Browsing by Author "Thompson, Caroline A."

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    Emergency department associated lung cancer diagnosis: Case series demonstrating poor outcomes and opportunities to improve cancer care
    (Elsevier, 2021) Pettit, Nicholas; Al-Hader, Ahmad; Thompson, Caroline A.; Emergency Medicine, School of Medicine
    The diagnosis of cancer through an emergency presentation of an undiagnosed malignancy constitutes around 20–50% of first-time cancer diagnoses. There is a paucity of evidence on the emergency presentations of undiagnosed malignancy with only a few epidemiological studies of large administrative databases. Limited administrative data has shown patients diagnosed with cancer after an emergency presentation suffer poorer clinical outcomes as compared to those diagnosed with cancer through elective routes. Further those diagnosed emergently are commonly among vulnerable populations, such as based on socioeconomic status and racial/ethnic groups. Lung cancer is the most common cancer diagnosed emergently, and while one of the most preventable and treatable, often presents to an emergency department in extremis. This case study of six patients seeks to augment administrative database research by adding detailed clinical information as to demonstrate the issues with diagnosing lung cancer through an emergency presentation. We found that patients diagnosed emergently have complex care pathways including delayed biopsies, delayed treatments, and poor outcomes. Research is needed to elucidate the optimal path on how to manage suspected lung cancer diagnoses from the emergency department.
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    Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study
    (Oxford University Press, 2024) Thompson, Caroline A.; Sheridan, Paige; Metwally, Eman; Peacock Hinton, Sharon; Mullins, Megan A.; Dillon, Ellis C.; Thompson, Matthew; Pettit, Nicholas; Kurian, Allison W.; Pruitt, Sandi L.; Lyratzopoulos, Georgios; Emergency Medicine, School of Medicine
    Background: Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. Methods: We analyzed Surveillance, Epidemiology, and End Results Program-Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have "ED involvement" in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. Results: Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. Conclusions: The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations.
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    Higher Absolute Lymphocyte Counts Predict Lower Mortality from Early-Stage Triple-Negative Breast Cancer
    (AACR, 2018-06) Afghahi, Anosheh; Purington, Natasha; Han, Summer S.; Desai, Manisha; Pierson, Emma; Mathur, Maya B.; Seto, Tina; Thompson, Caroline A.; Rigdon, Joseph; Telli, Melinda L.; Badve, Sunil S.; Curtis, Christina N.; West, Robert B.; Horst, Kathleen; Gomez, Scarlett L.; Ford, James M.; Sledge, George W.; Kurian, Allison W.; Pathology and Laboratory Medicine, School of Medicine
    Purpose: Tumor-infiltrating lymphocytes (TIL) in pretreatment biopsies are associated with improved survival in triple-negative breast cancer (TNBC). We investigated whether higher peripheral lymphocyte counts are associated with lower breast cancer–specific mortality (BCM) and overall mortality (OM) in TNBC. Experimental Design: Data on treatments and diagnostic tests from electronic medical records of two health care systems were linked with demographic, clinical, pathologic, and mortality data from the California Cancer Registry. Multivariable regression models adjusted for age, race/ethnicity, socioeconomic status, cancer stage, grade, neoadjuvant/adjuvant chemotherapy use, radiotherapy use, and germline BRCA1/2 mutations were used to evaluate associations between absolute lymphocyte count (ALC), BCM, and OM. For a subgroup with TIL data available, we explored the relationship between TILs and peripheral lymphocyte counts. Results: A total of 1,463 stage I–III TNBC patients were diagnosed from 2000 to 2014; 1,113 (76%) received neoadjuvant/adjuvant chemotherapy within 1 year of diagnosis. Of 759 patients with available ALC data, 481 (63.4%) were ever lymphopenic (minimum ALC <1.0 K/μL). On multivariable analysis, higher minimum ALC, but not absolute neutrophil count, predicted lower OM [HR = 0.23; 95% confidence interval (CI), 0.16–0.35] and BCM (HR = 0.19; CI, 0.11–0.34). Five-year probability of BCM was 15% for patients who were ever lymphopenic versus 4% for those who were not. An exploratory analysis (n = 70) showed a significant association between TILs and higher peripheral lymphocyte counts during neoadjuvant chemotherapy. Conclusions: Higher peripheral lymphocyte counts predicted lower mortality from early-stage, potentially curable TNBC, suggesting that immune function may enhance the effectiveness of early TNBC treatment.