Showing papers by "Linda S. Elting published in 2005"

Epidemiology and outcomes of serious influenza-related infections in the cancer population

Abstract: BACKGROUND Although patients with cancer generally respond favorably to vaccination, they may not receive annual influenza vaccinations. The current population-based study described the epidemiology and outcomes of potentially preventable, serious influenza-related infections in patients with cancer. METHODS From the Nationwide Inpatient Sample, the authors created a subsample that included discharges with any International Classification of Diseases, ninth revision, diagnosis code for cancer and principal diagnosis code for influenza, bronchopneumonia, or pneumonia caused by an unspecified organism. From the latter two diagnosis codes, the authors estimated excess cases during the influenza season for each year and stratum, then selected a random sample from fall and winter discharges. Subset analyses included weighted sample means, frequencies, and analysis of variance values. The authors converted charges to costs using cost-to-charge ratios and inflated these to 2003 U.S. dollars. Hospitalization and mortality rates were calculated using 5-year cancer prevalence estimates. RESULTS The estimated mean annual hospital discharges of patients with cancer with potentially preventable, serious influenza-related infections numbered 16,000. The average length and cost per stay were 6 days and > $6300, respectively. Approximately 9% of patients died in the hospital and 31% needed further skilled care. The estimated age-specific rates for hospitalization and death per 100,000 in the prevalent cancer population were 219 and 17.4, respectively, for patients age < 65 years and 623 and 59.4, respectively, for those age ≥ 65 years. Hospitalization costs averaged $1300 more for patients age < 65 years. CONCLUSIONS Death from influenza-related infections occurred in an estimated 9% of patients with cancer hospitalized for such. Using recommended vaccination schedules for patients with cancer and their contacts reduced hospitalizations, treatment delays, and deaths in this highly susceptible population. Cancer 2005. © 2005 American Cancer Society.

Correlation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study.

Abstract: BACKGROUND The association between high procedure volume and lower perioperative mortality is well established among cancer patients who undergo cystectomy. However, to the authors' knowledge, the association between volume and perioperative complications has not been studied to date and hospital characteristics contributing to the volume-outcome correlation are unknown. In the current study, the authors studied these associations, emphasizing hospital factors that contribute to the volume-outcome correlation. METHODS Multiple-variable models of inpatient mortality and complications were developed among all 1302 bladder carcinoma patients who underwent cystectomy between January 1, 1999 and December 31, 2001 in all Texas hospitals. General estimating equations were used to adjust for clustering within the 133 hospitals. Data were obtained from hospital claims, the 2000 U.S. Census, and databases from the Center for Medicare and Medicaid Services and the American Hospital Association. RESULTS Complications were reported to occur in 12% of patients, 2.2% of whom died. Mortality was higher in low-volume hospitals compared with high-volume hospitals (3.1% vs. 0.7%; P < 0.001); mortality in moderate-volume hospitals was reported to be intermediate (2.9%). After adjustment for advanced age and comorbid conditions, treatment in high-volume hospitals was associated with lower risks of mortality (odds ratio [OR] = 0.35; P = 0.02) and complications (OR = 0.53; P = 0.01). Hospitals with a high registered nurse-to-patient ratio also had a lower mortality risk (OR = 0.43; P = 0.04). CONCLUSIONS Mortality after cystectomy was found to be significantly lower in high-volume hospitals, regardless of patient age. Referral to a hospital performing greater than 10 cystectomies annually is indicated for all patients. However, patients with poor access to a high-volume hospital may derive similar benefit from treatment at a hospital with a high-registered nurse-to-patient ratio. This finding requires further confirmation. Cancer 2005. © 2005 American Cancer Society.

Cancer in an incarcerated population.

Abstract: BACKGROUND The challenge posed to prison health systems in the U.S. by an immense incarcerated population is significant. However, the patterns of presentation and associated mortality of cancer among the incarcerated population is unknown. METHODS An historical cohort of cancers diagnosed among inmates of the Texas Department of Criminal Justice over the course of 20 years who were followed at the University of Texas Medical Branch in Galveston, Texas was identified. There were 1807 inmates who were diagnosed with cancer. Two cohorts were chosen for comparison: a random sample of 179,757 patients from the Surveillance, Epidemiology, and End Results (SEER) registry, and an age-matched, gender-matched, race-matched SEER population comprised of 6124 patients (MSEER). Disease sites and associated mortality of the inmate cancer patients were determined and compared with SEER cohorts. RESULTS A marked rise in cancer diagnoses among inmates paralleled the rise in the inmate population. The leading cancers were lung carcinoma, non-Hodgkin lymphoma (NHL), and carcinomas of the oral cavity and pharynx. Among women, cervical carcinoma was the most common. Lung carcinoma, NHL, and hepatic carcinoma accounted for more cancer deaths among inmates than in the SEER cohort (P < 0.0001 for all comparisons). Lung carcinoma, hepatic carcinoma, and NHL were significantly more common in the inmate cohort than in the MSEER cohort (P < 0.001 for all comparisons). The median survival was inferior in the inmate cohort (21 mos) compared with the SEER cohort (55 mos) and the MSEER cohort (54 mos) (P < 0.0001 for both comparisons). CONCLUSIONS Cancers with unique epidemiology and high associated mortality have emerged among the incarcerated. This has significant implications for prison health systems. Cancer 2005. © 2005 American Cancer Society.

Epidemiology and outcomes of serious influenza infections in lung cancer patients

Abstract: 7222 Background: Cancer patients (pts) respond favorably to vaccination but their healthcare may be lacking in routine prevention efforts such as annual influenza vaccinations. This population-base...

Palifermin reduces estimated downstream costs of autologous stem cell transplant: Analysis of phase III trial results

Abstract: Introduction: Oral mucositis is a frequent and debilitating complication in patients (pts) who undergo high-dose chemotherapy (HDC) with SCT support and is associated with significantly worse clinical and economic outcomes in such settings (Sonis et al, J Clin Oncol, 2001). In a phase 3 randomized, placebo-controlled, double-blind clinical trial of palifermin in pts with hematologic malignancies undergoing HDC and total body irradiation (TBI) with auto-SCT support, palifermin (a rHuKGF molecule) has been shown to reduce the incidence, severity, and duration of oral mucositis as well as its downstream outcomes (bacteremia, febrile neutropenia [FN], total parenteral nutrition [TPN], and intubation) and hospitalization in this population (Spielberger, et al, ASCO, 2003). We estimated the expected impact of palifermin on the hospital costs of transplantation. Methods: We classified the 212 pts from the phase 3 trial by presence of downstream outcomes of oral mucositis (bacteremia, FN, TPN, intubation) and by the number of hospital days. The cost of hospital days was not collected in the clinical trial, hence, we estimated cost from the hospital claims of a nationally representative sample of pts with hematologic malignancies who underwent auto-SCT after TBI. We obtained charges from the National Inpatient Sample (NIS, 2000–2001), transformed them into costs using state-specific Medicare cost-to-charge ratios for operating and capital costs for urban centers, and adjusted them to 2003 U.S. dollars using the Consumer Price Index for medical care. We computed the mean cost per hospital day for NIS pts with 0, one, or more of the 4 downstream outcomes (FN, bacteremia, TPN, intubation), and applied these costs to the number of hospital days of clinical trial pts with corresponding downstream outcomes. We compared the estimated total hospital costs of palifermin pts to placebo pts. Out-pt costs of SCT were not estimated and the cost of palifermin has not yet been determined, therefore neither was included in this analysis. Results: The age and sex distributions of NIS and clinical trial pts were virtually identical as were the mean hospital days (22.52 vs. 22.87 days), but non-Hispanic whites were more common in the clinical trial population (79% vs. 63%). In pts with hematologic malignancies, the national mean cost per hospital day for auto SCT after TBI was $2,702, ranging from $2,572 per day when no downstream outcomes occurred to > $5,000 per day when all 4 downstream outcomes occurred. Applying these differing costs to the differing outcomes of clinical trial pts, the mean cost per pt was $61,160 with palifermin and $76,104 with placebo, yielding a mean savings of $14,943 per pt (95% CI: $12,043–$17,845) in this population. Savings will be partially offset by the cost of palifermin and may vary among centers, particularly those that perform outpatient transplants. Extrapolations of these data to the allogeneic and autologous non-TBI settings also will be presented. Conclusion: The clinical efficacy of palifermin should lead to significant hospital cost savings for pts with hematologic malignancies undergoing auto-SCT following HDC and TBI. The magnitude of savings will depend on the cost of the drug.