An Analysis of Factors Related to Care Engagement along the Cancer Survivorship Care Continuum for Cancer Survivors in Florida

PURPOSE

This study identifies factors associated with care engagement along the cancer survivorship care continuum for Floridians.

METHODS

We identified patients from the OneFlorida Data Trust with a cancer diagnosis at any age and encounters from 2012-2020. Multivariable logistic regression models produced odds ratios (OR) predicting 1) any outpatient non-acute care visit, 2) cancer-related visit with any provider, 3) cancer-related visit with a cancer provider, and 4) survivorship visit with a cancer provider. Encounter-based independent variables were insurance, Social Deprivation Index quartile, and Rural Urban Continuum Area (adjusted for age, sex, race, ethnicity, and treatment).

RESULTS

662,489 survivors were included in the sample. Those with Medicaid and dual eligible status (Medicare and Medicaid) were more likely to have an outpatient visit (Medicaid OR 2.02, 95%CI 1.93-2.12; dual eligible 3.06, 2.91-3.22) or a cancer-related visit with a cancer provider (Medicaid 1.82, 1.77-1.86; dual eligible 1.32, 1.28-1.35), and less likely to have a survivorship visit (Medicaid 0.27, 0.26-0.28; dual eligible 0.20, 0.19-0.21). Uninsured survivors were less likely to have all visit types, while those with Medicare were more likely. Those from the most socially deprived areas were more likely to have an outpatient visit (1.09, 1.03-1.14) and less likely to have a cancer-related visit with any provider (0.90, 0.88-0.92) or a cancer provider (0.93, 0.91-0.95). Survivors from non-metropolitan areas were more likely to have an outpatient visit (1.38, 1.22-1.56), cancer-related visit (1.22, 1.16-1.28), cancer-related visit with a cancer provider (1.45, 1.39-1.52), and a survivorship visit (1.34, 1.22-1.48).

CONCLUSIONS

Survivors who have public insurance are more likely to have outpatient visits, and those with Medicaid or dual eligible status are less likely to have survivorship visits. Uninsured status is consistently associated with lack of engagement across the care continuum. Those from areas with higher social deprivation are more likely to have outpatient visits, but less likely to have a cancer-related visit with or without a cancer provider. Survivors from non-metropolitan areas are more likely to engage in all visit types along the care continuum.

Fluconazole prophylaxis in preterm infants: a multicenter case-controlled analysis of efficacy and safety

BACKGROUND

Fluconazole prophylaxis has demonstrated efficacy in single and multicenter randomized controlled trials without side effects or emergence of resistance. Additional evidence based on incidence of invasive Candida infections, multicenter data, resistance, and safety is desired.

METHODS

We conducted a case-control analysis of efficacy and safety of fluconazole prophylaxis from a multicenter database from a neonatal infection study that included 2017 infants <1250 grams from 95 NICUs. Infants receiving intravenous antifungal prophylaxis were pre-identified during enrollment in the parent study. For each infant receiving antifungal prophylaxis (case), three infants not receiving antifungal (controls) were matched by birth weight (± 50 g), by gestational age (± 1 week), gender, and study site.

RESULTS

Fluconazole prophylaxis was administered to 127 patients [754 ± 163 g birth weight (BW) and 25.4 ± 1.7 weeks gestational age (GA)] and were compared with 399 control patients (756 ± 163 g BW and 25.5 ± 1.8 weeks GA). Invasive Candida infection occurred in 0.8% (1 of 127) infants who received fluconazole prophylaxis compared with 7.3% (29 of 399) of matched controls (p = 0.006). Candida bloodstream infection occurred in 0.8% (1 of 127) fluconazole prophylaxis infants compared with 5.5% (22 of 399) of matched controls (p = 0.02). There were no differences in late-onset sepsis due to gram-positive or gram-negative organisms, focal bowel perforation, necrotizing enterocolitis, cholestasis, or overall mortality.

CONCLUSION

Fluconazole prophylaxis is safe and efficacious in preventing invasive Candida infections. Even in NICUs with a low incidence of invasive Candida infections, antifungal prophylaxis for high-risk infants is a proven and safe opportunity for infection prevention in these patients.

Racial/ethnic discrepancies in the metabolic syndrome begin in childhood and persist after adjustment for environmental factors

BACKGROUND AND AIMS

Evaluation of metabolic syndrome (MetS) characteristics across an age spectrum from childhood to adulthood has been limited by a lack of consistent MetS criteria for children and adults and by a lack of adjustment for environmental factors. We used the pediatric and adult International Diabetes Federation (IDF) criteria to determine whether gender-specific and race-specific differences in MetS and its components are present in adolescents as in adults after adjustment for socio-economic status (SES) and lifestyle factors.

METHODS AND RESULTS

Waist circumference, blood pressure, triglycerides, HDL cholesterol, and fasting glucose measures were obtained from 3100 adolescent (12-19 years) and 3419 adult (20-69 years) non-Hispanic white, non-Hispanic black, and Mexican-American participants of the 1999-2006 National Health and Nutrition Examination Surveys. We compared odds of having MetS and its components across racial/ethnic groups by age group, while adjusting for income, education, physical activity and diet quality. After adjusting for possible confounding influences of SES and lifestyle, non-Hispanic-black adolescent males exhibited a lower odds of MetS and multiple components (abdominal obesity, hypertriglyceridemia, low HDL, hyperglycemia) compared to non-Hispanic-white and Mexican-American adolescents. Compared to non-Hispanic-white adolescent males, Mexican-American adolescent males had less hypertension. There were no differences in MetS prevalence among adolescent females, though non-Hispanic-black girls exhibited less hypertriglyceridemia.

CONCLUSION

Racial/ethnicity-specific differences in MetS and its components are present in both adolescence and adulthood, even after adjusting for environmental factors. These data help strengthen arguments for developing racial/ethnic-specific MetS criteria to better identify individuals at risk for future cardiovascular disease.

Communication of treatment goals in breast cancer: a comparison of perceptions of physicians, nurses and patients

Abstract #2099

Background: Previous evidence suggests that 20-50% of patients do not have a clear understanding of the goal of their cancer treatment, using the provider's goal as the standard for comparison. This lack of alignment between patients and providers may undermine the concept of informed decision making. We aimed to determine the current level of understanding of the goal of chemotherapy in patients with breast cancer by comparing treatment goals of the patients with those of their providers.&#x2028; Patients and methods: Forty – three women undergoing chemotherapy for breast cancer and their providers (nine physicians and three nurses) were surveyed. The primary outcome was the level agreement between the patient and the physician regarding the goal of chemotherapy. Additionally, to examine the extent to which disagreement was recognized by the participants, physicians and nurses were asked to give their perception of the patient's goal, and patients and nurses were asked to give their perception of the physician's goal. Agreement was estimated using generalized estimating equations, which allowed for correlation among patients seen by the same physician.&#x2028; Results: Agreement between the physicians and the patients regarding goal of chemotherapy was 38% (95% CI: 22-57%). The patient's goal and the nurse's perception of the patient's goal agreed 36% of the time (95% CI: 35-37%), while the patient's goal and the physician's perception of the patient's goal agreed 33% of the time (95% CI: 21-49%). When response categories were collapsed into groups with similar broad treatment intent (palliative versus curative/adjuvant), then the level of agreement improved dramatically (91% -100%).&#x2028; Discussion: While broad agreement regarding treatment intent as curative or palliative was higher in this study than in previous research, agreement of the goal on a more detailed level was still poor across varying combinations of the triad of patient, physician and nurse. Future communication studies should focus on interventions to align patients and providers around a common understanding of the goal of chemotherapy, which will improve the quality of care through the provision of truly informed decision making.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2099.

Discharge outcomes of extremely low birth weight infants with spontaneous intestinal perforations

OBJECTIVE

To examine discharge outcomes of extremely low birth weight infants (ELBW) with spontaneous intestinal perforation (SIP).

STUDY DESIGN

A single-center retrospective cohort study of all ELBW infants admitted to the University of Virginia neonatal intensive care unit between July 1996 and June 2004.

RESULTS

We found 35 patients with SIP (incidence 8.4%). The median gestational age was 25 weeks, median birth weight was 722 g, and 71% of the infants were male. Most infants (n=28) with SIP were diagnosed secondary to pneumoperitoneum; however, one-third (7) of infants<25 weeks had occult presentations without pneumoperitoneum. When controlled for gestational age, gender, multiple gestation, indomethacin, and glucocorticoid exposure, infants with SIP have a higher risk of PVL and death than infants without perforation.

SUMMARY

Periventricular leukomalacia and death are significantly associated with SIP in ELBW after adjusting for gestational age, multiple gestation, indomethacin, and glucocorticoid exposure.