114). The median age at diagnosis was 68 years (IQR, 61-73 years) with a median PSA at diagnosis of 8.8 ng/mL (IQR, 5.4-18.6 ng/mL) and 10% cT3-4 stage (0%-23.8%). Variability existed across individual SEER registries regarding age, PSA, cT stage, and annual number of SRPs (0-17), as well as cumulative numbers of SRPs (7-73) between 2004 and 2016. At 10 years, cancer-specific mortality was 23.2% vs. other cause mortality 19.3%. Finally, SRP patients exhibited higher 10-year overall mortality (43.3%) than predicted by life tables (31.8%). SRP is rarely performed. In most SEER registries, SRP use is very occasional. More than 2 average annual SRPs were reported in only 5 of all registries. Nonetheless, across all registries, SRP patients showed marginal to moderate differences in PSA, cT stage, and age at diagnosis. However, at 10 years of follow-up, 1 of 5 SRP patients died of other causes and observed overall mortality was higher than expected (36%).

Advanced cancer is also a heart failure syndrome: a hypothesis.

We present the hypothesis that advanced stage cancer is also a heart failure syndrome. It can develop independently of or in addition to cardiotoxic effects of anti‐cancer therapies. This includes an increased risk of ventricular arrhythmias. We suggest the pathophysiologic link for these developments includes generalized muscle wasting (i.e. sarcopenia) due to tissue homeostasis changes leading to cardiac wasting associated cardiomyopathy. Cardiac wasting with thinning of the ventricular wall increases ventricular wall stress, even in the absence of ventricular dilatation. In addition, arrhythmias may be facilitated by cellular wasting processes affecting structure and function of electrical cells and conduction pathways.We submit that in some patients with advanced cancer (but not terminal cancer), heart failure therapy or defibrillators may be relevant treatment options. The key points in selecting patients for such therapies may be the predicted life expectancy, quality of life at intervention time, symptomatic burden, and consequences for further anti‐cancer therapies.The cause of death in advanced cancer is difficult to ascertain and consensus on event definitions in cancer is not established yet. Clinical investigations on this are called for. Broader ethical considerations must be taken into account when aiming to target cardiovascular problems in cancer patients.We suggest that focused attention to evaluating cardiac wasting and arrhythmias in cancer will herald a further evolution in the rapidly expanding field of cardio‐oncology.

Preoperative functional status predicts 2-year mortality in patients undergoing fenestrated/branched endovascular aneurysm repair

BackgroundFenestrated/branched endovascular aneurysm repair (F/BEVAR) is a minimally invasive alternative for patients at high risk of open repair of complex aortic aneurysms. Nearly all investigative study protocols evaluating F/BEVAR have required a predicted life expectancy of >2 years for study inclusion. However, accurate risk models for predicting 2-year survival in this patient population are lacking. We sought to identify the preoperative predictors of 2-year survival for patients undergoing F/BEVAR. MethodsThe prospectively collected data for all consecutive F/BEVAR procedures, performed in an institutional review board-approved registry and/or a physician-sponsored investigational device exemption (IDE) trial (IDE no. G130210), were reviewed (November 2010 to February 2019). We assessed 44 preoperative patient characteristics, including comorbidities, preoperative functional status, aneurysm morphologies, and repair techniques. Preoperative functional status was defined as totally dependent (any impairment in activities of daily living or residing in a skilled nursing facility), partially dependent (any impairment in instrumental activities of daily living), or independent (no impairment in activities of daily living or instrumental activities of daily living). Using the results of univariate analysis (P < .2), a Cox proportional hazards model was constructed to identify the independent predictors of 2-year all-cause mortality. ResultsFor the 256 consecutive patients who had undergone F/BEVAR (6 common iliac [2.3%], 94 juxtarenal [41%], 35 pararenal [14%], 119 thoracoabdominal [47%], and 2 arch [0.8%] aneurysms), the 2-year mortality was 18%. On Cox modeling, the only independent preoperative predictor contributing to 2-year mortality was functional status (totally dependent: hazard ratio [HR], 5.4; 95% confidence interval [CI], 1.8-16; P = .0024; partially dependent: HR, 4.5; 95% CI, 2.4-8.7; P < .0000019). A history of an implanted anti-arrhythmic device was protective (HR, 0.4; 95% CI, 0.2-0.99; P = .0495). Factors such as age, congestive heart failure, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, aneurysm extent, and previous aortic surgery, were not significant. The 2-year mortality for the independent (n = 176; 69%), partially dependent (n = 69; 27%), and totally dependent (n = 10; 3.9%) groups was 11%, 33%, and 40%, respectively. ConclusionsFor patients undergoing F/BEVAR, decreased preoperative functional status was the strongest predictor of 2-year mortality, with totally dependent patients experiencing poor survival. The traditional risk factors were not independently significant, perhaps reflecting the high prevalence of severe chronic illness in these high-risk patients participating in an IDE trial. For the independent patients, the 2-year F/BEVAR survival rate was 89%, equivalent to patient survival after infrarenal EVAR. Therefore, for independent patients, it would be reasonable to expand the indication for F/BEVAR to low-risk patients.

Comparison of prognostic scales for patients with metastatic spine disease.

This is one-centre retrospective study with the aim to identify the scale, which provides the most accurate prediction of life expectancy in patients with metastatic lesions in spine. A retrospective analysis of clinical data of 138 patients with metastatic spinal tumors. Patients underwent spinal cord decompression and instrumented stabilization of affected area. We evaluated the general condition according to the Karnofsky and ECOG scales, the presence of metastases in the visceral organs, spine and other bones, the neurological status and conduction of the medical therapy before spinal surgery. Observed clinical parameters were converted to Tokuhashi, Tomita, and Katagiri scales. For statistical analysis, software environment R 3.4.1 was used. Assessment of prognostic accuracy was performed using ROC analysis. The Tokuhashi scale showed AUC 0.605 (95% CI 0.586-0.616), Tomita scale showed AUC 0.708 (95% CI 0.573-0.842), Katagiri scale showed AUC 0.650 (95% CI 0.508-0.792). The best results for survival rate predicting after surgical treatment for metastatic spinal lesions were shown the Tomita scale.

Life expectancy and mortality in 363 cities of Latin America

The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases

IntroductionPatients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy. MethodsA retrospective cohort study using the National Cancer Institute’s Surveillance Epidemiology and End Results—Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005–2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE. ResultsA total of 4560 patients (median age 74, interquartile range 70–78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52–1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96–1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04). ConclusionThe survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non–cancer-related causes.

A Novel Curriculum on Using Life Expectancy to Inform Cancer Screening in Older Adults.

Many older adults with limited life expectancy still receive cancer screening. One potential contributor is that primary care providers (PCP) are not trained to incorporate life expectancy in cancer screening recommendations. We describe the development and evaluation of a novel curriculum to address this need. We developed and implemented a web-based learning module within a large Maryland group practice with PCPs for older adults. We assessed attitude, knowledge, self-efficacy, and self-reported behavior outcomes before the module, immediately after completing the module, and 6 months afterwards. Of 172 PCPs who were invited, 86 (50%) completed the module and of these, 50 (58.1%) completed the 6-months follow up survey. Immediately after the module, there was a significant increase in perceived importance of life expectancy (increase of 0.50 point on 10-point scale, 95% confidence intervals (CI) = 0.27-0.73), confidence in predicting life expectancy (increase of 2.32 points on 10-point scale, 95% CI = 1.95-2.70) and confidence in discussion screening cessation (increase of 1.69 points on 10-point scale, 95% CI = 1.37-2.02). Knowledge in patient-preferred communication strategies improved from 55% correct response to 97% (P < .001). However, most of these improvements dissipated by 6 months and there was no change in self-reported behavior at 6 months compared to baseline (P = .34). Although the module resulted in significant short-term improvement in attitude, knowledge, and self-efficacy, the changes were not sustained over time. Educational interventions such as this can be coupled with ongoing reinforcing strategies and/or decision support interventions to improve cancer-screening practices in older adults.

Advanced cancer is also a heart failure syndrome: a hypothesis.

We present the hypothesis that advanced stage cancer is also a heart failure syndrome. It can develop independently of or in addition to cardiotoxic effects of anti-cancer therapies. This includes an increased risk of ventricular arrhythmias. We suggest the pathophysiologic link for these developments includes generalized muscle wasting (i.e. sarcopenia) due to tissue homeostasis changes leading to cardiac wasting associated cardiomyopathy. Cardiac wasting with thinning of the ventricular wall increases ventricular wall stress, even in the absence of ventricular dilatation. In addition, arrhythmias may be facilitated by cellular wasting processes affecting structure and function of electrical cells and conduction pathways. We submit that in some patients with advanced cancer (but not terminal cancer), heart failure therapy or defibrillators may be relevant treatment options. The key points in selecting patients for such therapies may be the predicted life expectancy, quality of life at intervention time, symptomatic burden, and consequences for further anti-cancer therapies. The cause of death in advanced cancer is difficult to ascertain and consensus on event definitions in cancer is not established yet. Clinical investigations on this are called for. Broader ethical considerations must be taken into account when aiming to target cardiovascular problems in cancer patients. We suggest that focused attention to evaluating cardiac wasting and arrhythmias in cancer will herald a further evolution in the rapidly expanding field of cardio-oncology.

Клинико-генетические аспекты альбинизма

Albinism is a clinically and genetically heterogeneous group of hereditary diseases whose pathogenesis is mediated by impaired synthesis of melanin which results in its partial or total loss. Reduced melatonin level clinically manifests as skin, hair, and ocular hypopigmentation. Ocular presentations include hypopigmentation/lack of pigmentation of eye fundus and iris, foveal hypoplasia, low vision, nystagmus and strabismus, photophobia, iris transillumination, and asymmetrical decussation of nerve fibers at the optic chiasm. However, albinism can be a part of more complex genetic syndromes, e.g., Hermansky-Pudlak syndrome or Chediak-Higashi syndrome. These disorders should be identified as early as possible to start therapy to prevent life-threatening conditions. Partial albinism with ocular, skin or hair hypopigmentation not associated with melanogenesis (e.g., Griscelli syndrome, Waardenburg syndrome, Aland Island eye disease, etc.) also occurs. Each case of albinism requires an accurate molecular genetic diagnosis to provide a personalized treatment approach, predict life expectancy and health status, and plan pregnancy. Keywords: albinism, Hermansky-Pudlak syndrome, Chediak-Higashi syndrome, hypopigmentation, clinical polymorphism, genetic heterogeneity. For citation: Kadyshev V.V., Ryazhskaya S.A., Khalanskaya O.V. et al. Clinical and genetic aspects of albinism. Russian Journal of Clinical Ophthalmology. 2021;21(3):175–180 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-175-180.

Analysis of Population Life Span Based on Grey Prediction

This paper studies the changing trend of population life expectancy and the impact of various influencing factors on life expectancy, and collects 8 influencing factor data from some provinces and cities in different locations across the country, and performs factor analysis on the 8 factors to determine their total Linear, classify the indicators with strong correlation into one category, make them a common factor, and name them. Then establish a multiple linear regression model of common factors and life expectancy; and use SPSS to fit the model to evaluate the accuracy of the built model. Finally, the gray prediction model is used to obtain the predicted value of 8 variables, and then the predicted value of the common factor is obtained, which is substituted into the regression equation to obtain the predicted life expectancy of the future population.