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Bonanno L, Calvetti L, Dal Maso A, Pavan A, Bao LC, De Nuzzo M, Frega S, Sartori G, Ferro A, Pasello G, Morandi P, Aprile G, Guarneri V. Real-world impact of the introduction of chemo-immunotherapy in extended small cell lung cancer: a multicentric analysis. Front Immunol 2024; 15:1353889. [PMID: 38322260 PMCID: PMC10845350 DOI: 10.3389/fimmu.2024.1353889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Background Recent clinical trials demonstrated longer survival in extended small cell lung cancer (SCLC) patients treated with immunotherapy in addition to chemotherapy. However, the magnitude of benefit is modest and the impact in real-world setting has to be fully established. Methods We collected clinical data and radiological imaging of patients affected by extended or relapsing SCLC and consecutively treated according to clinical practice between 2016 and 2023. As primary end-point, we compared pre-defined outcome indicators before and after the introduction of chemo-immunotherapy (May 2020): 6-month and 12-month progression free survival (PFS) rate, 12-month and 18-month overall survival (OS). Among those who were treated after May 2020, patients who did not receive immunotherapy according to treating physician's choice were included in the analysis to minimize clinical selection bias. Results The analysis included 214 patients: 132 (61.7%) were treated in an Academic cancer center and 82 (38.3%) in two community hospitals; 104 were treated before May 2020. Median PFS of the overall study population was 4.8 months (95% confidence interval [95% CI]: 4.4-5.4), median OS was 7.1 months (95% CI: 6.3-7.7). Estimated PFS and OS were significantly longer in patients treated after May 2020 with hazard ratio (HR) for PFS and OS of 0.61 (95% CI: 0.46-0.81, p < 0.001) and 0.70 (95% CI: 0.52-0.93, p = 0.015), respectively. 6-month PFS rate increased from 27% to 40% (p = 0.04) while 12-months PFS raised from 1% to 11% (p = 0.003). 12-month and 18-month OS rate increased from 15% to 28% (p = 0.03) and from 2.1% to 12% (p = 0.009), respectively. After May 2020 the median number of hospitalization days per patient decreased significantly and the incidence of severe AEs was similar. Among patients treated with chemo-immunotherapy, the onset of immune-related AEs was associated with improved PFS and OS (HR 0.55, 95% CI: 0.35-0.89, p = 0.012 and HR 0.47, 95%CI 0.28-0.77, p = 0.002, respectively). Conclusions The real-world analysis shows a meaningful improvement of outcome indicators after the introduction of chemo-immunotherapy, with reduction of the duration of hospitalization, thus supporting the use of chemo-immunotherapy and the need for further biomarker research.
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Affiliation(s)
- Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Lorenzo Calvetti
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | | | - Alberto Pavan
- Medical Oncology Department, Azienda ULSS 3 Serenissima, Dell’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Loc Carlo Bao
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mattia De Nuzzo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Sartori
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Alessandra Ferro
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Paolo Morandi
- Medical Oncology Department, Azienda ULSS 3 Serenissima, Dell’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Giuseppe Aprile
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Cuvillon P, Lefrant JY, Gricourt Y. Considerations for the Use of Local Anesthesia in the Frail Elderly: Current Perspectives. Local Reg Anesth 2022; 15:71-75. [PMID: 35982729 PMCID: PMC9379105 DOI: 10.2147/lra.s325877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
The frail, elderly population is at a high risk of postoperative complications. Besides perioperative rehabilitation techniques and management by geriatric teams, the least invasive techniques in anesthesia are required, making regional anesthesia very interesting in terms of benefit-risk ratio. Among them, local anesthesia is a simple, reproducible, inexpensive technique applied to many superficial or deep surgeries, which should make it a gold standard for the frail person. This review provides an update on the current possibilities for various surgeries and exclusion.
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Affiliation(s)
- Philippe Cuvillon
- Staff Anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Jean Yves Lefrant
- Staff Anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
| | - Yann Gricourt
- Staff Anesthesiologists, Department of Anesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Place du Professeur Debré, Nîmes, and Montpellier University 1, Montpellier, France
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Bernardelli G, Fappani C, Sangiovanni T, Villani L, Gianfranco G, Tanzi E, Amendola A. [Michelangelo COVID hotel in Milan (Northern Italy): analysis of a hospitality experience in time of Coronavirus]. Epidemiol Prev 2021; 45:598-601. [PMID: 34791869 DOI: 10.19191/ep21.6.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Il "progetto Michelangelo" è nato dall'esigenza di rallentare la diffusione dei contagi da SARS-CoV-2 e alleggerire il carico a livello ospedaliero. Inizialmente, la maggior parte degli ospiti dell'hotel Michelangelo di Milano erano pazienti dimessi dagli ospedali con test molecolare ancora positivo che non avevano la possibilità di restare in isolamento domiciliare. Ben presto, però, il progetto è stato esteso e circa un ospite su quattro era un adulto/nucleo familiare in condizioni di grave disagio economico o sociale o una persona senza fissa dimora. Inoltre, la maggior parte degli ospiti era di nazionalità non italiana: persone che, a causa di barriere linguistiche, legali, culturali e sociali, hanno trovato maggiore difficoltà ad avere un rapido accesso ai servizi sanitari. Il "progetto Michelangelo" non ha solo contribuito a ridurre il sovraffollamento degli ospedali, ma è stato di supporto ai servizi rivolti al contrasto della grave marginalità.
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Affiliation(s)
- Giuseppina Bernardelli
- These authors contributed equally to this work
- Dipartimento di scienze cliniche e di comunità, Università degli Studi di Milano
- IRCCS Istituto auxologico italiano, Milano
| | - Clara Fappani
- These authors contributed equally to this work
- Dipartimento di scienze della salute, Università degli Studi di Milano
| | | | | | | | - Elisabetta Tanzi
- Dipartimento di scienze della salute, Università degli Studi di Milano
- Centro di ricerca coordinata epidemiologia e sorveglianza molecolare delle infezioni, Università degli studi di Milano
| | - Antonella Amendola
- Dipartimento di scienze della salute, Università degli Studi di Milano;
- Centro di ricerca coordinata epidemiologia e sorveglianza molecolare delle infezioni, Università degli studi di Milano
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Van Eijk L, Zwijsen SA, Keeser D, Oosterman JM, Pogarell O, Engelbregt HJ. EEG-neurofeedback training and quality of life of institutionalized elderly women (a pilot study). Adv Gerontol 2017; 30:248-254. [PMID: 28575565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This pilot study attempted to study the applicability of neurofeedback for elderly persons living in nursing homes. We hypothesized an improve of cognitive functioning and the independence in daily life (IDL) of elderly people by using low beta (12-15HZ) EEG neurofeedback training (E-NFT). The participants (active E-NFT group, n=10; control group, n=6) were community living elderly women without dementia. Neurofeedback training was adjusted ten times within 9 weeks, with a training duration of 21 minutes by use of a single electrode, which was centrally placed on the skull surface. Executive functioning (measured with the Rey and fluency tasks), memory capacity (measured with the 15 words test), and IDL (measured with the Groningen Activity Restriction Scale) were measured before and after ten E-NFT sessions in nine weeks. No effects were found for IDL nor executive functioning. Interestingly, performance on the memory test improved in the experimental group, indicating a possible positive effect of E-NFT on memory in elderly women. This study demonstrates that E-NFT is applicable to older institutionalized women. The outcome of this pilot-study justifies the investigation of possible memory effects in future studies.
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Affiliation(s)
- L Van Eijk
- Hersencentrum Mental Health Institute, 1016 XW, Marnixstraat 358-366, Amsterdam, The Netherlands;
- Department of Clinical Neuropsychology, VU University, van der Boechorststraat 1,1081 BT Amsterdam, The Netherlands
| | - S A Zwijsen
- Department of General Practice and Elderly Care Medicine and the EMGO⁺ Institute for Health and Care Research, VU Medical Center, Van der Boechorststraat 7,1081 BT Amsterdam, The Netherlands
| | - D Keeser
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - J M Oosterman
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, 6525 EN, Kapittelweg 29, Nijmegen, The Netherlands
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - H J Engelbregt
- Hersencentrum Mental Health Institute, 1016 XW, Marnixstraat 358-366, Amsterdam, The Netherlands;
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 7, 80336 Munich, Germany
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