scholarly journals An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer

2008 ◽  
Vol 67 (3) ◽  
pp. 257-262 ◽  
Author(s):  
Donald C. McMillan
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Inflammatory Response ◽  
Advanced Cancer ◽  
Clinical Decision Making ◽  
Prognostic Score ◽  
Performance Status ◽  
Systemic Inflammatory Response ◽  
Patients With Cancer

Progressive involuntary weight loss, in particular the loss of lean tissue, is common in patients with advanced cancer and has long been recognised to result in a deterioration in performance status and quality of life, increased morbidity and mortality. The aetiology of such weight loss or cachexia is complex and involves both tumour and host responses. Thus, identification of patients who are or are likely to become cachectic has been problematic. In addition to a reduction in appetite and increased satiety leading to poor dietary intake, there is now increasing clinical evidence that the activation of a chronic ongoing systemic inflammatory response is one of the earliest and most important contributory factors to cachexia. Such findings help to explain the failure of simple nutritional programmes to reverse weight loss adequately in patients with cancer. In the present paper the development of an inflammation-based score is described, which is derived from the acute-phase proteins C-reactive protein and albumin and is termed the Glasgow prognostic score (GPS). Its value as a predictor of survival, independent of tumour stage, performance status and treatment (active or palliative), has been shown in a variety of advanced common solid tumours. The nature of the relationship between the GPS, appetite, body composition, performance status and quality of life of the patient with advanced cancer will be described. Recently, it has become evident that the systemic inflammatory response is also present in a smaller proportion of patients with primary operable cancer and is also predictive of disease progression and poor survival. The role of GPS in clinical decision making will be discussed.

scholarly journals Quality of Life in Patients With Advanced Cancer: Differential Association With Performance Status and Systemic Inflammatory Response

2016 ◽  
Vol 34 (23) ◽  
pp. 2769-2775 ◽  
Author(s):  
Barry J.A. Laird ◽  
Marie Fallon ◽  
Marianne J. Hjermstad ◽  
Sharon Tuck ◽  
Stein Kaasa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Inflammatory Response ◽  
Advanced Cancer ◽  
Systemic Inflammation ◽  
Prognostic Score ◽  
Performance Status ◽  
Systemic Inflammatory Response ◽  
Life Questionnaire ◽  
The Relationship

Purpose Quality of life is a key component of cancer care; however, the factors that determine quality of life are not well understood. The aim of this study was to examine the relationship between quality of life parameters, performance status (PS), and the systemic inflammatory response in patients with advanced cancer. Methods An international biobank of patients with advanced cancer was analyzed. Quality of life was assessed at a single time point by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30). PS was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. Systemic inflammation was assessed by using the modified Glasgow Prognostic Score (mGPS), which combines C-reactive protein and albumin. The relationship between quality of life parameters, ECOG PS, and the mGPS was examined. Results Data were available for 2,520 patients, and the most common cancers were GI (585 patients [22.2%]) and pulmonary (443 patients [17.6%]). The median survival was 4.25 months (interquartile range, 1.36 to 12.9 months). Increasing mGPS (systemic inflammation) and deteriorating PS were associated with deterioration in quality-of-life parameters (P < .001). Increasing systemic inflammation was associated with deterioration in quality-of-life parameters independent of PS. Conclusion Systemic inflammation was associated with quality-of-life parameters independent of PS in patients with advanced cancer. Further investigation of these relationships in longitudinal studies and investigations of possible effects of attenuating systemic inflammation are now warranted.

scholarly journals Effects of Melatonin on Appetite and Other Symptoms in Patients With Advanced Cancer and Cachexia: A Double-Blind Placebo-Controlled Trial

2013 ◽  
Vol 31 (10) ◽  
pp. 1271-1276 ◽  
Author(s):  
Egidio Del Fabbro ◽  
Rony Dev ◽  
David Hui ◽  
Lynn Palmer ◽  
Eduardo Bruera
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Advanced Cancer ◽  
Interim Analysis ◽  
Null Hypothesis ◽  
Controlled Trial ◽  
Double Blind ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale

Purpose Prior studies have suggested that melatonin, a frequently used integrative medicine, can attenuate weight loss, anorexia, and fatigue in patients with cancer. These studies were limited by a lack of blinding and absence of placebo controls. The primary purpose of this study was to compare melatonin with placebo for appetite improvement in patients with cancer cachexia. Patients and Methods We performed a randomized, double-blind, 28-day trial of melatonin 20 mg versus placebo in patients with advanced lung or GI cancer, appetite scores ≥ 4 on a 0 to 10 scale (10 = worst appetite), and history of weight loss ≥ 5%. Assessments included weight, symptoms by the Edmonton Symptom Assessment Scale, and quality of life by the Functional Assessment of Anorexia/Cachexia Therapy (FAACT) questionnaire. Differences between groups from baseline to day 28 were analyzed using one-sided, two-sample t tests or Wilcoxon two-sample tests. Interim analysis halfway through the trial had a Lan-DeMets monitoring boundary with an O'Brien-Fleming stopping rule. Decision boundaries were to accept the null hypothesis of futility if the test statistic z < 0.39 (P ≥ .348) and reject the null hypothesis if z > 2.54 (P ≤ .0056). Results After interim analysis of 48 patients, the study was closed for futility. There were no significant differences between groups for appetite (P = .78) or other symptoms, weight (P = .17), FAACT score (P = .95), toxicity, or survival from baseline to day 28. Conclusion In cachectic patients with advanced cancer, oral melatonin 20 mg at night did not improve appetite, weight, or quality of life compared with placebo.

scholarly journals Simple and Objective Prediction of Survival in Patients with Lung Cancer: Staging the Host Systemic Inflammatory Response

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Derek Grose ◽  
Graham Devereux ◽  
Louise Brown ◽  
Richard Jones ◽  
Dave Sharma ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Weight Loss ◽  
Inflammatory Response ◽  
Risk Stratification ◽  
Group Performance ◽  
Prognostic Score ◽  
Performance Status ◽  
Glasgow Prognostic Score ◽  
Systemic Inflammatory Response ◽  
Prediction Of Survival

Background. Prediction of survival in patients diagnosed with lung cancer remains problematical. The aim of the present study was to examine the clinical utility of an established objective marker of the systemic inflammatory response, the Glasgow Prognostic Score, as the basis of risk stratification in patients with lung cancer. Methods. Between 2005 and 2008 all newly diagnosed lung cancer patients coming through the multidisciplinary meetings (MDTs) of four Scottish centres were included in the study. The details of 882 patients with a confirmed new diagnosis of any subtype or stage of lung cancer were collected prospectively. Results. The median survival was 5.6 months (IQR 4.8–6.5). Survival analysis was undertaken in three separate groups based on mGPS score. In the mGPS 0 group the most highly predictive factors were performance status, weight loss, stage of NSCLC, and palliative treatment offered. In the mGPS 1 group performance status, stage of NSCLC, and radical treatment offered were significant. In the mGPS 2 group only performance status and weight loss were statistically significant. Discussion. This present study confirms previous work supporting the use of mGPS in predicting cancer survival; however, it goes further by showing how it might be used to provide more objective risk stratification in patients diagnosed with lung cancer.

A prospective study of the impact of weight loss and the systemic inflammatory response on quality of life in patients with inoperable non-small cell lung cancer

Lung Cancer ◽  
2003 ◽  
Vol 40 (3) ◽  
pp. 295-299 ◽  
Author(s):  
Hazel R Scott ◽  
Donald C McMillan ◽  
Duncan J.F Brown ◽  
Lynn M Forrest ◽  
Colin S McArdle ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Weight Loss ◽  
Inflammatory Response ◽  
Prospective Study ◽  
Small Cell ◽  
Small Cell Lung ◽  
A Prospective Study ◽  
The Impact

Assessment of Quality of Life in Outpatients With Advanced Cancer: The Accuracy of Clinician Estimations and the Relevance of Spiritual Well-Being—A Hoosier Oncology Group Study

2003 ◽  
Vol 21 (14) ◽  
pp. 2754-2759 ◽  
Author(s):  
Michael J. Fisch ◽  
Michael L. Titzer ◽  
Jean L. Kristeller ◽  
Jianzhao Shen ◽  
Patrick J. Loehrer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Performance Status ◽  
Well Being ◽  
Categorical Variables ◽  
Therapeutic Trial ◽  
Slight Variation ◽  
Cross Sectional ◽  
Spiritual Well Being

Purpose: To evaluate the association between quality-of-life (QOL) impairment as reported by patients and QOL impairment as judged by nurses or physicians, with and without consideration of spiritual well-being (SWB). Patients and Methods: A total of 163 patients with advanced cancer were enrolled onto a therapeutic trial, and cross-sectional data were derived from clinical and demographic questionnaires obtained at baseline, including assessment of patient QOL and SWB. Clinicians rated the QOL impairment of their patients as mild, moderate, or severe. Clinician-estimated QOL impairment and patient-derived QOL categories were compared. Correlation coefficients were estimated to associate QOL scores using different instruments. The analysis of variance method was used to compare Functional Assessment of Cancer Therapy–General scores on categorical variables. Results: There was no significant association between self-assessment scores and marital status, education level, performance status, or predicted life expectancy. However, a strong relationship between SWB and QOL was noted (P < .0001). Clinician-estimated QOL impairment matched the level of patient-derived QOL correctly in approximately 60% of cases, with only slight variation depending on the method of categorizing patient-derived QOL scores. The accuracy of clinician estimates was not associated with the level of SWB. Interestingly, a subset analysis of the inaccurate estimates revealed an association between lower SWB and clinician underestimation of QOL impairment (P = .0025). Conclusion: Clinician estimates of QOL impairment were accurate in more than 60% of patients. SWB is strongly associated with QOL, but it is not associated with the overall accuracy of clinicians’ judgments about QOL impairment.

scholarly journals Correlation between systemic inflammatory response and quality of life in patients with chronic rhinosinusitis

2019 ◽  
Vol 9 (5) ◽  
pp. 458-465 ◽  
Author(s):  
Quinn Orb ◽  
Abigail Pulsipher ◽  
Kristine A. Smith ◽  
Shaelene Ashby ◽  
Jeremiah A. Alt
Keyword(s):  
Quality Of Life ◽  
Inflammatory Response ◽  
Chronic Rhinosinusitis ◽  
Systemic Inflammatory Response

Rates and risks of suicidality in young adults (YAs) with advanced cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9015-9015
Author(s):  
Kelly Marie Trevino ◽  
Karen Fasciano ◽  
Holly Gwen Prigerson
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Major Depressive ◽  
Targeted Interventions

9015 Background: Suicide rates in YA cancer patients are higher than in the general population. Although cancer is associated with a four-fold increase in the likelihood of a suicide attempt, little is known about suicidality in YAs with cancer. This study examined rates and clinical risk factors associated with suicidality in a sample of YAs with advanced cancer. Methods: Structured interviews were conducted between 4/2010 and 9/2011 with 70 YA advanced cancer patients (range 20-40 yrs, M=33.97, SD=5.61) receiving care at the Dana-Farber Cancer Institute. Validated measures assessed suicidality (i.e., Yale Evaluation of Suicidality), quality of life, major depressive disorder, grief over cancer-related losses, and social support. Scores on the suicidality measure were dichotomized into positive screen = 1 and negative screen = 0. Chi-square, t-test, and logistic regression analyses evaluated the relationship between suicidality and participant characteristics and psychosocial variables, controlling for confounding variables. Results: Over one-fifth (21.4%) of the sample screened positive for suicidality. Female gender χ2(1, N = 70) = 4.95, p = .026), breast compared with other cancer diagnosis χ2(1, N = 70) = 5.66, p = .017), and better performance status (t(68) = 3.13, p < .01) were associated with lower rates of suicidality. Participants who met criteria for current (OR [95% CI] 8.67 [1.78, 42.22]) or lifetime major depressive disorder (5.38 [1.60, 18.12]) endorsed higher rates of suicidality. Better overall (.97 [.94, .99]), psychological (.93 [.87, .94]), and existential quality of life (.91 [.85, .98]) were associated with reduced suicidality risk. More severe grief was associated with greater risk (1.15 [1.04, 1.28]) whereas greater social support was associated with lower suicidality risk (.85 [.74, .97]). Conclusions: YAs with advanced cancer reported higher rates of suicidality than observed in other age groups. Developmentally targeted interventions that promote physical function, effectively treat depression, improve quality of life and reduce grief, and provide opportunities for social support may reduce rates of and risk for suicidality in this population.

The effect of melatonin on appetite and other symptoms in patients with advanced cancer and cachexia: A double-blind placebo-controlled trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9062-9062
Author(s):  
Egidio Del Fabbro ◽  
Rony Dev ◽  
David Hui ◽  
J. Lynn Palmer ◽  
Eduardo Bruera
Keyword(s):  
Quality Of Life ◽  
Weight Loss ◽  
Advanced Cancer ◽  
Interim Analysis ◽  
Controlled Trial ◽  
Well Being ◽  
Test Statistic ◽  
Double Blind ◽  
Edmonton Symptom Assessment Scale

9062 Background: Patients with advanced cancer experience anorexia and weight loss which impairs their quality of life. Prior studies suggest melatonin, a frequently used integrative medicine may attenuate weight loss, anorexia, fatigue, and depression. These studies were limited by a lack of blinding and absence of placebo controls. The primary objective of this study was to compare melatonin to placebo for appetite in patients with cachexia. Methods: A randomized, double-blind, 28 day trial of melatonin 20mg vs. placebo in patients with advanced lung or gastrointestinal cancer, appetite scores >3 on a 0 to 10 scale (10 = worst appetite) and a history of weight loss ≥ 5% within 6 months. Patients unable to maintain oral intake, thyroid or adrenal dysfunction, or with a karnofsky <40 were excluded from the study. The assessments included weight, symptom severity by Edmonton Symptom Assessment Scale (ESAS) and quality of life by the Functional Assessment of Anorexia/Cachexia Therapy (FAACT).Differences between groups from baseline to day 28 were analyzed using one-sided two sample t tests (appetite, pain and well-being) or Wilcoxon two-sample tests for the other variables. Interim analysis at half point had a Lan-DeMets monitoring boundary with an O’Brien-Fleming stopping rule. The decision boundaries for the interim test was to accept the null hypothesis of no treatment difference (futility) if the test statistic Z < 0.39 (p ≥ 0.348). Results: After interim analysis of 48 patients, the study was closed by the Data Safety Monitoring Board for futility. There were no significant differences between groups in appetite (p=0.78), weight (p= 0.17), FAACT score (p=0.95), insomnia (p=0.62) or other symptoms measured by the ESAS from baseline to day 28.No significant toxicities were observed. Conclusions: In cachectic patients with advanced cancer, 20mg oral Melatonin at night does not improve appetite, weight or quality of life compared to placebo.

scholarly journals Sleep quality with WHO Step III opioid use for cancer pain

2018 ◽  
Vol 9 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Gunnhild Jakobsen ◽  
Morten Engstrøm ◽  
Peter Fayers ◽  
Marianne J Hjermstad ◽  
Stein Kaasa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sleep Quality ◽  
Cancer Pain ◽  
Advanced Cancer ◽  
Poor Sleep ◽  
Global Score ◽  
Patients With Cancer ◽  
Emotional Function ◽  
Financial Difficulties

ObjectiveSleep is often disturbed in patients with advanced cancer. There is limited knowledge about sleep in patients with cancer treated with strong opioids. This study examines sleep quality in patients with advanced cancer who are treated with a WHO Step III opioid for pain.MethodsAn international, multicentre, cross-sectional study with 604 adult patients with cancer pain using WHO Step III opioids. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI) global score (range; 0–21; score >5 indicates poor sleep). PSQI includes sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications and daytime dysfunction. Pain and quality of life were assessed by Brief Pain Inventory and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core30.ResultsThe median age was 62 years, 42% were female, mean Karnofsky performance score (KPS) was 62.5 (±14.2) and mean oral daily morphine equivalent dose was 303 mg/24 hours (±543.8 mg). The mean PSQI global score was 8.8 (±4.2) (range 0–20). Seventy-eight per cent were poor sleepers. All PSQI components were affected, and 44% reported trouble sleeping caused by pain. In the multiple regression model, predictors of PSQI global scores were pain intensity, emotional function, constipation, financial difficulties and KPS (adjusted R2=0.21).ConclusionThe majority (78%) of these patients with cancer treated with Step III opioids experienced poor sleep quality. Pain intensity, emotional function, constipation, financial difficulties and KPS predicted poor PSQI global scores. The clinical implication is that healthcare personnel should routinely assess and treat sleep disturbance in patients with advanced cancer disease.

Sign in / Sign up

Export Citation Format

Share Document