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Li H, Huntington S, Gross C, Wang SY. Immunotherapy utilization patterns in patients with advanced cancer and autoimmune disease. PLoS One 2024; 19:e0300789. [PMID: 38625861 PMCID: PMC11020359 DOI: 10.1371/journal.pone.0300789] [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: 05/25/2023] [Accepted: 03/05/2024] [Indexed: 04/18/2024] Open
Abstract
PURPOSE Immunotherapy has been shown to improve cancer survival, but there are no consensus guidelines to inform use in patients with both cancer and autoimmune disease (AD). We sought to examine immunotherapy utilization patterns between cancer patients with and without AD. PATIENTS AND METHODS This retrospective cohort study utilized data from a de-identified nationwide oncology database. Patients diagnosed with advanced melanoma, non-small cell lung cancer, and renal cell carcinoma were included. Outcomes of interest included first-line immunotherapy, overall immunotherapy, and number of immunotherapy cycles. We used logistic and Poisson regression models to examine associations between AD and immunotherapy utilization patterns. RESULTS A total of 25,076 patients were included (796 with AD). Patients with AD were more likely to be female, White, receive care at academic centers, and have ECOG ≥ 3. Controlling for demographic and clinical variables, AD was associated with lower odds of receiving first-line (odds ratio [OR] = 0.68, 95% confidence interval [CI] 0.56-0.82) and overall (OR = 0.80, 95% CI 0.67-0.94) immunotherapy. Among patients who received at least one cycle of immunotherapy, there was no difference in mean number of cycles received between patients with and without AD (11.3 and 10.5 cycles respectively). The incident rate of immunotherapy cycles received for patients with AD was 1.03 times that of patients without AD (95% CI 1.01-1.06). DISCUSSION Patients with AD were less likely to receive immunotherapy as first-line and overall therapy for treatment of their advanced cancer. However, among those who did receive at least one cycle of immunotherapy, patients with AD received a similar number of cycles compared to patients without AD. This not only indicates that AD is not an absolute contraindication for immunotherapy in clinical practice but may also demonstrate overall treatment tolerability and net benefit in patients with AD.
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Affiliation(s)
- Huaqi Li
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Scott Huntington
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut, United States of America
- Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Cary Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut, United States of America
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center, New Haven, Connecticut, United States of America
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Thanarajasingam G, Kluetz P, Bhatnagar V, Brown A, Cathcart-Rake E, Diamond M, Faust L, Fiero MH, Huntington S, Jeffery MM, Jones L, Noble B, Paludo J, Powers B, Ross JS, Ritchie JD, Ruddy K, Schellhorn S, Tarver M, Dueck AC, Gross C. Integrating 4 methods to evaluate physical function in patients with cancer (In4M): protocol for a prospective cohort study. BMJ Open 2024; 14:e074030. [PMID: 38199641 PMCID: PMC10806877 DOI: 10.1136/bmjopen-2023-074030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Accurate, patient-centred evaluation of physical function in patients with cancer can provide important information on the functional impacts experienced by patients both from the disease and its treatment. Increasingly, digital health technology is facilitating and providing new ways to measure symptoms and function. There is a need to characterise the longitudinal measurement characteristics of physical function assessments, including clinician-reported outcome, patient-reported ported outcome (PRO), performance outcome tests and wearable data, to inform regulatory and clinical decision-making in cancer clinical trials and oncology practice. METHODS AND ANALYSIS In this prospective study, we are enrolling 200 English-speaking and/or Spanish-speaking patients with breast cancer or lymphoma seen at Mayo Clinic or Yale University who will receive intravenous cytotoxic chemotherapy. Physical function assessments will be obtained longitudinally using multiple assessment modalities. Participants will be followed for 9 months using a patient-centred health data aggregating platform that consolidates study questionnaires, electronic health record data, and activity and sleep data from a wearable sensor. Data analysis will focus on understanding variability, sensitivity and meaningful changes across the included physical function assessments and evaluating their relationship to key clinical outcomes. Additionally, the feasibility of multimodal physical function data collection in real-world patients with breast cancer or lymphoma will be assessed, as will patient impressions of the usability and acceptability of the wearable sensor, data aggregation platform and PROs. ETHICS AND DISSEMINATION This study has received approval from IRBs at Mayo Clinic, Yale University and the US Food and Drug Administration. Results will be made available to participants, funders, the research community and the public. TRIAL REGISTRATION NUMBER NCT05214144; Pre-results.
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Affiliation(s)
| | - Paul Kluetz
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Abbie Brown
- Health Education and Content Services, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew Diamond
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Louis Faust
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Scott Huntington
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale's Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Molly Moore Jeffery
- Division of Health Care Delivery Research and Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lee Jones
- Patient Advocate, Arlington, Virginia, USA
| | - Brie Noble
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brad Powers
- CancerHacker Lab, Boston, Massachusetts, USA
| | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jessica D Ritchie
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathryn Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah Schellhorn
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale's Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michelle Tarver
- US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Amylou C Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, Arizona, USA
| | - Cary Gross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale's Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
- Yale-New Haven Center for Outcomes Research and Evaluation (CORE), Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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Park JH, Devlin S, Durham BH, Winer ES, Huntington S, von Keudell G, Vemuri S, Shukla M, Falco V, Cuello B, Gore S, Stone R, Abdel-Wahab O, Tallman MS. Vemurafenib and Obinutuzumab as Frontline Therapy for Hairy Cell Leukemia. NEJM Evid 2023; 2:EVIDoa2300074. [PMID: 38320179 DOI: 10.1056/evidoa2300074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Vemurafenib and Obinutuzumab for Hairy Cell LeukemiaIn this study of vemurafenib plus obinutuzumab of patients with previously untreated hairy cell leukemia, treatment was administered for four cycles, and the primary end point was complete remission rate. Twenty-seven of 30 patients completed all four cycles of treatment and achieved complete remission. No dose-limiting toxicity was observed.
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Affiliation(s)
- Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
- Department of Medicine, Weill Cornell Medicine, New York
| | - Sean Devlin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York
| | - Benjamin H Durham
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Eric S Winer
- Leukemia Service, Department of Medicine, Dana-Farber Cancer Institute, Boston
| | | | | | - Shreya Vemuri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Madhulika Shukla
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Victoria Falco
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Bernadette Cuello
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | - Steven Gore
- Yale Cancer Center, New Haven, CT
- National Cancer Institute, Bethesda, MD
| | - Richard Stone
- Leukemia Service, Department of Medicine, Dana-Farber Cancer Institute, Boston
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
- Molecular Pharmacology Program, Sloan Kettering Institute, New York
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
- Department of Medicine, Northwestern Comprehensive Cancer Center, Chicago
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago
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Avery J, Chandhok N, Rainey C, Torres R, Huntington S, Isufi I, Seropian S, Xu ML, Foss F. Peripheral Blood Involvement at Staging in Patients With Aggressive Peripheral T-Cell Lymphoma. Clin Lymphoma Myeloma Leuk 2022; 22:680-689. [PMID: 35568635 DOI: 10.1016/j.clml.2022.04.019] [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: 11/29/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Peripheral T-Cell Lymphomas (PTCL) are a rare subgroup of lymphomas with a poor outcome.Traditional prognostic measures rely heavily on disease stage, and with the advent of targeted treatment, further stratificationcriteria are needed to guide treatment. To date, the impact of blood involvement at diagnosis on outcomes has not been assessed. MATERIALS AND METHODS We retrospectively reviewed blood involvement by flow cytometry at diagnosis in 102 consecutivelytreated patients who had flow cytometry data available at diagnosis. Of these, 78 patients with nodal subtypes were identified andstudied in this analysis. RESULTS Of 78 patients with nodal subtypes of PTCL who had flow data available at the time ofdiagnosis, circulating populations of malignant T cells matching those in the biopsied lymph nodes were found in 21 patients bymultiparameter flow cytometry. A positive flow cytometry was highly correlated with bone marrow involvement. The patientswith a negative flow cytometry had a trend toward a longer median PFS compared to those with a positive flow but there was noimpact on overall survival. CONCLUSIONS Circulating malignant tumor cells can be found in the peripheral blood in a subset ofpatients with aggressive nodal T-cell lymphomas, including peripheral t-cell lymphoma not otherwise specified andangioimmunoblastic T-cell lymphomas, and blood involvement is correlated with bone marrow involvement.
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Affiliation(s)
| | | | - Chanelle Rainey
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richard Torres
- Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Stuart Seropian
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mina L Xu
- Department of Hematopathology, Yale University School ofMedicine, New Haven, CT, USA
| | - Francine Foss
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
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5
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Mirza AS, Byrne M, Huntington S, Shallis RM, Zeidan A, Foss FM, Isufi I, Podoltsev N, Engelhardt BG, Kassim A, Savani B, Dholaria B, Jayani RV, Perrault S, Schiffer M, Seropian SE, Gowda L. Impact of Post-Remission Consolidation Therapy on Outcomes of Haploidentical Hematopoietic Cell Transplantation for Acute Myelogenous Leukemia. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00329-3] [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: 10/18/2022]
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Perreault S, Schiffer M, Clinchy-Jarmoszko V, Bocchetta N, Barbarotta L, Abdelghany O, Foss F, Huntington S, Seropian S, Isufi I. Mitigating the risk of COVID-19 exposure by transitioning from clinic-based to home-based immune globulin infusion. Am J Health Syst Pharm 2021; 78:1112-1117. [PMID: 33617630 PMCID: PMC7929449 DOI: 10.1093/ajhp/zxab072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Intravenous immune globulin (IVIG) therapy is used in patients with hypogammaglobulinemia to lower the risk of infections. IVIG and subcutaneous IVIG (SCIG) therapy have been to shown to be safe and effective when administered as clinic-based infusions. Concern from both patients and providers for increased transmission of the coronavirus disease 2019 (COVID-19) virus to immunosuppressed patients with scheduled medical visits and procedures made it necessary for us to reassess our process of how we manage patient care in general and chronic clinic infusions in particular. Here we describe our experience of transitioning patients from clinic-based to home based IVIG and/or SCIG infusions to decrease the risk of COVID-19 exposure. METHODS Criteria were developed to identify high-risk immunosuppressed patients who would be appropriate candidates for potential conversion to home based IVIG infusions. Data were collected via chart review, and cost analysis was performed using Medicare Part B reimbursement data. A patient outcome questionnaire was developed for administration through follow-up phone calls. RESULTS From March to May 2020, 45 patients met criteria for home-based infusion, with 27 patients (60%) agreeing to home-based infusion. Posttransition patient outcomes assessment, conducted in 26 patients (96%), demonstrated good patient understanding of the home-based infusion process. No infusion-related complications were reported, and 24 patients (92%) had no concerns about receiving future IVIG and/or SCIG doses at home. No patient tested positive for COVID-19 during the study period. Clinic infusion visits decreased by 26.6 visits per month, resulting in a total of 106 hours of additional available infusion chair time per month and associated cost savings of $12,877. CONCLUSION Transition of clinic based to home based IVIG/SCIG infusion can be successfully done to decrease potential exposure during a pandemic in a high-risk immunosuppressed population, with no impact on patient satisfaction, adherence, or efficacy. The home-based infusion initiative was associated with a reduction in costs to patients and an increase in available chair time in the infusion clinic.
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Affiliation(s)
- Sarah Perreault
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | - Molly Schiffer
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | | | - Nicole Bocchetta
- Department of Nursing, Yale New Haven Health, New Haven, CT, USA
| | - Lisa Barbarotta
- Department of Nursing, Yale New Haven Health, New Haven, CT, USA
| | - Osama Abdelghany
- Department of Pharmacy, Yale New Haven Health, New Haven, CT, USA
| | - Francine Foss
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| | - Scott Huntington
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| | - Stuart Seropian
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
| | - Iris Isufi
- Department of Hematology, Yale School of Medicine, New Haven, CT, and Yale New Haven Health, New Haven, CT, USA
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King ALO, Mirza FN, Lewis JM, Carlson KR, Huntington S, Foss FM, Girardi M. B-cell lymphoma 2 inhibitor venetoclax treatment of a patient with cutaneous T-cell lymphoma. JAAD Case Rep 2020; 8:89-92. [PMID: 33537387 PMCID: PMC7838714 DOI: 10.1016/j.jdcr.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Amber Loren O King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Fatima N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Julia M Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Kacie R Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Scott Huntington
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Francine M Foss
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Patel KK, Isufi I, Kothari S, Foss F, Huntington S. Cost-effectiveness of polatuzumab vedotin in relapsed or refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2020; 61:3387-3394. [PMID: 32835553 DOI: 10.1080/10428194.2020.1808208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/23/2022]
Abstract
A recent phase II trial showed that use of polatuzumab vedotin in combination with bendamustine plus rituximab (Pola-BR) in transplant-ineligible patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) resulted in longer progression-free survival and overall survival compared to bendamustine plus rituximab (BR) alone. In this study, we constructed a Markov model to assess the cost-effectiveness of Pola-BR versus BR in transplant-ineligible R/R DLBCL. We calculated the incremental cost-effectiveness ratio (ICER) of each treatment strategy from a US payer perspective, using a lifetime horizon and a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). Use of Pola-BR was associated with an incremental cost of $92,641 compared to BR alone ($200,905 vs $108,265, respectively), an incremental effectiveness of 1.76 QALYs (2.35 vs 0.59 QALYs, respectively), and an ICER of $52,519/QALY. These data suggest that use of Pola-BR for R/R DLBCL is likely to be cost-effective compared to BR alone.
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Affiliation(s)
- Kishan K Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Shalin Kothari
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
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Mato A, Jahnke J, Li P, Mehra M, Ladage VP, Mahler M, Huntington S, Doshi JA. Real-world treatment and outcomes among older adults with chronic lymphocytic leukemia before the novel agents era. Haematologica 2018; 103:e462-e465. [PMID: 29700170 DOI: 10.3324/haematol.2017.185868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Anthony Mato
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jordan Jahnke
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pengxiang Li
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | | | - Vrushabh P Ladage
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Scott Huntington
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jalpa A Doshi
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA .,Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
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Zeidan A, Hu X, Long J, Wang R, Ma X, Podoltsev N, Huntington S, Gore S, Davidoff A. Hypomethylating Agent Therapy use and Survival in Older Patients with Chronic Myelomonocytic Leukemia in USA: A Large Population-Based Study. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30145-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wang R, Zeidan A, Yu JB, Soulos PR, Davidoff AJ, Gore SD, Huntington S, Gross CP, Ma X. Myelodysplastic Syndromes and Acute Myeloid Leukemia After Radiotherapy for Prostate Cancer: A Population-Based Study. Prostate 2017; 77:437-445. [PMID: 27868212 PMCID: PMC5785924 DOI: 10.1002/pros.23281] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/04/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND To understand the impact of radiotherapy on the development of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) among elderly prostate cancer patients. METHODS We performed a retrospective cohort study of elderly prostate cancer patients diagnosed during 1999-2011 by using the National Cancer Institute's Surveillance, Epidemiology and End Results-Medicare linked database. Competing risk analyses adjusting for patient characteristics were conducted to assess the impact of radiotherapy on the development of subsequent MDS/AML, compared with surgery. RESULTS Of 32,112 prostate cancer patients, 14,672 underwent radiotherapy, and 17,440 received surgery only. The median follow-up was 4.68 years. A total of 157 (0.47%) prostate cancer patients developed subsequent MDS or AML, and the median time to develop MDS/AML was 3.30 (range: 0.16-9.48) years. Compared with prostate cancer patients who received surgery only, patients who underwent radiotherapy had a significantly increased risk of developing MDS/AML (hazard ratio [HR] =1.51, 95% confidence interval [CI]: 1.07-2.13). When radiotherapy was further categorized by modalities (brachytherapy, conventional conformal radiotherapy, and intensity-modulated radiotherapy [IMRT]), increased risk of second MDS/AML was only observed in the IMRT group (HR = 1.66, 95% CI: 1.09-2.54). CONCLUSIONS Our findings suggest that radiotherapy for prostate cancer increases the risk of MDS/AML, and the impact may differ by modality. Additional studies with longer follow-up are needed to further clarify the role of radiotherapy in the development of subsequent myeloid malignancies. A better understanding may help patients, physicians, and other stakeholders make more informed treatment decisions. Prostate 77:437-445, 2017. © 2016 Wiley Periodicals, Inc.
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MESH Headings
- Aged
- Aged, 80 and over
- Cohort Studies
- Follow-Up Studies
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Radiation-Induced/diagnosis
- Leukemia, Radiation-Induced/epidemiology
- Leukemia, Radiation-Induced/etiology
- Male
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/etiology
- Population Surveillance/methods
- Prostatic Neoplasms/diagnosis
- Prostatic Neoplasms/epidemiology
- Prostatic Neoplasms/radiotherapy
- Radiotherapy, Intensity-Modulated/adverse effects
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Rong Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
| | - Amer Zeidan
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - James B. Yu
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Therapeutic Radiology, Yale School of Medicine
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - Amy J. Davidoff
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Health Policy and Management, Yale School of Public Health
| | - Steven D. Gore
- Department of Internal Medicine, Yale School of Medicine
| | - Scott Huntington
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
- Department of Internal Medicine, Yale School of Medicine
| | - Xiaomei Ma
- Department of Chronic Disease Epidemiology, Yale School of Public Health
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale University
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13
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Huntington S, Heppner J, Vohra R, Mallios R, Geller RJ. Serious adverse effects from single-use detergent sacs: report from a U.S. statewide poison control system. Clin Toxicol (Phila) 2014; 52:220-5. [PMID: 24580062 DOI: 10.3109/15563650.2014.892122] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In recent years, serious adverse effects to children from exposure to single-use detergents sacs (SUDS) have been recognized. While most exposures result in minor symptoms, there have been serious outcomes. This study aims to classify which types of serious outcomes follow SUDS exposures, and to assess, if possible, differences in toxicity between various SUDS products. METHODS An observational case series with data collected retrospectively was performed for cases of SUDS exposures reported to a statewide poison system's records database from 1 January 2012 to 31 March 2013. Cases were identified and analyzed for clinical details and trends. A statewide database was queried for cases involving the American Association of Poison Control Centers (AAPCC) product-specific codes for SUDS products using following search terms: laundry pods, the AAPCC product-specific codes for Tide Pods, Purex Ultrapacks, ALL Mighty Pacs, and a unique agent code (AAPCC ID: 6903138; Generic: 077900) created by AAPCC to track SUDS exposures. RESULTS A total of 804 cases of exposures to SUDS were identified, the majority of which were exploratory ingestions in young children with a median age of 2 years. Serious adverse effects resulted from 65 (9%) exposures and 27 (3%) exposures resulted in admission to hospital. Binary logistic regression demonstrated that the presence of central nervous system (CNS) or respiratory system effects were associated with more severe outcomes, with a model accuracy of 96.4%. There were significant differences in morbidity among the three most common brand-name products: when compared with Tide Pods, odds ratios (OR) and 95% confidence intervals (CI) for severe outcome and admission rate were significantly greater following Purex Ultrapack exposures (severity OR 5.1 [CI: 2.13-12.23]; admission OR 10.36 [CI: 3.23-33.22]) and ALL Mighty Pac exposures (severity OR 11.22 [CI: 4.78-28.36]; admission OR 15.20 [CI: 5.01-46.12]). CONCLUSIONS Serious complications from exposure to SUDS occur in a small number of exposures for unclear reasons. Respiratory and CNS effects are associated with more severe outcomes. Some brand-name products are associated with a relatively higher risk of severe adverse effects and rates of admission.
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Affiliation(s)
- S Huntington
- California Poison Control System, Children's Hospital Central California , Madera, CA , USA
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Williams K, Huntington S, Shaw N, Conway S, Peckham D. 229 Prucalopride: a review of the first 12 months of use. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60398-1] [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: 10/28/2022]
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Abstract
OBJECTIVES The aims of the study were (1) to measure the distance required to travel, and the distance actually travelled, to HIV services by HIV-infected adults, and (2) to calculate the proportion of patients who travelled beyond local services and identify socio-demographic and clinical predictors of use of non-local services. METHODS The straight-line distance between a patient's residence and HIV services was determined for HIV-infected patients in England in 2007. 'Local services' were defined as the closest HIV service to a patient's residence and other services within an additional 5 km radius. Multivariable logistic regression was used to identify socio-demographic and clinical predictors of accessing non-local services. RESULTS In 2007, nearly 57 000 adults with diagnosed HIV infection accessed HIV services in England; 42% lived in the most deprived areas. Overall, 81% of patients lived within 5 km of a service, and 8.7% used their closest HIV service. The median distance to the closest HIV service was 2.5 km [interquartile range (IQR) 1.5-4.2 km] and the median actual distance travelled was 4.8 km (IQR 2.5-9.7 km). A quarter of patients used a 'non-local' service. Patients living in the least deprived areas were twice as likely to use non-local services as those living in the most deprived areas [adjusted odds ratio (AOR) 2.16; 95% confidence interval (CI) 1.98-2.37]. Other predictors for accessing non-local services included living in an urban area (AOR 0.77; 95% CI 0.69-0.85) and being diagnosed more than 12 months (AOR 1.48; 95% CI 1.38-1.59). CONCLUSION In England, 81% of HIV-infected patients live within 5 km of HIV services and a quarter of HIV-infected adults travel to non-local HIV services. Those living in deprived areas are less likely to travel to non-local services.
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Affiliation(s)
- S Huntington
- Health Protection Agency Centre for Infections, London, UK.
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Huntington S, Hope V, Hutchinson S, Goldberg D, Ncube F. Diversity of needle exchange provision in the UK: findings from a national survey. ACTA ACUST UNITED AC 2006; 11:E060810.4. [PMID: 16966779 DOI: 10.2807/esw.11.32.03022-en] [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] [Indexed: 11/20/2022]
Abstract
Needle exchanges are key to reducing transmission of bloodborne viruses (BBVs) in injecting drug users (IDUs) through the provision of sterile
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Affiliation(s)
- S Huntington
- Health Protection Agency Centre for Infections, London, United Kingdom.
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Gibson B, Huntington S, Rubanov S, Olivero P, Digweed-Lyytikäinen K, Canning J, Love J. Exposure and characterization of nano-structured hole arrays in tapered photonic crystal fibers using a combined FIB/SEM technique. Opt Express 2005; 13:9023-9028. [PMID: 19498937 DOI: 10.1364/opex.13.009023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper presents a technique to expose and characterize nano-structured hole arrays in tapered photonic crystal fibers. Hole array structures are examined with taper outer diameters ranging from 12.9 microm to 1.6 microm. A combined focused ion beam milling and scanning electron microscope system was used to expose and characterize the arrayed air-silica structures. Results from this combined technique are presented which resolve hole-to-hole pitch sizes and hole diameters in the order of 120 nm and 60 nm, respectively.
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Sidiroglou F, Huntington S, Roberts A, Baxter G. Micro-characterisation of erbium-doped fibers using a Raman confocal microscope. Opt Express 2005; 13:5506-5512. [PMID: 19498546 DOI: 10.1364/opex.13.005506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We demonstrate the application of a Fluorescence Intensity Confocal Optical Microscopy technique to the determination of the relative erbium ion distribution in optical fibers. As well as being able to acquire two dimensional profiles of the relative erbium ion distribution, this method can also provide valuable information on a sub-micron level regarding physical and optogeometric parameters of the examined samples.
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Canning J, Buckley E, Huntington S, Lyytikäinen K. Using multi-microchannel capillaries for determination of the zeta potential of a microfluidic channel. Electrochim Acta 2004. [DOI: 10.1016/j.electacta.2004.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lyytikainen K, Huntington S, Carter A, McNamara P, Fleming S, Abramczyk J, Kaplin I, Schötz G. Dopant diffusion during optical fibre drawing. Opt Express 2004; 12:972-977. [PMID: 19474911 DOI: 10.1364/opex.12.000972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Diffusion of Ge and F was studied during drawing of silica optical fibres. Preforms were drawn using various draw conditions and fibres analysed using the etching and Atomic Force Microscope (AFM) technique. The results were confirmed by comparison with fibre Refractive Index Profiles (RIP). Both Ge and F were found to diffuse at high temperature, 2100 degrees C, and low draw speed, 10m/min. Diffusion simulations showed that most diffusion occurred in the neck-down region. The draw temperature and preform feed rate had a comparable effect on diffusion, whereas preform diameter did not significantly affect the diffusion.
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Huntington S, Lyytikainen K, Canning J. Analysis and removal of fracture damage during and subsequent to holey fiber cleaving. Opt Express 2003; 11:535-540. [PMID: 19461762 DOI: 10.1364/oe.11.000535] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The damage caused by cleaving holey fibers is investigated as a function of cleaving force. Comparisons are made with standard optical fibers and holey fibers. Optimum cleaving forces are determined for a number of holey fiber air fractions and fiber diameters. A simple technique for removing cleave damage is also presented.
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Huntington S, Katsifolis J, Gibson B, Canning J, Lyytikainen K, Zagari J, Cahill L, Love J. Retaining and characterising nano-structure within tapered air-silica structured optical fibers. Opt Express 2003; 11:98-104. [PMID: 19461711 DOI: 10.1364/oe.11.000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Air-silica fiber 125m in diameter has been tapered down to ~15m. At this diameter, it is commonly assumed that the nanostructured fiber holes have collapsed. Using an Atomic Force Microscope, we show this assumption to be in error, and demonstrate for the first time that structures several hundred nanometers in diameter are present, and that hole array structures are maintained. The use of Atomic Force Microscopy is shown to be an efficient way of characterising these structures.
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Huntington S. Provider terminations: strategies for risk management. Healthc Financ Manage 2000; 54:35-7. [PMID: 10847913] [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: 02/16/2023]
Abstract
Managed care organizations should protect themselves from possible legal action by providers whom they have terminated, whether because of professional incompetence or for reasons related to the organization's business goals. Risk management begins by being aware of state and Federal laws regarding contracts, peer review, restraint of trade, discrimination, and retaliation against a provider. Managed care organizations should adopt a set of criteria for providers' professional competence as well as a list of business objectives that might necessitate the deselection of a provider. Because some courts have upheld a provider's right to a "fair procedure," managed care organizations also should consider offering providers an opportunity to respond to the termination decision.
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Affiliation(s)
- S Huntington
- Health Care Division, Chubb Executive Risk, Simsbury, Connecticut, USA
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Huntington S. Understanding managed care organizations' liability exposure. Healthc Financ Manage 1998; 52:41-2. [PMID: 10176447] [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: 02/11/2023]
Abstract
Managed care organizations can minimize their liability exposures by staying informed about industry changes and by implementing a comprehensive risk management program. Typically, managed care organizations face three general exposure areas: directors and officers liability (e.g., exposures associated with nonclinical aspects of an organization); errors and omissions (e.g., exposures involving the day-to-day operations of managing the health care received by an organization's members); and financial loss, or provider excess (e.g., exposures that occur when certain catastrophic events expose the organization to financial peril).
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McCullough J, Steeper TA, Connelly DP, Jackson B, Huntington S, Scott EP. Platelet utilization in a university hospital. JAMA 1988; 259:2414-8. [PMID: 3352130] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two hundred forty-three patients received 22,717 U of platelets in our hospital during a three-month period. Those with hematologic diseases accounted for 43% of the patients but used 86% of the platelets. Sixty-eight percent of the transfusions were given to prevent bleeding and 32% were given to treat active bleeding. Ninety-two percent of therapeutic transfusions but only 22% of prophylactic transfusions met guidelines established by the Transfusion Therapeutics Committee of the University of Minnesota Hospital and Clinics, Minneapolis. However, 78% of prophylactic platelet transfusions that did not meet the guidelines involved patients with at least one clinical factor that their physicians believed placed them at an increased risk of bleeding. Following this analysis, the guidelines were modified and applied prospectively to requests for platelets. This resulted in a 14% decrease in the number of platelet units used during the following year. We conclude that published recommendations for platelet transfusions do not reflect the complex nature of many patients' conditions and that the use of guidelines developed by the medical staff can alter the use of platelet transfusions.
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Affiliation(s)
- J McCullough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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Huntington S, Warnick JS. Pharmacists' attitudes toward PAs. Results of a Wisconsin study. Physician Assist 1987; 11:108, 110-1, 114. [PMID: 10314648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Eight months after physician assistants in Wisconsin were given the authority to write prescriptions, a survey of pharmacists in that state indicated that PAs were utilizing the privilege. The survey further concluded that the technical quality of prescriptions written by PAs was appropriate, that pharmacists have confidence in prescription writing by PAs, and that other professionals in health care and the public need to be informed about PA prescribing authority.
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Abstract
Peripheral blood lymphocytes are heterogeneous and can be divided into subpopulations based on cell surface markers. Lymphocytes from 101 normal individuals of all ages were tested for their ability to form spontaneous rosettes with sheep erythrocytes (T cells) and for surface immunoglobulins (B cells). Cord bloods of newborn infants and bloods from children (age 1-10 years) showed greater numbers of total lymphocytes, total T cells and unmarked cells than a control group of 50 individuals from age 11-60 years. In 22 normal elderly individuals (age 61-98 years), total lymphocytes and total T and B cells were not decreased. These data suggest that the depression of cellular immune response described in elderly populations may be related to a dysfunction in a segment of T cells or an aberration in the complex interaction among T cells, B cells and macrophages.
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