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Decreased Early Mortality Associated with Treatment of Acute Myeloid Leukemia at National Cancer Institute-Designated Cancer Centers in California
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5 01 2018
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Source: Cancer. 124(9):1938-1945
Details:
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Alternative Title:Cancer
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Personal Author:
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Description:Background
Few population-based studies have evaluated the association between location of care, complications with induction therapy and early mortality in acute myeloid leukemia (AML) patients.
Methods
Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999–2014), we identified adult AML patients (≥18 years) who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at an NCI-CC. Inverse probability-weighted, multivariable logistic regression models were used to determine associations between location of care, complications and early mortality (death ≤ 60 days from diagnosis).
Results
Of the 7007 patients with AML, 1762 (25%) were treated at a NCI-CC. AML patients treated at NCI-CCs were more likely to be ≤65 years of age, live in higher socioeconomic status neighborhoods, have fewer comorbidities and have public health insurance. Patients treated at NCI-CCs had higher rates of renal failure (23% vs 20%, P=0.010) and lower rates of respiratory failure (11% vs 14%, P=0.003) and cardiac arrest (1% vs 2%, P=0.014). After adjustment for baseline characteristics, treatment at a NCI-CC was associated with lower early mortality (OR 0.46, CI 0.38–0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality in patients with respiratory failure treated at non-NCI-CC.
Conclusions
Initial treatment of adult AML at NCI-CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non-NCI-CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care.
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Source:
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Pubmed ID:29451695
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Pubmed Central ID:PMC6911353
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Document Type:
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Funding:
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Volume:124
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Issue:9
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[PDF-231.04 KB]
