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E. Stanley Crawford Critical Issues Forum Tackles Value-Based Reimbursement
Vascular surgeons will learn how to navigate a value-based reimbursement system at the E. Stanley Crawford Critical Issues Forum on Thursday, June 1, from 10:30 a.m. to noon. This informative session, moderated by R. Clement Darling III, MD, of The Vascular Group in Albany, N.Y., will include an excellent panel of experts in the field.
“As everyone knows, the Affordable Care Act (ACA) will continue to be under serious discussion in the new administration, and we don’t know how it will affect our practices,” said Dr. Darling. “However, MACRA, MIPS, and alternative payment systems were decided on in a bipartisan fashion, so change in our reimbursement system is here to stay.”
The Forum will begin with a presentation by Michael C. Dalsing, MD, of Indiana University about “The Five Things We All Need to Know about MACRA and Alternative Payment Systems to Compete and Flourish.” MACRA – the Medicare Access and CHIP Reauthorization Act of 2015 – went into effect on January 1, 2017.
“It is extremely important for all vascular surgeons and health care professionals to participate in order to not be negatively affected by this rule,” noted Dr. Darling,
The next talk will be “Appropriate Care in Outpatient Angio Suites: How Do We Ensure the Correct Procedures Get Done on the Right Patients for the Right Reasons?” Daniel R. Gorin, MD, of Cape Cod Health Care, will cover this very important issue in current outpatient treatment of patients with venous and arterial disease. These suites have been well received by the public and third party payers; however, we may need to be involved with their accreditation to minimize the potential or perception of inappropriate indications or procedures. “A year and one-half ago,” said Dr. Darling, “Peter Lawrence talked about the increase in outpatient angio suites in his excellent SVS Presidential address.”
“I think this presentation will be absorbing and controversial for both those who are contemplating outpatient angio suites and those who are working in one,” continued Dr. Darling. “We need to police ourselves. It may be incumbent upon us to be the accreditation body that actively participates in ensuring that we are giving our patients the best and most appropriate care possible.”
An integral part of MACRA and value-based reimbursement systems is outcomes. The SVS Vascular Quality Initiative (VQI) has become a hot topic for many vascular surgeons whether they work for academic institutions, in a hospital, in multi-specialty practices, or independently.
Since MACRA and the alternative payment system include involvement with registries, the next subject will be “Outcome Registries – Necessary Evil or Useful Tool of the Future: How to Make Them Work in Your Practice” discussed by John “Jeb” Hallett, MD, of the Medical University of South Carolina. “This presentation will enlighten attendees on how to incorporate outcome registries into their daily lives,” noted Dr. Darling.
The final talk will be “Can Everyone Do It All? Regionalization and Center Accreditation: How to Make It Work for All of Us” by Anton Sidawy, MD, of GW Medical Faculty Associates and SVS Past President. “This is a fascinating topic, which should generate a fair amount of discussion,” noted Dr. Darling. “We are all aware that there is an extensive trauma center designation in this country that has helped improve mortality and patient care. Yet, for patients with vascular emergencies, recent data have shown regionalization can positively impact outcome and many patients do not suffer from transfer.” This complex problem will be analyzed from all perspectives.
“We hope that the SVS can be on the forefront of creating systems that benefit patient outcomes while maintaining excellent regional doctor/patient relationships,” stated Dr. Darling. “We will again look at the opportunity for SVS involvement in center accreditation – allowing us to maintain our preeminent position as the physicians who can best treat vascular, arterial, and venous emergencies and any vascular surgery pathology.”
The Crawford Critical Issues Forum will delve into very interesting and controversial subjects,” stated Dr. Darling. “We hope that physicians will attend the session and provide us with their input and thoughts on these critical issues.”
Dr. Darling does not have any financial conflicts of interest.
Thursday, June 1
10:30 a.m. – Noon
The E. Stanley Crawford Critical Issues Forum
Vascular surgeons will learn how to navigate a value-based reimbursement system at the E. Stanley Crawford Critical Issues Forum on Thursday, June 1, from 10:30 a.m. to noon. This informative session, moderated by R. Clement Darling III, MD, of The Vascular Group in Albany, N.Y., will include an excellent panel of experts in the field.
“As everyone knows, the Affordable Care Act (ACA) will continue to be under serious discussion in the new administration, and we don’t know how it will affect our practices,” said Dr. Darling. “However, MACRA, MIPS, and alternative payment systems were decided on in a bipartisan fashion, so change in our reimbursement system is here to stay.”
The Forum will begin with a presentation by Michael C. Dalsing, MD, of Indiana University about “The Five Things We All Need to Know about MACRA and Alternative Payment Systems to Compete and Flourish.” MACRA – the Medicare Access and CHIP Reauthorization Act of 2015 – went into effect on January 1, 2017.
“It is extremely important for all vascular surgeons and health care professionals to participate in order to not be negatively affected by this rule,” noted Dr. Darling,
The next talk will be “Appropriate Care in Outpatient Angio Suites: How Do We Ensure the Correct Procedures Get Done on the Right Patients for the Right Reasons?” Daniel R. Gorin, MD, of Cape Cod Health Care, will cover this very important issue in current outpatient treatment of patients with venous and arterial disease. These suites have been well received by the public and third party payers; however, we may need to be involved with their accreditation to minimize the potential or perception of inappropriate indications or procedures. “A year and one-half ago,” said Dr. Darling, “Peter Lawrence talked about the increase in outpatient angio suites in his excellent SVS Presidential address.”
“I think this presentation will be absorbing and controversial for both those who are contemplating outpatient angio suites and those who are working in one,” continued Dr. Darling. “We need to police ourselves. It may be incumbent upon us to be the accreditation body that actively participates in ensuring that we are giving our patients the best and most appropriate care possible.”
An integral part of MACRA and value-based reimbursement systems is outcomes. The SVS Vascular Quality Initiative (VQI) has become a hot topic for many vascular surgeons whether they work for academic institutions, in a hospital, in multi-specialty practices, or independently.
Since MACRA and the alternative payment system include involvement with registries, the next subject will be “Outcome Registries – Necessary Evil or Useful Tool of the Future: How to Make Them Work in Your Practice” discussed by John “Jeb” Hallett, MD, of the Medical University of South Carolina. “This presentation will enlighten attendees on how to incorporate outcome registries into their daily lives,” noted Dr. Darling.
The final talk will be “Can Everyone Do It All? Regionalization and Center Accreditation: How to Make It Work for All of Us” by Anton Sidawy, MD, of GW Medical Faculty Associates and SVS Past President. “This is a fascinating topic, which should generate a fair amount of discussion,” noted Dr. Darling. “We are all aware that there is an extensive trauma center designation in this country that has helped improve mortality and patient care. Yet, for patients with vascular emergencies, recent data have shown regionalization can positively impact outcome and many patients do not suffer from transfer.” This complex problem will be analyzed from all perspectives.
“We hope that the SVS can be on the forefront of creating systems that benefit patient outcomes while maintaining excellent regional doctor/patient relationships,” stated Dr. Darling. “We will again look at the opportunity for SVS involvement in center accreditation – allowing us to maintain our preeminent position as the physicians who can best treat vascular, arterial, and venous emergencies and any vascular surgery pathology.”
The Crawford Critical Issues Forum will delve into very interesting and controversial subjects,” stated Dr. Darling. “We hope that physicians will attend the session and provide us with their input and thoughts on these critical issues.”
Dr. Darling does not have any financial conflicts of interest.
Thursday, June 1
10:30 a.m. – Noon
The E. Stanley Crawford Critical Issues Forum
Vascular surgeons will learn how to navigate a value-based reimbursement system at the E. Stanley Crawford Critical Issues Forum on Thursday, June 1, from 10:30 a.m. to noon. This informative session, moderated by R. Clement Darling III, MD, of The Vascular Group in Albany, N.Y., will include an excellent panel of experts in the field.
“As everyone knows, the Affordable Care Act (ACA) will continue to be under serious discussion in the new administration, and we don’t know how it will affect our practices,” said Dr. Darling. “However, MACRA, MIPS, and alternative payment systems were decided on in a bipartisan fashion, so change in our reimbursement system is here to stay.”
The Forum will begin with a presentation by Michael C. Dalsing, MD, of Indiana University about “The Five Things We All Need to Know about MACRA and Alternative Payment Systems to Compete and Flourish.” MACRA – the Medicare Access and CHIP Reauthorization Act of 2015 – went into effect on January 1, 2017.
“It is extremely important for all vascular surgeons and health care professionals to participate in order to not be negatively affected by this rule,” noted Dr. Darling,
The next talk will be “Appropriate Care in Outpatient Angio Suites: How Do We Ensure the Correct Procedures Get Done on the Right Patients for the Right Reasons?” Daniel R. Gorin, MD, of Cape Cod Health Care, will cover this very important issue in current outpatient treatment of patients with venous and arterial disease. These suites have been well received by the public and third party payers; however, we may need to be involved with their accreditation to minimize the potential or perception of inappropriate indications or procedures. “A year and one-half ago,” said Dr. Darling, “Peter Lawrence talked about the increase in outpatient angio suites in his excellent SVS Presidential address.”
“I think this presentation will be absorbing and controversial for both those who are contemplating outpatient angio suites and those who are working in one,” continued Dr. Darling. “We need to police ourselves. It may be incumbent upon us to be the accreditation body that actively participates in ensuring that we are giving our patients the best and most appropriate care possible.”
An integral part of MACRA and value-based reimbursement systems is outcomes. The SVS Vascular Quality Initiative (VQI) has become a hot topic for many vascular surgeons whether they work for academic institutions, in a hospital, in multi-specialty practices, or independently.
Since MACRA and the alternative payment system include involvement with registries, the next subject will be “Outcome Registries – Necessary Evil or Useful Tool of the Future: How to Make Them Work in Your Practice” discussed by John “Jeb” Hallett, MD, of the Medical University of South Carolina. “This presentation will enlighten attendees on how to incorporate outcome registries into their daily lives,” noted Dr. Darling.
The final talk will be “Can Everyone Do It All? Regionalization and Center Accreditation: How to Make It Work for All of Us” by Anton Sidawy, MD, of GW Medical Faculty Associates and SVS Past President. “This is a fascinating topic, which should generate a fair amount of discussion,” noted Dr. Darling. “We are all aware that there is an extensive trauma center designation in this country that has helped improve mortality and patient care. Yet, for patients with vascular emergencies, recent data have shown regionalization can positively impact outcome and many patients do not suffer from transfer.” This complex problem will be analyzed from all perspectives.
“We hope that the SVS can be on the forefront of creating systems that benefit patient outcomes while maintaining excellent regional doctor/patient relationships,” stated Dr. Darling. “We will again look at the opportunity for SVS involvement in center accreditation – allowing us to maintain our preeminent position as the physicians who can best treat vascular, arterial, and venous emergencies and any vascular surgery pathology.”
The Crawford Critical Issues Forum will delve into very interesting and controversial subjects,” stated Dr. Darling. “We hope that physicians will attend the session and provide us with their input and thoughts on these critical issues.”
Dr. Darling does not have any financial conflicts of interest.
Thursday, June 1
10:30 a.m. – Noon
The E. Stanley Crawford Critical Issues Forum
High allele level linked to lamotrigine-induced SCAR
, reported Byung-Keun Kim, MD, of Seoul National University and associates.
In a study of 18 Korean patients with lamotrigine-induced SCAR, a control group of Korean lamotrigine-tolerant patients, and a control group of the general Korean population, the frequency of the HLA-A*31:01 allele was significantly higher in the lamotrigine-induced SCAR patients than in the lamotrigine-tolerant patients (odds ratio, 11.43; P = .0037) or the other control group (OR, 7.27; P = .00034).
High levels of the HLA-A*31:01 allele also have been reported in Korean patients with carbamazepine-induced SCAR, suggesting an association with the HLA allele and drug-induced SCAR that is specific to ethnicity.
That idea is supported by reports that the HLA-B*15:02 allele is a well-known risk allele of carbamazepine-induced SCAR in Han Chinese and Southeast Asians and that other HLA alleles have been significantly associated with SCAR only with patients of European ancestry or only with patients of Mestizo Mexican ancestry, Dr. Kim and associates said.
The SCAR in this study were Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic syndrome, also known as DRESS.
Read more in the Annals of Allergy, Asthma & Immunology (2017 May;118[5]:629-30).
, reported Byung-Keun Kim, MD, of Seoul National University and associates.
In a study of 18 Korean patients with lamotrigine-induced SCAR, a control group of Korean lamotrigine-tolerant patients, and a control group of the general Korean population, the frequency of the HLA-A*31:01 allele was significantly higher in the lamotrigine-induced SCAR patients than in the lamotrigine-tolerant patients (odds ratio, 11.43; P = .0037) or the other control group (OR, 7.27; P = .00034).
High levels of the HLA-A*31:01 allele also have been reported in Korean patients with carbamazepine-induced SCAR, suggesting an association with the HLA allele and drug-induced SCAR that is specific to ethnicity.
That idea is supported by reports that the HLA-B*15:02 allele is a well-known risk allele of carbamazepine-induced SCAR in Han Chinese and Southeast Asians and that other HLA alleles have been significantly associated with SCAR only with patients of European ancestry or only with patients of Mestizo Mexican ancestry, Dr. Kim and associates said.
The SCAR in this study were Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic syndrome, also known as DRESS.
Read more in the Annals of Allergy, Asthma & Immunology (2017 May;118[5]:629-30).
, reported Byung-Keun Kim, MD, of Seoul National University and associates.
In a study of 18 Korean patients with lamotrigine-induced SCAR, a control group of Korean lamotrigine-tolerant patients, and a control group of the general Korean population, the frequency of the HLA-A*31:01 allele was significantly higher in the lamotrigine-induced SCAR patients than in the lamotrigine-tolerant patients (odds ratio, 11.43; P = .0037) or the other control group (OR, 7.27; P = .00034).
High levels of the HLA-A*31:01 allele also have been reported in Korean patients with carbamazepine-induced SCAR, suggesting an association with the HLA allele and drug-induced SCAR that is specific to ethnicity.
That idea is supported by reports that the HLA-B*15:02 allele is a well-known risk allele of carbamazepine-induced SCAR in Han Chinese and Southeast Asians and that other HLA alleles have been significantly associated with SCAR only with patients of European ancestry or only with patients of Mestizo Mexican ancestry, Dr. Kim and associates said.
The SCAR in this study were Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic syndrome, also known as DRESS.
Read more in the Annals of Allergy, Asthma & Immunology (2017 May;118[5]:629-30).
FROM THE ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY
FDA approves pembrolizumab for first-line advanced NSCLC
The Food and Drug Administration has granted accelerated approval to checkpoint inhibitor pembrolizumab in combination with pemetrexed and carboplatin for the treatment of patients with previously untreated metastatic nonsquamous non–small cell lung cancer (NSCLC).
The immunotherapy pembrolizumab was approved as a second-line treatment for metastatic NSCLC in 2015.
First-line approval was based on an improved overall response rate (ORR) and progression-free survival (PFS) in a cohort of 123 patients within an open-label, multicohort study (KEYNOTE-21). Enrollees in cohort G1 had locally advanced or metastatic NSCLC and no prior systemic treatment for metastatic disease. They were randomized to receive either pembrolizumab, in combination with pemetrexed and carboplatin (PC) for four cycles followed by pembrolizumab for a maximum of 24 months (n = 60) or PC alone (n = 63). Randomization was stratified by PD-L1 tumor expression (tumor proportion score [TPS] less than 1% vs. TPS greater than or equal to 1%).
The hazard ratio for PFS was 0.53 (95% CI: 0.31, 0.91, P = .0205). The median PFS was 13.0 months for the pembrolizumab plus PC arm and 8.9 months for the PC-alone arm. In the TPS less than 1% subgroup, the ORR was 57% and 13% in the pembrolizumab-plus-PC and in the PC-alone arms, respectively. In the TPS greater-than-or-equal-to-1% subgroup, the ORR was 54% in the pembrolizumab-plus-PC arm and 38% in the pembrolizumab-plus-PC arm, the FDA said.
There were serious adverse events in 41% of the patients in the pembrolizumab-plus-PC arm compared with 28% in the PC-alone arm. Pembrolizumab was discontinued for adverse reactions in 10% of patients, most commonly due to acute kidney injury. The most common grade 3-4 adverse reactions were fatigue, dyspnea, nausea, vomiting, diarrhea, and rash.
The FDA cautioned that immune-mediated adverse reactions can occur with pembrolizumab including pneumonitis, colitis, hepatitis, endocrinopathies, and nephritis. Based on the severity of the adverse reaction, pembrolizumab should be withheld or discontinued and corticosteroids administered when appropriate. The recommended dose and schedule for NSCLC is 200 mg as an intravenous infusion every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
Pembrolizumab is marketed as Keytruda by Merck.
The Food and Drug Administration has granted accelerated approval to checkpoint inhibitor pembrolizumab in combination with pemetrexed and carboplatin for the treatment of patients with previously untreated metastatic nonsquamous non–small cell lung cancer (NSCLC).
The immunotherapy pembrolizumab was approved as a second-line treatment for metastatic NSCLC in 2015.
First-line approval was based on an improved overall response rate (ORR) and progression-free survival (PFS) in a cohort of 123 patients within an open-label, multicohort study (KEYNOTE-21). Enrollees in cohort G1 had locally advanced or metastatic NSCLC and no prior systemic treatment for metastatic disease. They were randomized to receive either pembrolizumab, in combination with pemetrexed and carboplatin (PC) for four cycles followed by pembrolizumab for a maximum of 24 months (n = 60) or PC alone (n = 63). Randomization was stratified by PD-L1 tumor expression (tumor proportion score [TPS] less than 1% vs. TPS greater than or equal to 1%).
The hazard ratio for PFS was 0.53 (95% CI: 0.31, 0.91, P = .0205). The median PFS was 13.0 months for the pembrolizumab plus PC arm and 8.9 months for the PC-alone arm. In the TPS less than 1% subgroup, the ORR was 57% and 13% in the pembrolizumab-plus-PC and in the PC-alone arms, respectively. In the TPS greater-than-or-equal-to-1% subgroup, the ORR was 54% in the pembrolizumab-plus-PC arm and 38% in the pembrolizumab-plus-PC arm, the FDA said.
There were serious adverse events in 41% of the patients in the pembrolizumab-plus-PC arm compared with 28% in the PC-alone arm. Pembrolizumab was discontinued for adverse reactions in 10% of patients, most commonly due to acute kidney injury. The most common grade 3-4 adverse reactions were fatigue, dyspnea, nausea, vomiting, diarrhea, and rash.
The FDA cautioned that immune-mediated adverse reactions can occur with pembrolizumab including pneumonitis, colitis, hepatitis, endocrinopathies, and nephritis. Based on the severity of the adverse reaction, pembrolizumab should be withheld or discontinued and corticosteroids administered when appropriate. The recommended dose and schedule for NSCLC is 200 mg as an intravenous infusion every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
Pembrolizumab is marketed as Keytruda by Merck.
The Food and Drug Administration has granted accelerated approval to checkpoint inhibitor pembrolizumab in combination with pemetrexed and carboplatin for the treatment of patients with previously untreated metastatic nonsquamous non–small cell lung cancer (NSCLC).
The immunotherapy pembrolizumab was approved as a second-line treatment for metastatic NSCLC in 2015.
First-line approval was based on an improved overall response rate (ORR) and progression-free survival (PFS) in a cohort of 123 patients within an open-label, multicohort study (KEYNOTE-21). Enrollees in cohort G1 had locally advanced or metastatic NSCLC and no prior systemic treatment for metastatic disease. They were randomized to receive either pembrolizumab, in combination with pemetrexed and carboplatin (PC) for four cycles followed by pembrolizumab for a maximum of 24 months (n = 60) or PC alone (n = 63). Randomization was stratified by PD-L1 tumor expression (tumor proportion score [TPS] less than 1% vs. TPS greater than or equal to 1%).
The hazard ratio for PFS was 0.53 (95% CI: 0.31, 0.91, P = .0205). The median PFS was 13.0 months for the pembrolizumab plus PC arm and 8.9 months for the PC-alone arm. In the TPS less than 1% subgroup, the ORR was 57% and 13% in the pembrolizumab-plus-PC and in the PC-alone arms, respectively. In the TPS greater-than-or-equal-to-1% subgroup, the ORR was 54% in the pembrolizumab-plus-PC arm and 38% in the pembrolizumab-plus-PC arm, the FDA said.
There were serious adverse events in 41% of the patients in the pembrolizumab-plus-PC arm compared with 28% in the PC-alone arm. Pembrolizumab was discontinued for adverse reactions in 10% of patients, most commonly due to acute kidney injury. The most common grade 3-4 adverse reactions were fatigue, dyspnea, nausea, vomiting, diarrhea, and rash.
The FDA cautioned that immune-mediated adverse reactions can occur with pembrolizumab including pneumonitis, colitis, hepatitis, endocrinopathies, and nephritis. Based on the severity of the adverse reaction, pembrolizumab should be withheld or discontinued and corticosteroids administered when appropriate. The recommended dose and schedule for NSCLC is 200 mg as an intravenous infusion every 3 weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
Pembrolizumab is marketed as Keytruda by Merck.
Genes may play role in breast cancer racial disparities
A new analysis of data from The Cancer Genome Atlas revealed 142 genes differentially expressed between white and African Americans that may influence breast cancer survival.
Researchers sifted through gene expression, protein expression, somatic mutations, somatic DNA copy number alteration, and DNA methylation patterns between 154 black patients of African ancestry (mean age at diagnosis, 55.66 years); and 776 white patients (mean age, 59.51) of European ancestry. They also looked at germline genetic variants for breast cancer subtypes and estimated subtype heritability.
African American patients were more likely than were whites to have basal-like breast cancer (odds ratio [OR], 3.80; 95% confidence interval [CI], 2.46-5.87; P less than .001) and HER2-enriched breast cancer (OR, 2.22; 95% CI, 1.10-4.47; P =.027).
After adjustment for subtype, 142 genes were differentially expressed between the two populations, a finding that held true after correction for testing of multiple comparisons (Bonferroni-adjusted P less than .05), reported Dezheng Huo, MD, PhD, of the department of public health sciences, University of Chicago, and his coauthors (JAMA Oncol. 2017 May 4. doi: 10.1001/jamaoncol.2017.0595).
During a median follow-up of 29 months, African Americans were more likely to experience recurrences (hazard ratio [HR], HR = 1.67, 95 CI, 1.02-2.74; P =.043). They had higher odds of basal-like breast cancer (OR, 3.80; 95% CI, 2.46-5.87; P less than .001) and human epidermal growth factor receptor 2 ERBB2 (HER2)-enriched breast cancer (OR, 2.22; 95% CI, 1.10-4.47; P =.027).
After adjusting for intrinsic subtypes, the researchers found differential expression of 16 DNA methylation probes, 4 DNA copy number segments, and 1 protein,
“If you have African ancestry, you’re more likely to have tumors that grow really fast. If we have drugs that can treat that kind of tumor, we need to find you and get you into treatment as quickly as possible,” she said.
A new analysis of data from The Cancer Genome Atlas revealed 142 genes differentially expressed between white and African Americans that may influence breast cancer survival.
Researchers sifted through gene expression, protein expression, somatic mutations, somatic DNA copy number alteration, and DNA methylation patterns between 154 black patients of African ancestry (mean age at diagnosis, 55.66 years); and 776 white patients (mean age, 59.51) of European ancestry. They also looked at germline genetic variants for breast cancer subtypes and estimated subtype heritability.
African American patients were more likely than were whites to have basal-like breast cancer (odds ratio [OR], 3.80; 95% confidence interval [CI], 2.46-5.87; P less than .001) and HER2-enriched breast cancer (OR, 2.22; 95% CI, 1.10-4.47; P =.027).
After adjustment for subtype, 142 genes were differentially expressed between the two populations, a finding that held true after correction for testing of multiple comparisons (Bonferroni-adjusted P less than .05), reported Dezheng Huo, MD, PhD, of the department of public health sciences, University of Chicago, and his coauthors (JAMA Oncol. 2017 May 4. doi: 10.1001/jamaoncol.2017.0595).
During a median follow-up of 29 months, African Americans were more likely to experience recurrences (hazard ratio [HR], HR = 1.67, 95 CI, 1.02-2.74; P =.043). They had higher odds of basal-like breast cancer (OR, 3.80; 95% CI, 2.46-5.87; P less than .001) and human epidermal growth factor receptor 2 ERBB2 (HER2)-enriched breast cancer (OR, 2.22; 95% CI, 1.10-4.47; P =.027).
After adjusting for intrinsic subtypes, the researchers found differential expression of 16 DNA methylation probes, 4 DNA copy number segments, and 1 protein,
“If you have African ancestry, you’re more likely to have tumors that grow really fast. If we have drugs that can treat that kind of tumor, we need to find you and get you into treatment as quickly as possible,” she said.
A new analysis of data from The Cancer Genome Atlas revealed 142 genes differentially expressed between white and African Americans that may influence breast cancer survival.
Researchers sifted through gene expression, protein expression, somatic mutations, somatic DNA copy number alteration, and DNA methylation patterns between 154 black patients of African ancestry (mean age at diagnosis, 55.66 years); and 776 white patients (mean age, 59.51) of European ancestry. They also looked at germline genetic variants for breast cancer subtypes and estimated subtype heritability.
African American patients were more likely than were whites to have basal-like breast cancer (odds ratio [OR], 3.80; 95% confidence interval [CI], 2.46-5.87; P less than .001) and HER2-enriched breast cancer (OR, 2.22; 95% CI, 1.10-4.47; P =.027).
After adjustment for subtype, 142 genes were differentially expressed between the two populations, a finding that held true after correction for testing of multiple comparisons (Bonferroni-adjusted P less than .05), reported Dezheng Huo, MD, PhD, of the department of public health sciences, University of Chicago, and his coauthors (JAMA Oncol. 2017 May 4. doi: 10.1001/jamaoncol.2017.0595).
During a median follow-up of 29 months, African Americans were more likely to experience recurrences (hazard ratio [HR], HR = 1.67, 95 CI, 1.02-2.74; P =.043). They had higher odds of basal-like breast cancer (OR, 3.80; 95% CI, 2.46-5.87; P less than .001) and human epidermal growth factor receptor 2 ERBB2 (HER2)-enriched breast cancer (OR, 2.22; 95% CI, 1.10-4.47; P =.027).
After adjusting for intrinsic subtypes, the researchers found differential expression of 16 DNA methylation probes, 4 DNA copy number segments, and 1 protein,
“If you have African ancestry, you’re more likely to have tumors that grow really fast. If we have drugs that can treat that kind of tumor, we need to find you and get you into treatment as quickly as possible,” she said.
FROM JAMA ONCOLOGY
Key clinical point: Genetic differences may play role in racial disparities in breast cancer outcomes.
Major finding: The Cancer Genome Atlas data show that 142 genes were differentially expressed between whites and African Americans.
Data source: Analysis of genetic and outcome data from 930 patients.
Disclosures: The study was funded by the National Cancer Institute, the Breast Cancer Research Foundation, the National Human Genome Research Institute, Susan G. Komen, and the American Cancer Society. Dr. Olopade is a cofounder of CancerIQ and Prosigna.
More pulmonary patients getting palliative care
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
More neurology patients getting palliative care
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
More cardiac patients getting palliative care
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Noncancer diagnoses on the rise in palliative care
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
Referrals by specialty were led by hospital medicine, which accounted for 48% of all patients referred to palliative care in 2015, with internal medicine/family medicine next at 14%, followed by pulmonary/critical care at 13% and oncology at 7%, the report said.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
"But doc, isn't hospice just for cancer patients?"
"But doc, isn't hospice just for cancer patients?"
"But doc, isn't hospice just for cancer patients?"
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
Referrals by specialty were led by hospital medicine, which accounted for 48% of all patients referred to palliative care in 2015, with internal medicine/family medicine next at 14%, followed by pulmonary/critical care at 13% and oncology at 7%, the report said.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Patients referred to palliative care are most likely to have cancer, but the proportion has gone down since 2009 as other diagnoses have increased, according to a report from the National Palliative Care Registry.
In 2015, cancer patients made up 26% of the patients referred to palliative care, compared with 35% in 2009. The situation was reversed for the next three most common diagnoses in 2015: Cardiac diagnoses rose from 5% in 2009 to 13%, pulmonary diagnoses increased from 6% to 12%, and neurologic diagnoses went from 3% to 8%, the report showed.
Referrals by specialty were led by hospital medicine, which accounted for 48% of all patients referred to palliative care in 2015, with internal medicine/family medicine next at 14%, followed by pulmonary/critical care at 13% and oncology at 7%, the report said.
An increase in overall palliative care penetration was seen from 2009 to 2015, as the percentage of annual hospital admissions seen by a palliative care team increased from 2.7% to 4.8%. Over that same time period, the percentage of palliative care patients who died in the hospital decreased from 29% to 22%, according to the report.
In 2015, there were 420 palliative care programs participating in the registry, which is a joint project of the Center to Advance Palliative Care and the National Palliative Care Research Center.
Ankylosing spondylitis disease severity worsened by smoking
BIRMINGHAM, ENGLAND – Patients with axial spondyloarthritis who currently smoke have been found to have worse disease activity than those who do not in an early analysis of data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS).
Smoking was associated with worse disease not only when comparing ever smokers with never smokers, but also when current smokers were compared to ex-smokers, and there was some evidence that the amount of smoking was important with heavier smokers having worse disease activity than light smokers.
Dr. Zhao, of Aintree University Hospital in Liverpool, England, added that, as in previous studies, these data show that “smoking is associated with worse disease activity at baseline and this needs to be accounted for in the next stage of longitudinal analysis.”
An association between smoking and worse disease activity in patients with axSpA has been reported previously, Dr. Zhao acknowledged, but this is not as clear cut as in rheumatoid arthritis where smoking is known to have a pathogenic effect. The small number of earlier studies looking at the possible effect of smoking in AS have been limited by their size and varying methodology, he added, and the studies’ researchers were not able to see if there was any potential dose effect of smoking.
The BSRBR-AS, which started recruiting patients with an Assessment of SpondyloArthritis international Society (ASAS) classification of axSpA in 2012, offers a unique opportunity to explore the association between smoking and axSpA further, he said. More than 2,500 patients are included in the register at present, none of whom should have not been treated with biologic agents at the time of recruitment.
The aim of the present analysis that looked at data on 932 patients was to quantify the effect of smoking status and quantity on several disease outcomes as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Bath Ankylosing Spondylitis Metrology Index (BASMI). Spinal pain was also assessed, by way of a visual analog scale (VAS), and quality of life was determined via the disease-specific Ankylosing Spondylitis Quality of Life Instruments (ASQoL).
Most of the patients recruited were male (71%), and the mean age was 50 years. HLA-B27 data were available for 64% of the cohort, and 84% were positive.
Self-reported smoking status was recorded, with 19% saying they were current smokers, 37% saying they were ex-smokers, and 44% saying they had never smoked. If patients reported being ever smokers, the frequency with which they smoked (daily, weekly, monthly, once or twice, or never) was recorded, and if patients smoked daily, then the number of cigarettes smoked per day was obtained. Heavy smoking was defined as smoking 10 or more cigarettes per day and light smoking as fewer than 10 cigarettes per day. By this definition, around 37% of daily smokers were classed as heavy smokers.
In a comparison of ever smokers with never smokers, the mean BASDAI, BASFI, BASMI, spinal VAS, and ASQoL were significantly higher if patients had smoked at some point. All comparisons were adjusted for age, gender, body mass index, and HLA-B27 status.
The mean BASDAI score, for example, was more than 1 unit higher in a comparison of ever smokers with never smokers, with an adjusted regression coefficient of 1.04 and a 95% confidence interval (CI) of 0.72-1.36.
The adjusted regression coefficients for the other measures assessed were 1.34 (95% CI, 0.98-1.69) for BASFI, 0.61 (95% CI 0.36-0.87) for BASMI, 1.11 (95% CI, 0.74-1.49) for spinal VAS, and 2.71 (95% CI, 2.01–3.41) for ASQoL.
Similar findings were seen in the analysis comparing current with ex-smokers across all measures studied, and there was a trend for disease activity to be worse in heavier than in lighter smokers. The latter may not have reached significance because of the smaller number of patients (n = 172) involved in that part of the analysis. Nevertheless, these preliminary findings suggest that even being a light smoker can affect disease outcomes and so cutting down (i.e., to fewer than 10 cigarettes per day) may not be sufficient to reduce the effect that smoking has on disease activity.
“We should be actively encouraging our patients [with axSpA] to stop smoking,” Dr. Zhao concluded.
The BSRBR-AS is managed by a team of investigators based at the University of Aberdeen in collaboration with 83 centers throughout the United Kingdom. It is funded by the BSR, which in turn receives funding from the manufacturers of the biologic therapies included in this study (currently AbbVie, Pfizer, and UCB). Dr. Zhao and coauthors had no conflicts of interest to disclose.
BIRMINGHAM, ENGLAND – Patients with axial spondyloarthritis who currently smoke have been found to have worse disease activity than those who do not in an early analysis of data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS).
Smoking was associated with worse disease not only when comparing ever smokers with never smokers, but also when current smokers were compared to ex-smokers, and there was some evidence that the amount of smoking was important with heavier smokers having worse disease activity than light smokers.
Dr. Zhao, of Aintree University Hospital in Liverpool, England, added that, as in previous studies, these data show that “smoking is associated with worse disease activity at baseline and this needs to be accounted for in the next stage of longitudinal analysis.”
An association between smoking and worse disease activity in patients with axSpA has been reported previously, Dr. Zhao acknowledged, but this is not as clear cut as in rheumatoid arthritis where smoking is known to have a pathogenic effect. The small number of earlier studies looking at the possible effect of smoking in AS have been limited by their size and varying methodology, he added, and the studies’ researchers were not able to see if there was any potential dose effect of smoking.
The BSRBR-AS, which started recruiting patients with an Assessment of SpondyloArthritis international Society (ASAS) classification of axSpA in 2012, offers a unique opportunity to explore the association between smoking and axSpA further, he said. More than 2,500 patients are included in the register at present, none of whom should have not been treated with biologic agents at the time of recruitment.
The aim of the present analysis that looked at data on 932 patients was to quantify the effect of smoking status and quantity on several disease outcomes as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Bath Ankylosing Spondylitis Metrology Index (BASMI). Spinal pain was also assessed, by way of a visual analog scale (VAS), and quality of life was determined via the disease-specific Ankylosing Spondylitis Quality of Life Instruments (ASQoL).
Most of the patients recruited were male (71%), and the mean age was 50 years. HLA-B27 data were available for 64% of the cohort, and 84% were positive.
Self-reported smoking status was recorded, with 19% saying they were current smokers, 37% saying they were ex-smokers, and 44% saying they had never smoked. If patients reported being ever smokers, the frequency with which they smoked (daily, weekly, monthly, once or twice, or never) was recorded, and if patients smoked daily, then the number of cigarettes smoked per day was obtained. Heavy smoking was defined as smoking 10 or more cigarettes per day and light smoking as fewer than 10 cigarettes per day. By this definition, around 37% of daily smokers were classed as heavy smokers.
In a comparison of ever smokers with never smokers, the mean BASDAI, BASFI, BASMI, spinal VAS, and ASQoL were significantly higher if patients had smoked at some point. All comparisons were adjusted for age, gender, body mass index, and HLA-B27 status.
The mean BASDAI score, for example, was more than 1 unit higher in a comparison of ever smokers with never smokers, with an adjusted regression coefficient of 1.04 and a 95% confidence interval (CI) of 0.72-1.36.
The adjusted regression coefficients for the other measures assessed were 1.34 (95% CI, 0.98-1.69) for BASFI, 0.61 (95% CI 0.36-0.87) for BASMI, 1.11 (95% CI, 0.74-1.49) for spinal VAS, and 2.71 (95% CI, 2.01–3.41) for ASQoL.
Similar findings were seen in the analysis comparing current with ex-smokers across all measures studied, and there was a trend for disease activity to be worse in heavier than in lighter smokers. The latter may not have reached significance because of the smaller number of patients (n = 172) involved in that part of the analysis. Nevertheless, these preliminary findings suggest that even being a light smoker can affect disease outcomes and so cutting down (i.e., to fewer than 10 cigarettes per day) may not be sufficient to reduce the effect that smoking has on disease activity.
“We should be actively encouraging our patients [with axSpA] to stop smoking,” Dr. Zhao concluded.
The BSRBR-AS is managed by a team of investigators based at the University of Aberdeen in collaboration with 83 centers throughout the United Kingdom. It is funded by the BSR, which in turn receives funding from the manufacturers of the biologic therapies included in this study (currently AbbVie, Pfizer, and UCB). Dr. Zhao and coauthors had no conflicts of interest to disclose.
BIRMINGHAM, ENGLAND – Patients with axial spondyloarthritis who currently smoke have been found to have worse disease activity than those who do not in an early analysis of data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS).
Smoking was associated with worse disease not only when comparing ever smokers with never smokers, but also when current smokers were compared to ex-smokers, and there was some evidence that the amount of smoking was important with heavier smokers having worse disease activity than light smokers.
Dr. Zhao, of Aintree University Hospital in Liverpool, England, added that, as in previous studies, these data show that “smoking is associated with worse disease activity at baseline and this needs to be accounted for in the next stage of longitudinal analysis.”
An association between smoking and worse disease activity in patients with axSpA has been reported previously, Dr. Zhao acknowledged, but this is not as clear cut as in rheumatoid arthritis where smoking is known to have a pathogenic effect. The small number of earlier studies looking at the possible effect of smoking in AS have been limited by their size and varying methodology, he added, and the studies’ researchers were not able to see if there was any potential dose effect of smoking.
The BSRBR-AS, which started recruiting patients with an Assessment of SpondyloArthritis international Society (ASAS) classification of axSpA in 2012, offers a unique opportunity to explore the association between smoking and axSpA further, he said. More than 2,500 patients are included in the register at present, none of whom should have not been treated with biologic agents at the time of recruitment.
The aim of the present analysis that looked at data on 932 patients was to quantify the effect of smoking status and quantity on several disease outcomes as measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), and the Bath Ankylosing Spondylitis Metrology Index (BASMI). Spinal pain was also assessed, by way of a visual analog scale (VAS), and quality of life was determined via the disease-specific Ankylosing Spondylitis Quality of Life Instruments (ASQoL).
Most of the patients recruited were male (71%), and the mean age was 50 years. HLA-B27 data were available for 64% of the cohort, and 84% were positive.
Self-reported smoking status was recorded, with 19% saying they were current smokers, 37% saying they were ex-smokers, and 44% saying they had never smoked. If patients reported being ever smokers, the frequency with which they smoked (daily, weekly, monthly, once or twice, or never) was recorded, and if patients smoked daily, then the number of cigarettes smoked per day was obtained. Heavy smoking was defined as smoking 10 or more cigarettes per day and light smoking as fewer than 10 cigarettes per day. By this definition, around 37% of daily smokers were classed as heavy smokers.
In a comparison of ever smokers with never smokers, the mean BASDAI, BASFI, BASMI, spinal VAS, and ASQoL were significantly higher if patients had smoked at some point. All comparisons were adjusted for age, gender, body mass index, and HLA-B27 status.
The mean BASDAI score, for example, was more than 1 unit higher in a comparison of ever smokers with never smokers, with an adjusted regression coefficient of 1.04 and a 95% confidence interval (CI) of 0.72-1.36.
The adjusted regression coefficients for the other measures assessed were 1.34 (95% CI, 0.98-1.69) for BASFI, 0.61 (95% CI 0.36-0.87) for BASMI, 1.11 (95% CI, 0.74-1.49) for spinal VAS, and 2.71 (95% CI, 2.01–3.41) for ASQoL.
Similar findings were seen in the analysis comparing current with ex-smokers across all measures studied, and there was a trend for disease activity to be worse in heavier than in lighter smokers. The latter may not have reached significance because of the smaller number of patients (n = 172) involved in that part of the analysis. Nevertheless, these preliminary findings suggest that even being a light smoker can affect disease outcomes and so cutting down (i.e., to fewer than 10 cigarettes per day) may not be sufficient to reduce the effect that smoking has on disease activity.
“We should be actively encouraging our patients [with axSpA] to stop smoking,” Dr. Zhao concluded.
The BSRBR-AS is managed by a team of investigators based at the University of Aberdeen in collaboration with 83 centers throughout the United Kingdom. It is funded by the BSR, which in turn receives funding from the manufacturers of the biologic therapies included in this study (currently AbbVie, Pfizer, and UCB). Dr. Zhao and coauthors had no conflicts of interest to disclose.
AT RHEUMATOLOGY 2017
Key clinical point:
Major finding: Mean BASDAI, BASFI, BASMI, spinal VAS, and ASQoL were all significantly higher in ever vs. never smokers.
Data source: The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis (BSRBR-AS).
Disclosures: The BSRBR-AS is managed by a team of investigators based at the University of Aberdeen in collaboration with 83 centers throughout the United Kingdom. It is funded by the BSR, which in turn receives funding from the manufacturers of the biologic therapies included in this study (currently AbbVie, Pfizer, and UCB). Dr. Zhao and coauthors had no conflicts of interest to disclose.
Survey: Botulinum toxin achieves durable improvements in hyperhidrosis
SYDNEY, AUSTRALIA – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.
Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).
Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.
More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.
Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.
“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.
Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.
In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”
Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
SYDNEY, AUSTRALIA – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.
Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).
Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.
More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.
Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.
“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.
Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.
In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”
Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
SYDNEY, AUSTRALIA – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.
Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).
Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.
More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.
Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.
“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.
Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.
In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”
Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.
AT ACDASM 2017
Key clinical point: Botulinum toxin therapy achieves substantial and durable improvements in axillary hyperhidrosis symptoms in a majority of patients with hyperhidrosis.
Major finding: Almost all patients (96%) reported moderate improvement or better with botulinum toxin treatment of primary axillary hyperhidrosis.
Data source: A retrospective review of 200 patients with primary axillary hyperhidrosis, treated over a decade.
Disclosures: Dr. Rosen declared consultancies with Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.