Dale Hardy

Racial disparities and treatment trends in a large cohort of elderly black and white patients with nonsmall cell lung cancer

This study investigated whether there was a significant gap in receipt of treatment for nonsmall cell lung cancer (NSCLC) between blacks and whites, and whether the gap or disparity changed during the past 12 years from 1991 to 2002.

Cardiac toxicity in association with chemotherapy and radiation therapy in a large cohort of older patients with non-small-cell lung cancer

BACKGROUND The studys objective was to investigate the risks of developing cardiac disorders following the administration of chemotherapy and radiation therapy in patients with non-small-cell lung cancer (NSCLC). METHODS The study consisted of 34 209 patients aged > or =65 years with American Joint Committee on Cancer stages I-IV NSCLC identified from the Surveillance, Epidemiology, and End Result-Medicare linked database (1991-2002) who were free of cardiac disorders at NSCLC diagnosis. RESULTS There were significant associations between the use of chemotherapy/radiation and the risks of developing ischemic heart disease, conduction disorders, cardiac dysfunction, and heart failure. The absolute risks for cardiac dysfunction increased with the administration of chemotherapy-only and radiation-only, and incrementally with chemoradiation. Men, blacks, older patients, those with higher comorbidity scores, and advanced disease were at higher risk. The risk for ischemic heart disease increased when radiation/chemoradiation were rendered to the left lung and both lungs and for cardiac dysfunction, radiation administered to the left lung. CONCLUSIONS There were significant associations especially for cardiac dysfunction with use of chemotherapy/radiation therapy and risks of developing cardiac toxicity in NSCLC patients. The risks of treatment-associated cardiac toxicity, specifically ischemic heart disease and cardiac dysfunction, were greatest among those with left-sided lung tumors.

Racial disparities in the use of hospice services according to geographic residence and socioeconomic status in an elderly cohort with nonsmall cell lung cancer

The authors investigated whether there were racial disparities in the receipt of hospice services within geographic residence and socioeconomic status (SES) levels.

Cardiac toxicity associated with anthracycline-containing chemotherapy in older women with breast cancer

The purpose of this study was to determine the risk of chemotherapy‐associated cardiac toxicity, including cardiac dysrhythmia, cardiomyopathy, congestive heart failure, ischemic heart disease, and conduction disorders among breast cancer patients with up to 16 years of follow‐up.

Racial disparities and survival for nonsmall-cell lung cancer in a large cohort of black and white elderly patients

This study aimed to examine disparities in survival and associated factors for patients with nonsmall‐cell lung cancer (NSCLC) and to determine whether racial disparities varied over time (1991‐1995, 1996‐1999, and 2000‐2002).

Risk of chemotherapy-induced peripheral neuropathy in large population-based cohorts of elderly patients with breast, ovarian, and lung cancer.

There is little information on chemotherapy-induced peripheral neuropathy (PN) for community-dwelling patients with cancer. We studied 65,316 patients with breast cancer, 9242 with ovarian cancer, and 86,278 with non-small cell lung cancer from 1991 through 2002 identified from the 16 areas of Surveillance, Epidemiology and End Results. The incidence density of PN was 15.3, 21.5, and 18.3 per 1000 person-years for patients with breast, ovarian, and lung cancer who received platinum-taxane combination chemotherapy, respectively. Patients with breast, ovarian, and lung cancer receiving taxanes were more than twice as likely to develop PN compared with those not receiving chemotherapy (adjusted hazard ratio = 2.22, 95% confidence interval = 1.85-2.66 in patients with breast cancer), whereas patients who received platinum-taxane combination chemotherapy were more than 3 times as likely to develop PN compared with women who did not receive chemotherapy (adjusted hazard ratio = 3.33, 95% confidence interval = 2.05-5.05). In patients with ovarian or lung cancer receiving taxanes or platinum-taxane combination therapy, the risk of PN was increased with increasing number of chemotherapy cycles. These findings remained similar after adjusting for the history of preexisting PN or diabetes. Close monitoring for PN in patients receiving taxanes alone or in combination with platinum compounds may be warranted.

Relationship between chemotherapy use and cognitive impairments in older women with breast cancer: findings from a large population-based cohort.

Background:Several small scale clinical trials indicated a possible relationship between chemotherapy administration and the increased risk of cognitive impairments in patients with breast cancer, but little information was available from large population-based cohort studies. Methods:We studied 62,565 women who were diagnosed with stages I-IV breast cancer at age ≥65 years from 1991 through 2002 from 16 regions in the Surveillance, Epidemiology and End Results program who were free of cognitive impairments at diagnosis with up to 16 years of follow-up, and also studied 9752 matched cohort based on the propensity of receiving chemotherapy. The cumulative incidence of cognitive impairments was calculated and the time to event (cognitive impairments) analysis was conducted using Cox hazard regression model. Results:Overall, patients who received chemotherapy were 8% more likely to have drug-induced dementia compared with those without chemotherapy, but that was not statistically significant after adjusting for patient and tumor characteristics (hazard ratio = 1.08, 95% confidence interval = 0.85–1.37). The risk of developing Alzheimer disease, vascular dementia, or other dementias was significantly lower in patients receiving chemotherapy except for cognitive disorder which was not significantly different between the 2 chemotherapy groups. The results were somewhat similar in the entire cohort and the matched cohort based on the probability of receiving chemotherapy. Conclusion:There was no significant association between chemotherapy and the risk of developing drug-induced dementia and unspecified cognitive disorders. The risk of developing Alzheimer disease, vascular dementia, or other dementias was significantly lower in patients receiving chemotherapy. This study with long-term follow-up did not support the findings that chemotherapy was associated with an increased risk of late stage cognitive impairments.

Chemotherapy-associated toxicity in a large cohort of elderly patients with non-small cell lung cancer.

Background: The objective of this study was to examine the risks for short-term (≤3 months) and long-term (>3 months) chemotherapy-associated toxicities in a large population-based cohort of patients with non-small cell lung cancer from 1991 to 2002. Methods: The population consisted of 41,361 men and 30,804 women ≥65 years identified from the Surveillance, Epidemiology, and End Results—Medicare-linked database. The incidence of 50 toxicity-associated end points was calculated for 14 chemotherapy agents. Short- and long-term toxicities with a ≥2-fold increase in incidence compared with the no-chemotherapy group were defined as chemotherapy-associated toxicities. Hazard ratios and 95% confidence intervals for the risk of toxicity were calculated for the four most common chemotherapy agents for non-small cell lung cancer: cisplatin/carboplatin, paclitaxel, vinorelbine/vinblastine, and gemcitabine. Results: The most common short-term toxicities (9.2–60%) included acute anemia, nausea, and neutropenia. The most common long-term toxicities (15–37%) included acute anemia, respiratory failure, pulmonary fibrosis, dehydration, neutropenia, nausea, and fever. Multivariate analysis for selected chemotherapies demonstrated that after adjusting for other risk factors and confounders, some short-term toxicities became nonsignificant; however, almost all long-term toxicities remained significant. Long-term toxicity increased over time and was more likely in women, minority populations, those with fewer baseline comorbidities, and across disease stages. Conclusions: The administration of various chemotherapy agents for non-small cell lung was associated with a number of short- and long-term toxicities. The projected survival benefits of chemotherapy must be weighed against the risk of long-term toxicities.

Temporal and geographic variations in the receipt of colony-stimulating factors and erythropoiesis-stimulating agents in a large retrospective cohort of older women with breast cancer from 2000 to 2009

The purpose of this study was to use the most recent national data for a large cohort of patients diagnosed with breast cancer to evaluate temporal trend of receiving hematopoietic growth factors from 2000 to 2009 and to examine significant factors associated with increasing trends and geographic variations. We identified 26,130 women aged 65–89 years who were diagnosed with breast cancer and received chemotherapy in 2000–2009 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Colony-stimulating factors (CSFs) were identified if there was a claim from the following procedure codes: filgrastim, pegfilgrastim, or sargramostim. Erythropoiesis-stimulating agents (ESAs) were identified if there was a claim from the following procedure codes: epoetin or darbepoetin. Overall, 51.7% of patients with breast cancer received CSFs, which increased from 21.7% in 2000 to 63.2% in 2009. The percentage of patients receiving pegfilgrastim increased from 2.7% in 2000 to 19.5% in 2003 and then continuously to 49.7% in 2009. The overall percentage of patients receiving ESAs was 39.3%, which increased from 26.4% in 2000 to 60.8% in 2006, and then decreased significantly from 40.7% in 2007 to 12.9% in 2009. The receipt of both CSFs and ESAs differed significantly across different geographic areas. The receipt of CSFs continued to increase from 2000 to 2009, and pegfilgrastim started to replace filgrastim since 2003. The receipt of ESAs increased until 2006 and then declined substantially due to the black box warning. There were substantial geographic variations in the use of these hematopoietic growth factors.