Details:

Alternative Title:
Cancer
Personal Author:
Ho, Gwendolyn ; Wun, Ted ; Muffly, Lori ; Li, Qian ; Brunson, Ann ; ... More +
Ho, Gwendolyn ; Wun, Ted ; Muffly, Lori ; Li, Qian ; Brunson, Ann ; Rosenberg, Aaron S. ; Jonas, Brian A. ; Keegan, Theresa H.M. Less -
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.


Keywords:
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Adult Aged Antineoplastic Agents California Cancer Care Facilities Female Heart Arrest Humans Leukemia, Myeloid, Acute Male Middle Aged National Cancer Institute (U.S.) Registries Remission Induction Renal Insufficiency Respiratory Insufficiency Social Class Survival Analysis Time Factors Treatment Outcome United States United States Department Of Veterans Affairs Young Adult
Source:
Cancer. 124(9):1938-1945
Pubmed ID:
29451695
Pubmed Central ID:
PMC6911353
Document Type:
Journal Article
Funding:
HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; UL1 TR001860/TR/NCATS NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; ... More +
HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; UL1 TR001860/TR/NCATS NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; K12 CA138464/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:13748367276b36f497d625a35663c136a561ccd02db16b2b3ca2ff47036d8eb8
Download URL:
https://stacks.cdc.gov/view/cdc/83664/cdc_83664_DS1.pdf
File Type:

Supporting Files

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  	NIHMS1061050-supplement-Supplemental_document.docx	docx
  	NIHMS1061050-supplement-Supplemental_Figure_1.tif	tiff

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