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  • American Society of Clinical Oncology (ASCO)  (7)
  • Chang, Victor T  (7)
  • 1
    Online Resource
    Online Resource
    Comorbidity and other predictors of survival in veterans with colorectal cancer (CRC).
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 15_suppl ( 2012-05-20), p. e14125-e14125
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. e14125-e14125
    Abstract: e14125 Background: The role of comorbidity as a prognostic marker is an area of great interest. This study aimed to determine whether comorbidity indices predict survival in Veterans with CRC. Methods: In an IRB-approved protocol, we reviewed the records of pts diagnosed with CRC at a VA Medical Center from 1/1/2003 to 12/31/2007. Demographics, stage, grade, ECOG performance status (PS), CEA, hemoglobin (HGB), Albumin (ALB) at diagnosis, history of surgical resection (SR) were abstracted. Comorbidity was assessed with the Charlson Comorbidity Index (CCI), the Kaplan-Feinstein Index (KFI), the Cumulative Illness Rating Scale (CIRS), and VA Comorbidity Scale (VACS). We developed a survival model with stage, ECOG PS, HGB, ALB, SR, and ECOG PS. Comorbidity indices were tested by determining if they were independent predictors of survival after inclusion in this model. Cox regression analyses were performed with SAS V9.2. Results: There were 175 pts with colorectal ca with 111 colon (C) and 64 rectal ca (R) pts. The median (M) age at diagnosis was 71 (45-90). 54% of study population was deceased at the time of data collection. Median survival was 1157 days (5-3256). Results of multivariate analyses with comorbidity indices are summarized in the table. Conclusions: Charlson, CIRS 16 and CIRS 19 comorbidity indices were significant predictors for veterans with colorectal cancer and appear to be important for the subset of veterans with colon cancer. Confirmatory studies should be done in larger populatins. These indices may be used in the design of future clinical trials. This was supported by the New Jersey Commission for Cancer Research 09-1133-CCR-EO. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.15_suppl.e14125
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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  • 2
    Online Resource
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    Demographics and patterns of care for veterans with colorectal cancer.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 15_suppl ( 2012-05-20), p. e14124-e14124
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. e14124-e14124
    Abstract: e14124 Background: This study is to analyze demographics and patterns of care for veterans with colorectal cancer. Methods: In an IRB approved protocol, we reviewed the records of pts diagnosed with colorectal adenocarcinoma at a VA Medical Center from 1/1/2003 to 12/31/2007. Demographics including age, sex, ECOG PS, stage, grade, site, CEA, hemoglobin (HGB), liver function tests at diagnosis, treatments and cause of death were reviewed. Results: There were 176 pts with colorectal ca with 112 colon (C) and 64 rectal ca (R) pts. One was a woman and the rest were men. The median age at diagnosis was 71 years (range 45-90). Median survival was 1157 days (5-3256). 95 (54%) pts were dead at this analysis. Median ECOG PS is 0. 160 pts had ECOG PS 0-2, 16pts ECOG 3-4. 4 (2.4%). 4 (2.4%) pts has stage 0, 51 (30.7%) stage 1, 42 (25.3%) stage 2, 35 (21.1%) stage 3, and 34 (20.5%) stage 4. 6 (3.7%) has grade 1, 111 (68.1%) grade 2, and 46 (28.2%) grade 3. Median CEA at diagnosis was 2.9 (0-3117), HGB 12.4 g/dl (6.6-16.7), albumin g/dl 3.98(1.7-4.7), AST 23 units/L (4-107), ALT 20 units/L (8-107), ALKP 77 units/L (37-352), Total bilirubin 0.7 mg/dl (0.1-4.5). 29 pts has liver metastasis at diagnosis. 147 pts (85.4%) received surgical resection. Total 43 pts had adjuvant treatment. 17 pts with rectal cancer had neoadjuvant chemoradiation . 7 pts had down staging and 3 pts had no residual disease after neoadjuvant chemoradiatoion. Total 14 pts had recurrence. 23 pts received palliative chemotherapy when metastatic. 54 of 95 pts (57%) died from cancer progression. Conclusions: This study provides a basis for understanding the epidemiology of colorectal cancer patient in a VA medical center.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.15_suppl.e14124
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 3
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    Online Resource
    Patient-reported KPS and other measures as predictors of survival in patients with advanced cancer.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 15_suppl ( 2012-05-20), p. e19606-e19606
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. e19606-e19606
    Abstract: e19606 Background: Understanding determinants of survival remains a challenge in patients(pts) with advanced cancer. Prognostic factors of interest include pts rating of their own performance status, and patient responses from the EQ-5D. Methods: This prospective study was approved by the VA New Jersey HCS IRB. Pts with metastatic cancer whose cancer had already been treated with standard or experimental chemotherapy with KPS 〈 80%, or who did not wish to receive systemic chemotherapy, were recruited in a specified manner. At entry, Karnofsky performance status (KPS) was estimated, pts rated their own KPS, and answered a modified version of the EQ-5D. Cox regression survival analyses were performed. Results: Of 242 pts enrolled, 237 pts were analyzable. Median (M) age was 67 years (range 44-88), with 56% white, 41% black and 3% other; lung (26%) and prostate (18%) were the 2 most common primary sites and M KPS was 60% (range 30-100%). The majority (97%) of pts have died, with M survival of 95 days, range 4-2032 days. Higher KPS is associated with decreased risk of death (p 〈 .0001). Both patient KPS (p 〈 0.0319) and physician rated KPS were predictive of survival (p 〈 0.004). Discrepancy between physician and pt KPS was noted, with upstaging by pts 48%, same for 27%, and downstaging in 25%, with no effect on survival. Physician KPS was a better predictor than pt KPS at each level. The EQ-5D pain item showed an increased risk of death with increasing pain (p 〈 0.0001). The pain item was associated with KPS: pts with no pain had average KPS 75; moderate pain average KPS 63; extreme pain average KPS 48. The patient’s EQ-5D health rating was positively correlated with survival (p=0.0054), and with KPS (r=0.36). The other items in the EQ-5D did not predict survival. When all the factors (physician KPS, pt KPS, pain, health) were incorporated into a Cox model, only physician KPS was statistically significant (p=0.0033). Conclusions: Pts ratings of health and pain are significantly associated with KPS. Pts have a more positive outlook on their performance status. Physician KPS may be a better predictor because physicians have a wider frame of reference. Physician KPS can contribute to determination of hospice eligibility. Supported by VA HSRD IIR 2-103
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.15_suppl.e19606
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 4
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    Online Resource
    Comorbidity and other predictors of survival in veterans with metastatic renal cell carcinoma (RCC).
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. e15561-e15561
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. e15561-e15561
    Abstract: e15561 Background: Comorbidity as a prognostic marker has been reported in several solid tumors. We examined whether co-morbidity indices predict survival in Veterans with metastatic renal cell carcinoma (RCC) who were treated with signal transduction inhibitors. Methods: In an IRB-approved protocol, we reviewed the records of patients (Pts) diagnosed with RCC at a VA Medical Center from 1/1/2000 to 12/31/2011. Age, ECOG Performance Status (ECOG PS), Hemoglobin (Hgb), Albumin (Alb), Corrected Calcium (CCa), history of Nephrectomy, and histology (clear cell (CC) vs. non clear cell (NCC)) were abstracted. Co-morbidity was assessed with Charlson Comorbidity Index (CCI), and the Kaplan-Feinstein Index (KFI). We developed a survival model with age, ECOG PS, Hgb, Alb, CCa, history of nephrectomy, and histology. Co-morbidity indices were tested by determining if they were independent predictors of survival after inclusion in this model. Cox regression analyses were performed with SAS V9.2. Results: There were 24 Pts;6 (25%) are alive. The Median (M) age when seen at VA was 64 years (54-85). The M Hgb level was 12.1g/dL (6.7-16.5), Alb was 4.1g/dL (2.8-5.0), and CCa was 9.19mg/dL (7.9-12.5). The M CCI was 4.2 (1.4-12.0) and KFI was 2.0 (1-3). The M Survival was 823 days (24-3482). 17(68%) pts had clear cell carcinoma and 18(72%) had nephrectomies Median ECOG PS was one range(0-4). The median number of treatments was 2, range 1-7. Results of univariate analyses with co-morbidity indices were significant for age (p 〈 ,029) and history of nephrectomy p 〈 .068). There were no multivariate predictors of survival. Conclusions: In the univariate analysis, ECOG PS as well as Nephrectomy status were significant predictors for M survival. CCI and KFI did not predict M survival. In distinction to other solid tumor histologies where chemotherapy is used, KFI and CCI in RCC may not be associated with overall survival due to either RCC histology or use of signal transduction inhibitors as treatment. Confirmatory studies should be done in larger populations. This was supported by the New Jersey Commission for Cancer Research.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.e15561
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 5
    Online Resource
    Online Resource
    Effect of statin and metformin on survival in veterans (V) with B-cell lymphoproliferative disorders (BLD).
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. 1602-1602
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. 1602-1602
    Abstract: 1602 Background: The incidence of BLD has been increasing in V. As many V are on statin and metformin for comorbid conditions, we evaluated the impact of their use on survival. Methods: In an IRB-approved protocol, we reviewed the records of 332 V diagnosed with BLD from January 1997 to Dec 2011 for demographics, height(H),weight(W), BMI,statin and metformin use, clinical and laboratory data and ECOG PS. Comorbidity was assessed using the Charlson Comorbidity Index (CCI),Kaplan-Feinstein Index (KFI) and Cumulative Illness Rating Scale (CIRS). Cox regression analysis was performed using SAS v 9.2. Results: There were 332 V with a median (M) age of 70 years (27-94). The M for H 70 inches (58-78), W 183lbs (99-356.5) and BMI 26.7 kg/m 2 (15.54 -48.45). The M for hemoglobin(Hgb) 12.8 g/dl (7.3-17.4), albumin 3.9(1.2-5.4), lactate dehydrogenase( LDH) 183 IU/L (85-1905), beta 2-microglobulin 2.6 mg/dl (0.8-39) . The M for CCI was 4.7 (0.8-12), KFI 2 (0-3), CIRS15 3 (0-6), CIRS16 6(0 -14), CIRS17 1.9(0-6), CIRS18 0(0-3), CIRS19 0(0-3). M survival was 1297days(4-7468).The number of V receiving statin was 167 (51%) and metformin 46 (14%). Statin use was a predictor of survival by both univariate and multivariate analysis but metformin was a predictor only by univariate analysis. Conclusions: Statin use was an independent and significant predictor of survival in this group of V with BLD and needs to be validated in a larger group of patients. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.1602
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 6
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    Online Resource
    Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.
    American Society of Clinical Oncology (ASCO) ; 2013
    In:  Journal of Clinical Oncology Vol. 31, No. 15_suppl ( 2013-05-20), p. 9567-9567
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 31, No. 15_suppl ( 2013-05-20), p. 9567-9567
    Abstract: 9567 Background: A Recursive Partitioning Analysis (RPA) algorithm predicted four groups with distinct median survivals in patients with advanced cancer entering palliative care (ASCO 2010, Abst 9040). We investigated whether this algorithm could apply to cancer patients starting systemic therapy. Methods: The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires prior to starting the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through August 2011, and determined survival as of December 1, 2012. Analyses were performed with STATA 11.0. Results: There were 72 patients (pts). The median age was 63 yrs, (range 46-86). Men comprised 71 (98%) pts. First line systemic therapy was given to 59 (82%) pts. The most common primary sites were lung cancer (25 pts, 35%), prostate 9 pts(12%) and colon 7 pts (10%). Median KPS was 90% (range 40-100%), PWB median 23 (range 6-28), and MSAS SF median PHYS 0.73 (range 0-2.93). Overall median survival was 269 days (range 6-1762) and 57 pts (79%) had died. There was 1 pt in group 1, 45 pts in group 2, 8 pts in group 3, and 18 pts in group 4. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 610 for group 4 (p=.011). Conclusions: These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting chemotherapy into prognostic groups. It may have applications in clinical trials. Further development is indicated. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2013.31.15_suppl.9567
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2013
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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  • 7
    Online Resource
    Online Resource
    Comparison of clinical parameters and survival in Vietnam era (V) versus non-Vietnam era (non-V) veterans with non-Hodgkin lymphoma (NHL).
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 15_suppl ( 2012-05-20), p. e18516-e18516
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. e18516-e18516
    Abstract: e18516 Background: The incidence of NHL has been increasing in the US population. Agent Orange exposure has been implicated in the development of B cell lymphoproliferative disorders including NHL. We explored possible differences in the clinical and lab parameters and predictors of survival in V versus Non-V veterans with diagnosis of NHL at the VAHCSNJ. Methods: In an IRB-approved protocol, the records of veterans diagnosed with NHL from January 1997 to December 2011 were reviewed for demographic, clinical, and pathology data, including HIV, Hep B, Hep C titers, Vietnam Veteran status and survival. We tabulated the ECOG Performance Status (PS), International Prognosis Index (IPI)/ Follicular Lymphoma International Prognostic Index (FLIPI), Charlson Comorbidity Index (CMI), the Kaplan-Feinstein Index (KFI), the Cumulative Illness Rating Scale (CIRS) and Vietnam status. Cox regression analyses were performed to determine predictors of survival. Results: There were 152 veterans who met the eligibility criteria; 78 V and 74 non-V; the groups did not differ by PS, stage, beta 2microglobulin (b2m), and HIV status, IPI/FLIPI. Differences in their clinical features are summarized (Table). The proportion of V vets with high grade lymphomas was greater than non V vets (p .036). Survival predictors for both the V and non-V veterans were the age, PS, hemoglobin, LDH, albumin, grade, IPI/FLIPI. However, in V veterans, b2m (p 〈 0.001) and stage were additional predictors of survival. Median survival for V veterans was 1454 days (95%CI 864-3377) and Non-V was 1824 days (95% CI 560-2075). Conclusions: The V veterans were younger with higher grade disease compared to the Non-V veterans. While their stage and PS were not different, survival was shorter. These should be studied further in a larger sample. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.15_suppl.e18516
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
    Location Call Number Limitation Availability
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