Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute‐designated cancer centers in California. Issue 9 (16th February 2018)

• Record Type: Journal Article
• Authors: Ho, Gwendolyn; Wun, Ted; Muffly, Lori; Li, Qian; Brunson, Ann; Rosenberg, Aaron S.; Jonas, Brian A.; Keegan, Theresa H.M.
• Is Part Of: Cancer. Volume 124:Issue 9(2018)
• Page Start: 1938
• Page End: 1945
• Publication Date: 2018-02-16
• Subjects: acute myeloid leukemia (AML) -- complications -- early mortality -- epidemiology -- health services -- location of care; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.31296
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: To the authors' knowledge, few population‐based studies to date have evaluated the association between location of care, complications with induction therapy, and early mortality in patients with acute myeloid leukemia (AML). METHODS: Using linked data from the California Cancer Registry and Patient Discharge Dataset (1999‐2014), the authors identified adult (aged ≥18 years) patients with AML who received inpatient treatment within 30 days of diagnosis. A propensity score was created for treatment at a National Cancer Institute‐designated cancer center (NCI‐CC). Inverse probability‐weighted, multivariable logistic regression models were used to determine associations between location of care, complications, and early mortality (death ≤60 days from diagnosis). RESULTS: Of the 7007 patients with AML, 1762 (25%) were treated at an NCI‐CC. Patients with AML who were treated at NCI‐CCs were more likely to be aged ≤65 years, live in higher socioeconomic status neighborhoods, have fewer comorbidities, and have public health insurance. Patients treated at NCI‐CCs had higher rates of renal failure (23% vs 20%; P = .010) and lower rates of respiratory failure (11% vs 14%; P = .003) and cardiac arrest (1% vs 2%; P = .014). After adjustment for baseline characteristics, treatment at an NCI‐CC was associated with lower early mortality (odds ratio, 0.46; 95% confidence interval, 0.38‐0.57). The impact of complications on early mortality did not differ by location of care except for higher early mortality noted among patients with respiratory failure treated at non‐NCI‐CCs. CONCLUSIONS: The initial treatment of adult patients with AML at NCI‐CCs is associated with a 53% reduction in the odds of early mortality compared with treatment at non‐NCI‐CCs. Lower early mortality may result from differences in hospital or provider experience and supportive care. Cancer 2018;124:1938‐45 . © 2018 American Cancer Society . Abstract : In this observational cohort study that includes 7007 adult patients with acute myeloid leukemia hospitalized in California, those patients treated at National Cancer Institute‐designated cancer centers have a 53% reduction in the odds of death within 60 days of diagnosis compared with those treated elsewhere. Patients treated at National Cancer Institute‐designated cancer centers are more likely to be younger, live in more affluent neighborhoods, have fewer comorbidities, and have public health insurance.