Pattern of chemotherapy use at end of life (EOL) in patients with solid tumors (ST).

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 93-93 ◽  
Author(s):  
Thomas W. Burke ◽  
Yvette A DeJesus ◽  
Lee Cheng ◽  
Aman Buzdar ◽  
Maria Alma Rodriguez
Keyword(s):  
Metastatic Disease ◽  
Physical Symptoms ◽  
Administrative Databases ◽  
Cancer Center ◽  
Chemotherapy Treatment ◽  
Chi Square ◽  
Exact Test ◽  
University Of Texas ◽  
Treatment Research ◽  
Chemotherapy Agents

93 Background: Quality performance measures for cancer care, including use of chemotherapy in the last two-weeks of life, will be required for reporting. In this study, we evaluated the pattern and frequency of chemotherapy use for ST patients in the last two-weeks of life, and whether such treatment included standard or investigational drugs. Methods: We conducted a retrospective study of 5,607 adult cancer patients (≥18 years) who received their care at The University of Texas MD Anderson Cancer Center and died between December 01, 2010 through May 31, 2012. Data on patients’ demographics, and chemotherapy agents dispensed (excluded: hormones) were obtained from the institution’s administrative databases. Type of treatment (research versus standard) was obtained from our chemotherapy dispensed database. Chi-square test and Fisher's exact test were used to determine the association between categorical variables.All statistically significant levels were determined with p values < 0.05. Results: Only 3.9% (216/5,607) of ST patients who died had received chemotherapy within 14 days EOL. For those 216 patients who received chemothapy: median age 64 years; 48% female; 89% metastatic disease. The distribution by chemotherapy treatment route: intravenous (IV) 85%; IV plus oral 6%; oral 6%; other 3%. The distribution of patients by number of chemotherapy agents: one 56%; two 31%, and three or more 13%. Among those who received chemotherapy, 98.6% (213/216) of the chemotherapy administered were standard agents. There were no differences in frequency distribution for chemotherapy treatment route (p>0.05), number of chemotherapy agents (p>0.05) between patients with metastatic and non-metastatic disease, or between men and women (p>0.05). Conclusions: Our results indicate EOL chemotherapy use was infrequent in our patients with STs, and most of those treated received standard chemotherapy, with simple one or two drug regimens. We need more research to determine factors that influence chemotherapy use at EOL, and if it palliates physical symptoms and/or emotional distress in advanced stages of disease.

Pattern of chemotherapy use at end-of-life (EOL) in patients with solid tumors (ST).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9539-9539
Author(s):  
Thomas W. Burke ◽  
Yvette A DeJesus ◽  
Lee Cheng ◽  
Aman Buzdar ◽  
Maria Alma Rodriguez
Keyword(s):  
Metastatic Disease ◽  
Physical Symptoms ◽  
Administrative Databases ◽  
Cancer Center ◽  
Chemotherapy Treatment ◽  
Chi Square ◽  
Exact Test ◽  
University Of Texas ◽  
Treatment Research ◽  
Chemotherapy Agents

9539 Background: Quality performance measures for cancer care, including use of chemotherapy in the last two-weeks of life, will be required for reporting. In this study, we evaluated the pattern and frequency of chemotherapy use for ST patients in the last two-weeks of life, and whether such treatment included standard or investigational drugs. Methods: We conducted a retrospective study of 5,607 adult cancer patients (≥18 years) who received their care at The University of Texas MD Anderson Cancer Center and died between December 01, 2010 through May 31, 2012. Data on patients’ demographics, and chemotherapy agents dispensed (excluded: hormones) were obtained from the institution’s administrative databases. Type of treatment (research versus standard) was obtained from our chemotherapy dispensed database. Chi-square test and Fisher's exact test were used to determine the association between categorical variables.All statistically significant levels were determined with P values < 0.05. Results: Only 3.9% (216/5,607) of ST patients who died had received chemotherapy within 14 days EOL. For those 216 patients who received chemothapy: median age 64 years; 48% female; 89% metastatic disease. The distribution by chemotherapy treatment route: intravenous (IV) 85%; IV plus oral 6%; oral 6%; other 3%. The distribution of patients by number of chemotherapy agents: one 56%; two 31%, and three or more 13%. Among those who received chemotherapy, 98.6% (213/216) of the chemotherapy administered were standard agents. There were no differences in frequency distribution for chemotherapy treatment route (p>0.05), number of chemotherapy agents (p>0.05) between patients with metastatic and non-metastatic disease, or between men and women (p>0.05). Conclusions: Our results indicate EOL chemotherapy use was infrequent in our patients with STs, and most of those treated received standard chemotherapy, with simple one or two drug regimens. We need more research to determine factors that influence chemotherapy use at EOL, and if it palliates physical symptoms and/or emotional distress in advanced stages of disease.

scholarly journals The influence of chemiotherapic agents and their accessories on oral manifestations of acute lymphoid leukemic children

2017 ◽  
Vol 4 (6) ◽  
pp. 141
Author(s):  
Leila Maués Oliveira Hanna ◽  
Maria Teresa Boti Rodrigues Santos ◽  
Rodolfo José Gomes De Araújo ◽  
Jéssica Mendes Damasceno ◽  
Gelson Gomes De Andrade Filho
Keyword(s):  
Total Sample ◽  
Fisher Exact Test ◽  
Oral Manifestations ◽  
Chemotherapy Treatment ◽  
Exact Test ◽  
Clinical Exam ◽  
Mouth Cavity ◽  
The Face ◽  
Chemotherapy Agents ◽  
Second Period

Aim: To evaluate the influence of chemotherapy agents and their accessories on oral manifestations of children who have acute lymphoid leukemia.Material and Methods: After the stipulated period for the research, the total sample reached was of  68children. Nevertheless, only 46 children had continued for the second period. Children from 2 to 12 years of age who had been diagnosed with ALL – and would be submitted to treatment at Ophir Loyola Hospital, in Belém, State of Pará – had been included in the research. The first evaluation has been held before the chemotherapy treatment and had offered anamnesis and clinical exams. The second evaluation has been held in 10 to 15 days after the beginning of chemotherapy treatment and has offered a new clinical exam and annotations of the drugs which had been utilized during the chemotherapy.Results: From the drugs given at Ophir Loyola Hospital, it has been observed that 14 to 24mg (83%), vincristine 0,6mg to 1 g (80%), ARA-C 20mg to 1600mg (74%), cardioxane13mg to 340mg (65%), methotrexate  12mg to 2400mg (63%), cyclophosphamide 104mg to 1540mg (59%), asparaginase 50UI to 9600UI (57%) andmesna 75mg to 510mg (54%)  have been used the most. No drug has presented statistic at 5% levelin Fisher exact test, when crossing with the presence of the main mouth manifestations: mucositis, xerostomia, toothache,and dysphagia.Conclusions: In the face of the results, it can be concluded that there has been no influence of the chemotherapy agents and their accessories in the oral manifestations of acute lymphoid leukemic children; nevertheless, these patients may present any kind of lesion on the mouth cavity during or after the beginning of chemotherapy. The dental surgeon needs to recognize the oral manifestations and intervene on the buccal health of the ALL patients, contributing and helping with his/her treatment.

Appropriateness of opioid prescribing in cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24129-e24129
Author(s):  
Robert M. Matera ◽  
Christine M. Duffy ◽  
James Robbins ◽  
Camille Higel-Mcgovern ◽  
Ashley Chartier ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Retrospective Chart Review ◽  
Cancer Center ◽  
Cancer Type ◽  
Chi Square ◽  
Cancer Society ◽  
Exact Test ◽  
Opioid Prescribing ◽  
Pain Medications ◽  
Chi Square Analysis

e24129 Background: The American Cancer Society estimates 48% people with cancer and 34% of cancer survivors report issues with chronic pain and 43 and 10% report taking an opioid, respectively. We sought to further examine the indications for pain medications in people with cancer and whether they were related to cancer, treatment, or neither. Methods: Retrospective chart review was conducted on 122 cancer patients treated at a single American academic cancer center. Authors created criteria to categorize whether patients’ pain was attributable to their malignancy or treatment regimen. Two trained coders reviewed each case with a third to resolve coding differences. Pain due to disease was further subdivided into pre-determined categories (tumor site, fracture, surgery, neuropathy, disease progression). The relationship between demographic, disease and pain type were examined in relation to inappropriate opioid prescribing using Chi-square analysis and Fischer’s exact test. Results: 55% of patients were male, 39% had metastatic disease, and 33% NED. 95% had received chemotherapy 69% radiation and 43% surgery. Factors associated with inappropriate opioid prescribing included increased age and female sex. Appropriateness of opioid prescribing was not associated with a specific cancer type or pain indication subset. Conclusions: As survivorship among cancer patients increases this may result in a cohort of patients in which opioid pain medication may not be indicated and in whom the risks may outweigh the benefits.

Effect of New Institutional Algorithm for Chemotherapy Induced Anemia (CIA) on Erythropoiesis-Stimulating Agent Treatment Patterns and Costs in Lymphoma Patients

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1299-1299
Author(s):  
Aditya D. Raju ◽  
Lal S. Lal ◽  
Lesley-Ann Miller ◽  
Hua Chen ◽  
Sujit S Sansgiry
Keyword(s):  
Treatment Patterns ◽  
Cancer Center ◽  
Control Group ◽  
Chi Square ◽  
University Of Texas ◽  
Institutional Practice ◽  
Significant Difference ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Recently there has been accumulating data regarding the increased risks of mortality, thrombosis, cardiovascular events, and of possible tumor promotion when administering erythropoiesis-stimulating agents (ESAs) to a target hemoglobin (Hgb) level of 12 g/dL. In response to this evidence, the FDA mandated a Black Box warning and the CMS mandated changes in coverage for ESAs. Subsequently, in December, 2007, the University of Texas M.D. Anderson Cancer Center (M. D. Anderson) developed and implemented an institutional practice algorithm to advise physicians regarding treatment of CIA, which included recommendations for the initiation and continued use of ESAs. The objective of this study was to assess the impact of the new institutional practice algorithm on the treatment patterns and costs of CIA in lymphoma patients. The study design was a retrospective study with a historical control group. The historical controls (pre-group) consisted of lymphoma patients diagnosed with CIA between January 1, 2007–April 30, 2007 and the cases (post-group) consisted of lymphoma patients diagnosed with CIA between January 1, 2008–April 30, 2008, who were all followed for a period of up to 16 weeks. Patient demographics, chemotherapy type, ESA type and dosage, transfusions received, Hgb values at the time of ESA usage and transfusions (for all doses and transfusions received at the institution during the study period), and costs for ESA treatment and transfusions were extracted from patient medical charts and institutional databases at M. D. Anderson. Descriptive statistics, t-tests, Mann- Whitney U, and chi-square analyses were conducted to evaluate the study objectives. The study population consisted of 154 patients; 90 patients in the pre-group and 64 patients in the post-group. Both groups had similar demographic and baseline clinical characteristics. In the post period, though there was a significant decrease in the overall amount of ESA units dispensed per patient (p=0.0125), there was an increase in the amount of ESA units dispensed in the first eight weeks of treatment (p=0.03), indicating potentially less use of outside pharmacies. There was a significant decrease in the mean Hgb at the time of ESA usage, from 9.59g/dL to 8.98g/dL (p&lt;0.0001). The proportion of patients who received an ESA at a Hgb level &gt; 10 g/dL decreased significantly, from 66% to 17% (p&lt;0.0001). There was no significant difference in the mean Hgb level at week 4 of therapy, which may indicate that patients were not clinically affected by the change in practice. There was also no significant difference in the number of transfusions administered, or the costs associated with the treatment of CIA in the study population. The results indicate that the new institutional algorithm was effective in altering the treatment patterns of CIA with respect to the ESA units prescribed and dispensed and the hemoglobin levels at the time of ESA usage in lymphoma patients.

scholarly journals Investigation of Premenstrual Syndrome among the Students of Medical Sciences

2016 ◽  
Vol 9 (3) ◽  
pp. 193
Author(s):  
Ameneh Safarzadeh Sarasiyabi ◽  
Gholamreza Ghoreishinia ◽  
Marzieh Rakhshkhorshid ◽  
Sadegh Zare ◽  
Saeedeh Rigi Yousefabadi
Keyword(s):  
Nursing Students ◽  
Adverse Effects ◽  
Premenstrual Syndrome ◽  
Psychological Symptoms ◽  
Physical Symptoms ◽  
Medical Sciences ◽  
Chi Square ◽  
Exact Test ◽  
Wide Range ◽  
Chi Square Test

<p><strong>INTRODUCTION</strong><strong>:</strong> Premenstrual syndrome (PMS) is the advent of physical and psychological symptoms related to the menstrual cycle, the symptoms of this syndrome start in luteal phase and ends at the end of menstrual period. During the last decades, the patterns of PMS (PMS) have studied in a wide range. But those researches had had different methodologies and definitions and the results were not well comparable. Hence, the researchers decided to conduct a study with the aim of investigation of the prevalent of PMS among the students of the Zahedan University of Medical Sciences.</p><p><strong>MATERIALS </strong><strong>&amp; METHODS</strong><strong>:</strong> This descriptive–analytical study was done on 200 students of Zahedan University of Medical Sciences, Iran. A two-part questionnaire was used in order to collect data. The first part related to the demographic features and the second part was related to the PSTT standard questionnaire. After collecting data, the data was analyzed by using SPSS 19 software through the statistical descriptive tests, Chi square test, Fisher’s exact test and t-test.</p><p><strong>FINDINGS</strong><strong>:</strong> The mean age of subjects was 21.9 ± 2.61. A total of 89 subjects were diagnosed with PMS. The most percentage of moderate to severe PMS was for students of medicine and the least percentage was for students of nursing. The highest percentage of mild PMS was in nursing students while the lowest percentage was for students of medicine.</p><p><strong>CONCLUSION</strong><strong>:</strong> Regarded to the fact that PMS is from the common problems of premenopausal ages in women and a high percentage of them are with psychological and physical symptoms, and since this condition can cause adverse effects on the quality of women’s life; hence, it is necessary to consider the supportive and therapeutic strategies in order to reduce the severity of its symptoms and adverse effects.</p>

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

PREEMPTIVE ANALGESIA WITH AMITRIPTYLINE IN WOMEN UNDERGOING ABDOMINAL HYSTERECTOMY: A RANDOMIZED CLINICAL TRIAL

2020 ◽  
pp. 2-5
Author(s):  
Antônio Henriques De França Neto ◽  
Alexandre Magno Nóbrega Marinho ◽  
Eveline Pereira De Arruda Agra ◽  
Priscilla Guimarães Alves ◽  
Josikwylkson Costa Brito ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Pressure Pain Threshold ◽  
Abdominal Hysterectomy ◽  
Tricyclic Antidepressant ◽  
Preemptive Analgesia ◽  
Chi Square ◽  
Double Blind ◽  
Exact Test ◽  
Student’S T

The concept of preemptive analgesia, albeit long-standing, has reemerged. Consequently, recent research has focused on testing a variety of drugs preoperatively to prevent the occurrence of postoperative pain, a major factor of morbidity. Amitriptyline is a tricyclic antidepressant used to treat chronic pain. Because amitriptyline acts on pain transmission pathways, it could theoretically be used as an agent for the prevention of postoperative pain. This study evaluated the effectiveness of amitriptyline in preventing pain in patients submitted to hysterectomy, the most commonly performed gynecological surgery. A randomized, double-blind clinical trial was conducted with 145 patients, 72 of these receiving amitriptyline and 73 placebo. All patients were evaluated at 6, 12, 24 and 48 hours after surgery using a visual analog scale (VAS) for pain and algometry to determine the pressure-pain threshold. Statistical analysis was conducted using the chi-square test of association, Student's t-test, and the Mann-Whitney test, with Fisher's exact test being used whenever appropriate. No statistically signicant difference was found between the two groups with respect to pain at any of the time points evaluated, leading to the conclusion that at a dose of 25 mg, amitriptyline is ineffective in preventing postoperative pain in patients submitted to abdominal hysterectomy

Success Rate of Obturation of Root Canals by Different Techniques in Primary Molars: A Comparative Clinical Study

2020 ◽  
Vol 2 (1) ◽  
pp. 36-44
Author(s):  
Satyawan G. Damle ◽  
Ritika Bansal ◽  
Dhanashree D. Sakhare
Keyword(s):  
Success Rate ◽  
Study Groups ◽  
Primary Molars ◽  
Control Group ◽  
Second Primary ◽  
Chi Square ◽  
Exact Test ◽  
Root Canals ◽  
Significant Difference ◽  
Comparative Clinical Study

Objective: To compare the success rate of different obturation procedures in primary mandibular second molars clinically and also by digital radiovisiography. Methods: A total of 40 children aged between 4-8 years with deeply carious mandibular second primary molars indicated for single session pulpectomy were selected. Canals were obturated with Metapex. The 3 study groups (Endodontic plugger, Handheld lentulospiral, Navi Tip syringe) were compared with the control group (reamer) both clinically and radiovisiographically. The data collected were statistically analyzed using Pearson’s Chi-square and Fisher’s exact test. Results: The use of Navi tip syringe led to the least number of voids followed by Endodontic plugger and Reamer and the highest number of voids was reported with Lentulospiral. Navitip presented maximum number of optimally filled cases followed by Endodontic plugger and Lentulospiral and least number of optimally filled cases with reamer. However, there was no statistically significant difference (p>0.05) in any of the groups with clinical (pain and tenderness to percussion) and radiographic parameters (presence or absence of voids and length of obturation). Conclusion: Within the limitations of the present study, though the clinical outcome was statistically insignificant, Navitip syringe exhibited encouraging results and is a promising option for obturation in primary teeth.

Comparison of Clinical Outcomes With Drug Coated Balloons Versus Plain Balloon Angioplasty In Chronic Limb-Threatening Ischemia

2021 ◽  
pp. 153857442110225
Author(s):  
Joel Mathew John ◽  
Vimalin Samuel ◽  
Dheepak Selvaraj ◽  
Prabhu Premkumar ◽  
Albert A Kota ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Arterial Disease ◽  
Multivariable Logistic Regression Analysis ◽  
Tertiary Care Centre ◽  
Chi Square ◽  
Exact Test ◽  
Institutional Review ◽  
Chi Square Test

Objective: The use of drug coated balloon (DCB) for angioplasty has shown superior efficacy against plain balloons for treating complex infrainguinal arterial disease. We report and compare the clinical outcomes following application of DCB(Paclitaxel) and plain angioplasty (POBA) in our tertiary care centre. Methods: A retrospective, single centre analysis of 301 patients with chronic limb-threatening ischemia involving the infrainguinal segment was conducted between September 2014 and September 2018, after approval from the Institutional review board. We analyzed clinical outcomes by measuring postoperative ABI improvement, restenosis requiring reintervention procedure, minor and major amputations at the end of 18 months. . To find the association between the group variables (POBA and DCB) and other risk variables, Chi-square test/Fisher’s exact test was used. Multivariable logistic regression analysis was used. Results: Patients who underwent treatment with plain balloon (POBA) and DCB(Paclitaxel) angioplasty were 246(81.7%) and 55(18.3%) respectively. Our study group was predominantly male (Male: Female = 6.7:1), most patients were more than 50 years of age (n = 251, 83.4%). Smoking (n = 199, 66.1%) and diabetes (n = 210, 69.8%) were the most common atherosclerotic risk factors. Postoperative Ankle Brachial Pressure Index (ABI) improvement were similar in both groups (POBA = 57.7%; DCB = 69.8%; p = 0.103). Minor and major amputations following POBA were 26% and 22%; and DCB were 12.7% and 16.4% respectively. Re-stenosis requiring a re-interventional procedure within 18 months was 15%, (n = 37) following POBA; and 12.7% (n = 7) following DCB (p = 0.661). Conclusions: This retrospective study shows similar clinical limb related outcomes following POBA and DCB at 18 months. However, our comparative analysis between the POBA and DCB groups was totally unadjusted and not adjusted for common confounders such as age and sex. Hence, for one to draw definitive conclusions leading to changes in clinical practice; a randomized, prospective study with a larger patient cohort is needed.

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