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Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society.

Background and Objectives Epidural analgesia may increase survival after cancer surgery by reducing recurrence. This population-based study compared survival and treated recurrence after gastric cancer resection between patients receiving epidurals and those who did not. Methods We used the linked federal Surveillance, Epidemiology, and End Results (SEER) Program/Medicare database to identify patients aged ≥66 with nonmetastatic gastric carcinoma diagnosed 1996–2005 who underwent resection. Exclusions included diagnosis at autopsy, no Medicare Part B, familial cancer syndrome, emergency surgery, and laparoscopic procedures. Epidurals were identified by CPT codes. Treated recurrence was defined as chemotherapy ≥ 16 months and/or radiation ≥ 12 months after surgery. Recurrence was compared by conditional logistic regression. Survival was compared via marginal Cox proportional hazards regression. Results We identified 2745 patients, 766 of whom had epidural codes. Patients receiving epidurals were more likely to have regional disease, be white, and live in areas with relatively high socioeconomic status. Overall treated recurrence was 25.6% (27.5% epidural and 24.9% non-epidural). In the adjusted logistic regression, there was no difference in recurrence (odds ratio [OR] 1.40, 95% CI 0.96 to 2.05). Median survival did not differ: 28.1 months (95% CI 24.8 to 32.3) in the epidural versus 27.4 months (95% CI 24.8 to 30.0) in the non-epidural groups. The marginal Cox models showed no association between epidural use and mortality (adjusted HR 0.93, 95% CI 0.84 to 1.03). Conclusions There was no difference between groups regarding treated recurrence or survival. Whether this is true or simply a result of insufficient power is unclear. Prospective studies are needed to provide stronger evidence.

Background Randomized trials demonstrate the cardioprotective effects of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA). We evaluated their relative cardiovascular effectiveness in routine care populations with a broad spectrum of atherosclerotic cardiovascular diseases (CVDs) or heart failure (HF). Methods and Results We identified Medicare beneficiaries from 2013 to 2017, aged >65 years, initiating SGLT2i (n=24 747) or GLP‐1RA (n=22 596) after a 1‐year baseline. On the basis of diagnoses during baseline, we classified patients into: (1) no HF or CVD, (2) HF but no CVD, (3) no HF but CVD, and (4) both HF and CVD. We identified hospitalized HF and atherosclerotic CVD outcomes from drug initiation until treatment changes, death, or disenrollment. We estimated propensity score–weighted 2‐year risk ratios (RRs) and risk differences, accounting for measured confounding, informative censoring, and competing risk. In patients with no CVD or HF, SGLT2i reduced the hospitalized HF risk compared with GLP‐1RA (propensity score–weighted RR, 0.65; 95% CI, 0.43–0.96). The association was strongest in those who had HF but no CVD (RR, 0.48; 95% CI, 0.25–0.85). The combined myocardial infarction, stroke, and mortality outcome risk was slightly higher for SGLT2i compared with GLP‐1RA in those without CVD or HF (RR, 1.31; 95% CI, 1.09–1.56). The association was favorable toward SGLT2i in subgroups with a history of HF. Conclusions SGLT2i reduced the cardiovascular risk versus GLP‐1RA in patients with a history of HF but no CVD. Atherosclerotic CVD events were less frequent with GLP‐1RA in those without prior CVD or HF.