Association of Surgical Delay and Overall Survival in Patients With T2 Renal Masses: Implications for Critical Clinical Decision-making During the COVID-19 Pandemic

Abstract Background Brain metastasis represents a major complication with a significantly shorter overall survival of many oncological diseases, in particular of lung cancer, breast cancer and malignant melanoma patients. However, despite the poor prognosis, sometimes clinical decision-making, between on the one hand not to harm the patient and on the other hand not withholding a potential therapeutic option, is very challenging. Thus the aim of this retrospective study was to compare various scores, including scores for activities of daily living (ADL) before resection of brain metastases and to analyse their impact on survival. Methods Our single institution retrospective patient cohort (N = 100) with a median age of 63.6 years, which had all undergone resection of one or more brain metastases, was categorized using the original patient files. The cohort includes 52 patients with lung cancer, 27 patients with breast cancer, 8 patients with colorectal carcinoma and 13 patients with kidney cancer. To categorize, we used different score systems which were capable to evaluate the patient in relation to self-sufficiency, activity and self-determination as part of ADL. The retrospective analysis includes the ECOG-Status, Karnofsky-Index, Barthel-Index, ASA-Classification and Katz-Index. Pre-processing and the analysis of the data was implemented using KNIME, where we used the R-plugin nodes to perform the final statistical tests with R. Results Our analysis reveals that most of the ADL scores we tested are able to give a reliable prediction on overall survival after brain metastasis surgery. The survival rates decrease significantly with a lower score in all tested score systems, with the exception of the ASA-Risk score. In particular, the Katz Index < 6 was identified to have a significant correlation with a lower cancer specific survival (CSS) (HR 3.33, 95%-CI [2.17–5.00]; p-Value = 9.6*10− 9), which is easy to use and has reproducible measurements. Conclusions Pre-operative independence assessment by indices of ADL represents a predictor for overall survival after resection of brain metastases. Especially the easily, objectively and rapidly applicable Katz-Score is a very helpful tool to assess the pre-operative status, which could be additionally included in clinical decision making in daily practice.

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Utilization and contemporary results of renal mass biopsy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.623 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 623-623

Author(s):

David Cahn ◽

Caitlin Lim ◽

Rosaleen Parsons ◽

Benjamin T. Ristau ◽

Alexander Kutikov ◽

...

Keyword(s):

Decision Making ◽

Surgical Resection ◽

Renal Mass ◽

Clinical Decision Making ◽

Clinical Decision ◽

Performance Characteristics ◽

Published Data ◽

Renal Masses ◽

Poor Grade ◽

Renal Mass Biopsy

623 Background: Renal mass biopsy (RMB) for localized renal masses (RM) is being re-evaluated to improve risk stratification and minimize morbidity from over-treatment. We review our institutional experience with RMB to identify performance characteristics and highlight opportunities to improve management. Methods: Using our prospectively maintained database, we identified patients who underwent core RMB +/- fine needle aspiration (FNA). We describe performance characteristics and assess pathologic concordance. Using the University of Michigan (UM) algorithm, we reviewed the potential that RMB influenced therapeutic decision-making. Results: We noted 374 RMBs performed from 1999-2015 (66% within last 5 years). Core RMB (+/- FNA) was performed in 65.2% (244/374) of cases, of which 41% (99/244) underwent surgical resection. Initial core RMB was non-diagnostic in 9% (9/99) of surgical cases and subsequently diagnosed with RCC. RCC diagnosed on core RMB that underwent surgical resection demonstrated histologic and grade concordance of 94.3% and 62.5%. All discordant grades were upgraded at surgery. 11% of all RMB were benign and no surgical intervention occurred. In our cohort, 19% of all RMB patients treated surgically had tumors classified as favorable or intermediate < 2cm using the UM algorithm and might otherwise have been candidates for AS. Conversely, 42% of all surgically treated patients had UM favorable characteristics but had tumors > 4cm and therefore underwent surgical resection based on size criteria in the context of RMB results. Conclusions: RMB is effective in the evaluation of RM with minimal morbidity. Our histologic/grade concordance is consistent with published data and underscores that RMB harbors clinical uncertainties. Clinical management pathways incorporating RMB may decrease over-treatment but also may risk under-treatment based on poor grade concordance. Using the UM algorithm, 30% of lesions in our cohort were AS candidates after RMB (over-treatment risk). Conversely, 18% of surgically treated lesions were UM AS candidates after RMB and upgraded on final pathology, demonstrating the risk of under treatment. RMB may be considered in patients where results would influence clinical decision-making.

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Clinical Decision Making and Oral Motor Treatments

ASHA Leader ◽

10.1044/leader.ftr3.10082005.8 ◽

2005 ◽

Vol 10 (8) ◽

pp. 8-35 ◽

Cited By ~ 9

Author(s):

Heather M. Clark

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Oral Motor

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Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

2011 ◽

Vol 20 (4) ◽

pp. 121-123

Author(s):

Jeri A. Logemann

Keyword(s):

Decision Making ◽

Patient Care ◽

Clinical Outcomes ◽

Clinical Judgment ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Method ◽

Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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