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PubMed · 10388013

Tempus Fugit.

Abstract

In northern hemispheres, October heralds the onset of autumn and we are reminded that its cool breezes will soon blow wintry as 1996 draws to a close. Tempus fugit! The swift passage of time also reminds us that the first volume of The Oncologist will soon conclude with its sixth issue in December. However, before 1996 becomes history, let's pause and reflect on the pledges we made to our readership at the beginning of the year. The Founding Editors conceived the Journal to provide authoritative, topical, innovative articles in an attractive format for a very special reader: the busy, practicing physician who cares for cancer patients. Our commitment is to critically review and publish papers designed to interpret the vast amounts of data available to physicians. As the famed radiotherapist and Founding Editor, Eli Glatstein, summarized, "The Oncologist emphasizes the interpretation rather than the data." The Oncologist to date has published more than forty manuscripts from international authorities. The inaugural issue featured, among other highly acclaimed papers, "Locally Advanced Breast Cancer," by Valero, Buzdar and Hortobagyi, and David Kuter's "Thrombopoietin: Biology and Clinical Applications." Fidias, Chabner and Grossbard contributed "Purine Analogs for the Treatment of Low-Grade Lymphoproliferative Disorders" in the next issue, and Pavletic and Armitage proffered an update on "Bone Marrow Transplantation for Cancer." Issue 4 highlighted Jemi Olak and Arthur Ng's "Diagnosis and Management of Early-Stage Non-Small Cell Lung Cancer," as well as "Multimodality Therapy for Esophageal Cancer" by Siewert, Stein and Fink. In this current issue, "Dose Intensity of Chemotherapy for Childhood Cancers," by Smith, Abrams, Trimble and Ungerleider, and "Surgical Sphincter Preservation in Rectal Cancer" by Peter M. Schlag present contemporary and authoritative views of two important clinical topics which also document the Journal's intent to discuss both adult and pediatric cancer care. Our Meet The Professor section is fast becoming a popular feature which attracts comments from readers and responses from the author professor. We call your attention to Professor Barrie R. Cassileth's fascinating article, "Alternative and Complementary Cancer Treatments," and her commentary in this issue. The Physician Education section has presented hematopoiesis through informative and beautifully illustrated papers with texts by distinguished hematologists and molecular biologists. In this issue, we feature the first Patient Care section, From The Bethesda Post, wherein clinical trials and experimental treatments are announced. In cooperation with The Cancer Letter, The Oncologist News Bulletin presents late-breaking news pertinent to the world's cancer care community. With this issue, we have instituted an addition to this section, featuring information from Memorial Sloan-Kettering Cancer Center on a study involving Ashkenazi Jewish women. We urge cancer centers, pharmaceutical and biotechnology companies to avail themselves of this section by sending our editorial office your newsworthy reports. We hope that our readers are benefiting from the Journal and enjoying the art which has graced it. In order to assess how well we are fulfilling our pledges to our readership, we need to hear from you. Tell us how we can make The Oncologist more relevant to your medical practice. We promise to share your comments with our Editorial Board to further enhance the Journal. In so doing, we will draw closer to fulfilling our pledge to you, our readers.

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BibTeXRIS

MJ Murphy. 1996. Tempus Fugit.. https://pubmed.ncbi.nlm.nih.gov/10388013/

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Effectiveness of high-dose versus standard-dose influenza vaccines against hospitalisation according to frailty risk: a prespecified analysis of the randomised trial DANFLU-2.

BACKGROUND: Frailty is a major risk factor for influenza-related complications and can influence vaccine effectiveness. We aimed to assess the relative vaccine effectiveness (rVE) of high-dose (HD-IIV) versus standard-dose inactivated influenza vaccine (SD-IIV) in older adults aged 65 years or older according to frailty risk. METHODS: This study was a prespecified analysis of DANFLU-2, an open-label, individually randomised trial, conducted in Denmark during three consecutive influenza seasons (2022-23, 2023-24, and 2024-25). Adults aged 65 years or older were randomised (1:1) to the HD-IIV or SD-IIV group. The primary endpoint was hospitalisation for influenza or pneumonia. Frailty was defined according to the validated Hospital Frailty Risk Score (HFRS) based on ICD-10 codes within 10 years before randomisation. Participants were stratified into three HFRS categories, namely low (<5 points), intermediate (5-15 points), and high (>15 points) frailty risk. The rVE of HD-IIV versus SD-IIV against the primary endpoint was assessed across prespecified HFRS categories and treating HFRS as a continuous variable. Pearson's chi-square test was used to compare safety events across frailty risk groups and randomisation groups. FINDINGS: Among 332&#x2009;438 randomised participants (mean age 73&#xb7;7 years [SD 5&#xb7;8]; 161&#x2009;538 [48&#xb7;6%] were female), 276&#x2009;173 (83&#xb7;1%) had low frailty risk, 52&#x2009;395 (15&#xb7;8%) had intermediate frailty risk, and 3861 (1&#xb7;2%) had high frailty risk. The primary endpoint of hospitalisation for influenza or pneumonia occurred in 1424 (0&#xb7;5%) of 276&#x2009;173 participants with low frailty risk, 761 (1&#xb7;5%) of 52&#x2009;395 with intermediate frailty risk, and 163 (4&#xb7;2%) of 3861 with high frailty risk (relative risk [RR] for intermediate vs low frailty risk 2&#xb7;8 [95% CI 2&#xb7;6-3&#xb7;1]; RR for high vs low frailty risk 8&#xb7;2 [7&#xb7;0-9&#xb7;6]). HFRS as a continuous variable significantly modified the effect of HD-IIV versus SD-IIV against the primary endpoint with higher rVE estimates with increasing HFRS (pinteraction=0&#xb7;020). The rVE was 0&#xb7;2% (95% CI -10&#xb7;8 to 10&#xb7;2) among those with low frailty risk, 13&#xb7;1% (-0&#xb7;4 to 24&#xb7;8) among those with intermediate frailty risk, and 19&#xb7;9% (-10&#xb7;3 to 42&#xb7;1) among those with high frailty risk. No significant interaction was observed when HFRS was assessed according to the prespecified categorical frailty groups (pinteraction=0&#xb7;17). The proportion of participants with at least one serious adverse event increased across frailty risk groups (13&#x2009;366 [4&#xb7;8%] of 275&#x2009;795 for low frailty risk, 5475 [10&#xb7;5%] of 52&#x2009;315 for intermediate frailty risk, and 777 [20&#xb7;2%] of 3850 for high frailty risk; p<0&#xb7;0001), with similar proportions of serious adverse events in the HD-IIV and SD-IIV groups for each frailty risk group. INTERPRETATION: Among adults aged 65 years or older in Denmark, frailty risk might modify the effects of HD-IIV versus SD-IIV against hospitalisation for influenza or pneumonia, with higher rVE estimates with increasing frailty risk. These findings might support considering high-dose influenza vaccines for frail older adults. However, effect modification was not evident when frailty was assessed using prespecified categorical subgroups, and subgroup-specific estimates were imprecise, with 95% CIs crossing the null. These results should be considered exploratory, warranting further investigation. FUNDING: The DANFLU-2 trial was funded by Sanofi.

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