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Ramanathan S, Hochstedler KA, Laucis AM, Movsas B, Stevens CW, Kestin LL, Dominello MM, Grills IS, Matuszak M, Hayman J, Paximadis PA, Schipper MJ, Jolly S, Boike TP. Predictors of Early Hospice or Death in Patients With Inoperable Lung Cancer Treated With Curative Intent. Clin Lung Cancer 2024; 25:e201-e209. [PMID: 38290875 DOI: 10.1016/j.cllc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/11/2023] [Accepted: 12/23/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Treatment for inoperable stage II to III non-small cell lung cancer (NSCLC) involves chemo-radiotherapy (CRT). However, some patients transition to hospice or die early during their treatment course. We present a model to prognosticate early poor outcomes in NSCLC patients treated with curative-intent CRT. METHODS AND MATERIALS Across a statewide consortium, data was prospectively collected on stage II to III NSCLC patients who received CRT between 2012 and 2019. Early poor outcomes included hospice enrollment or death within 3 months of completing CRT. Logistic regression models were used to assess predictors in prognostic models. LASSO regression with multiple imputation were used to build a final multivariate model, accounting for missing covariates. RESULTS Of the 2267 included patients, 128 experienced early poor outcomes. Mean age was 71 years and 59% received concurrent chemotherapy. The best predictive model, created parsimoniously from statistically significant univariate predictors, included age, ECOG, planning target volume (PTV), mean heart dose, pretreatment lack of energy, and cough. The estimated area under the ROC curve for this multivariable model was 0.71, with a negative predictive value of 95%, specificity of 97%, positive predictive value of 23%, and sensitivity of 16% at a predicted risk threshold of 20%. CONCLUSIONS This multivariate model identified a combination of clinical variables and patient reported factors that may identify individuals with inoperable NSCLC undergoing curative intent chemo-radiotherapy who are at higher risk for early poor outcomes.
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Affiliation(s)
| | | | - Anna M Laucis
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI
| | | | | | - Larry L Kestin
- Genesis Care / Michigan Healthcare Professionals, Troy, MI
| | | | | | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI
| | - James Hayman
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI
| | | | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI.
| | - Thomas P Boike
- Genesis Care / Michigan Healthcare Professionals, Troy, MI
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Teixeira LFN, Sandrin F, da Silva RFKC, Petrella F, Bertolaccini L, Simoncini MC, Spaggiari L. The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study. Thorac Cardiovasc Surg 2024. [PMID: 38698601 DOI: 10.1055/s-0044-1786196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience. METHODS We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up. RESULTS A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS. CONCLUSION The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit.
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Affiliation(s)
| | - Fabio Sandrin
- Department of Physiotherapy, European Institute of Oncology, Milano, Italy
| | | | - Francesco Petrella
- Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
| | - Luca Bertolaccini
- Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
| | | | - Lorenzo Spaggiari
- Department of Thoracic Surgery, Istituto Europeo di Oncologia, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Trembecki Ł, Sztuder A, Dębicka I, Matkowski R, Maciejczyk A. The pilot project of the National Cancer Network in Poland: Assessment of the functioning of the National Cancer Network and results from quality indicators for lung cancer (2019–2021). BMC Cancer 2022; 22:939. [PMID: 36045330 PMCID: PMC9434856 DOI: 10.1186/s12885-022-10020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This analysis presents the outcomes of the operations of the National Cancer Network (NCN) pilot project in Lower Silesian Voivodeship, Poland, for lung cancer for the period of 2019–2021. The results concerning measures of the quality of medical processes were analysed.
Methods
Twenty-one measures used to gauge the quality of oncological care for lung cancer were assessed. Data collection and processing for the purpose of calculating the measures were carried out as part of the NCN pilot project based on the Regulation of the Ministry of Health enacted on 13 December 2018. The measures were calculated at the Voivodeship Coordination Center, and the data were derived from the centres included in the network in the area of the analysed voivodeship.
Results
A total of 3,638 patients diagnosed with lung cancer were enrolled in the NCN pilot program during the analysed period. For 3 measures, out of 21, target values were obtained. For 2 measures, the values differed significantly from the assumed target value.
Conclusion
In our opinion, the NCN pilot study, as a test of the network’s functioning, meets the assumed goal. The NCN assessment is based on, inter alia, analysis of the outcomes of oncological quality of care measures for lung cancer, and facilitates monitoring of the quality of medical services provided and the identification of areas for improvement. In addition, the pilot program, which will last until the end of 2022, will allow for further in-depth analysis regarding the network’s limitations before implementing the system on a national scale in Poland. This will be the subject of further investigation.
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Hubler A, Wakefield DV, Makepeace L, Carnell M, Sharma AM, Jiang B, Dove AP, Garner WB, Edmonston D, Little JG, Ozdenerol E, Hanson RB, Martin MY, Shaban-Nejad A, Pisu M, Schwartz DL. Independent Predictors for Hospitalization-Associated Radiotherapy Interruptions. Adv Radiat Oncol 2022; 7:101041. [PMID: 36158745 PMCID: PMC9489733 DOI: 10.1016/j.adro.2022.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Radiation treatment interruption associated with unplanned hospitalization remains understudied. The intent of this study was to benchmark the frequency of hospitalization-associated radiation therapy interruptions (HARTI), characterize disease processes causing hospitalization during radiation, identify factors predictive for HARTI, and localize neighborhood environments associated with HARTI at our academic referral center. Methods and Materials This retrospective review of electronic health records provided descriptive statistics of HARTI event rates at our institutional practice. Uni- and multivariable logistic regression models were developed to identify significant factors predictive for HARTI. Causes of hospitalization were established from primary discharge diagnoses. HARTI rates were mapped according to patient residence addresses. Results Between January 1, 2015, and December 31, 2017, 197 HARTI events (5.3%) were captured across 3729 patients with 727 total missed treatments. The 3 most common causes of hospitalization were malnutrition/dehydration (n = 28; 17.7%), respiratory distress/infection (n = 24; 13.7%), and fever/sepsis (n = 17; 9.7%). Factors predictive for HARTI included African-American race (odds ratio [OR]: 1.48; 95% confidence interval [CI], 1.07-2.06; P = .018), Medicaid/uninsured status (OR: 2.05; 95% CI, 1.32-3.15; P = .0013), Medicare coverage (OR: 1.7; 95% CI, 1.21-2.39; P = .0022), lung (OR: 5.97; 95% CI, 3.22-11.44; P < .0001), and head and neck (OR: 5.6; 95% CI, 2.96-10.93; P < .0001) malignancies, and prescriptions >20 fractions (OR: 2.23; 95% CI, 1.51-3.34; P < .0001). HARTI events clustered among Medicaid/uninsured patients living in urban, low-income, majority African-American neighborhoods, and patients from middle-income suburban communities, independent of race and insurance status. Only the wealthiest residential areas demonstrated low HARTI rates. Conclusions HARTI disproportionately affected socioeconomically disadvantaged urban patients facing a high treatment burden in our catchment population. A complementary geospatial analysis also captured the risk experienced by middle-income suburban patients independent of race or insurance status. Confirmatory studies are warranted to provide scale and context to guide intervention strategies to equitably reduce HARTI events.
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Affiliation(s)
- Adam Hubler
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel V. Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Tennessee Oncology, Nashville, Tennessee
| | - Lydia Makepeace
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Matt Carnell
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Ankur M. Sharma
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Bo Jiang
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Austin P. Dove
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennesse
| | - Wesley B. Garner
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Drucilla Edmonston
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - John G. Little
- University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Esra Ozdenerol
- Department of Earth Sciences, University of Memphis, Memphis, Tennessee
| | - Ryan B. Hanson
- Department of Earth Sciences, University of Memphis, Memphis, Tennessee
| | - Michelle Y. Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Arash Shaban-Nejad
- UTHSC-ORNL Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, Tennesse
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David L. Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Corresponding author: David L. Schwartz, MD, FACR
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Wu DM, Li J, Shen R, Li J, Yu Y, Li L, Deng SH, Liu T, Zhang T, Xu Y, Wang DG. Autophagy Induced by Micheliolide Alleviates Acute Irradiation-Induced Intestinal Injury via Inhibition of the NLRP3 Inflammasome. Front Pharmacol 2022; 12:773150. [PMID: 35115927 PMCID: PMC8804324 DOI: 10.3389/fphar.2021.773150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/20/2021] [Indexed: 01/02/2023] Open
Abstract
Radiation-induced enteropathy (RIE) is one of the most common and fatal complications of abdominal radiotherapy, with no effective interventions available. Pyroptosis, a form of proinflammatory regulated cell death, was recently found to play a vital role in radiation-induced inflammation and may represent a novel therapeutic target for RIE. To investigate this, we found that micheliolide (MCL) exerted anti-radiation effects in vitro. Therefore, we investigated both the therapeutic effects of MCL in RIE and the possible mechanisms by which it may be therapeutic. We developed a mouse model of RIE by exposing C57BL/6J mice to abdominal irradiation. MCL treatment significantly ameliorated radiation-induced intestinal tissue damage, inflammatory cell infiltration, and proinflammatory cytokine release. In agreement with these observations, the beneficial effects of MCL treatment in RIE were abolished in Becn1+/− mice. Furthermore, super-resolution microscopy revealed a close association between NLR pyrin domain three and lysosome-associated membrane protein/light chain 3-positive vesicles following MCL treatment, suggesting that MCL facilitates phagocytosis of the NLR pyrin domain three inflammasome. In summary, MCL-mediated induction of autophagy can ameliorate RIE by NLR pyrin domain three inflammasome degradation and identify MCL as a novel therapy for RIE.
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Affiliation(s)
- Dong-ming Wu
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Jing Li
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Rong Shen
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jin Li
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Ye Yu
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Li Li
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Shi-hua Deng
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Teng Liu
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Ting Zhang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Ying Xu
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
- *Correspondence: Ying Xu, ; De-gui Wang,
| | - De-gui Wang
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- *Correspondence: Ying Xu, ; De-gui Wang,
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Nakandi K, Mora D, Stub T, Kristoffersen AE. Conventional health care service utilization among cancer survivors that visit traditional and complementary providers in the Tromsø study: a cross-sectional study. BMC Health Serv Res 2022; 22:53. [PMID: 35016666 PMCID: PMC8751219 DOI: 10.1186/s12913-021-07445-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background Traditional and complementary medicine (T&CM) is commonly used among cancer patients worldwide. Cancer patients in Norway mainly visit T&CM providers in addition to conventional health care services. It is not known how their utilization of T&CM providers influences their use of conventional health care services. The aim of this study was to investigate the difference between the utilization of conventional health care services among cancer survivors that visit T&CM providers and those that do not, and their associated factors. Method Health care service utilization data were obtained from cancer survivors 40 years and above participating in the Tromsø Study: Tromsø 7 conducted in 2015–2016. Data were collected from self-administered questionnaires. Pearson chi-square tests, Fisher exact tests, t-test, and logistic regression were used, with the significance level considered at p < 0.05. Results Of 1553 individuals, 10% (n = 155) reported visiting T&CM providers in the past 12 months. As both cancer survivors visiting and not visiting T&CM providers were frequent users of conventional health care, no significant differences were found in the overall use of conventional health care (98.1vs.94.5%, p = .056). Users of T&CM providers were however more likely to visit physiotherapists (40.1% vs 25%, p < .001), emergency rooms (29.2% vs 16.5%, p < .001), chiropractors (17% vs 6%, p < .001), and psychologist/psychiatrist (8.9% vs 3.4%, p < .001). They also had more frequent visits to conventional health care (11.45 vs 8.31 yearly visits, p = 0.014), particularly to general practitioners (5.21 visits vs. 3.94 visits, p = .002). Conclusion Results from this study show that visits to T&CM providers are associated with more visits to conventional health care services among cancer survivors. Further studies are needed to investigate the reasons for this high use behavior.
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Nieder C, Imingen KS, Haukland E. Palliative Thoracic Radiotherapy for Non-Small Cell Lung Cancer in Outpatients: Reasons for Unplanned Hospitalization and Its Impact on Survival. J Clin Med Res 2021; 13:177-183. [PMID: 33854658 PMCID: PMC8016527 DOI: 10.14740/jocmr4445] [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: 02/09/2021] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background The aims of the study were to examine the rates of and reasons for unplanned hospitalization after start of palliative radiotherapy or chemoradiation (CRT), and to study whether unplanned hospitalization deteriorates patients’ prognosis. In addition, risk factors were identified. Methods A retrospective review of 136 patients treated with palliative radiotherapy or CRT was performed. Inclusion criteria were prescribed total dose at least 30 Gy and outpatient at the start of treatment. Uni- and multivariate analyses were employed. Results Fifty-eight patients (43%) were hospitalized within 3 months from start of radiotherapy or CRT. Their median overall survival was 6.7 months as compared to 11.1 months in non-hospitalized patients (P = 0.09). The median length of hospitalization was 8 days (range 1 - 61). In patients with possibly treatment-related hospitalization (n = 32), median survival was 5.0 months, significantly shorter than the 11.1 months observed in the remaining patients (P = 0.006). In multivariate analysis, only one variable was significantly associated with higher risk of unplanned hospitalization: previous hospitalization in the last 4 weeks before commencing radiotherapy or CRT. Conclusions Unplanned hospitalization occurred frequently in a standard care setting without early involvement of a dedicated palliative team. Patients with preceding hospitalization might represent a group that is particularly vulnerable, thus qualifying for a targeted intervention aiming at continued outpatient care.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, 9037 Tromso, Norway
| | - Kristian S Imingen
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, 9037 Tromso, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodo, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromso, 9037 Tromso, Norway.,SHARE - Center for Resilience in Healthcare, Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, 4036 Stavanger, Norway
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