Rohit Kumar

PURPOSE: Quality-of-life (QoL) end points are essential for treatment decisions and value assessment in genitourinary (GU) cancer, yet the extent of QoL planning-reporting concordance and outcome reporting bias is unknown. We evaluated the frequency, correlates, and concordance of QoL end point planning and reporting in phase III GU cancer trials. METHODS: We conducted a systematic review of phase III randomized clinical trials evaluating systemic therapies for GU malignancies published from 2020 through 2024 (PubMed, EMBASE). QoL prespecification was ascertained from ClinicalTrials.gov or protocols. Associations with QoL reporting were assessed using univariable and multivariable logistic regression. RESULTS: Among 80 clinical trials, QoL was prespecified in 68 (85%) yet reported in only 38 (47.5%). Of the 68 trials that prespecified QoL, 30 (44.1%) did not report results. Positive primary end point results were the strongest correlate of QoL reporting (63% v 25%; adjusted odds ratio [OR], 4.84 [95% CI, 1.74 to 14.60]; P = .003). Single-country scope was independently associated with lower QoL reporting (OR, 0.22 [95% CI, 0.04 to 0.83]; P = .04). Among trials that prespecified QoL, the association with result direction persisted (71% v 31%; P = .001), and neither funding source nor journal impact factor explained the discrepancy. QoL reporting rates were similar from 2020 through 2023 (50%-61%) and dropped to 11% in 2024; in a sensitivity analysis modeling publication year categorically, only 2024 differed significantly from 2020 (OR, 0.07 [95% CI, 0.01 to 0.34]; P = .003). No trial designated QoL as a primary end point. CONCLUSION: QoL end points in GU cancer trials are frequently planned but selectively reported, with findings consistent with result-dependent disclosure. This pattern may compromise value assessment frameworks and shared decision making. Enforcement of CONSORT-PRO, SPIRIT-PRO, and SISAQOL standards is needed.

Introduction: Obstructive Sleep Apnoea (OSA) is traditionally evaluated using a diagnostic Polysomnography (PSG) which is then followed by a PSG with Continuous Positive Airway Pressure (CPAP) titration. Split Night PSG (SN-PSG) includes the diagnostic and titration study in a single night. Split Night PSG is a better technique however, the requirements for CPAP titration are too strict. Aim: To assess the accuracy of different duration of split night compared to a Full Night PSG (FN-PSG) in OSA Syndrome. Materials and Methods: A retrospective observational study was performed in the Department of Pulmonary Medicine at VMMC and Safdarjung Hospital, from January 2019 to May 2019 at Safdarjung Hospital was done. Apnoea-Hypopnea Index (AHI) was assessed at the 1 hour, 2 hour, 3 hour and 4 hour from analysis of SN-PSG data obtained from FN-PSG. Using the Area Under Receiver Operating Characteristic (AUROC) curve, it was compared to the FN-PSG. Calculations were made to validate the diagnosis by a 2 hour PSG using different AHI cut-off points (5/hour to 15/hour). Results: Data from 20 PSG recordings was processed. A stronger correlation of FN-AHI was demonstrated with AHI at 2 hour (p-value <0.0001) (r value=0.902). At 2 hours of study, with an AHI cut-off of 5 hour, the sensitivity and specificity was 92.9% and 83.3%, respectively. The Positive Predictive Value (PPV) was 100% and Negative Predictive Value (NPV) was 83.3% (AUROC=0.976; p-value <0.0001). At 2 hours, AHI cutoff of 15 hour, the sensitivity and specificity was 71.4% and 100%, respectively. The PPV was 100% and NPV was 86.7% (AUROC=1.000; p-value <0.0001). Conclusion: Split-night PSG is effective for diagnosing severe OSA. A lower cut-off of AHI may be used to qualify patients for CPAP titration.

Objective/Background: According to the U.S. Census Bureau, 18% of the total population in the United States identified themselves as Hispanic in 2016 making it the largest minority group. This study aimed to evaluate the effect of Hispanic ethnicity on the overall survival of patients with non-small cell lung cancer (NSCLC) using a large national cancer database. Methods: We used the National Cancer Database to identify patients diagnosed with NSCLC between 2010 and 2015. The two comparative groups for this study were non-Hispanic Whites (NHWs) and Hispanics. The primary outcome was overall survival. Results: Of the 555,475 patients included in the study, 96.9% and 3.1% were NHWs and Hispanics with a median follow up of 12.6 months (interquartile range 4.1–30.6) and 12.1 months (interquartile range 3.8–29.5), respectively. Hispanics were more likely to be uninsured, and live in areas with lower median household income or education level. In the age-, sex-, and comorbidities-adjusted Cox model, the overall survival was significantly better in Hispanics compared with NHWs (hazard ratio [HR] 0.92, 95% confidence interval 0.90–0.93, p < .001). In a demographic, socioeconomic, clinical, and facility characteristics adjusted Cox model, Hispanics had further improvement in survival (HR 0.79, 95% confidence interval 0.78–0.81, p < .001). The survival advantage was seen in all cancer stages: Stage I–HR 0.76 (0.71–0.80), Stage II–HR 0.85 (0.79–0.92), Stage III–HR 0.81 (0.77–0.85), and Stage IV–HR 0.79 (0.77–0.81). Conclusion: Hispanic ethnicity was associated with better survival in NSCLC. This survival advantage is likely the result of complex interactions amongst several physical, social, cultural, genomic, and environmental factors.

Background: The incidence of invasive melanoma is rising, and approval for the first immune checkpoint inhibitor (ICI) to treat metastatic melanoma occurred in 2011. We aim to describe the epidemiology and outcomes in recent years, sociodemographic factors associated with the presence of metastasis at diagnosis, and the real-world impact of ICI approval on survival based on melanoma subtype and race. Methods: This is a retrospective analysis of the National Cancer Database (NCDB) from the years 2004–2015. The primary outcome was the overall survival of metastatic melanoma by subtype. Secondary outcomes included sociodemographic factors associated with the presence of metastasis at diagnosis and the impact of treatment facility type and ICI approval on the survival of metastatic melanoma. Results: Of the 419,773 invasive melanoma cases, 93.80% were cutaneous, and 4.92% were metastatic at presentation. The odds of presenting with metastatic disease were higher in African Americans (AA) compared to Caucasians (OR 2.37; 95% CI 2.11–2.66, p < 0.001). Treatment of metastatic melanoma at an academic/research facility was associated with lower mortality versus community cancer programs (OR 0.75, 95 % CI 0.69–0.81, p-value < 0.001). Improvement in survival of metastatic melanoma was noted for Caucasians after the introduction of ICI (adjusted HR 0.80, 95% CI 0.78–0.83, p < 0.001); however, this was not statistically significant for AA (adjusted HR 0.80, 95% CI 0.62–1.02, p-value = 0.073) or ocular cases (HR 1.03, 95% CI 0.81–1.31, p-value = 0.797). Conclusion: Real-world data suggest a 20% improvement in survival of metastatic melanoma since the introduction of ICI. The disproportionately high odds of metastatic disease at presentation in AA patients with melanoma suggest the need for a better understanding of the disease and improvement in care delivery.

Background: Cardiopulmonary arrest is known to have a poor prognosis, further worsened by preexisting comorbidities. With improved treatment, the prevalence of metastatic cancers is rapidly increasing; however, the outcomes of in‐hospital cardiopulmonary resuscitation (ICPR) remain to be well described. This study examines the epidemiology, associations, and outcomes of ICPR in these patients.Methods: This is a retrospective cohort analysis of the Nationwide Inpatient Sample database (2012‐2014) including patients aged ≥18 years with metastatic cancers. Primary outcome was inpatient mortality following ICPR. Factors associated with the primary outcome were analyzed using univariate/multivariate logistic regression analysis.Results: Among all admissions with metastatic cancers (n = 5,500,684), 0.47% (n = 26,070) received ICPR. Inpatient mortality was 81.77% (n = 8905) versus 68.90% among those without metastatic solid cancers and receiving ICPR. Inpatient palliative care encounter was documented in 18.95% of patients with metastatic cancer who received ICPR. On multivariate logistic regression, some of the notable factors associated with higher mortality included being of African American or Hispanic race and hospital admission over the weekend. Factors associated with lower mortality included female sex, elective admission, and head and neck as the primary site. Admissions with ICPR were associated with higher mean total charge of hospitalization (by $48,670) compared with admissions without ICPR. Of those who survived ICPR, 43.82% were transferred to another facility after discharge.Conclusions: Among adult patients with metastatic solid cancers having ICPR, 81.8% died within the same hospital admission. Race and admission type predicted mortality. Despite known poor prognosis, only a minority had palliative care.Lay Summary: Cardiopulmonary resuscitation during hospitalization for patients who have metastatic cancer has a very poor outcome with a mortality rate of 81.77%. Inpatient cardiopulmonary resuscitation in these patients is also associated with a significantly higher cost of care, longer length of stay, and high rate of transfer to a different health care facility upon discharge. Knowledge of these outcomes is helpful in discussing the pros and cons of pursuing aggressive resuscitative interventions with patients and families.