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Nieder C, Haukland EC, Mannsaker B, Yobuta R. Palliative Radiotherapy During the Last Month of Life: Have COVID-19 Recommendations Led to Reduced Utilization? In Vivo 2021; 35:649-652. [PMID: 33402522 DOI: 10.21873/invivo.12304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM The study aimed to evaluate practice changes in the time period of the early wave of the COVID-19 pandemic. PATIENTS AND METHODS This was a retrospective single institution study. We defined palliative radiotherapy (PRT) initiated before Saturday, March 14th as pre-COVID and PRT initiated later as during-COVID (through June 30th). RESULTS National COVID-19 recommendations led to a significant decrease in PRT with 10 or more fractions, while re-irradiation and radiotherapy during the final 30 days of life were equally common before and after these recommendations had been issued in March 2020. CONCLUSION Rapid adoption of modified PRT regimens was feasible. However, the challenge of overtreatment in the final phase of the disease, due to inaccurate survival prediction, persisted.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Ellinor C Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Bard Mannsaker
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Rosalba Yobuta
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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Nieder C, Dalhaug A, Haukland E. Is there a seasonal variation of survival after systemic chemotherapy for metastatic castration-resistant prostate cancer in a rural part of North Norway? Int J Circumpolar Health 2020; 79:1742520. [PMID: 32191614 PMCID: PMC7144237 DOI: 10.1080/22423982.2020.1742520] [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] [Indexed: 11/04/2022] Open
Abstract
The winter darkness or polar night induces endocrine and metabolic mechanisms, which might reduce the efficacy of cancer treatment and thus contribute to shorter survival. Moreover, season-and weather-related treatment delays and irregularities might also cause reduced efficacy of anti-cancer drugs. Therefore, this study evaluated the prognostic impact of timing of chemotherapy (start during winter darkness or outside of this season), in terms of overall survival, in patients with metastatic castration-resistant prostate cancer (MCRPC) who received oncology care at the Nordland hospital Bodø. The study included 111 patients treated with first-line docetaxel chemotherapy for MCRPC. Twenty patients (18%) started their treatment during winter darkness (arbitrarily defined as ±4 weeks around 21 December). In unadjusted univariate analysis, survival was shorter in this group (median 10.2 vs. 18.9 months, p = 0.055). However, not all baseline parameters were equally distributed between the two groups. In multivariable-adjusted Cox regression analysis accounting for several confounding variables, only one factor was statistically significant: pre-chemotherapy serum lactate dehydrogenase level (a surrogate marker of disease burden). Thus, the present results suggest that seasonal variation is not a major contributor to the diverging survival outcomes observed after docetaxel chemotherapy.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT- the Arctic University of Norway, Tromsø, Norway
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Nieder C, Dalhaug A, Haukland E. Feasibility and efficacy of sequential systemic therapy for metastatic castration-resistant prostate cancer in a rural health care setting. Scand J Urol 2020; 54:110-114. [PMID: 32091322 DOI: 10.1080/21681805.2020.1730435] [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: 10/24/2022]
Abstract
Aim: The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of sequential systemic therapy in patients with metastatic castration-resistant prostate cancer (MCRPC) who lived in Nordland County, Norway, a large region with a challenging geography, yet only one department of oncology located in the main city, Bodø.Patients and methods: Overall 77 patients who had received at least 2 lines of treatment were included in this retrospective study.Results: Management included docetaxel in 69 patients (90%), often prescribed in first line. Only 12 patients (16%) started their treatment with a sequence of two endocrine drugs (enzalutamide or abiraterone acetate). Thirty-two patients (42%) were not eligible for treatment beyond second line, while 31 (40%) received 3 lines, and 14 (18%) more than 3 lines (for example cabazitaxel or Ra-223). Distance to the department of oncology did not predict for treatment with more than 2 lines. Only two factors were statistically significant: age <75 years and not initiating treatment with two lines of endocrine drugs. Survival increased with increasing number of lines of treatment. None of the five individual drugs available to these patients was significantly associated with survival.Conclusions: There was no indication toward under-treatment with systemic therapy among patients from the distant regions. Sequential treatment was feasible and survival increased with each additional line.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Nieder C, Dalhaug A, Haukland E, Norum J. Management of patients with metastatic prostate cancer (mPC) in a rural part of North Norway with a scattered population: does living near the department of oncology translate into a different pattern of care and survival? Int J Circumpolar Health 2020; 78:1620086. [PMID: 31120400 PMCID: PMC6534221 DOI: 10.1080/22423982.2019.1620086] [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] [Indexed: 02/06/2023] Open
Abstract
The goal of the Norwegian Ministry of Health and Care Services is to offer an equal health-care service with the same outcomes wherever people are living within the country. The aim of this study was to evaluate whether this was true for patients diagnosed with metastatic prostate cancer (mPC) and living in Nordland County, a region with a challenging geography and climate and having, several small and remote communities and only 1 department of oncology. The latter is located in the main city, Bodø. We also compared a subgroup living in communities having lower average annual income (less than NOK 240,000 (equivalent to USD 28,600)) with patients living in Bodø (NOK 285,000 (USD 33,900)). Overall 288 patients were included and stratified into 3 subgroups (favourable distance and income, unfavourable distance and income, and unfavourable distance and favourable income). No statistically significant differences were observed regarding patient characteristics. There was no indication towards under-treatment among patients from the distant regions or the lower income region. Given that disparities were not observed, it was not surprising to see comparable survival outcomes (p=0.35). In conclusion, these results suggest that the health-care system in Nordland County successfully delivers state-of-the-art oncology care to patients with mPC.
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Affiliation(s)
- Carsten Nieder
- a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.,b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway
| | - Astrid Dalhaug
- a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.,b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway
| | - Ellinor Haukland
- a Department of Oncology and Palliative Medicine , Nordland Hospital , Bodø , Norway.,b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway
| | - Jan Norum
- b Department of Clinical Medicine, Faculty of Health Sciences , UiT- The Arctic University of Norway , Tromsø , Norway.,c Department of Surgery , Finnmark Hospital , Hammerfest , Norway
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Abstract
INTRODUCTION Improved treatment approaches have resulted in longer survival of patients with certain types of incurable cancer, without eliminating the need for symptom palliation and supportive measures. In this context, re-irradiation is an increasingly important option. Little data exists about a second or repeat re-irradiation. METHODS From a single institution database, patients who received a second re-irradiation with cumulative equivalent doses (equivalent dose in 2-Gy fractions (EQD2) for late effects, alpha/beta-value 3 Gy) of more than 90 Gy and survived for more than six months were identified. Illustrative clinical examples were provided. RESULTS The examples describe the treatment of sacral bone metastases, recurrent rectal cancer, and pelvic lymph node metastases. The maximum cumulative EQD2 was 142 Gy. Symptomatic responses were obtained without clinically relevant side effects. CONCLUSION These three cases illustrate that a second re-irradiation has the potential to provide worthwhile palliative effects without causing overt late toxicity during the remaining life time. In patients who tolerated previous radiotherapy well, further re-irradiation may contribute to the ever-increasing armamentarium of options that increase the survival of patients with incurable cancer and try to prolong the time period where independent living is possible.
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Affiliation(s)
- Carsten Nieder
- Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, NOR
| | | | - Bård Mannsåker
- Oncology and Palliative Medicine, Nordland Hospital Trust, Bodø, NOR
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