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Suh SY, Won SH, Hiratsuka Y, Choi SE, Cheng SY, Mori M, Chen PJ, Yamaguchi T, Morita T, Tsuneto S, LeBlanc TW, Kim SH, Yoon SJ, Lee ES, Hwang SW. Assessment of Changes in Symptoms Is Feasible and Prognostic in the Last Weeks of Life: An International Multicenter Cohort Study. J Palliat Med 2021; 25:388-395. [PMID: 34668798 DOI: 10.1089/jpm.2021.0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Symptoms are not typically part of established various prognostic factors and scoring systems but are among the most frequently assessed issues in patient care. Objectives: To evaluate that, changes in symptoms can provide additional useful prognostic information. Design: A secondary analysis of an international cohort study in Japan, Korea, and Taiwan. Setting/Subjects: Subjects were adult patients with advanced cancer (n = 2074) who were admitted to 37 palliative care units (PCUs) in 3 countries from January 2017 to September 2018. Measurements: Symptoms (dyspnea, fatigue, dry mouth, and drowsiness) were assessed at admission and one-week later. Dyspnea was assessed by the presence of resting and exertional dyspnea, whereas other symptoms were assessed using the Integrated Palliative care Outcome Scales (IPOS) (range 0-4). For analysis, we grouped patients by symptom change, as either Improved, Stable, or Worsened (by having at least a one increment decrease, no change, or at least a one increment increase, respectively). Results: Worsened groups had the shortest survival (median survival 15-21 days) compared with those with Improved (median survival 23-31 days) and Stable symptoms (median survival 27-29 days) across all four symptoms (dyspnea, fatigue, dry mouth, and drowsiness). Survival differences were statistically significantly different across all three groups for all symptoms (all p < 0.001). Interestingly, Improved symptoms were associated with similar survival compared with Stable groups, with no statistical differences. Conclusions: Worsened symptoms at one week after admission were useful predictors of survival for patients with advanced cancer in PCUs during the final weeks of life. Longitudinal assessments are needed to reflect passage of time as well as impact of treatments.
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Affiliation(s)
- Sang-Yeon Suh
- Department of Medicine, Dongguk University-Seoul, Seoul, South Korea.,Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang si, South Korea
| | - Seon-Hye Won
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang si, South Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University-Seoul, Seoul, South Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | | | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Thomas W LeBlanc
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Sun Wook Hwang
- Department of Family Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Enteral Nutrition Combined with Improved-Sijunzi Decoction Shows Positive Effect in Precachexia Cancer Patients: A Retrospective Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7357521. [PMID: 34603476 PMCID: PMC8486522 DOI: 10.1155/2021/7357521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
Background Cancer has been considered as the leading cause of death in the world. In patients with cancer, up to 80% display a cachectic period after diagnosis. Cachexia is known to have a negative impact on function, treatment tolerance, higher rates of hospitalizations, and mortality. Anorexia is often used as a warning sign of precachexia. Long-term anorexia may lead to malnutrition and, then, accelerate the occurrence of cachexia. A safe and effective treatment, which can both improve appetite and assist nutritional support for precachexia cancer patients shows its particular important role. Methods A retrospective analysis comparing the different therapeutic effects on precachexia cancer patients with anorexia-malnutrition. We recorded 46 patients with the improved-Sijunzi decoction combined with enteral nutrition emulsion (ISJZ group) and 35 patients with single enteral nutrition emulsion (SEN group). The different therapeutic effects of the two groups were observed by recording indicators before and 2 weeks after treatment, including patient-generated subjective global assessment score, quality of life score, Karnofsky performance status scale, Eastern cooperative oncology group scale standard and traditional Chinese medicine syndrome, daily total dietary intake, red blood cells, hemoglobin, prealbumin, albumin, total protein cholinesterase, C-reactive protein, leukocytes, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, urea nitrogen, and creatinine. Results ISJZ group exhibited prominent improvement of traditional Chinese medicine syndrome (TCMS), nutritional condition, and quality of life compared with the SEN group (QOL: p=0.0001, PG-SGA: p=0.019, dietary intake: p=0.0001, TCMS: p=0.0001). The levels of HGB (p=0.006), PAlb (p=0.001), Alb (p=0.0001), TP (p=0.008), and ChE (p=0.0001) in the ISJZ group were higher than the SEN group after treatment. Moreover, the ratios of CRP/ALB (p=0.028) and CRP/PALB (p=0.005) in the two groups have obvious differences; they were lower for the ISJZ group than the SEN group. Conclusions Enteral nutrition combined with ISJZ decoction is an effective treatment in precachexia cancer patients for the prevention of cachexia. This treatment therapy can alleviate the inflammatory response, improve malnutrition state, and promote the performance status. Tianjin Medical University Cancer Institute and Hospital approved this study (Trial No. 1913).
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Seow H, Tanuseputro P, Barbera L, Earle CC, Guthrie DM, Isenberg SR, Juergens RA, Myers J, Brouwers M, Tibebu S, Sutradhar R. Development and validation of a prediction model of poor performance status and severe symptoms over time in cancer patients (PROVIEW+). Palliat Med 2021; 35:1713-1723. [PMID: 34128429 PMCID: PMC8532207 DOI: 10.1177/02692163211019302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Predictive cancer tools focus on survival; none predict severe symptoms. AIM To develop and validate a model that predicts the risk for having low performance status and severe symptoms in cancer patients. DESIGN Retrospective, population-based, predictive study. SETTING/PARTICIPANTS We linked administrative data from cancer patients from 2008 to 2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). Using the derivation cohort, we developed a multivariable logistic regression model to predict the risk of an outcome at 6 months following diagnosis and recalculated after each of four annual survivor marks. Model performance was assessed using discrimination and calibration plots. Outcomes included low performance status (i.e. 10-30 on Palliative Performance Scale), severe pain, dyspnea, well-being, and depression (i.e. 7-10 on Edmonton Symptom Assessment System). RESULTS We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%); and lung (13%)). At diagnosis, the predicted risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13%, and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms); the corresponding discrimination for each outcome model had high AUCs of 0.807, 0.713, 0.709, 0.790, and 0.723, respectively. Generally these covariates increased the outcome risk by >10% across all models: lung disease, dementia, diabetes; radiation treatment; hospital admission; pain; depression; transitional performance status; issues with appetite; or homecare. CONCLUSIONS The model accurately predicted changing cancer risk for low performance status and severe symptoms over time.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Peter Tanuseputro
- Division of Palliative Care, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | - Craig C Earle
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Dawn M Guthrie
- Department of Kinesiology and Physical Education and Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sarina R Isenberg
- Division of Palliative Care, Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jeffrey Myers
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Semra Tibebu
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Hiramatsu Y, Kumamaru H, Kikuchi H, Usune S, Kamiya K, Miyata H, Konno H, Kakeji Y, Kitagawa Y, Takeuchi H. Significance of the Glasgow prognostic score for short-term surgical outcomes: A nationwide survey using the Japanese National Clinical Database. Ann Gastroenterol Surg 2021; 5:659-668. [PMID: 34585050 PMCID: PMC8452482 DOI: 10.1002/ags3.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/18/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
AIM Preoperative inflammation-based Glasgow prognostic score (GPS) is a useful tool for predicting long-term prognosis in cancer patients. However, its association with postoperative short-term outcomes remains unknown. The aim of this study is to investigate the association between GPS and postoperative morbidity and mortality among patients undergoing surgery for various gastrointestinal malignancies. METHODS Using the Japanese National Clinical Database, we analyzed the records of 312 357 patients with gastrointestinal malignancy who underwent six typical elective surgeries, including esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, and pancreaticoduodenectomy, between January 2015 and December 2018. We assigned GPS of 0, 1, or 2 to patients with no, one, or both decreased albumin and elevated C-reactive protein levels, respectively. We investigated the relationship of GPS with operative morbidity and mortality for each procedure with adjustments for patients' demographics, preoperative status, comorbidities, and cancer stages. RESULTS Crude operative morbidity was significantly higher for GPS 1 and 2 than GPS 0 patients in all procedures except pancreaticoduodenectomy. The postoperative length of hospital stay was significantly longer for GPS 1 and 2 patients in all procedures (P < .001). Operative mortality was also higher for GPS 1 and 2 patients in all procedures. The associations remained significant after adjustments for potential confounders of age, sex, physical status, tumor classification, use of preoperative therapy, and comorbidities. CONCLUSION This nationwide study provides solid evidence on the strong association between GPS and postoperative outcomes.
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Affiliation(s)
- Yoshihiro Hiramatsu
- The Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
- Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
- Department of Perioperative Functioning Care and SupportHamamatsu University School of MedicineHamamatsuJapan
| | - Hiraku Kumamaru
- Department of Healthcare Quality AssessmentGraduate School of MedicineUniversity of TokyoBunkyo‐kuJapan
| | - Hirotoshi Kikuchi
- The Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
- Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
| | - Shiyori Usune
- Department of Healthcare Quality AssessmentGraduate School of MedicineUniversity of TokyoBunkyo‐kuJapan
| | - Kinji Kamiya
- The Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
- Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of MedicineUniversity of TokyoBunkyo‐kuJapan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
- Hamamatsu University School of MedicineHamamatsuJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
| | - Hiroya Takeuchi
- The Japanese Society of Gastroenterological SurgeryMinato‐kuJapan
- Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
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Sagberg LM, Jakola AS, Reinertsen I, Solheim O. How well do neurosurgeons predict survival in patients with high-grade glioma? Neurosurg Rev 2021; 45:865-872. [PMID: 34382108 PMCID: PMC8827174 DOI: 10.1007/s10143-021-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/16/2021] [Accepted: 07/18/2021] [Indexed: 12/01/2022]
Abstract
Due to the lack of reliable prognostic tools, prognostication and surgical decisions largely rely on the neurosurgeons’ clinical prediction skills. The aim of this study was to assess the accuracy of neurosurgeons’ prediction of survival in patients with high-grade glioma and explore factors possibly associated with accurate predictions. In a prospective single-center study, 199 patients who underwent surgery for high-grade glioma were included. After surgery, the operating surgeon predicted the patient’s survival using an ordinal prediction scale. A survival curve was used to visualize actual survival in groups based on this scale, and the accuracy of clinical prediction was assessed by comparing predicted and actual survival. To investigate factors possibly associated with accurate estimation, a binary logistic regression analysis was performed. The surgeons were able to differentiate between patients with different lengths of survival, and median survival fell within the predicted range in all groups with predicted survival < 24 months. In the group with predicted survival > 24 months, median survival was shorter than predicted. The overall accuracy of surgeons’ survival estimates was 41%, and over- and underestimations were done in 34% and 26%, respectively. Consultants were 3.4 times more likely to accurately predict survival compared to residents (p = 0.006). Our findings demonstrate that although especially experienced neurosurgeons have rather good predictive abilities when estimating survival in patients with high-grade glioma on the group level, they often miss on the individual level. Future prognostic tools should aim to beat the presented clinical prediction skills.
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Affiliation(s)
- Lisa Millgård Sagberg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Neurosurgery, St Olavs University Hospital, Olav Kyrres gt 17, 7006, Trondheim, Norway.
| | - Asgeir S Jakola
- Department of Neurosurgery, St Olavs University Hospital, Olav Kyrres gt 17, 7006, Trondheim, Norway.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Ingerid Reinertsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St Olavs University Hospital, Olav Kyrres gt 17, 7006, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Naszai M, Kurjan A, Maughan TS. The prognostic utility of pre-treatment neutrophil-to-lymphocyte-ratio (NLR) in colorectal cancer: A systematic review and meta-analysis. Cancer Med 2021; 10:5983-5997. [PMID: 34308567 PMCID: PMC8419761 DOI: 10.1002/cam4.4143] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 12/24/2022] Open
Abstract
Background Inflammation is a hallmark of cancer, and systemic markers of inflammation are increasingly recognised as negative prognostic factors for clinical outcome. Neutrophil‐to‐lymphocyte ratio (NLR) is readily available from routine blood testing of patients diagnosed with cancer. Methods Peer‐reviewed publications from PubMed/MEDLINE, Web of Science and EMBASE were identified according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Hazard ratios (HR) for overall survival (OS) and surrogate endpoints (SE; comprising disease‐, recurrence‐ and progression‐free survival) were pooled using a random effects model. Additional analysis was carried out to further investigate NLR as an independent prognostic factor and account for heterogeneity. Results Seventy‐one eligible papers comprising 32,788 patients were identified. High NLR was associated with poor clinical outcomes. Significant publication bias was observed, and larger studies also adjusted for more covariates. Correcting for publication bias in multivariate studies brought our best estimate for true effect size to HR = 1.57 (95% CI 1.39–1.78; p < 0.0001) for OS and to HR = 1.38 (95% CI 1.16–1.64; p = 0.0003) for SE. Conclusions NLR is confirmed as an easily available prognostic biomarker in colorectal cancer, despite the limitations of some studies previously reporting this finding. As such, it should be routinely collected in prospective clinical trials. While more standardised and rigorous large‐scale studies are needed before high NLR can be fully assessed as an independent predictor of CRC progression and outcome, the data suggest that it may be used to highlight individuals with tumour‐promoting inflammatory context.
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Affiliation(s)
- Mate Naszai
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Alina Kurjan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Timothy S Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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Lee SH, Lee JG, Choi YJ, Seol YM, Kim H, Kim YJ, Yi YH, Tak YJ, Kim GL, Ra YJ, Lee SY, Cho YH, Park EJ, Lee Y, Choi J, Lee SR, Kwon RJ, Son SM. Prognosis palliative care study, palliative prognostic index, palliative prognostic score and objective prognostic score in advanced cancer: a prospective comparison. BMJ Support Palliat Care 2021:bmjspcare-2021-003077. [PMID: 34215569 DOI: 10.1136/bmjspcare-2021-003077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Predicting how long a patient with far advanced cancer has to live is a significant part of hospice and palliative care. Various prognostic models have been developed, but have not been fully compared in South Korea. OBJECTIVES We aimed to compare the accuracy of the Prognosis in Palliative Care Study (PiPS), Palliative Prognostic Index (PPI), Palliative Prognostic Score (PaP) and Objective Prognostic Score (OPS) for patients with far advanced cancer in a palliative care unit in South Korea. METHODS This prospective study included patients with far advanced cancer who were admitted to a single palliative care unit at the National University Hospital. Variables for calculating the prognostic models were recorded by a palliative care physician. The survival rate was estimated using the Kaplan-Meier method. The sensitivity, specificity, positive predictive value and negative predictive value of each model were calculated. RESULTS A total of 160 patients participated. There was a significant difference in survival rates across all groups, each categorised through the five prognostic models. The overall accuracy (OA) of the prognostic models ranged between 54.5% and 77.6%. The OA of clinicians' predictions of survival ranged between 61.9% and 81.3%. CONCLUSION The PiPS, PPI, PaP and OPS were successfully validated in a palliative care unit of South Korea. There was no difference in accuracy between the prognostic models, and OA tended to be lower than in previous studies.
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Affiliation(s)
- Seung Hun Lee
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Jeong Gyu Lee
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Young Jin Choi
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Young Mi Seol
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Hyojeong Kim
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Yun Jin Kim
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Yu Hyeon Yi
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Young Jin Tak
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
| | - Gyu Lee Kim
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
| | - Young Jin Ra
- Family Medicine, Pusan National University Hospital, Busan, Korea (the Republic of)
| | - Sang Yeoup Lee
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
- Department of Medical Education, Pusan National University School of Medicine, Yangsan, Korea (the Republic of)
| | - Young Hye Cho
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Eun Ju Park
- Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea (the Republic of)
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Youngin Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Jungin Choi
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Sae Rom Lee
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Ryuk Jun Kwon
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Soo Min Son
- Department of Family Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
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Al-Rashdan A, Sutradhar R, Nazeri-Rad N, Yao C, Barbera L. Comparing the Ability of Physician-Reported Versus Patient-Reported Performance Status to Predict Survival in a Population-Based Cohort of Newly Diagnosed Cancer Patients. Clin Oncol (R Coll Radiol) 2021; 33:476-482. [DOI: 10.1016/j.clon.2021.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/30/2020] [Accepted: 01/14/2021] [Indexed: 02/01/2023]
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Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews. BMC Palliat Care 2021; 20:89. [PMID: 34162377 PMCID: PMC8223342 DOI: 10.1186/s12904-021-00782-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. METHODS Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. RESULTS A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers' outcomes. The evidence of interventions delivered across other settings was generally inconsistent. CONCLUSIONS Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.
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Yoon SJ, Suh SY, Hui D, Choi SE, Tatara R, Watanabe H, Otani H, Morita T. Accuracy of the Palliative Prognostic Score With or Without Clinicians' Prediction of Survival in Patients With Far Advanced Cancer. J Pain Symptom Manage 2021; 61:1180-1187. [PMID: 33096217 DOI: 10.1016/j.jpainsymman.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
CONTEXT Previous studies suggest that clinicians' prediction of survival (CPS) may have reduced the accuracy of objective indicators for prognostication in palliative care. OBJECTIVES We aimed to examine the accuracy of CPS alone, compared to the original Palliative Prognostic Score (PaP), and five clinical/laboratory variables of the PaP in patients with far advanced cancer. METHODS We compared the discriminative accuracy of three prediction models (the PaP-CPS [the score of the categorical CPS of PaP], PaP without CPS [sum of the scores of only the objective variables of PaP], and PaP total score) across 3 settings: inpatient palliative care consultation team, palliative care unit, and home palliative care. We computed the area under receiver operating characteristic curve (AUROC) for 30-day survival and concordance index (C-index) to compare the discriminative accuracy of these three models. RESULTS We included a total of 1534 subjects with median survival of 34.0 days. The AUROC and C-index in the three settings were 0.816-0.896 and 0.732-0.799 for the PaP total score, 0.808-0.884 and 0.713-0.782 for the PaP-CPS, and 0.726-0.815 and 0.672-0.728 for the PaP without CPS, respectively. The PaP total score and PaP-CPS showed similar AUROCs and C-indices across the three settings. The PaP total score had significantly higher AUROCs and C-indices than the PaP without CPS across the three settings. CONCLUSION Overall, the PaP total score, PaP-CPS, and PaP without CPS showed good discriminative performances. However, the PaP total score and PaP-CPS were significantly more accurate than the PaP without CPS.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sang-Yeon Suh
- Department of Medicine, Dongguk University-Seoul, Seoul, South Korea; Department of Family Medicine, Hospice and Palliative Care Center, Dongguk University Ilsan Hospital, Goyang-si, South Korea.
| | - David Hui
- Division of Cancer Medicine, Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sung-Eun Choi
- Department of Statistics, Dongguk University-Seoul, Seoul, South Korea
| | - Ryohei Tatara
- Department of Palliative Medicine, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Hiroyuki Otani
- Department of Palliative Care Team and Palliative and Supportive Care, National Kyushu Cancer Center, Fukuoka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Prompantakorn P, Angkurawaranon C, Pinyopornpanish K, Chutarattanakul L, Aramrat C, Pateekhum C, Dejkriengkraikul N. Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study. BMC Palliat Care 2021; 20:74. [PMID: 34039322 PMCID: PMC8157447 DOI: 10.1186/s12904-021-00773-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 11/12/2022] Open
Abstract
Background Palliative Performance Scale (PPS) has been frequently used to estimate the survival time of palliative care patients. The objective was to determine the associations between the PPS and survival time among cancer and non-cancer patients in Thailand. Methods This is a retrospective cohort study. All in-patient adults who received a palliative care consultation at Chiang Mai University Hospital between 1 July 2018 to 31 July 2019 were included in the study and were followed-up until 26 June 2020. The Palliative Performance Scale was assessed using the validated Thai-Palliative Performance Scale for Adults. Survival analysis was used to determine the association between the Palliative Performance Scale and survival time among cancer and non-cancer patients. Results Out of 407 patients, 220 were male (54.1%). There were 307 cancer patients (75.4%) and 100 non-cancer patients (24.6%). The PPS and survival time in cancer patients were significantly correlated. Cancer patients with PPS 10, 20, 30, 40–60, and 70–80% had a median survival time of 2, 6, 13, 39, and 95 days, respectively. Non-cancer patients with PPS 10, 20, and 30% had a median survival time of 8, 6, and 24 days, respectively. Conclusions While useful for estimating survival time for cancer patients, other factors should be taken into account in estimating the survival time for non-cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00773-8.
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Affiliation(s)
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanapat Pateekhum
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Just J, Schmitz MT, Grabenhorst U, Joist T, Horn K, Engel B, Weckbecker K. Factors influencing length of survival in ambulatory palliative care - a cross sectional study based on secondary data. BMC Palliat Care 2021; 20:69. [PMID: 34001099 PMCID: PMC8130350 DOI: 10.1186/s12904-021-00762-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality of life and patient self-determination are key elements in successful palliative care. To achieve these goals, a robust prediction of the remaining survival time is useful as it can provide patients and their relatives with information for individual goal setting including appropriate priorities. The Aim of our study was to assess factors that influence survival after enrollment into ambulatory palliative care. METHODS In this cross-sectional, multicenter study (n = 14 study centers) clinical records of all palliative care patients who were treated in 2017 were extracted and underwent statistical analysis. The main outcome criterion was the association of survival time with clinical characteristics such as age, type of disease, symptoms and performance status. RESULTS A total of 6282 cases were evaluated. Median time of survival was 26 days (95 % CI: 25-27 days). The strongest association for an increased hazard ratio was found for the following characteristics: moderate/severe weakness (aHR: 1.91; 95 % CI: 1.27-2.86) Karnofsky score 10-30 (aHR: 1.80; 95 % CI: 1.67-1.95), and age > 85 (aHR: 1.50; 95 % CI: 1.37-1.64). Surprisingly, type of disease (cancer vs. non-cancer) was not associated with a change in survival time (aHR: 1.03; 95 % CI: 0.96-1.10). CONCLUSIONS In this cross-sectional study, the most relevant predictor for a short survival time in specialized ambulatory palliative care was the performance status while type of disease was irrelevant to survival.
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Affiliation(s)
- Johannes Just
- Institute of General Practice and Interprofessional Care Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58453, Witten, Germany.
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ulrich Grabenhorst
- VSTN e.V. (Association of SAPV Teams in North Rhine), Venloer Straße 40, 41751, Viersen, Germany
| | - Thomas Joist
- VSTN e.V. (Association of SAPV Teams in North Rhine), Venloer Straße 40, 41751, Viersen, Germany
| | - Kirsten Horn
- VSTN e.V. (Association of SAPV Teams in North Rhine), Venloer Straße 40, 41751, Viersen, Germany
| | - Bettina Engel
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, 26129, Oldenburg, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Interprofessional Care Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58453, Witten, Germany
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Vargas A. Is Performance Status Enough to Decide the Palliative Radiotherapy Schedule in Lung Cancer? Clin Oncol (R Coll Radiol) 2021; 33:e463. [PMID: 33966949 DOI: 10.1016/j.clon.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 01/16/2023]
Affiliation(s)
- A Vargas
- Radiation Oncology Department, Clínica Instituto de Radiomedicina (IRAM), Santiago, Chile
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Stone P, Vickerstaff V, Kalpakidou A, Todd C, Griffiths J, Keeley V, Spencer K, Buckle P, Finlay D, Omar RZ. Prognostic tools or clinical predictions: Which are better in palliative care? PLoS One 2021; 16:e0249763. [PMID: 33909658 PMCID: PMC8081205 DOI: 10.1371/journal.pone.0249763] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The Palliative Prognostic (PaP) score; Palliative Prognostic Index (PPI); Feliu Prognostic Nomogram (FPN) and Palliative Performance Scale (PPS) have all been proposed as prognostic tools for palliative cancer care. However, clinical judgement remains the principal way by which palliative care professionals determine prognoses and it is important that the performance of prognostic tools is compared against clinical predictions of survival (CPS). METHODS This was a multi-centre, cohort validation study of prognostic tools. Study participants were adults with advanced cancer receiving palliative care, with or without capacity to consent. Key prognostic data were collected at baseline, shortly after referral to palliative care services. CPS were obtained independently from a doctor and a nurse. RESULTS Prognostic data were collected on 1833 participants. All prognostic tools showed acceptable discrimination and calibration, but none showed superiority to CPS. Both PaP and CPS were equally able to accurately categorise patients according to their risk of dying within 30 days. There was no difference in performance between CPS and FPN at stratifying patients according to their risk of dying at 15, 30 or 60 days. PPI was significantly (p<0.001) worse than CPS at predicting which patients would survive for 3 or 6 weeks. PPS and CPS were both able to discriminate palliative care patients into multiple iso-prognostic groups. CONCLUSIONS Although four commonly used prognostic algorithms for palliative care generally showed good discrimination and calibration, none of them demonstrated superiority to CPS. Prognostic tools which are less accurate than CPS are of no clinical use. However, prognostic tools which perform similarly to CPS may have other advantages to recommend them for use in clinical practice (e.g. being more objective, more reproducible, acting as a second opinion or as an educational tool). Future studies should therefore assess the impact of prognostic tools on clinical practice and decision-making.
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Affiliation(s)
- P. Stone
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - V. Vickerstaff
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - A. Kalpakidou
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - C. Todd
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J. Griffiths
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - V. Keeley
- Palliative Medicine Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - K. Spencer
- Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - P. Buckle
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - D. Finlay
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London (UCL), London, United Kingdom
| | - R. Z. Omar
- Department of Statistical Science, University College London (UCL), London, United Kingdom
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Maltoni M, Rossi R. Risk of detrimental recommendations for cancer pain management. J Transl Med 2021; 19:160. [PMID: 33879181 PMCID: PMC8056571 DOI: 10.1186/s12967-021-02831-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura Dei Tumori (IRST) IRCCS, via P. Maroncelli 40, Meldola, FC, Italy.
| | - Romina Rossi
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura Dei Tumori (IRST) IRCCS, via P. Maroncelli 40, Meldola, FC, Italy
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Liang F, Dong XY, Tang GF, Qi KM, Chen W, Sang W, Sun HY, Cao J, Cheng H, Li DP, Li ZY, Xu KL. [Influence of prognostic nutritional index and controlling nutritional status on the prognosis of patients with multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:332-337. [PMID: 33979979 PMCID: PMC8120130 DOI: 10.3760/cma.j.issn.0253-2727.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Indexed: 12/21/2022]
Abstract
Objective: To explore the influence of prognostic nutritional index (PNI) and controlling nutritional status (CONUT) on the prognosis of patients with multiple myeloma. Methods: Data of 157 patients with multiple myeloma (MM) at the affiliated hospital of Xuzhou medical university from January 2014 to December 2018 were retrospectively evaluated. The operating characteristic (ROC) curve analysis was adopted as the optimal cut-off point. PNI and CONUT were grouped based on the cut-off points of 44.45 and 3.5, respectively, and the differences between age, gender, serum calcium, β(2)-microglobulin, serum creatinine, lactate dehydrogenase, and hemoglobin were analyzed. The prognostic factors were analyzed via univariate and Cox multivariate regression analyses. Results: The level of PNI and CONUT is the influencing factor of OS time. The univariate analysis revealed that age, LDH, plasma cell ratio, β(2)-microglobulin, ISS stage, PNI, and CONUT were the risk factors for the prognosis of patients with MM. The multivariate analysis revealed that age (HR=1.636, 95%CI 1.014-2.640) , plasma cell ratio (HR=1.953, 95%CI 1.232-3.096) , and PNI (HR=0.513, 95%CI 0.287-0.917) were the independent prognostic risk factors of patients with MM. Conclusion: Low PNI in patients with MM indicates a poor prognosis, which is an independent prognosis risk factor.
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Affiliation(s)
- F Liang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - X Y Dong
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - G F Tang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - K M Qi
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - W Chen
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - W Sang
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - H Y Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - J Cao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - H Cheng
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - D P Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Z Y Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - K L Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
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Kishino T, Mori T, Miyashita T, Ouchi Y, Samukawa Y, Fukumura T, Takahashi S, Monden N, Akisada N, Hayashi Y, Nakamura M, Hoshikawa H. The Utility of Glasgow Prognostic Score and Palliative Prognostic Index in Patients With Head and Neck Squamous Cell Carcinoma Under Palliative Care. EAR, NOSE & THROAT JOURNAL 2021; 102:379-384. [PMID: 33765857 DOI: 10.1177/01455613211005114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Palliative care patients with head and neck squamous cell carcinoma (HNSCC) often experience dysphagia and airway trouble; thus, each patient requires a specific palliative care plan based on their prognostication. However, no established specific prognostic tool performed on the day of starting end-of-life care is available for such patients. We assessed the accuracy of Glasgow prognostic score (GPS) and palliative prognostic index (PPI) and their combination to establish a specified prognostic tool for patients with HNSCC in end-of-life setting. METHODS A retrospective clinical chart review was undertaken on patients with HNSCC in end-of life setting who were decided in Kagawa University Hospital and National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. The patients were divided into 2 categories according to GPS (0-1 and 2) and PPI (groups A-B and C). These were combined into 4 categories (PPI group A-B and GPS score 0-1: good; PPI group A-B and GPS score 2: intermediate; PPI group C and GPS score 2: poor; and PPI group C and GPS score 0-1: others). The survival curves were compared for the former 3 categories. RESULTS The median survival of the scores 0-1 and 2 on GPS were 114 (72-148) and 39 (25-52) days, respectively (P < .01). These of groups A-B and C on PPI were 79 (64-99) and 16 (9-29) days, respectively (P < .01). The median survival of the good, intermediate, and poor categories was 127 (73-149), 64 (44-80), and 15 (9-27) days, respectively (P < .01 among all categories). CONCLUSIONS In this study, the survival of terminally ill patients with HNSCC can be predicted by the GPS, PPI, and their combination with sufficient probability.
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Affiliation(s)
- Takehito Kishino
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Terushige Mori
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takenori Miyashita
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yohei Ouchi
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasushi Samukawa
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Fukumura
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Satoshi Takahashi
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nobuya Monden
- Division of Head and Neck and Thyroid Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Naoki Akisada
- Division of Head and Neck and Thyroid Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Yuji Hayashi
- Division of Head and Neck and Thyroid Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Masataka Nakamura
- Division of Head and Neck and Thyroid Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hiroshi Hoshikawa
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Bi Y, Zhang J, Zeng D, Chen L, Ye W, Yang Q, Ling Y. Cholinesterase is Associated With Prognosis and Response to Chemotherapy in Advanced Gastric Cancer. Pathol Oncol Res 2021; 27:580800. [PMID: 34257526 PMCID: PMC8262142 DOI: 10.3389/pore.2021.580800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/15/2021] [Indexed: 01/26/2023]
Abstract
Background: Cholinesterase (CHE) is a routine serum biomarker in gastric cancer (GC). However, little research has been done on its clinical value in advanced GC. In addition, it is not clear whether it can be used as biomarker for the response and prognosis of advanced GC patients. Methods: Between Jan. 2013 and Dec. 2016, a total of 150 patients with advanced GC treated with first-line chemotherapy were admitted to Changzhou Tumor Hospital Affiliated to Soochow University. We retrospectively identified serum CHE level on the day before chemotherapy and at the end of chemotherapy and abstracted clinicopathologic features and treatment outcomes. Univariate and multivariate survival analyses were performed to assess the relationship between serum CHE levels and progression-free survival (PFS) and overall survival (OS). Results: A total of 150 advanced GC patients were included and divided into serum level ≥5,000 IU/L and serum level <5,000 IU/L. CHE level lower than 5,000 IU/L was associated with poorer PFS (HR, 1.60; 95% CI, 1.141–2.243; p = 0.006), poorer OS (HR, 1.76; 95% CI, 1.228–2.515; p = 0.002) and trend of poorer response (HR, 0.56; 95% CI, 0.272–1.129; p = 0.104). In univariate and multivariate logistic regression analysis, only liver metastasis and PS score were significantly associated with objective response (p < 0.05). The medium PFS was 8.0 months in patients with post-treatment CHE increased vs. 3.8 months in patients with CHE decreased after chemotherapy (HR, 1.82; 95% CI 1.28–2.57; p = 0.0002). The medium OS was 13.1 months in patients with increased post-treatment CHE vs. 8.1 months in patients with decreased post-treatment CHE (HR, 1.87; 95% CI 1.29–2.71; p = 0.0002). Conclusion: Advanced GC with CHE levels below 5,000 IU/L was significantly associated with poor PFS and OS. The results suggested that CHE analysis before chemotherapy was a promising prognostic marker for advanced GC.
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Affiliation(s)
- Yanzhi Bi
- Department of Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, China
| | - Junling Zhang
- The Medical Department, 3D Medicines Inc., Shanghai, China
| | - Dongxiang Zeng
- Department of Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, China
| | - Lili Chen
- Department of Hematology, The Suqian Affiliated Hospital of Xuzhou Medicine University, Suqian, China
| | - Wei Ye
- Department of Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, China
| | - Quanliang Yang
- Department of Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, China
| | - Yang Ling
- Department of Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, China
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Koyama N, Matsumura C, Shitashimizu Y, Sako M, Kurosawa H, Nomura T, Eguchi Y, Ohba K, Yano Y. The role of EORTC QLQ-C15-PAL scores and inflammatory biomarkers in predicting survival in terminally ill patients with cancer. BMC Cancer 2021; 21:304. [PMID: 33757453 PMCID: PMC7988985 DOI: 10.1186/s12885-021-08049-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/16/2021] [Indexed: 01/19/2023] Open
Abstract
Background The clinical use of patient-reported outcomes as compared to inflammatory biomarkers for predicting cancer survival remains a challenge in palliative care settings. We evaluated the role of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores (EORTC QLQ-C15-PAL) and the inflammatory biomarkers C-reactive protein (CRP), albumin (Alb), and neutrophil-lymphocyte ratio (NLR) for survival prediction in patients with advanced cancer. Methods This was an observational study in terminally ill patients with cancer hospitalized in a palliative care unit between June 2018 and December 2019. Patients’ data collected at the time of hospitalization were analyzed. Cox regression was performed to examine significant factors influencing survival. A receiver operating characteristic (ROC) analysis was performed to estimate cut-off values for predicting survival within 3 weeks, and a log-rank test was performed to compare survival curves between groups divided by the cut-off values. Results Totally, 130 patients participated in the study. Cox regression suggested that the QLQ-C15-PAL dyspnea and fatigue scores and levels of CRP, Alb, and NLR were significantly associated with survival time, and cut-off values were 66.67, 66.67, 3.0 mg/dL, 2.5 g/dL, and 8.2, respectively. The areas under ROC curves of these variables were 0.6–0.7. There were statistically significant differences in the survival curves between groups categorized using each of these cut-off values (p < .05 for all cases). Conclusion Our findings suggest that the assessment of not only objective indicators for the systemic inflammatory response but also patient-reported outcomes using EORTC QLQ-C15-PAL is beneficial for the prediction of short-term survival in terminally ill patients with cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08049-3.
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Affiliation(s)
- Nanako Koyama
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, 5-Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Chikako Matsumura
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, 5-Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Yoshihiro Shitashimizu
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, 5-Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto, 607-8414, Japan
| | - Morito Sako
- Department of Pharmacy, Tachibana Medical Corporation Higashisumiyoshi-Morimoto Hospital, Osaka, Japan
| | - Hideo Kurosawa
- Department of Pharmacy, Tachibana Medical Corporation Higashisumiyoshi-Morimoto Hospital, Osaka, Japan
| | - Takehisa Nomura
- Department of Pharmacy, Tachibana Medical Corporation Higashisumiyoshi-Morimoto Hospital, Osaka, Japan
| | - Yuki Eguchi
- Palliative Care Unit, Tachibana Medical Corporation Higashisumiyoshi-Morimoto Hospital, Osaka, Japan
| | - Kazuki Ohba
- Department of Palliative Care, Tachibana Medical Corporation Higashisumiyoshi-Morimoto Hospital, Osaka, Japan
| | - Yoshitaka Yano
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, 5-Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto, 607-8414, Japan.
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Molfino A, de van der Schueren MAE, Sánchez-Lara K, Milke P, Amabile MI, Imbimbo G, Di Lazzaro L, Cavuto S, Ronzani G, Snegovoy A, Gioulbasanis I, Laviano A. Cancer-associated anorexia: Validity and performance overtime of different appetite tools among patients at their first cancer diagnosis. Clin Nutr 2021; 40:4037-4042. [PMID: 33676774 DOI: 10.1016/j.clnu.2021.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Anorexia is a frequent symptom in cancer and we aimed to assess its prevalence among patients at their first cancer diagnosis by different appetite tools and the relationship between each tool with self-reports of food intake. We also tested whether cancer anorexia influences outcomes independently of reduced food intake or body weight loss (BWL) overtime and whether BWL was associated with complications during anticancer-therapy. METHODS Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score, self-assessment of appetite, Anorexia Questionnaire (AQ) and Visual Analog Scale (VAS) were administered. Percent of food intake was used as a criterion measure of anorexia. We registered BWL and anticancer-therapy complications over 3-month-follow-up. RESULTS 438 cancer patients from 7 cancer-centers worldwide were included. The prevalence of anorexia was 39.9% by FAACT score, 40.2% by VAS, 40.6% by the self-assessment of appetite and 65.4% by AQ. Low food intake (≤50%) was reported in 28% of patients. All appetite tools correlated with food intake percent (P < 0.0001). We documented a correlation between self-assessment of appetite, FAACT score, VAS and BWL overtime (P < 0.04). The self-assessment of appetite (P = 0.0152) and the FAACT score (P = 0.043) were associated with BWL independently of anticancer therapies. Among patients with BWL, the risk to develop complications was greater with respect to those who maintained a stable or gained body weight (P = 0.03). CONCLUSIONS In our sample of cancer patients, FAACT score and self-assessment of appetite performed well when low food intake was used as a criterion measure, and revealed an association of anorexia with BWL, which was, in turn, related to the development of anticancer-therapy complications.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Marian A E de van der Schueren
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, VU Amsterdam Main Building De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; HAN University of Applied Sciences, School of Allied Health, Department of Nutrition and Dietetics, Nijmegen, the Netherlands
| | | | - Pilar Milke
- National Institute of Health Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Maria Ida Amabile
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Luca Di Lazzaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Infrastructure Research and Statistic, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Anton Snegovoy
- N.N. Blokhin Cancer Research Centre, Moscow, Russian Federation
| | | | - Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University of Rome, V.le dell'Università 37, Rome, Italy.
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Li H, Huang H, Zhang X, Wang Y, Ren X, Cui Y, Sui D, Lin S, Jiang Z, Zhang G. Postoperative Long-Term Independence Among the Elderly With Meningiomas: Function Evolution, Determinant Identification, and Prediction Model Development. Front Oncol 2021; 11:639259. [PMID: 33763371 PMCID: PMC7982808 DOI: 10.3389/fonc.2021.639259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background Maintenance of postoperative long-term independence has value for older adults who undergo surgical procedures. However, independence has barely caught attention for the elderly with meningiomas. Preventing postoperative long-term independence decline in this population necessitates the identification of the factors related to this outcome and minimizing their implications. Therefore, we assessed the independence evolution and identified potential determinants and population. Materials and Methods From 2010 to 2016, elderly meningioma patients (≥65 years old) undergoing operation at Beijing Tiantan Hospital were included in our study. The primary outcome was 3-year (i.e., long-term) postoperative independence measured by Karnofsky performance scale (KPS) score. We used univariate and multivariate analyses to determine the risk factors for postoperative long-term independence, and nomogram was established. Results A total of 470 patients were included eligibly. The distribution in each KPS was significantly different before and 3 years after resection (P < 0.001). Especially in patients with preoperative KPS 80 and 70, only 17.5 and 17.3% of the patients kept the same KPS after 3 years, and the remaining patients experienced significant polarization. The most common remaining symptom cluster correlated with postoperative long-term independence included fatigue (R = −0.795), memory impairment (R = −0.512), motor dysfunction (R = −0.636) and communication deficits (R = −0.501). Independent risk factors for postoperative long-term non-independence included: advanced age (70–74 vs. 65–69 OR: 2.631; 95% CI: 1.545–4.481 and ≥75 vs. 65–69 OR: 3.833; 95% CI: 1.667–8.812), recurrent meningioma (OR: 7.791; 95% CI: 3.202–18.954), location in the skull base (OR: 2.683; 95% CI: 1.383–5.205), tumor maximal diameter >6 cm (OR: 3.089; 95% CI: 1.471–6.488), nerves involved (OR: 3.144; 95% CI: 1.585–6.235), high risk of WHO grade and biological behavior (OR: 2.294; 95% CI: 1.193–4.408), recurrence during follow-up (OR: 10.296; 95% CI: 3.253–32.585), lower preoperative KPS (OR: 0.964; 95% CI: 0.938–0.991) and decreased KPS on discharge (OR: 0.967; 95% CI: 0.951–0.984) (P < 0.05). The discrimination and calibration of the nomogram revealed good predictive ability (C-index: 0.810). Conclusion Elderly meningioma patients might present significant polarization trend in maintaining long-term independence after surgery. Our findings will be helpful for guiding surgical management for the elderly with meningioma and provide proposals for early functional rehabilitation.
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Affiliation(s)
- Haoyi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huawei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaokang Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yonggang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dali Sui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongli Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guobin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Appetite problem in cancer patients: Pathophysiology, diagnosis, and treatment. Cancer Treat Res Commun 2021; 27:100336. [PMID: 33607591 DOI: 10.1016/j.ctarc.2021.100336] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 01/02/2023]
Abstract
AIM This study aims to review the current evidence regarding appetite problem in cancer patients, mainly focusing on pathophysiology, diagnosis, and treatment. INTRODUCTION Anorexia is the common symptom of malnutrition in cancer patients. Recently, the understanding of the pathophysiological mechanism of the appetite problem in cancer patients has been increasing that give impact to rigorous research to find the therapies for improving appetite in cancer patients. DISCUSSION The development of anorexia in cancer patients is a complex process that involves many cytokines, receptors, chemical mediators/substances, hormones, and peptides. Growth and differentiation factor-15 (GDF-15) and toll-like receptor (TLR-4) have recently been found to be implicated in the pathogenesis of anorexia. To help diagnose the appetite problem in cancer patients, several questionnaires can be used, starting from well-known questionnaires such as Functional Assessment of Anorexia Cachexia Therapy (FAACT), Visual Analog Scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ30). Several drugs with different mechanisms of action have been studied to help in improving appetite in cancer patients. New repurposed agents such as anamorelin, mirtazapine, thalidomide, and eicosapentaenoic acid (EPA) have shown a beneficial effect in improving appetite and quality of life in cancer patients, however more phase 3 clinical trial studies is still needed. CONCLUSION The pathophysiology of appetite problems in cancer patients is a complex process that involves many factors. Several drugs that target those factors have been studied, however more phase 3 clinical trial studies are needed to confirm the findings from previous studies.
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Hwang IG, Kwon M, Kim JW, Kim SH, Lee YG, Kim JY, Koh SJ, Ko YH, Shin SH, Hong S, Kim TY, Kim SY, Kim HJ, Kim HJ, Lee MA, Kwon JH, Hong YS, Lee KH, Bae SH, Koo DH, Kim JH, Woo IS. Prevalence and Predictive Factors for Upfront Dose Reduction of the First Cycle of First-Line Chemotherapy in Older Adults with Metastatic Solid Cancer: Korean Cancer Study Group (KCSG) Multicenter Study. Cancers (Basel) 2021; 13:cancers13020331. [PMID: 33477423 PMCID: PMC7829741 DOI: 10.3390/cancers13020331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Arbitrary upfront dose reduction (UDR) of palliative chemotherapy has often been performed according to the judgement of the physician of older adults with metastatic solid cancer in current practice. UDR might decrease treatment efficacy in older adults but may be helpful for palliation, so selecting older adults who benefit from UDR and the identification of predictors of UDR are required. The authors investigated the prevalence and predictors of UDR through variables of geriatric assessment (GA). Chemotherapy compliance between the UDR and standard dose patient groups was also compared. The results of this study demonstrated that approximately 60% of older adults with metastatic solid cancer received UDR. Poor performance status (PS) and living without a spouse were predictive factors of UDR of first-line palliative chemotherapy, and patients with UDR better-tolerated chemotherapy compared with patients with standard doses. Abstract Old age alone does not reflect an intolerability to chemotherapy. However, upfront dose reduction (UDR) of the first cycle of first-line palliative chemotherapy has sometimes been chosen by physicians for older adults with metastatic cancer due to concerns regarding adverse events. The development of predictive factors for UDR of palliative chemotherapy would be helpful for treatment planning among older adults. This was a secondary analysis of a study on predicting adverse events of first-line palliative chemotherapy in 296 patients (≥70 years) with solid cancer. We assessed the prevalence of UDR of the first cycle of first-line chemotherapy and the association of UDR with the variables of geriatric assessment (GA) and chemotherapy compliance. Among the 296 patients, 177 (59.8%) patients were treated with UDR. The mean percentage of UDR for the total patient group was 19.2% (range: 4–47%) of the standard dose. In a multivariate analysis, poor performance status (PS) and living without a spouse were independent predictive factors of UDR of first-line palliative chemotherapy in older adults. Patients with UDR showed fewer grade 3–5 adverse events versus the standard dose group. Study completion as planned was significantly higher in the UDR group versus the standard dose group. Older adults with UDR better tolerated chemotherapy than patients with a standard dose.
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Affiliation(s)
- In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea; (I.G.H.); (M.K.)
| | - Minsuk Kwon
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea; (I.G.H.); (M.K.)
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.W.K.); (S.H.K.); (J.H.K.)
| | - Se Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.W.K.); (S.H.K.); (J.H.K.)
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (Y.-G.L.); (D.-H.K.)
| | - Jin Young Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, College of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Yoon Ho Ko
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03476, Korea;
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan 49267, Korea;
| | - Soojung Hong
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (Y.S.H.)
| | - Hyun Jung Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea;
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Myung Ah Lee
- Department of Internal Medicine, Seoul St. Mary’s Hospital, Cancer Research Institute, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 35015, Korea;
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.Y.K.); (Y.S.H.)
| | - Kyung Hee Lee
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Sung Hwa Bae
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu Catholic University College of Medicine, Daegu 42472, Korea;
| | - Dong-Hoe Koo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea; (Y.-G.L.); (D.-H.K.)
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea; (J.W.K.); (S.H.K.); (J.H.K.)
| | - In Sook Woo
- Division of Medical Oncology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Korea
- Correspondence: ; Tel.: +82-2-3779-1574; Fax: 82-2-780-3132
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Prognostic model for patients with advanced cancer using a combination of routine blood test values. Support Care Cancer 2021; 29:4431-4437. [PMID: 33443662 DOI: 10.1007/s00520-020-05937-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to develop a simple prognostic model based on objective indicators alone, i.e., routine blood test data, without using any subjective variables such as patient's symptoms and physician's prediction. METHODS The subjects of this retrospective study were patients at the palliative care unit of Tohoku University Hospital, Japan. Eligible patients were over 20 years old and had advanced cancer (n = 225). The model for predicting survival was developed based on Cox proportional hazards regression models for univariable and multivariable analyses of 20 items selected from routine blood test data. All the analyses were performed according to the TRIPOD statement ( https://www.tripod-statement.org/ ). RESULTS The univariable and multivariable regression analyses identified total bilirubin, creatinine, urea/creatinine ratio, aspartate aminotransferase, albumin, total leukocyte count, differential lymphocyte count, and platelet/lymphocyte ratio as significant risk factors for mortality. Based on the hazard ratios, the area under the curve for the new risk model was 0.87 for accuracy, 0.83 for sensitivity, and 0.74 for specificity. Diagnostic accuracy was higher than provided by the Palliative Prognostic Score and the Palliative Prognostic Index. The Kaplan-Meier analysis demonstrated a survival significance of classifying patients according to their score into low-, medium-, and high-mortality risk groups having median survival times of 67 days, 34 days, and 11 days, respectively (p < 0.001). CONCLUSIONS We developed a simple and accurate prognostic model for predicting the survival of patients with advanced cancer based on routine blood test values alone that may be useful for appropriate advanced care planning in a palliative care setting.
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Hum A, George PP, Tay RY, Wu HY, Ali NB, Leong I, Chin JJ, Lee A, Tan L, Koh M. Prognostication in Home-Dwelling Patients with Advanced Dementia: The Palliative Support DEMentia Model (PalS-DEM). J Am Med Dir Assoc 2020; 22:312-319.e3. [PMID: 33321077 DOI: 10.1016/j.jamda.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/17/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Difficulties with prognostication prevent more patients with advanced dementia from receiving timely palliative support. The aim of this study is to develop and validate a prognostic model for 6-month and 1-year mortality in home-dwelling patients with advanced dementia. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The data set of 555 home-dwelling patients with dementia at Functional Assessment Staging Test stage 7 was split into derivation (n = 275) and validation (n = 280) cohorts. METHODS Cox proportional hazards regression modeled survival in the derivation cohort using prognostic variables identified in univariate analysis. The model was validated internally and using 10-fold cross-validation. Area under the receiver operating characteristic curve measured the accuracy of the final model. RESULTS Four hundred nineteen (75.5%) patients died with a median follow-up of 47 days [interquartile range (IQR) 161]. Prognostic variables in the multivariate model included serum albumin level, dementia etiology, number of homecare admission criteria fulfilled, presence of moderate to severe chronic kidney disease, peripheral vascular disease, quality of life in late-stage dementia scores, housing type, and the Australian National Sub-Acute and Non-Acute Patient palliative care phase. The model was refined into a parsimonious 6-variable model [Palliative Support DEMentia Model (PalS-DEM)] consisting of age, dementia etiology, Functional Assessment Staging Test stage, Charlson Comorbidity Index scores, Australian National Sub-Acute and Non-Acute Patient palliative care phase, and 30-day readmission frequency for the prediction of 1-year mortality. The area under the receiver operating characteristic curve was 0.65 (95% confidence interval 0.59-0.70). Risk scores categorized patients into 3 prognostic groups, with a median survival of 175 days (IQR 365), 104 days (IQR 246), and 19 days (IQR 88) for the low-risk (0‒1 points), moderate-risk (2‒4), and high-risk (≥5) groups, respectively. CONCLUSIONS AND IMPLICATIONS The PalS-DEM identifies patients at high risk of death in the next 1 year. The model produced consistent survival results across the derivation, validation, and cross-validation cohorts and will help healthcare providers identify patients with advanced dementia earlier for palliative care.
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Affiliation(s)
- Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore; The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore.
| | | | - Ri Yin Tay
- The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore
| | - Huei Yaw Wu
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore; The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore
| | - Noorhazlina Binte Ali
- The Palliative Care Center for Excellence in Research and Education, Singapore; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Ian Leong
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Jing Jih Chin
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
| | - Angel Lee
- St Andrew's Community Hospital, Singapore
| | - Laurence Tan
- The Palliative Care Center for Excellence in Research and Education, Singapore; Department of Geriatric Medicine, Yishun Health System, Singapore
| | - Mervyn Koh
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore; The Palliative Care Center for Excellence in Research and Education, Singapore; Dover Park Hospice, Singapore
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Kawakatsu S, Bruno R, Kågedal M, Li C, Girish S, Joshi A, Wu B. Confounding factors in exposure-response analyses and mitigation strategies for monoclonal antibodies in oncology. Br J Clin Pharmacol 2020; 87:2493-2501. [PMID: 33217012 DOI: 10.1111/bcp.14662] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/03/2020] [Accepted: 11/08/2020] [Indexed: 12/29/2022] Open
Abstract
Dose selection and optimization is an important topic in drug development to maximize treatment benefits for all patients. While exposure-response (E-R) analysis is a useful method to inform dose-selection strategy, in oncology, special considerations for prognostic factors are needed due to their potential to confound the E-R analysis for monoclonal antibodies. The current review focuses on 3 different approaches to mitigate the confounding effects for monoclonal antibodies in oncology: (i) Cox-proportional hazards modelling and case-matching; (ii) tumour growth inhibition-overall survival modelling; and (iii) multiple dose level study design. In the presence of confounding effects, studying multiple dose levels may be required to reveal the true E-R relationship. However, it is impractical for pivotal trials in oncology drug development programmes. Therefore, the strengths and weaknesses of the other 2 approaches are considered, and the favourable utility of tumour growth inhibition-overall survival modelling to address confounding in E-R analyses is described. In the broader scope of oncology drug development, this review discusses the downfall of the current emphasis on E-R analyses using data from single dose level trials and proposes that development programmes be designed to study more dose levels in earlier trials.
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Affiliation(s)
- Sonoko Kawakatsu
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA.,Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - René Bruno
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA
| | - Matts Kågedal
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA
| | - Chunze Li
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA
| | - Sandhya Girish
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA
| | - Amita Joshi
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA
| | - Benjamin Wu
- Clinical Pharmacology, Development Sciences, gRED, Genentech/Roche, South San Francisco, CA, USA
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Oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care: a preliminary retrospective cohort study. Palliat Care 2020; 19:3. [PMID: 31900147 PMCID: PMC6942361 DOI: 10.1186/s12904-019-0511-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/26/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The role of oxygen therapy in end-of-life care for patients with advanced cancer is incompletely understood. We aimed to evaluate the association between oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care.
Methods
We conducted a retrospective cohort study at a primary care practice in suburban Tokyo. Adult patients in home care with advanced cancer demonstrating first low oxygen saturation (less than 90%) detected in home visits were consecutively included in the study. Cox proportional hazards regression was used to investigate the effect of oxygen use on overall survival and survival at home, adjusted for systolic blood pressure, decreased level of consciousness, dyspnea, oral intake, performance status, and cardiopulmonary comorbidity.
Results
Of 433 identified patients with advanced cancer, we enrolled 137 patients (oxygen use, n = 35; no oxygen use, n = 102) who developed low oxygen saturation. In multivariable analysis, the adjusted hazard ratio (HR) of oxygen use was 0.68 (95% confidence interval 0.39–1.17) for death and 0.70 (0.38–1.27) for death at home. In patients with dyspnea, the HR was 0.35 (0.13–0.89) for death and 0.33 (0.11–0.96) for death at home; without dyspnea, it was 1.03 (0.49–2.17) for death and 0.84 (0.36–1.96) for death at home.
Conclusions
Oxygen use was not significantly associated with survival in patients with advanced cancer and low oxygen saturation, after adjusting for potential confounders. It may not be necessary to use oxygen for prolongation of survival in such patients, particularly in those without dyspnea.
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Zhou J, Xu S, Cao Z, Tang J, Fang X, Qin L, Zhou F, He Y, Zhong X, Hu M, Wang Y, Lu F, Bao Y, Dai X, Wu Q. Validation of the Palliative Prognostic Index, Performance Status-Based Palliative Prognostic Index and Chinese Prognostic Scale in a home palliative care setting for patients with advanced cancer in China. BMC Palliat Care 2020; 19:167. [PMID: 33129305 PMCID: PMC7603699 DOI: 10.1186/s12904-020-00676-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The predictive value of the prognostic tool for patients with advanced cancer is uncertain in mainland China, especially in the home-based palliative care (HPC) setting. This study aimed to compare the accuracy of the Palliative Prognostic Index (PPI), the Performance Status-Based Palliative Prognostic Index (PS-PPI), and the Chinese Prognosis Scale (ChPS) for patients with advanced cancer in the HPC setting in mainland China. METHODS Patients with advanced cancer admitted to the hospice center of Yuebei People's Hospital between January 2014 and December 2018 were retrospectively calculated the scores according to the three prognostic tools. The Kaplan-Meier method was used to compare survival times among different risk groups. Receiver operating characteristic curve analysis was used to assess the predictive value. The accuracy of 21-, 42- and 90-day survival was compared among the three prognostic tools. RESULTS A total of 1863 patients were included. Survival time among the risk groups of all prognostic tools was significantly different from each other except for the PPI. The AUROC of the ChPS was significantly higher than that of the PPI and PS-PPI for 7-, 14, 21-, 42-, 90-, 120-, 150- and 180-day survival (P < 0.05). The AUROC of the PPI and PS-PPI were not significantly different from each other (P > 0.05). CONCLUSIONS The ChPS is more suitable than the PPI and PS-PPI for advanced cancer patients in the HPC setting. More researches are needed to verify the predictive value of the ChPS, PPI, and PS-PPI in the HPC setting in the future.
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Affiliation(s)
- Jun Zhou
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Sitao Xu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ziye Cao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Jing Tang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiang Fang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ling Qin
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Fangping Zhou
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yuzhen He
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xueren Zhong
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Mingcai Hu
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yan Wang
- Emergency rescue command center of Shaoguan city, Shaoguan, Guangdong China
| | - Fengjuan Lu
- Hospice center of Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi China
| | - Yongzheng Bao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiangheng Dai
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Qiang Wu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
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Høgdal N, Eidemak I, Sjøgren P, Larsen H, Sørensen J, Christensen J. Occupational therapy and physiotherapy interventions in palliative care: a cross-sectional study of patient-reported needs. BMJ Support Palliat Care 2020:bmjspcare-2020-002337. [PMID: 32788277 DOI: 10.1136/bmjspcare-2020-002337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION An interdisciplinary team approach to patients in specialised palliative care is recommended; however, the composition of the professionals tends to vary, and the roles of physiotherapists and occupational therapists may be underestimated. We aimed to investigate patient-reported unmet needs, which potentially could benefit from physiotherapy and occupational therapy interventions in a specialised palliative care team. METHODS Adult patients with chronic advanced diseases referred to the Specialised Palliative Care Team at Copenhagen University Hospital, Rigshospitalet were enrolled in the study. The Three-Levels-of-Needs Questionnaire was used as primary outcome to assess symptom/problem intensity, symptom/problem burden and felt needs for 12 commonly reported symptoms/problems for patients referred to a specialised palliative care team. Furthermore, participants' level of distress, fatigue and physical activity, symptoms of anxiety and depression, and barriers towards the rehabilitation programme were registered with other measures. RESULTS In total, 43 of 67 (64%) patients participated. The majority of participants reported severe symptoms/problems concerning fatigue (81%), impaired physical activities (77%), carrying out work and daily activities (77%), pain (72%), and worries (58%). Furthermore, need for help was expressed concerning physical activities (79%), work and daily activities (77%), fatigue (70%), pain (65%), concentration (58%) and worries (51%). On average the patients characterised 6 (out of 12) symptoms/problems as severe. CONCLUSION Patients referred to a specialised palliative care team reported extensive unmet needs concerning physical activities, work and daily activities, fatigue, pain, concentration and worries. Unmet needs that potentially could be alleviated by physiotherapists or occupational therapists implemented in the interdisciplinary team.
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Affiliation(s)
- Nina Høgdal
- Section of Occupational Therapy and Physiotherapy, Rigshospitalet HovedOrtoCentret, Copenhagen, Denmark
| | - Inge Eidemak
- Section of Palliative Medicine, Rigshospitalet Department of Oncology, Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Rigshospitalet Department of Oncology, Copenhagen, Denmark
| | - Henrik Larsen
- Section of Palliative Medicine, Rigshospitalet Department of Oncology, Copenhagen, Denmark
| | - Jonas Sørensen
- Section of Palliative Medicine, Rigshospitalet Department of Oncology, Copenhagen, Denmark
| | - Jan Christensen
- Section of Occupational Therapy and Physiotherapy, Rigshospitalet HovedOrtoCentret, Copenhagen, Denmark
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
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80
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Arkin FS, Aras G, Dogu E. Comparison of Artificial Neural Networks and Logistic Regression for 30-days Survival Prediction of Cancer Patients. Acta Inform Med 2020; 28:108-113. [PMID: 32742062 PMCID: PMC7382770 DOI: 10.5455/aim.2020.28.108-113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction A machine learning technique that imitates neural system and brain can provide better than traditional methods like logistic regression for survival prediction and create an algorithm by determining influential factors. Aim To determine the influential factors on survival time of palliative care cancer patients and to compare two statistical methods for better prediction of survival. Methods One-year data is gathered from the patients that we followed in the palliative care clinic of our hospital (2017-2018) (n = 189). All data were retrospectively evaluated. After descriptive statistics, we used Pearson and Spearman correlations for parametric and non-parametric variables. The Artificial Neural Networks (ANN) and logistic regression model were applied to parameters which have a significant correlation with short survival. Results Significantly correlated variables with short survival were Palliative Performance Scale (PPS), Edmonton Symptom Assessment System (ESAS), Karnofsky Performance Scale (KPS), brain, liver, and distant metastasis, hemogram parameters, cero-reactive protein (CRP) and albumin (ALB). ANN model showed 89.3% prediction accuracy while the logistic regression model showed 73.0%. ANN model achieved a better AUC value of 0.86 than logistic regression model (0.76). Discussion There are several prognostic evaluation tools such as PPS, KPS, CRP, albumin, leukocytes, neutrophil were reported several studies as survival-related parameters in logistic regression models, also. Many studies compare ANN with logistic regression. When we evaluated these parameters totally, we observed the same relations with survival then we used the same parameters in the ANN model. The effectivity of the survival prediction models can be improved with the use of ANN. Conclusion ANN provides a more accurate estimation than logistic regression. ANN model is an important statistical method for survival prediction of cancer patients.
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Affiliation(s)
- Funda Secik Arkin
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Palliative Clinic, Istanbul, Turkey
| | - Gulfidan Aras
- Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Palliative Clinic, Istanbul, Turkey
| | - Elif Dogu
- Department of Industrial Engineering, Galatasaray University, Istanbul, Turkey
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81
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Alsuhail AI, Punalvasal Duraisamy B, Alkhudhair A, Alshammary SA, AlRehaili A. The Accuracy of Imminent Death Diagnosis in a Palliative Care Setting. Cureus 2020; 12:e9503. [PMID: 32879825 PMCID: PMC7458715 DOI: 10.7759/cureus.9503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022] Open
Abstract
Background Prognostication is important for patients and their family members as they need this information for the preparation and planning of their future. It is important for physicians as they desire to be accurate in their prognostication skills in order to plan and deliver better care to their patients; healthcare managers require it as they need this information for planning and distribution of hospital resources. We intended to study the accuracy of imminent death diagnosis (IDD) in a palliative care setting in all patients who died at the Palliative Care Unit (PCU) at King Fahad Medical City between December 2012 and December 2014. Methods We conducted a retrospective chart review of all consecutive patients who died in the PCU between 2012 and 2014. We studied the percentage of patients who were diagnosed with imminent death. We further looked at the accuracy of IDD by calculating the time between the diagnosis of imminent death and death. The primary outcomes were the percentage of patients who had an IDD and the proportion of those who died within 14 days of IDD. The secondary outcomes were the difference between patients who die after IDD and patients who die without imminent death diagnosis (NIDD) at the end of life interventions. Results During the period from December 2012 until December 2014, 48 patients died in the PCU. The majority of 28/48 (58%) died with IDD. However, 20/48 (42%) died NIDD. In the IDD group, 25/28 (89.3%) died within 14 days of diagnosis while 3/28 (10.3%) died after 14 days Conclusions IDD is a critical skill for palliative care physicians to make an advance care plan. Our study showed a high degree of accuracy of prediction of fourteen-day mortality in PCU patients. The median survival was two days. However, a large proportion of patients still died without a documented IDD. Multidisciplinary team input improves the accuracy of IDD. We recommend further studies be done to explore how IDD could improve care planning for dying patients and families.
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82
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Almasaudi AS, Dolan RD, Edwards CA, McMillan DC. Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer. Cancers (Basel) 2020; 12:cancers12071986. [PMID: 32708140 PMCID: PMC7409314 DOI: 10.3390/cancers12071986] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin < 35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP > 10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ2 or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.
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Affiliation(s)
- Arwa S. Almasaudi
- Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK;
- Correspondence: or
| | - Ross D. Dolan
- Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK; (R.D.D.); (D.C.M.)
| | - Christine A. Edwards
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK;
| | - Donald C. McMillan
- Academic Unit of Surgery, College of Medical, Veterinary and Life of Sciences-University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK; (R.D.D.); (D.C.M.)
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83
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Ni J, Zhang L. Cancer Cachexia: Definition, Staging, and Emerging Treatments. Cancer Manag Res 2020; 12:5597-5605. [PMID: 32753972 PMCID: PMC7358070 DOI: 10.2147/cmar.s261585] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/26/2020] [Indexed: 12/26/2022] Open
Abstract
Cachexia is a multifactorial disease characterized by weight loss via skeletal muscle and adipose tissue loss, an imbalance in metabolic regulation, and reduced food intake. It is caused by factors of catabolism produced by tumors in the systemic circulation as well as physiological factors such as the imbalanced inflammatory activation, proteolysis, autophagy, and lipolysis that may occur with gastric, pancreatic, esophageal, lung cancer, liver, and bowel cancer. Cancer cachexia not only negatively affects the quality of life of patients with cancer but also reduces the effectiveness of anti-cancer chemotherapy and increases its toxicity, leading to increased cancer-related mortality and expenditure of medical resources. Currently, there are no effective medical interventions to completely reverse cachexia and no approved drugs. Adequate nutritional support is the main method of cachexia treatment, while drugs that target the inhibition of catabolism, cell damage, and excessive activation of inflammation are under study. This article reviews recent advances in the diagnosis, staging, and evaluation of cancer cachexia.
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Affiliation(s)
- Jun Ni
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, People's Republic of China
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84
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Epstein–Barr Virus Infection Related to Low White Blood Cell Count in Cancer Patients Receiving Chemotherapy in Al-Najaf Governorate/Iraq. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.2.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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85
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Jakob M, Sharaf K, Schirmer M, Leu M, Küffer S, Bertlich M, Ihler F, Haubner F, Canis M, Kitz J. Role of cancer stem cell markers ALDH1, BCL11B, BMI-1, and CD44 in the prognosis of advanced HNSCC. Strahlenther Onkol 2020; 197:231-245. [PMID: 32588101 PMCID: PMC7892527 DOI: 10.1007/s00066-020-01653-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
Purpose Cancer stem cells (CSCs) are held accountable for the progress of head and neck squamous cell carcinoma (HNSCC). In the presented study, the authors evaluated the prognostic value of CSC markers in two particular HNSCC cohorts. Methods This two cohort study consisted of 85 patients with advanced stage HNSCC, treated with primary radio(chemo)therapy (pRCT), and 95 patients with HNSCC, treated with surgery and partially adjuvant radio(chemo)therapy. Overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) were assessed. Samples were assessed for the expression of different molecular stem cell markers (ALDH1, BCL11B, BMI‑1, and CD44). Results In the pRCT cohort, none of the baseline patient and tumor features exhibited a statistically significant relation with survival in either the cohort or the human papillomavirus (HPV)-stratified subcohorts. High expression of BMI‑1 significantly decreased OS and DFS, while high expression of CD44 decreased all modes of survival. Multivariate analysis showed significant prognostic influence for all tested CSC markers, with high BMI‑1 and CD44 decreasing survival (BMI-1: OS, DFS, DSS; CD44: OS, DFS) and high ALDH1 and BCL11B showing a beneficial effect on survival (ALDH1: OS, DFS; BCL11B: OS, DSS). In the surgical cohort, classical prognosticators such as HPV status, R1 resection, and nodal status in HPV-negative HNSCC played a significant role, but the tested CSC markers showed no significant effect on prognosis. Conclusion Although validation in independent cohorts is still needed, testing for CSC markers in patients with advanced or late stage HNSCC might be beneficial, especially if many comorbidities exist or disease is irresectable. The findings might guide the development and earlier use of targeted therapies in the future. Electronic supplementary material The online version of this article (10.1007/s00066-020-01653-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Jakob
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany. .,Department of Otolaryngology, University Medical Center Göttingen, Göttingen, Germany.
| | - Kariem Sharaf
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Markus Schirmer
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Leu
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Küffer
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Mattis Bertlich
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Friedrich Ihler
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,German Center of Vertigo and Dizziness, University Hospital, LMU Munich, Munich, Germany
| | - Frank Haubner
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Martin Canis
- Department of Otolaryngology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julia Kitz
- Department of Pathology, University Medical Center Göttingen, Göttingen, Germany
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Hansen MB, Nylandsted LR, Petersen MA, Adsersen M, Rojas-Concha L, Groenvold M. Patient-reported symptoms and problems at admission to specialized palliative care improved survival prediction in 30,969 cancer patients: A nationwide register-based study. Palliat Med 2020; 34:795-805. [PMID: 32186244 DOI: 10.1177/0269216320908488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Large, nationally representative studies of the association between quality of life and survival time in cancer patients in specialized palliative care are missing. AIM The aim of this study was to investigate whether symptoms/problems at admission to specialized palliative care were associated with survival and if the symptoms/problems may improve prediction of death within 1 week and 1 month, respectively. SETTING/PARTICIPANTS All cancer patients who had filled in the EORTC QLQ-C15-PAL at admission to specialized palliative care in Denmark in 2010-2017 were included through the Danish Palliative Care Database. Cox regression was used to identify clinical variables (gender, age, type of contact (inpatient vs outpatient), and cancer site) and symptoms/problems significantly associated with survival. To test whether symptoms/problems improved survival predictions, the overall accuracy (area under the receiver operating characteristic curve) for different prediction models was compared. The validity of the prediction models was tested with data on 5,508 patients admitted to palliative care in 2018. RESULTS The study included 30,969 patients with an average age of 68.9 years; 50% were women. Gender, age, type of contact, cancer site, and most symptoms/problems were significantly associated with survival time. The predictive value of symptoms/problems was trivial except for physical function, which clearly improved the overall accuracy for 1-week and 1-month predictions of death when added to models including only clinical variables. CONCLUSION Most symptoms/problems were significantly associated with survival and mainly physical function improved predictions of death. Interestingly, the predictive value of physical function was the same as all clinical variables combined (in hospice) or even higher (in palliative care teams).
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Affiliation(s)
- Maiken B Hansen
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Ross Nylandsted
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten A Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathilde Adsersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Leslye Rojas-Concha
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Stereotactic radiosurgery for the treatment of bulky spine metastases. J Neurooncol 2020; 148:381-388. [DOI: 10.1007/s11060-020-03534-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
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88
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Budhwani S, Moineddin R, Wodchis WP, Zimmermann C, Howell D. Do Longitudinally Collected Symptom Scores Predict Time to Death in Advanced Breast Cancer: A Joint Modeling Analysis. J Pain Symptom Manage 2020; 59:1009-1018. [PMID: 31837454 DOI: 10.1016/j.jpainsymman.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 01/19/2023]
Abstract
CONTEXT Patients with advanced breast cancer have low rates of survival that can be associated with symptom burden. OBJECTIVES This study seeks to characterize the effect of longitudinally collected symptom scores on predicting time to death for patients with advanced breast cancer. METHODS A cohort of 993 Stage IV breast cancer patients was constructed using linked population-level health administrative databases that captured longitudinally collected symptom data using the Edmonton Symptom Assessment System. Data were captured on individual symptom scores (20,371 assessments) for pain, tiredness, drowsiness, nausea, appetite, dyspnea, depression, anxiety, and wellbeing, as well as three summative scores of total symptom distress score, physical subscore, and psychological subscore. A joint modeling approach was undertaken to simultaneously model repeated-measures longitudinal data and time-to-event data. RESULTS Of patients who died in the study, 56.11% survived for a mean time of less than three years and had lower mean symptom scores for all symptoms except shortness of breath, in comparison with patients who lived for more than three years. Symptom burden was predictive of patient time to death for all symptoms, with risk of death increasing with worsening symptom scores. For total symptom distress score, age at diagnosis (0.009; P < 0.05), chemotherapy (-0.63; P < 0.001), and palliative care (3.15; P < 0.001) were significant predictors of patient time to death. CONCLUSION Patients with advanced breast cancer experience chronic ongoing low symptom burden, which predicts patient time to death. Future research should examine the mechanisms by which patient characteristics, treatment, and supportive and palliative care can have an impact on patient survival.
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Affiliation(s)
- Suman Budhwani
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada.
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Health System Performance Research Network, University of Toronto, Toronto, Ontario, Canada; Trillium Health Partners' Institute for Better Health, Mississauga, Ontario, Canada
| | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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Gómez-Batiste X, Turrillas P, Tebé C, Calsina-Berna A, Amblàs-Novellas J. NECPAL tool prognostication in advanced chronic illness: a rapid review and expert consensus. BMJ Support Palliat Care 2020; 12:e10-e20. [PMID: 32241958 DOI: 10.1136/bmjspcare-2019-002126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a proposal for a 2-year mortality prognostic approach for patients with advanced chronic conditions based on the palliative care need (PCN) items of the NECesidades PALiativas (NECPAL) CCOMS-ICO V.3.1 2017 tool. METHODS A phase 1 study using three components based on the NECPAL items: (1) a rapid review of systematic reviews (SRs) on prognostic factors of mortality in patients with advanced chronic diseases and PCNs; (2) a clinician and statistician experts' consensus based on the Delphi technique on the selection of mortality prognostic factors; and (3) a panel meeting to discuss the findings of components (1) and (2). RESULTS Twenty SRs were included in a rapid review, and 50% were considered of moderate quality. Despite methodological issues, nutritional and functional decline, severe and refractory dyspnoea, multimorbidity, use of resources and specific disease indicators were found to be potentially prognostic variables for mortality across four clinical groups and end-of-life (EoL) trajectories: cancer, dementia and neurologic diseases, chronic organ failure and frailty. Experts' consensus added 'needs' identified by health professionals. However, clinicians were less able to discriminate which NECPAL items were more reliable for a 'general' model. A retrospective cohort study was designed to evaluate this proposal in phase 2. CONCLUSIONS We identified several parameters with prognostic value and linked them to the tool's utility to timely identify PCNs of patients with advanced chronic conditions in all settings of care. Initial results show this is a clinical and feasible tool, that will help with clinical pragmatic decision-making and to define services.
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Affiliation(s)
- Xavier Gómez-Batiste
- The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain .,Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
| | - Pamela Turrillas
- The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain.,Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
| | - Cristian Tebé
- Department of Statistics, Biomedical Research Institute of Bellvitge (IDIBELL), Barcelona, Spain
| | - Agnès Calsina-Berna
- The 'Qualy' Observatory/WHO Collaborating Centre for Public Health Palliative Care Programmes, Institut Catala d' Oncologia, Barcelona, Spain.,Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain
| | - Jordi Amblàs-Novellas
- Chair of Palliative Care, Faculty of Medicine, University of Vic ‒ Central University of Catalonia, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
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Seow H, Tanuseputro P, Barbera L, Earle C, Guthrie D, Isenberg S, Juergens R, Myers J, Brouwers M, Sutradhar R. Development and Validation of a Prognostic Survival Model With Patient-Reported Outcomes for Patients With Cancer. JAMA Netw Open 2020; 3:e201768. [PMID: 32236529 PMCID: PMC7113728 DOI: 10.1001/jamanetworkopen.2020.1768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Existing prognostic cancer tools include biological and laboratory variables. However, patients often do not know this information, preventing them from using the tools and understanding their prognosis. OBJECTIVE To develop and validate a prognostic survival model for all cancer types that incorporates information on symptoms and performance status over time. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective, population-based, prognostic study of data from patients diagnosed with cancer from January 1, 2008, to December 31, 2015, in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). The derivation cohort was used to develop a multivariable Cox proportional hazards regression model with baseline characteristics under a backward stepwise variable selection process to predict the risk of mortality as a function of time. Covariates included demographic characteristics, clinical information, symptoms and performance status, and health care use. Model performance was assessed on the validation cohort by C statistics and calibration plots. Data analysis was performed from February 6, 2018, to November 6, 2019. MAIN OUTCOMES AND MEASURES Time to death from diagnosis (year 0) recalculated at each of 4 annual survivor marks after diagnosis (up to year 4). RESULTS A total of 255 494 patients diagnosed with cancer were identified (135 699 [53.1%] female; median age, 65 years [interquartile range, 55-73 years]). The cohort decreased to 217 055, 184 822, 143 649, and 109 569 patients for each of the 4 years after diagnosis. In the derivation cohort year 0, and the most common cancers were breast (30 855 [20.1%]), lung (19 111 [12.5%]), and prostate (18 404 [12.0%]). A total of 47 614 (31.1%) had stage III or IV disease. The mean (SD) time to death in year 0 was 567 (715) days. After backward stepwise selection in year 0, the following factors were associated with increased risk of death by more than 10%: being hospitalized; having congestive heart failure, chronic obstructive pulmonary disease, or dementia; having moderate to high pain; having worse well-being; having functional status in the transitional or end-of-life phase; having any problems with appetite; receiving end-of-life home care; and living in a nursing home. Model discrimination was high for all models (C statistic: 0.902 [year 0], 0.912 [year 1], 0.912 [year 2], 0.909 [year 3], and 0.908 [year 4]). CONCLUSIONS AND RELEVANCE The model accurately predicted changing cancer survival risk over time using clinical, symptom, and performance status data and appears to have the potential to be a useful prognostic tool that can be completed by patients. This knowledge may support earlier integration of palliative care.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Craig Earle
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Dawn Guthrie
- Department of Kinesiology and Physical Education, Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rosalyn Juergens
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Myers
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Brouwers
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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91
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Frilling B. Geriatrisches Assessment – Evidenz und Anwendungsmöglichkeiten in der HNO-Heilkunde. HNO 2020; 68:150-154. [DOI: 10.1007/s00106-020-00815-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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92
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Terzi C, Bingul M, Arslan NC, Ozturk E, Canda AE, Isik O, Yilmazlar T, Obuz F, Birkay Gorken I, Kurt M, Unlu M, Ugras N, Kanat O, Oztop I. Randomized controlled trial of 8 weeks' vs 12 weeks' interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer. Colorectal Dis 2020; 22:279-288. [PMID: 31566843 DOI: 10.1111/codi.14867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
Abstract
AIM The aim was to compare the pathological complete response (pCR) rate at 8 compared to 12 weeks' interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery in patients with locally advanced rectal cancer. METHOD This was a randomized trial which included a total of 330 patients from two institutions. Patients with locally advanced (T3-4N0M0, TxN+M0) rectal cancer were randomized into 8- and 12-week interval groups. All the patients received long-course CRT (45 Gy in 1.8 Gy fractions and concomitant oral capecitabine or 5-fluorouracil infusion). Surgery was performed at either 8 or 12 weeks after CRT. The primary end-point was pCR. Secondary end-points were sphincter preservation, postoperative morbidity and mortality. RESULTS Two-hundred and fifty-two patients (n = 125 in the 8-week group, n = 127 in the 12-week group) were included. Demographic and clinical characteristics were similar between groups. The overall pCR rate was 17.9% (n = 45): 12% (n = 15) in the 8-week group and 23.6% (n = 30) in the 12-week group (P = 0.021). Sphincter-preserving surgery was performed in 107 (85.6%) patients which was significantly higher than the 94 (74%) patients in the 12-week group (P = 0.016). Postoperative mortality was seen in three (1.2%) patients overall and was not different between groups (1.6% in 8 weeks vs 0.8% in 12 weeks, P = 0.494). Groups were similar in anastomotic leak (10.8% in 8 weeks vs 4.5% in 12 weeks, P = 0.088) and morbidity (30.4% in 8 weeks and 20.1% in 12 weeks, P = 0.083). CONCLUSION Extending the interval between CRT and surgery from 8 to 12 weeks resulted in a 2-fold increase in pCR rate without any difference in mortality and morbidity.
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Affiliation(s)
- C Terzi
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - M Bingul
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - N C Arslan
- Department of General Surgery, Medipol University, Istanbul, Turkey
| | - E Ozturk
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - A E Canda
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - O Isik
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - T Yilmazlar
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - F Obuz
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - I Birkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University, Izmir, Turkey
| | - M Kurt
- Department of Radiation Oncology, Uludag University Hospital, Bursa, Turkey
| | - M Unlu
- Department of Pathology, Dokuz Eylul University, Izmir, Turkey
| | - N Ugras
- Department of Pathology, Uludag University Hospital, Bursa, Turkey
| | - O Kanat
- Department of Medical Oncology, Uludag University Hospital, Bursa, Turkey
| | - I Oztop
- Department of Medical Oncology, Dokuz Eylul University, Izmir, Turkey
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93
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Jozwiak R, Recka K. The Anorexia-Cachexia Syndrome: Definitions, Evaluation, and Nonpharmacological Management #386. J Palliat Med 2020; 23:287-289. [DOI: 10.1089/jpm.2019.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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94
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Chu C, Anderson R, White N, Stone P. Prognosticating for Adult Patients With Advanced Incurable Cancer: a Needed Oncologist Skill. Curr Treat Options Oncol 2020; 21:5. [PMID: 31950387 PMCID: PMC6965075 DOI: 10.1007/s11864-019-0698-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patients with advanced cancer and their families commonly seek information about prognosis to aid decision-making in medical (e.g. surrounding treatment), psychological (e.g. saying goodbye), and social (e.g. getting affairs in order) domains. Oncologists therefore have a responsibility to identify and address these requests by formulating and sensitively communicating information about prognosis. Current evidence suggests that clinician predictions are correlated with actual survival but tend to be overestimations. In an attempt to cultivate prognostic skills, it is recommended that clinicians practice formulating and recording subjective estimates of prognosis in advanced cancer patient’s medical notes. When possible, a multi-professional prognostic estimate should be sought as these may be more accurate than individual predictions alone. Clinicians may consider auditing the accuracy of their predictions periodically and using feedback from this process to improve their prognostic skills. Clinicians may also consider using validated prognostic tools to complement their clinical judgements. However, there is currently only limited evidence about the comparative accuracy of different prognostic tools or the extent to which these measures are superior to clinical judgement. Oncologists and palliative care physicians should ensure that they receive adequate training in advanced communication skills, which builds upon their pre-existing skills, to sensitively deliver information on prognosis. In particular, clinicians should acknowledge their own prognostic uncertainty and should emphasise the supportive care that can continue to be provided after stopping cancer-directed therapies.
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Affiliation(s)
- Christina Chu
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Rebecca Anderson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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95
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Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis. Support Care Cancer 2020; 28:2071-2078. [DOI: 10.1007/s00520-019-05261-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/20/2019] [Indexed: 11/26/2022]
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96
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Verhoef MJ, de Nijs EJM, Fiocco M, Heringhaus C, Horeweg N, van der Linden YM. Surprise Question and Performance Status Indicate Urgency of Palliative Care Needs in Patients with Advanced Cancer at the Emergency Department: An Observational Cohort Study. J Palliat Med 2019; 23:801-808. [PMID: 31880489 DOI: 10.1089/jpm.2019.0413] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The surprise question (SQ), "Would I be surprised if this patient died within one year?", is a simple instrument to identify patients with palliative care needs. The SQ-performance has not been evaluated in patients with advanced cancer visiting the emergency department (ED). Objective: To evaluate SQ's test characteristics and predictive value in patients with advanced cancer visiting the ED. Design: Observational cohort study. Setting: Patients >18 years with advanced cancer in the palliative phase visiting the ED of an academic medical center. Methods: Attending physicians answered the SQ (not surprised [NS] or surprised [S]) and estimated Eastern Cooperative Oncology Group (ECOG)-performance status. Disease, visit, and follow-up characteristics were retrospectively collected from charts. SQ's sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and Harrell's c-index were calculated. Prognostic values of SQ and other variables were assessed by using Cox proportional hazards models. Results: Two-hundred-and-forty-five patients were included (203 NS [83%] and 42 S [17%]), median age 62 years, 48% male. Follow-up on overall survival was updated until February 2019. At ED entry, NS-patients had worse ECOG-performance and more symptoms. At study closure, 233 patients had died (95%). Median survival was three months for NS-patients (interquartile [IQ]-range: 1-8); nine months for S-patients (IQ-range: 3-28) (p < 0.0001). SQ-performance for one-year mortality: sensitivity 89%, specificity 40%, PPV 85%, NPV 50%, c-index 0.56, and hazard ratio 2.1 for approaching death. ECOG 3-4 predicted death in NS-patients; addition to the SQ improved c-index (0.65); sensitivity (40%), specificity (92%), PPV (95%), and NPV (29%). Conclusions: At the ED, the SQ plus ECOG 3-4 helps identifying patients with advanced cancer and a limited life expectancy. Its use supports initiating appropriate care related to urgency of palliative care needs.
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Affiliation(s)
- Mary-Joanne Verhoef
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen J M de Nijs
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Marta Fiocco
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.,Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Christian Heringhaus
- Department of Emergency Medicine and Leiden University Medical Center, Leiden, the Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvette M van der Linden
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
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97
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Okamoto S, Ureshino H, Kidoguchi K, Kusaba K, Kizuka-Sano H, Sano H, Nishioka A, Yamaguchi K, Kamachi K, Itamura H, Yoshimura M, Yokoo M, Shindo T, Kubota Y, Ando T, Kojima K, Kawaguchi A, Sueoka E, Kimura S. Clinical impact of the CONUT score in patients with multiple myeloma. Ann Hematol 2019; 99:113-119. [PMID: 31768678 DOI: 10.1007/s00277-019-03844-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022]
Abstract
Novel anti-myeloma drugs have significantly improved the overall survival (OS) of patients with multiple myeloma (MM). However, not all MM patients treated with these drugs show survival benefits, and biologic and genetic prognostic factors are insufficient to predict the response to treatment. Decreasing treatment-related complications is important to improve the efficacy of treatment in patients with MM. The Controlling Nutritional Status (CONUT) score is a screening method for poor nutritional status, which is associated with poor prognosis in several cancers because it increases the rate of treatment-related complications. We retrospectively analyzed the OS of 64 patients with symptomatic MM and evaluated the correlation between the CONUT score and patient prognosis in MM. The median age at diagnosis was 66 years, and multivariate analysis showed that a high CONUT score (≥ 5; hazard ratio, 3.937; 95% confidence interval, 1.214-12.658; P = 0.022) was an independent prognostic risk factor. Subgroup analysis was performed according to patient age because the choice of treatment strategy, particularly autologous peripheral blood stem cell transplantation (auto-PBSCT), can vary depending on age in MM patients. Younger patients (< 65 years old) who received auto-PBSCT and had a lower CONUT score (0-3) showed a significantly better survival outcome than those with a higher CONUT score (≥ 4) (median OS, not reached vs. 64.1 months; P = 0.011). The CONUT score is simple to calculate and provides a useful prognostic indicator in patients with MM, especially transplant-eligible patients.
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Affiliation(s)
- Sho Okamoto
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.,Department of Internal Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Hiroshi Ureshino
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan. .,Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan.
| | - Keisuke Kidoguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kana Kusaba
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Haruna Kizuka-Sano
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Haruhiko Sano
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Atsujiro Nishioka
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kyosuke Yamaguchi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kazuharu Kamachi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hidekazu Itamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Mariko Yoshimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masako Yokoo
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Takero Shindo
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.,Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Kubota
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Toshihiko Ando
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Kensuke Kojima
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Atsushi Kawaguchi
- Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Eisaburo Sueoka
- Department of Clinical Laboratory Medicine, Faculty of Medicine, Saga University, Saga, Japan.,Department of Laboratory Medicine, Saga University Hospital, Saga, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.,Department of Drug Discovery and Biomedical Sciences, Faculty of Medicine, Saga University, Saga, Japan
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98
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Modifiable factors affecting older patients' quality of life and physical function during cancer treatment. J Geriatr Oncol 2019; 10:904-912. [DOI: 10.1016/j.jgo.2019.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/12/2019] [Accepted: 08/03/2019] [Indexed: 12/13/2022]
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99
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Internal medicine and palliative care: Science and humanism. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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100
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Cotogni P, Pedrazzoli P, De Waele E, Aprile G, Farina G, Stragliotto S, De Lorenzo F, Caccialanza R. Nutritional Therapy in Cancer Patients Receiving Chemoradiotherapy: Should We Need Stronger Recommendations to Act for Improving Outcomes? J Cancer 2019; 10:4318-4325. [PMID: 31413751 PMCID: PMC6691712 DOI: 10.7150/jca.31611] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/26/2019] [Indexed: 01/06/2023] Open
Abstract
One of the challenges during chemotherapy and radiotherapy is to complete the planned cycles and doses without dose-limiting toxicity. Growing evidence clearly demonstrates the relationship between dose-limiting toxicity and low muscle mass. Moreover, malnutrition leads to low performance status, impaired quality of life, unplanned hospital admissions, and reduced survival. In the past, the lack of clear and authoritative recommendations and guidelines has meant that oncologists have not always fully appreciated the importance of nutritional therapy in patients receiving anticancer treatments. Therefore, collaboration between oncologists and clinical nutrition specialists needs to be urgently improved. Recent guidelines from scientific societies and practical recommendations by inter-society consensus documents can be summarized as follows: 1) timely nutritional therapy should be carefully considered if patients undergoing anticancer treatments are malnourished or at risk of malnutrition due to inadequate oral intake; 2) if oral intake is inadequate despite counseling and oral nutritional supplements, supplemental enteral nutrition or, if this is not sufficient or feasible, parenteral nutrition should be considered; 3) home artificial nutrition should be prescribed and regularly monitored using defined protocols developed between oncologists and clinical nutrition specialists; 4) appropriate nutritional management in the context of simultaneous care should become a guaranteed right for all patients with cancer. The purpose of this review is to provide oncologists with an overview of the aims and current evidence about nutrition in oncology, together with updated practical and concise recommendations on the application of nutritional therapy in cancer patients receiving chemoradiotherapy.
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Affiliation(s)
- Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, Molinette Hospital, University of Turin, Turin, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Elisabeth De Waele
- Intensive Care Unit and Department of Nutrition, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Gabriella Farina
- Department of Oncology, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | | | - Riccardo Caccialanza
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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