Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.
s211 status (RECIST 1.1 responder/non-responder) at a 6-month landmark, we performed Kaplan-Meier analysis of subsequent OS and sensitivity analyses. Time-dependent Cox regressions were also performed. Results: Overall response rate was 19% (56/292) for nivolumab and 12% (36/290) for docetaxel. The number of responders (non-responders) at 6 months was 49 and 26 (132 and 149) among nivolumab and docetaxel patients, respectively. For nivolumab, median post-landmark OS was 12.2 months (95% CI: 9.5-15.1) for non-responders and not reached (NR) (95% CI: 23.9-NR) for responders. For docetaxel, median post-landmark OS was 7.1 months (95% CI: 5.4-9.4) for non-responders and 13.8 months (95% CI: 11.1-28.7) for responders. The hazard ratio between responders and non-responders was 0.24 (95% CI: 0.15-0.39) in the nivolumab arm and 0.55 (95% CI: 0.34-0.88) in the docetaxel arm. Time-dependent Cox analyses showed significantly reduced responders' mortality, and the risk reduction was significantly greater for nivolumab than for docetaxel (p= 0.003). Sensitivity analysis using alternative landmarks yielded qualitatively similar findings. ConClusions: In CheckMate 057, response at 6-months was significantly and positively associated with subsequent survival in both arms; however, the relationship was stronger for nivolumab than for docetaxel. Additionally, non-responders to nivolumab showed a longer median post-landmark survival than non-responders to docetaxel. These findings support incorporating separate response-based survival curves by treatment arm in economic models, especially when comparing an I-O to a non-I-O treatment.
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