Search

Background: Risk models of chemotherapy-induced (CIN) and febrile neutropenia (FN) have to date focused on determinants measured at the start of chemotherapy. We extended this static approach with a dynamic approach of CIN/FN risk modeling at the start of each cycle. Design: We applied predictive modeling using multivariate logistic regression to identify determinants of CIN/FN episodes and related hospitalizations and chemotherapy disturbances (CIN/FN consequences) in analyses at the patient ('ever' during the whole period of chemotherapy) and cycle-level (during a given chemotherapy cycle). Statistical dependence of cycle data being 'nested' under patients was managed using generalized estimation equations. Predictive performance of each model was evaluated using bootstrapped c concordance statistics. Results: Static patient-level risk models of 'ever' experiencing CIN/FN adverse events and consequences during a planned chemotherapy regimen included predictors related to history, risk factors, and prophylaxis initiation and intensity. Dynamic cycle-level risk models of experiencing CIN/FN adverse events and consequences in an upcoming cycle included predictors related to history, risk factors, and prophylaxis initiation and intensity; as well as prophylaxis duration, CIN/FN in prior cycle, and treatment center characteristics. Conclusion(s): These 'real-world evidence' models provide clinicians with the ability to anticipate CIN/FN adverse events and their consequences at the start of a chemotherapy line (static models); and, innovatively, to assess risk of CIN/ FN adverse events and their consequences at the start of each cycle (dynamic models). This enables individualized patient treatment and is consistent with the EORTC recommendation to re-appraise CIN/FN risk at the start of each cycle. Prophylaxis intensity (under-, correctly-, or over-prophylacted relative to current EORTC guidelines) is a major determinant. Under-prophylaxis is clinically unsafe. Over-prophylaxis of patients administered chemotherapy with intermediate or low myelotoxicity levels may be beneficial, both in patients with and without risk factors, and must be validated in future studies. [ABSTRACT FROM AUTHOR]

Purpose Overweight and obesity are not unexpected following heart transplantation (HTx). The variability in body mass index (BMI) of populations has been observed, yet no study has addressed BMI disparities after HTx in different countries. We thus examined the variability in BMI of HTx recipients among countries who participated in the multi-continental BRIGHT study. Methods We conducted a secondary data analysis of the BRIGHT self-reported data for 1,373 HTx recipients in four continents, 11 countries, and 36 heart transplant centers. The BMI (kg/m2) was categorized into underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Controlling for age, gender, and education, the association between country and BMI was examined using multivariable linear regression. Results The median age was 56 years (IQR= 45, 63), 27.3% were female, and 34.1% had at least some university education. The mean BMI was 27.1 ± 5.7, and 59% were overweight or obese (see Figure). The highest mean BMI was in North America, followed by Australia, Europe, and South America. The regression analysis showed that higher age (B= 0.029, p=.013), male gender (B= 1.65, p<.001), and country (B= -0.11, p=.045) were significant predictors for higher BMI (R2= 0.03). The post-hoc analysis for the dummy-coded country showed that only the United States (B= 4.27, p <.001), Canada (B= 2.12, p=.005), and Australia (B= 2.24, p=.018) had a significantly higher BMI than the reference country with median BMI mean (Italy). Conclusion Our data show that overweight and obesity are highly prevalent in HTx with variation among geographical regions, which calls for population-specific weight control interventions. Despite the small variance in BMI explained by the predictors, our results about geographical disparities in BMI are comparable to the ISHLT registry data for the same period. More research is warranted to elucidate the etiologies and outcomes of these geographical differences. [ABSTRACT FROM AUTHOR]

Gender differences have been observed in health behavior, but have been understudied in transplantation. The aim of this study is to describe and compare gender differences in nonpharmacological health-related behaviors after heart transplantation (HTx) globally. This is a sub-analysis of the cross-sectional BRIGHT study (ClinicalTrials.gov ID: NCT01608477), including self-reported data of 1321 adult HTx recipients from 36-HTx-centers, 11-countries, and 4-continents. Design-adjusted, weighted Wald tests, weighted Chi-square, multiple linear regression and multivariate logistic regression were used when appropriate to compare gender differences in nonpharmacological health-related behaviors post-HTx (i.e. sun protection, diet keeping, physical activity, appointment keeping, alcohol use and smoking) globally and by continent. Overall, compared to males, females were more adherent to sun protection (p=0.00), to alcohol use and smoking cessation (OR 2.51 (95% CI [1.40-4.51])), females were less adherent to physical exercise (OR 2.18 (95% CI [1.28-3.73])). In Europe, compared to males, females were more adherent to sun protection alcohol use and smoking cessation (OR 3.78 (95% CI [1.73-8.27])). In Australia, compared to males, females were more adherent to sun protection A gender gap in post-HTx non pharmacological health behaviors was observed in sun protection, alcohol use and smoking cessation , with females being more adherent than males, yet less adherent regarding sufficient exercise. Gender specific approaches in adherence enhancing interventions should be developed and implemented [ABSTRACT FROM AUTHOR]