Measurements: We captured baseline demographic, pre-hospitalization antiplatelet medication use, and clinical encounter data for all patients who met inclusion criteria. The primary endpoint was peak score on a 6point modified ordinal scale (MOS), which is based on World Health Organization blueprint R&S groups, used to grade severity of illness through clinical outcomes of interest. Scores indicate the following: 1 À COVID-19 infection not requiring hospitalization, 2 À requiring hospitalization but not supplemental oxygen, 3 À hospitalization requiring supplemental oxygen, 4 À hospitalization requiring high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV), 5 À hospitalization requiring intubation or extracorporeal membrane oxygenation (ECMO), 6 À death. Multivariable adjusted partial proportional odds model (PPOM) was performed to examine the association between pre-hospitalization antiplatelet medication use and likelihood of each MOS score. Main Results: Of 762 people admitted with COVID-19, 239 (31.4%) used antiplatelet medications pre-hospitalization while 523 (68.6%) did not. Antiplatelet users were older and had more co-morbidities at baseline. Before adjusting for covariates, patients who used antiplatelet medications pre-hospitalization were more likely than non-users to have peak MOS score 6 (death, OR 1.75, 95% CI 1.21À2.52), peak MOS score 5 (intubation/ECMO or death, OR 1.4, 95% CI 1.00À1.98) and peak MOS score 4 (HFNC, NIPPV, intubation/ECMO or death, OR 1.40, 95% CI 1.01À1.94). On multivariable adjusted PPOM analysis controlling for 13 covariates, there were no longer any significant differences in peak MOS scores between users and non-users. Conclusions: After adjusting for covariates, pre-hospital antiplatelet use was not associated with COVID-19 severity in hospitalized patients.
Objectives Paid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify 1) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and 2) factors associated with these trajectories. Methods We used group-based multiple trajectory modelling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study (NHATS) respondents with dementia who died or moved to a nursing home (n=334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modelling. Results A three group model best fit our data: 1) “low/stable care” (61.3% of respondents) with stable, low/no paid care and moderate family care, 2) “increasing paid care” with increasing, moderate paid and family care, and 3) “high family care” with increasing, high family care and stable, low paid care. While both the “increasing paid care” and “high family care” groups were more functionally impaired than the “low/stable care” group, the “high family care” group was also more likely to be non-white and experience multiple medical comorbidities, depression, and social isolation. Discussion Study findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.
e12117 Background: Capecitabine has been studied as a radiosensitizer in rectal cancer, but its role in BC is unclear. Our study seeks to examine the association of concurrent capecitabine/radiation therapy (RT) on survival in women with BC and residual disease after neoadjuvant chemotherapy (NAC). Methods: In a retrospective study of women with stage I-III BC who received Adriamycin/Taxane-based NAC from 2010-2016, we identified 21 women administered concurrent capecitabine/RT. To assess differences in survival, we selected a clinical control cohort (n = 64) based on criteria used to select patients for capecitabine/RT including pathological stage II/III disease and non-HER2+ tumor subtype. We also created a matched cohort (2:1), matching on tumor subtype, pathological stage, and age ( < 50 or 50+ years). Differences in progression-free survival (PFS), using STEEP criteria, and overall survival (OS), using all-cause mortality, between those who received capecitabine/RT and controls were assessed. Results: Of the 21 women who received capecitabine/RT, the majority were 50+ years (n = 12), pathological stage III (n = 15), and hormone receptor positive/HER2 negative BC (n = 20). Compared with clinical controls, women who received capecitabine/RT had larger disease (p = 0.041) and a higher pathological stage (p = 0.067), but there were no other differences. In those receiving capecitabine/RT, there were 9 recurrences (3 local, 6 distant) compared with 14 recurrences (4 local, 10 distant) in the clinical controls and 10 recurrences (all distant) in the matched controls. In multivariate models, capecitabine/RT was associated with worse PFS (HR 3.04 95% CI 1.24-7.43 p = 0.015) and OS (HR 4.29 95% CI 1.45- 12.6 p = 0.008), after adjusting for clinical size and pathologic stage. In the 2:1 matched cohort, capecitabine/RT was also associated with worse PFS (HR 2.96 95% CI 1.20-7.29 p = 0.018) and OS (HR 5.61 95% CI 1.76-17.9 p = 0.004). Conclusions: Capecitabine/RT after NAC is associated with worse PFS and OS using two control populations, suggesting capecitabine/RT should be discouraged in BC.
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