Maggie L. Shaw

 gene dropped precipitously between 2008 and 2018, according to 

 pathogenic variants help to inform the treatment and prevention of related cancers, with positive findings indicating higher risk, but changing testing criteria likely mean fewer women know these results. The present study investigated the impact of these changes.

A chief finding was the greater likelihood of a BRCA-positive result among women who were non-Hispanic Black (adjusted odds ratio [aOR], 1.52; 95% CI, 1.04-2.22), living in the West (aOR, 2.67; 95% CI, 1.63-4.49) or South (aOR, 1.80; 95% CI, 1.14-2.86) regions of the United States, and living in areas with few college graduates (aOR, 1.54; 95% CI, 1.10-2.17), as well as those 

 a personal history of breast or ovarian cancer (aOR, 1.30; 95% CI, 1.12-1.50).

“The current study evaluates how the rate of documented positive results for 

 testing changed over time and also evaluates the association between clinical and demographic characteristics and positive test results among US women 65 years of age or older,” the authors noted.

The study population of 5533 women, with a mean age of 68.1 (95% CI, 67.9-68.4) years, were culled from Optum’s Claims-Clinical data set. All received 

test results between January 1, 2008, and March 31, 2018. The primary outcome was percentage change in positive 

results and how that was affected by race/ethnicity, region of residence, income, educational level, and personal history of breast or ovarian cancer.

results: from 85.7% (36/42) in 2008 to 55.6 (140/252) in 2018, for an annual percentage change (APC) of –2.55 (95% CI, –3.45 to –1.64)

results for women with breast or ovarian cancer: from 83.3% (20/24) in 2008 to 61.6% (61/99) in 2018, for an APC of –3.17

results for women without breast or ovarian cancer: from 87.5% (21/24) in 2008 to 48.4% (74/153) in 2018, for an APC of –2.49

Drops in positive findings were also soon over the 10-year period in the Midwest and Northeast regions, while in the West they increased.

During the study period, most of the women tested were non-Hispanic White (84.6%, n = 4679) and from the Midwest (34.6%; n = 1915). The Optum database their data came from represents more than 91 million lives across all states, and race/ethnicity were self-reported.

“The significantly decreasing rate of positive 

 test results is evident among women 65 years of age or older, which may be partly explained by loosening of testing criteria during the evaluated time range,” they concluded. “However, socioeconomic and regional disparities were identified and persisted in testing use.”

Future studies should investigate their findings compared with those of women younger than 65, the authors recommended.

Fangjian G, School M, Fuchs EL, Wong R, Yong-Fang K, Berenson AB. Trends in positive 

test results among older women in the United States, 2008-2018. JAMA Netw Open. Published online November 5, 2020. doi:10.1001/jamanetworkopen.2020.24358

Articles

Among older women with and without breast and ovarian cancers, testing for the BRCA gene dropped precipitously between 2008 and 2018.

10-Year BRCA Testing Decreases, Study Shows 

A recent survey of UK Biobank participants showed a possible 42% lower risk of 

 among adults with advantageous sleep habits vs those with unhealthy sleep habits, even after adjusting for several confounders, 

, hypertension, medication use, genetic variations, and other covariates (HR, 0.87; 95% CI, 0.84-0.90).

“Our findings highlight the importance of improving overall sleep patterns to help prevent heart failure,” said Lu Qi, Md, PhD, corresponding author and professor of epidemiology and director of the Obesity Research Center at Tulane University in New Orleans, 

Overall, close to 1.3% (n = 5221) of the individuals developed heart failure within the 10-year follow-up period. However, they had a 42% lower risk of developing the condition and a lower chance overall if they met the following criteria:

Avoided excessive daytime sleepiness (ie, unintentionally dozing or falling asleep)

The team of investigators looked at overall sleep patterns and quality, which encompassed sleep duration, insomnia and snoring, and other sleep-related features, which itself included 2 questions: (1) Is this participant an early bird or a night owl? and (2) Have they had instances of daytime sleepiness? Sleep duration comprised 3 measures: short (less than 7 hours/day), recommended (7-8 hours/day), and prolonged (9 or more hours/day)

Additional analyses revealed independent associations between lower risk of developing heart failure and the following:

Not having daytime sleepiness (34% lower)

The observational study covered 408,802 participants with UK Biobank, which 

 to better prevent, diagnose, and treat serious and life-threatening illnesses. These participants, ranging in age from 37 to 73 years, were recruited between 2006 and 2010 and followed for a median 10 years. Data were collected through April 1, 2019. Participants were excluded if they currently had heart failure or were missing information on their sleep behaviors at baseline. Heart failure was categorized based on 

International Classification of Diseases, Tenth Edition 

Sleep score was also determined by combining 

, sleep duration, insomnia, snoring and excessive daytime sleepiness. The higher the score, the healthier the sleep pattern. Overall, for every 1-point increase in healthy sleep score, the HR for heart failure was 0.85 (95% CI, 0.83-0.87).

Study limitations are that the sleep behaviors were self-reported (via touchscreen questionnaires), which could have introduced recall bias, and the follow-up period did not include evaluation on any possible changes in sleep behaviors. However, its strengths include the large sample size and prospective study design.

“Our results provide new evidence to indicate that adherence to the healthy sleep pattern is associated with a lower risk of heart failure, independent of the conventional risk factors,” the authors concluded. “Our findings highlight the potential importance of overall sleep behaviors in the prevention of heart failure.”

Li X, Xue Q, Wang M, et al. Adherence to a healthy sleep pattern and incident heart failure: a prospective study of 408802 UK Biobank participants. 

Published online November 16, 2020. doi:10.1161/CIRCULATIONAHA.120.050792

A recent survey of UK Biobank participants showed that healthy sleep habits were associated with a possible lower risk of heart failure among adults, even after adjusting for several confounders.

Sufficient Sleep Results in Possible Lower Risk of Heart Failure Among Adults

 (mBC) between the ages of 25 and 64 years who live in predominantly mixed-race, Hispanic, Black, or Asian neighborhoods are more likely to use intense end-of-life (EOL) care, according to 

This EOL care comprises more than 1 hospital admission, 2 or more emergency department (ED) visits, or intensive care unit (ICU) admission and/or antineoplastic therapy in the last 2 weeks of life. The authors investigated whether demographic, socioeconomic, and regional factors influence these outcomes, because they have been investigated less thoroughly in younger patients with mBC vs patients at least 65 years old with Medicare coverage.

“Differences in insurance coverage, life expectancy, life circumstances, and overall health could lead to different intensity of treatment at the EOL for younger compared with older patients,” the authors noted.

Using overall commercial claims data for women younger than 65 years who died between May 1, 2000, and December 31, 2014, the authors looked at 4 periods: 2000 to 2003, 2004 to 2006, 2007 to 2009, and 2010 to 2014. With the index date being that for the first observed diagnosis of secondary metastatic cancer, the 2007-2009 period had the highest number of deaths (n = 637), followed by 2010-2014 (n = 617), 2004-2006 (n = 482), and 2000-2003 (n = 390).

For the ICU admission and ED visit measures, there were increases from 14% (95% CI, 10%-17%) to 23% (95% CI, 20%-26%) and 10% (95% CI, 7%-13%) to 12% (95% CI, 9%-15%), respectively, in the patients’ final month of life when comparing the 2000-2003 and 2010-2014 periods. These were both deemed statistically significant.

However, the final results for EOL hospital admission rate and antineoplastic treatment were not deemed significant for the 2010-2014 period, at 14% (95% CI, 11%-17%) and 24% (95% CI, 21%-27%), respectively.

Most of the women studied lived in the South (47%) or Midwest (30%), as well as non-Hispanic White neighborhoods (64%).

There also were overall 1.39 times greater odds (

= .01) of receiving ICU care and 1.38 times higher chances (

= .03) of hospitalization if a woman lived in a neighborhood with a predominantly mixed racial population or where a majority of citizens were Hispanic, Black, or Asian American.

Analyses also found that living in a more deprived neighborhood had a negative correlation with receiving EOL antineoplastic treatment (odds ratio [OR], 0.71; 

< .01) and that living in the South vs the Midwest was associated with a lesser likelihood of having EOL ED visits (OR, 0.70; 

“In this study, we find that, despite broadening consensus on less intense EOL care for patients with cancer, frequency of ICU admissions and, to a smaller extent, EOL ED visits in a cohort of commercially insured women who died with metastatic breast cancer has increased over time,” the authors concluded. “These findings provide new evidence on EOL care in an understudied group, <65-year-old commercially insured patients, and longitudinal data on the intensity of EOL care over time.”

They did, however, cite limitations on their results’ generalizability, which included having just the month of death and not the day and possible underreporting of deaths.

Ferrario A, Fang Z, Ross-Degnan D, Wharam JF, Wagner AK. Intensity of end-of-life care in a cohort of commercially insured women with metastatic breast cancer in the United States. 

Published online November 10, 2020. doi:10.1200/OP.20.00089

Patients younger than 65 years represent close to 40% of deaths from metastatic breast cancer, yet their use of end-of-life (EOL) care has not been thoroughly investigated until now.

Younger, Minority Women With Metastatic Breast Cancer Using More EOL Care

In light of the coronavirus disease 2019 (COVID-19) pandemic, care for persons living with 

 (PWH) has become even more critical—especially considering that consistent retention in care can improve health outcomes and help to prevent transmission of the virus, according to 

 presented at the recent ID Week that looked at the use of telehealth among PWH.

“Several definitions exist for retention in care, but they are centered around outpatient clinic visits,” the authors note. “It is now more important than ever to understand PWH’s attitudes about using telemedicine for HIV care instead of face-to-face clinic visits.”

This additional method of care can help to address some of the issues PWH may face when accessing care, such as transportation challenges, longer travel times to clinics, competing life events, and managing their infection, the poster noted.

To uncover these attitudes toward acceptability, benefits, and concerns about telehealth for HIV care, for the study period of February to June 2018, a survey was administered to current outpatients of an HIV center in Houston; their electronic medical records were also reviewed for viral load closest to the survey date and current antiretroviral treatment (ART) regimen. Among the 371 participants in this cross-sectional study, most were African American (63%), were born in the United States (83%), and acquired HIV through heterosexual transmission. Just over one-third (36%) were female, and the median (interquartile range) age was 51 (41-57) years.

Citing such advantages as telehealth being a good schedule fit (69%), decreased travel time (63%), and privacy (62%), an overall 57% (n = 211) of the respondents indicated a greater likelihood of using telehealth vs one-on-one in-person care if the former were offered. Meanwhile, 37% (n = 137) indicated they would use the service on a frequent basis, perhaps always, instead of visiting a clinic. Sixty-seven percent had undetectable viral loads, and 49% had been on ART for more than 10 years.

Additionally, 3 types of factors—personal, HIV-related, and structural—were used to evaluate the likelihood of using telehealth or the disinclination to do so. Those more likely to engage with telehealth were born in the United States, were men having sex with other men, and had a higher level of terminal education and higher perceived HIV-related stigma. Individuals less likely to utilize telehealth had long-standing HIV (>10 years), difficulty with in-person visits, and lack of appropriate technology.

Concerns expressed regarding switching to telehealth were lack of effective communication (23%) and a good physical examination (37%), along with the safety of online personal information (28%). Questions and statements to gauge both level of comfortableness and hesitation toward HIV included:

If you can use live video call to see and talk to your doctor instead of coming to clinic appointments, how often would you use it?

This service will be good for me because I will have more privacy at home.

My doctor will not be able to examine me well.

I will not be able to express myself very well.

Overall, there was a “positive attitude toward the use of telehealth for HIV care among PHW,” the authors noted. In fact, 52% retained their favorable opinion of telehealth despite still needing to pick up medications or present for laboratory tests in person.

“Telehealth programs for PWH can improve retention in care,” they concluded. “A modification of the definition for retention in care, incorporating telehealth, should be considered. Availability and confidence using various telehealth technologies need to be addressed to increase acceptability and usage of telehealth among PWH.”

Dandachi D, Dang B, Giordano TG. The attitude of patients with HIV about telehealth for their HIV care. Presented at: ID Week; October 21-25, 2020. Poster 1042.

A poster on telehealth presented at ID Week in October attempted to identify where care advancement and improvement are needed for individuals living with HIV. 

Maggie L. Shaw

Articles

10-Year BRCA Testing Decreases, Study Shows

Sufficient Sleep Results in Possible Lower Risk of Heart Failure Among Adults

Younger, Minority Women With Metastatic Breast Cancer Using More EOL Care

How Might Telehealth Benefit Persons Living With HIV?