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Seftel MD, Terrell D, Cuker A, Cheung M, Pai M. Diversity, equity, and inclusion in ASH guidelines. Lancet Haematol 2024; 11:e317. [PMID: 38697728 DOI: 10.1016/s2352-3026(24)00099-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Matthew D Seftel
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, BC V6H 2M9, Canada.
| | - Deirdra Terrell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Adam Cuker
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Menaka Pai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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2
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Buckstein R, Callum J, Prica A, Bowen D, Wells RA, Leber B, Heddle N, Chodirker L, Cheung M, Mozessohn L, Yee K, Gallagher J, Parmentier A, Jamula E, McQuilten Z, Wood EM, Weinkov R, Zhang L, Mamedov A, Stanworth SJ, Lin Y. Red cell transfusion thresholds in outpatients with myelodysplastic syndromes: Combined results from two randomized controlled feasibility studies. Am J Hematol 2024; 99:473-476. [PMID: 38126081 DOI: 10.1002/ajh.27181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Rena Buckstein
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Anca Prica
- Department of Medicine, Princess Margaret Hospital, United Health Network, Toronto, Ontario, Canada
| | - David Bowen
- Department of Medicine, University of York, York, UK
| | - Richard A Wells
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian Leber
- Department of Medicine, Mcmaster University, Hamilton, Ontario, Canada
| | - Nancy Heddle
- Mcmaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Chodirker
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Cheung
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Mozessohn
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Karen Yee
- Department of Medicine, Princess Margaret Hospital, United Health Network, Toronto, Ontario, Canada
| | - Jennifer Gallagher
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anne Parmentier
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Erin Jamula
- Department of Medicine, Mcmaster University, Hamilton, Ontario, Canada
| | - Zoe McQuilten
- Transfusion Research Unit, Division of Acute and Critical Care, Monash University, Melbourne, Victoria, Australia
| | - Erica M Wood
- Transfusion Research Unit, Division of Acute and Critical Care, Monash University, Melbourne, Victoria, Australia
| | - Robert Weinkov
- Malaghan Institute of Medical Research Newton, Wellington, New Zealand
| | | | - Alex Mamedov
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simon J Stanworth
- NHS Blood and Transplant, Oxford, UK
- Oxford University NHS Trust, The John Radcliffe Hospital, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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3
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Ravindran M, Mozessohn L, Cheung M, Buckstein R, Teichman J. A Markov analysis of azacitidine and venetoclax vs induction chemotherapy for medically fit patients with AML. Blood Adv 2024; 8:629-639. [PMID: 38029373 PMCID: PMC10839604 DOI: 10.1182/bloodadvances.2023011219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/23/2023] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
ABSTRACT Although induction chemotherapy (IC) is the standard of care in medically fit patients with newly diagnosed acute myeloid leukemia (AML), limited retrospective data indicate that patients at adverse-risk may benefit from azacytidine and venetoclax (aza-ven). Our goal was to perform a Markov decision analysis to determine whether IC or aza-ven is the optimal induction regimen in this population. Using the TreeAge software, Markov models were created for adverse-risk and intermediate-risk cohorts. A systematic review of the literature informed the transition probabilities and utilities included in the analyses. Our primary outcome was quality-adjusted life years (QALYs) gained over 5 years after diagnosis. Overall, patients at adverse risk treated with IC gained 1.4 QALYs, compared with 2.0 QALYs in patients treated with aza-ven. Patients at adverse risk treated with IC and allogeneic stem cell transplantation (allo-SCT), IC, aza-ven and allo-SCT, or aza-ven gained 2.1, 1.5, 3.0, and 1.9 QALYs, respectively. Meanwhile, patients at intermediate risk treated with IC gained 2.0 QALY, compared with 1.7 QALY in patients treated with aza-ven. Patients at intermediate risk treated with IC and allo-SCT, IC, aza-ven and allo-SCT, and aza-ven gained 2.7, 2.3, 2.6, and 1.8 QALYs, respectively. We have demonstrated that medically fit patients with newly diagnosed adverse-risk AML may benefit from treatment with aza-ven over those treated with IC, whereas IC remains the preferred approach for patients at intermediate risk. Our work challenges the use of the European LeukemiaNet risk classification for patients treated with aza-ven and highlights the need for prospective investigation into aza-ven as induction therapy for medically fit patients.
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Affiliation(s)
| | - Lee Mozessohn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Matthew Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rena Buckstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jennifer Teichman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Chow BJW, Cheung M, Prosperi-Porta G, Tavoosi A, Motazedian P, Guler EC, Yam Y, Burwash I, Dennie C, Small GR, Golian M. Left Atrial Imaging Prior to Cardioversion: Leveraging Computed Tomography to Rule Out Thrombus (LACLOT). JACC Cardiovasc Imaging 2024:S1936-878X(24)00029-9. [PMID: 38363265 DOI: 10.1016/j.jcmg.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/21/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
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5
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Buckstein R, Callum J, Prica A, Bowen D, Wells RA, Leber B, Heddle N, Chodirker L, Cheung M, Mozessohn L, Yee K, Gallagher J, Parmentier A, Jamula E, Zhang L, Mamedov A, Stanworth SJ, Lin Y. Red cell transfusion thresholds in outpatients with myelodysplastic syndromes: Results of a pilot randomized trial RBC-ENHANCE. Transfusion 2024; 64:223-235. [PMID: 38323704 DOI: 10.1111/trf.17721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The optimal hemoglobin (Hb) threshold for red blood cell transfusions in adult patients with myelodysplastic syndromes (MDS) has not been defined. STUDY DESIGN AND METHODS We conducted a pilot randomized multi-center study of two transfusion algorithms (liberal, to maintain Hb 110-120 g/L, transfuse 2 units if Hb < 105 g/L and 1 unit if Hb 105-110 g/L vs. restrictive, 85-105 g/L, transfuse 2 units when Hgb < 85 g/L). Primary objectives were 70% compliance in maintaining the q2 week hemoglobin within the targeted range and the achievement of a 15 g/L difference in pre-transfusion Hb. Secondary outcomes included measures of quality of life (QOL), iron studies and safety. RESULTS Twenty-eight patients were randomized between February 2015-2020, 13 to the restrictive arm and 15 to the liberal arm in three tertiary care centers. The compliance was 66% and 45% and the mean pre-transfusion Hb thresholds were 86 (standard deviation [SD] 8) and 98 g/L (SD 10) in the restrictive and liberal arms, (mean difference 11.8 g/L, p < .0001), respectively. Patients in the liberal arm experienced a mean of 3.4 (SD 2.6) more transfusion visits and received a mean of 5.3 (SD 5.5) more units of blood during the 12-week study. Ferritin increased by 1043 (SD 1516) IU/L and 148 (SD 1319) IU/L in the liberal and restrictive arms, respectively. Selected QOL scores were superior pre-transfusion and more patients achieved clinically important improvements in the liberal arm compared with the restrictive arm for selected symptoms and function domains. CONCLUSION The results establish that policies for transfusion support can be delivered in practice at multiple hospitals, but further research is required to understand the full clinical effects and safety of liberal transfusion policies in MDS outpatients.
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Affiliation(s)
- Rena Buckstein
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Anca Prica
- Department of Medicine, Princess Margaret Hospital, United Health Network, Toronto, Ontario, Canada
| | - David Bowen
- Department of Medicine, University of York, York, UK
| | - Richard A Wells
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian Leber
- Department of Medicine, Mcmaster University, Hamilton, Ontario, Canada
| | - Nancy Heddle
- Mcmaster Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Chodirker
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Cheung
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Mozessohn
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Karen Yee
- Department of Medicine, Princess Margaret Hospital, United Health Network, Toronto, Ontario, Canada
| | - Jennifer Gallagher
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anne Parmentier
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Erin Jamula
- Department of Medicine, Mcmaster University, Hamilton, Ontario, Canada
| | | | - Alex Mamedov
- Department of Medicine, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simon J Stanworth
- NHS Blood and Transplant, Oxford, UK
- Oxford University NHS Trust, The John Radcliffe Hospital, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Yulia Lin
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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6
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Bankar A, Chan WC, Liu N, Cheung M, Alibhai S, Gupta V. Prevalence of frailty and its association with clinical outcomes in myeloproliferative neoplasms: a population-based study. Blood Adv 2023; 7:5014-5026. [PMID: 37184988 PMCID: PMC10471933 DOI: 10.1182/bloodadvances.2023009825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023] Open
Abstract
Clinical implications of frailty in myeloproliferative neoplasms (MPN), including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF), are unknown. In this population-based study, all incident cases of MPN from the Ontario cancer registry between 2004 and 2019 (N = 10 336; ET = 5108; PV = 3843; MF = 1385) and their matched controls (for age, sex, residence, and income) in a 1:4 ratio were included. Baseline frailty measured using the Johns Hopkins Adjusted Clinical Groups frailty indicator and McIsaac frailty index (mFI), categorized as fit, prefrail, or frail if mFI <0.10, 0.11 to 0.20, >0.20), was significantly higher in ET, PV, and MF compared with matched controls (standardized mean difference of 0.27, 0.27, and 0.28). Over 23%, 20%, and 34% of patients with ET, PV, and MF were frail or prefrail despite a younger age (<65 years) or minimal comorbidities. In Cox proportional regression, frailty was independently associated with worse overall survival (OS) after adjusting for age, sex, and comorbidities compared with mFI-fit patients. The hazard ratios (95% confidence interval) for OS for mFI-prefrail and mFI-frail patients were: 1.6 (1.3-1.9) and 3.6 (2.9-4.4) in ET, 1.3 (1.1-1.5) and 2.7 (2.1-3.4) in PV, and 1.2 (1.0-1.5) and 2.0 (1.5-2.7) in MF. Patients with MPN have a substantially higher prevalence of frailty compared with matched controls, which is associated with reduced OS, independent of age or comorbidities.
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Affiliation(s)
- Aniket Bankar
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Wing C. Chan
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Matthew Cheung
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Shabbir Alibhai
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Toronto General Hospital, Toronto, ON, Canada
| | - Vikas Gupta
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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Byrne M, Mattison R, Bercovitz R, Lottenberg R, Rezende SM, Silverstein R, Terrell D, Kunkle R, Smith D, Bollard C, Haberichter S, Holter-Chakrabarty J, Pai M, Cheung M, Cuker A, Seftel M, Djulbegovic B. Identifying experts for clinical practice guidelines: perspectives from the ASH Guideline Oversight Subcommittee. Blood Adv 2023; 7:4323-4326. [PMID: 37186271 PMCID: PMC10424133 DOI: 10.1182/bloodadvances.2023010039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
| | - Ryan Mattison
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, Madison, WI
| | | | - Richard Lottenberg
- Department of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
| | - Suely M. Rezende
- Department of Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roy Silverstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Deirdra Terrell
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rob Kunkle
- American Society of Hematology, Washington, DC
| | - Deion Smith
- American Society of Hematology, Washington, DC
| | - Catherine Bollard
- Children's National Medical/George Washington University, Washington, DC
| | | | - Jennifer Holter-Chakrabarty
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Menaka Pai
- Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | | | - Adam Cuker
- Department of Pathology/Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew Seftel
- Department of Medicine, Division of Hematology, University of British Columbia and Canadian Blood Services, Vancouver, BC, Canada
| | - Benjamin Djulbegovic
- Department of Medicine, Division of Hematology/Medical Oncology, Medical University of South Carolina, Charleston, SC
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Cooley JH, Larson S, Cheung M. A preceptor development program using an interactive board game. Curr Pharm Teach Learn 2023; 15:769-773. [PMID: 37482493 DOI: 10.1016/j.cptl.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND PURPOSE Colleges and schools of pharmacy and residency programs must be engaged in the purposeful development of their preceptors. Preceptor development needs vary widely from a new preceptor needing foundational preceptor skills to a more experienced preceptor who may wish to incorporate more sophisticated precepting methods such as layered learning or interprofessional precepting. It can be challenging to create preceptor development activities that meet these varied needs and keep preceptors of all levels engaged. EDUCATIONAL ACTIVITY AND SETTING The Preceptor's Game of Life was developed to incorporate serious gaming into preceptor development to increase engagement and promote learning across all precepting levels. This game was designed to review precepting fundamentals and focused heavily on the application of these principles to authentic precepting scenarios. An element of friendly competition, collaboration, and storytelling created a safe and fun environment where participants could discuss solutions to scenario-based problems. FINDINGS The Preceptor's Game of Life has been well received by state and national audiences. Audience members were engaged and invested as they discussed the scenarios presented. Individual, informal feedback following the session and formal session evaluations were positive. SUMMARY Though the Preceptor's Game of Life required careful logistical planning, the outcome was positive. High levels of engagement amongst the participants were noted in the form of note taking and audience participation. Audience members appreciated activating their prior knowledge and experiences and applying that to future scenarios. This manuscript serves as a tool for others interested in novel preceptor development methods.
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Affiliation(s)
- Janet Heather Cooley
- Experiential Education Pharmacy Practice and Science, The University of Arizona, Roy P. Drachman Hall, B306J, P.O. Box 210202, Tucson, AZ 85721, United States.
| | - Suzanne Larson
- Midwestern University College of Pharmacy, Glendale Campus, 19555 North 59th Avenue, Glendale, AZ 85308, United States.
| | - Matthew Cheung
- Covetrus Pharmacy Services, 711 E. Carefree Highway, Phoenix, AZ 85085, United States
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9
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Visram A, Seow H, Fiala MA, Gayowsky A, Cheung M, Davies G, Pond GR, Mian H. Socioeconomic marginalization and health outcomes in newly diagnosed multiple myeloma: A population-based cohort study. Am J Hematol 2023. [PMID: 37190964 DOI: 10.1002/ajh.26957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Alissa Visram
- The Ottawa Hospital, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Fiala
- Oncology Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Matthew Cheung
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Gwynivere Davies
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Hira Mian
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Rayani K, Davies B, Cheung M, Comber D, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, MacIntyre C, Angaran P, Duff H, Hamilton R, Arbour L, Leather R, Seifer C, Fournier A, Atallah J, Kimber S, Makanjee B, Alqarawi W, Cadrin-Tourigny J, Joza J, Gardner M, Talajic M, Bagnall RD, Krahn AD, Laksman ZWM. Identification and in-silico characterization of splice-site variants from a large cardiogenetic national registry. Eur J Hum Genet 2023; 31:512-520. [PMID: 36138163 PMCID: PMC10172209 DOI: 10.1038/s41431-022-01193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
Splice-site variants in cardiac genes may predispose carriers to potentially lethal arrhythmias. To investigate, we screened 1315 probands and first-degree relatives enrolled in the Canadian Hearts in Rhythm Organization (HiRO) registry. 10% (134/1315) of patients in the HiRO registry carry variants within 10 base-pairs of the intron-exon boundary with 78% (104/134) otherwise genotype negative. These 134 probands were carriers of 57 unique variants. For each variant, American College of Medical Genetics and Genomics (ACMG) classification was revisited based on consensus between nine in silico tools. Due in part to the in silico algorithms, seven variants were reclassified from the original report, with the majority (6/7) downgraded. Our analyses predicted 53% (30/57) of variants to be likely/pathogenic. For the 57 variants, an average of 9 tools were able to score variants within splice sites, while 6.5 tools responded for variants outside these sites. With likely/pathogenic classification considered a positive outcome, the ACMG classification was used to calculate sensitivity/specificity of each tool. Among these, Combined Annotation Dependent Depletion (CADD) had good sensitivity (93%) and the highest response rate (131/134, 98%), dbscSNV was also sensitive (97%), and SpliceAI was the most specific (64%) tool. Splice variants remain an important consideration in gene elusive inherited arrhythmia syndromes. Screening for intronic variants, even when restricted to the ±10 positions as performed here may improve genetic testing yield. We compare 9 freely available in silico tools and provide recommendations regarding their predictive capabilities. Moreover, we highlight several novel cardiomyopathy-associated variants which merit further study.
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Affiliation(s)
- Kaveh Rayani
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Drake Comber
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Martin S Green
- Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Laval University, Quebec City, QC, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Paul Angaran
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Duff
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Robert Hamilton
- Division of Cardiology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Laura Arbour
- Division of Medical Genetics, Island Health, Victoria, BC, Canada
| | | | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
| | - Joseph Atallah
- Division of Pediatric Cardiology, University of Alberta Stollery Children's Hospital, Edmonton, AB, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bhavanesh Makanjee
- Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - Wael Alqarawi
- Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Gardner
- Division of Cardiology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Richard D Bagnall
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zachary W M Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Beber S, Moshkelgosha S, Cheung M, Hedley D, Levy L, Samuels J, Renaud-Picard B, Hwang D, Martinu T, Juvet S. Exploration of Intragraft T Cell Phenotypes in Minimal Acute Cellular Rejection (ACR) Using Imaging Mass Cytometry (IMC). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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12
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Halajha G, Chen Y, Fang J, Austin P, Su H, Cheung M, Prica A, Thavendiranathan P, Abdel-Qadir HM. HOSPITALIZATIONS FOR CARDIOVASCULAR DISEASE IN LYMPHOMA SURVIVORS: A POPULATION-BASED MATCHED COHORT STUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Powis M, Sutradhar R, Patrikar A, Cheung M, Gong I, Vijenthira A, Hicks LK, Wilton D, Krzyzanowska MK, Singh S. Factors associated with timely COVID-19 vaccination in a population-based cohort of patients with cancer. J Natl Cancer Inst 2023; 115:146-154. [PMID: 36321960 PMCID: PMC9905967 DOI: 10.1093/jnci/djac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In many jurisdictions, cancer patients were prioritized for COVID-19 vaccination because of increased risk of infection and death. To understand sociodemographic disparities that affected timely receipt of COVID-19 vaccination among cancer patients, we undertook a population-based study in Ontario, Canada. METHODS Patients older than 18 years and diagnosed with cancer January 2010 to September 2020 were identified using administrative data; vaccination administration was captured between approval (December 2020) up to February 2022. Factors associated with time to vaccination were evaluated using multivariable Cox proportional hazards regression. RESULTS The cohort consisted of 356 535 patients, the majority of whom had solid tumor cancers (85.9%) and were not on active treatment (74.1%); 86.8% had received at least 2 doses. The rate of vaccination was 25% lower in recent (hazard ratio [HR] = 0.74, 95% confidence interval [CI] = 0.72 to 0.76) and nonrecent immigrants (HR = 0.80, 95% CI = 0.79 to 0.81). A greater proportion of unvaccinated patients were from neighborhoods with a high concentration of new immigrants or self-reported members of racialized groups (26.0% vs 21.3%, standardized difference = 0.111, P < .001), residential instability (27.1% vs 23.0%, standardized difference = 0.094, P < .001), or material deprivation (22.1% vs 16.8%, standardized difference = 0.134, P < .001) and low socioeconomic status (20.9% vs 16.0%, standardized difference = 0.041, P < .001). The rate of vaccination was 20% lower in patients from neighborhoods with the lowest socioeconomic status (HR = 0.82, 95% CI = 0.81 to 0.84) and highest material deprivation (HR = 0.80, 95% CI = 0.78 to 0.81) relative to those in more advantaged neighborhoods. CONCLUSIONS Despite funding of vaccines and prioritization of high-risk populations, marginalized patients were less likely to be vaccinated. Differences are likely due to the interplay between systemic barriers to access and cultural or social influences affecting uptake.
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Affiliation(s)
- Melanie Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aditi Patrikar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Matthew Cheung
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Inna Gong
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abi Vijenthira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa K Hicks
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Oncology, St. Michael’s Hospital—Unity Health, Toronto, ON, Canada
| | - Drew Wilton
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre—University Health Network, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simron Singh
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Cheung M, Husain A, Du D, Li COY, Parker J, Weissler-Snir A, Geske JB, Ong K, Laksman Z. International Practice Patterns in the Detection and Management of Arrhythmias in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2022; 11:e027385. [PMID: 36193937 PMCID: PMC9673716 DOI: 10.1161/jaha.122.027385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew Cheung
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Ali Husain
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Darson Du
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Christopher O Y Li
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Jeremy Parker
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | | | - Jeffrey B Geske
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Kevin Ong
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Zachary Laksman
- Division of Cardiology, Department of Medicine, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
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Powis ML, Sutradhar R, Patrikar A, Cheung M, Gong IY, Vijenthira A, Hicks LK, Wilton D, Krzyzanowska MK, Singh S. Factors associated with timely receipt of COVID vaccination in patients with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
167 Background: In many jurisdictions patients with new hematological cancers, or those receiving hematopoietic stem cell transplant or immunosuppressive agents, were prioritized for COVID vaccination due to increased risk of infection and death. In Ontario, Canada those residing in congregate settings, or regions with high positivity rates or high proportions of essential workers were also prioritized. While vaccine inequities exist, it remains unclear whether they persisted amongst the prioritized cancer population. Methods: We undertook a retrospective, population-based study to evaluate factors associated with COVID vaccination in patients residing in Ontario, Canada, >18 years of age, and diagnosed with cancer between 01/2010 and 09/2020. Factors associated with time from vaccine approval to full vaccination (two doses) and third doses were evaluated using multivariable Cox proportional hazards regression models. Results: The cohort consisted of 356,535 patients; as of 30 January 2022 of which 86.8% had received at least two doses. Compared to patients with more remote diagnoses (> 1 year), newly diagnosed patients rate of vaccination was lower (HR: 0.89, 95%CI: 0.88-0.91, p < 0.01) and a greater proportion were unvaccinated (13.6% vs 11.8%; p < 0.01). Conversely, rate of vaccination was higher in patients treated with systemic therapy in the last 6 months (HR: 1.04, 95%CI: 1.03-1.05, p < 0.01). Rate of vaccination was 25% lower in recent (HR:0.74,95% CI: 0.72-0.76, p < 0.01) and non-recent immigrants (HR: 0.80, 95% CI: 0.79-0.81, p < 0.01), and a greater proportion remained unvaccinated, compared to those who were Canadian-born (20.1 and 16.6% vs 10.9%; p < 0.01). Compared to the most advantaged quintiles, quintiles with the lowest socioeconomic status (14.5% vs 9.4%; p < 0.01), or highest residential instability (13.3% vs 10.8%; p < 0.01), material deprivation (10.5% vs 9.6%; p < 0.01), or ethnic concentration quintiles (13.7% vs 10.4%; p < 0.01) had higher proportions of unvaccinated patients. Rate of vaccination was 20% lower in patients with the lowest socioeconomic status (HR: 0.83, 95% CI: 0.81-0.84, p < 0.01) and those with highest material deprivation (HR: 0.80, 95% CI: 0.79-0.82, p < 0.01) relative to more advantaged groups. Similar trends were observed for receipt of third doses in the eligible cohort. Conclusions: Despite direct government funding of COVID vaccines and distribution policies aimed a prioritizing high-risk populations marginalized patients with cancer were less likely to be vaccinated than other cancer patients. Differences in receipt of vaccination are likely due to the interplay between systemic barriers to access (low trust, transportation barriers, work schedules), and cultural/ social influences impacting uptake. Future efforts should work directly members of high-risk communities to understand how to improve vaccine delivery among these communities.
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Affiliation(s)
- Melanie Lynn Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Matthew Cheung
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Lisa K. Hicks
- St. Michael's Hospital, Division of Hematology/Oncology; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Simron Singh
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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Jung RG, Di Santo P, Mathew R, Simard T, Parlow S, Weng W, Abdel-Razek O, Malhotra N, Cheung M, Hutson JH, Marbach JA, Motazedian P, Thibert MJ, Fernando SM, Nery PB, Nair GM, Russo JJ, Hibbert B, Ramirez FD. Arrhythmic events and mortality in patients with cardiogenic shock on inotropic support: results of the DOREMI randomized trial. Can J Cardiol 2022; 39:394-402. [PMID: 36150583 DOI: 10.1016/j.cjca.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Inotropic support is widely used in the management of cardiogenic shock (CS). Existing data on the incidence and significance of arrhythmic events in patients with CS on inotropic support is at high risk of bias. METHODS The DObutamine compaREd to MIlrinone (DOREMI) trial randomized patients to receive dobutamine or milrinone in a double-blind fashion. Patients with and without arrhythmic events (defined as arrhythmias requiring intervention or sustained ventricular arrhythmias) were compared to (1) identify factors associated with their occurrence and (2) examine their association with in-hospital mortality and secondary outcomes. RESULTS Ninety-two patients (47.9%) had arrhythmic events, occurring equally with dobutamine and milrinone (P=0.563). The need for vasopressor support at inotrope initiation and a history of atrial fibrillation were positively associated with arrhythmic events whereas predominant right ventricular dysfunction, previous myocardial infarction, and increasing left ventricular ejection fraction were negatively associated with them. Supraventricular arrhythmic events were not associated with mortality (RR 0.97, 95% CI 0.68-1.40, P=0.879) but were positively associated with resuscitated cardiac arrests and hospital length of stay. Ventricular arrhythmic events were positively associated with mortality (RR 1.66, 95% CI 1.13-2.43; P=0.026) and resuscitated cardiac arrests. Arrhythmic events were most often treated with amiodarone (97%) and electrical cardioversion (27%), which were not associated with mortality. CONCLUSIONS Clinically relevant arrhythmic events occur in approximately half of patients with CS treated with dobutamine or milrinone and are associated with adverse clinical outcomes. Five factors may help identify patients most at risk of arrhythmic events.
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Affiliation(s)
- Richard G Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Trevor Simard
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Willy Weng
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Nikita Malhotra
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew Cheung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jordan H Hutson
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey A Marbach
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Pouya Motazedian
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael J Thibert
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Shannon M Fernando
- Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Pablo B Nery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Girish M Nair
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Juan J Russo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - F Daniel Ramirez
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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Truong J, Cheung M, Seung SJ, Dharma C, Cheng SY, Earle C, Singh S, Mittmann N. Phase-specific costs of care in diffuse large B-cell lymphoma in Ontario, Canada. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18840 Background: This Canadian study analyzes real-world data to estimate phase-specific costs and health care resource utilization for patients with diffuse large B-cell lymphoma (DLBCL). Methods: A cohort of adult patients diagnosed with DLBCL were identified between 2003-2014 from the Ontario Cancer Registry (OCR) and linked to treatment data from Cancer Care Ontario and other provincial administrative health care databases. Health system costs and resource utilization were determined for four defined phases of care in which index date was defined as the OCR diagnosis date, including: pre-diagnosis (90 days prior to index date), initial treatment (index date to 6 months), follow-up (end of treatment phase to beginning of end-of-life or completion of cohort follow-up) and end-of-life (last 6 months of life for patients who died). Costs (Canadian dollars in 2014) and resource utilization were normalized to 30-days. Results: There were 5,392 individuals (53% males; median age 64 years (IQR 53-74)) diagnosed with DLBCL. The median follow-up was 1,903 days (IQR 1,194-2,882) from index date. At follow-up completion, 4,015 (74.5%) individuals were alive. Total mean 30-day cost was $1,175 (±2,267) in pre-diagnosis, $9,166 (±5,581) during initial treatment, $1,462 (±2,757) during follow-up, and $7,965 (±7,104) during end-of-life. The total 30-day cost for inpatient care was $3,864 (±5,013) during treatment (n = 3,362 hospitalized during treatment) and $5,045 (±5,908) for end-of-life (n = 1,367 hospitalized during end-of-life). For home care, the mean 30-day costs were $528 (±512) during initial treatment (n = 3,508, 65% of cohort) and $725 (±884) during end-of-life (n = 1,211, 23% of cohort). Mean 30-day cost of cancer medication was $80 (±455) in pre-diagnosis, $3,115 (±1,236) during initial treatment, $232 (±712) during follow-up, and $305 (±694) during end-of-life. A subset of 239 individuals had autologous stem cell transplantation (ASCT) for relapsed/refractory DLBCL. For the ASCT subgroup, the mean total 30-day cost was $11,653 (±4632) in pre-ASCT phase, $1,542 (±2961) in post-ASCT phase, and $14,094 (±12,845) in end-of-life phase for those that subsequently died (n = 118). A further subset of 52 individuals had relapsed and proceeded to third-line therapy. The total mean total 30-day cost was $8,288 (±8,943) in the first 6-month follow-up, $2,584 (±4,000) in the post 6-month follow-up, and $14,999 (±9,443) in end-of-life phase for those that died (n = 29). Conclusions: Total mean 30-day cost was highest in initial treatment phase and end-of-life phases following a U-shaped pattern. Inpatient care was the cost driver across all phases. Individuals who required ASCT had significantly increased costs. Home care was less frequently accessed during end-of-life phase compared to initial treatment phase (23% vs. 65%). These findings can help allocate appropriate resources throughout the different phases of cancer care.
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Affiliation(s)
| | - Matthew Cheung
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Simron Singh
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nicole Mittmann
- HOPE Research Centre, Sunnybrook Hospital, Toronto, ON, Canada
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Finkelstein N, Dayam RM, Law J, Goetgebuer R, Chao G, Abe KT, Sutton M, Stempak JM, Pereira D, Croitoru D, Acheampong L, Rizwan S, Rymaszewski K, Milgrom R, Ganatra D, Batista NV, Girard M, Lau I, Law R, Cheung M, Rathod B, Kitaygorodsky J, Samson R, Hu Q, Haroon N, Inman R, Piguet V, Silverberg M, Grigras AC, Watts TH, Chandran V. POS1217 ANTI-TNF THERAPY FOR IMMUNE MEDIATED INFLAMMATORY DISEASES MAY BE ASSOCIATED WITH LOWER ANTIBODY LEVELS AND VIRUS NEUTRALIZATION EFFICACY FOLLOWING SARS-CoV-2 mRNA VACCINATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe impact of immunosuppressants on COVID-19 vaccination response and durability in patients with immune-mediated inflammatory diseases (IMID) is yet to be fully characterized. Humoral response may be attenuated in these patients especially those on B cell depleting therapy and higher doses of corticosteroids, but data regarding other immunosuppressants are scarce.ObjectivesWe aimed to investigate antibody and T cell responses and durability to SARS-CoV-2 mRNA vaccines (BNT162b and/or mRNA 1273) in IMID patients on immunomodulatory maintenance therapy other than B-cell depleting therapy and corticosteroids.MethodsThis prospective observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with IMIDs (psoriatic arthritis, psoriasis, inflammatory bowel disease and rheumatoid arthritis) with or without maintenance immunosuppressive therapies (anti-TNF, methotrexate/azathioprine [MTX/AZA], anti-TNF + MTX/AZA, anti IL12/23, anti-IL-17, anti-IL23) compared to healthy controls. Automated ELISA for IgGs to spike trimer, spike receptor binding domain (RBD) and the nucleocapsid (NP) and T-cell release of 9 cytokines (IFNg, IL2, IL4, IL17A, TNF) and cytotoxic molecules (sFasL, GzmA, GzmB, Perforinin) in cell culture supernatants following stimulation with spike or NP peptide arrays were conducted at 4 time points: T1=pre vaccination, T2=median 26 days after dose 1, T3=median 16 days after dose 2 and T4=median 106 days after dose 2. Neutralization assays against four SARS-CoV-2 variants (wild type, delta, beta and gamma) were conducted at T3.ResultsWe followed 150 subjects: 26 healthy controls and 124 IMID patients: 9 untreated, 44 on anti-TNF, 16 on anti-TNF with MTX/AZA, 10 on anti-IL23, 28 on anti-IL12/23, 9 on anti-IL17, 8 on MTX/AZA (Table 1). Most patients mounted antibody and T cell responses with increases from dose 1 to dose 2 (100% seroconversion at T3) and some decline by T4, with variability within groups. Antibody levels and neutralization efficacy was lower in anti-TNFgroups (anti-TNF, anti-TNF + MTX/AZA) compared to controls and waned by T4 (Figure 1). T cell responses were not consistently different between groups. Pooled data showed a higher antibody response to mRNA-1273 compared to BNT162b.Table 1.Baseline characteristics of study participantsControluntreated IMIDAnti- TNFAnti- TNF +MTX/AZAAnti-IL-23Anti -IL-12/23Anti -IL-17MTX/AZAn=26n=9n=44n=16n=10n=28n=9n=8p-valueIMID*N/A IBD9301002704 Psoriasis1318122 PA0732172 AS0830010 RA1100011Age median years [IQR]36 [26-46]33 [27-41]38 [30-51]53 [44-59]48 [45-61]34 [28-47]49 [46-61]42 [31-55]<0.001^Sex male (%)16 (62)5 (56)18 (41)8 (50)5 (50)13 (46)6 (67)4 (50)0.772~BMImedian kg/m2 [IQR]25 [23-28]26 [22-27]22 [24-26]26 [24-28]27 [24-35]22 [21-24]32 [26-34]26[25-33]0.001^Vaccine interval median days [IQR]74 [35-84]54 [31-64]60 [45-69]64 [50-72]74 [35-84]62 [49-69]65 [52-75]58 [21-97]0.372^*multiple IMIDs per patient possibleFigure 1.Antibody responses (A) Anti spike and anti RBD IgG levels at indicated time points. Blue line represents median ratio in convalescent patients. The red line is the seropositivity threshold: the median antibody level of those that pass both a 1% false positive rate and show ≥3SD from the log means of the negative controls. (B) Relative ratio of RBD, spike and NP across time. Black and gray lines indicate median and mean values, respectively. *p≤0.05, **p≤0.01, ***p≤0.001, ****p≤0.0001ConclusionFollowing 2 doses of mRNA vaccination there is 100% seroconversion in IMID patients on maintenance therapy. Antibody levels and neutralization efficacy in anti-TNF group are lower than controls, and wane substantially by 3 months after dose 2. These findings highlight the need for third dose in patients undergoing treatment with anti-TNF therapy and continued monitoring of immunity in these patient groups, taking into consideration newer variants and additional vaccine doses.AcknowledgementsThis work was funded by a donation from Juan and Stefania Speck and by grants VR-1 172711, VS1-175545, FDN-143250, GA1- 177703 and GA2- 177716, from Canadian Institutes of Health Research and COVID Immunity task force and by Sinai Health FoundationDisclosure of InterestsNaomi Finkelstein: None declared, Roya M. Dayam: None declared, Jaclyn Law: None declared, Rogier Goetgebuer: None declared, Gary Chao: None declared, Kento T. Abe: None declared, Mitchell Sutton: None declared, Joanne M. Stempak: None declared, Daniel Pereira: None declared, David Croitoru: None declared, Lily Acheampong: None declared, Saima Rizwan: None declared, Klaudia Rymaszewski: None declared, Raquel Milgrom: None declared, Darshini Ganatra: None declared, Nathalia V. Batista: None declared, Melanie Girard: None declared, Irene Lau: None declared, Ryan Law: None declared, Michelle Cheung: None declared, Bhavisha Rathod: None declared, Julia Kitaygorodsky: None declared, Reuben Samson: None declared, Queenie Hu: None declared, Nigil Haroon: None declared, Robert Inman Consultant of: AbbVie, Janssen, Lilly, Novartis., Grant/research support from: AbbVie, Novartis, Vincent Piguet Consultant of: AbbVie, Almirall, Celgene, Janssen, Kyowa Kirin Co. Ltd, LEO Pharma,Novartis, Pfizer, Sanofi, UCB, and Union Therapeutic, Grant/research support from: Unrestricted educational grants from AbbVie, Bausch Health, Celgene, Janssen, LEO Pharma, Lilly, L’Oréal, NAOS, Novartis, Pfizer, Pierre-Fabre, Sandoz, and Sanofi, Mark Silverberg Speakers bureau: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Consultant of: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Grant/research support from: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Anne-Claude Grigras: None declared, Tania H. Watts: None declared, Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, Eli-Lilly.
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Renaud-Picard B, Cheung M, Moshkelgosha S, Berra G, Hwang D, Hedley D, Juvet S, Martinu T. Imaging Mass Cytometry for Detailed Cellular and Spatial Characterization of Chronic Lung Allograft Dysfunction (CLAD). J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ling Y, Chan KK, Patrikar A, Liu N, Lofters A, Fox C, Cheung M, Singh S. Impact of the COVID-19 pandemic on primary care access for patients with gastrointestinal malignancies. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
32 Background: Primary care physicians (PCPs) provide essential support for cancer patients. Both primary and cancer care have been affected by the COVID-19 pandemic. In the US, cancer related encounters and screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al JCO Clin Cancer Inform 2020). However, the impact of the pandemic on primary care access for cancer patients remains unclear. Methods: This was a population-based, retrospective cohort study using administrative healthcare databases held at ICES in Ontario, Canada. Patients with a new gastrointestinal (GI) malignancy diagnosed within the year prior to the pandemic, between July 1 and Sept 30, 2019 (COVID-19 cohort), were compared to patients diagnosed in years unaffected by the pandemic, between July 1 – Sept 30, 2018 and July 1 – Sept 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the pandemic. The primary outcome was number of in-person and telemedicine visits with a PCP. Secondary outcomes were number of in-person and telemedicine visits with a medical oncologist, number of emergency department (ED) visits, and number of unplanned hospitalizations. Outcomes, reported as number of visits per person-year, were compared between the COVID-19 and pre-pandemic cohorts. Results: 2833 individuals diagnosed with a new GI malignancy in the COVID-19 cohort were compared to 5698 individuals in the pre-pandemic cohort. The number of in-person visits to PCPs per person-year significantly decreased from 7.13 [95% CI 7.05 – 7.20] in the pre-pandemic cohort to 4.75 [4.66 – 4.83] in the COVID-19 cohort. Telemedicine visits to PCPs increased from 0.06 [0.05 – 0.07] to 2.07 [2.01 – 2.12]. Combined in-person and telemedicine visits to PCPs decreased from 7.19 [7.11 – 7.26] to 6.82 [6.71 – 6.92]. In-person visits to medical oncologists decreased from 3.73 [3.68 – 3.79] to 2.87 [2.80 – 2.94], and telemedicine visits increased from 0.10 [0.10 – 0.11] to 0.95 [0.91 – 0.99]. Combined in-person and telemedicine visits to medical oncologists remained stable (3.84 [3.78 – 3.89] vs. 3.82 [3.74 – 3.90]). The number of ED visits per person-year decreased from 1.04 [1.01 – 1.07] in the pre-pandemic cohort to 0.93 [0.89 – 0.97] in the COVID-19 cohort. Unplanned hospitalizations did not show a significant change (0.56 [0.54 – 0.58] vs. 0.53 [0.50 – 0.56]). Conclusions: PCP visits for patients with newly diagnosed GI malignancies overall decreased during the pandemic, with a dramatic shift from in-person to telemedicine visits. Visits to medical oncologists also shifted from in-person to telemedicine, but the overall combined visits remained the same. While the number of ED visits decreased, the shift in ambulatory practices did not seem to impact the number of unplanned hospitalizations.
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Affiliation(s)
- Ying Ling
- University of Toronto, Toronto, ON, Canada
| | - Kelvin K. Chan
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Aisha Lofters
- Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Colleen Fox
- Person-Centered Care, Ontario Health, Toronto, ON, Canada
| | - Matthew Cheung
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Simron Singh
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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21
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Cheung M, Husain A, Ong K, Weissler-Snir A, Geske J, Laksman Z. International Expert Practice Patterns Display Heterogeneity With Respect to the Management and Screening of Atrial Fibrillation and Non-Sustained Ventricular Tachycardia in Patients with Hypertrophic Cardiomyopathy. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Parlow S, Cheung M, Verreault-Julien L, Wu KY, Berardi P, Nair V, Di Santo P, Jung RG, Mathew R, Hibbert B. An Unusual Case of Obstructive Shock. JACC Case Rep 2021; 3:1913-1917. [PMID: 34984352 PMCID: PMC8693255 DOI: 10.1016/j.jaccas.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 11/18/2022]
Abstract
A 54-year-old man presented in profound obstructive shock. Investigations revealed a right atrial mass causing severe right ventricular inflow obstruction and compromised cardiac output. The patient was treated with emergency balloon catheter intervention to relieve the obstruction, with resulting hemodynamic stability. The pathology report later returned a positive result for diffuse large B-cell lymphoma. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Simon Parlow
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Matthew Cheung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Louis Verreault-Julien
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kai Yi Wu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Philip Berardi
- Department of Pathology and Laboratory Medicine, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine, University of Ottawa and Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- CAPITAL Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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23
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Chin LHQ, Cheung M, Ng GHT, Lam WWM. Kidney and Inferior Vena Cava Abnormalities with Leg Thrombosis (KILT Syndrome) in a Young Healthy Male: a Case Report. Hong Kong Journal of Radiology 2021. [DOI: 10.12809/hkjr2117261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- LHQ Chin
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - M Cheung
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - GHT Ng
- Department of Radiology, Queen Mary Hospital, Hong Kong
| | - WWM Lam
- Department of Radiology, Queen Mary Hospital, Hong Kong
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24
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Barker S, Maguire N, Gearing R, Cheung M, Price D, Narendorf S, Buck D. Community-engaged healthcare model for currently under-served individuals involved in the healthcare system. SSM Popul Health 2021; 15:100905. [PMID: 34568536 PMCID: PMC8449048 DOI: 10.1016/j.ssmph.2021.100905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as 'high needs, high cost' (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with 'currently under-served'; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients.
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Affiliation(s)
- S.L. Barker
- University of Southampton, School of Psychology, Building 44, University Road, Southampton, SO17 1BJ, United Kingdom
| | - N. Maguire
- University of Southampton, School of Psychology, Building 44, University Road, Southampton, SO17 1BJ, United Kingdom
| | - R.E. Gearing
- University of Houston, Graduate College of Social Work, Houston, TX, 77204, USA
| | - M. Cheung
- University of Houston, Graduate College of Social Work, Houston, TX, 77204, USA
| | - D. Price
- University of Houston, Honors College, Houston, TX, 77204, USA
| | - S.C. Narendorf
- University of Houston, Graduate College of Social Work, Houston, TX, 77204, USA
| | - D.S. Buck
- University of Houston College of Medicine, Houston, TX, 77204, USA
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25
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Lesley GC, Tahmasebi H, Meti N, Wright FC, Thawer A, Cheung M, Singh S. Cancer Treatment During COVID-19: A Qualitative Analysis of Patient-Perceived Risks and Experiences with Virtual Care. J Patient Exp 2021; 8:23743735211039328. [PMID: 34485693 PMCID: PMC8411616 DOI: 10.1177/23743735211039328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
During the COVID-19 pandemic, most cancer centers shifted from in-person to virtual cancer care to curb community spread and ensure care continuity. This qualitative descriptive study aimed to understand cancer patient-perceived risks related to COVID-19 and cancer treatment, as well as the patient-perceived and experienced value of virtual care. From June to August 2020, focus groups were conducted with patients under active management or observation for a diagnosed malignancy in Toronto, Canada. A thematic analysis of six focus groups found that most participants worried more about treatment delays than they did about COVID-19 infection. Despite some concern about COVID-19 exposure in the hospital, care delays contributed to increased anxiety among participants who already subscribed to strict safety measures in their everyday lives. Most participants accepted virtual care for some appointment types; however, preference for in-person care was found to sustain the humanistic and therapeutic aspects of cancer care that many participants valued. Nuances in the appropriateness and adequacy of virtual cancer care still need exploration. Preserving the humanistic aspects of care is of paramount importance.
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Affiliation(s)
- Gotlib Conn Lesley
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
| | - Houman Tahmasebi
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
| | - Nicholas Meti
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Frances C. Wright
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Alia Thawer
- Department of Pharmacy, Sunnybrook Health Sciences
Center, Toronto, Canada
| | - Matthew Cheung
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Simron Singh
- Evaluative Clinical Sciences, Sunnybrook Research
Institute, Toronto, Canada
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada
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26
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Suleman A, Bilbily A, Cheung M, Chodirker L. Hypermetabolic lymphadenopathy on positron emission tomography scan following COVID-19 vaccination: A mimicker of disease progression in Hodgkin lymphoma. EJHaem 2021; 2:678-679. [PMID: 34518831 PMCID: PMC8427026 DOI: 10.1002/jha2.268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Adam Suleman
- Department of Medicine University of Toronto Toronto Canada
| | - Alexander Bilbily
- Department of Medical Imaging Sunnybrook Health Sciences Centre Toronto Canada
| | - Matthew Cheung
- Division of Hematology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Lisa Chodirker
- Division of Hematology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
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27
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Suleman A, Aktar S, Liu N, Chan K, Cheung M, Prica A. BENDAMUSTINE‐RITUXIMAB COMPARED TO RITUXIMAB‐CHOP/CVP FOR TREATMENT OF PATIENTS WITH INDOLENT LYMPHOMA IN ONTARIO: A POPULATION‐BASED STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.28_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A. Suleman
- University of Toronto, Department of Medicine Toronto Canada
| | - S. Aktar
- Institute for Clinical Evaluative Sciences, (ICES) Toronto Canada
| | - N. Liu
- Institute for Clinical Evaluative Sciences, (ICES) Toronto Canada
| | - K. Chan
- Sunnybrook Health Sciences Centre Odette Cancer Centre Toronto Canada
| | - M. Cheung
- Sunnybrook Health Sciences Centre Odette Cancer Centre Toronto Canada
| | - A. Prica
- Princess Margaret Cancer Centre Cancer Clinical Research Unit Toronto Canada
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28
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Villa D, Scott DW, Morin R, Nakamura H, Larouche JF, Cheung M, Johnson N, Elemary M, Keating MM, Tonseth P, Zukotynski K, Mayo S, Goswami R, Laister R, Kuruvilla J. A PHASE II STUDY OF ACALABRUTINIB IN COMBINATION WITH R‐CHOP CHEMOTHERAPY PRIOR TO AUTOLOGOUS STEM CELL TRANSPLANTATION IN PREVIOUSLY UNTREATED MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.171_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- D. Villa
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - D. W. Scott
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - R. Morin
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - H. Nakamura
- BC Cancer, Centre for Lymphoid Cancer Vancouver Canada
| | - J. F. Larouche
- Centre Hospitalier Universitaire de Québec Hôpital de l’Enfant‐Jésus Quebec City Canada
| | - M. Cheung
- Sunnybrook Health Sciences Centre Department of Hematology Toronto Canada
| | - N. Johnson
- Jewish General Hospital Department of Hematology Montreal Canada
| | - M. Elemary
- Saskatchewan Cancer Agency Saskatoon Cancer Centre Saskatoon Canada
| | - M. M. Keating
- Nova Scotia Cancer Centre QEII Health Sciences Centre Halifax Canada
| | - P. Tonseth
- BC Cancer Department of Functional Imaging Vancouver Canada
| | - K. Zukotynski
- McMaster University Departments of Radiology and Medicine Hamilton Canada
| | - S. Mayo
- University of Toronto Lawrence S. Bloomberg Faculty of Nursing Toronto Canada
| | - R. Goswami
- Sunnybrook Health Sciences Centre Department of Laboratory Medicine and Pathobiology Toronto Canada
| | - R. Laister
- University Health Network Princess Margaret Cancer Centre Toronto Canada
| | - J. Kuruvilla
- University Health Network Princess Margaret Cancer Centre Toronto Canada
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29
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Siu A, Chan S, Cheung M, Mo C, Lai S, Shek D. Predictors of psychosocial adaptation and mental wellbeing among people with chronic illness and disabilities in a chinese context. Eur Psychiatry 2021. [PMCID: PMC9480170 DOI: 10.1192/j.eurpsy.2021.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction The process of adjustment to disability and illness among people with chronic illness and disabilities (CID) impacts on motivation for rehabilitation illness self-management, and psychological well-being. It involves a complex interplay of biopsychosocial factors, and was seldom examined in the Chinese context. Objectives Identify the predictors of mental well-being of people with from a set of variables including illness and social support, functional abilities, coping strategies, resilience. Examine how these factors interact in determining psychosocial adaptation and mental well-being by structural equations modelling (SEM). Methods We conducted a survey of people with CID, who were recruited from community-rehabilitation settings and self-help groups (N = 244). The research questionnaire collected basic demographic information, illness-related variables (e.g. pain, fatigue, functional limitations), and RIDI), social support, measures of resilience, coping, psychosocial ad as predictors, and mental well-being. Results Of General Linear Model (GLM) revealed that males have better adaptation than females. Resilience, social coping, & active problem solving are significant predictors of adaptation (Table 1), while age, breathing, pain, resilience, avoidance coping, are predictors of maladaptation (Table 2). A SEM was tested to examine the interaction among the predictors and outcome of adaptation and mental well-being (Figure 1), and the model fit was fair (CFI = 0.89; RMSEA = 0.09) Conclusions The results indicated that there are gender differences in adaptation. While all the hypothesized groups of variables contributed to mental well-being of people with CID. Resilience, illness variables, and some forms of coping are closely linked to adaptation and maladaptation. Disclosure No significant relationships.
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30
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Noel CW, Sutradhar R, Li Q, Forner D, Hallet J, Cheung M, Singh S, Coburn NG, Eskander A. Association of Immigration Status and Chinese and South Asian Ethnicity With Incidence of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:1125-1135. [PMID: 33151263 DOI: 10.1001/jamaoto.2020.4197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Head and neck cancer (HNC) incidence varies worldwide, although it remains one of the most common cancers among those of East Asian and South Asian ethnicity. Objective To determine the association of Chinese and South Asian ethnicity, independent of immigration status, with HNC incidence. Design, Setting, and Participants This was a retrospective population-based matched cohort study that examined data collected between 1994 and 2017 in Ontario, Canada. Data were analyzed between July 2019 and March 2020. Individuals who immigrated to Canada between 1985 and 2017 were classified as immigrants, whereas Canadian-born individuals and those who immigrated prior to 1985 were classified as long-standing residents. Two separate, matched cohorts were created: an immigration cohort, consisting of immigrants and long-standing residents hard matched on age and sex, and an ethnicity cohort, where participants were further matched on ethnicity (Chinese, South Asian, or non-Chinese/non-South Asian). Exposures Chinese ethnicity, South Asian ethnicity, and immigration status. Main Outcomes and Measures Patients newly diagnosed with primary HNC were captured in both the immigration and the ethnicity cohorts. Cause-specific hazard models were used to estimate the association of immigration status and ethnicity with HNC incidence. Results In the immigration cohort, 3 328 434 matched individuals (mean [SD] age, 36.73 [13.46] years; 52.8% female) were followed, across which 3173 unique HNC diagnoses were made. The hazard ratio (HR) for a new diagnosis of oropharynx cancer was lower in immigrants compared with long-standing residents (HR, 0.26 [95% CI, 0.22-0.31]). In the ethnicity cohort, after adjusting for age, sex, rurality, and deprivation, the rate of HNC diagnosis was higher for Chinese individuals (HR, 1.49 [95% CI, 1.36-1.64]) and South Asian individuals (HR, 1.29 [95% CI, 1.14-1.45]), although it was lower for immigrants (HR, 0.48 [95% CI, 0.44-0.52]) when compared with non-Chinese and non-South Asian individuals. There was no difference in the incidence of nasopharynx cancer when comparing immigrants and long-standing residents of Chinese ethnicity. Conclusions and Relevance Immigration status appears to offer a protective effect against a diagnosis of HNC. Chinese and South Asian ethnic groups may experience higher HNC incidence when compared with the general Ontario population.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Qing Li
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Cheung
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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31
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Cheung M, Zhao F, Dave VS. Physical-chemical Stability of Compounded Sildenafil 100-mg Rapid-dissolving Tablets. Int J Pharm Compd 2021; 25:82-87. [PMID: 33503013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sildenafil citrate is a phosphodiesterase-5 inhibitor that is approved by the U.S. Food and Drug Administration for the treatment of erectile dysfunction. Rapid-dissolving tablets are relatively novel dosage forms that can be prepared by extemporaneous compounding and potentially provide unique advantages for medications like sildenafil. However, such preparations may present newer stability considerations previously unreported. Therefore, the purpose of this study was to assess the physical and chemical stability of sildenafil 100-mg rapid-dissolving tablets prepared by a commonly practiced molding method, using two different proprietary rapid-dissolving tablet bases (Medi-RDT or RDTPlus) immediately after preparation and over six months of storage at ambient room temperature. To prepare the rapid-dissolving tablets, the powder ingredients were homogeneously mixed, filled, and compressed into a 96-cavity metal mold. The formulation was then heated at 110°C for 10 minutes in the mold, released from the mold, and cooled at room temperature for 15 minutes. The prepared tablets were packaged in amber-colored blister packs with cold-adhesive backing seals and stored at ambient room temperature. At predetermined time points, rapid-dissolving tablets of each formulation were retrieved to perform stability analyses. These analyses included weight variation, breaking force, disintegration, friability, and potency via high-performance liquid chromatography following the United States Pharmacopoeia methods and visual inspection. At time 0 (immediately after preparation), the results of the tests for rapid-dissolving tablets made with Medi-RDT base v. RDT-Plus base were as follows: average tablet weight (649.7 mg v. 753.6 mg); breaking force (24.01 N v. 32.34 N); friability (8.52% v. 7.55%); disintegration time (34 seconds v. 35 seconds); and potency (98.61% v. 101.41%), respectively. Over the six-month storage period, both formulations of rapid-dissolving tablets had no significant changes in visual appearance, tablet weight, breaking force, or disintegration time. High-performance liquid chromatographic-based tablet assays for both formulations were consistently above 95% label claim at each time point, with no chromatographic evidence of degradation. Thus, the studied formulations of compounded sildenafil 100-mg rapid-dissolving tablets prepared using both Medi-RDT or RDT-Plus were found to be physically and chemically stable over six months of storage at ambient room temperature.
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Affiliation(s)
- Matthew Cheung
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York.
| | - Fang Zhao
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York
| | - Vivek S Dave
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York
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Engelhart S, Cheung M, Croxford R, Singh S. Days Spent at Home before Death from Cancer for Immigrants and Long-Term Residents in Ontario, Canada. J Palliat Med 2020; 24:593-598. [PMID: 33351717 DOI: 10.1089/jpm.2020.0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Time at home before death is an emerging patient-centered metric of quality end-of-life care. It is unknown if immigrants who die from cancer in Ontario spend less time at home near the end of life. Objective: Compare the number of days at home (DAH) in the last six months of life for immigrants and long-term residents (LTRs) who die from cancer. Methods: Population-based cohort study (January 1, 2005 to December 31, 2013) using administrative databases. Participants were adults (≥18 years) who died from cancer in Ontario. Immigrants were defined as those who immigrated from 1985 onward. The outcome was DAH in the last six months of life. Analysis included univariate and multivariable regression, adjusting for patient and disease characteristics. Subgroup analyses assessed DAH by immigration class, time since immigration, and region of birth. Sensitivity analyses excluded patients with breast and prostate cancer to examine for sex differences. Results: Seventy-two thousand nine hundred eighty-eight individuals (3988 immigrants) were identified. Immigrants spent fewer DAH in the last six months (unadjusted 162 days vs. 164 days, p < 0.001). This remained statistically significant after adjusting (p = 0.0087). DAH varied by immigration class and region of birth. Sensitivity analyses suggest a sex difference in end-of-life time spent at home. Conclusions: Immigrants who die from cancer in Ontario spend fewer DAH before death than LTRs. This may be due to patient preferences, inequitable access to services, or availability of local relatives for support. Further research is needed to understand the causes of this association.
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Affiliation(s)
- Sarah Engelhart
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sinai Health Systems, Toronto, Ontario, Canada
| | - Matthew Cheung
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Simron Singh
- Odette Cancer Centre, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Noel CW, Sutradhar R, Li Q, Forner D, Hallet J, Cheung M, Singh S, Coburn NG, Eskander A. Chinese and South Asian ethnicity, immigration status and head and neck cancer outcomes: A population based study. Oral Oncol 2020; 113:105118. [PMID: 33341005 DOI: 10.1016/j.oraloncology.2020.105118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE While it is known that certain ethnic and immigrant groups are at increased risk of developing head and neck cancer, the individual effects of immigration status and ethnicity on head and neck cancer outcomes is less clear. We sought examine the independent effects of immigration and Chinese and South Asian ethnicity on overall survival in a head and neck cancer patient population. METHODS This was a population-based retrospective matched cohort study using linked Ontario administrative databases between 1994 and 2017. Incident cancer cases were captured in long-standing residents of Chinese and South Asian ethnicity, Chinese and South Asian immigrants, as well as a reference population. Subjects were followed until death. A hard-matching approach was used to adjust for key differences and ensure both groups were balanced with respect to age, sex and cancer site. Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on overall survival while further adjusting for baseline covariates. RESULTS Among 1639 immigrants with head and neck cancer, matched to 3278 controls, the overall 5-year survival rate was 66% and 59%, respectively. After adjusting for between group-differences, all-cause mortality was lower for immigrants (HR 0.76[95%CI 0.69-0.83]) and individuals of Chinese ethnicity (HR 0.78[95%CI 0.68-0.90]), relative to the general population. CONCLUSIONS In Ontario, immigrants experience lower mortality rates following a head and neck cancer diagnosis. Individuals of Chinese ethnicity with head and neck cancer experience a survival advantage, relative to South Asian individuals and the general population.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada
| | - Qing Li
- Institute for Clinical and Evaluative Sciences, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Matthew Cheung
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Bhella S, Varela NP, Aw A, Bredeson C, Cheung M, Crump M, Fraser G, Sajkowski S, Kouroukis T. First-line therapy, autologous stem-cell transplantation, and post-transplantation maintenance in the management of newly diagnosed mantle cell lymphoma. Curr Oncol 2020; 27:e632-e644. [PMID: 33380879 PMCID: PMC7755434 DOI: 10.3747/co.27.7053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In Ontario, no clearly defined standard of care for the management of mantle cell lymphoma (mcl) has been developed, and substantial variability from centre to centre is evident. This guidance document was prompted by the need to harmonize practice in Ontario with respect to first-line, conditioning, and post-transplantation maintenance therapy for patients newly diagnosed with transplantation-eligible mcl. Methods The medline and embase databases were systematically searched from January 2013 to January 2020 for evidence, and the best available evidence was used to draft recommendations relevant to first-line therapy, autologous stem-cell transplantation, and post-transplantation maintenance in the management of transplantation-eligible newly diagnosed mcl. Final approval of this guidance document was obtained from the Stem Cell Transplant Advisory Committee. Recommendations These recommendations apply to all cases of transplantation-eligible newly diagnosed mcl:■ Alternating cycles of r-chop (rituximab plus cyclophosphamide-doxorubicin-vincristine-prednisolone) and r-dhap [rituximab plus dexamethasone-high-dose cytarabine-cisplatin] is the recommended first-line treatment for symptomatic patients newly diagnosed with mcl before autologous stem-cell transplantation (asct).■ Rituximab plus hyperfractionated cyclophosphamide-vincristine-doxorubicin-dexamethasone (r-hypercvad), alternating with methotrexate and cytarabine, is not recommended for the treatment of patients with newly diagnosed mcl.■ beam (carmustine-etoposide-cytarabine-melphalan), beac (carmustine-etoposide-cytarabine-cyclophosphamide), and total-body irradiation-based regimens are reasonable conditioning options for patients with mcl who have responded to first-line therapy and who are undergoing asct.■ Maintenance therapy with rituximab is recommended for patients with newly diagnosed mcl who have undergone asct.
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Affiliation(s)
- S Bhella
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - N P Varela
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - A Aw
- Division of Hematology, The Ottawa Hospital, Ottawa, ON
| | - C Bredeson
- Malignant Hematology and Stem Cell Transplantation, The Ottawa Hospital, Ottawa, ON
| | - M Cheung
- Division of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - M Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - G Fraser
- Division of Malignant Hematology, Juravinski Cancer Centre, and Department of Oncology, McMaster University, Hamilton, ON
| | | | - T Kouroukis
- Division of Malignant Hematology, Juravinski Cancer Centre, and Department of Oncology, McMaster University, Hamilton, ON
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Thomas N, Hilton LK, Michaud N, Bushell K, Rys R, Jain M, Shepherd L, Marra MA, Kuruvilla J, Crump M, Mann K, Assouline S, Steidl C, Cragg MS, Scott DW, Johnson N, Morin RD, Rushton CK, Arthur SE, Alcaide M, Cheung M, Jiang A, Coyle KM, Cleary KLS. Abstract IA42: Detecting and quantifying mutations associated with treatment resistance in aggressive lymphomas using ctDNA. Blood Cancer Discov 2020. [DOI: 10.1158/2643-3249.lymphoma20-ia42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
A significant proportion of diffuse large B-cell lymphoma (DLBCL) patients treated with immunochemotherapy containing rituximab (R-CHOP) exhibit either primary or acquired treatment resistance. The advancement of therapeutics in the relapse setting has likely been encumbered by our limited understanding of the molecular features that underlie resistance to R-CHOP. Unfortunately, our knowledge of DLBCL genetics is mostly limited to analyses conducted on diagnostic tissue biopsies, which have not been exposed to the selective pressures imposed by therapy. Identifying genetic alterations that contribute to treatment resistance may reveal additional treatment options and lead to biomarkers allowing patients to be paired with appropriate treatments. Genetic subgroups are gaining popularity as a new strategy to implement precision medicine in DLBCL (1). The relevance of these and other biomarkers in the relapse setting remains unclear due to limited genetic exploration of relapsed and refractory DLBCL (rrDLBCL). Progress has been limited, in part, by the requirement of tissue biopsies collected after relapse. It is well established that quantitative genomic techniques such as digital PCR and targeted sequencing can be used to determine the proportion of tumor DNA in plasma from lymphoma patients (2). With a sufficiently broad panel, sequencing affords additional opportunities including the ability to identify subclonal structure and population dynamics over time. This presentation will discuss our recent analysis of a large collection of ctDNA primarily comprising DLBCL patients on various clinical trials (3). Targeted sequencing of these samples and comparison to exome data from a meta-cohort of previously characterized untreated DLBCL biopsies revealed six genes significantly enriched for mutations upon relapse. We found both TP53 and KMT2D were mutated in the majority of rrDLBCLs, and these mutations persisted in the dominant clone following relapse, suggesting a role in primary treatment resistance. By inferring subclonal dynamics, we observed recurrent patterns of clonal expansion and contraction following rituximab-based therapy, with MS4A1 mutations representing the only example of consistent clonal expansion. MS4A1 missense mutations within the transmembrane domains led to loss of CD20 expression in vitro, and patient tumors harboring these mutations lacked CD20 protein expression. Our analysis nominates TP53 and KMT2D mutation status as novel prognostic factors that may facilitate the identification of high-risk patients prior to therapy. Moreover, we have demonstrated the potential to identify tumors with loss of CD20 surface expression stemming from MS4A1 mutations. Implementation of noninvasive assays to detect such features of acquired treatment resistance may allow timely transition to more effective treatment regimens. In certain scenarios whole-exome sequencing (WES) or whole-genome sequencing (WGS) can be successfully applied to ctDNA, thereby allowing the identification of mutations, structural variation, and copy number changes. Low-pass sequencing of shotgun libraries can also be used to ascertain course estimates of ctDNA levels as well as the copy number landscape (4). Given the importance of copy number and structural alterations in the inference of genetic subgroups, these methods may allow the exploration of these groups and their stability over time. Through a series of illustrative examples, this presentation will explore the benefits of each of these techniques in the study of tumor evolution and acquired treatment resistance in DLBCL.
References: 1. Morin RD, Scott DW. DLBCL subclassification: Divide and conquer? Blood 2020;135:1722–4. 2. Rossi D et al. The development of liquid biopsy for research and clinical practice in lymphomas: Report of the 15-ICML workshop on ctDNA. Hematol Oncol 2020;38:34–7. 3. Rushton CK et al. Genetic and evolutionary patterns of treatment resistance in relapsed B-cell lymphoma. Blood Adv 2020;4:2886–98. 4. Adalsteinsson VA et al. Scalable whole-exome sequencing of cell-free DNA reveals high concordance with metastatic tumors. Nat Commun 2017;8:1324.
Citation Format: Nicole Thomas, Laura K. Hilton, Neil Michaud, Kevin Bushell, Ryan Rys, Michael Jain, Lois Shepherd, Marco A. Marra, John Kuruvilla, Michael Crump, Koren Mann, Sarit Assouline, Christian Steidl, Mark S. Cragg, David W. Scott, Nathalie Johnson, Ryan D. Morin, Christopher K. Rushton, Sarah E. Arthur, Miguel Alcaide, Matthew Cheung, Aixiang Jiang, Krysta M. Coyle, Kirstie L. S. Cleary. Detecting and quantifying mutations associated with treatment resistance in aggressive lymphomas using ctDNA [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr IA42.
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Affiliation(s)
| | | | | | | | - Ryan Rys
- 3McGill University, Montreal, QC, Canada,
| | | | | | | | | | - Michael Crump
- 7Princess Margaret Cancer Centre, Toronto, ON, Canada,
| | - Koren Mann
- 3McGill University, Montreal, QC, Canada,
| | | | | | - Mark S. Cragg
- 8University of Southampton, Southampton, United Kingdom
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Yeo W, Yip C, Lau T, Lai K, Chan V, Li L, Pang E, Cheung M, Kwok C, Chan V, Mo F. 332MO Comparison of NEPA-based versus olanzapine/aprepitant-based antiemetic regimen for Chinese breast cancer patients undergoing highly emetogenic chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hershenfeld SA, Matelski J, Ling V, Paterson M, Cheung M, Cram P. Utilisation and outcomes of allogeneic hematopoietic cell transplantation in Ontario, Canada, and New York State, USA: a population-based retrospective cohort study. BMJ Open 2020; 10:e039293. [PMID: 33130568 PMCID: PMC7783612 DOI: 10.1136/bmjopen-2020-039293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Allogeneic haematopoietic cell transplantation (HCT) is a potentially curative treatment for haematologic and oncologic diseases. There is a perception that the United States of America (USA) offers greater access to expensive therapies such as HCT. Alternatively, Canada is thought to suffer from protracted wait times, but lower spending. Our objective was to compare HCT utilisation and short-term outcomes in Ontario (ON), Canada, and New York State (NY), USA. DESIGN, SETTING AND PARTICIPANTS We conducted a population-based cohort study using administrative health data to identify all residents of ON and NY who underwent allogeneic HCT between 2012 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were age and sex standardised HCT utilisation rates, in-hospital mortality, hospital length of stay (LOS) and readmission rates in ON and NY. Secondary outcomes included comparing ON and NY HCT recipients with respect to demographic characteristics and patient wealth (using neighbourhood income quintile). RESULTS We identified 547 HCT procedures in ON and 1361 HCT procedures performed in NY. HCT recipients in ON were younger than NY (mean age 49.0 vs 51.6 years; p<0.001) and a lower percentage of ON recipients resided in affluent neighbourhoods compared with NY (47.2% vs 52.6%; p=0.026). Utilisation of HCT was 14.4 per 1 million population per year in ON and 26.7 per 1 million per year in NY (p<0.001). The magnitude of the ON-NY difference in utilisation was larger for older patients. In-hospital mortality, LOS and readmission rates were lower in ON than NY in both unadjusted and adjusted analyses. CONCLUSIONS We found significantly lower utilisation of HCT in ON compared with NY, particularly among older patients. Higher in-hospital mortality in NY relative to ON requires further study. These differences are thought provoking for patients, healthcare providers and policy-makers in both jurisdictions.
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Affiliation(s)
| | - John Matelski
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Vicki Ling
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Michael Paterson
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Matthew Cheung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Peter Cram
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada
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Belch A, Bahlis N, White D, Cheung M, Chen C, Shustik C, Song K, Tosikyan A, Dispenzieri A, Anderson K, Brown D, Robinson S, Srinivasan S, Facon T. Continuous lenalidomide and low-dose dexamethasone in patients with transplant-ineligible newly diagnosed MM: FIRST trial subanalysis of Canadian/US patients. Cancer Med 2020; 9:8923-8930. [PMID: 33049118 PMCID: PMC7724300 DOI: 10.1002/cam4.3511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/16/2020] [Accepted: 09/05/2020] [Indexed: 12/14/2022] Open
Abstract
The phase 3 FIRST trial demonstrated significant improvement in progression-free survival (PFS) and overall survival (OS) with an immune-stimulatory agent, lenalidomide, in combination with low-dose dexamethasone until disease progression (Rd continuous) vs melphalan +prednisone + thalidomide (MPT) in transplant-ineligible patients with newly diagnosed multiple myeloma (NDMM). Rd continuous similarly extended PFS vs fixed-duration Rd for 18 cycles (Rd18). Outcomes in the Canadian/US subgroup (104 patients per arm) are reported in this analysis. Rd continuous demonstrated a significant improvement in PFS vs MPT (median, 29.3 vs 20.2 months; HR, 0.69 [95% CI, 0.49-0.97]; p = 0.03326) and an improvement vs Rd18 (median, 21.9 months). Median OS was 56.9 vs 46.8 months with Rd continuous vs MPT (p = 0.15346) and 59.5 months with Rd18. The overall response rate was higher with Rd continuous and Rd18 (78.8% and 79.8%) vs MPT (65.4%). In the 49.0%, 52.9%, and 29.8% of patients with at least very good partial response in the Rd continuous, Rd18, and MPT arms, respectively, the median PFS was 56.0, 30.9, and 40.2 months, respectively. The most common grade 3/4 treatment-emergent adverse events were neutropenia (28.4%, 30.1%, and 52.0%), anemia (23.5%, 21.4%, and 23.5%), and infections (37.3%, 30.1%, and 24.5%) with Rd continuous, Rd18, and MPT, respectively. These results were consistent with those in the intent-to-treat population, confirming the benefit of Rd continuous vs MPT in the Canadian/US subgroup and supporting the role of Rd continuous as a standard of care for transplant-ineligible patients with NDMM.
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Affiliation(s)
| | | | - Darrell White
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | | | - Chaim Shustik
- McGill University Health Centre, Montréal, QC, Canada
| | - Kevin Song
- Leukemia/Bone Marrow Transplant Program of British Columbia, Division of Hematology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Axel Tosikyan
- Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada
| | | | | | - Diane Brown
- Celgene, a Bristol-Myers Squibb Company, Mississauga, ON, Canada
| | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
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Yeo W, Li L, Lau T, Lai K, Chan V, Wong K, Yip C, Pang E, Cheung M, Chan V, Kwok C, Suen J, Mo F. Evaluation of optimal prophylactic antiemetic regimens for doxorubicin-cyclophosphamide chemotherapy. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rodin D, Glicksman R, Kakani P, Clark K, Cheung M, Singh S, Rosenthal M, Sinaiko A. 187: Mammographic Surveillance in Older Women with Breast Cancer in Canada and The United States: Are We Choosing Wisely? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Habbous S, Guo H, Beca J, Dai WF, Isaranuwatchai W, Cheung M, Chan KKW. The effectiveness of rituximab and HIV on the survival of Ontario patients with diffuse large B-cell lymphoma. Cancer Med 2020; 9:7072-7082. [PMID: 32794362 PMCID: PMC7541135 DOI: 10.1002/cam4.3362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction For patients with diffuse large B‐cell lymphoma (DLBCL), standard‐care is rituximab administered with CHOP or CHOP‐like chemotherapy (R‐CHOP). However, the effectiveness and safety of R‐CHOP among DLBCL patients with human immunodeficiency virus (HIV) infection is less clear, as HIV+ patients were omitted from most clinical trials and population‐level data from unselected patients are limited. R‐CHOP was funded for HIV‐associated DLBCL patients with CD4 >50/mm3 in Ontario in February 2015. Methods Patients with a new diagnosis of DLBCL were identified from the Ontario Cancer Registry between April 2010 and March 2018. HIV diagnosis and chemotherapy regimen were ascertained using administrative databases at Ontario Health. The effect of rituximab and HIV on overall survival was assessed in the HIV+ subgroup (R‐CHOP vs CHOP) and in the R‐CHOP subgroup (HIV+ vs HIV−). Results Among HIV+ patients, receipt of R‐CHOP was associated with a fivefold improvement in overall survival (hazard ratio [HR] 0.29 (0.13‐0.66) compared with CHOP), after adjustment. Among patients who received R‐CHOP (n = 6106), older age, male sex, lower neighborhood income, and higher comorbidity were associated with worse overall survival, after adjustment (P < .001 for all), but HIV positivity was not prognostic (HR 1.12 (0.60‐2.10)). Within 1‐year after diagnosis, HIV+ patients receiving R‐CHOP had a similar proportion of patients who visited the emergency department (67% vs 66% P = .43) or admitted to hospital (58% vs 52%, P = .43) and as HIV− patients receiving R‐CHOP. Conclusion HIV status did not affect prognosis for patients with DLBCL receiving R‐CHOP in an unselected general population when rituximab was used according to funding criteria. R‐CHOP was safe and effective for DLBCL treatment, regardless of HIV status.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Helen Guo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Jaclyn Beca
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Wei Fang Dai
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Matthew Cheung
- Hematology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada.,Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
BACKGROUND Necrotizing skin and soft tissue infection (NSTI) is a surgical emergency that is associated with high morbidity and mortality. This study aims to identify predictors of in-hospital death following a NSTI. MATERIAL AND METHODS We queried the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for California between 2006 and 2011. We used conventional and advanced statistical methods to identify predictors of in-hospital mortality, which included: logistic regression, stepwise logistic regression, decision trees, and K-nearest neighbor (KNN) algorithms. RESULTS A total of 10,158 patients had a NSTI. The full and stepwise logistic regression models had a ROC AUC in the validation dataset of 0.83 (95% CI [0.80, 0.86]) and 0.81 (95% CI [0.78, 0.83]), respectively. The KNN and decision tree model had a ROC AUC of 0.84 (95% CI [0.81, 0.85]) and 0.69 (95% CI [0.65, 0.72]), respectively. The top predictors of in-hospital mortality in the KNN and stepwise logistic model included: (1) the presence of in-hospital coagulopathy, (2) having an infectious or parasitic diagnoses, (3) electrolyte disturbances, (4) advanced age, and (5) the total number of beds in a hospital. CONCLUSION Patients with a NSTI have high rates of in-hospital mortality. This study highlights the important factors in managing patients with a NSTI which include: correcting coagulopathy and electrolyte imbalances, treating underlying infectious processes, providing adequate resources to the elderly population, and managing patients in high-volume centers.
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Affiliation(s)
- Emanuel Eguia
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA.
| | - Vincent Vivirito
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Adrienne N Cobb
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Matthew Cheung
- Department of Surgery, Burn Shock Trauma Research Institute, Loyola University Medical Center, 2160 S. 1st Avenue, Maywood, IL, 60153, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida, Tampa, FL, USA
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Rushton CK, Arthur SE, Alcaide M, Cheung M, Jiang A, Coyle KM, Cleary KLS, Thomas N, Hilton LK, Michaud N, Daigle S, Davidson J, Bushell K, Yu S, Rys RN, Jain M, Shepherd L, Marra MA, Kuruvilla J, Crump M, Mann K, Assouline S, Connors JM, Steidl C, Cragg MS, Scott DW, Johnson NA, Morin RD. Genetic and evolutionary patterns of treatment resistance in relapsed B-cell lymphoma. Blood Adv 2020; 4:2886-2898. [PMID: 32589730 PMCID: PMC7362366 DOI: 10.1182/bloodadvances.2020001696] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients are typically treated with immunochemotherapy containing rituximab (rituximab, cyclophosphamide, hydroxydaunorubicin-vincristine (Oncovin), and prednisone [R-CHOP]); however, prognosis is extremely poor if R-CHOP fails. To identify genetic mechanisms contributing to primary or acquired R-CHOP resistance, we performed target-panel sequencing of 135 relapsed/refractory DLBCLs (rrDLBCLs), primarily comprising circulating tumor DNA from patients on clinical trials. Comparison with a metacohort of 1670 diagnostic DLBCLs identified 6 genes significantly enriched for mutations upon relapse. TP53 and KMT2D were mutated in the majority of rrDLBCLs, and these mutations remained clonally persistent throughout treatment in paired diagnostic-relapse samples, suggesting a role in primary treatment resistance. Nonsense and missense mutations affecting MS4A1, which encodes CD20, are exceedingly rare in diagnostic samples but show recurrent patterns of clonal expansion following rituximab-based therapy. MS4A1 missense mutations within the transmembrane domains lead to loss of CD20 in vitro, and patient tumors harboring these mutations lacked CD20 protein expression. In a time series from a patient treated with multiple rounds of therapy, tumor heterogeneity and minor MS4A1-harboring subclones contributed to rapid disease recurrence, with MS4A1 mutations as founding events for these subclones. TP53 and KMT2D mutation status, in combination with other prognostic factors, may be used to identify high-risk patients prior to R-CHOP for posttreatment monitoring. Using liquid biopsies, we show the potential to identify tumors with loss of CD20 surface expression stemming from MS4A1 mutations. Implementation of noninvasive assays to detect such features of acquired treatment resistance may allow timely transition to more effective treatment regimens.
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Affiliation(s)
- Christopher K Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah E Arthur
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Miguel Alcaide
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Matthew Cheung
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Aixiang Jiang
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Krysta M Coyle
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Kirstie L S Cleary
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nicole Thomas
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Laura K Hilton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - Jordan Davidson
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Kevin Bushell
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Stephen Yu
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | | | - Michael Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Marco A Marra
- Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Centre, Toronto, ON, Canada; and
| | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada; and
| | - Koren Mann
- Lady Davis Institute for Medical Research
- Jewish General Hospital, Montreal, QC, Canada
| | | | | | | | - Mark S Cragg
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | | | - Ryan D Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
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44
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Chan CC, Cheung M, Tsui M. Games supporting organ donation: an interview with Dr Ka-foon Chau. Hong Kong Med J 2020; 26:273-274. [PMID: 32554821 DOI: 10.12809/hkmj-hc202006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- C C Chan
- Year 6, The Chinese University of Hong Kong
| | - M Cheung
- Year 5, The University of Hong Kong
| | - M Tsui
- Year 4, The Chinese University of Hong Kong
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45
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Svystonyuk DA, Mewhort HEM, Hassanabad AF, Heydari B, Mikami Y, Turnbull JD, Teng G, Belke DD, Wagner KT, Tarraf SA, DiMartino ES, White JA, Flewitt JA, Cheung M, Guzzardi DG, Kang S, Fedak PWM. Acellular bioscaffolds redirect cardiac fibroblasts and promote functional tissue repair in rodents and humans with myocardial injury. Sci Rep 2020; 10:9459. [PMID: 32528051 PMCID: PMC7289874 DOI: 10.1038/s41598-020-66327-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023] Open
Abstract
Coronary heart disease is a leading cause of death. Tissue remodeling and fibrosis results in cardiac pump dysfunction and ischemic heart failure. Cardiac fibroblasts may rebuild damaged tissues when prompted by suitable environmental cues. Here, we use acellular biologic extracellular matrix scaffolds (bioscaffolds) to stimulate pathways of muscle repair and restore tissue function. We show that acellular bioscaffolds with bioinductive properties can redirect cardiac fibroblasts to rebuild microvascular networks and avoid tissue fibrosis. Specifically, when human cardiac fibroblasts are combined with bioactive scaffolds, gene expression is upregulated and paracrine mediators are released that promote vasculogenesis and prevent scarring. We assess these properties in rodents with myocardial infarction and observe bioscaffolds to redirect fibroblasts, reduce tissue fibrosis and prevent maladaptive structural remodeling. Our preclinical data confirms that acellular bioscaffold therapy provides an appropriate microenvironment to stimulate pathways of functional repair. We translate our observations to patients with coronary heart disease by conducting a first-in-human observational cohort study. We show that bioscaffold therapy is associated with improved perfusion of infarcted myocardium, reduced myocardial scar burden, and reverse structural remodeling. We establish that clinical use of acellular bioscaffolds is feasible and offers a new frontier to enhance surgical revascularization of ischemic heart muscle.
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Affiliation(s)
- Daniyil A Svystonyuk
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Holly E M Mewhort
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bobak Heydari
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yoko Mikami
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jeannine D Turnbull
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Guoqi Teng
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darrell D Belke
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Karl T Wagner
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Samar A Tarraf
- Department of Civil Engineering, Libin Cardiovascular Institute and Centre for Bioengineering Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Elena S DiMartino
- Department of Civil Engineering, Libin Cardiovascular Institute and Centre for Bioengineering Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline A Flewitt
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Cheung
- Department of Radiology, Cumming School of Medicine, Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - David G Guzzardi
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean Kang
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul W M Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
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46
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Cheung M, Campbell J, Braybrook J, Thomas R, Petzing J. Benchmarking automated flow cytometry data analysis software using synthetic datasets. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Cheung M, Ng G, Lam W. Magnetic Resonance Imaging with Spectroscopy Findings in Neonatal Nonketotic Hyperglycinaemia: A Case Report. Hong Kong Journal of Radiology 2020. [DOI: 10.12809/hkjr2017104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Cheung
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - G Ng
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W Lam
- Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
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48
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Waters M, Krajden S, Kim C, Elsobky R, Lychacz B, Cheung M, Crowther M, Keystone J. Case Report: Two Cases of Strongyloidiasis Presenting with Thrombotic Events. Am J Trop Med Hyg 2020; 101:418-421. [PMID: 31218995 DOI: 10.4269/ajtmh.19-0347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report two unusual cases of clinical strongyloidiasis that present as extensive thrombosis: a case of hyperinfection with concurrent eosinophilia and a case of disseminated infection as a complication of immunosuppression. We discuss risk factors for the development of Strongyloides stercoralis infection and thromboembolism, and the recommended management.
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Affiliation(s)
- Mara Waters
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sigmund Krajden
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,St. Joseph's Health Centre, Toronto, Canada
| | | | | | | | - Matthew Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Jay Keystone
- Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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49
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Lee M, Yao J, Binny S, Cheung M, Larobina M, Skillington P, Grigg L, Zentner D. 669 Long-Term Outcome of Adult Survivors of Tetralogy of Fallot. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Saluja R, Cheung M, Chan KKW. Correcting the Conclusion in a Study of Frameworks for Measurement of Absolute or Clinical Benefit-In Reply. JAMA Oncol 2019; 5:1807-1808. [PMID: 31621814 DOI: 10.1001/jamaoncol.2019.4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ronak Saluja
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Matthew Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.,Cancer Care Ontario, Toronto, Ontario, Canada
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