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Fujii Y, Yoshikawa R, Kashima R, Saho W, Onishi H, Matsumoto T, Harada R, Takeoka Y, Sawada R, Fukase N, Hara H, Kakutani K, Akisue T, Sakai Y. Evaluation of Changes in Activities of Daily Living and Quality of Life of Patients with Bone Metastasis Who Underwent Conservative Therapy through Bone Metastasis Cancer Boards. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:906. [PMID: 38929523 PMCID: PMC11205938 DOI: 10.3390/medicina60060906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Changes in activities of daily living (ADL) and quality of life (QOL) of patients with bone metastasis who underwent surgical treatment through Bone Metastasis Cancer Boards (BMCBs), a recent multidisciplinary approach for managing bone metastases, have been reported; however, no reports exist on patients who undergo conservative treatment. In this study, we aimed to evaluate these patients' ADL and QOL and examine the factors influencing changes in these parameters. Materials and Methods: We retrospectively reviewed 200 patients with bone metastases who underwent conservative therapy through BMCBs between 2013 and 2021. A reassessment was conducted within 2-8 weeks after the initial assessment. Patients' background and changes in performance status (PS), Barthel Index (BI), EuroQol five-dimension (EQ-5D) scores, and Numerical Rating Scale (NRS) scores were initially assessed. Furthermore, we categorized patients into two groups based on improvements or deteriorations in ADL and QOL and performed comparative analyses. Results: Significant improvements in EQ-5D (0.57 ± 0.02 versus [vs.] 0.64 ± 0.02), NRS max (5.21 ± 0.24 vs. 3.56 ± 0.21), and NRS average (2.98 ± 0.18 vs. 1.85 ± 0.13) scores were observed between the initial assessment and reassessment (all p < 0.001). PS (1.84 ± 0.08 vs. 1.72 ± 0.08) and BI (83.15 ± 1.68 vs. 84.42 ± 1.73) also showed improvements (p = 0.06, and 0.054, respectively). In addition, spinal cord paralysis (odds ratio [OR]: 3.69, p = 0.049; OR: 8.42, p < 0.001), chemotherapy (OR: 0.43, p = 0.02; OR: 0.25, p = 0.007), and NRS average scores (OR: 0.38, p = 0.02; OR: 0.14, p < 0.001) were independent factors associated with ADL and QOL. Conclusions: Patients with bone metastases who underwent conservative treatment through BMCBs exhibited an increase in QOL without a decline in ADL. The presence of spinal cord paralysis, absence of chemotherapy, and poor pain control were associated with a higher risk of deterioration in ADL and QOL.
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Affiliation(s)
- Yasumitsu Fujii
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Ryo Yoshikawa
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
| | - Ryoga Kashima
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Wataru Saho
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Hirokazu Onishi
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
| | - Tsuyoshi Matsumoto
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
| | - Risa Harada
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Ryoko Sawada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan;
| | - Yoshitada Sakai
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan (Y.S.)
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan
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Alajroush DR, Smith CB, Anderson BF, Oyeyemi IT, Beebe SJ, Holder AA. A Comparison of In Vitro Studies between Cobalt(III) and Copper(II) Complexes with Thiosemicarbazone Ligands to Treat Triple Negative Breast Cancer. Inorganica Chim Acta 2024; 562:121898. [PMID: 38282819 PMCID: PMC10810091 DOI: 10.1016/j.ica.2023.121898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Metal complexes have gained significant attention as potential anti-cancer agents. The anti-cancer activity of [Co(phen)2(MeATSC)](NO3)3•1.5H2O•C2H5OH 1 (where phen = 1,10-phenanthroline and MeATSC = 9-anthraldehyde-N(4)-methylthiosemicarbazone) and [Cu(acetylethTSC)Cl]Cl•0.25C2H5OH 2 (where acetylethTSC = (E)-N-ethyl-2-[1-(thiazol-2-yl)ethylidene]hydrazinecarbothioamide) was investigated by analyzing DNA cleavage activity. The cytotoxic effect was analyzed using CCK-8 viability assay. The activities of caspase 3/7, 9, and 1, reactive oxygen species (ROS) production, cell cycle arrest, and mitochondrial function were further analyzed to study the cell death mechanisms. Complex 2 induced a significant increase in nicked DNA. The IC50 values of complex 1 were 17.59 μM and 61.26 μM in cancer and non-cancer cells, respectively. The IC50 values of complex 2 were 5.63 and 12.19 μM for cancer and non-cancer cells, respectively. Complex 1 induced an increase in ROS levels, mitochondrial dysfunction, and activated caspases 3/7, 9, and 1, which indicated the induction of intrinsic apoptotic pathway and pyroptosis. Complex 2 induced cell cycle arrest in the S phase, ROS generation, and caspase 3/7 activation. Thus, complex 1 induced cell death in the breast cancer cell line via activation of oxidative stress which induced apoptosis and pyroptosis while complex 2 induced cell cycle arrest through the induction of DNA cleavage.
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Affiliation(s)
- Duaa R. Alajroush
- Department of Chemistry and Biochemistry, Old Dominion University 4501 Elkhorn Avenue, Norfolk, VA 23529, U.S.A
| | - Chloe B. Smith
- Department of Chemistry and Biochemistry, Old Dominion University 4501 Elkhorn Avenue, Norfolk, VA 23529, U.S.A
| | - Brittney F. Anderson
- Department of Biological Sciences, University of the Virgin Islands, 2 John Brewers Bay, St. Thomas, VI 00802, U.S.A
| | - Ifeoluwa T. Oyeyemi
- Department of Chemistry and Biochemistry, Old Dominion University 4501 Elkhorn Avenue, Norfolk, VA 23529, U.S.A
- Department of Biological Sciences, University of Medical Sciences, Ondo City, Nigeria
| | - Stephen J. Beebe
- Frank Reidy Research center for Bioelectrics, Old Dominion University, 4211 Monarch Way, Suite 300, Norfolk, VA, 23508, U.S.A
| | - Alvin A. Holder
- Department of Chemistry and Biochemistry, Old Dominion University 4501 Elkhorn Avenue, Norfolk, VA 23529, U.S.A
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Neves MBM, Neves YCS, Bomonetto JVB, Matos PPC, Giglio AD, Cubero DDIG. Evaluation of factors predicting the benefit from systemic oncological treatment for severely ill hospitalized patients: a retrospective study. BMC Palliat Care 2023; 22:131. [PMID: 37674155 PMCID: PMC10481478 DOI: 10.1186/s12904-023-01256-8] [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: 07/03/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Patients with cancer in the disease's end-stage with poor performance represent a challenging clinical scenario, as they have high chance of a fatal outcome due to clinical conditions, oncological emergencies, and/or metastatic disease. This study examines the factors predicting the potential benefit of "urgent" chemotherapy during hospitalization in this setting, thus addressing a research gap. METHODS This retrospective observational study was conducted in the largest cancer center in the outskirts of São Paulo. It identified factors predicting the benefit from antineoplastic treatment in severe in-hospital patients admitted during 2019-2020, considering post-chemotherapy survival time as the main dependent variable. Data were retrieved from medical records. All patients aged ≥ 18 years, with an ECOG-PS score ≥ 2, and undergoing non-elective systemic cancer treatment were included. RESULTS This study evaluated 204 records, of which 89 were included in the final analysis. A statistically significant association with the worse outcome (death within 30 days of chemotherapy) was found with higher ECOG performance status; chemotherapy dose reduction; lower values of serum albumin, hemoglobin, and creatinine clearance; and higher values of leukocytes, neutrophils, direct bilirubin, urea, and C-reactive protein. In the multivariate analysis, only albumin remained statistically associated with the outcome (hazard ratio = 0.35; confidence interval: 0.14, 0.90; p = 0.034). CONCLUSIONS Serum albumin and other clinical and laboratory variables might be associated with early post-treatment deaths in patients with cancer. The study data might help guide the decision to administer systemic treatment in this scenario and manage critically ill patients. This study adds to our knowledge of the factors predicting the objective benefits from "heroic" or "urgent" chemotherapy for hospitalized and severely ill patients with cancer.
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Affiliation(s)
- Milena Brachmans Mascarenhas Neves
- Centro Universitário Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brazil.
- Hospital Alemão Oswaldo Cruz, 212. Vila Mariana, 0412601, São Paulo, SP, Brazil.
| | - Yuri Costa Sarno Neves
- Instituto de Radiologia (InRad), Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Auro Del Giglio
- Centro Universitário Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brazil
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Ushiku C, Akiyama S, Ikegami T, Inoue T, Shinohara A, Kobayashi S, Kajiwara T, Arimura D, Katsumi S, Obata S, Soshi S, Saito M. Clinical study of preoperative skeletal muscle mass as a predictor of physical performance recovery following palliative surgery for spinal metastases. J Orthop Sci 2022:S0949-2658(22)00170-1. [PMID: 35811255 DOI: 10.1016/j.jos.2022.06.006] [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: 03/01/2022] [Revised: 05/05/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical treatment of spinal metastases has been associated with high morbidity and mortality in patients with sarcopenia based on low skeletal muscle mass. We assessed physical performance using the Eastern Cooperative Oncology Group performance status scale and the Barthel Index on the 30th day after palliative surgery for spinal metastases and investigated the effectiveness of surgery according to sarcopenia assessed by skeletal muscle mass. METHODS We retrospectively analyzed 78 consecutive patients with thoracic and lumbar spinal metastases who underwent palliative surgery. The value of the area of the psoas major muscle at the L3 level normalized by the vertebral area was divided into first, middle, and third tertiles. Clinical variables were compared by tertile. Variables affecting the 30-day good performance status were investigated with univariate and multivariate analyses. RESULTS The 30-day morbidity rates were 50%, 38.5%, and 15.4% by tertile. The 30-day mortality rate was 2%; all were in the first tertile. Good preoperative performance status scores were seen in 15.4% of first and 50% of third tertile patients. Postoperatively, the performance status improved in all groups, with 30.8%, 65.4%, and 92.3% by tertile. Multivariate regression analysis revealed that a good preoperative performance status (OR: 15.50, 95% CI: 1.610-149.00, P < 0.05) and the value of the area of the psoas major muscle at the L3 level normalized by the vertebral area not in the first tertile (OR: 0.22, 95% CI: 0.06-0.82, P < 0.05) were significant predictors of a good postoperative 30-day performance status. CONCLUSIONS A good preoperative performance status and exclusion from the first tertile were clinical factors predicting a good postoperative 30-day performance status. In patients with large psoas muscle mass (third tertile), a good 30-day performance status can be expected after surgery, suggesting that surgery in this population should be pursued aggressively.
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Affiliation(s)
- Chikara Ushiku
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Kashiwashita 163-1, Kashiwa, Chiba, 2778567, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan.
| | - Shoshi Akiyama
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Kashiwashita 163-1, Kashiwa, Chiba, 2778567, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Taku Ikegami
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Takeshi Inoue
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Akira Shinohara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shunsuke Kobayashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Takayoshi Kajiwara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Daigo Arimura
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shunsuke Katsumi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shintaro Obata
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shigeru Soshi
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Kashiwashita 163-1, Kashiwa, Chiba, 2778567, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
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Shepherd J, Waller A, Sanson-Fisher R, Zdenkowski N, Douglas C, Clark K. Oncology patients’ and oncology nurses’ views on palliative chemotherapy: A cross-sectional comparison. Collegian 2021. [DOI: 10.1016/j.colegn.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mieras A, Becker-Commissaris A, Klop HT, Pasman HRW, de Jong D, Pronk L, Onwuteaka-Philipsen BD. Patients with Metastatic Lung Cancer and Oncologists' Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study. Med Decis Making 2021; 41:515-526. [PMID: 33783264 DOI: 10.1177/0272989x21998951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous studies have investigated patients' treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. AIM To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. DESIGN AND PARTICIPANTS A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. RESULTS According to patients and oncologists, treatment goals were achieved in 30% and 37% for 'quality of life,' 49% and 41% for 'life prolongation,' 26% and 44% for 'decrease in tumor size,' and 44% for 'cure', respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment even if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do 'something.' CONCLUSIONS Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing 'something.'
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Denise de Jong
- Department of Pulmonary Diseases, Haags Medisch Centrum, Leidschendam, Zuid-Holland, The Netherlands
| | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Mieras A, Pasman HRW, Klop HT, Onwuteaka-Philipsen BD, Tarasevych S, Tiemessen MA, Becker-Commissaris A. What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer? Clin Lung Cancer 2020; 22:242-251.e5. [PMID: 32698949 DOI: 10.1016/j.cllc.2020.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Metastatic lung cancer is an incurable disease that can be treated with systemic therapy. These treatments might prolong survival and reduce symptoms, but they may also cause serious adverse effects. We studied the treatment goals of patients with metastasized lung cancer and their oncologists before starting systemic therapy, concordance between patients' and oncologists' goals, and feasibility of these goals. PATIENTS AND METHODS This research was conducted between November 2016 and April 2018 in 1 academic and 5 nonacademic hospitals across the Netherlands. A total of 266 patients with metastatic lung cancer and their prescribing oncologists (n = 23) filled out a questionnaire about their treatment goals and the estimated feasibility of these goals before treatment was started. Additional interviews were conducted with patients and oncologists. RESULTS Patients and oncologists reported quality of life (respectively, 45% and 72%), life prolongation (45% and 55%), decrease in tumor size (39% and 66%), and cure (19% and 2%) as treatment goals. The interviews showed that the latter appeared to be often as motivation to stay alive. Concordances between patients' and oncologists' treatment goals were low (ranging from 24% to 33%). Patients had slightly higher feasibility scores than oncologists (6.8 vs. 5.8 on a 10-point scale). Educational level, age, religious views, and performance status of patients were associated with treatment goals. CONCLUSION Patients and oncologists set various goals for the treatment they receive/prescribe. Low concordance might exist because different goals are set or because the patient misunderstands something. Clear communication about treatment goals should be integrated into clinical care.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Svitlana Tarasevych
- Department of Pulmonary Diseases, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Marian A Tiemessen
- Department of Pulmonary Diseases, Dijklander Ziekenhuis Hoorn, Hoorn, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Mieras A, Onwuteaka-Philipsen BD, Becker-Commissaris A, Bos JCM, Pasman HRW. Relatives of deceased patients with metastatic lung cancer's views on the achievement of treatment goals and the choice to start treatment: a structured telephone interview study. BMC Palliat Care 2020; 19:86. [PMID: 32560645 PMCID: PMC7305592 DOI: 10.1186/s12904-020-00591-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Lung cancer has a high impact on both patients and relatives due to the high disease burden and short life expectancy. Previous studies looked into treatment goals patients have before starting a systemic treatment. However, studies on relatives’ perceptions of treatment at the end of life are scarce. Therefore, we studied the perspectives of relatives in hindsight on the achievement of treatment goals and the choice to start treatment for metastatic lung cancer of their loved one. Methods We conducted a structured telephone interview study in six hospitals across the Netherlands, one academic and five non-academic hospitals, between February 2017 and November 2019. We included 118 relatives of deceased patients diagnosed with metastatic lung cancer who started a systemic treatment as part of usual care (chemotherapy, immunotherapy or targeted therapy with tyrosine kinase inhibitors (TKIs) and who completed a questionnaire on their treatment goals before the start of treatment and when treatment was finished. We asked the relatives about the achievement of patients’ treatment goals and relatives’ satisfaction with the choice to start treatment. This study is part of a larger study in which 266 patients with metastatic lung cancer participated who started a systemic treatment and reported their treatment goals before start of the treatment and the achievement of these goals after the treatment. Results Relatives reported the goals ‘quality of life’, ‘decrease tumour size’ and ‘life prolongation’ as achieved in 21, 37 and 41% respectively. The majority of the relatives (78%) were satisfied with the choice to start a treatment and even when none of the goals were achieved, 70% of the relatives were satisfied. About 50% of relatives who were satisfied with the patients’ choice mentioned negative aspects of the treatment choice, such as the treatment did not work, there were side effects or it would not have been the relatives’ choice. Whereas, 80% of relatives who were not satisfied mentioned negative aspects of the treatment choice. The most mentioned positive aspects were that they tried everything and that it was the patient’s choice. Conclusion The majority of relatives reported patients’ treatment goals as not achieved. However, relatives were predominantly satisfied about the treatment choice. Satisfaction does not provide a full picture of the experience with the treatment decision considering that the majority of relatives mentioned (also) negative aspects of this decision. At the time of making the treatment decision it is important to manage expectations about the chance of success and the possible side effects of the treatment.
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Affiliation(s)
- Adinda Mieras
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands. .,Public Health research Institute, Expertise Center for Palliative Care, de Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Annemarie Becker-Commissaris
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
| | - Jose C M Bos
- Dijklander Ziekenhuis, Department of Pulmonary Diseases, Purmerend, The Netherlands
| | - H Roeline W Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research Institute, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, Netherlands
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Beebe SJ, Celestine MJ, Bullock JL, Sandhaus S, Arca JF, Cropek DM, Ludvig TA, Foster SR, Clark JS, Beckford FA, Tano CM, Tonsel-White EA, Gurung RK, Stankavich CE, Tse-Dinh YC, Jarrett WL, Holder AA. Synthesis, characterization, DNA binding, topoisomerase inhibition, and apoptosis induction studies of a novel cobalt(III) complex with a thiosemicarbazone ligand. J Inorg Biochem 2020; 203:110907. [PMID: 31715377 PMCID: PMC7053658 DOI: 10.1016/j.jinorgbio.2019.110907] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 01/09/2023]
Abstract
In this study, 9-anthraldehyde-N(4)-methylthiosemicarbazone (MeATSC) 1 and [Co(phen)2(O2CO)]Cl·6H2O 2 (where phen = 1,10-phenanthroline) were synthesized. [Co(phen)2(O2CO)]Cl·6H2O 2 was used to produce anhydrous [Co(phen)2(H2O)2](NO3)33. Subsequently, anhydrous [Co(phen)2(H2O)2](NO3)33 was reacted with MeATSC 1 to produce [Co(phen)2(MeATSC)](NO3)3·1.5H2O·C2H5OH 4. The ligand, MeATSC 1 and all complexes were characterized by elemental analysis, FT IR, UV-visible, and multinuclear NMR (1H, 13C, and 59Co) spectroscopy, along with HRMS, and conductivity measurements, where appropriate. Interactions of MeATSC 1 and complex 4 with calf thymus DNA (ctDNA) were investigated by carrying out UV-visible spectrophotometric studies. UV-visible spectrophotometric studies revealed weak interactions between ctDNA and the analytes, MeATSC 1 and complex 4 (Kb = 8.1 × 105 and 1.6 × 104 M-1, respectively). Topoisomerase inhibition assays and cleavage studies proved that complex 4 was an efficient catalytic inhibitor of human topoisomerases I and IIα. Based upon the results obtained from the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay on 4T1-luc metastatic mammary breast cancer cells (IC50 = 34.4 ± 5.2 μM when compared to IC50 = 13.75 ± 1.08 μM for the control, cisplatin), further investigations into the molecular events initiated by exposure to complex 4 were investigated. Studies have shown that complex 4 activated both the apoptotic and autophagic signaling pathways in addition to causing dissipation of the mitochondrial membrane potential (ΔΨm). Furthermore, activation of cysteine-aspartic proteases3 (caspase 3) in a time- and concentration-dependent manner coupled with the ΔΨm, studies implicated the intrinsic apoptotic pathway as the major regulator of cell death mechanism.
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Affiliation(s)
- Stephen J Beebe
- The Frank Reidy Center for Bioelectrics, 4211 Monarch Way, Suite 300, Norfolk, VA 23529, USA
| | - Michael J Celestine
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Jimmie L Bullock
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Shayna Sandhaus
- Department of Chemistry and Biochemistry, Biomolecular Sciences Institute, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA
| | - Jessa Faye Arca
- Department of Chemistry and Biochemistry, The University of Southern Mississippi, 118 College Drive, Hattiesburg, MS 39406, USA
| | - Donald M Cropek
- U.S. Army Corps of Engineers, Construction Engineering Research Laboratory, Champaign, IL 61822, USA
| | - Tekettay A Ludvig
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Sydney R Foster
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Jasmine S Clark
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Floyd A Beckford
- The University of Virginia's College at Wise, 1 College Avenue, Wise, VA 24293, USA
| | - Criszcele M Tano
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Elizabeth A Tonsel-White
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Raj K Gurung
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Courtney E Stankavich
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA
| | - Yuk-Ching Tse-Dinh
- Department of Chemistry and Biochemistry, Biomolecular Sciences Institute, Florida International University, 11200 SW 8th St., Miami, FL 33199, USA
| | - William L Jarrett
- School of Polymers and High-Performance Materials, The University of Southern Mississippi, 118 College Drive, #5050, Hattiesburg, MS 39406, USA
| | - Alvin A Holder
- Department of Chemistry and Biochemistry, Old Dominion University, 4541 Hampton Boulevard, Norfolk, VA 23529, USA.
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10
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Mieras A, Becker-Commissaris A, Pasman HRW, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Onwuteaka-Philipsen BD. Chemotherapy and Tyrosine Kinase Inhibitors in the last month of life in patients with metastatic lung cancer: A patient file study in the Netherlands. Eur J Cancer Care (Engl) 2019; 29:e13210. [PMID: 31863609 PMCID: PMC9285506 DOI: 10.1111/ecc.13210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/01/2019] [Accepted: 11/28/2019] [Indexed: 12/27/2022]
Abstract
Objective Chemotherapy in the last month of life for patients with metastatic lung cancer is often considered as aggressive end‐of‐life care. Targeted therapy with Tyrosine Kinase Inhibitors (TKIs) is a relatively new treatment of which not much is known yet about use in the last month of life. We examined what percentage of patients received chemotherapy or TKIs in the last month of life in the Netherlands. Methods Patient files were drawn from 10 hospitals across the Netherlands. Patients had to meet the following eligibility criteria: metastatic lung cancer; died between June 1, 2013 and July 31, 2015. Results From the included 1,322 patients, 39% received no treatment for metastatic lung cancer, 52% received chemotherapy and 9% received TKIs. A total of 232 patients (18%) received treatment in the last month of life (11% chemotherapy, 7% TKIs). From the patients who received chemotherapy, 145 (21%) received this in the last month of life and 79 (11%) started this treatment in the last month of life. TKIs were given and started more often in the last month of life: from the patients who received TKIs, 87 (72%) received this treatment in the last month of life and 15 (12%) started this treatment in the last month of life. Conclusion A substantial percentage of patient received and even started chemotherapy or TKIs in the last month of life. For chemotherapy, this might be seen as aggressive care. TKIs are said to have less side effects, do not lead to many hospital visits and due to the rapid response, are considered good palliation. However, it is not known, yet possible that, when patients still receiving treatment until shortly before death, this might influence preparing for death in a negative way.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC, Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.,Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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11
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Mieras A, Pasman HRW, Onwuteaka-Philipsen BD, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Becker-Commissaris A. Is In-Hospital Mortality Higher in Patients With Metastatic Lung Cancer Who Received Treatment in the Last Month of Life? A Retrospective Cohort Study. J Pain Symptom Manage 2019; 58:805-811. [PMID: 31283970 DOI: 10.1016/j.jpainsymman.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care. OBJECTIVES We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life. METHODS This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records. RESULTS In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital. CONCLUSION In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, The Netherlands; Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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12
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Povsic M, Enstone A, Wyn R, Kornalska K, Penrod JR, Yuan Y. Real-world effectiveness and tolerability of small-cell lung cancer (SCLC) treatments: A systematic literature review (SLR). PLoS One 2019; 14:e0219622. [PMID: 31318909 PMCID: PMC6638917 DOI: 10.1371/journal.pone.0219622] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES SCLC makes up approximately 15% of all lung carcinomas and is characterized by relatively aggressive spread and poorer prognosis compared to other lung cancers. Treatment options are limited, and their efficacy in randomized trials is poor, whilst outcomes in clinical practice remain unclear. The aim of this study was to assess the real-world effectiveness and tolerability of SCLC treatments. METHODS An SLR was conducted across nine databases accessed through OVID, capturing observational, non-randomized studies published between 01/2006-11/2018. In total, 554 abstracts were retrieved and systematically screened for eligibility. The eligible publications included effectiveness and tolerability data from adult SCLC patients (at any line of therapy). Additional grey literature searches were conducted. RESULTS Forty-three publications were included in this review-data from first-line therapies were captured most often (n = 32), while data from second (n = 14) and third line (n = 7) and beyond (n = 7) were less frequent. The publications reported primarily on chemotherapy/radiotherapy. The majority of publications lacked robustness and only 14/43 conducted statistical analyses or controlled for bias. Median OS for the largest SCLC populations were 9.6 months at first line (n = 23,535) and 4.9 months at second line (n = 254) for treatment with chemotherapy, and 4.7 months at third line (n = 120) for predominantly platinum-based chemotherapy or cyclophosphamide/adriamycin/vincristine. Hematologic toxicities (such as neutropenia, thrombocytopenia and anemia) were the most frequently reported TRAEs (n = 9). CONCLUSIONS Real-world treatment effectiveness and tolerability data were fragmented and inconsistently reported, and available publications were primarily of poor quality and lacked statistical analyses. This SLR showed limited treatment options and poor OS in SCLC, with no treatment option being clearly superior. TRAEs additionally increased the burden of this already challenging disease. Recent data suggest real-world outcomes are even poorer that those reported in clinical trials, and that novel therapies are needed to offer new treatment options for patients.
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Affiliation(s)
- Manca Povsic
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - Robin Wyn
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - John R. Penrod
- Bristol-Myers Squibb, Princeton, NJ, United States of America
| | - Yong Yuan
- Bristol-Myers Squibb, Princeton, NJ, United States of America
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13
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Murakawa Y, Sakayori M, Otsuka K. Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan. BMC Palliat Care 2019; 18:45. [PMID: 31159782 PMCID: PMC6547558 DOI: 10.1186/s12904-019-0428-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to analyze the determinants of patients' choice between palliative chemotherapy and best supportive care (BSC) and to investigate how this choice affects overall survival (OS) and length of hospitalization according to Eastern Cooperative Oncology Group (ECOG) performance status (PS). METHODS An oncologist explained the palliative chemotherapy and BSC options to 129 patients with incurable cancer during their first consultation. Data on the ECOG PS, treatment decision, OS, and the length of hospitalization were retrospectively collected over 4 years. RESULTS Patients with an ECOG PS of 0-2 chose palliative chemotherapy more often than those with an ECOG PS of 3-4 (P < 0.01). Patients with ≤70 years chose palliative chemotherapy more often than those with > 70 (P < 0.05). And patients with gastric cancer and colon cancer chose palliative chemotherapy more often than those with CUP (carcinoma of unknown primary) (P < 0.05, P < 0.05 respectively). Factors associated with a significantly poorer OS in an adjusted analysis included the ECOG PS and treatment decision (hazard ratios: 0.18 and 0.43; P < 0.001, P < 0.01 respectively). In patients with an ECOG PS of 0-2, palliative chemotherapy was not associated with a longer OS compared with BSC (median OS: 14.5 vs. 6.8 months, respectively; P = 0.144). In patients with an ECOG PS of 3-4, palliative chemotherapy resulted in a significant survival gain compared to with BSC (median OS: 3.8 vs. 1.4 months, respectively; P < 0.05). Strong positive correlations between OS and the length of hospitalization were observed in patients with an ECOG PS of 3-4 who underwent palliative chemotherapy (r2 = 0.683) and the length of hospitalization was approximately one-third of their OS. CONCLUSIONS The determinants for treatment choice were age, ECOG PS and type of cancer, not sex difference. Oncologists should explain to patients that OS and the length of hospitalization vary according to the ECOG PS when selecting between palliative chemotherapy and BSC.
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Affiliation(s)
- Yasuko Murakawa
- Department of Medical Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima, Natori, Japan.
| | - Masato Sakayori
- Department of Medical Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima, Natori, Japan
| | - Kazunori Otsuka
- Department of Medical Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima, Natori, Japan
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14
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Fiorin de Vasconcellos V, Rcc Bonadio R, Avanço G, Negrão MV, Pimenta Riechelmann R. Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status. BMC Palliat Care 2019; 18:42. [PMID: 31109330 PMCID: PMC6528308 DOI: 10.1186/s12904-019-0427-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. Methods We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3–4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. Results Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1–507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. Conclusions Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.
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Affiliation(s)
- Vitor Fiorin de Vasconcellos
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil.
| | - Renata Rcc Bonadio
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil
| | - Guilherme Avanço
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil
| | - Marcelo Vailati Negrão
- Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil.,Department of Thoracic/Head and Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 432, Houston, TX, 77030, USA
| | - Rachel Pimenta Riechelmann
- Department of Clinical Oncology, AC Camargo Cancer Center, R. Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil
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15
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Toshima H, Ikusue T, Hisamatsu A, Kobayashi K, Shimada K. Two cases of lymphangitic carcinomatosis as the primary symptom of colorectal carcinoma that achieved complete remission using combination anti-EGFR antibody therapy. Onco Targets Ther 2019; 12:2089-2093. [PMID: 30936723 PMCID: PMC6430998 DOI: 10.2147/ott.s194224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Clinicians often encounter cases of pulmonary lymphangitic carcinomatosis when treating patients with cancer. When such a condition develops before the diagnosis of cancer, its diagnosis is often challenging. Herein, we report about two patients with colorectal carcinoma diagnosed after the identification of lymphangitic carcinomatosis, which achieved complete remission with combination anti-epidermal growth factor receptor (anti-EGFR) antibody therapy. In case 1, a 74-year-old woman presented with cough and dyspnea that had persisted for 1 month. She had unresectable advanced carcinoma of the sigmoid colon with lymphangitic carcinomatosis. Her respiratory status gradually deteriorated due to the disease. Thus, FOLFIRI plus cetuximab therapy was initiated. Her dyspnea rapidly resolved with the treatment, and complete remission of lymphangitic carcinomatosis was achieved. In case 2, a 46-year-old man presented with fever and dyspnea that had persisted for 1 month. He had unresectable advanced carcinoma of the transverse colon with lymphangitic carcinomatosis. FOLFOXIRI therapy was then initiated. However, his respiratory status did not improve. Therefore, his treatment was immediately switched to FOLFIRI plus panitumumab. His dyspnea rapidly resolved with the treatment, and complete remission of lymphangitic carcinomatosis was achieved. In oncologic emergencies, such as lymphangitic carcinomatosis, requiring an early response to treatment, the administration of anti-EGFR antibodies may be a highly effective treatment option.
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Affiliation(s)
- Hirokazu Toshima
- Medical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan,
| | - Toshikazu Ikusue
- Medical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan,
| | - Atsushi Hisamatsu
- Medical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan,
| | - Kouji Kobayashi
- Medical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan,
| | - Ken Shimada
- Medical Oncology, Showa University Koto Toyosu Hospital, Tokyo, Japan,
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16
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Gotfrit J, Jonker C, Zhang T, Goss G, Nicholas G, Laurie S, Wheatley-Price P. Inpatients versus outpatients with advanced non-small cell lung cancer: Characteristics and outcomes. Cancer Treat Res Commun 2019; 19:100130. [PMID: 30927666 DOI: 10.1016/j.ctarc.2019.100130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Most newly diagnosed advanced NSCLC patients have an initial medical oncology consult as an outpatient. Sometimes, the initial consult occurs as an inpatient. We explored differences among NSCLC patients presenting to medical oncology while hospitalized versus as outpatients. METHODS With ethics approval, we performed a retrospective analysis of all stage IIIB and IV NSCLC patients at our institution consulted by medical oncology between 2009 and 2012. The primary analysis is descriptive, exploring differences in baseline characteristics, treatment choices, and overall survival (OS). RESULTS In total, 637 patients were included: 123 inpatients and 514 outpatients. Among outpatients, 55% received systemic therapy compared to 21% of inpatients. Among treated patients, inpatients were likely to be younger (81% vs 70% <70 years, p = 0.04), have PS 3-4 (38% vs 5%, p<0.001), have ≥5% weight loss (54% vs 42%, p = 0.01), anemia (19% vs 4%, p = 0.001), leukocytosis (38% vs 32%, p = 0.001), thrombocytosis (27 vs 23%, p = 0.001), renal dysfunction (12% vs 5%, p = 0.01) and more rapid onset of symptoms (27% vs 6% for <2 weeks, 35% vs 11% for 2-6 weeks; p<0.001). Inpatients who received systemic therapy were more likely to have a complete or partial response (42% vs 26%, p = 0.007), however had a shorter median OS than treated outpatients (8.4 vs 10.5 months, p = 0.003). CONCLUSIONS Patients initially consulted by medical oncologists while hospitalized were more unwell and fewer received systemic therapy. However, if treated, they had higher response rates than outpatients and reasonable OS. Systemic therapy can be considered in hospitalized advanced NSCLC patients. MICROABSTRACT A minority of patients with lung cancer have an initial oncology consultation as an inpatient. We compared the characteristics and outcomes of inpatients with their outpatient counterparts. Inpatients were more unwell at diagnosis and fewer received systemic therapy, but among those who did, they were more likely to respond and their overall survival approached that of the outpatient cohort.
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Affiliation(s)
- Joanna Gotfrit
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Caleb Jonker
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Tinghua Zhang
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Glenwood Goss
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Garth Nicholas
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Scott Laurie
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Paul Wheatley-Price
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada.
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Rocha LSDS, Riechelmann RP. Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges. Clinics (Sao Paulo) 2018; 73:e542s. [PMID: 30281700 PMCID: PMC6142860 DOI: 10.6061/clinics/2018/e542s] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/02/2018] [Indexed: 12/18/2022] Open
Abstract
Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.
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Affiliation(s)
- Lucila Soares da Silva Rocha
- Departamento de Radiologia e Oncologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Rachel P. Riechelmann
- Departamento de Oncologia – AC Camargo Cancer Center, Sao Paulo, BR
- Programa de Pós-Graduação em Oncologia, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, BR
- *Corresponding author. E-mail:
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Piredda M, Bartiromo C, Capuzzo MT, Matarese M, De Marinis MG. Nursing care dependence in the experiences of advanced cancer inpatients. Eur J Oncol Nurs 2016; 20:125-32. [DOI: 10.1016/j.ejon.2015.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 06/15/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
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Rayson D, Kain DA. Reflecting on inpatient palliative chemotherapy-is there ever a "right place" at the "right time"? Curr Oncol 2014; 21:158-60. [PMID: 25089095 DOI: 10.3747/co.21.2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early in clinical training, medical oncologists are taught that the goals of any palliative oncologic therapy include symptom control, quality-of-life improvement through disease stabilization, and prolongation of progression-free survival.[...]
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Affiliation(s)
- D Rayson
- Division of Medical Oncology and Atlantic Clinical Cancer Research Unit, QEII Health Sciences Centre, Dalhousie University, Halifax, NS
| | - D A Kain
- Division of Palliative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS
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