scholarly journals Undiagnosed Esophageal Adenocarcinoma Presenting as Multiple Brain Metastases

2017 ◽  
Vol 10 (3) ◽  
pp. 938-944 ◽  
Author(s):  
Vincent Grzywacz ◽  
Ernie Balcueva
Keyword(s):  
Brain Metastases ◽  
Esophageal Adenocarcinoma ◽  
Poor Prognosis ◽  
Past History ◽  
Performance Status ◽  
Stage Iv ◽  
Smoking History ◽  
Gastrointestinal Malignancies ◽  
Head Ct ◽  
History Of

Brain metastases from gastrointestinal malignancies are exceedingly rare occurrences that carry a very poor prognosis. This holds especially true in cases where brain metastases from esophageal primaries are the initial presentation of a previously unidentified gastrointestinal malignancy. Our patient, a 60-year-old male with a past history of a right temporal teratoma, family history of breast cancer, and no smoking history, presented with a chief complaint of recurrent headaches. His history of present illness and physical examination included a two-month history of frontal headache, progressive fatigue, and unintentional weight loss. He underwent an extensive initial workup including CT-head, CT-abdomen/pelvis, CT-chest, bone scan, tumor marker analysis, and MRI-brain. The initial head CT revealed multiple intracranial lesions suspicious for malignancy. A PET scan later revealed his primary to be a malignancy of the distal esophagus. His treatment course thus far has been aggressive, consisting of surgical resection, systemic chemotherapy with capcetibine-oxaliplatin as well as paclitaxel-carboplatin, and radiation therapy. He has had several recurrences since starting treatment, but has continued to maintain a good performance status with only minor symptoms. Currently, the patient has survived for 17 months after his diagnosis of stage IV (T3, N2, M1) moderately differentiated adenocarcinoma and is undergoing treatment with trastuzumab and stereotactic radiosurgery. This report demonstrates that although cases of esophageal adenocarcinoma that present as brain metastases typically carry a poor prognosis, with early and aggressive treatment patients can survive well past one year after diagnosis.

Outcomes after the diagnosis of brain metastases in Brazilian NSCLC patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20568-e20568
Author(s):  
Juliano Ce Coelho ◽  
Luiza Weis ◽  
Patricia Marks ◽  
Guilherme Geib ◽  
Pedro Emanuel Rubini Liedke ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Brain Metastases ◽  
Palliative Treatment ◽  
Karnofsky Performance Status ◽  
Systemic Disease ◽  
Performance Status ◽  
Stage Iv ◽  
Best Supportive Care ◽  
Smoking History ◽  
Nsclc Patients

e20568 Background: Brain metastases (BM) are common and affects near half of patients with non-small-cell lung cancer (NSCLC), with poor prognosis. Few data is available about this group of patients and Brazilian are underrepresented. Methods: Patients with NSCLC that developed BM between January 05 and December 15 at Hospital de Clinicas de Porto Alegre were identified and medical records were reviewed. OS and PFS were estimated by Kaplan-Meier curves. Multivariate analysis was performed to identify factors associated with survival. Statistical analysis was performed with SPSS 22.0. Results: 113 patients were identified. Mean age was 60.1 ± 8.7 years, 50% were female, 84% were Caucasian, 87% had a positive smoking history, 71% had adenocarcinoma histology and 72% had stage IV disease at presentation. BM was present at initial diagnosis in 38% of patients. At diagnosis of BM, 39% of patients had a Karnofsky performance status < 70, 20% had systemic disease under control, 31% had more than 3 brain lesions and 81% had a GPA score ≤2. 35 patients (31%) were submitted to either surgery or stereotaxic radiotherapy (SRDT), 52 (46%) to whole brain radiation (WBRT) and 26 (23%) to best supportive care (BSC). With a median follow-up of 11.2 months, 96% of patients have died. The OS was 11.2 months (95% IC, 9.4 to 13.1). The median survival time following diagnosis of BM was 4.9 months and survival according to treatment was 16.3 months for resection, 8.9 months for SRDT, 3.8 months for WBRT and 0.7 months for BSC. A Karnofsky performance status < 70 at diagnosis of BM and palliative treatment to BM (WBRT or BSC) were associated with worse outcome in multivariate analysis. The GPA score wasn't statically associated with prognosis. A longer survival of patients submitted to WBRT was seen when compare to BSC, HR of 0.38. There is a trend for longer survival in patients submitted to BM resection when compared to SRDT, but without statically significance. Conclusions: To our knowledge this is the largest report of NSCLC patients with BM from Latin America. Our data is in line with previous reports. A poor Karnofsky performance status and palliative treatment to BM are associated with poor survival. WBRT is associated with longer survival when compared to BSC in all the GPA score stratus.

Multiple cutaneous and haemorrhagic brain metastases as the sentinel presentation of lung adenocarcinoma

2020 ◽  
Vol 13 (11) ◽  
pp. e235938
Author(s):  
Pooja Gogia ◽  
Jonathan Wallach ◽  
Anil Kumar Dhull ◽  
Sidharth Bhasin
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Lung Adenocarcinoma ◽  
Poor Prognosis ◽  
Treatment Plan ◽  
Performance Status ◽  
Memory Loss ◽  
Whole Brain Radiotherapy ◽  
Smoking History ◽  
Cutaneous Lesions

Skin is a relatively uncommon site of metastasis in lung cancer and is associated with a poor prognosis. Although, lung cancer does not uncommonly metastasise to the brain, haemorrhagic brain metastases are rarely reported. In this report, we present a dramatic presentation of a female smoker with a 3-week history of numerous cutaneous lesions over her body and two episodes of transient memory loss. Work-up demonstrated widely metastatic, poorly differentiated lung adenocarcinoma with haemorrhagic brain metastases. She proceeded with whole brain radiotherapy, but her performance status quickly declined afterwards; she succumbed to her malignancy within 6 weeks of presentation. This case presentation demonstrates that, for patients who present with cutaneous masses, especially those aged more than 60 years, and who have extensive smoking history, metastatic lung cancer should remain on the differential diagnosis. Also, the very poor prognosis of multiple metastases may influence medical and social decisions in the patient’s treatment plan.

scholarly journals Past, Present and Future? of Colorectal Cancer Epidemiology and Clinical Study in Misan

2018 ◽  
Vol 4 ◽  
Author(s):  
Hayder Qasim Saadoon Alhilfi ◽  
Khalid Obiad Mohsin Almohammadawi ◽  
Nyaz Ahmed Ameen ◽  
Basima Kadhim Abbood Aliedani ◽  
Husam Jihad Imran Aldubaisi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Family History ◽  
Colorectal Carcinoma ◽  
Past History ◽  
Stage Iv ◽  
Smoking History ◽  
History Of ◽  
Advanced Stages ◽  
Colon And Rectum ◽  
Prostate Cancers

Background: Colorectal carcinoma is commonest cancer of GIT. It is represent third cancer in man worldwide beyond lung and prostate cancers. It is fourth cancer in woman beyond breast, lung and uterus cancers. Deaths from colorectal cancer is more in compare with other GIT cancers. The study aimed to determine epidemiological and clinical data of colorectal cancer in Misan province.Methods: Our study conducted in Misan province, Iraq. The data were collected from 2013 to 2016. Seventy one patients that found have colorectal cancer. An epidemiological, clinical and descriptive study perform which included frequency of gender, age, residency, site of cancer, family history, past history, year of onset, smoking history, alcohol intake, presentation of cancer at time of diagnosis, staging and histopathology pattern in relation to colorectal cancer.Results: Overall prevalence of colon and rectum carcinoma is 3.75%. The most age group affected was 51-60 years as 30.99%. The gender and residency of patients have no effect on cancer percent. Obesity, Family history, cigarette smoking and alcohol consumption represented risk factors for colorectal cancer. In 42.25% of patients had family history of cancer. Most common site of colorectal carcinoma was left colon, which present in 61.97%. Conclusion: There was slight increase in new cases detection of colorectal carcinoma from 2013 to 2016. Advanced stages of colorectal cancer were most common stages description as stage IIIA, IIIB, IIIC and stage IV in 12.67%, 16.90%, 19.72% and 15.49% respectively. The common histopathological pattern of colorectal cancer was moderately differentiated adenocarcinoma as 53.52%.

scholarly journals Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

2021 ◽  
Author(s):  
Sergej Telentschak ◽  
Daniel Ruess ◽  
Stefan Grau ◽  
Roland Goldbrunner ◽  
Niklas von Spreckelsen ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Poor Prognosis ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Salvage Treatment ◽  
Treatment Modalities ◽  
Large Tumor ◽  
Fractionated Radiotherapy ◽  
Hypofractionated Stereotactic Radiosurgery

Abstract Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

Clinical outcome of sequential chemotherapy in metastatic and/or recurrent gastric cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15521-e15521
Author(s):  
Y. Moon ◽  
S. Rha ◽  
H. Jeung ◽  
S. Shin ◽  
N. Yoo ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Natural History ◽  
Performance Status ◽  
Stage Iv ◽  
Poor Performance ◽  
Median Number ◽  
Care Group ◽  
Metastatic Site ◽  
Stage Iv Gastric Cancer ◽  
History Of

e15521 Background: Little is known about data on subsequent chemotherapy (CTx) following 1st-line CTx in stage IV gastric cancer. The purpose of this study was to analyze the natural history of stage IV gastric cancer with sequential CTx Methods: A total of 532 patients (pts) with unresectable gastric adenocarcinoma were studied. They were managed with a strategy of maximal administration of CTx only if pts’ general conditions were allowed. Response evaluation was performed by RECIST every 2 cycles. Response of unmeasurable lesions was dichotomized only into stable disease or progressive disease. Results: When pts were divided into CTx group (460 of 532, 87%) and best supportive care group (BSC; 72 of 532, 13%) resulting from poor performance/pt's refusal/comorbidity (31/23/18), the former had younger age (p = 0.046), better performance (p < 0.001), and less advanced metastatic sites (p = 0.001) than the latter. Median overall survivals from diagnosis of unresectable cancer were 12.0/13.3/2.5 months for overall/CTx/BSC, respectively. 87%/47%/23% of the whole pts received 1st/2nd/3rd-line CTx, respectively. Median number of regimens delivered was 2. Maximally 5th-line CTx was given to 15 pts (3%). Response and disease control rates were 21.7%/12.5%/11.8% and 79.4%/56.3%/49.4% for 1st/2nd/3rd lines, respectively. Median progression-free and overall survivals from CTx were 5.5/3.4/2.5 months and 12.1/7.9/5.5 months for 1st/2nd/3rd lines, respectively. The most common cause of discontinuation of CTx was disease progression (68%/74%/70%) followed by pt's refusal (22%/13%/12%) for 1st/2nd/3rd lines, respectively. Prognosticators were performance status, histology, metastatic site, and CTx before 1st or 2nd line. Conclusions: When pts with unresectable gastric cancer were managed with a strategy of maximal administration of CTx, a considerable number of pts could receive 2nd or 3rd line CTx, showing modest activity. Performance status and metastatic site were consistent prognosticators even if lines changed. Our data on the natural history of stage IV gastric cancer with sequential CTx may suggest that clinical trials can be performed in a 2nd or 3rd line setting as well. No significant financial relationships to disclose.

Three-year survival in stage IV non-small cell lung cancer (NSCLC): The importance of metastatic distribution.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7608-7608
Author(s):  
Daniel D. Karp ◽  
Jan M Hanneken ◽  
Sarah H Taylor ◽  
Taoyan Men ◽  
Xifeng Wu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Metastatic Disease ◽  
Cancer Survival ◽  
Survival Curve ◽  
Performance Status ◽  
Stage Iv ◽  
Staging System ◽  
Smoking History ◽  
Solitary Lesion ◽  
Term Survival

7608 Background: Although long term survival (LTS) is an important goal of lung cancer treatment, those with metastatic disease at presentation have a median of only 8-9 months in most series with a small “tail” on the survival curve. We analyzed a large cohort of Stage IV pts by performance status (PS), smoking history, number and sites of disease to assess factors associated with 36 month survival. Methods: From 2004–2008, 526 newly diagnosed untreated pts with Stage IV NSCLC received initial treatment at our institution. Sites of disease were analyzed according to lung, brain, bone, liver, adrenal, skin, malignant effusion, lymphangitic, bulky pleural disease, and “other”. No patient had definitive surgery. Results: Overall, 58/526 pts (10.8%) survived 36 months or more. 453 pts died within 36 months. 15 pts alive with follow-up time less than 36 months were removed from further analysis. Of those, 38/58 (65.5%) had only 1 metastatic site (p<0.001). 14 (24.1%) had 2 sites, only 6 (10.3%) had 3 or more sites. Those 19 pts with lung to lung spread were the most common (32.8%) with LTS – reflecting the M1 status in the new International Staging System. Only 1 LTS pt had liver mets at diagnosis – a solitary lesion treated with radiofrequency ablation. 20 pts had PS=0 (0.019) and 29 had PS=1 (NS). PS=2 pts made up 6. 2 pts had PS=3 initially. 1 unknown. Only 6/58 (10.3%) were current smokers, 23 (39.7%) were never-smokers (p<0.001). Adenocarcinoma made up 65.5%. Conclusions: Progress in lung cancer survival has been slow. Very few LTS pts have more than 1 site of metastatic disease at presentation, virtually none with liver disease (p=0.02). Number of metastatic sites and presence of liver metastases appear to be important stratification variables for lung cancer clinical trials.

Survival of melanoma patients with brain metastases treated with ipilimumab combined with stereotactic radiosurgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20019-e20019
Author(s):  
Karim Tazi ◽  
Cody Chiuzan ◽  
Keisuke Shirai
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Performance Status ◽  
Survival Rates ◽  
Stage Iv ◽  
Rank Test ◽  
Group A ◽  
Stage Iv Melanoma

e20019 Background: Historically, melanoma with brain metastases has a poor prognosis and is a major contributor to patient morbidity and mortality. Recently, the use of ipilimumab has improved overall survival in stage IV melanoma; however, the outcome of patients with brain metastases remains unclear. In this retrospective medical record review, we report the outcome of patients with stage IV melanoma with brain metastases treated with ipilimumab and brain stereotactic radiosurgery (SRS). Methods: All patients with metastatic melanoma treated with ipilimumab from April 2010 to March 2012 were identified and stratified by presence (A) or absence (B) of brain metastases. All patients with brain metastases received SRS. Performance status, dates of stage IV diagnosis, brain SRS and cycle 1 of ipilimumab administration were recorded. We used the Disease Specific Graded Prognostic Assessment (DS-GPA) to estimate the predicted survival. Overall survival was defined as time (months) from the date of the stage IV diagnosis and the time of ipilimumab administration to death or last follow-up. Survival curves were estimated using the Kaplan-Meier method, and compared using a two-tailed log-rank test. Results: Twelve of 30 patients treated with ipilimumab had brain metastases. Median age was 66 years. Median DS-GPA score was 3 (estimated mean survival of 8.7 months). Four patients (33%) in group A and 6 patients (33%) in group B died as of last follow-up. Median number of SRS treatment was 1 (1 to 4), and median total treated lesions were 3 (1-14). Median survivals from date of Stage IV for A and B were 29.1 and 32.9 months, respectively (p=0.67). The estimated 2 year survival rates from date of cycle 1 ipilimumab administration for A and B were 58% (95% CI: 32-100%) and 55% (95% CI: 32-93%), respectively. Ten out of 12 patients in group A maintained an ECOG PS of 0-1 as of last follow-up. Conclusions: Survival of patients with melanoma brain metastases treated with ipilimumab combined with SRS may be comparable to patients without brain metastases. Ipilimumab and SRS do not seem to adversely impact quality of life.

Hormone Replacement Therapy Is Associated With Decreased Survival in Women With Lung Cancer

2006 ◽  
Vol 24 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Apar Kishor Ganti ◽  
Abe E. Sahmoun ◽  
Amit W. Panwalkar ◽  
Ketki K. Tendulkar ◽  
Anil Potti
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Past History ◽  
Hormone Replacement ◽  
Smoking History ◽  
History Of ◽  
The Impact ◽  
History Of Cancer

Purpose Lung cancer is the leading cause of cancer-related death in women. Hormone replacement therapy (HRT) is frequently prescribed to postmenopausal women, but there is little data on its effect on lung cancer. Hence, we conducted a retrospective study to examine the impact of HRT on the natural history of lung cancer. Methods We conducted a retrospective chart review of women diagnosed with lung cancer between January 1994 and December 1999. Data collected included age, stage, past history of cancer, smoking history, family history of cancer, HRT use, treatment, and overall survival. The effects of various clinical features on survival were examined using Cox proportional hazards regression models. Results Four hundred ninety-eight women (median age, 67 years; range, 31 to 93 years) with lung cancer were included. A history of smoking was present in 429 women (86%), whereas 86 women (17%) had taken HRT. Women with lung cancer who received HRT were younger than women with lung cancer who never received HRT (63 v 68 years old, respectively; P < .0001). Overall survival was significantly higher in patients with no HRT compared with patients who received HRT (79 v 39 months, respectively; hazard ratio = 1.97; 95% CI, 1.14 to 3.39). This effect seemed to be more pronounced in women with a smoking history. Conclusion HRT may affect outcomes from lung cancer adversely. Further studies examining the role of HRT use on outcomes from lung cancer, especially in women with a history of smoking, are urgently needed to clarify this important problem.

Identification of good and poor prognosis HPV associated oropharyngeal cancer based on CD103 immune cell expression in patients treated with cetuximab and radiotherapy on TROG 12.01 and De-ESCALaTE randomized trials.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 109-109
Author(s):  
Danny Rischin ◽  
Hisham Mohamed Mehanna ◽  
Richard J. Young ◽  
Mathias Bressel ◽  
Janet Dunn ◽  
...  
Keyword(s):  
Poor Prognosis ◽  
Immune Cell ◽  
Cox Model ◽  
Survival Rates ◽  
Symptom Burden ◽  
Stage Iv ◽  
Low Risk ◽  
Smoking History ◽  
Free Survival ◽  
Significant Difference

109 Background: Trials in human papilloma virus associated oropharyngeal squamous cell carcinoma (HPVOPSCC), substituting cetuximab (CETUX) for cisplatin (CIS) with radiotherapy (RT), resulted in decreased efficacy without improved toxicity or symptom burden. We reported that high intratumoral immune cell (ITIC) CD103 expression (> 30%), a marker of tissue-resident memory T cells, is associated with better prognosis in unselected patients with HPVOPSCC treated with CIS/RT. In this study our aim was to determine whether low risk HPVOPSCC patients treated with CETUX/RT with high CD103 have a superior prognosis. Methods: TROG 12.01 and De-ESCALaTE are randomised multicentre trials that compared 70Gy RT/CETUX with 70Gy RT/CIS (weekly in TROG 12.01, 3-weekly in De-ESCALaTE) in patients with HPVOPSCC, low risk by Ang criteria: AJCC 7th Stage III (excluding T1-2N1) or stage IV (excluding N2b-c if smoking history > 10 pack years and/or distant metastases). In TROG 12.01 T4 and/or N3 patients were also excluded. Eligible patients required tumor samples available for immune cell quantification on immunohistochemistry. Data from the two trials were pooled, with analyses performed in eligible randomised patients who commenced treatment. The primary endpoint was failure-free survival (FFS) in patients receiving CETUX/ RT comparing CD103 ITIC > 30% (high) vs. < 30% (low). High/low CD103 were compared using Cox model adjusting for age, stage and trial. Results: Samples for CD103 testing were available in 159/182 patients on TROG 12.01 and 145/334 on De-ESCALaTE. ITIC CD103 expression was high in 26% of patients. The median follow-up was 3.2 years. The 3 -year failure-free survival rates in patients treated with CETUX/RT were 92% (95% CI: 78-97%) in high CD103 and 74% (95% CI: 64-82%) in low CD103, adjusted HR 0.25 (95% CI: 0.14-0.44); p < 0.001. The 3 -year overall survival (OS) in patients treated with CETUX/RT were 100% in high CD103 and 86% (95% CI: 76-92%) in low CD103, p < 0.001. Superior FFS in the high CD103 group was independent of stage. In patients treated with CIS/RT there was no significant difference in FFS (3-year 86% in high CD103 and 90% in low CD103; p = 0.55) or in OS (3-year 100% in high CD103 and 95% in low CD103; p = 0.14). The increase in failures in the low CD103 patients treated with CETUX/RT was evenly split between distant and locoregional failures. Conclusions: ITIC CD103 separates CETUX/RT treated low risk HPVOPSCC into excellent and poor prognosis subgroups. In a low risk population CIS/RT achieves excellent outcomes in both high and low ITIC CD103 groups. The high ITIC CD103 population is a rational target for future de-intensification trials.

Utilization of a prognostic question as a trigger for palliative care consultation.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 325-325
Author(s):  
Megan H. Begnoche ◽  
Dana Guyer
Keyword(s):  
Palliative Care ◽  
Poor Prognosis ◽  
Disease Process ◽  
Stage Iv ◽  
Published Data ◽  
Decision Tool ◽  
Screening Process ◽  
Gastrointestinal Malignancies ◽  
Palliative Care Consultation ◽  
Extensive Stage

325 Background: The Lifespan Cancer Institute (LCI) initiated ClinicalPath in 2018 as an evidence-based decision tool to support oncologists in providing high quality care. The prognostic question used by the decision tool, “would you be surprised if this patient died in the next year,” is a validated question for predicting poor prognosis for patients with stage III, IV or extensive stage cancer. The palliative care (PC) team hypothesized that if an oncologist answered “no, I would not be surprised,” the patient would benefit from a PC consultation. The LCI prioritized efforts to provide PC upstream in the disease process by reviewing the “would not be surprised” patients and offering consultation to the ordering oncologist if deemed appropriate by the PC physician. Methods: Patients navigated through ClinicalPath from Jan to Dec 2019 were analyzed to allow for one full year after the last navigation for those marked as “would be surprised” and “would not be surprised,” and frequency of PC consultation was evaluated. Results: 729 patients triggered the prognostic question in 914 total navigations. Of those navigations, oncologists selected “I would not be surprised if patient died within the next year” 54% of the time. In 45% of decisions, the oncologist selected “I would be surprised if patient died within the next year,” suggesting that the oncologist expected the patient to live a year or more. 53% of the patients were categorized as Stage IV or extensive stage. The most common diseases were gastrointestinal malignancies, followed by thoracic and then neuro-oncology. Among the patients whose oncologist selected “I would be surprised,” 36% of patients had died within 365 days of the decision, 13% died more than a year after and 51% are still alive. Among the patients whose oncologist selected “I would not be surprised,” 60% died within 365 days of the decision and an additional 16% have since died, with 24% still alive at this time. PC consultation increased since initiation of the palliative physician conducting prognostic clinical review. In a review from Nov 19-April 20 (1157 visits) and Nov 20-April 21 (1656 visits), overall PC visits increased by 43%. Conclusions: LCI’s data aligns with prior published data that suggest the prognostic question is valid. We further examined if this question could be used as a screening tool to initiate a PC consultation since patients with a poor prognosis benefit from PC. 56% of patients navigated through the system had a PC consult at some time during their disease course, and 54% of those patients saw PC as an inpatient only. A simple screening process for those patients that were navigated to “I would not be surprised” is a way of providing earlier integration of PC. This prognostic question, which relies heavily on oncologist “gut feeling “or “intuition,” is a helpful indicator that PC consultation is appropriate and can be used effectively to ensure earlier integration of PC for oncology patients.

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