Ambulatory 2 hours infusion of 5-FU modulated by low-dose leucovorin in the palliative treatment of advanced epithelial cancer patients with low performance status

Aims and background Patients with disseminated gastric cancer are generally in very bad clinical conditions, which make them not eligible for potentially active polychemotherapies. This justifies the development of less toxic therapies such as the use of biological response modifiers. Unfortunately, IL-2, one of the most promising cytokines, does not seem to be effective in gastric cancer. Our previous studies have shown that the pineal hormone melatonin (MLT) may amplify IL-2 activity, which becomes biologically effective also at very low doses. Based on these considerations, a pilot study was performed with low-dose subcutaneous IL-2 in combination with MLT in metastatic gastric cancer patients with low performance status. Methods The study included 14 patients with metastatic gastric cancer who received IL-2 at a dose of 3 million IU/day at 8.00 p.m. subcutaneously for 6 days/week for 4 weeks. MLT was given orally at a dose of 50 mg/day at 8.00 p.m. every day starting 7 days before IL-2. In patients in whom the disease did not progress, a second cycle was given after a rest period of 21 days. Results A tumor regression was obtained in 3/14 (21 %) patients, complete response in 1 and partial in 2, with a median duration of 13+ months. The disease stabilized in 6/14 (43 %) patients and progressed in the remaining 5 (36 %). Survival was significantly longer in patients with response or stable disease than in those with progression. Toxicity was low in all cases. Conclusions These preliminary results show that the combination on of low-dose subcutaneous IL-2 and the pineal hormone MLT may represent a new well tolerated biotherapy, capable of inducing objective tumor regression also in patients with metastatic gastric cancer and low performance status.

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Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review

Palliative Medicine ◽

10.1177/02692163211007387 ◽

2021 ◽

pp. 026921632110073

Author(s):

Christine Lau ◽

Christopher Meaney ◽

Matthew Morgan ◽

Rose Cook ◽

Camilla Zimmermann ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Cancer Patients ◽

Performance Status ◽

Retrospective Chart Review ◽

Care Needs ◽

Care Facilities ◽

Palliative Care Services ◽

Low Performance ◽

Electronic Referral

Background: To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. Aim: To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. Design: A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. Setting/participants: Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. Results: A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015–2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%–20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%–40% were associated with decreased rates and/or likelihood of admission. Conclusion: Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are “sicker” with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.

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The PROVIEW+ tool: Developing and validating a tool to predict risk of poor performance status and severe symptoms in cancer patients over time.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12095 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12095-12095

Author(s):

Hsien Seow ◽

Rinku Sutradhar ◽

Lisa Catherine Barbera ◽

Peter Tanuseputro ◽

Dawn Guthrie ◽

...

Keyword(s):

Decision Making ◽

Palliative Care ◽

Cancer Patients ◽

Severe Pain ◽

Performance Status ◽

Well Being ◽

Assessment System ◽

Low Performance ◽

Performance Scale ◽

Over Time

12095 Background: There are numerous predictive cancer tools that focus on survival. However, no tools predict risk of low performance status or severe symptoms, which are important for patient decision-making and early integration of palliative care. The aim of this study was to develop and validate a model for all cancer types that predicts the risk for having low performance status and severe symptoms. Methods: A retrospective, population-based, predictive study using linked administrative data from cancer patients from 2008-2015 in Ontario, Canada. Patients were randomly selected for model derivation (60%) and validation (40%). The derivation cohort was used to develop a multivariable logistic regression model to predict the risk of having the reported outcomes in the subsequent 6 months. Model performance was assessed using discrimination and calibration plots. The main outcome was low performance status using the Palliative Performance Scale. Secondary outcomes included severe pain, dyspnea, well-being, and depression using the Edmonton Symptom Assessment System. Outcomes were recalculated after each of 4 annual survivor marks. Results: We identified 255,494 cancer patients (57% female; median age of 64; common cancers were breast (24%) and lung (13%)). At diagnosis, the risk of having low performance status, severe pain, well-being, dyspnea, and depression in 6-months is 1%, 3%, 6%, 13% and 4%, respectively for the reference case (i.e. male, lung cancer, stage I, no symptoms). Generally these covariates increased the outcome risk by > 10% across all models: obstructive lung disease, dementia, diabetes; radiation treatment; hospital admission; high pain; depression; Palliative Performance Scale score of 60-10; issues with appetite; or homecare. Model discrimination was high across all models. Conclusions: The model accurately predicted changing cancer risk for low performance status and severe symptoms over time. Providing accurate predictions of future performance status and symptom severity can support decision-making and earlier initiation of palliative care, even alongside disease modifying therapies.

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Safety Profile and Therapeutic Efficacy of One Cycle of Lu177-PSMA in End-Stage Metastatic Castration-Resistant Prostate Cancer Patients with Low Performance Status

Nuclear Medicine and Molecular Imaging ◽

10.1007/s13139-019-00624-8 ◽

2019 ◽

Vol 53 (6) ◽

pp. 423-431 ◽

Cited By ~ 2

Author(s):

Manoj Gupta ◽

Partha Sarathi Choudhury ◽

Sudhir Rawal ◽

G. Karthikeyan ◽

Vineet Talwar ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Safety Profile ◽

Therapeutic Efficacy ◽

Performance Status ◽

Castration Resistant Prostate Cancer ◽

Castration Resistant ◽

Low Performance ◽

End Stage

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Weekly Low Dose Epirubicin in Elderly Cancer Patients

Tumori Journal ◽

10.1177/030089169608200414 ◽

1996 ◽

Vol 82 (4) ◽

pp. 369-371 ◽

Cited By ~ 10

Author(s):

Dario Nicolella ◽

Giuseppe Grimaldi ◽

Giuseppe Colantuoni ◽

Mario Belli ◽

Giuseppe Frasci ◽

...

Keyword(s):

Side Effects ◽

Elderly Patients ◽

Cancer Patients ◽

Combination Chemotherapy ◽

Clinical Studies ◽

Low Dose ◽

Performance Status ◽

Elderly Cancer Patients ◽

Grade 3 ◽

Severe Mucositis

Aims and background The treatment of elderly patients with metastatic solid tumours is still a debated problem. Patients over 75 years are generally excluded from combination chemotherapy trials because of higher toxicity. Several clinical studies have shown that weekly low dose epirubicin is a well tolerated and effective treatment for elderly cancer patients (breast, prostate, lung). Methods We report a study of patients aged between 75 and 85 years affected by metastatic anthracyclines-sensible carcinomas, to assess the tolerance of epirubicin given weekly at a dose of 25 mg/m2. Results 25 patients (13 males, 12 females; ECOG P.S. 0-2) entered the study and were evaluable for side effects. One-hundred and ninety-six cycles of therapy have been administered. Side effects were never severe. Mucositis (9 patients), leucopenia (7 patients), anemia (5 patients) were usually of grade 1 or 2. Grade 1 cardiotoxicity (tachycardia) was observed in only one case. Grade 3 toxicity consisted in anemia (1 patient) and mucositis (1 patient), while grade 4 toxicity never occurred. Nineteen patients were evaluable for response: 0 CR, 4 PR (1 lung, 3 breast), 8 SD (3 lung, 3 breast, 2 prostate) have been observed. Compliance was encouraging and the majority of patients showed a decrease in symptoms and an improvement in performance status. Conclusions Weekly low-dose epirubicin is a very well tolerated treatment in elderly cancer patients. In view of the negligible toxicity encountered, it could be of utility to test this regimen in patients aged 75 years or older, affected by anthracyclines-sensible metastatic tumors, also to assess activity.

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Does chemotherapy reduce stress?

Palliative & Supportive Care ◽

10.1017/s1478951510000337 ◽

2010 ◽

Vol 8 (4) ◽

pp. 455-460 ◽

Cited By ~ 9

Author(s):

Francisco Gil ◽

G. Costa ◽

F.J. Pérez

Keyword(s):

Cancer Patients ◽

Performance Status ◽

Adjustment Disorder ◽

Clinical Interview ◽

Screening Tools ◽

Anxiety And Depression ◽

Chemotherapy Treatment ◽

Psychological Care ◽

Care Needs ◽

Low Performance

AbstractObjective:The purpose of this study was to assess the psychological care needs of cancer patients throughout the healthcare process: after diagnosis, after medical treatment (surgery, chemotherapy, radiotherapy) and during follow-up.Method:A total of 703 ambulatory cancer patients were assessed in this study. The inclusion period was from April 1, 2005 to April 30, 2007. The first psychological scales used were the 14-item Hospital Anxiety and Depression Scales (HADS), which has two sub-scales for anxiety (7 items) and for depression (7 items). All patients with a score ≥14 were assessed through the Structured Clinical Interview for Psychiatric Disorder (SCID-I) of the DSM-IV. All data were compared with sociodemographic and medical characteristics.Results:Of the 703 cancer patients in the study, 349 were men and 354 women, with a mean age of 53 years. The median time between the cancer diagnosis and our clinical interview was 6 months (range, 12 days to 190 months). Overall, the screening tools indicated that one in four patients needed psychological care. The most common psychiatric diagnosis was adjustment disorder (129 cases), whereas 10 patients were diagnosed with major depression. Using a HADS cut-off score of >7 for anxiety and depression, 28% and 17% of patients, respectively, were classified as “possible clinical cases.” Risk factors for distress included age <65 years, asthenia, constipation, and a low performance status. However, chemotherapy treatment was found to be a protector against distress in cancer patients.Significance of Results:Chemotherapy treatment is interpreted by the patients as a protector against cancer, thereby reducing distress levels.

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Development of a prognostic index in cancer patients with low performance status

Supportive Care in Cancer ◽

10.1007/s00520-005-0800-0 ◽

2005 ◽

Vol 13 (9) ◽

pp. 752-756 ◽

Cited By ~ 1

Author(s):

José Ferraz Gonçalves ◽

Isabel Costa ◽

Carolina Monteiro

Keyword(s):

Cancer Patients ◽

Performance Status ◽

Prognostic Index ◽

Low Performance

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Palliative treatment with gefitinib (G) in advanced and heavy pre-treated non-small cell lung cancer (NSCLC)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17139 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17139-17139

Author(s):

E. Tamburini ◽

S. Nicoletti ◽

M. Papi ◽

M. Fantini ◽

C. Possenti ◽

...

Keyword(s):

Palliative Treatment ◽

Advanced Nsclc ◽

Performance Status ◽

Small Cell ◽

Rank Test ◽

Time To Progression ◽

Small Cell Lung ◽

Log Rank Test ◽

Heavily Pretreated ◽

Low Performance

17139 Background: G has demonstrated to be active in patients with advanced NSCLC pretreated with chemotherapy. We report our experience about activity and safety of G in patients with advanced, heavily pre-treated NSCLC or chemotherapy-naive patients with a low performance status. Methods: The records of the patients treated with G were reviewed; all the patients pre-treated with at least one course of a platinum-containing regimen or with low performance status were considered eligible and enrolled in the trial. All the patients were treated with G 250 mg/die until progression of the disease or intractable toxicity. All the patients were evaluated every 21 days for toxicity and every 2 months for survival. Primary end point was time to progression (TTP); secondary ones were overall survival (OS) and safety. Results: Till today 56 patients were considered eligible and enrolled in the trial; the results are summarised in the table . *: using Kaplan-Meyer test. No significant differences in OS were observed between the patients chemotherapy-naive with low performance status or pre-treated with one line of chemotherapy vs heavily pretreated ones (respectively 170 days vs 120 days, p = 0.85 using the Log-Rank test). Toxicity was mild with no haematological side effects and grade IV diarrhoea in 1 patient (1.7%). Conclusions: G seems to represent an interesting option in patients with NSCLC with low performance status or heavily pre-treated with chemotherapy. Our data seem to confirm that G is an active and safe treatment in such a subset of patients, opening a novel dimension in the treatment of pre-treated NSCLC (supported by IOR). [Table: see text] No significant financial relationships to disclose.

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