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Brugel M, Dupont M, Carlier C, Botsen D, Essi DE, Sanchez V, Slimano F, Perrier M, Bouché O. Association of palliative care management and survival after chemotherapy discontinuation in patients with advanced pancreatic adenocarcinoma: A retrospective single-centre observational study. Pancreatology 2023:S1424-3903(23)00069-8. [PMID: 37037682 DOI: 10.1016/j.pan.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Palliative care (PC) is integrated into standard oncology care. However, its clinical impact at the end of life remains unclear in pancreatic adenocarcinoma (PA). We aimed to describe the end-of-life care pathway and to assess whether PC referral influences survival after chemotherapy discontinuation (CD) among advanced PA patients. METHODS This retrospective single-centre observational study was conducted among deceased patients with advanced PA who had received chemotherapy between January 1, 2016, and December 31, 2021. Baseline characteristics, the timing of PC referral and events after CD were collected. The primary outcome was time from CD to death. RESULTS Among the 148 included patients, 53.4% (n = 79) received PC, mostly late after the CD (n = 133, 89.9%), 16.9% (n = 25) received chemotherapy in the last 14 days of life and 75.6% died at the hospital. None received PC in the 8 weeks following the diagnosis. PC referral significantly increased PC department admissions (p < 0.001) and decreased medical unit admissions (p < 0.001). The median survival after the CD was 35 days (IQR: 19-64.5). PC referral was associated with increased survival after CD (HR: 0.65 [0.47-0.90], p = 0.010, Cox) and after adjusting (HR: 0.65 [0.42-0.99], p = 0.045, Cox). CONCLUSION The study suggests that PC may be associated with longer survival after CD in advanced PA patients. However, PC is underused, and patients are referred late in their care pathway.
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Affiliation(s)
- M Brugel
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France.
| | - M Dupont
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - C Carlier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Botsen
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France; Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - D Edoh Essi
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - V Sanchez
- Department of Palliative Care, CHU Reims, Reims, France
| | - F Slimano
- Université de Reims Champagne-Ardenne, Department of Pharmacy, CHU Reims, Reims, France
| | - M Perrier
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
| | - O Bouché
- Université de Reims Champagne-Ardenne, Department of Ambulatory Oncology Care Unit, CHU Reims, Reims, France
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Nagarajah S, Powis ML, Fazelzad R, Krzyzanowska MK, Kukreti V. Implementation and Impact of Choosing Wisely Recommendations in Oncology. JCO Oncol Pract 2022; 18:703-712. [DOI: 10.1200/op.22.00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Choosing Wisely (CW) campaign, launched in 2012, includes oncology-specific recommendations to promote evidence-based care and deimplementation of low-value practices. However, it is unclear to what extent the campaign has prompted practice change. We systematically reviewed the literature to evaluate the uptake of cancer-specific CW recommendations focusing on the period before the declaration of the COVID-19 pandemic. We used Grimshaw's deimplementation framework to thematically group the findings and extracted information on implementation strategies, barriers, and facilitators from articles reporting on active implementation. In the 98 articles addressing 32 unique recommendations, most reported on passive changes in adherence pre-post publication of CW recommendations. Use of active surveillance for low-risk prostate cancer and reduction in staging imaging for early breast cancer were the most commonly evaluated recommendations. Most articles assessing passive changes in adherence pre-post CW publication reported improvement. All articles evaluating active implementation (10 of 98) reported improved compliance (range: 3%-73% improvement). Most common implementation strategies included provider education and/or stakeholder engagement. Preconceived views and reluctance to adopt new practices were common barriers; common facilitators included the use of technology and provider education to increase provider buy-in. Given the limited uptake of oncology-specific CW recommendations thus far, more attention toward supporting active implementation is needed. Effective adoption of CW likely requires a multipronged approach that includes building stakeholder buy-in through engagement and education, using technology-enabled forced functions to facilitate change along with policy and reimbursement models that disincentivize low-value care. Professional societies have a role to play in supporting this next phase of CW.
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Affiliation(s)
- Sonieya Nagarajah
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Lynn Powis
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Monika K. Krzyzanowska
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Cancer Quality Lab (CQuaL), Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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3
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Choi CCM, Choi J, Houli N, Smith M, Usatoff V, Lipton L, Chan S. Evaluation of palliative treatments in unresectable pancreatic cancer. ANZ J Surg 2021; 91:915-920. [PMID: 33870626 DOI: 10.1111/ans.16669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) presents as unresectable disease in 80% of patients. Limited Australian data exists regarding management and outcome of palliative management for PDAC. This study aims to: (i) identify patients with PDAC being managed with palliative intent; (ii) assess the type of palliative management being used. METHODS A prospectively maintained pancreatic database at Western Health (2015-2017) was used to identify patient demographics; stage and multidisciplinary decision regarding resectability and operative interventions; palliative care; use of chemotherapy, radiotherapy and; management of exocrine and endocrine insufficiency. Data on chemotherapy use, number of hospital admissions, emergency department attendances and intensive care unit admissions 30 days prior to death were recorded. RESULTS One-hundred and eleven patients had diagnosis of PDAC, 15% with locally advanced and 45% with metastatic PDAC. Among the locally advanced and metastatic PDAC, 48% received biliary stent insertions, 93% had palliative care referral, 45% received palliative chemotherapy and 10% received radiotherapy. Dietitian referral occurred in 79% and 36% were prescribed with a pancreatic enzyme replacement therapy. Diabetes mellitus was present in 52% of which 31% was new onset. Within 30 days prior to death, 11% patients received palliative chemotherapy, 32% were hospitalized and 11% visited an emergency department more than once. Sixty-five percent died in hospital. CONCLUSION A high proportion of patients diagnosed with locally advanced and metastatic PDAC received palliative care referrals and appropriate level of end-of-life care. Further prospective studies are necessary, examining the management and impacts of pancreatic insufficiency in this group.
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Affiliation(s)
- Colin Chan-Min Choi
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia
| | - Julian Choi
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nezor Houli
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia
| | - Marty Smith
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia
| | - Val Usatoff
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lara Lipton
- Department of Oncology, Western Health, Melbourne, Victoria, Australia
| | - Steven Chan
- Department of Upper Gastrointestinal/Hepatobiliary (HPB) Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
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Plasma Membrane Ca 2+ ATPase Isoform 4 (PMCA4) Has an Important Role in Numerous Hallmarks of Pancreatic Cancer. Cancers (Basel) 2020; 12:cancers12010218. [PMID: 31963119 PMCID: PMC7016988 DOI: 10.3390/cancers12010218] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is largely resistant to standard treatments leading to poor patient survival. The expression of plasma membrane calcium ATPase-4 (PMCA4) is reported to modulate key cancer hallmarks including cell migration, growth, and apoptotic resistance. Data-mining revealed that PMCA4 was over-expressed in pancreatic ductal adenocarcinoma (PDAC) tumors which correlated with poor patient survival. Western blot and RT-qPCR revealed that MIA PaCa-2 cells almost exclusively express PMCA4 making these a suitable cellular model of PDAC with poor patient survival. Knockdown of PMCA4 in MIA PaCa-2 cells (using siRNA) reduced cytosolic Ca2+ ([Ca2+]i) clearance, cell migration, and sensitized cells to apoptosis, without affecting cell growth. Knocking down PMCA4 had minimal effects on numerous metabolic parameters (as assessed using the Seahorse XF analyzer). In summary, this study provides the first evidence that PMCA4 is over-expressed in PDAC and plays a role in cell migration and apoptotic resistance in MIA PaCa-2 cells. This suggests that PMCA4 may offer an attractive novel therapeutic target in PDAC.
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Michael N, Beale G, O'Callaghan C, Melia A, DeSilva W, Costa D, Kissane D, Shapiro J, Hiscock R. Timing of palliative care referral and aggressive cancer care toward the end-of-life in pancreatic cancer: a retrospective, single-center observational study. BMC Palliat Care 2019; 18:13. [PMID: 30691417 PMCID: PMC6350289 DOI: 10.1186/s12904-019-0399-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/21/2019] [Indexed: 01/05/2023] Open
Abstract
Background Pancreatic cancer is noted for its late presentation at diagnosis, limited prognosis and physical and psychosocial symptom burden. This study examined associations between timing of palliative care referral (PCR) and aggressive cancer care received by pancreatic cancer patients in the last 30 days of life through a single health service. Method A retrospective cohort analysis of end-of-life (EOL) care outcomes of patients with pancreatic cancer who died between 2012 and 2016. Key indicators of aggressive cancer care in the last 30 days of life used were: ≥1 emergency department (ED) presentations, acute inpatient/intensive care unit (ICU) admission, and chemotherapy use. We examined time from PCR to death and place of death. Early and late PCR were defined as > 90 and ≤ 90 days before death respectively. Results Out of the 278 eligible deaths, 187 (67.3%) were categorized as receiving a late PCR and 91 (32.7%) an early PCR. The median time between referral and death was 48 days. Compared to those receiving early PCR, those with late PCR had: 18.1% (95% CI 6.8–29.4%) more ED presentations; 12.5% (95% CI 1.7–24.8%) more acute hospital admissions; with no differences in ICU admissions. Pain and complications of cancer accounted for the majority of overall ED presentations. Of the 166 patients who received chemotherapy within 30 days of death, 23 (24.5%) had a late PCR and 12 (16.7%) an early PCR, with no association of PCR status either unadjusted or adjusted for age or gender. The majority of patients (55.8%) died at the inpatient palliative care unit. Conclusion Our findings reaffirm the benefits of early PCR for pancreatic cancer patients to avoid inappropriate care toward the EOL. We suggest that in modern cancer care, there can sometimes be a need to reconsider the use of the term ‘aggressive cancer care’ at the EOL when the care is appropriately based on an individual patient’s presenting physical and psychosocial needs. Pancreatic cancer patients warrant early PCR but the debate must thus continue as to how we best achieve and benchmark outcomes that are compatible with patient and family needs and healthcare priorities.
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Affiliation(s)
- Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia. .,School of Medicine, University of Notre Dame, Sydney, NSW, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
| | - Greta Beale
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia.,Departments of Psychosocial Cancer Care and Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Institute for Ethics and Society, University of Notre Dame, Sydney, NSW, Australia
| | - Adelaide Melia
- Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia
| | - William DeSilva
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Daniel Costa
- Pain Management Research Institute, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Kissane
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, VIC, Australia
| | - Jeremy Shapiro
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
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Carrato A, Falcone A, Ducreux M, Valle JW, Parnaby A, Djazouli K, Alnwick-Allu K, Hutchings A, Palaska C, Parthenaki I. A Systematic Review of the Burden of Pancreatic Cancer in Europe: Real-World Impact on Survival, Quality of Life and Costs. J Gastrointest Cancer 2016; 46:201-11. [PMID: 25972062 PMCID: PMC4519613 DOI: 10.1007/s12029-015-9724-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to assess the overall burden of pancreatic cancer in Europe, with a focus on survival time in a real-world setting, and the overall healthy life lost to the disease. METHODS Real-world data were retrieved from peer-reviewed, observational studies identified by an electronic search. We performed two de novo analyses: a proportional shortfall analysis to quantify the proportion of healthy life lost to pancreatic cancer and an estimation of the aggregate life-years lost annually in Europe. RESULTS Ninety-one studies were included. The median, age-standardised incidence of pancreatic cancer per 100,000 was 7.6 in men and 4.9 in women. Overall median survival from diagnosis was 4.6 months; median survival was 2.8-5.7 months in patients with metastatic disease. The proportional shortfall analysis showed that pancreatic cancer results in a 98 % loss of healthy life, with a life expectancy at diagnosis of 4.6 months compared to 15.1 years for an age-matched healthy population. Annually, 610,000-915,000 quality-adjusted life-years (QALYs) are lost to pancreatic cancer in Europe. Patients had significantly lower scores on validated health-related quality of life instruments versus population norms. CONCLUSIONS To the best of our knowledge, this is the first study to systematically review real-world overall survival and patient outcomes of pancreatic cancer patients in Europe outside the context of clinical trials. Our findings confirm the poor prognosis and short survival reported by national studies. Pancreatic cancer is a substantial burden in Europe, with nearly a million aggregate life-years lost annually and almost complete loss of healthy life in affected individuals.
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Affiliation(s)
- A. Carrato
- />Medical Oncology Department, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo Km. 9,100, Madrid, Spain
| | - A. Falcone
- />Unit of Medical Oncology, Pisa University Hospital, Via Roma 67, Pisa, 56126 Italy
| | - M. Ducreux
- />Gastrointestinal Unit, Gustave Roussy Institute, 114 Rue Edouard-Vaillant, 94805 Villejuif, France
| | - J. W. Valle
- />Department of Medical Oncology, University of Manchester and Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX UK
| | - A. Parnaby
- />Celgene Corporation, Route de Perreux 1, 2017 Boudry, Switzerland
| | - K. Djazouli
- />Celgene Corporation, Route de Perreux 1, 2017 Boudry, Switzerland
| | | | - A. Hutchings
- />Dolon Ltd, 175-185 Grays Inn Road, London, WC1X 8UE UK
| | - C. Palaska
- />Dolon Ltd, 175-185 Grays Inn Road, London, WC1X 8UE UK
| | - I. Parthenaki
- />Dolon Ltd, 175-185 Grays Inn Road, London, WC1X 8UE UK
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Shrotriya S, Walsh D, Bennani-Baiti N, Thomas S, Lorton C. C-Reactive Protein Is an Important Biomarker for Prognosis Tumor Recurrence and Treatment Response in Adult Solid Tumors: A Systematic Review. PLoS One 2015; 10:e0143080. [PMID: 26717416 PMCID: PMC4705106 DOI: 10.1371/journal.pone.0143080] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/30/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A systematic literature review was done to determine the relationship between elevated CRP and prognosis in people with solid tumors. C-reactive protein (CRP) is a serum acute phase reactant and a well-established inflammatory marker. We also examined the role of CRP to predict treatment response and tumor recurrence. METHODS MeSH (Medical Subject Heading) terms were used to search multiple electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, EBM-Cochrane). Two independent reviewers selected research papers. We also included a quality Assessment (QA) score. Reports with QA scores <50% were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology was utilized for this review (S1 PRISMA Checklist). RESULTS 271 articles were identified for final review. There were 45% prospective studies and 52% retrospective. 264 had intermediate QA score (≥50% but <80%); Seven were adequate (80% -100%); A high CRP was predictive of prognosis in 90% (245/271) of studies-80% of the 245 studies by multivariate analysis, 20% by univariate analysis. Many (52%) of the articles were about gastrointestinal malignancies (GI) or kidney malignancies. A high CRP was prognostic in 90% (127 of 141) of the reports in those groups of tumors. CRP was also prognostic in most reports in other solid tumors primary sites. CONCLUSIONS A high CRP was associated with higher mortality in 90% of reports in people with solid tumors primary sites. This was particularly notable in GI malignancies and kidney malignancies. In other solid tumors (lung, pancreas, hepatocellular cancer, and bladder) an elevated CRP also predicted prognosis. In addition there is also evidence to support the use of CRP to help decide treatment response and identify tumor recurrence. Better designed large scale studies should be conducted to examine these issues more comprehensively.
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Affiliation(s)
- Shiva Shrotriya
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Declan Walsh
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- * E-mail:
| | - Nabila Bennani-Baiti
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Shirley Thomas
- Department of Solid Tumor Oncology, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
- The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, United States of America
| | - Cliona Lorton
- Our Lady’s Hospice & Care Services, Harold’s Cross, Dublin, Ireland
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Brom L, Onwuteaka-Philipsen BD, Widdershoven GAM, Pasman HRW. Mechanisms that contribute to the tendency to continue chemotherapy in patients with advanced cancer. Qualitative observations in the clinical setting. Support Care Cancer 2015; 24:1317-25. [PMID: 26329398 PMCID: PMC4729795 DOI: 10.1007/s00520-015-2910-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 08/16/2015] [Indexed: 11/25/2022]
Abstract
Purpose The study aims to describe mechanisms that contribute to the tendency towards continuing chemotherapy in patients with advanced cancer. Methods The study conducted qualitative observations of outpatient clinic visits of 28 patients with advanced cancer (glioblastoma and metastatic colorectal cancer). Results We uncovered four mechanisms in daily oncology practice that can contribute to the tendency towards continuing chemotherapy in patients with advanced cancer: (1) “presenting the full therapy sets the standard”—patients seemed to base their justification for continuing chemotherapy on the “standard” therapy with the maximum number of cycles as presented by the physician at the start of the treatment; (2) “focus on standard evaluation moments hampers evaluation of care goals”—whether or not to continue the treatment was mostly only considered at standard evaluation moments; (3) “opening question guides towards focus on symptoms”—most patients gave an update of their physical symptoms in answer to the opening question of “How are you doing?” Physicians consequently discussed how to deal with this at length, which often took up most of the visit; (4) “treatment is perceived as the only option”—patients mostly wanted to continue with chemotherapy because they felt that they had to try every available option the physician offered. Physicians also often seemed to focus on treatment as the only option. Conclusion Discussing care goals more regularly with the patient, facilitated for instance by implementing early palliative care, might help counter the mechanisms and enable a more well-considered decision. This could be either stopping or continuing chemotherapy.
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Affiliation(s)
- Linda Brom
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Department of Medical Humanities, EMGO Institute for Health and Care research, VU University Medical Center, Amsterdam, the Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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9
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Fuentes S, Frödin JE. Why is intravenous chemotherapy cancelled and how often. Could it be prevented? A prospective analysis of all planned and given intravenous anti-tumor treatments at the Department of Oncology, Karolinska University Hospital, Stockholm during one month. Acta Oncol 2015; 54:1056-62. [PMID: 25591938 DOI: 10.3109/0284186x.2014.990108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chemotherapy and targeted drugs are important tools in the treatment of malignant diseases. A number of the planned treatments are cancelled late which is a great challenge for the clinic to minimize in order to prevent the risk for misused resources. The aim of this study was to analyze the frequency and reasons for late (<48 hours) cancellations and also to get an overview of all intravenous medical anti-cancer treatment at the clinic. MATERIAL AND METHODS During four weeks in October 2010 all patients with intravenously administered chemotherapy and/or targeted drugs were registered at the Department of Oncology, Karolinska University Hospital. The survey comprehends the vast majority of all such treatment for solid tumors in adult patients in the Stockholm region with two million inhabitants. All bookings and late cancellations including their reasons were recorded. Diagnoses, treatment indication, line of treatment and survival, in particular short term survival, were analyzed. RESULTS Almost 3000 bookings for 1460 patients were included and 13% were cancelled late. Patient detoriation was the dominating cause for late cancellation in patients with palliative treatment (59%), while hematological toxicity was most common in the adjuvant group (42%). The most common treatment indication was palliative (62%). Of the palliative treatments, 95% where given in the first to third treatment line. Breast cancer (31.9%) and colorectal cancer (29.9%) were the two most common diagnoses. Seventy-one patients (4.9%) died within two months after the treatment. CONCLUSION A more careful selection and monitoring of the patients might reduce the number of late cancellations due to patient detoriation. To record performance status (PS) as a routine for all patients might be helpful in that process. If the number of late cancellations could be reduced, resources at the clinic could be used more efficiently.
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Affiliation(s)
- Stina Fuentes
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Jan-Erik Frödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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10
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Karim SM, Zekri J, Abdelghany E, Dada R, Munsoor H, Ahmad I. Time from last chemotherapy to death and its correlation with the end of life care in a referral hospital. Indian J Med Paediatr Oncol 2015; 36:55-9. [PMID: 25810576 PMCID: PMC4363852 DOI: 10.4103/0971-5851.151792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A substantial number of cancer patients receive chemotherapy until the end of life (EoL). Various factors have been shown to be associated with receipt of chemotherapy until near death. In this study, we determine our average time from last chemotherapy to death (TLCD) and explore different factors that may be associated with decreased TLCD. Materials and Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. Chi-square test and t-test were used to examine the correlation between selected factors and use of chemotherapy within 60 days of death. Multivariate analysis was used to test independent significance of factors testing positive in univariate analysis. Kaplan-Meier method was used to perform survival analysis. Results: Of the 115 cancer patients who died in the hospital, 41 (35.6%) had TLCD of 60 days or less. Patients with better performance status and those dying under medical oncology service were more likely to be in this group of patients. Univariate analysis showed that these patients were less likely to have palliative care involvement, were more likely to die of treatment related causes, and more likely to have died in the Intensive Care Unit. Multivariate analysis confirmed lack of palliative care involvement and better performance status as independent factors for TLCD less than 60 days. Survival analyses showed that patients with palliative care involvement and those dying under palliative care service were likely to have significantly longer TLCD. Conclusions: Cancer patients who have no involvement of palliative care team in their management tend to receive chemotherapy near the EoL, have more aggressive EoL care, and have higher risk of dying die from treatment related complications. Palliative care should be involved early in the care of cancer patients.
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Affiliation(s)
- Syed Mustafa Karim
- Section of Medical Oncology, Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Riyadh, Saudi Arabia
| | - Jamal Zekri
- Section of Medical Oncology, Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Riyadh, Saudi Arabia
| | - Ehab Abdelghany
- Section of Medical Oncology, Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Riyadh, Saudi Arabia ; Department of Oncology, University of Cairo, National Cancer Institute, Cairo, Egypt
| | - Reyad Dada
- Section of Medical Oncology, Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Riyadh, Saudi Arabia
| | - Husna Munsoor
- Section of Palliative Care, Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Section of Medical Oncology, Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Riyadh, Saudi Arabia
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Sezgin Goksu S, Gunduz S, Unal D, Uysal M, Arslan D, Tatlı AM, Bozcuk H, Ozdogan M, Coskun HS. Use of chemotherapy at the end of life in Turkey. BMC Palliat Care 2014; 13:51. [PMID: 25435808 PMCID: PMC4247666 DOI: 10.1186/1472-684x-13-51] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 11/10/2014] [Indexed: 12/18/2022] Open
Abstract
Background An increasing number of patients receive palliative chemotherapy near the end of life. The aim of this study is to evaluate the aggressiveness of chemotherapy in Turkish individuals near the end of life. Methods Patients diagnosed with solid tumors and died from 2010 to 2011 in the medical oncology department of Akdeniz University were included in the study. Data about the diagnosis, treatment details and imaging procedures were collected. Results Three hundred and seventy-three people with stage IV solid tumors died from 2010 to 2011 in our clinic. Eighty-nine patients (23.9%) patients underwent chemotherapy in the last month of life while 39 patients (10.5%) received chemotherapy in the last 14 days. The probability of undergoing chemotherapy in the last month of life was influenced by: age, ‘newly diagnosed’ patients, and performance status. There was no significant association of chemotherapy in the last month of life with gender and tumor type. Having a PET-CT scan did not alter the chemotherapy decision. Conclusion In conclusion, chemotherapy used in the last month of life in a tertiary care center of Turkey is high. Increasing quality of life should be a priority near the end of life and physicians should consider ceasing chemotherapy and direct the patient to early palliative care.
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Affiliation(s)
- Sema Sezgin Goksu
- Department of Medical Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey
| | - Seyda Gunduz
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Dilek Unal
- Department of Radiation Oncology, Kayseri State Hospital of Research and Education, Kayseri, Turkey
| | - Mukremin Uysal
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Deniz Arslan
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Ali M Tatlı
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Hakan Bozcuk
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Mustafa Ozdogan
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
| | - Hasan S Coskun
- Department of Medical Oncology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
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12
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Zhu SK, Zhou Y, Cheng C, Zhong S, Wu HQ, Wang B, Fan P, Xiong JX, Yang HJ, Wu HS. Overexpression of membrane-type 2 matrix metalloproteinase induced by hypoxia-inducible factor-1α in pancreatic cancer: Implications for tumor progression and prognosis. Mol Clin Oncol 2014; 2:973-981. [PMID: 25279184 DOI: 10.3892/mco.2014.357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/15/2014] [Indexed: 01/06/2023] Open
Abstract
Membrane-type 2 matrix metalloproteinase (MT2-MMP) has been identified as a powerful modulator of the pericellular environment that promotes tumor invasion and metastasis. In this study, we investigated the association of MT2-MMP and hypoxia-inducible factor-1α (HIF-1α) expression in pancreatic cancer with regard to their clinical prognostic significance. Of the tissue specimens obtained from the 78 patients included in this study, 46 (59%) were found to be positive for MT2-MMP immunostaining and MT2-MMP expression was colocalized with HIF-1α in pancreatic cancer. Using the Spearman's rank analysis, the protein and mRNA expression level of MT2-MMP was found to be significantly correlated with HIF-1α and CD34-microvascular density in pancreatic cancer. Furthermore, the expression of MT2-MMP in response to hypoxia was increased in a time-dependent manner and the promoter luciferase reporter revealed upregulation of MT2-MMP expression induced by HIF-1α in pancreatic cancer cells. Moreover, the Cox regression model indicated that MT2-MMP was an independent prognostic factor in patients with pancreatic cancer. Our results demonstrated that the overexpression of MT2-MMP was induced by HIF-1α in response to hypoxia and was an independent prognostic factor for pancreatic cancer progression.
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Affiliation(s)
- Shi-Kai Zhu
- Organ Transplant Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China ; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - Yu Zhou
- Institute of Laboratory Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China ; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - Chao Cheng
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Shan Zhong
- Organ Transplant Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China ; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - Han-Qing Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Bo Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Ping Fan
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jiong-Xin Xiong
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Hong-Ji Yang
- Organ Transplant Center, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China ; School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, P.R. China
| | - He-Shui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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13
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Näppä U, Rasmussen BH, Axelsson B, Lindqvist O. Challenging situations when administering palliative chemotherapy - a nursing perspective. Eur J Oncol Nurs 2014; 18:591-7. [PMID: 24997518 DOI: 10.1016/j.ejon.2014.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/30/2014] [Accepted: 06/09/2014] [Indexed: 12/01/2022]
Abstract
UNLABELLED Palliative chemotherapy treatments (PCT) are becoming more common for patients with incurable cancer; a basic challenge is to optimize tumour response while minimizing side-effects and harm. As registered nurses most often administer PCT, they are most likely to be confronted with difficult situations during PCT administration. This study explores challenging situations experienced by nurses when administering PCT to patients with incurable cancer. METHODS Registered nurses experienced in administering PCT were asked in interviews to recall PCT situations they found challenging. Inspired by the narrative tradition, stories were elicited and analysed using a structural and thematic narrative analysis. RESULTS A total of twenty-eight stories were narrated by seventeen nurses. Twenty of these were dilemmas that could be sorted into three storylines containing one to three dilemmatic situations each. The six dilemmatic situations broadly related to three interwoven areas: the uncertainty of the outcome when giving potent drugs to vulnerable patients; the difficulty of resisting giving PCT to patients who want it; and insufficient communication between nurses and physician. CONCLUSION Nurses who administer PCT are engaged in a complex task that can give rise to a number of dilemmatic situations. The findings may be interpreted as meaning that at least some situations might be preventable if the knowledge and insight of all team members - nurses, physicians, patients, and relatives - are jointly communicated and taken into account when deciding whether or not to give PCT. Forming palliative care teams early in the PCT trajectory, could be beneficial for staff and patients.
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Affiliation(s)
- Ulla Näppä
- Department of Radiation Sciences, Unit of Clinical Research Centre - Östersund, Umeå University, S-901 87 Umeå, Sweden; Department of Nursing, Umeå University, S-901 87 Umeå, Sweden.
| | | | - Bertil Axelsson
- Department of Radiation Sciences, Unit of Clinical Research Centre - Östersund, Umeå University, S-901 87 Umeå, Sweden.
| | - Olav Lindqvist
- Department of Nursing, Umeå University, S-901 87 Umeå, Sweden; Department of Learning, Informatics, Management and Ethics/Medical Management Centre, Karolinska Institutet, S-171 77 Stockholm, Sweden.
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14
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Oligometastases/Oligo-recurrence of lung cancer. Pulm Med 2013; 2013:438236. [PMID: 23476762 PMCID: PMC3586482 DOI: 10.1155/2013/438236] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 11/21/2022] Open
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Guo X, Wang M, Jiang J, Xie C, Peng F, Li X, Tian R, Qin R. Balanced Tiam1-rac1 and RhoA drives proliferation and invasion of pancreatic cancer cells. Mol Cancer Res 2013; 11:230-9. [PMID: 23322732 DOI: 10.1158/1541-7786.mcr-12-0632] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tiam1 is a rac1-specific guanine nucleotide exchange factor, and Tiam1-rac1 is involved in a number of cellular processes. Rac1 and RhoA act as molecular switches that cycle between GTP- and GDP-bound states to balance the activities of rac1 and RhoA. The downregulation of rac1 activity leads to upregulation of RhoA activity, which promotes invasion and migration of pancreatic cancers cells. At present, however, the role of Tiam1-rac1 and RhoA in pancreatic cancers is not fully understood. We found that Tiam1 was upregulated in pancreatic cancers and was significantly expressed in tumors without lymph node involvement or distant metastasis compared with cancers where there was involvement. Although Tiam1-rac1 signaling promoted pancreatic cancer cell proliferation and tumor growth via the Wnt signaling pathway in vitro and in vivo, inhibiting Tiam1-rac1 signaling did not prolong the overall survival time in vivo. This provided evidence that there was a balance between rac1 and RhoA activities in pancreatic cancers. Furthermore, only the combined inhibition of Tiam1-rac1 and RhoA had a beneficial effect on the growth of pancreatic cancers in vivo. Taken together, these results suggest that the progression of pancreatic tumors is partially controlled by the balance between Tiam1-rac1 and RhoA.
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Affiliation(s)
- Xingjun Guo
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, PR China
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