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2015 ; 39
(2
): 222-8
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Differences in community and academic practice patterns for newly diagnosed
myelodysplastic syndromes (MDS) patients
#MMPMID25701277
Pease DF
; Ross JA
; Poynter JN
; Nguyen PL
; Hirsch B
; Cioc A
; Roesler MA
; Warlick ED
Cancer Epidemiol
2015[Apr]; 39
(2
): 222-8
PMID25701277
show ga
PURPOSE: The heterogeneous nature of myelodysplastic syndromes (MDS) complicates
therapeutic decision making, particularly for newly diagnosed disease. Factors
impacting the treatment plan in this early period of disease course are poorly
defined. This study determines whether therapeutic choices for newly diagnosed
MDS are associated with location of treatment (community or academic), prognostic
risk category, and patient age. METHODS: The adults in Minnesota with
myelodysplastic syndromes (AIMMS) database was utilized in this statewide,
prospective population-based study conducted by the University of Minnesota
(UMN), Mayo Clinic, and Minnesota Department of Health. Adult (age 20+ years)
cases of MDS newly diagnosed starting in April 2010 were invited to participate.
This analysis includes patients enrolled during the first study year with 1-year
follow-up data. Treatment choices (supportive, active, and transplant) were
stratified by the international prognostic scoring system (IPSS) and the
revised-IPSS (IPSS-R), then separated into groups by location of care and age
(<65 or 65+ years). Academic-based care was any contact with the UMN and Mayo
Clinic; community-based care was all other clinical sites. RESULTS:
Stratification by IPSS and IPSS-R showed supportive care decreased and active
care increased with advancing risk categories (p<0.0001). Comparing treatment
setting, community-based care had 77% supportive and 23% active treatment;
academic-based care was 36% supportive, 41% active, and 23% transplant
(p<0.0001). By age groups, patients <65 years with intermediate, high, or very
high risk disease by IPSS-R received 97% active care/transplant, compared to only
52% of patients age 65+. CONCLUSIONS: Younger patients and those treated at
academic centers had a more aggressive treatment approach. Whether these
treatment differences convey improved disease control and mortality, and
therefore should be extended more frequently to older and community-based
patients, is the subject of ongoing prospective study.