Rates Of Chemotherapy Administration Research Articles

The impact of COVID-19 on national trends of hospitalization and outcomes for acute leukemias.

e18869 Background: Acute leukemias are traditionally managed in a hospital setting. During the initial phase of the COVID-19 pandemic, there was a gross shortage of hospital resources and rationing of care. We aimed to study the differences in national trends of hospitalizations and outcomes for acute leukemias in 2019 (pre-pandemic) and 2020 across the United States. Methods: We performed a retrospective study utilizing the National Inpatient Sample (NIS) of adults hospitalized for management of acute leukemias as the primary diagnosis using ICD-10-CM codes. We excluded all patients with a prior or current hospitalization for stem cell transplantation. We compared the outcomes between patients presenting in 2019 (pre-pandemic) and 2020. Outcomes included mortality, length of stay (LOS) and cost of hospitalization. We compared mortality among patients with and without COVID in 2020 using chi-square analysis. Results: Of 166795 admissions for acute leukemia, 71.8% were acute myeloid leukemia (AML), 25.2% were acute lymphoblastic leukemia (ALL) and 3.1% were acute promyelocytic leukemia (APML). Overall, patients were predominantly male (55%), White (68%) presenting to large hospitals (67%) specifically urban teaching hospitals (88%). When compared between 2019 and 2020, there was no difference in the proportion not receiving chemotherapy for their leukemia (77.7% vs 78.6% in 2019 and 2020 respectively). There were no differences between mortality (8.6% vs 8.7%) or median LOS (6 days vs 5 days). The total cost of hospitalization was higher in 2020 ($155,961) compared to 2019 ($151,372). When stratified by COVID-19 infection in 2020, mortality was higher among COVID infected patients in AML (27.5% vs 10.08%, p=0.000), in ALL (16.87% vs 3.30%, p=0.000) as well as APML (26.32% vs 11.5%, p=0.139). Conclusions: Overall, there were no differences in the hospitalizations, rates of chemotherapy administration, mortality or LOS for acute leukemia pre and post COVID-19. However, in 2020, patients with AML and ALL with a concurrent COVID-19 diagnosis had a higher mortality. [Table: see text]

Abstract PS6-27: Secondary invasive breast events (SIBE) among patients with oncotype DX recurrence scores (RS) 26-30 and >31: Results from a large oncotype database

Abstract Background: Oncotype RS is a 21-gene assay used to predict the likelihood of distant recurrence and benefit of chemotherapy in patients with lymph node negative (LN-), hormone positive (HR+) breast cancer (BC). The Oncotype RS is used to identify patients who may be spared chemotherapy in the adjuvant setting without adverse impact on survival or secondary invasive breast events (SIBE). Results of the TAILORx trial (Sparano et al, 2018) provided evidence that chemotherapy can likely be spared for most patients with oncotype RS<25, with chemotherapy benefit potentially related to chemotherapy-induced menopause. More aggressive endocrine therapy with concurrent ovarian suppression in pre-menopausal women may mitigate the need for chemotherapy among patients with higher RS. We developed a large oncotype database to determine rates of SIBE (ipsilateral recurrence, contralateral breast cancer or metastatic recurrence) among patients with higher genomic risk (Oncotype RS 26-30 and > 31) to determine the benefit of chemotherapy among these groups. Methods:We identified 887 patients with early-stage, HR+ BC treated between 2006-2018. Among these patients, 515 had treatment and follow-up data available for SIBE analysis. Median follow-up for SIBE was 62 months with 41 SIBE (8%) including both LN+ and LN- patients. When stratified by RS using conservative cutoffs (Sparano et al, 2018): low risk (<10), intermediate risk (11-25), and high risk (>26), 5 year rates of SIBE were 4%, 6% and 16% respectively. The Kaplan Meier method was used to estimate the time to SIBE distributions overall and among different RS groups with the log rank test used to compare distributions between groups. Results: Among 887 patients, 616 (69%) were post-menopausal. A total of 654 (74%) patients had surgical management, of which 226 underwent mastectomy (35%) and 428 underwent lumpectomy (65%). Among the 630 patients who received adjuvant therapy, 14 (2%) received chemotherapy alone, 143 (23%) received a combination of chemotherapy/endocrine therapy and 473 (75%) received endocrine therapy alone. Twenty-four patients (3%) refused one or more recommended therapies. Three hundred fourteen patients (50%) also received radiation therapy. Rates of chemotherapy administration were 8% among low RS, 16% among intermediate RS and 82% among high RS patients (73% for RS 26-30 and 90% for RS >31). One-hundred eighty six of 887 patients were missing chemotherapy administration data as they were likely treated at another center. Patients with treatment data available and adequate follow up were included in the SIBE analysis (n=515). Among the 27 LN- patients with RS 26-30, twenty (74%) received chemotherapy and the remaining seven (26%) did not. The five year rate of SIBE was 25% among patients who received chemotherapy and 33% among those who did not receive chemotherapy; p=0.5489. Among the 23 LN negative patients with RS >31, twenty-one (91%) patients received chemotherapy and the remaining two (9%) did not. The five year rate of SIBE was 0% in both patients who received chemotherapy and in patients who did not receive chemotherapy; p-value not estimable in this subgroup due to no SIBE in either group. Conclusion: In this large oncotype database, there was no statistically significant difference in SIBE for patients with higher genomic risk (RS 26-30 and >31) whether or not they received chemotherapy. This data was limited by small numbers of patients in these sub-groups. More aggressive endocrine therapy with ovarian suppression has become an alternative option to spare chemotherapy in intermediate risk patients (RS 11-25). This approach may be useful among patients with even higher risk oncotype scores. Prospective randomized studies may be useful to determine utility of chemotherapy among patients with RS >26. Citation Format: Brittney S Zimmerman, Krystal Cascetta, Natalie Berger, Serena Tharakan, Kelly Suchman, Julia Blanter, Erin Moshier, Meng Ru, Shabnam Jaffer, Amy Tiersten. Secondary invasive breast events (SIBE) among patients with oncotype DX recurrence scores (RS) 26-30 and >31: Results from a large oncotype database [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-27.

Real-world patterns of chemotherapy administration and attrition among patients with metastatic colorectal cancer.

To assess the real-world patterns of systemic treatment attrition rates among patients with metastatic colorectal cancer. Databases based from the provincial cancer registry and electronic medical records in Alberta were accessed, and cases with a de novo diagnosis of metastatic colorectal cancer with no history of other primary cancers (2004-2017) were reviewed. Rates of chemotherapy administration in first and subsequent lines of treatment were assessed. Multivariable logistic regression analysis for factors associated with non-administration of chemotherapy was evaluated. The impact of administration of all three chemotherapy agents (fluoropyrimidines, oxaliplatin, and irinotecan) across the course of treatment was assessed through multivariable Cox regression analysis with time-dependent covariates. A total of 4179 patients with metastatic colorectal cancer were included in the current study. This includes 1988 patients receiving at least one cycle of chemotherapy and 2191 patients who did not receive any chemotherapy. The following factors were associated with a higher probability of no chemotherapy use: older age (OR 1.064; 95% CI 1.057-1.070), higher Charlson comorbidity index (OR 1.444; 95% CI 1.342-1.554), female sex (OR for male sex versus female sex 0.763; 95% CI 0.660-0.881), rural residence (OR for residence in zone 2 (Calgary) versus zone 5 (North zone) 0.346; 95% CI 0.272-0.440), proximal tumor location (OR 1.255; 95% CI 1.083-1.454), and earlier year at diagnosis (OR (continuous) 0.895; 95% CI 0.879-0.911). Within the cohort of patients who received at least one cycle of chemotherapy, 42.5% received one line of chemotherapy only, and 30.5% received two lines of chemotherapy. The use of all three chemotherapy drugs was associated with better overall survival (HR 3.305; 95% CI 2.755-3.965) and colorectal cancer-specific survival (HR 3.367; 95% CI 2.753-4.117). A considerable proportion of metastatic colorectal cancer patients who received active chemotherapy in this population-based study received only one line of therapy. This highlights the significance of choosing effective treatments in the first-line treatment as the attrition rate is high. Furthermore, the use of all three chemotherapy agents across the course of treatment was associated with better outcomes.

Is neoadjuvant chemotherapy for pT2 bladder cancer associated with a survival benefit in a population-based analysis?

BackgroundPatients with organ confined muscle-invasive bladder cancer (MIBC) who are candidates for radical cystectomy (RC) should receive neoadjuvant chemotherapy (CHT). However, the most contemporary CHT use rates indicate low adherence to these guidelines. We tested contemporary neoadjuvant CHT rates and associated cancer-specific mortality (CSM) and overall mortality (OM) in pT2N0 MIBC patients treated with RC. Materials and methodsWithin the SEER database (2004–2015), we identified patients with pT2N0 MIBC patients who underwent RC. CHT administration rates were evaluated using estimated annual percentage changes (EAPCs) analyses. After inverse probability of treatment weighting (IPTW), Kaplan–Meier (KM) analyses and Cox regression models (CRMs) were used to test the effect of CHT vs no CHT on survival. Landmark analyses tested for immortal time bias. ResultsOf 3978 RC patients, 38.2% of patients received CHT. Between 2004 and 2015, CHT rates increased from 15.9% to 66.2% (EAPC: +14.2%; p < 0.001). IPTW-adjusted KM showed 10-year CSM-free survival rates of 78.9% for CHT vs 76.7% for no CHT patients (p = 0.6). Similarly, IPTW-adjusted KM showed 10-year OM-free survival rates of 54.6% for CHT vs 57.9% for no CHT patients (p = 0.8). In IPTW-adjusted MCRMs, CHT was not significantly associated with lower CSM (HR 0.97, CI 0.82–1.14; p = 0.7) or OM (HR 1.02, CI 0.90–1.16; p = 0.7). Virtually the same CSM and OM rates were recorded after landmark analyses. ConclusionsCHT use in pT2N0 MIBC RC patients sharply increased over the study span. However, neoadjuvant CHT was not associated with better survival in this patient group.

Adjuvant Chemotherapy Administration and Survival Outcomes in Lymphoma Survivors with Common Solid Tumors: A Population-Based Study

Background: Adjuvant therapy is an essential component of treatment for many early-stage (stage I-III) breast, colon, or lung cancers after curative surgery. Patients newly diagnosed with these cancers who also have a history of diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma (HL) have typically undergone anthracycline-based chemotherapy to treat their lymphoma, and may be less likely to receive adjuvant chemotherapy for subsequent solid cancers because of prior toxicities or limits on cumulative doses. Some studies suggested lower use of adjuvant chemotherapy in HL survivors with breast cancer (Elkin et al., JCO 2011), and worse overall survival (OS) outcomes in lymphoma survivors with solid tumors (Sanna et al., Ann Oncol 2007). Our objective was to examine the use of adjuvant chemotherapy and OS among DLBCL/HL survivors compared with the general population of patients with three common cancers: breast, colon, and lung.Methods: From the Surveillance, Epidemiology, and End Results (SEER) database, we identified patients aged 20-79 diagnosed with breast (stage I-III), colon (stage II-III), or lung (stage II-IIIA) cancers in 2004-2015, who underwent surgery and were thus candidates for adjuvant chemotherapy by virtue of age and stage. Among them we distinguished “cases” of DLBCL or HL survivors (diagnosed with lymphoma >1 year before the index cancer), treating other patients as “controls”. We compared administration of chemotherapy (versus no or unknown administration status, as recorded by SEER) and OS in each cancer, in multivariable robust Poisson regression or Cox models, respectively, reporting relative risk (RR) or hazard ratio (HR) with 95% confidence intervals (CI). All models were adjusted for age, sex, race, year of diagnosis, stage of the index cancer, lymph node involvement, type of surgery (e.g. breast conservation or mastectomy, partial or total colectomy, lobectomy or pneumonectomy), and endocrine receptor status for breast cancer.Results: Among patients with breast cancer (n=532,686), we identified 360 DLBCL and 349 HL survivors (with median latency between lymphoma and cancer diagnoses of 79 and 222 months, respectively). Among patients with colon cancer (n=149,993), there were 165 DLBCL and 88 HL survivors (median latency 71 and 156 months, respectively). Among patients with lung cancer (n=23,396) there were 37 DLBCL and 25 HL survivors (medial latency 60 and 147 months, respectively). In breast and colon cancers, DLBCL survivors were significantly older, and HL survivors younger than controls, but this difference was absent in lung cancer (Table). HL survivors were diagnosed with breast cancer at an earlier stage than controls (P=.006), but in all other studied scenarios we observed no significant difference in stage or extent of nodal spread between DLBCL/HL survivors and controls.After adjustment for baseline characteristics, we observed no significant difference between patients with and without a history of lymphoma in the rates of chemotherapy administration (adjusted RR, 0.87 to 1.04), except HL survivors with colon cancer, who had a 20% lower rate than controls (RR, 0.80, 95% CI, 0.64-1.00). OS was significantly worse for patients with prior HL lymphoma in all 3 cancers, but for DLBCL survivors only in breast cancer. Consistent results were observed in the subpopulation of patients who actually received adjuvant chemotherapy.Conclusions: In most studied scenarios, despite prior exposure to intensive chemotherapy, survivors of DLBCL or HL received adjuvant chemotherapy for common cancers at similar rates relative to patients with no history of lymphoma. Therefore, contrary to prior suggestions, differences in application of chemotherapy cannot explain survival disparities between lymphoma survivors and other patients with the same cancers. HL survivors had consistently worse OS even in the subpopulation receiving chemotherapy, suggesting that other (e.g. cardiovascular) sources of mortality related to late toxicities of HL treatment may be contributing, rather than differences in treatment. Unique survival patterns among DLBCL survivors suggest that limits on anthracycline-based chemotherapy due to cumulative lifetime dosing may impair outcomes in breast cancer, but not in cancers like colon or lung, which are treated with non-overlapping taxane- or fluorouracil-based adjuvant regimens. DisclosuresOlszewski:Genentech: Research Funding; TG Therapeutics: Research Funding; Spectrum Pharmaceuticals: Consultancy, Research Funding.