scholarly journals Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet

Blood ◽  
2013 ◽  
Vol 122 (17) ◽  
pp. 2943-2964 ◽  
Author(s):  
Luca Malcovati ◽  
Eva Hellström-Lindberg ◽  
David Bowen ◽  
Lionel Adès ◽  
Jaroslav Cermak ◽  
...  
Keyword(s):  
Performance Status ◽  
Development Program ◽  
Poor Performance ◽  
World Health ◽  
Individual Risk ◽  
Poor Performance Status ◽  
Level Of Evidence ◽  
Related Factors ◽  
Health Organization

Abstract Within the myelodysplastic syndrome (MDS) work package of the European LeukemiaNet, an Expert Panel was selected according to the framework elements of the National Institutes of Health Consensus Development Program. A systematic review of the literature was performed that included indexed original papers, indexed reviews and educational papers, and abstracts of conference proceedings. Guidelines were developed on the basis of a list of patient- and therapy-oriented questions, and recommendations were formulated and ranked according to the supporting level of evidence. MDSs should be classified according to the 2008 World Health Organization criteria. An accurate risk assessment requires the evaluation of not only disease-related factors but also of those related to extrahematologic comorbidity. The assessment of individual risk enables the identification of fit patients with a poor prognosis who are candidates for up-front intensive treatments, primarily allogeneic stem cell transplantation. A high proportion of MDS patients are not eligible for potentially curative treatment because of advanced age and/or clinically relevant comorbidities and poor performance status. In these patients, the therapeutic intervention is aimed at preventing cytopenia-related morbidity and preserving quality of life. A number of new agents are being developed for which the available evidence is not sufficient to recommend routine use. The inclusion of patients into prospective clinical trials is strongly recommended.

scholarly journals Gestational trophoblastic neoplasm and women living with HIV and/or AIDS

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Pieter Barnardt ◽  
Martha Relling
Keyword(s):  
Performance Status ◽  
Poor Performance ◽  
Sub Saharan Africa ◽  
World Health ◽  
Response To Treatment ◽  
Poor Performance Status ◽  
Current Estimate ◽  
Related Disorder ◽  
Women Living With Hiv ◽  
Health Organization

The 2011 World Health Organization global report on HIV and/or AIDS estimated that sub-Saharan Africa comprised 67% of the global HIV burden, with a current estimate of 5.9 million cases in South Africa. Since the introduction of antiretroviral therapy, there has been an increase in the incidence of non-AIDS-defining cancers. Gestational trophoblastic neoplasm (GTN) is a rare pregnancy-related disorder with an incidence ranging from 0.12–0.7/1000 pregnancies in Western nations. The overall cure rate is about 90%. Response to treatment for GTN is generally favourable; but the sequelae of HIV and/or AIDS, the resultant low CD4 counts, comorbidities, poor performance status and the extent of metastatic disease in patients receiving chemotherapy, compromise the prognosis and survival.

How I treat primary CNS lymphoma

Blood ◽  
2011 ◽  
Vol 118 (3) ◽  
pp. 510-522 ◽  
Author(s):  
Andrés J. M. Ferreri
Keyword(s):  
Molecular Mechanisms ◽  
Performance Status ◽  
Primary Cns Lymphoma ◽  
Poor Performance ◽  
Cns Lymphoma ◽  
Poor Performance Status ◽  
Level Of Evidence ◽  
Therapeutic Decisions ◽  
New Ideas ◽  
Rare Malignancy

Abstract Primary CNS lymphoma (PCNSL) is a rare malignancy with peculiar clinical and biologic features, aggressive course, and unsatisfactory outcome. It represents a challenge for multidisciplinary clinicians and scientists as therapeutic progress is inhibited by several issues. Molecular and biologic knowledge is incomplete, limiting the identification of new therapeutic targets, and the particular microenvironment of this malignancy, and sanctuary sites where tumor cells grow undisturbed, strongly affects treatment efficacy. Moreover, active treatments are known to be associated with disabling neurotoxicity, posing the dilemma of whether to intensify therapy to improve the cure rate or to de-escalate treatment to avoid sequels. The execution of prospective trials is also difficult because of the rarity of the tumor and the impaired general condition and poor performance status of patients. Thus, level of evidence is low, with consequent uncertainties in therapeutic decisions and lack of consensus on primary endpoints for future trials. Despite this unfavorable background, laboratory and clinical researchers are coordinating efforts to develop new ideas, resulting in the recent publication of studies on PCNSL's biology and molecular mechanisms and of the first international randomized trials. Herein, these important contributions are analyzed to provide recommendations for everyday practice and the rationale for future trials.

Hypofractionated radiotherapy for complicated bone metastases in patients with poor performance status: a phase II international trial

2018 ◽  
Vol 105 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Mauricio F. Silva ◽  
Gustavo N. Marta ◽  
Felipe P.C. Lisboa ◽  
Guilherme Watte ◽  
Fabio Trippa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bone Metastases ◽  
Phase Ii ◽  
Weight Bearing ◽  
Performance Status ◽  
Poor Performance ◽  
Hypofractionated Radiotherapy ◽  
Poor Performance Status ◽  
Life Questionnaire

Purpose: To evaluate the efficacy and safety of hypofractionated radiotherapy (16 Gy in 2 fractions, 1 week apart) in patients with complicated bone metastases and poor performance status. Methods: A prospective single-arm phase II clinical trial was conducted from July 2014 to May 2016. The primary endpoint was pain response as defined in the International Consensus on Palliative Radiotherapy Endpoints. Secondary endpoints included quality of life as measured by quality of life questionnaire (QLQ) PAL-15 and QLQ-BM22 European Organisation for Research and Treatment of Cancer guidelines, pain flare, adverse events, re-irradiation, and skeletal complications. Results: Fifty patients were enrolled. There were 23 men with a median age of 58 years (range 26-86). Of the 50 patients, 38 had an extraosseous soft tissue component, 18 needed postsurgical radiation, 3 had neuropathic pain, and 3 had an impending fracture in a weight-bearing bone. At 2 months, 33 patients were alive (66%). Four (12.5%) had a complete response and 12 (37.5%) had a partial response. A statistically significant improvement was seen in the functional interference (p = 0.01) and psychosocial aspects (p = 0.03) of the BM22. No patient had spinal cord compression. One patient required surgery for pathologic fracture, and another re-irradiation. Conclusions: Hypofractionated radiotherapy (16 Gy in 2 fractions of 8 Gy 1 week apart) achieved satisfactory pain relief and safety results in patients with complicated bone metastases and poor performance status.

scholarly journals Relationship Between Quality of Life and Fear of COVID-19 in Patients With Myocardial Infarction (Case Study: Shahid Madani Cardiac Hospital, Tabriz, Iran)

2021 ◽  
Author(s):  
Fatemeh Golabi ◽  
Mohammad Bagher Alizadeh Aghdam ◽  
Mir Mojtaba Hosseini Mazraehshadi ◽  
Hamed Akbarian
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Psychological Health ◽  
World Health ◽  
Life Questionnaire ◽  
Related Factors ◽  
World Health Organization Quality ◽  
Effective Role ◽  
Health Organization

Abstract Background: Quality of life is one of the most important concepts in the fields of health and development, and the study of its related factors can play an effective role in strengthening the quality of life. COVID-19 is one of the emerging crises in the world, and fear of it can affect the quality of life of people.Purpose: The purpose of this study was to investigate the relationship between quality of life and fear of COVID-19 in patients with myocardial infarction.Methods: In this study, we administered WHOQOL-BREF (World Health Organization quality of life questionnaire) and the Fear of COVID-19 Scale (FCV-19S) to 200 patients with myocardial infarction admitted to the hospital from February to April 2021. Then, we calculated the correlation between the quality of life and fear of COVID-19.Results: The results of this study showed a moderate to high score in all domains of QoL and overall QoL among patients. The mean score of fear of COVID-19 was lower than average level. The research revealed that there was a negative correlation between fear of COVID-19 and physical health, environmental health, and overall quality of life (p < 0.05), but there was not a significant relationship between fear of coronavirus and psychological health and social relationships (p > 0.05). Furthermore, there were significant correlations between quality of life and sociodemographic variables including gender, age, marital status, and level of education. So that, female, widow(er), uneducated, and older patients had a lower quality of life.Conclusions: Since the quality of life is one of the main indicators of health, managers must take strategies to improve the quality of life of people, especially patients. One of the measures that they can take is to reduce the fear of COVID-19 among patients by taking wise strategies.

scholarly journals Self-directed home-based neuromuscular electrical stimulation (NMES) in patients with advanced cancer and poor performance status: a feasibility study

2020 ◽  
Vol 28 (11) ◽  
pp. 5529-5536 ◽  
Author(s):  
Dominic O’Connor ◽  
Olive Lennon ◽  
Sarah Wright ◽  
Brian Caulfield
Keyword(s):  
Quality Of Life ◽  
Electrical Stimulation ◽  
Advanced Cancer ◽  
Performance Status ◽  
Neuromuscular Electrical Stimulation ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Walk Test ◽  
Timed Up And Go

Abstract Purpose Concurrent neuromuscular electrical stimulation (NMES) involving sub-tetanic low frequency and tetanic high frequency which targets aerobic and muscular fitness is a potential alternative to conventional exercise in cancer rehabilitation. However, its safety and feasibility in patients with advanced cancer are unknown. The aim of this feasibility study was to determine safety and feasibility and evaluate changes in functional and health-related quality of life (HR-QoL) outcomes in individuals with advanced cancer and poor performance status after concurrent NMES. These results should help inform the design of future studies. Methods Participants with advanced cancer and poor performance status (Eastern Cooperative Oncology Group scale ≥ 2) (n = 18) were recruited. The intervention included a novel NMES intervention implemented over a 4-week period. Functional exercise capacity, lower limb muscle endurance and HR-QoL were measured by 6-min walk test (6MWT), 30-s sit-to-stand (30STS) and European Organization for Research and Treatment quality of life questionnaire core-30 (EORTC QLQ C30) pre and post-intervention. Participants unable to complete the 6-min walk test completed the timed up and go test. Participant experience and the impact of the intervention on daily life were investigated through semi-structured interviews. Results Ten of 18 participants completed the intervention. No adverse events were reported. Seven of 8 participants improved 6MWT performance (2 of 2 improved timed up and go), 8 of 10 participants improved 30STS and 8 of 10 participants improved Global quality of life. Perceived benefits included improved mobility and muscle strength. Conclusions Neuromuscular electrical stimulation appears safe and feasible in advanced cancer and may improve physical and HR-QoL outcomes. Future prospective trials are warranted to confirm these findings prior to clinical implementation in an advanced cancer setting.

Psychosocial functioning and quality of life in patients with primary brain tumors

1996 ◽  
Vol 84 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Michael A. Weitzner ◽  
Christina A. Meyers ◽  
Kevin Byrne
Keyword(s):  
Quality Of Life ◽  
Brain Tumors ◽  
Psychosocial Functioning ◽  
Research Question ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Content Type ◽  
Primary Brain Tumors

✓ Perceived quality of life (QOL) was evaluated in a group of 50 patients with primary brain tumors. Participants completed two QOL measures and a demographic profile. Age was found not to be an important factor in differentiating QOL in these patients. All areas of QOL were found to be affected adversely by one or more of five factors: being female, being divorced, having bilateral tumor involvement, having received chemotherapy, and having a poor performance status. Pearson product-moment correlations conducted on the subscale and total scores of the two QOL instruments revealed that the two scales measure different QOL aspects and overlap in only a few areas. This may be related to the different measurement paradigms that these two instruments represent. This study is one of the first to evaluate the multidimensional aspects of QOL in patients with primary brain tumors, an understudied group. A prospective study of QOL in this group, already underway at the authors' institution, is needed to evaluate comprehensively the effect of different treatments and interventions on the QOL functioning of primary brain tumor patients. Additionally, this study shows that the choice of QOL instruments is very important and needs to be driven by the research question.

Predictors of hypomethylating agent discontinuation among patients with higher-risk myelodysplastic syndromes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7043-7043
Author(s):  
Amer Methqal Zeidan ◽  
Namita Joshi ◽  
Hrishikesh Kale ◽  
Wei-Jhih Wang ◽  
Shelby Corman ◽  
...  
Keyword(s):  
Myelodysplastic Syndromes ◽  
Real World ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Poor Performance ◽  
Risk Groups ◽  
Refractory Anemia ◽  
Poor Performance Status ◽  
Related Factors

7043 Background: Real-world studies have shown that persistence with intravenous (IV) and subcutaneous (SC) hypomethylating agents (HMAs) among patients (pts) with higher-risk myelodysplastic syndromes (MDS) is poor, with over one-third of treated pts receiving <4 cycles or having a ≥90-day gap in therapy, despite recommendations for at least 4-6 cycles to elicit response in absence of progression/unacceptable toxicity. Survival outcomes have also been shown to be worse, and direct medical costs higher, among HMA non-persistent vs persistent pts. We explored factors associated with early discontinuation of HMA therapy in this population. Methods: This was a retrospective cohort study among pts from the 2010-2016 SEER-Medicare linked database with a diagnosis of refractory anemia with excess blasts (RAEB; a surrogate for higher-risk MDS) from 2011-2015. Included pts had to have received HMA therapy and have ≥12 months’ continuous follow-up after diagnosis. Discontinuation was defined as stopping HMA therapy before 4 cycles. Multivariable logistic regression was used to assess predictors of HMA discontinuation. Results: In total, 664 pts with RAEB and treated with HMAs were included. Overall, 193 (29%) discontinued before 4 cycles; of these, 91 (47%) discontinued after 1 cycle, 57 (30%) 2 cycles, and 45 (23%) 3 cycles. Compared with pts continuing for ≥4 cycles, pts discontinuing before 4 cycles were generally older and more likely to be single/separated/divorced/widowed, have more comorbidities, and have poor performance status (PS) (Table). These trends were most pronounced among pts discontinuing HMA therapy after only 1 cycle vs ≥4 cycles (Table). In multivariable analysis, age 71-75 vs ≥80 y (odds ratio [OR] 0.556, p=0.017) and poor PS (OR 1.585, p=0.019) remained significant predictors of HMA discontinuation. Among treatment-related factors, the most statistically significant association with HMA discontinuation was observed for GCSF use (OR 0.453, p<0.001). Number of pills/day was not a predictor of HMA discontinuation (OR 1.009, p=NS). Conclusions: In this real-world study, almost one-third of RAEB pts treated with IV/SC HMAs discontinued before 4 cycles, with almost half of these pts discontinuing after only 1 cycle. Predictors of HMA discontinuation included older age and poor PS. Novel approaches are needed to improve persistence with HMA therapy, particularly among these higher-risk groups.[Table: see text]

Evaluation of the Quality of Life and Related Factors in the Nursing Staff of Selected Hospitals in Tehran, Iran

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ali Sadeghpour Tabaee ◽  
Mohhamad Ali Najafikhah ◽  
Bahador Baharestani ◽  
Hooman Bakhshande Abkenar ◽  
Sepehr Sadeghpour Tabaei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Environmental Health ◽  
Nursing Staff ◽  
Demographic Data ◽  
Social Health ◽  
World Health ◽  
Related Factors ◽  
World Health Organization Quality ◽  
Health Organization

Background: There are various ways to improve the quality of life of social groups. Evaluation of these strategies and improvement of the quality of life of nursing staff should be prioritized by the healthcare administration. Objectives: This study aimed to measure the quality of life and related factors in the nursing staff of three selected hospitals. Methods: This periodic descriptive study was conducted on 200 nurses working in three hospitals of Tehran, Iran. The quality of life data were collected using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the demographic data were collected and analyzed in SPSS for Windows, version 16 (released in 2007, SPSS Inc., Chicago, USA). Results: The average scores of physical, mental, social, and environmental health were measured in this study. Mental health showed the highest score, whereas environmental health had the lowest score. No significant correlation was found between the nurses’ income level and quality of life. Conclusions: The environmental and social health scores were significantly higher in married women as compared to men. Also, the score of social health was higher in married nurses, regardless of gender. Therefore, improvement of nurses’ quality of life should be prioritized by health managers in healthcare plans in the light of various factors described in this study.

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