We previously demonstrated disparate acute myelogenous leukemia (AML) survival for black and Hispanic patients; these differences persisted despite younger ages and higher prevalence of favorable ...cytogenetics in these groups. This study determined: (i) whether there are differences in treatment delivered to minorities, and (ii) how these differences affect outcomes in AML. We hypothesize that differences in treatment explain some proportion of survival disparities.
We used California Cancer Registry data linked to hospital discharge abstracts for patients with AML (1998-2008). Logistic regression models estimated odds of treatment (chemotherapy and/or hematopoietic stem cell transplant) by race/ethnicity. Cox proportional hazard models estimated mortality by race after adjustment for treatment.
We analyzed 11,084 records. Black race was associated with lower odds of chemotherapy OR, 0.74; 95% confidence interval (CI), 0.61-0.91. Black and Hispanic patients had decreased odds of transplant (OR, 0.64; 95% CI, 0.46-0.87); (OR, 0.74; 95% CI, 0.62-0.89), respectively. Black patients had increased hazard of mortality (HR, 1.14; 95% CI, 1.04-1.25) compared with whites. Adjustment for receipt of any treatment resulted in decreased mortality (HR, 1.09; 95% CI, 1.00-1.20) for black patients.
AML treatment differences for black patients explain some proportion of the disparity. Future AML disparities studies should investigate socioeconomic and other characteristics.
Study findings may better elucidate drivers of disparities in AML.
Purpose Multiple smaller studies have demonstrated an association between overall survival and lymph node (LN) count from neck dissection in patients with head and neck cancer. This is a large cohort ...study to examine these associations by using a national cancer database. Patients and Methods The National Cancer Database was used to identify patients who underwent upfront nodal dissection for mucosal head and neck squamous cell carcinoma between 2004 and 2013. Patients were stratified by LN count into those with < 18 nodes and those with ≥ 18 nodes on the basis of prior work. A multivariable Cox proportional hazards regression model was constructed to predict hazard of mortality. Stratified models predicted hazard of mortality both for patients who were both node negative and node positive. Results There were 45,113 patients with ≥ 18 LNs and 18,865 patients with < 18 LNs examined. The < 18 LN group, compared with the ≥ 18 LN group, had more favorable tumor characteristics, with a lower proportion of T3 and T4 lesions (27.9% v 39.8%), fewer patients with positive nodes (46.6% v 60.5%), and lower rates of extracapsular extension (9.3% v 15.1%). Risk-adjusted Cox models predicting hazard of mortality by LN count showed an 18% increased hazard of death for patients with < 18 nodes examined (hazard ratio HR 1.18; 95% CI, 1.13 to 1.22). When stratified by clinical nodal stage, there was an increased hazard of death in both groups (node negative: HR, 1.24; 95% CI, 1.17 to 1.32; node positive: HR, 1.12; 95% CI, 1.05 to 1.19). Conclusion The results of our study demonstrate a significant overall survival advantage in both patients who are clinically node negative and node positive when ≥ 18 LNs are examined after neck dissection, which suggests that LN count is a potential quality metric for neck dissection.
No information is available on oncology patients' level of stress and symptom burden during the coronavirus disease 2019 (COVID-19) pandemic.
To evaluate for differences in demographic and clinical ...characteristics, levels of social isolation and loneliness, and the occurrence and severity of common symptoms between oncology patients with low vs. high levels of COVID-19 and cancer-related stress. In addition, to determine which of these characteristics were associated with membership in the high-stressed group.
Patients were 18 years and older; had a diagnosis of cancer; and were able to complete an online survey.
Of the 187 patients in this study, 31.6% were categorized in the stressed group (Impact of Event Scale—Revised score of ≥24). Stressed group's Impact of Event Scale—Revised score exceeds previous benchmarks in oncology patients and equates with probable post-traumatic stress disorder. In this stressed group, patients reported occurrence rates for depression (71.2%), anxiety (78.0%), sleep disturbance (78.0%), evening fatigue (55.9%), cognitive impairment (91.5%), and pain (75.9%). Symptom severity scores equate with clinically meaningful levels for each symptom.
We identified alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer, exceeding those previously benchmarked in this population and on par with noncancer patients with post-traumatic stress disorder. Given that the COVID-19 pandemic will likely impact cancer care for an indefinite period, clinicians must exhibit increased vigilance in their assessments of patients' level of stress and symptom burden. Moreover, an increase in referrals to appropriate supportive care resources must be prioritized for high-risk patients.
Although a significant proportion of patients are readmitted to non-index hospitals after surgery, risk factors for non-index hospital readmission are not well defined.
Using the California Office of ...State Health Planning and Development database from 2008 to 2012, patients readmitted to index versus non-index hospitals after colorectal surgery were directly compared. Risk factors for non-index hospital readmission were assessed through logistic regression.
Among the 14,401 patients requiring readmission, 10,890 (75.6%) were readmitted to index hospitals, whereas 3,511 (24.4%) were readmitted to non-index hospitals. Patients readmitted to non-index hospitals were more likely to be men and have a greater Charlson comorbidity index, non-private insurance, longer initial length of stay, longer travel distance, and non-home discharge disposition. On multivariable logistic regression analysis, living ≥10 miles from the index hospital was strongly predictive of non-index hospital readmission (odds ratio, 1.8; 95% confidence interval, 1.63 to 2.00).
Approximately 25% of readmissions after colorectal surgery will be to non-index hospitals. Risks factors include greater comorbidities, non-private health insurance, occurrence of an inpatient complication, longer length of stay, greater travel distance, and non-home discharge disposition.
•Up to one fourth of readmissions after colorectal surgery will be to non-index hospitals.•Substantial variability in non-index hospital readmission rates exists.•Multiple factors are associated with non-index hospital readmission.•Greater travel distance is one of the strongest predictors.
Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few ...studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality, and disparities.
This retrospective secondary-data analysis study, using the California Cancer Registry linked to state discharge abstracts of patients treated for colon cancer (2001 to 2006), compared the rates of National Comprehensive Cancer Network (NCCN) guideline-based care, the hazard of mortality, and racial/ethnic disparities in an IHS versus other settings.
More than 30,000 patient records were evaluated. The IHS had overall higher rates of adherence to NCCN guidelines. Propensity score-matched Cox models showed an independent and protective association between care in the IHS and survival (hazard ratio HR, 0.87; 95% CI, 0.85 to 0.90). This advantage persisted across stage groups. Black race was associated with increased hazard of mortality in all other settings (HR, 1.15; 95% CI, 1.04 to 1.27); however, there was no disparity within the IHS for any minority group (P > .11 for all groups) when compared with white race.
The IHS delivered higher rates of evidence-based care and was associated with lower 5-year mortality. Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.
Abstract
Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could ...potentially affect the course of coronavirus disease 2019 (COVID-19) treatment. We analyzed pulse oximeter accuracy and its association with COVID-19 treatment outcomes using electronic health record data from Sutter Health, a large, mixed-payer, integrated health-care delivery system in Northern California. We analyzed 2 cohorts: 1) 43,753 non-Hispanic White (NHW) or non-Hispanic Black/African-American (NHB) adults with concurrent arterial blood gas oxygen saturation/SpO2 measurements taken between January 2020 and February 2021; and 2) 8,735 adults who went to a hospital emergency department with COVID-19 between July 2020 and February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (−3.1 percentage points), dexamethasone treatment (−3.1 percentage points), and supplemental oxygen treatment (−4.5 percentage points), as well as increased time to treatment: 37.2 minutes before dexamethasone initiation and 278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
Although evidence suggests worse outcomes for patients admitted to the hospital on a weekend, to our knowledge, no previous studies have investigated the effects of weekend discharge.
To determine ...whether weekend discharge would be associated with an increased rate of 30- and 90-day hospital readmission.
Retrospective review of discharge abstracts from the California Office of State Health Planning and Development from 2012 identifying all patients who underwent abdominal aortic aneurysm (AAA) repair, colectomy, total hip arthroplasty, and pancreatectomy. This study was conducted from January to December 2012.
Thirty- and 90-day readmission rates were compared between patients discharged on a weekend vs weekday.
Of 128 057 patients, 5225 patients (4.1%) underwent AAA repair; 29 388 (22.9%), colectomy; 91 168 (71.2%), hip replacement; and 2276 (1.8%), pancreatectomy. Overall, 29 883 (23.3%) were discharged on a weekend. Although there were no significant differences with respect to sex, age, race/ethnicity, insurance status, or type of admission, patients discharged on a weekend had shorter length of stays and were less often discharged to a skilled nursing facility. Overall, the 30-day readmission rate was 9.4% after AAA repair, 13.6% after colectomy, 7.5% after hip replacement, and 16.3% after pancreatectomy. Hospital readmission rates were similar for those discharged on a weekend vs weekday after AAA repair (8.8% vs 9.3%; P = .55) and pancreatectomy (17.5% vs 15.9%; P = .40). However, weekend discharge was associated with a lower 30-day readmission rate for patients undergoing colectomy (12.1% vs 14.1%; P < .001) and hip replacement (6.9% vs 7.7%; P < .001). On multivariable analysis, weekend discharge was inversely associated with readmission after colectomy (odds ratio OR, 0.86; 95% CI, 0.79-0.93) but not AAA repair (OR, 0.93; 95% CI, 0.73-1.19), hip replacement (OR, 0.97; 95% CI, 0.91-1.03), or pancreatectomy (OR, 1.02; 95% CI, 0.76-1.36). Finally, a substantial percentage of 30-day readmissions occurred at a different hospital (AAA repair: 40.5%; colectomy: 25.8%; hip replacement: 32.5%; and pancreatectomy: 19.7%) compared with the index hospitalization. Similar results were seen for 90-day readmissions.
Weekend discharge after major surgery is not associated with higher 30- or 90-day readmission rates.
Background
Loneliness and social isolation are significant public health problems that are being exacerbated during the coronavirus disease 2019 pandemic. Little is known about the associations ...between loneliness and symptom burden in oncology patients before and during the pandemic. Study purposes include determining the prevalence of loneliness in a sample of oncology patients; evaluating for differences in demographic, clinical, and symptom characteristics between lonely and nonlonely patients; and determining which demographic, clinical, and symptom characteristics were associated with membership in the lonely group.
Methods
A convenience sample (n = 606) completed online surveys that evaluated the severity of loneliness, social isolation, and common symptoms (ie, anxiety, depression, fatigue, sleep disturbance, cognitive dysfunction, and pain) in oncology patients. Parametric and nonparametric tests were used to evaluate for differences in scores between the lonely and nonlonely groups. Logistic regression analysis was used to determine risk factors for membership in the loneliness group.
Results
Of the 606 patients, 53.0% were categorized in the lonely group. The lonely group reported higher levels of social isolation, as well as higher symptom severity scores for all of the symptoms evaluated. In the multivariate model, being unmarried, having higher levels of social isolation, as well as higher levels of anxiety and depressive symptoms were associated with membership in the lonely group.
Conclusions
Study findings suggest that a significant number of oncology patients are experiencing loneliness, most likely as a result of mandate social distancing and isolation procedures. The symptom burden of these patients is extremely high and warrants clinical evaluation and interventions.
Little is known about the experience of loneliness in oncology patients during COVID‐19. Of the 606 patients in this study, 53% report a clinically meaningful level of loneliness. Associations are found between loneliness and higher levels of social isolation, anxiety, and depressive symptoms.
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