Treatment decisions in older adults with acute myeloid leukemia (AML) are challenging, particularly for those who are not candidates for intensive chemotherapy (IC), and the trade-offs patients, their families and physicians consider when choosing a treatment option are not well understood. This qualitative research explored the value of extending survival and the treatment decision-making process from a multi-stakeholder perspective. Overall, 28 patients with AML (≥ 65 years old, unsuitable for IC), 25 of their relatives and 10 independent physicians from the US, UK and Canada took part in one-on-one, 60-minute qualitative interviews. Across all stakeholders, improved health-related quality of life (HRQoL), extended survival and relief of AML symptoms were recognized as most important in AML treatment decision-making. However, extending survival in ‘good health’ was more important than extending survival alone, particularly because of the extra time it gives patients and their relatives together, and allows patients to achieve important goals. Patients’ limited understanding of available treatment options, paired with incorrect perceptions of treatment side effects, impacted their involvement in the treatment decision-making process. Patients and physicians perceived physicians to have the most influence in the decision-making process despite their priorities not always aligning. These findings illustrate the importance of having structured discussions which explicitly assess patients’ goals and their understanding and expectations of treatments and also the need for patient friendly resources about the lived experience of AML and available treatment options. These measures will help to ensure that patients are fully involved in the shared decision-making process.

7016 Background: AML patients may be treated with intensive chemotherapy (IC), or non-intensive chemotherapy (NIC) or they may receive best supportive care (BSC) or hospice care. Balancing treatment efficacy and toxicities is key in treatment decision-making. IC is efficacious with extensive toxicities, while NIC has lower risk of toxicities but reduced efficacy. This study provides an international, multi-stakeholder perspective on the role of side effects in AML treatment decision-making. Methods: We conducted one-on-one, 60-minute interviews with 28 AML patients (>65 years, not receiving IC), 25 of their family members and 10 independent physicians from the US, UK and Canada. Interviews included open-ended questions to explore the treatment decision-making process. Participants also rated the importance of various factors in AML treatment decision-making from 0 (not important) to 3 (very important). Results: The sample included patients with varying treatment histories (13 no treatment, 11 on NIC, 3 discontinued NIC, 1 BSC). Side effects were rated as a ‘very important’ factor in treatment decision-making by a greater proportion of patients not on treatment (n = 9/13; 69.2%) and their relatives (n = 12/13; 92.3%) compared to those with experience of NIC (n = 5/11 who answered, 45.5%), their relatives (n = 3/11; 27.3%), and physicians (n = 4/10; 40.0%). When discussing side effects in detail, there was a disconnect between perceptions of patients not on treatment, and side effects that patients on NIC actually experienced. Many patients with no treatment experience were worried that side effects would be worse than their current symptoms (n = 6/13), referring to constant vomiting, hair loss, organ failure, or death. Fear of side effects was the primary reason for opting not to take treatment (n = 9/13), though it was not clear if these patients were distinguishing between IC and NIC. In contrast, although two patients’ experiences of side effects resulted in them discontinuing NIC (n = 2/14), a higher proportion (n = 9/14) reported that the side effects had little impact on their life. Side effects most frequently reported by patients with experience of NIC (n = 11/14) were considered mild and included fatigue, reduced appetite, generally feeling unwell, nausea and injection site irritation (all n = 3). It was most commonly reported that the worst aspect of NIC was the time commitment (n = 4/8 asked). When accounting for different treatments paths no international variation in findings was observed. Conclusions: The nature and severity of side effects of AML treatment were perceived to be worse than reality. This incorrect perception may lead to undertreatment of patients and result in worse outcomes. There is a need for more patient education and resources about the lived treatment experience, to enhance understanding and mitigate pre-conceived notions of side effects.

Background: AML is a haematologic cancer primarily affecting older people (median age 68 at diagnosis). Prognosis is poor, with median survival ranging from 2 to 10 months from diagnosis, depending on patient health, age, and treatment path. Some patients described struggling with uncertainty about the future, but it is unclear how this differs across patients and treatment paths. Aims: This study explored the experiences of AML patients (≥65 years old, not receiving intensive chemotherapy), their close relatives, and independent clinicians. Specifically, patient expectations for the future and how these varied by treatment path and by time since diagnosis were investigated. Methods: A total of 28 AML patients (aged 65-83;median 74), 25 relatives, and 10 clinicians from the US, UK, and Canada each took part in a 60-minute, semi-structured telephone interview. Open-ended questions were used to elicit spontaneous content, followed by focused questions when needed. Results: Patients had diverse treatment histories: 13 no treatment, 14 with experience of non-intensive chemotherapy (NIC) including 3 who discontinued treatment, and 1 on best supportive care (BSC). At time of interview the mean time since diagnosis was 5 (range 2 to 9) months for patients with no treatment experience, and 8 (range 2 to 19) months for those with treatment experience. The BSC patient was diagnosed 9 months prior to interview. Patients discussed positive and negative expectations for the future related to: physical functioning;treatment;life expectancy;ability to do hobbies, spend time with family, and go on vacation. In the no treatment group, there was evidence that expectations about the future became more negative over time. Few patients (n=4/13) recalled having negative expectations about the future at diagnosis, while most (n=10/13) did at time of interview. In contrast, patients with treatment experience appeared to have increasingly positive expectations. Most of these patients (n=11/14) recalled negative expectations when diagnosed, whereas at interview most (n=9/14) felt hopeful about future events. Further, of patients with treatment experience, almost all those diagnosed ≥6 months prior to interview had positive expectations about their future (n=6/7), while under half of those diagnosed <6 months prior (n=3/7) did. Clinicians (n=7/10) further highlighted that patient expectations changed over time depending on treatment success. Additionally, patients (n=15/28) and relatives (n=15/25) discussed feeling uncertain throughout the AML journey, reporting unknowns around life expectancy, what they would be able to accomplish, and future plans. Uncertainty was a consistent experience regardless of treatment history, with similar proportions of patients not on treatment (n=7/13) and those with NIC experience (n=7/14) reporting the sentiment. Additionally, recently interviewed patients (n=7/13) and relatives (n=7/10) noted that the ongoing COVID-19 pandemic contributed to experiences of uncertainty and difficulties planning for the future. Summary/Conclusion: There were key differences between patients not on treatment and those with experience of NIC, as patients with treatment experience demonstrated more hope for the future. Regardless, uncertainty is a key element of the AML journey. For some patients, this was exacerbated by the COVID-19 pandemic. These findings highlight the importance of ensuring all patients are provided with emotional and spiritual support to help them process their diagnosis and plan for the future, both during this pandemic and beyond.

Pilot trial of telemedicine in urology: video vs. telephone consultations David-Dan Nguyen1, Anne Xuan-Lan Nguyen1, David Bouhadana1, Kahina Bensaadi2, François Peloquin3, Jean-Baptiste Lattouf3, Daniel Liberman3, Manon Choinière4, Naeem Bhojani3 1Faculty of Medicine, McGill University, Montreal, QC, Canada; 2Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada; 3Division of Urology, Faculty of Medicine, Université de Montréal, Centre hospitalier de l’Université de Montréal, Montréal, QC, Canada; 4Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada Introduction: In the past year, in-person clinical activities have been drastically restricted due to the COVID-19 pandemic, driving the already growing interest in the use of telemedicine in the urban setting to reduce unnecessary commuting. Therefore, there has been a rapid shift to telephone and video consultations in outpatient practice. We sought to conduct a pilot trial to establish the feasibility and acceptability of video consultations as an alternative to telephone consultations in urology patients to inform the design of a future randomized controlled trial. Methods: We conducted a single-center, prospective, non-randomized pilot trial comparing telephone consultations (TC) vs. video consultations (VC) for urology outpatient visits. Two patient questionnaires were used to collect demographic information, as well as data about acceptability, feasibility, satisfaction, cost, and issues with telemedicine. Questions were identical for both VC and TC except for certain questions inquiring about issues specific to each technology. Results: Forty-eight TC and 66 VC urology patients were included in this study. Patients believed that telemedicine visits did not significantly hinder their ability to communicate with their urologists and that these visits would be associated with cost savings. There was 1/48 (2.1%) failed TC and 16/66 (24.2%) failed VC. VC failures were concentrated at the beginning of the trial, prior to giving feedback to the VC platform creators, with only one failure occurring thereafter. When comparing TC to VC, differences between the two patient groups were small but tended to be in favor of VC. Patient satisfaction was greater with VC compared to TC. Both modalities were associated with many cost benefits for patients Conclusions: Despite more technical issues with VC, this modality is feasible and acceptable to patients, likely due to improved shared decisionmaking with VC. Future considerations for trials comparing VC and TC should include adequate Wi-Fi infrastructure and choice of platform. For the VC, continuous knowledge transfer between investigators and platform engineers plays an important role in limiting failed encounters.

INTRODUCTION:In the past year, due to the COVID-19 pandemic, in-person clinical activities have been drastically restricted, driving the already growing interest in the use of telemedicine in the urban setting to reduce unnecessary commute. Therefore, there has been a rapid shift to telephone and video consultations in outpatient practice. We sought to conduct a pilot trial to establish feasibility and acceptability of video consultations as an alternative to telephone consultations in urology patients to inform the design of a future randomized controlled trial.METHODS:We conducted a single-center, prospective, non-randomized pilot trial comparing telephone consultations (TC) vs. video consultations (VC) for urology outpatient visits. Two patient questionnaires were used to collect demographic information, as well as data about acceptability, feasibility, satisfaction, cost, and issues with telemedicine. Questions were identical for both VC and TC except for certain questions inquiring about issues specific to each technology.RESULTS:Forty-eight TC and 66 VC urology patients were included in this study. Patients believed that telemedicine visits did not significantly hinder their ability to communicate with their urologists and that these visits would be associated with cost savings. There was 1/48 (2.1%) failed TC and 16/66 (24.2%) failed VC. VC failures were concentrated at the beginning of the trial prior to giving feedback to the VC platform creators, with only one failure occurring thereafter. When comparing TC to VC, differences between the two patient groups were small but tended to be in favor of VC. Patients' satisfaction was greater with VC compared to TC. Both modalities were associated with many cost benefits for patients.CONCLUSIONS:Despite more technical issues with VC, this modality is feasible and acceptable to patients, likely due to improved shared decision-making with VC. Future considerations for trials comparing VC and TC should include adequate Wi-Fi infrastructure and choice of platform. For the VC, continuous knowledge transfer between investigators and platform engineers plays an important role in limiting failed encounters.

Objective A model was developed to estimate the historical impact (including total societal health and economic benefit) of pneumococcal conjugate vaccine (PCV) programs in the overall Canadian population between 2005 and 2015, inclusively. Methods Historical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) were obtained from epidemiologic databases supplemented with published and unpublished data. Two scenarios were considered: (1) the observed historical incidence from 2005 to 2015 in the setting of PCV use; (2) a hypothetical scenario in which we estimated the number of disease cases assuming no PCV use. Disease cases averted as a result of PCV programs were calculated by subtracting the number of observed historical cases from the number of estimated cases expected in the absence of PCV use. Results PCV programs were estimated to have saved 6631 lives and averted 14,990 IPD cases, 735,700 pneumonia episodes, and 3,697,993 AOM episodes. Positive clinical outcomes resulted in total cost savings of CAD $1.76 billion over 11 years. Vaccination costs were offset by the direct medical cost savings from fewer cases of IPD, pneumonia, and AOM. Conclusions Canadian PCV programs have provided significant health benefits and resulted in a substantial value for money. Net savings achieved over the reviewed period would have provided funding for $1.76 billion in other health care costs or public health initiatives. These findings highlight the importance of considering the total value of a vaccination program, rather than vaccine acquisition costs only, when assessing the value of immunization programs.

7520 Background: Current treatment options for acute myeloid leukemia (AML) are diverse, including intensive chemotherapy (IC), low intensity therapy, best supportive care (BSC), and hospice care. Despite continued development of new therapies, recent data suggest that approximately 60% of older US patients remain untreated, but reasons for this are not well understood. By gathering insights from physicians, patients, and their family members, this study aims to better understand the factors that influence treatment decisions for adults with AML. Methods: Physicians in the US (n=4), UK (n=3) and Canada (n=3), and 15 US AML patient-family member dyads took part in one-on-one, 60-minute semi-structured interviews. Each participant rated a series of factors on a scale from 0 (not at all important) to 3 (very important) to determine their importance in treatment decision-making. Among the 15 adults with AML (>65 years, not taking IC) interviewed thus far, 13 had not received any treatment. Additional interviews are scheduled in the UK and Canada with patients having varied treatment experiences (data will be available for presentation). Results: To date, findings highlight the key role perceptions of side effects and patient health play in treatment decision making. A fear of treatment side effects was the primary reason patients (n=9/13) opted not to receive treatment. For the 2/15 study patients who had received treatment, side effects were considered the worst part of their treatment experience. Physicians also stated patients on BSC would be more willing to take low intensity treatments if risks (e.g., side effects) were minimized. Patients (n=11/15), their family members (n=11/15), and physicians (n=10/10) agreed that patients’ health (including age and comorbidities) influenced if treatment was pursued. Additionally, US physicians suggested that some patients have little desire to pursue treatment, with patients’ perception of low intensity therapy having poor efficacy and proximity of care influencing their choice for BSC or hospice care. Further analysis will explore other factors influencing patients’ treatment decisions and differences among patients who receive treatment versus those who do not. Conclusions: The treatment decision-making process for older adults with AML is complex and multifactorial. Understanding factors that influence treatment decisions is important if drug developers and prescribers are to ensure the availability of therapies that better align with individual patients’ needs.

Expectations relating to treatment and survival, and factors influencing treatment decisions are not well understood in adult patients with acute myeloid leukemia. This study analyzed combined findings from a targeted literature review with patient-reported information shared on YouTube to further understand patient perspectives in hematologic cancers and, in particular, acute myeloid leukemia. The targeted literature review included articles concerning patient (aged ≥ 18 years) experiences or perspectives in acute myeloid leukemia or other hematologic cancers. YouTube video selection criteria included patients (aged ≥ 60 years) with self-reported acute myeloid leukemia. In total, 26 articles (13 acute myeloid leukemia–specific and 14 other hematologic cancers, with one relevant to both populations) and 28 videos pertaining to ten unique patients/caregivers were identified. Key concepts reported by patients included the perceived value of survival for achieving personal and/or life milestones, the emotional/psychological distress of their diagnosis, and the uncertainties about life expectancy/prognosis. Effective therapies that could potentially delay progression and extend life were of great importance to patients; however, these were considered in terms of quality-of-life impact and disruption to daily life. Many patients expressed concerns regarding the lack of treatment options, the possibility of side effects, and how their diagnosis and treatment would affect relationships, daily lives, and ability to complete certain tasks. Both data sources yielded valuable and rich information on the patient experience and perceptions of hematologic cancers, in particular for acute myeloid leukemia, and its treatments. Further understanding of these insights could aid discussions between clinicians, patients, and their caregivers regarding treatment decisions, highlight outcomes of importance to patients in clinical studies, and ultimately, inform patient-focused drug development and evaluation.

Introduction: Acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML) are both hematological malignancies characterized by rapid onset. While AML is more common than ALL, both typically receive cytotoxic chemotherapy in first line. Upon complete remission, patients will be considered for allogeneic hematopoietic stem cell transplant (HSCT). The economic burden of malignant blood disorders was recently studied in Europe, with an estimated €3.6 billion in productivity losses. The objective of this review is to evaluate the impact on productivity and understand the societal burden of HSCT in ALL and AML patients. Methods: A rapid review was conducted to identify real-world evidence reporting work and productivity loss associated with ALL and AML, including the impact of HSCT. A search of PubMed was executed for citations published between April 1, 2014 to April 1, 2019 and limited to English language. Eligible studies examined outcomes on work productivity in patients diagnosed with ALL, AML, or combined hematological malignancies, with no geographical restriction. A single reviewer screened all identified citations and extracted key data from included papers. Results: A total of 13 unique real-world data studies were identified. Seven studies examined the impact of hematological cancers (including ALL and AML) with varied return-to-work outcomes reported. Of these, 3 studies observed positive return-to-work outcomes over time, while 4 reported decreased employment among patients when compared to the general population, although 2 of the 4 studies were focused on childhood hematological cancer survivors. A total of 6 studies examined the impact of HSCT on work productivity. Two studies reported opposing results in unemployment in adult survivors of childhood hematological cancers who received HSCT. The remaining 4 studies found a general decrease in employment or increase in low-income status among adult patients when comparing pre-HSCT to post-HSCT; however, 2 of these studies reported most patients were still employed post-HSCT, with 62% returning to work over 1 year post-HSCT and 77% of patients returning to work 5 years post-HSCT. Overall, there was a trend towards work reintroduction as an important outcome post-HSCT. Further, recurring themes included structural changes in the current delivery of health services or potential interventions to help rehabilitation post-transplantation and optimize employment. Conclusions: Work productivity outcomes are important facets of long-term survivorship care in patients with hematological cancers. Although there was a limited number of studies identified, results from the current rapid review indicate that while productivity is lower in patients with AML or ALL, including those treated with HSCT, a substantial proportion of patients are still actively employed. Future research should be directed toward understanding the causes of unemployment post-HSCT to help prevent adverse financial outcomes following this life-saving procedure. In terms of limitations, none of the identified studies compared work productivity outcomes of those who received HSCT to those who did not receive HSCT, among patients with hematological cancer. Four of the studies only examined patients pre- and post-HSCT and the remaining 2 studies compared patients to the general population; thus, the effect of HSCT could not be discerned from the effect of the disease. While HSCT is a costly and resource-intensive procedure, it remains the only potentially curative intervention for most hematological cancers. Advances in HSCT have dramatically improved clinical outcomes in cancer patients; resulting in lowered HSCT-related morbidity and mortality. Future studies with direct comparisons of patients with hematological cancer who received HSCT to those who did not receive HSCT would be desirable to estimate the indirect costs of impact of work productivity in these patients; however, ability to receive HSCT may remain confounded by variables that are challenging to measure, such as disease state, donor availability, HSCT reimbursement policies, and patient preference. Disclosures Scory: Medlior Health Outcomes Research: Employment. Shaw:Medlior Health Outcomes Research: Employment. Cowling:Medlior Health Outcomes Research: Employment. Peloquin:Pfizer Inc: Employment, Equity Ownership. Welch:Pfizer Inc: Employment, Equity Ownership. Charaan:Pfizer Inc: Employment, Equity Ownership. Brown:Pfizer: Employment, Equity Ownership.

INTRODUCTION: Acute myeloid leukemia (AML) is a rare hematologic cancer primarily affecting older people, with a median age at diagnosis of 67 years old (Almeida & Ramos, 2016). Heterogeneity in the presentation, functional status and presence of comorbidities among AML patients presents unique challenges for treatment. Intensive chemotherapy (IC), although the best option for prolonging survival, carries a risk of early death and other trade-offs, including significant time spent in the hospital. The toxicity of IC treatment and the requirement for prolonged hospitalizations may negatively affect patients' physical functioning and health-related quality of life (HRQoL). Novel, low-intensity treatments can be administered in the clinic and may pose less risk of immediate toxicities but may be associated with reduced efficacy. Each patient and family will approach these trade-offs differently, yet few studies examine the process of shared decision-making in AML. We aimed to better understand this process by eliciting patient/family and physician narratives about expectations and attitudes towards AML treatments. METHODS: Ten physicians in the US (n=4), UK (n=3) and Canada (n=3) and 12 AML patients (all US) and a member of their family took part in an individual, 60-minute qualitative telephone interview. Further interviews are scheduled and any additional data at the time of presentation will also be reported. The interviews followed a semi-structured guide comprising open-ended questions. The overarching aim of the interviews was to understand the value of living longer for AML patients who are not candidates for standard IC and to explore the treatment decision process from the patient, family and physician perspective. During the interviews, each participant (patient, family member or physician) completed a rating exercise in which they were asked to rate a list of pre-defined factors (9-10 factors) on a scale of 0 (not at all important) to 3 (very important) to determine their importance in AML treatment decisions. As well as providing a numerical rating for each factor, each participant was asked why they selected their rating and which three factors they would consider the most important. RESULTS: Across all three groups, relief in AML symptoms (namely fatigue and pain), longer survival and better QoL were equally considered the three most important factors when making a treatment decision. All three groups described the interaction between QoL and longer survival, explaining that any increase in survival would be important, but only if QoL (time spent with family, maintaining hobbies/interests) was maintained or improved. Physician's advice was also important to AML patients when making decisions regarding treatment. Other treatment-related factors within the rating task were rated as very important for at least a subset of patients, with no factors widely considered to be of limited importance. All participants noted that while relief of AML symptoms, longer survival and quality of life were all important, these had to be considered in light of treatment side effects and risk of infection. Likelihood of being hospitalized was important to family members, as they wanted to spend quality time at home with their loved ones, while patients and physicians considered hospitalization as an inevitable consequence of the disease and treatment. All participants reported that AML patients would consider taking any form of treatment if suitable and effective, regardless of the mode of administration. However, it was acknowledged that oral treatments would be more convenient and less invasive. The relative importance of location of care/treatment delivery was influenced by proximity to resources and whether the participant was based in an urban or rural setting. The ability to receive treatment at home was considered beneficial. CONCLUSIONS: The results from this rating exercise and qualitative interviews showed convergence across all stakeholders, indicating that AML patients, family and physicians have similar priorities regarding treatment decisions, prioritizing symptom relief, survival, and quality of life. The predominant treatment pathways in AML each require trade-offs in these factors, demonstrating the importance of shared decision making in ensuring the most appropriate treatment is selected for a given individual, in accordance with their values, goals, and preferences. Figure Disclosures LeBlanc: Jazz Pharmaceuticals: Research Funding; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Membership on an entity's Board of Directors or advisory committees; Heron: Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy; Flatiron: Consultancy; NINR/NIH: Research Funding; Duke University: Research Funding; Astra Zeneca: Consultancy, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; Medtronic: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Research Funding; Celgene: Honoraria; AbbVie: Membership on an entity's Board of Directors or advisory committees; Pfizer Inc: Consultancy; American Cancer Society: Research Funding; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CareVive: Consultancy. Walter:Seattle Genetics: Research Funding; Agios: Consultancy; Amgen: Consultancy; Amphivena Therapeutics: Consultancy, Equity Ownership; Aptevo Therapeutics: Consultancy, Research Funding; Argenx BVBA: Consultancy; Astellas: Consultancy; BioLineRx: Consultancy; BiVictriX: Consultancy; Boehringer Ingelheim: Consultancy; Boston Biomedical: Consultancy; Covagen: Consultancy; Daiichi Sankyo: Consultancy; Jazz Pharmaceuticals: Consultancy; Kite Pharma: Consultancy; New Link Genetics: Consultancy; Pfizer: Consultancy, Research Funding; Race Oncology: Consultancy. Hernandez-Aldama:Pfizer Inc: Consultancy. Sully:Pfizer Inc: Consultancy; Adelphi Values Ltd: Employment. Bell:Pfizer Inc.: Employment, Equity Ownership. Johnson:Pfizer Inc: Consultancy; Adelphi Values Ltd: Employment. Peloquin:Pfizer Inc: Employment, Equity Ownership. Gater:Pfizer Inc: Consultancy; Adelphi Values Ltd: Employment. Welch:Pfizer Inc: Employment, Equity Ownership. O'Hara:Adelphi Values Ltd: Employment; Pfizer Inc: Consultancy. Russell:Astellas: Consultancy, Honoraria, Speakers Bureau; Pfizer Inc: Consultancy, Honoraria, Speakers Bureau; Jazz: Consultancy, Honoraria, Speakers Bureau; DSI: Consultancy, Honoraria, Speakers Bureau. Horikoshi:Pfizer Inc: Consultancy. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees.

INTRODUCTION: Patient experience data provides an opportunity to explore patient's perspectives on current and potential treatments. Gaining patient narratives on the expectation, tolerance and attitudes towards treatments can enhance clinical management and inform discussions with payers and regulatory agencies. Patient experience data is particularly beneficial in conditions where there is no clear, prescribed treatment pathway as it can contextualize joint treatment decisions made by patients and their treating physicians. Life expectancy among elderly patients with hematogical cancers such as acute myeloid leukemia (AML) is short. Patients with these conditions may be eligible for intensive chemotherapy (IC) or may face a decision between non-intensive chemotherapy (NIC) or palliative care. Further, eligible patients may not wish to undergo the taxing treatment regimens associated with IC. A targeted literature review was conducted to understand the trade-offs associated with treatment decision making and to gain patient perspectives on the value of extended overall survival (OS) in hematological cancers.

Pneumococcal conjugate vaccines (PCVs) have been available in Canada since 2001, with 13-valent PCV (PCV13) added to the infant routine immunization program throughout all Canadian provinces by 2011. The use of PCVs has dramatically reduced the burden of pneumococcal disease in Canada. As a result, decision-makers may consider switching from a more costly, higher-valent vaccine to a lower-cost, lower-valent vaccine in an attempt to allocate funds for other vaccine programs. We assessed the health and economic impact of switching the infant vaccination program from PCV13 to 10-valent PCV (PCV10) in the context of the Canadian health care system.

Introduction of pneumococcal conjugate vaccines (PCV) to the Canadian childhood routine immunization schedules (RIS) resulted in significant benefits. The 7-valent PCV was added to all provinces’ RIS between 2002 and 2006. The 10-valent PCV was used in Ontario and Quebec for 12 to 18 months in 2009 and 2010. The 13-valent PCV was marketed in 2010 and rapidly adopted by all provinces. Direct vaccine protection reduced incidence of invasive pneumococcal disease (IPD), pneumonia (PNE) and acute otitis media (AOM) in vaccinated children. Indirect vaccine protection also reduced the burden of disease (BOD) in other age groups. Sensible public funds allocation motivates continued evaluation of public health programs. Objective: To evaluate the economic impact of PCVs to Canadian society following nationwide RIS implementation. Canadian databases and literature were reviewed to obtain pre- and post-PCV incidence of IPD, PNE and AOM, as well as direct and indirect medical costs (reported in 2017 $ CAD). Case counting index date was set to Jan 2005, at which point PCV RIS were implemented for over 90% of Canadians. A steady state scenario using pre-PCV incidence rates was projected to Dec 2015 to estimate the number of cases without PCVs. Averted cases were obtained by subtracting the cases reported from the estimated case count without PCVs. Disease specific costs were assigned to averted cases and vaccine spend was subtracted from the total to obtain net savings to Canadian society. Successive implementation of PCVs on the provinces’ RIS saved 2,365 lives and resulted in net savings of CAD $203 million between Jan 2005 and Dec 2015. These savings stem from averted direct and indirect medical costs associated with IPD, PNE and AOM cases. BOD and related costs avoided by PCV use, 2005–2015 BOD and related costs avoided by PCV use, 2005–2015 Introduction of PCVs resulted in reduced pneumococcal burden of disease and net economic benefits to Canadian society. F. Peloquin, Pfizer: Employee, Salary; M. C. Breton, Pfizer: Employee, Salary; M. Wasserman, Pfizer: Employee, Salary; M. Wilson, Pfizer: Consultant, Consulting fee; C. McDade, Pfizer: Consultant, Consulting fee; R. Farkouh, Pfizer: Employee, Salary

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122175 GREENLIGHT HPS-120W VS GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A PROSPECTIVE COMPARATIVE OUTCOMES ANALYSIS Daniel Liberman, Pierre-Alain Hueber, Tal Ben-Zvi, Francois Peloquin, and Kevin C. Zorn Daniel LibermanDaniel Liberman Montreal, Canada More articles by this author , Pierre-Alain HueberPierre-Alain Hueber Montreal, Canada More articles by this author , Tal Ben-ZviTal Ben-Zvi Montreal, Canada More articles by this author , Francois PeloquinFrancois Peloquin Montreal, Canada More articles by this author , and Kevin C. ZornKevin C. Zorn Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2348AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the safety, efficacy and short-term outcome of the new 532nm Greenlight XPS 180W laser system(AMS,Minnetonka, MI,USA) in comparison to the former generation HPS-120W system for treating benign prostatic hyperplasia(BPH) in a prospective non-randomized single-centre study. METHODS From June 2010 to September 2011, 145 consecutive patients with lower urinary tract symptoms secondary to BPH were included; 60 patients were treated with HPS-120W and 85 with XPS-180W laser vaporization of the prostate. Perioperative variables, and complications were evaluated. International Prostate Symptom Score (IPSS), maximum flow rate (Q(max)), post-void residual urine (PVR), Sexual Health Inventory for Men (SHIM), and quality of life score (Qols) were recorded at baseline, 1-, 3- and 6-months. Serum PSA was assessed at baseline and 6-month follow-up. RESULTS Mean age of the patients was 69.6 years and 67.2 years for the HPS-120W system and the XPS-180W system respectively. Moreover, the mean preoperative TRUS-prostate volume was 81.7ml and 78.2 ml for the HPS and XPS systems respectively. Patient preoperative characteristics were comparable including retention rate (52% and 47% respectively). Mean operative duration (79min vs. 44.2min; p<0.01) as well as mean laser time (37min vs. 24min; p<0.01) were significantly shorter for the XPS and HPS systems, respectively. Despite comparable energy delivery, mean fiber use (1.6 vs.1.0; p<0.01) and 3L Saline bags (4.1 vs. 7; p<0.01) were significantly lower for the XPS group. There were no significant differences in 30-day dysuria, incontinence, retention, retrograde ejaculation and erectile dysfunction (all p>0.05). With a mean follow-up of 11.8 and 7.5 months for HPS and XPS groups respectively, no urethral strictures or retreatments were observed. Baseline and clinical follow-up is summarized in Figure #1. 6 month -PSA reduction was significantly greater for the XPS group compared to the HPS group (54% vs. 78%; p<0.01). CONCLUSIONS Both Greenlight systems provide safe and effective tissue vaporization properties with significant clinical improvement. The XPS-180W laser system appears to be more favorable with regards to reduced operative time, fibre need and PSA-reduction suggesting more effective tissue removal. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e877 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Liberman Montreal, Canada More articles by this author Pierre-Alain Hueber Montreal, Canada More articles by this author Tal Ben-Zvi Montreal, Canada More articles by this author Francois Peloquin Montreal, Canada More articles by this author Kevin C. Zorn Montreal, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE To examine population‐based rates of cancer‐specific and other‐cause mortality after either non‐surgical management (NSM) or nephrectomy, in patients with small renal masses, as several reports from selected institutions support the applicability of surveillance in patients with small renal masses, but there are no population‐based studies confirming the general applicability of this therapy. PATIENTS AND METHODS Of 43 143 patients with renal cell carcinoma identified in the 1988–2004 Surveillance, Epidemiology and End Results database, 10 291 had localized small renal masses (≤4 cm) and were offered NSM (433, 4.2%) or nephrectomy (9858, 95.8%). Univariable matched and multivariable unmatched competing‐risks regression models were used in the analyses. RESULTS Cumulative incidence plots based on unmatched data, where the effect of other‐cause mortality was controlled for, showed a 5.2%, 6.5% and 9.4% survival benefit for nephrectomy vs NSM at 1, 2 and 5 years after nephrectomy or diagnosis, respectively. The same magnitude of the benefit (4.5%, 5.6% and 8.0%) persisted in analyses matched for age, tumour size and year of diagnosis or of nephrectomy. Finally, in multivariable analyses, treatment type, age, tumour size and year of diagnosis or of nephrectomy were independent predictors. CONCLUSION Relative to nephrectomy, NSM appears to undermine the overall and cancer‐specific survival of patients with small renal masses by as much as 9.4%, at 5 years.

Purpose: To test the discrimination and calibration properties of the newly developed 2007 Partin Tables in two European cohorts with localized prostate cancer.Methods: Data on clinical and pathologic characteristics were obtained for 1,064 men treated with radical prostatectomy at the Creteil University Health Center in France (n = 839) and at the Milan University Vita-Salute in Italy (n = 225). Overall discrimination was assessed with receiver operating characteristic curve analysis, which quantified the accuracy of stage predictions for each center. Calibration plots graphically explored the relationship between predicted and observed rates of extracapsular extension (ECE), seminal vesicle invasion (SVI) and lymph node invasion (LNI).Results: The rates of ECE, SVI, and LNI were 28%, 14%, and 2% in the Creteil cohort vs. 11%, 5%, and 5% in the Milan cohort. In the Creteil cohort, the accuracy of ECE, SVI, and LNI prediction was 61%, 71%, and 82% vs. 66%, 92% and 75% for the Milan cohort. Important departures were recorded between Partin Tables' predicted and observed rates of ECE, SVI, and LNI within both cohorts.Conclusions: The 2007 Partin Tables demonstrated worse performance in European men than they originally did in North American men. This indicates that predictive models need to be externally validated before their implementation into clinical practice. (c) 2009 Elsevier Inc.

OBJECTIVE:To examine the cancer-specific mortality (CSM) of patients with T4N0-2M0 renal cell carcinoma (RCC) treated with either nephrectomy (RN) or no surgery (NS).PATIENTS AND METHODS:Of 43 143 patients with RCC identified in the Surveillance, Epidemiology and End Results database, 310 had tumours involving adjacent organs with no evidence of distant metastases (T4NanyM0) and had RN (246, 79.4%) or NS (64, 20.6%). Kaplan-Meier analyses, Cox regression and competing-risks regression models were used to compare the effect of RN vs NS on CSS.RESULTS:In patients with T4N0 disease the median survival benefit associated with RN vs NS was 42 months (48 vs 6 months, P < 0.001). Conversely, the median survival in patients T4N1-2 was no different between RN and NS (9.3 vs 9.1 months, P = 0.9). Multivariable analyses in T4N0 cases indicated a substantial survival disadvantage for patients having NS vs RN (hazard ratio 4.8, P < 0.001). Conversely, in patients with N1-2 stages, the CSS was virtually the same for NS and RN (hazard ratio 0.9, P = 0.9). Competing-risks regression models confirmed the benefit of RC in patients with T4N0 and the lack of benefit in those with T4N1-2 disease, after controlling for other-cause mortality.CONCLUSION:Our data suggest a survival benefit in patients with T4N0 RCC treated with RC. By contrast, RN seems to have no effect on survival in patients with evidence of nodal metastases.

PURPOSE:A recent multi-institutional analysis of 995 patients treated for renal cell cancer questioned the relationship between tumor size and the synchronous metastasis rate. We revisited the hypothesis that metastatic potential is unrelated to tumor size.MATERIALS AND METHODS:We tested the relationship between tumor size and synchronous metastasis in 22,204 patients with T1a and T1b renal cell cancer diagnosed and/or treated with nephrectomy for clear cell, papillary or chromophobe histological subtypes in 1 of 9 Surveillance, Epidemiology and End Results registries between 1988 and 2004.RESULTS:In the study population the synchronous metastasis rate was 9.6%, including 5.6% vs 14.2% for T1a vs T1b. Stratification by 1 cm tumor size intervals revealed that the rate increased with increasing tumor size, that is 4.8% at 1.0 cm or less, 4.2% at 1.1 to 2.0 cm, 4.9% at 2.1 to 3.0 cm, 7.1% at 3.1 to 4.0 cm, 12.1% at 4.1 to 5.0 cm, 13.3% at 5.1 to 6.0 cm and 18.4% 6.1 to 7.0 cm (chi-square trend p <0.001). Cubic spline analysis showed that tumor size was virtually linearly related to the synchronous metastasis rate. Stratification by histological subtype in patients treated with nephrectomy revealed that clear cell renal cell cancer was most frequently associated with synchronous metastasis. Finally, tumor size was an independent predictor of synchronous metastasis in multivariate regression models adjusted for age, gender, histological subtype and year of diagnosis quartiles.CONCLUSIONS:Our study confirms that tumor size is an important determinant of the likelihood of synchronous metastasis in patients with T1a and T1b renal cell cancer. The synchronous metastasis rate directly increases with increasing tumor size. Even patients with small renal masses are at risk for synchronous metastasis and patients with clear cell renal cell cancer are at highest risk.

Purpose: Large variability exists in the rates of perioperative mortality after cystectomy. Contemporary estimates range from 0.7% to 5.6%. We tested several predictors of perioperative mortality and devised a model for individual perioperative mortality prediction.Materials and Methods: We relied on life tables to quantify 30, 60 and 90-day mortality rates according to age, gender, stage (localized vs regional), grade, type of surgery (partial vs radical cystectomy), year of cystectomy and histological bladder cancer subtype. We fitted univariable and multivariable logistic regression models using 5,510 patients diagnosed with bladder cancer and treated with partial or radical cystectomy within 4 SEER (Surveillance, Epidemiology, and End Results) registries between 1984 and 2004. We then externally validated the model on 5,471 similar patients from 5 other SEER registries.Results: At 30, 60 and 90 days the perioperative mortality rates were 1.1%, 2.4% and 3.9%, respectively. Age, stage and histological subtype represented statistically significant and independent predictors of 90-day mortality. The combined use of these 3 variables and of tumor grade resulted in the most accurate model (70.1%) for prediction of individual probability of 90-day mortality after cystectomy.Conclusions: The accuracy of our model could potentially be improved with the consideration of additional parameters such as surgical and hospital volume or comorbidity. While better models are being developed and tested we suggest the use of the current model in individual decision making and in informed consent considerations because it provides accurate predictions in 7 of 10 patients.

INTRODUCTIONElevated body mass index (BMI) may predispose to several pelvic pathologies.AIMSWe tested the association between BMI and five end points, namely, (i) erectile dysfunction (ED); (ii) lower urinary tract symptoms (LUTS); (iii) chronic prostatitis-associated pain (CPP); and ejaculatory dysfunction that is subdivided between (iv) pain/discomfort on ejaculation; and (v) subjectively decreased ejaculate volume.METHODSAge, height, and weight were prospectively recorded in a cohort of 590 consecutive healthy men undergoing prostate cancer screening. Continuously coded and categorized BMI (World Health Organization classification) were studied.MAIN OUTCOME MEASURESAge-adjusted analyses relied on logistic and linear regression models, according to data type.RESULTSThe average age was 54.1 years (range 30-83). Of all, 296 were overweight (50.2%, BMI 25-29.9 kg/m(2)) and 85 were obese (14.4%, BMI > or = 30 kg/m(2)). After age adjustment, elevated continuously coded BMI (P < 0.001) and elevated categorized BMI (P = 0.01) were associated with worse erectile function. Conversely, after age adjustment, elevated continuously coded BMI (P = 0.02) and elevated categorized BMI (P = 0.05) were associated with a lower rate of subjectively decreased ejaculate volume. Finally, after age adjustment, elevated categorically coded BMI was related to lower rates of CPP (P < 0.001) and to a lower rate of pain/discomfort on ejaculation (P = 0.03).CONCLUSIONSIn men undergoing prostate cancer screening, the effect of BMI on the five end points is not invariably detrimental. Elevated BMI may predispose to ED, but may also decrease the rate of pain/discomfort on ejaculation and may lower the reported rate of subjectively decreased ejaculate volume. Finally, it appeared to have no effect on LUTS.