Real-World Treatment Patterns and Outcomes among Elderly Acute Myeloid Leukemia Patients in the United States

Over half of patients diagnosed with acute myeloid leukemia (AML) are 65 years or older. Using the linked SEER-Medicare database, we conducted a retrospective cohort analysis to examine patient characteristics, treatment patterns, and survival among the elderly AML patients in routine clinical practice. Out of 29,857 patients with AML in the database, 8336 were eligible for inclusion in the study. The inclusion criteria included a diagnosis with first primary AML between January 1, 2000 and December 31, 2009, >66 years of age, and continuous enrollment in Medicare Parts A and B in the year before diagnosis. Forty percent (N = 3327) of the cohort received chemotherapy within 3 months after diagnosis. The multivariable overall survival analyses showed a lower risk of death among those receiving intensive and hypomethylating agent therapies compared with no therapy. Among the younger cohort, a significant lower mortality was also noted with receipt of allogeneic hematopoietic stem cell transplantation. Over the past decade, about 60% of the elderly AML patients remain untreated in routine clinical practice. Use of antileukemic therapy was associated with a significant survival benefit and provides further support that age alone should not deter the use of guideline-recommended therapies particularly because of the high disparities in outcomes between treatment receipt and palliative care in this elderly cohort

Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort

Experience (POSSIBLE US) were used to assess the prevalence of risk factors (RFs) and on-study fracture. RFs assessed at study entry were age >70 years; fracture since age 50; minimum T-score (hip/spine) ≤ −2.5 at diagnosis; body mass index <18.5 kg/m 2 ; rheumatoid arthritis; parental history of hip fracture; current smoking; and recent oral glucocorticoid use. Data were collected with semiannual self-administered questionnaires. Results were stratified by physician-reported osteoporosis/osteopenia diagnosis. Low T-score and age >70 years were the most common RFs in the osteoporosis group, and age >70 years and prior fracture were the most common risk factors in the osteopenia group. Multiple RFs were more common than a single RF in osteoporotic women (54.2% versus 34.6%; < 0.0001) but not osteopenic women (13.8% versus 33.6%; < 0.0001). Women with multiple RFs had more on-study osteoporosis-related fractures than women with a single RF (osteoporosis group: 9.9% versus 6.2%; = 0.0092; osteopenia group: 11.2% versus 4.7%; < 0.0001). In postmenopausal women receiving osteoporosis treatment, multiple RFs increased fracture risk. RFs, in addition to bone mineral density, can help identify candidates for osteoporosis treatment

Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort

Subject- and physician-reported data from 4,429 postmenopausal women receiving osteoporosis treatment in the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US) were used to assess the prevalence of risk factors (RFs) and on-study fracture. RFs assessed at study entry were age >70 years; fracture since age 50; minimum T-score (hip/spine) ≤−2.5 at diagnosis; body mass index 70 years were the most common RFs in the osteoporosis group, and age >70 years and prior fracture were the most common risk factors in the osteopenia group. Multiple RFs were more common than a single RF in osteoporotic women (54.2% versus 34.6%; P<0.0001) but not osteopenic women (13.8% versus 33.6%; P<0.0001). Women with multiple RFs had more on-study osteoporosis-related fractures than women with a single RF (osteoporosis group: 9.9% versus 6.2%; P=0.0092; osteopenia group: 11.2% versus 4.7%; P<0.0001). In postmenopausal women receiving osteoporosis treatment, multiple RFs increased fracture risk. RFs, in addition to bone mineral density, can help identify candidates for osteoporosis treatment

Risk of second primary cancer in men with breast cancer

INTRODUCTION: A retrospective registry-based cohort study was conducted to examine the risk of second primary cancer following the occurrence of breast cancer in males. METHODS: Data obtained from the California Cancer Registry in the period 1988 to 2003 included 1,926 men aged 85 years and younger diagnosed with a first primary breast cancer. Person-year analysis was applied to determine the risk of second primary cancers after the occurrence of a first primary breast cancer. The effects of age, race, and time since the first breast cancer diagnosis were assessed. RESULTS: Of the 1,926 male breast cancer cases, 221 (11.5%) developed a second primary cancer. Men with first incidence of breast cancer have a significantly higher risk of second cancer (standardized incidence ratio (SIR) = 1.16, 95% confidence interval (CI) = 1.01–1.32). The risk of a second site-specific cancer is elevated for breast cancer (SIR = 52.12, 95% CI = 31.83–80.49), cutaneous melanoma (SIR = 2.98, 95% CI = 1.63–5.00) and stomach cancer (SIR = 2.11, 95% CI = 1.01–3.88). There is a general tendency towards higher risks of second malignancies among younger men compared to older men and the risk increased with the passage of time. CONCLUSION: Male breast cancer patients should be monitored carefully for the occurrence of second primary cancers, especially a second primary breast cancer

Is There a Difference in Treatment Patterns Among Follicular Lymphoma Patients Receiving Care in the Outpatient Hospital Versus the Community Clinic Setting?

Abstract Abstract 3134 Introduction: No studies have addressed whether the site of care involved in the treatment of patients with follicular lymphoma (FL) affects the delivery of appropriate treatment for this condition. We investigated the differences in treatment patterns between two sites of care: the outpatient hospital (OH) and the community clinic (CC) setting. Methods: Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort analysis of 4225 FL patients diagnosed between January 1, 1998 to December 31, 2007, &gt;66 years, enrolled in Medicare Part A and B, and received initial treatment with rituximab (R), chemotherapy (CT), or R+CT. Chi-square test for categorical variables and ANOVA or t-test for continuous variables were used to assess differences in patient and disease related characteristics by site of care. Kaplan-Meier curves and corresponding log-rank test were used to compare time to initial treatment by site of care. Results: There were 3149 CC patients and 541 OH patients. The mean age was 75 years, 55% were female, and 92% were white. In general, the demographic and clinical characteristics were balanced between both sites of care, with the exception of disease stage at diagnosis where patients treated in the OH setting were more likely to be diagnosed with stage IV disease (39% vs. 34%; p&lt;.05). Overall, 29% of patients received CT, 25% received R and 45% received R+CT. The mean time to treatment initiation was generally shorter in the CC (10 months versus 11 months) across all treatment categories (log rank p=0.1961). In the CC, the mean time to treatment initiation was 10 months for CT, 14 months for R, and 8 months for R+CT. In the OH, the mean time to treatment initiation was 12 months for CT, 16 months for R and 9 months for R+CT. Duration of treatment was similar in the CC and OH for CT and R+CT, but R had a slightly longer duration in the CC (median = 66 days) compared to the OH (median =59 days). There were more treatment cycles delivered in the CC compared to the OH. In the CC, 61% of patients received &lt;6 cycles, 21% received 6–8 cycles and 18% received &gt;8 cycles. In the OH, 77% received &lt;6 cycles, 12% received 6–8 cycles and 11% received &gt;8 cycles. Compliance with the R+CT dosing schedule (once every 3 weeks for up to 8 cycles) was higher in the CC (54%) compared to the OH (34%) cohorts (p&lt;.0001). Conclusions: This observational study showed that patients treated in the OH setting tend to have longer time to treatment initiation, less cycles across all regimens, and were less likely to receive a compliant R+CT dosing schedule for FL compared to patients in the CC. These results suggest an opportunity to improve delivery of treatment to optimize outcomes in different treatment settings. Disclosures: Satram-Hoang: Genentech, Inc: Consultancy. Reyes:Genentech, Inc: Employment. </jats:sec

Risk of second primary cancer in men with breast cancer.

IntroductionA retrospective registry-based cohort study was conducted to examine the risk of second primary cancer following the occurrence of breast cancer in males.MethodsData obtained from the California Cancer Registry in the period 1988 to 2003 included 1,926 men aged 85 years and younger diagnosed with a first primary breast cancer. Person-year analysis was applied to determine the risk of second primary cancers after the occurrence of a first primary breast cancer. The effects of age, race, and time since the first breast cancer diagnosis were assessed.ResultsOf the 1,926 male breast cancer cases, 221 (11.5%) developed a second primary cancer. Men with first incidence of breast cancer have a significantly higher risk of second cancer (standardized incidence ratio (SIR) = 1.16, 95% confidence interval (CI) = 1.01-1.32). The risk of a second site-specific cancer is elevated for breast cancer (SIR = 52.12, 95% CI = 31.83-80.49), cutaneous melanoma (SIR = 2.98, 95% CI = 1.63-5.00) and stomach cancer (SIR = 2.11, 95% CI = 1.01-3.88). There is a general tendency towards higher risks of second malignancies among younger men compared to older men and the risk increased with the passage of time.ConclusionMale breast cancer patients should be monitored carefully for the occurrence of second primary cancers, especially a second primary breast cancer