1
|
Rivero-Santana B, Jimenez-Valero S, Jurado-Roman A, Galeote G, Lopez-Fernandez T, Moreno R. The BALTO Registry: Long-term results of percutaneous BALloon pericardioTomy in oncological patients. Catheter Cardiovasc Interv 2024; 103:482-489. [PMID: 38204382 DOI: 10.1002/ccd.30953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The aim of this study was to analyze the efficacy and safety of percutaneous balloon pericardiotomy (PBP) in oncological patients who present with a malignant pericardial effusion (MPE). BACKGROUND The use of PBP as a treatment for MPE is not standardized due to the limited evidence. Furthermore, the performance of a second PBP for a recurrence after a first procedure is controversial. METHODS The BALTO Registry (BALloon pericardioTomy in Oncological patients) is a prospective, single-center, observational registry that includes consecutive PBP performed for MPE from October 2007 to February 2022. Clinical and procedural, characteristics, as well as clinical outcome were analyzed. RESULTS Seventy-six PBP were performed in 61 patients (65% female). Mean age was of 66.4 ± 11.2 years. In 15 cases, a second PBP procedure was performed due to recurrence despite the first PBP. The procedure could be performed effectively in all cases with only two serious complications. Ninety-five percent of cases were discharged alive from the hospital. During a median follow-up of 6.3 months (interquartile range [IQR], 0.9-10.8), MPE recurred in 24.5% cases although no recurrences were reported after the second procedure. No evidence of malignant pleural effusion developed on follow-up. The median overall survival time was 5.8 months (IQR, 0.8-10.2) and the time to recurrence after the first PBP was 2.4 months (IQR, 0.7-4.5). CONCLUSIONS PBP is a safe and effective treatment for MPE. It could be considered an acceptable therapy in most MPE, even in those who recur after a first procedure.
Collapse
Affiliation(s)
- Borja Rivero-Santana
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Santiago Jimenez-Valero
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Alfonso Jurado-Roman
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Guillermo Galeote
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Teresa Lopez-Fernandez
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| | - Raul Moreno
- Cardiology Department, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain
| |
Collapse
|
2
|
Lyons PG, McEvoy CA, Hayes-Lattin B. Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further? Curr Opin Crit Care 2023; 29:472-483. [PMID: 37641516 PMCID: PMC11142388 DOI: 10.1097/mcc.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Care and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures. RECENT FINDINGS The prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing. Sepsis and acute respiratory failure remain the most common critical illness syndromes affecting these patients, although other complications are also frequent. Recent research in oncologic sepsis has described outcome variation - including ICU, hospital, and 28-day mortality - across different types of cancer (e.g., solid vs. hematologic malignancies) and different sepsis definitions (e.g., Sepsis-3 vs. prior definitions). Research in acute respiratory failure in oncology patients has highlighted continued uncertainty in the value of diagnostic bronchoscopy for some patients and in the optimal respiratory support strategy. For both of these syndromes, specific challenges include multifactorial heterogeneity (e.g. in etiology and/or underlying cancer), delayed recognition of clinical deterioration, and complex outcomes measurement. SUMMARY Improving outcomes in oncologic critical care requires attention to the heterogeneity of cancer diagnoses, timely recognition and management of critical illness, and defining appropriate ICU outcomes.
Collapse
Affiliation(s)
- Patrick G Lyons
- Department of Medicine, Oregon Health & Science University
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University
- Knight Cancer Institute, Oregon Health & Science University
| | - Colleen A McEvoy
- Department of Medicine, Washington University School of Medicine
- Siteman Cancer Center, Washington University School of Medicine
| | - Brandon Hayes-Lattin
- Department of Medicine, Oregon Health & Science University
- Knight Cancer Institute, Oregon Health & Science University
| |
Collapse
|
3
|
Lo YH, Kuo CH, Tsai CC, Chen SC. Factors Influencing Posttraumatic Growth Among Primary Caregivers of Patients with Oncologic Emergencies in Taiwan Intensive Care Units: A Cross-Sectional Study of Patient-Caregiver Dyads. Semin Oncol Nurs 2023; 39:151497. [PMID: 37598022 DOI: 10.1016/j.soncn.2023.151497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE (1) To assess the levels of fear of cancer recurrence (FCR), social support, coping styles, and posttraumatic growth; (2) to identify factors associated with posttraumatic growth; and (3) to compare patient and primary caregiver characteristics by level of posttraumatic growth (no-to-little posttraumatic growth vs. moderate-to-high posttraumatic growth) in the primary caregivers of patients with an oncologic emergency. DATA SOURCES A cross-sectional study design was adopted. Data were collected by convenience sampling of cancer patient-caregiver dyads who experienced an oncologic emergency within the last 6 months at a medical center in northern Taiwan. The patients, who had completed cancer treatment, were in an intensive care unit. They were assessed for disease severity, physical performance, and demographic and clinical characteristics. Primary caregivers were assessed for FCR, social support, coping styles, and posttraumatic growth using a set of questionnaires. We found that 80.8% of primary caregivers reported moderate-to-high posttraumatic growth and 19.2% reported no-to-little posttraumatic growth. CONCLUSION Greater posttraumatic growth in primary caregivers was associated with experiencing more patient oncologic emergencies, younger caregiver age, a higher caregiver FCR score, and caregivers' use of active coping behaviors. Caregivers were less likely to report posttraumatic growth if they experienced fewer patient oncologic emergencies, were older, reported lower FCR, and used active coping strategies less frequently. IMPLICATIONS FOR NURSING PRACTICE Developing scenario-based simulations to facilitate caregiving for an oncologic emergency and providing psychological counseling to encourage active coping can help primary caregivers recover emotionally from an oncologic emergency and facilitate growth.
Collapse
Affiliation(s)
- Ya-Hsin Lo
- Head Nurse, Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hsi Kuo
- Attending Physician, Division of Thoracic Oncology, Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Professor, Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Ching Tsai
- Associate Professor, Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Associate Research Fellow, Department of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Ching Chen
- Professor, School of Nursing and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Research Fellow, Department of Radiation Oncology and Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
4
|
Basha NR, Wessly P, Chamsi-Pasha MA. Think Outside the Heart: An Unusual Cause of Large Hemopericardium. Methodist Debakey Cardiovasc J 2023; 19:69-74. [PMID: 37694169 PMCID: PMC10487124 DOI: 10.14797/mdcvj.1276] [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: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023] Open
Abstract
Pericardial effusions secondary to tumors are commonly metastatic, originating primarily from the lung, breast, and lymphomas. Pericardial tamponade is a rare oncological emergency warranting early identification and treatment. We describe a 66-year-old male found to have a large bloody pericardial effusion causing tamponade physiology, and multimodality imaging was consistent with intrapericardial malignancy with no identifiable primary source. He was subsequently diagnosed with type B3 thymoma after mediastinal resection.
Collapse
Affiliation(s)
- Nabel Rajab Basha
- College of Medicine, Alfaisal University, Riyadh, Riyadh Province, Kingdom of Saudi Arabia
| | - Priscilla Wessly
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Mohammed A. Chamsi-Pasha
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| |
Collapse
|
5
|
Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management. Cancers (Basel) 2023; 15:cancers15061796. [PMID: 36980681 PMCID: PMC10046378 DOI: 10.3390/cancers15061796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.
Collapse
|
6
|
Issani A. An updated narrative review on the management of the most common oncological and hematological emergencies. Dis Mon 2023; 69:101355. [PMID: 35379468 DOI: 10.1016/j.disamonth.2022.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncological emergencies are defined as an acute life-threatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to end-stage disease. These oncological emergencies are broadly classified into four major categories; metabolic, structural, hematological and treatment-related causes; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. This study aims to cover an in-depth review of the underlying pathogenesis, clinical presentation, and updated management protocol of most common emergencies belonging to the above-mentioned categories. An all-language literature search was conducted on 15th October 2021 and 10th March 2022, limited to 5 years on PubMed database using the following search strings: oncological emergencies, malignant spinal cord compression, febrile neutropenia, hyperviscosity syndrome, superior vena cava syndrome, immune related adverse events, tumor lysis syndrome, hypercalcemia of malignancy, corrected calcium, malignant pericardial effusion and chemotherapy extravasation.
Collapse
Affiliation(s)
- Ali Issani
- Baqai Medical University, Karachi, Pakistan.
| |
Collapse
|
7
|
Muacevic A, Adler JR, Conde I, Pereira VH, Azevedo P. A Case of a Large Malignant Pericardial Effusion on Computed Tomography Without Electrocardiographic Gating. Cureus 2023; 15:e34176. [PMID: 36843767 PMCID: PMC9957554 DOI: 10.7759/cureus.34176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/27/2023] Open
Abstract
A 67-year-old female was admitted due to dyspnea. A computed tomography (CT) disclosed a suspicious pulmonary mass and a pericardial effusion. A transthoracic echocardiogram confirmed a large-volume circumferential pericardial effusion. A pericardiocentesis was performed, and the cytological and histochemical studies later confirmed the diagnosis of pulmonary adenocarcinoma. This case report highlights the casualty of having found a cardiac tamponade through a CT not synchronized with an electrocardiogram.
Collapse
|
8
|
Cao K, Wu JC, Hernandez M, Ganti L. Steroid-Induced Tumor Lysis Syndrome Accompanied by Diabetic Ketoacidosis and Acute Renal Failure in a Non-Hodgkin Lymphoma Patient. Cureus 2022; 14:e24491. [PMID: 35651382 PMCID: PMC9135592 DOI: 10.7759/cureus.24491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
|
9
|
Wu Y, Li Y, Wang M, Li W, Qiu X. Percutaneous Endovascular Stent Placement for Treatment of Malignant Superior Vena Cava Syndrome: A Retrospective Review. Ann Vasc Surg 2021; 80:325-332. [PMID: 34780937 DOI: 10.1016/j.avsg.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/22/2021] [Accepted: 10/03/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We assessed the safety as well as the efficacy of self-expanding stent placement for the treatment of malignant superior vena cava syndrome (SVCS), besides identifying the predictable probable factors for the clinical improvement of endovascular stent treatment in SVCS. METHODS The study reviewed 112 patients (92 men) with malignant SVCS retrospectively from January 2015 to December 2020. RESULTS Out of total 112 patients, 106 stents were successfully placed in 102 patients, however 4 patient's occlusions could not be passed and 6 patient's procedure was abandoned due to intraluminal thrombus as detected in venography. In 92 patients, complete resolution of syndrome was observed within 72 hrs but 10 patients did not to intervention. In 102 patients, procedure-related 8 complications were noted including stent migrations (n = 4), pulmonary embolism (n = 2), and pulmonary edemas (n = 2). Besides after stenting, 3 hemorrhages with anticoagulation therapy were observed with 4 recurrences at 22, 36, 51 and day 58 in 6 months. The pressure gradient across the lesion (≥ 20mmHg) was used as a predictor for clinical efficacy of stent therapy for SVCS. CONCLUSIONS Endovascular stent insertion is a safe and effective intervention for malignant SVCS, especially for those with pressure gradient across the lesions ≥ 20mmHg.
Collapse
Affiliation(s)
- Yilin Wu
- Department of Cardiology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yanjie Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Wang
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Weizhen Li
- Department of Cardiology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xingbiao Qiu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|