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Comorbidity and Survival With Receipt of Adjuvant Immunotherapy in Stage III Melanoma: An Analysis of the National Cancer Database
Background: Within melanoma, comorbidity is associated with delayed diagnosis, advanced stage, and less aggressive treatment. Using the National Cancer Database (NCDB), this is the largest study to determine the influence of comorbidity (Charlson-Deyo) on receipt of adjuvant immunotherapy and survival in stage III melanoma.
Methods: We identified 10,739 patients with stage III melanoma between 2006-2012, for which high dose interferon was the standard adjuvant treatment. The probability of receipt was estimated using multivariable marginal logistic regression model, whereas survival was estimated using both the Kaplan-Meier method and multivariable marginal Cox regression model. Multivariable models adjusted for patient and facility-level characteristics.
Results: Greater receipt of adjuvant immunotherapy was observed in patients with fewer comorbidities (28.2%, 23.6%, and 13.8%, respectively, for 0, 1, and 2 or more comorbidities; P < .001). Patients with two or more comorbid conditions had a 44.0% lower adjusted odds of receiving adjuvant immunotherapy relative to patients with none (P < .001), and 45.5% lower adjusted odds relative to 1 comorbidity (P < .001). Regarding survival estimates, patients receiving adjuvant immunotherapy had significantly longer survival with fewer than 2 comorbid conditions (both P < .001); no difference was observed in patients with 2 or more (P = .077). In patients with no comorbidities, at 5-years postdiagnosis, 60.4% of those receiving adjuvant immunotherapy were alive compared to 49.8% of those who did not. In patients with 1 comorbid condition, 51.3% of those receiving adjuvant immunotherapy were alive compared to 37.7% of those who did not. The adjusted risk of death in patients who received adjuvant immunotherapy was not moderated by the number of comorbidities (χ2 = 0.51, P = .775). As such, the 20.4% lower risk of death favoring patients who received adjuvant immunotherapy (P < .001) was constant across different numbers of comorbidities. Lower risk of death and receipt of adjuvant immunotherapy were observed in younger patients with private insurance.
Conclusions: Risk of death findings suggest that adjuvant immunotherapy works equally well across numbers of comorbidities, despite a decrease in receipt with greater comorbidity. Additionally, overall survival findings support this in patients with 1 comorbidity.
Background: Within melanoma, comorbidity is associated with delayed diagnosis, advanced stage, and less aggressive treatment. Using the National Cancer Database (NCDB), this is the largest study to determine the influence of comorbidity (Charlson-Deyo) on receipt of adjuvant immunotherapy and survival in stage III melanoma.
Methods: We identified 10,739 patients with stage III melanoma between 2006-2012, for which high dose interferon was the standard adjuvant treatment. The probability of receipt was estimated using multivariable marginal logistic regression model, whereas survival was estimated using both the Kaplan-Meier method and multivariable marginal Cox regression model. Multivariable models adjusted for patient and facility-level characteristics.
Results: Greater receipt of adjuvant immunotherapy was observed in patients with fewer comorbidities (28.2%, 23.6%, and 13.8%, respectively, for 0, 1, and 2 or more comorbidities; P < .001). Patients with two or more comorbid conditions had a 44.0% lower adjusted odds of receiving adjuvant immunotherapy relative to patients with none (P < .001), and 45.5% lower adjusted odds relative to 1 comorbidity (P < .001). Regarding survival estimates, patients receiving adjuvant immunotherapy had significantly longer survival with fewer than 2 comorbid conditions (both P < .001); no difference was observed in patients with 2 or more (P = .077). In patients with no comorbidities, at 5-years postdiagnosis, 60.4% of those receiving adjuvant immunotherapy were alive compared to 49.8% of those who did not. In patients with 1 comorbid condition, 51.3% of those receiving adjuvant immunotherapy were alive compared to 37.7% of those who did not. The adjusted risk of death in patients who received adjuvant immunotherapy was not moderated by the number of comorbidities (χ2 = 0.51, P = .775). As such, the 20.4% lower risk of death favoring patients who received adjuvant immunotherapy (P < .001) was constant across different numbers of comorbidities. Lower risk of death and receipt of adjuvant immunotherapy were observed in younger patients with private insurance.
Conclusions: Risk of death findings suggest that adjuvant immunotherapy works equally well across numbers of comorbidities, despite a decrease in receipt with greater comorbidity. Additionally, overall survival findings support this in patients with 1 comorbidity.
Background: Within melanoma, comorbidity is associated with delayed diagnosis, advanced stage, and less aggressive treatment. Using the National Cancer Database (NCDB), this is the largest study to determine the influence of comorbidity (Charlson-Deyo) on receipt of adjuvant immunotherapy and survival in stage III melanoma.
Methods: We identified 10,739 patients with stage III melanoma between 2006-2012, for which high dose interferon was the standard adjuvant treatment. The probability of receipt was estimated using multivariable marginal logistic regression model, whereas survival was estimated using both the Kaplan-Meier method and multivariable marginal Cox regression model. Multivariable models adjusted for patient and facility-level characteristics.
Results: Greater receipt of adjuvant immunotherapy was observed in patients with fewer comorbidities (28.2%, 23.6%, and 13.8%, respectively, for 0, 1, and 2 or more comorbidities; P < .001). Patients with two or more comorbid conditions had a 44.0% lower adjusted odds of receiving adjuvant immunotherapy relative to patients with none (P < .001), and 45.5% lower adjusted odds relative to 1 comorbidity (P < .001). Regarding survival estimates, patients receiving adjuvant immunotherapy had significantly longer survival with fewer than 2 comorbid conditions (both P < .001); no difference was observed in patients with 2 or more (P = .077). In patients with no comorbidities, at 5-years postdiagnosis, 60.4% of those receiving adjuvant immunotherapy were alive compared to 49.8% of those who did not. In patients with 1 comorbid condition, 51.3% of those receiving adjuvant immunotherapy were alive compared to 37.7% of those who did not. The adjusted risk of death in patients who received adjuvant immunotherapy was not moderated by the number of comorbidities (χ2 = 0.51, P = .775). As such, the 20.4% lower risk of death favoring patients who received adjuvant immunotherapy (P < .001) was constant across different numbers of comorbidities. Lower risk of death and receipt of adjuvant immunotherapy were observed in younger patients with private insurance.
Conclusions: Risk of death findings suggest that adjuvant immunotherapy works equally well across numbers of comorbidities, despite a decrease in receipt with greater comorbidity. Additionally, overall survival findings support this in patients with 1 comorbidity.
Treatment Trends in Stage 3 Prostate Cancer in VA vs Academic Centers
Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.
Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.
Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).
Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.
Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.
Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.
Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).
Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.
Background: Prostate cancer is the second leading cause of cancer death in American men, diagnosed mainly in older men. Treatment options for stage 3 prostate cancer include external beam radiation plus hormone therapy (HT) vs external beam radiation plus brachytherapy vs radical prostatectomy in selected cases.
Methodology: A total of 52,384 patients with stage 3 prostate cancer have been studied from national cancer database comparing Veterans Affairs Hospital (VAH) vs Academic Centers from years 2003-2013. Fisher exact test was used to make direct comparisons between centers and treatment type. We used a Bonferroni-adjusted P.
Results: Within both the 50-59 and 60-69-year-old age groups, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (87.6% vs 77.4% and 86.1% vs 77.7%, respectively) and performed Surgery + Radiation and Radiation + Hormone therapy at a significantly higher rate (8.2% vs 15.0% and 6.8% vs 10.0%, respectively). In 70-79 year age group, when compared to Academic hospitals, VAH performed surgery alone at a lower rate (73.5% vs 43.1%) and Hormone therapy only and Radiation + Hormone therapy at significantly higher rate (3.7% vs 17.3% and 20.8% vs 33.9%, respectively) (all P < .001).
Conclusion: In VAH, people within age groups of 50-59, 60-69 years had more surgery plus radiation, radiation plus HT and less surgery alone than Academic centers. In 70-79 age group, VAH performed much more HT only, radiation plus HT and less surgery alone than Academic Centers.