scholarly journals Incidence of Severe Pain in Newly Diagnosed Ambulatory Patients with Stage IV Cancer

2012 ◽  
Vol 17 (5) ◽  
pp. 347-352 ◽  
Author(s):  
Thomas Isaac ◽  
Sherri O Stuver ◽  
Roger B Davis ◽  
Susan Block ◽  
Jane C Weeks ◽  
...  
Keyword(s):  
Head And Neck ◽  
Severe Pain ◽  
Stage Iv ◽  
Initial Visit ◽  
Newly Diagnosed ◽  
Ambulatory Oncology ◽  
Ambulatory Patients ◽  
Stage Iv Cancer ◽  
One Year ◽  
Thoracic Malignancies

BACKGROUND: Pain is common among cancer patients.OBJECTIVE: To characterize the incidence of severe pain among newly diagnosed patients with stage IV cancer in ambulatory care.METHODS: A retrospective cohort of 505 ambulatory oncology patients with newly diagnosed stage IV solid tumours at a comprehensive cancer centre (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) was followed from January 1, 2004, to December 31, 2006. Pain intensity scores were extracted from electronic medical records. The incidence of severe pain was calculated using the maximum monthly pain scores reported at outpatient visits.RESULTS: Of the 505 patients included in the present study, 340 (67.3%) were pain-free at the initial visit, 90 (17.8%) experienced mild pain, 48 (9.5%) experienced moderate pain and 27 (5.4%) experienced severe pain. At least one episode of severe pain within one year of diagnosis was reported by 29.1% of patients. Patients with head and neck, gastrointestinal and thoracic malignancies were more likely to experience severe pain compared with patients with other types of cancer (52.6%, 33.9% and 30.5%, respectively). In the multivariable model, patients whose primary language was not English (OR 2.90 [95% CI 1.08 to 7.80]), patients who reported severe pain at the initial visit (OR 9.30 [95% CI 3.72 to 23.23]) and patients with head and neck (OR 10.17 [95% CI 2.87 to 36.00]) or gastrointestinal (OR 4.05 [95% CI 1.23 to 13.35]) cancers were more likely to report severe pain in the following year.CONCLUSIONS: The incidence of severe pain was high in ambulatory patients with newly diagnosed stage IV cancer.

Impact of opioid use on survival in patients with newly diagnosed stage IV non-hematologic malignancies.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 188-188 ◽  
Author(s):  
Dylan Michael Zylla ◽  
Sara Richter ◽  
Alice C. Shapiro ◽  
Pankaj Gupta
Keyword(s):  
Overall Survival ◽  
Severe Pain ◽  
Stage Iv ◽  
Hematologic Malignancies ◽  
Advanced Lung Cancer ◽  
Tumor Type ◽  
Newly Diagnosed ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Short Acting

188 Background: Pain is a challenging problem in patients with advanced cancers. Opioids are commonly required to treat cancer-related pain, but may be associated with tumor progression and shorter survival. We recently reported that high opioid use during the first 90 days after diagnosis is associated with shorter survival in patients with advanced lung cancer. Methods: We identified 1386 newly diagnosed stage IV non-hematologic malignancies from 2005-2013 and gathered pain and opioid utilization within 90 days of treatment using data from electronic medical records and the tumor registry. Opioid utilization was stratified into low opioid exposure (LOE; no opioid prescriptions or one prescription for a short-acting opioid) and high opioid exposure (HOE; any long-acting opioid prescription or 2 or more short-acting opioid prescriptions). Pain was analyzed by the proportion of time patients reported levels of moderate-severe pain (i.e., pain level ≥ 4). The effects of opioid exposure, prognosis of tumor type ( < 1 year vs ≥ 1 year), and gender on overall survival were analyzed in univariable and multivariable models. Results: Patients in the HOE (n = 887) and LOE (n = 499) groups were well matched for age, gender, and tumor type. Moderate-severe pain was higher in the HOE group compared to the LOE group (29.3% vs 14.0%). HOE was associated with shorter median survival compared to LOE (7.2 vs 13.2 months, p-value < 0.0001). On multivariable analysis, HOE was associated with shorter overall survival after adjusting for age, gender and tumor prognosis (HR 1.4, 95% CI 1.2- 1.6) (Table). Conclusions: Results support prior studies of advanced prostate and lung cancers, and show early utilization of opioids is a strong prognostic factor for survival. Further prospective investigation on the role of opioid receptors and opioid utilization is urgently needed. [Table: see text]

Improving palliative care integration for patients with stage IV lung cancer at UConn Health by initiating a best practice advisory (BPA) in the electronic medical record (EMR).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 331-331
Author(s):  
Sarah Loschiavo ◽  
Lisa Holle ◽  
Carolyn Guarino ◽  
Ruth Kalish ◽  
Cheryl Coppola ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Stage Iv ◽  
Palliative Care Team ◽  
Care Team ◽  
Clinical Staging ◽  
Newly Diagnosed ◽  
Care Clinic ◽  
Stage Iv Cancer ◽  
Stage Iv Lung Cancer

331 Background: The American Society of Clinical Oncology (ASCO) practice updates on the integration of palliative care into standard oncology practice provides a key recommendation that patients with advanced cancer should receive palliative care services. Specifically, ASCO recommends that all patients with stage IV cancer receive a referral to an interdisciplinary palliative care team early in their course of disease and within 8 weeks of diagnosis. At UConn Health, it has been previously documented that only 28% of patients with stage IV cancer receive a referral to the palliative care team. To improve the quality of cancer care, a BPA with standardized criteria for palliative care referral was developed and implemented for patients with stage IV lung cancer. In this pilot study, the goal was to get 80-90% of patients a referral to palliative care team within 8 weeks of stage IV lung cancer diagnosis. Methods: The Model for Improvement using Plan-Do-Study-Act Cycles was completed: 1) created an EMR report to identify patients with stage IV lung cancer; 2) completed a retrospective review of patients with stage IV lung cancer referred to palliative care 6 months prior to BPA implementation; 3) created and implemented BPA; 4) educated providers about palliative care referral and BPA; 5) retrospectively reviewed referrals 6 months following BPA implementation; and 6) evaluated potential barriers. The palliative care EMR BPA was developed in collaboration with information technology specialists. The BPA alert populates the EMR when the provider opens a patient chart or visit encounter for all patients with 1) diagnosis of lung cancer; 2) stage IV disease; and 3) does not have a current order for palliative care referral. Results: Prior to BPA implementation (January 1, 2020- July 31, 2020), 8 of 28 patients (32%) with stage IV lung cancer were referred to palliative care service. The BPA became active on 9/15/2020. Within the six months following BPA implementation, 16 patients were newly diagnosed with stage IV lung cancer. Of these 16 patients, 81% of them had a referral to palliative care made within 8 weeks of clinical staging. Several barriers were identified with current process, including lack of staging tool use by all providers; lack of documentation of all data required for staging tool to automatically calculate stage, and inability to track patients who declined palliative care appointment. Conclusions: Incorporating a BPA reminding providers to consider a palliative care referral improved referrals of patients with newly diagnosed stage IV lung cancer to the palliative care clinic within 8 weeks of diagnosis, improving compliance with ASCO’s practice guidance on integration of palliative care. Next steps are to address barriers and expand the use of palliative care referral BPA to all patients with stage IV cancer.

scholarly journals The predictive factors of primary head and neck cancer stage at presentation and survival in a developing nation’s tertiary hospital

2018 ◽  
Vol 6 ◽  
pp. 205031211879241 ◽  
Author(s):  
Adeyi A Adoga ◽  
Daniel D Kokong ◽  
Nuhu D Ma’an ◽  
Joyce G Mugu ◽  
Chukwunonso J Mgbachi ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Head And Neck ◽  
Tobacco Use ◽  
Odds Ratio ◽  
Stage Iv ◽  
Tertiary Hospital ◽  
Hazard Ratio ◽  
Head And Neck Cancers ◽  
Health Records ◽  
Stage Iv Cancer

Background: Stage of head and neck cancers at presentation is a strong determinant of outcomes. Objective: To evaluate predictors of stage of head and neck cancers at presentation and survival in a Nigerian tertiary hospital. Patients and methods: Health records that met the inclusion criteria for head and neck cancers were retrieved using the International Classification of Diseases, 10th revision and analyzed with associations between variables modeled using logistic regression analysis. Results: From a record of 487 head and neck neoplasms, 129 (26.5%) were malignant of which 122 health records met the criteria for analysis consisting of 83 (68.0%) males and 39 (32.0%) females aged 13–85 years (mean = 51 years; standard deviation = ±16 years). Alcohol (odds ratio = 1.99; 95% confidence interval = 1.08–3.69; p = 0.02) and tobacco exposure (odds ratio = 3.07; 95% confidence interval = 1.32–7.16; p = 0.01) were associated with increased odds for advanced tumor stage at presentation. Stage IV cancer (hazard ratio = 1.44; 95% confidence interval = 1.80–2.59), alcohol (hazard ratio = 2.19; 95% confidence interval = 1.18–4.10) and tobacco use (hazard ratio = 3.40; 95% confidence interval = 1.22–8.74) were associated with increased hazards for death. Conclusion: Alcohol, tobacco use and smoke from cooking wood are predictive factors for advanced HNC stage at presentation. Stage IV cancer, alcohol and tobacco use were associated with an increased hazard for death.

Treatment of Patients with Stage IV Cancer: Do the Ends Justify the Means?

1987 ◽  
Vol 97 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Lawrence Burns ◽  
Dan Chase ◽  
W. Jarrard Goodwin
Keyword(s):  
Head And Neck ◽  
Relevant Literature ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Treatment Quality ◽  
Aggressive Treatment ◽  
Upper Aerodigestive Tract ◽  
Primary Tumors ◽  
Stage Iv Cancer ◽  
Disease Free

Most experienced head and neck surgeons recommend aggressive treatment-Including radical surgery—for patients with resectable Stage IV cancers. Yet, given the poor overall cure rate of 15% and the deformity and disability often associated with treatment, one of the most frequently asked questions at our conference on tumors was: Are we really helping these patients? We found little data in the relevant literature to answer this or other questions. Are there subgroups with a better outlook? What is the evidence for palliation in the 85% of patients who fail treatment and how is it best achieved? How do patients and their families view their treatment In retrospect? To find the answers, we studied the records of 76 consecutive patients (previously untreated) who presented with Stage IV carcinoma of the upper aerodigestive tract in 1981–82. We also interviewed surviving patients or family members and friends by phone. Overall mean survival was 15 months, with a 2-year disease-free survival rate of 16%. More to the point, resectable patients treated with curative intent had a mean survival of 19.4 months, and 12 of 42 patients (29%) were disease-free at 2 years. Patients with laryngeal cancer had the best survival results, and patients with sinus cancers had the worst (25.2 vs. 10.5 months). Those with N2A staging lived longer than other groups (24.1 vs. 12.1 months). T4 lesions portend a particularly poor prognosis; mean survival was just 7.5 months and only 1 of 28 patients (3.6%) was alive and disease-free at 2 years. Twenty-five percent of patients returned to normal function, but 75% had significant problems eating or speaking. Thirty-four interviews revealed that 44% of patients enjoyed life after treatment and that 55% (in retrospect) would accept treatment. Quality of life, as determined by our adjustment index, was better In patients who had undergone operation; radiation and/or chemotherapy—when offered for palliation—gave little benefit. We conclude that the results justify aggressive treatment in resectable Stage IV cancer of the head and neck—particularly in patients who do not have T4 primary tumors.

Multimodality treatment in stage IV squamous cell carcinoma of the head and neck. A long-term follow-up

1992 ◽  
Vol 106 (3) ◽  
pp. 234-237 ◽  
Author(s):  
A. Klima ◽  
I. Bergmann ◽  
S. Szepesi
Keyword(s):  
Head And Neck ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Multimodality Treatment ◽  
Complete Response ◽  
Free Survival ◽  
Long Term Follow Up ◽  
Stage Iv Cancer

AbstractWe treated 114 patients with advanced inoperable head and neck cancer with a combined-modality protocol that included two cycles of chemotherapy followed by radiotherapy or three cycles of chemotherapy and in 18 patients with a radiosensitizing agent. At the beginning of the treatment all but one patient presented with a stage IV cancer. With a follow-up of 42–58 months, four patients are alive (three from the radiosensitizing group and one of the chemotherapy group). Complete response after the radiosensitizing agent correlated with superior prolonged disease-free survival in comparison to complete responses after chemotherapy at the level of p<0.009.

scholarly journals What's New in Molecular Targeted Therapies for Head and Neck Cancer?

2021 ◽  
Vol 37 (2) ◽  
pp. 11-17
Author(s):  
Seoyoung Lee ◽  
Hye Ryun Kim
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Checkpoint Inhibitors ◽  
Locally Advanced ◽  
Stage Iv ◽  
Hpv Infection ◽  
Pi3k Pathway ◽  
Cell Cycle Pathway ◽  
One Year

Head and neck cancer is the 6th most frequently diagnosed solid tumor in the world. Alcohol consumption, smoking, and HPV infection are associated with the incidence of head and neck squamous cell carcinoma (HNSCC). Although a multidisciplinary approach is a key strategy for the treatment of locally advanced HNSCC, systemic therapy is the mainstream of recurrent or metastatic HNSCC treatment. Stage IV HNSCC has a relatively poor prognosis with median overall survival of around one year. There have been many clinical trials to investigate the efficacy of target agents in the treatment of HNSCC. In the HPV-negative HNSCC, TP53 and CDKN2A are the most commonly mutated genes. In the HPV-positive HNSCC, the PI3K pathway is frequently altered. EGFR, PI3K, cell cycle pathway, MET, HRAS, and IL6/JAK/STAT pathway are explored targets in HNSCC. In this study, we review the target pathways and agents under research. We also introduce here umbrella trials of recurrent or metastatic HNSCC conducted by the Korea Cancer Study Group. The combination of target agents with immune checkpoint inhibitors or cytotoxic chemotherapies would be a future step in the precision medicine of HNSCC treatment.

scholarly journals Lived Experience among Patients Newly Diagnosed with Lung Adenocarcinoma Stage IV within One Year

2015 ◽  
Vol 16 (15) ◽  
pp. 6633-6638
Author(s):  
Whei-Mei Jean Shih ◽  
Hsiu-Chin Hsu ◽  
Ru-Shang Jiang ◽  
Mei-Hsiang Lin
Keyword(s):  
Lung Adenocarcinoma ◽  
Lived Experience ◽  
Stage Iv ◽  
Newly Diagnosed ◽  
One Year

Sustained normoglycemia in newly diagnosed type I diabetic subjects. Short-term effects and one-year follow-up

Diabetes ◽  
1984 ◽  
Vol 33 (10) ◽  
pp. 995-1001 ◽  
Author(s):  
K. Perlman ◽  
R. M. Ehrlich ◽  
R. M. Filler ◽  
A. M. Albisser
Keyword(s):  
Type I ◽  
Newly Diagnosed ◽  
Short Term ◽  
One Year ◽  
Short Term Effects

4307Lung ultrasound in stable ambulatory chronic heart failure patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Domingo ◽  
L Conangla ◽  
J Lupon ◽  
M De Antonio ◽  
P Moliner ◽  
...  
Keyword(s):  
Cox Regression ◽  
Functional Class ◽  
Class Iii ◽  
Nyha Functional Class ◽  
End Point ◽  
Ambulatory Patients ◽  
Beta Coefficient ◽  
One Year ◽  
B Lines

Abstract Background The role of lung ultrasound (LUS) in diagnosis and response to diuretic treatment of patients with acute HF has been widely studied, but less is known about its value in chronic HF. Purpose To assess the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients and to explore the relationship of LUS findings with clinical data, such as NYHA functional class, left ventricular ejection fraction (LVEF) and NTproBNP. Methods Consecutive stable ambulatory patients who attended a scheduled follow-up visit in a HF clinic were included. LUS were performed with a pocket device and examined 4 chest areas per side (two anterior and two lateral). Scans were analysed offline by two investigators blinded to clinical data, who evaluated the number of B-lines of each area. The addition number of B-lines of each area and the quartiles of such addition were used for the analyses. The primary outcome end-point was the composite of all-cause death or hospitalization due to HF at one year. Linear regression and Cox regression analyses were performed. Results Five-hundred seventy-seven patients were included between July 2016 and July 2017 (age 69±12 years, 72% men). The main HF aetiology was ischemic heart disease (43%) followed by dilated cardiomyopathy (20%). Median HF duration was 79 months (Q1-Q3 38–144). Mean LVEF was 45%±13 (mean LVEF when admitted at the Unit 34%±13). Most patients were in NYHA functional class II (70%), 13% were in class I and 17% in class III. Median NTproBNP was 722 ng/L (Q1-Q3 262–1760). Mean number of B-lines was 5±6 (Q1, 0; Q2, 1–3; Q3, 4–7; Q4, ≥8). The number of B-lines was associated with age (beta-coefficient 0.11, p<0.001), NYHA functional class (beta-coefficient 1.75, p<0.001), and logNTproBNP (beta-coefficient 1.40, p<0.001). Mean number of B-lines according to NYHA functional class was: class I, 3.5±6; class II, 4.9±6; and class III, 7.1±7. During the one year follow-up 47 patients suffered the primary end-point. In total there were 24 HF related hospitalizations and 26 deaths. In Cox regression analysis, Q4 of B-lines showed a double risk of suffering the primary end-point (HR 2.13 [95% CI 1.18–3.84], p=0.01). However, statistically significance was not maintained for LUS results in the multivariable analysis when age, NYHA functional class and logNTproBNP were included in the model, although a 38% increase in the risk of suffering the primary end-point for Q4 was observed (HR 1.38 [95% CI 0.75–2.54], p=0.31). Conclusion In outpatients with stable chronic HF, the number of B-lines detected in LUS was associated with age, NYHA functional class and NTproBNP. Patients having ≥8 B-lines had a significant double risk of HF related hospitalization or all-cause death at one year. However, when strongly powerful prognostic variables such as NYHA class and NTproBNP were included in the model LUS did not retain an independent prognostic role.

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