Impact of patient demographics on treatment outcomes in AML: a population-based registry in England, 2013-2020.

We report 1- and 5-year survival following AML diagnosis and early mortality, within 30 days of systemic anti-cancer therapy (SACT) treatments, using national cancer registry data in England. Patients aged 18-99 years diagnosed between 2013 and 2020 were included. Overall survival (OS) was calculated using Kaplan-Meier methodology and hazard ratios (aHRs, adjusted for intensity of treatment, age at diagnosis, gender, ethnicity, socioeconomic deprivation, comorbidity, and year of diagnosis) using Cox proportional hazards regression. Odds of 30-day mortality (aORs, adjusted for characteristics listed above, along with performance status (PS) and body mass index (BMI), were calculated using logistic regression. Amongst 17107 patients identified, older age and comorbidity were associated with worse survival. Asian and Black patients had better survival than White: 5-year OS 34.6%, 29.7%, and 17.8%; aHR 0.86 (95% CI 0.77-0.96) Asian vs White, and 0.84 (0.73-0.96) Black vs White. Socioeconomic deprivation was associated with worse survival. 7906 (46.2%) patients were documented as having received SACT. 30-day mortality was lower for patients receiving intensive rather than non-intensive SACT. After adjustment for co-factors the risk was higher in those treated intensively (aOR 0.74 [95% CI 0.60-0.92]). We show that ethnicity and socio-economic status impacts outcomes in AML. Further work is needed to understand how these effects may differ in different healthcare settings, and whether this due to effects on disease biology, responsiveness to treatment or drug toxicity. Selection of intensive vs non-intensive treatment should be based on individual patient factors, balancing improved long-term survival against higher early mortality.

Medical curricula and preventing childhood obesity: pooling the resources of medical students and primary care to inform curricula.

AIMS: The study aimed to firstly provide a small self-selecting group of medical students with the opportunity to explore current approaches and opportunities addressing the prevention of childhood obesity and, secondly, to consider what aspects could be part of the taught curriculum. METHODS: Medical students in their third and fourth year were invited to self-design special study modules (SSMs) exploring interventions and processes addressing the growing concern about childhood obesity. One student looked at the role of the primary care teams, two looked at community-based opportunities to improve physical activity in urban areas where there is significant deprivation and one student explored the complex role of the media as a social determinant of dietary patterns and sedentary behaviour. FINDINGS: Primary care health professionals questioned their role in regard to raising the topic of obesity in the consultation and had limited awareness of current NICE guidelines and local interventions for referral. Local authority physical activity programmes have an important role in preventing and tackling obesity and although the media are regulated, there is limited impact on reducing obesity. Conversely, the influence of the media is complex and enables medical students and teachers to be aware of some of the social determinants influencing health-related behaviour. IMPLICATIONS: About a third of UK GP practices have some role in medical undergraduate education. It will therefore be inevitable that students will encounter GPs working with prevention and management of childhood obesity, however limited, and this will increasingly be part of the teaching agenda, whether formal and planned or opportunistic. Curricula could include being familiar with the evidence that informs NICE guidelines, observing these guidelines being implemented and their limitations, awareness of local schemes for referral to prevent or treat obesity and the influence of wider determinants on diet and physical activity behaviour, including the media.