Socioeconomic Determinants of the Use of Molecular Testing in Stage IV Colorectal Cancer.

OBJECTIVES: Treatment with epidermal growth factor receptor monoclonal antibodies extends life for patients with advanced colorectal cancers (CRCs) whose tumors exhibit wild-type KRAS, but KRAS testing may be underused. We studied the role of socioeconomic factors in the application of KRAS testing. MATERIALS AND METHODS: We identified subjects with stage IV colorectal adenocarcinoma diagnosed 2010-2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We used multivariable logistic regression models to evaluate associations between clinical/demographic factors and the rate of KRAS testing. We used multivariable-adjusted Cox proportional hazards models to assess survival. RESULTS: We identified 37,676 patients with stage IV CRC, 31.1% of whom were tested for KRAS mutations, of those who had documented KRAS testing, 44% were KRAS mutant. Patients were more likely to be tested if they were younger (odds ratio [OR]=5.10 for age 20 to 29 vs. 80+, 95% confidence interval [CI]: 3.99-6.54, P<0.01), diagnosed more recently (OR=1.92 for 2015 vs. 2010, 95% CI: 1.77-2.08, P<0.01), or lived in an area of high median household income (OR=1.24 for median household income of >$69,311 vs. <$49,265, 95% CI: 1.14-1.35, P<0.01). Patients were less likely to be tested if they had Medicaid (OR=0.83, 95% CI: 0.77-0.88, P<0.01) or were unmarried (OR=0.78, 95% CI: 0.75-0.82, P<0.0001). The risk of death was decreased in patients who received KRAS testing (hazard ratio=0.77, 95% CI: 0.75-0.80, P<0.01). CONCLUSIONS: We found a low rate of KRAS testing in CRC patients with those living in low-income areas less likely to be tested, even after controlling for Medicaid insurance. Our study suggests that socioeconomic disparities persist despite Medicaid insurance.

COVID-19 outcomes in hospitalized patients with active cancer: Experiences from a major New York City health care system.

BACKGROUND: The authors sought to study the risk factors associated with severe outcomes in hospitalized coronavirus disease 2019 (COVID-19) patients with cancer. METHODS: The authors queried the New York University Langone Medical Center's records for hospitalized patients who were polymerase chain reaction-positive for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) and performed chart reviews on patients with cancer diagnoses to identify patients with active cancer and patients with a history of cancer. Descriptive statistics were calculated and multivariable logistic regression was used to determine associations between clinical, demographic, and laboratory characteristics with outcomes, including death and admission to the intensive care unit. RESULTS: A total of 4184 hospitalized SARS CoV-2+ patients, including 233 with active cancer, were identified. Patients with active cancer were more likely to die than those with a history of cancer and those without any cancer history (34.3% vs 27.6% vs 20%, respectively; P < .01). In multivariable regression among all patients, active cancer (odds ratio [OR], 1.89; CI, 1.34-2.67; P < .01), older age (OR, 1.06; CI, 1.05-1.06; P < .01), male sex (OR for female vs male, 0.70; CI, 0.58-0.84; P < .01), diabetes (OR, 1.26; CI, 1.04-1.53; P = .02), morbidly obese body mass index (OR, 1.87; CI, 1.24-2.81; P < .01), and elevated D-dimer (OR, 6.41 for value >2300; CI, 4.75-8.66; P < .01) were associated with increased mortality. Recent cancer-directed medical therapy was not associated with death in multivariable analysis. Among patients with active cancer, those with a hematologic malignancy had the highest mortality rate in comparison with other cancer types (47.83% vs 28.66%; P < .01). CONCLUSIONS: The authors found that patients with an active cancer diagnosis were more likely to die from COVID-19. Those with hematologic malignancies were at the highest risk of death. Patients receiving cancer-directed therapy within 3 months before hospitalization had no overall increased risk of death. LAY SUMMARY: Our investigators found that hospitalized patients with active cancer were more likely to die from coronavirus disease 2019 (COVID-19) than those with a history of cancer and those without any cancer history. Patients with hematologic cancers were the most likely among patients with cancer to die from COVID-19. Patients who received cancer therapy within 3 months before hospitalization did not have an increased risk of death.

Reflexo inibitório retoanal: gradiente de pressäo e de duraçäo do relaxamento em canal anal após distensäo retal / Rectoanal inhibitory reflex: gradient of pressure and time in the anal canal during relaxation after rectal distension

A resposta fisiológica do canal anal à distensäo retal é o relaxamento de sua porçäo proximal (PPC). A preservaçäo da continência após este relaxamento se dá principalmente pela existência de um gradiente de pressäo em entre a porçäo de maior pressäo em canal anal (zona de alta pressäo, ZAP) e a PPC. A hipótese formulada neste estudo é que estaria envolvido no mecanismo de preservaçäo da continência, näo só um gradiente de pressäo mas também de duraçäo desse relaxamento. Métodos: Foram estudados 16 voluntários normais (10 do sexo masculino) com idade média de 41,5 anos (24 - 60 anos) com a realizaçäo de manometria anal, utilizando-se cateter flexível de oito canais, com orifícios de perfusäo dispostos axialmente, em intervalos de 1 cm, dotado de baläo em seu extremo distal. O relaxamento era produzido por distensäo retal com insuflaçäo do baläo com pequeno volume de ar (15 - 30 ml) e concomitantemente registrado até a recuperaçäo da pressäo anal de repouso (PAR) (duraçäo de relaxamento). A amplitude do relaxamento foi determinada entre os valores da PAR antes da distensäo retal e no ponto de relaxamento máximo (PAR - PRM). O gradiente de pressäo foi determinado pela comparaçäo entre PAR - PRM na ZAP e PPC. A ocorrência de contraçäo na porçäo distal do canal anal foi interpretada como contraçäo do esfíncter anal externo e foi comparada com a PAR - PRM da zona de alta pressäo. Resultados: O relaxamento foi maior no PPC do que na ZAP (50 por cento vs. 36 por cento, p = 0,001), enquanto que a RAP - PMR foi significantemente maior na ZAP do que na PPC (30,7 vs. 12,6 mmHg, p = 0,001). Contraçäo do esfincter anal externo ocorreu em seis casos e näo foi significantemente diferente da PAR - PRM na ZAP (39,7 mmHg vs. 36,3 mmHg, NS). O relaxamento começou ao mesmo tempo em todos os níveis do canal anal, mas teve maior duraçäo em PPC do que na zona de alta pressäo (13,5 seg vs. 9,4 seg, p = 0,003). Conclusäo: Relaxamento de canal anal induzido pela distensäo retal com pequenos volumes está associado näo somente a ocorrência de um gradiente de pressäo mas também de duraçäo do evento entre a PPC e ZAP. Nas condiçöes estudadas, a preservaçäo da continência após o relaxamento näo depende da contraçäo voluntária do esfíncter anal externo