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Edwards CV, Sheikh AR, Dennis MJ, Hunter A, Mackay ZP, Catudal EC, Elias R, Cabral HJ, Sarosiek SR, Tapan U. The impact of substance use on health care utilization, treatment, and outcomes in patients with non-small cell lung cancer. J Thorac Dis 2022; 14:3865-3875. [PMID: 36389291 PMCID: PMC9641327 DOI: 10.21037/jtd-21-1992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Mortality from non-small cell lung cancer (NSCLC) has improved with screening and novel treatments. The substance use epidemic has threatened health outcomes in a variety of diseases, but little is known about how it is associated with NSCLC outcomes. METHODS We performed a retrospective cohort study of 211 patients with NSCLC treated at a safety-net hospital. Sociodemographic data and clinical outcomes were extracted via review of electronic medical records. Patients were stratified based on substance use status. Comparative and multivariable analyses were performed to evaluate baseline characteristics and lung cancer outcomes including survival. RESULTS Among 193 patients (91.5%) with information available on substance use, 24.9% reported substance use; specifically, alcohol, marijuana, and illicit substances. Patients with substance use were more likely to have increased health care utilization and poor social determinants of health, including safe housing, stable employment, and social support. There were no significant differences in treatment adherence. Only 6.3% of patients with substance use did not receive guideline concordant care (GCC) compared to 24.8% of patients without substance use; due to poor performance status, increased comorbidities, or loss to follow up. On univariable analysis, patients with substance use experienced inferior median overall survival (OS) if they had metastatic disease (0.40 vs. 1.03 years, P=0.01). However, in the multivariable analysis, substance use did not predict for survival. Independent predictors of mortality were sex (male HR, 1.67; 95% CI: 1.04-2.68; P=0.04), smoking status (current smoking HR, 2.63; 95% CI: 1.14-6.08; P=0.02), and stage (stage IV HR, 14.96; 95% CI: 6.28-35.63; P=0.008). CONCLUSIONS Substance use is associated with poor social determinants of health and increased health care utilization. On multivariable analysis, substance use was not independently associated with OS once guideline-concordant care was used. Future studies should focus on improving our understanding of these associations, delineating potential mechanisms, and developing evidence-based strategies to reduce health care utilization and overcome challenges related to poor social determinants of health.
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Affiliation(s)
- Camille V. Edwards
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA;,Boston University School of Medicine, Boston, MA, USA
| | - Ayesha R. Sheikh
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA;,Saint Vincent Medical Group, Worcester, MA, USA
| | - Michael J. Dennis
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA
| | - Andrew Hunter
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA
| | - Zoe P. Mackay
- Boston University School of Medicine, Boston, MA, USA
| | | | - Rawad Elias
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA;,Department of Medical Oncology, Hartford Hospital/Hartford Healthcare Cancer Institute, Hartford, CT, USA
| | | | - Shayna R. Sarosiek
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA;,Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Umit Tapan
- Section of Hematology/Oncology, Boston Medical Center, Boston, MA, USA;,Boston University School of Medicine, Boston, MA, USA
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Acute Myeloid Leukemia Relapse Presenting as Complete Monocular Vision Loss due to Optic Nerve Involvement. Case Rep Hematol 2016; 2016:3794284. [PMID: 27668104 PMCID: PMC5030445 DOI: 10.1155/2016/3794284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/17/2016] [Indexed: 11/18/2022] Open
Abstract
Acute myeloid leukemia (AML) involvement of the central nervous system is relatively rare, and detection of leptomeningeal disease typically occurs only after a patient presents with neurological symptoms. The case herein describes a 48-year-old man with relapsed/refractory AML of the mixed lineage leukemia rearrangement subtype, who presents with monocular vision loss due to leukemic eye infiltration. MRI revealed right optic nerve sheath enhancement and restricted diffusion concerning for nerve ischemia and infarct from hypercellularity. Cerebrospinal fluid (CSF) analysis showed a total WBC count of 81/mcl with 96% AML blasts. The onset and progression of visual loss were in concordance with rise in peripheral blood blast count. A low threshold for diagnosis of CSF involvement should be maintained in patients with hyperleukocytosis and high-risk cytogenetics so that prompt treatment with whole brain radiation and intrathecal chemotherapy can be delivered. This case suggests that the eye, as an immunoprivileged site, may serve as a sanctuary from which leukemic cells can resurge and contribute to relapsed disease in patients with high-risk cytogenetics.
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