scholarly journals Comparison of common risk stratification indices to predict outcomes among stage IV cancer patients with bowel obstruction undergoing surgery

2017 ◽  
Vol 117 (3) ◽  
pp. 479-487 ◽  
Author(s):  
Sarah B. Bateni ◽  
Richard J. Bold ◽  
Frederick J. Meyers ◽  
Daniel J. Canter ◽  
Robert J. Canter
Keyword(s):  
Risk Stratification ◽  
Cancer Patients ◽  
Bowel Obstruction ◽  
Stage Iv ◽  
Stage Iv Cancer

Exploratory Study of Advance Care Discussions Among Chinese American and White Stage IV Cancer Patients at an American Tertiary Medical Center

2021 ◽  
pp. 104990912110126
Author(s):  
Avery Caz Glover ◽  
Courtney Schroeder ◽  
Emma Ernst ◽  
Tamara Vesel
Keyword(s):  
Cancer Patients ◽  
Exploratory Study ◽  
Stage Iv ◽  
Chinese American ◽  
Chinese Americans ◽  
Do Not Resuscitate ◽  
Essential Components ◽  
Advance Care ◽  
Stage Iv Cancer ◽  
White Patients

Purpose: Timely advance care discussions are essential components of quality care for diverse populations; however, little is known about these conversations among Chinese American cancer patients. This exploratory study describes differences in advance care discussions and planning between Chinese American and White advanced cancer patients. Methods: We collected data for 63 Chinese American and 63 White stage IV cancer patients who died between 2013 and 2018. We compared: frequency and timing of prognosis, goals of care (GOC), and end-of-life care (EOLC) discussions in the final year of life; family inclusion in discussions; healthcare proxy (HCP) identification; do not resuscitate (DNR) order, do not intubate (DNI) order, and other advance directive (AD) completion. We did not conduct statistical tests due to the study’s exploratory nature. Results: Among Chinese American and White patients, respectively, 76% and 71% had prognosis, 51% and 56% had GOC, and 89% and 84% had EOLC discussions. Prognosis, GOC, and EOLC discussions were held a median of 34.0, 15.5, and 34.0 days before death among Chinese American and 17.0, 13.0, and 24.0 days before death among White patients. Documentation rates among Chinese American and White patients were 79% and 76% for DNRs, 81% and 71% for DNIs, 79% and 81% for HCPs, and 52% and 40% for other ADs. Conclusions: Findings suggest that Chinese Americans had similar rates of advance care discussions, completed conversations earlier, and had similar to higher rates of AD documentation compared to White patients. Further studies are needed to confirm our preliminary findings.

scholarly journals Perubahan Status Koagulasi Pasien Kanker Padat Pasca Kemoterapi di Indonesia: Sebuah Studi Prospektif

2020 ◽  
Vol 7 (1) ◽  
pp. 2
Author(s):  
Noorwati Sutandyo ◽  
Lyana Setiawan
Keyword(s):  
Cancer Patients ◽  
Prospective Cohort ◽  
Stage Iv ◽  
Stage Iii ◽  
Solid Cancer ◽  
Significant Difference ◽  
Before And After ◽  
Coagulation Status ◽  
Stage Iv Cancer ◽  
D Dimer

Pendahuluan. Hiperkoagulasi merupakan faktor yang mendasari tingginya mortalitas akibat kejadian tromboemboli vena pada pasien kanker. Kemoterapi merupakan salah satu faktor yang diduga berkontribusi terhadap status hiperkoagulasi pada pasien kanker. Studi ini bertujuan untuk mengevaluasi perubahan status koagulasi yang ditandai dengan kadar D-dimer pada pasien kanker yang menjalani kemoterapi.Metode. Studi ini merupakan studi kohort prospektif di Pusat Kanker Nasional Indonesia yang melibatkan pasien kanker yang sudah terkonfirmasi melalui pemeriksaan histopatologi, dan memulai kemoterapi pada periode Mei hingga Juli 2018. Perubahan status koagulasi dinilai melalui kadar D-dimer plasma. Kadar D-dimer diukur sebelum dan 7 hari setelah kemoterapi. Analisis statistik menggunakan uji t berpasangan untuk menilai kemaknaan perubahan kadar D-dimer plasma sebelum dan setelah kemoterapi.Hasil. Sejumlah 89 pasien memenuhi kriteria inklusi, yang mana 74,2% adalah perempuan dan hampir separuh dari keseluruhan subjek terdiagnosis kanker payudara (44,9%). Mayoritas subjek (69,6%) terdiagnosis pada stadium III atau IV. Sejumlah 12,4% dari subjek mendapatkan kemoterapi berbasis cisplatin. Terdapat perbedaan yang bermakna antara kadar D-dimer sebelum dan setelah kemoterapi (p = 0,05). Studi ini juga menemukan perbedaan bermakna kadar D-dimer sebelum dan sesudah kemoterapi pada pasien kanker stadium III (t(35) = 2,48, p = 0,02) dan stadium IV (t(25) = 2,14, p = 0,04). Tidak terdapat perbedaan bermakna antara kadar D-dimer sebelum dan setelah kemoterapi pada pasien stadium I dan II. Analisis lanjutan berdasarkan kelompok kemoterapi menunjukkan bahwa terdapat perubahan kadar D-dimer yang bermakna pada kelompok yang mendapatkan kemoterapi cisplatin (t(10) = 2,31, p = 0,04), namun tidak pada kelompok yang mendapat kemoterapi non-cisplatin (t(77) = 1,50, p = 0,14).Simpulan. Terdapat perbedaan bermakna status koagulasi yang ditandai dengan kadar D-dimer 7 hari pasca mendapatkan kemoterapi, khususnya pada pasien kanker stadium III atau IV dan mendapatkan kemoterapi berbasis cisplatin. Kata Kunci: Cisplatin, kanker, kemoterapi, status koagulasiChange of Coagulation Status in Solid Cancer Patients Undergoing Chemotherapy in Indonesia: A Prospective Cohort StudyIntroduction. Cancer-associated hypercoagulability was an underlying factor of high mortality of cancer due to venous thromboembolism. Chemotherapy is proposed as one of the contributing factors of the hypercoagulable state. We aim to evaluate the change of coagulation status, which was marked by D-dimer level, in cancer patients receiving chemotherapy.Methods. This is a prospective cohort study in Indonesian national cancer center which involves all adult histologically-confirmed-cancer patients who started chemotherapy between May and July 2018. The coagulation status is assessed by plasma of D-dimer level. We measured D-dimer before chemotherapy and one week after chemotherapy. Paired t-test was performed to assess the significant difference in D-dimer levels before and after chemotherapy.Results. A total of 89 patients fulfilled the eligibility criteria, of whom 74.2% were female and almost half of total subjects (44.9%) were breast cancer patients. Majority of subjects (69.6%) were stage III or stage IV cancer. There were 12.4% of subjects received cisplatin-based chemotherapy. There was a marginally significant difference in plasma level of D-dimers before and after chemotherapy (p = 0.05). We also found significant differences between D-dimer level before and after chemotherapy in stage III patients (t(35) = 2.48, p = 0.02) and stage IV patients (t(25) = 2.14, p = 0.04). There was no significant difference between D-dimer level before and after chemotherapy in stage I and stage II patients. Subgroup analyses based on chemotherapy agents showed that there was significant D-dimer change in cisplatin-based chemotherapy subjects (t(10) = 2.31, p = 0.04), but not in non-cisplatin-based chemotherapy subjects (t(77) = 1,50, p = 0.14).Conclusion. Compared to before chemotherapy, there is a significant difference of coagulation status marked by plasma D-dimer level one week after chemotherapy, particularly in patients with stage III or stage IV cancer and in patients receiving cisplatin-based chemotherapy.

Advance Directive and Do-Not-Resuscitate Status among Advanced Cancer Patients with Acute Care Surgical Consultation

2018 ◽  
Vol 84 (10) ◽  
pp. 1565-1569
Author(s):  
Lobsang Marcia ◽  
Zane W. Ashman ◽  
Eric B. Pillado ◽  
Dennis Y. Kim ◽  
David S. Plurad
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Acute Care ◽  
Metastatic Cancer ◽  
Stage Iv ◽  
Acute Care Surgery ◽  
Do Not Resuscitate ◽  
Stage Iv Cancer ◽  
Care Surgery ◽  
Dnr Orders

Formal communication of end-of-life preferences is crucial among patients with metastatic cancer. Our objective is to describe the prevalence of advance directives (AD) and do-not-resuscitate (DNR) orders among stage IV cancer patients with acute care surgery consultations, and the associated outcomes. This is a single institution retrospective review over an eight-year period. Two hundred and three patients were identified; mean age was 55.3 ± 11.4 years and 48.8 per cent were male. Fifty (24.6%) patients underwent exploratory surgery. Nineteen (10.6%) patients had another type of surgery. Twenty-one (10.3%) patients had a DNR order, and none had an AD on-admission. Fifty-four (26.6%) patients had a DNR order placed and four (2%) patients completed an AD postadmission. DNR postadmission was associated with the highest mortality at 42.6 per cent compared with 14.3 per cent for DNR on-admission and 1.56 per cent for full-code patients ( P < 0.001). Compared with patients that remained full-code and those with DNR on-admission, DNR postadmission was associated with longer length of stay (19.6 days; P < 0.001) and ICU length of stay (7.72 days; P < 0.001). The prevalence of AD and DNR orders among stage IV cancer patients is low. The higher in-hospital mortality of patients with DNR postadmission reflects the use of DNR orders during clinical decline.

Bowel obstruction with stage IV cancer: The benefit of introduction of formal palliative care service.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20573-e20573
Author(s):  
Moshim Kukar ◽  
Adrienne Groman ◽  
Yashodhara K. Satchidanand ◽  
Amy I. Alvarez-Perez ◽  
Kelli B. Dunn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Bowel Obstruction ◽  
Care Service ◽  
Palliative Care Service ◽  
Stage Iv ◽  
Palliative Care Team ◽  
Care Team ◽  
Comorbid Conditions ◽  
Stage Iv Cancer

e20573 Background: Patients with stage IV cancer and bowel obstruction (BO) present a complicated management problem. The aim of this study was to evaluate the role of introduction of an organized palliative care service in the management of this complex disease process. Methods: We conducted a retrospective analysis of all patients admitted to the Roswell Park Cancer Institute with stage IV cancer and BO after the institution of formal palliative care service (PS) in 2009. This cohort was compared to a group prior to 2009 (No Palliative care service Group; NPS). The two groups were compared with respect to demographics, comorbid conditions, DNR status, laboratory parameters, medical, surgical management, length of stay and disposition status. Results: 28 patients were identified in PS group as compared to 40 patients in NPS group. The 2 groups were similar in terms of age, gender, race, comorbid conditions, primary site of cancer, chemotherapy, radiation therapy and weight loss. There was a statistically significant difference in the medication regimen provided, as those who had palliative care consults were more likely to receive alternative medications to standard anti-emetics (Table). The palliative care team followed 19/28 patients and 14/19 patients showed improvement in their symptoms (nausea, pain control) in initial 24 hours after the palliative care consult. 50 % ( n=14) of patients in PS group had a formal DNR order in place as compared to 15.4% in NPS group (p<0.001). In 9/14 patients the first discussion regarding DNR was held by palliative care team. A significantly higher percentage of patients were discharged to the hospice care in PS group (42.9% vs. 7.5%, p =0.006). Conclusions: BO in patients with stage IV cancer often poses a dilemma in the choice of surgery versus medical management. Palliative care consults, early in the hospitalization, may help improve symptom management, end of life discussions, better psychosocial support, discharge placements and will eventually translate to shorter length of stay. [Table: see text]

Aggressive care at the end of life: A study of practice based factors in patients with stage IV cancer.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 80-80
Author(s):  
Mohammad Omar Atiq ◽  
Rahul Ravilla ◽  
Ajay Kumar ◽  
Sajjad Haider ◽  
Ji-Ling Tang ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Cancer Patients ◽  
Stage Iv ◽  
Goals Of Care ◽  
Significant Difference ◽  
Aggressive Care ◽  
Stage Iv Cancer ◽  
End Stage

80 Background: Numerous studies established that early utilization of palliative care-hospice services are beneficial to cancer patients. To reduce the incidence of aggressive care in terminal cancer patients, we conducted a quality improvement study to identify pertinent risk factors and develop interventions. Methods: Through chart review, we retrospectively identified patients with stage IV cancer that were followed by oncology clinic and were admitted to the University Hospital between 8/1/2015-10/31/15. For those patients who died during the last hospitalization or were discharged to hospice care, we obtained demographic, cancer related and practice related variables listed in Table. We used Mann Whitney U test and multivariable regression to find effects of factors related to length of stay (LOS) and cost of stay (COS). Results: Length of stay was significantly prolonged in those receiving chemotherapy within the past month (6 vs 3 p=0.035). Multivariate analyses found that patients with goals of care documented in the clinic had lower COS by 36.7% and LOS by 46.7%. On average, an ICU stay resulted in COS 2.2 times higher. No significant difference was seen in LOS based on a documented palliative care clinic visit or presence of an advanced directive. Conclusions: We identified practice based factors that need improvement including earlier goals of care conversations and less chemotherapy at the end of life. Identifying end stage patients in earlier admissions, collaborating with palliative care, and adding goals of care documentation to clinic note templates, are all interventions we are studying to improve care for end stage cancer patients. [Table: see text]

scholarly journals Outcome of stage IV cancer patients receiving in-hospital cardiopulmonary resuscitation: a population-based cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Meng-Rui Lee ◽  
Kai-Lun Yu ◽  
Hung-Yang Kuo ◽  
Tsung-Hao Liu ◽  
Jen-Chung Ko ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
Cancer Patients ◽  
Stage Iv ◽  
Population Based ◽  
Stage Iv Cancer

Il livello di speranza nei pazienti oncologici in cura chemioterapica. Un’indagine sperimentale / The level of hope in the cancer patients receiving chemotherapy. An experimental investigation

2018 ◽  
Vol 67 (5) ◽  
pp. 525-543
Author(s):  
Melissa Maioni
Keyword(s):  
Cancer Patients ◽  
Clinical Sample ◽  
Age Groups ◽  
Stage Iv ◽  
Sono State ◽  
Human Dimensions ◽  
Disease Stage ◽  
Experimental Sample ◽  
Stage Iv Cancer ◽  
The Impact

La speranza è una caratteristica multidimensionale che coinvolge diverse dimensioni umane, il cui costrutto è stato più volte studiato in molteplici ambiti disciplinari. Il presente studio si propone di: valutare l’impatto della patologia in relazione al livello di speranza; comparare il livello di speranza con altre variabili cliniche e socio-demografiche, attraverso lo studio di 83 pazienti oncologici del Policlinico Campus Bio-Medico di Roma in cura chemioterapica, e di 83 soggetti sani, con caratteristiche socio-demografiche comparabili al campione clinico, a cui sono state sottoposte due scale: l’HHI (Herth Hope Scale) e la SF-12 (Questionario sullo stato di salute). L’analisi statistica utilizzata è finalizzata a valutare l’interdipendenza lineare tra le due variabili considerate (la speranza e lo stato di salute) sulla popolazione in generale e nelle sottopopolazioni considerate, tramite il calcolo dell’indice R2. I risultati mostrano che: a) il campione sperimentale composto per l’84,3% da pazienti affetti da cancro al IV stadio, ha mediamente un medio livello di speranza (media ± es = 35.47 ± 0.78); b) non emerge una correlazione significativa tra lo stato di salute e il livello di speranza; c) non emergono differenze significative riguardo il livello di speranza, mentre emergono delle differenze significative relativamente alla PCS (stato di salute fisica). I dati raccolti indicherebbero come la speranza sia una dimensione indipendente dalla diagnosi, dalla stadiazione della patologia, dal sesso, dal tipo di ospedalizzazione, dallo stato civile e non si modifichi nelle varie fasce d’età. Sembrerebbe un costrutto che si mantiene stabile nel tempo e che viene scarsamente influenzato da altre variabili. ---------- Hope is a multidimensional characteristic that involves different human dimensions, the construction of which has been studied several times in multiple disciplinary fields. The present study aims to: assess the impact of the pathology in relation to the level of hope; compare the level of hope with other clinical and socio-demographic variables, through the study of 83 cancer patients receiving chemotherapy at the Policlinico Campus Bio-Medico in Rome, and 83 healthy subjects, with socio-demographic characteristics comparable to the clinical sample, who were given two scales: the HHI (Herth Hope Index) and the SF-12 (SF-12 Health Survey). The statistical analysis used is aimed at assessing the linear interdependence between the two variables under consideration (hope and health) for the general population and the subpopulations under consideration, by calculating the R2 index. The results show that: a) the experimental sample, 84.3% of which was composed of stage IV cancer patients, had an average hope level (mean ± es = 35.47 ± 0.78); b) there was no significant correlation between health and hope; c) there were no significant differences in hope levels, while there were significant differences in physical health (PCS). The data collected would indicate that hope is a dimension independent of diagnosis, disease stage, sex, type of hospitalization, marital status and does not change in the various age groups. It would seem to be a construct that remains stable over time and is poorly influenced by other variables.

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