Outcomes in cancer patients (pts) admitted to a surgical (SICU) or medical ICU (MICU) compared to a newly opened cancer specific ICU (HICU).

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 279-279
Author(s):  
David D. Stenehjem ◽  
Meredith Bannon ◽  
Jonathan Boltax
Keyword(s):  
Overall Survival ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Quality Metrics ◽  
Primary Objective ◽  
Cancer Classification ◽  
Icu Mortality ◽  
University Of Utah ◽  
The University

279 Background: The University of Utah opened a cancer specific ICU (HICU) in 2011 admitting medical and surgical cancer pts. Prior to this, medical cancer pts were admitted to the MICU while the SICU admitted both and medical and surgical pts. The primary objective of this study was to compare the quality metrics of mortality and length of stay (LOS). Methods: Pts with a cancer diagnosis and admitted to the MICU or SICU from 2009-2011 or the HICU from 2011-2013 were evaluated. Pts were stratified by ICU type and the HICU was also analyzed by excluding post-operative pts (HICU-MED). Survival from admission, hospital and ICU mortality, and LOS was assessed. Results: A total of 1,375 pts were included with 259 (19%), 416 (30%), and 700 (51%) pts admitted to the MICU, SICU, and HICU, respectively. The median age was 62 years (range 18-91 years) and 57% (n = 787) were male; no significant differences in age (p = 0.1975) and sex (p = 0.7681) were observed between ICU’s. Cancer classification was oncology (65%, n = 888), hematology (32%, n = 435), and BMT (4%, n = 52). Of all pts admitted to the HICU, 44% (n = 308) were post-operative and excluded from HICU-MED (n = 392). See table for survival and LOS comparisons. Conclusions: No differences in overall survival and hospital morality (ICU and out-of-ICU) were observed comparing pts admitted to the HICU vs SICU and HICU-MED vs MICU. ICU-free days were significantly shorter resulting in shorter hospitalizations for the HICU vs SICU, which may have contributed to the reduced 30-day mortality in pts admitted to the HICU. [Table: see text]

Identification and Characterization of Recurrent Venous Thrombosis In Cancer Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3328-3328
Author(s):  
Catherine Weber ◽  
Nelly G. Adel ◽  
Elyn Riedel ◽  
Gerald A. Soff
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Hazard Ratio ◽  
Older Age ◽  
Recurrent Thrombosis ◽  
Recurrent Vte ◽  
The Impact

Abstract Abstract 3328 Background: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients. Standard of care for treatment is Low Molecular Weight Heparin, but recurrence of VTE remains a concern. We performed a retrospective analysis of our institutional experience, to characterize the patients who had a recurrence of VTE while on therapeutic doses of Dalteparin. Objectives: 1. To determine the VTE recurrence rate for cancer patients on therapeutic Dalteparin. 2. To elucidate potential risk factors for recurrence. 3. To determine the impact of recurrent VTE on overall survival. Methods: Patients beginning treatment for VTE with dalteparin between 1/1/2008 and 12/10/ 2009 were retrospectively identified through the hospital's electronic medical records system and cases of recurrent VTE were characterized. Overall survival was estimated using the Kaplan-Meier method and the influence of VTE recurrence on overall survival was analyzed as a time-dependent covariate using a Cox proportional hazards model. Results: 1,392 patients, treated for VTE with dalteparin were included in this study. 34 recurrent VTE episodes were identified. The overall incidence of recurrent thrombosis by six months was 2.3% (95% CI: 1.7%-3.3%). Older age was significantly associated with recurrence (p=0.04). Lung cancer patients had a significantly elevated risk of recurrence (5.6%, p=0.03). No other cancer types were associated with a significant trend to increased recurrent VTE rates. The incidence of recurrent VTE was higher among females compared to males (3.0% vs. 1.6%), although this trend was not statistically significant (P = 0.08). After adjusting for gender, sex and cancer diagnosis, developing a recurrent VTE was associated with a 3.0-fold hazard ratio of death (<0.0001). Conclusions: The rate of recurrent VTE in cancer patients at MSKCC is low in comparison with previously published reports. However, we identified both older age and lung cancer diagnosis as statistically significant risk factors for recurrent VTE. Females also experienced a higher rate of recurrent thrombosis when compared to males, although this result was not statistically significant. The hazard ratio for death was three times that for a patient with recurrent thrombosis when compared to one without subsequent VTE, suggesting recurrence of VTE remains an important influence on cancer-associated mortality. Disclosures: No relevant conflicts of interest to declare.

The effect of palliative care consults on deprescribing in palliative cancer patients.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 92-92
Author(s):  
Helen Marin ◽  
Patrick Mayo ◽  
Deonne Dersch-Mills ◽  
Spencer Ling ◽  
Vincent Thai ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Positive Impact ◽  
Primary Objective ◽  
Secondary Outcome ◽  
Potentially Inappropriate Medications ◽  
University Of Alberta ◽  
Drug Risk ◽  
One Year ◽  
The University

92 Background: The transition from active cancer treatment to palliative care often results in a shift in drug risk-benefit assessment which requires the deprescribing of various medications. In addition, a change in patients’ goals of care (GOC) necessitates the alteration of drug therapy which includes both deprescribing and the addition of medications intended to improve quality of life. Depending on a patient’s GOC, a medication can be considered as inappropriate. Methods: The study was a one year retrospective database review and included cancer patients seen by the PCC team at the University of Alberta Hospital. Primary Objective: Comparison between potentially inappropriate medications (PIMs) prior to the palliative care consult (PCC) versus after the PCC. Secondary objective: Association between PIMs and GOC. The OncPal guidelines were used to identify and determine the number of PIMs prior to the PCC and after the PCC. Results: The reduction in PIMs prior to PCC versus after the PCC was 49% and was statistically significant (p < 0.001), demonstrating the PCC has a positive significant impact on deprescribing PIMs. For our secondary outcome, an overall decrease in PIMs was observed with the changes of GOC. This decrease in PIMs associated with GOC although not statistically significant, demonstrates that one of the benefits of a PCC is the GOC conversation. Conclusions: Deprescribing in palliative cancer patients can benefit patients by reducing their pill burden, decrease potentially side effects, and potentially decrease healthcare costs. This study shows the positive impact a PCC has on deprescribing and reassessing GOC. Furthermore, this study reveals the importance of using guidelines for deprescribing in palliative oncology and brings to light other medications that may be considered PIMs.

Adjuvant gemcitabine plus docetaxel followed by 5FU chemoradiation for patients with resected pancreaticobiliary cancers: A single institution phase II study.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 325-325
Author(s):  
May Cho ◽  
Andrea Wang-Gillam ◽  
Feng Gao ◽  
David Linehan ◽  
William G. Hawkins ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Pancreatic Head ◽  
Ampullary Cancer ◽  
Primary Objective ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Pancreatic Head Cancer ◽  
Grade 3

325 Background: Adjuvant chemotherapy with Gemcitabine for six months has improved overall survival (OS) in resected pancreatic cancer compared to observation alone. The RTOG study showed adding gemcitabine to 5FU chemoradiation therapy showed improved OS in pancreatic head cancer patients. We evaluated the feasibility and safety of adjuvant gemcitabine plus docetaxel followed by radiation with 5FU after curative resection of pancreatic and biliary adenocarcinomas at our institution. Methods: Patients with resected pancreaticobiliary cancers were treated with 2 cycles of gemcitabine with docetaxel. Infusional 5FU at was given with 3-D conformal external beam radiation followed 4 weeks later by 2 more cycles of gemcitabine plus docetaxel. The primary objective was to evaluate the feasibility and safety of this regimen with the secondary aims to describe the toxicities, disease-free (DFS) and overall survival (OS) in these patients. Results: 50 patients were enrolled in the study. Median age was 59 with M;F ratio of 1:1.4 and 12% African-American. 30 patients had pancreatic cancer, 8 patients had ampullary cancer and 12 patients had gallbladder cancers. 30 patients completed all therapy. 4 patients withdrew the study due to non-medically related reasons. 7 patients had early disease recurrence. 6 patients withdrew consent due to side effects. 2 were taken off study after developing infection and 1 patient died of viral pneumonia leading into ARDS. Grade 3-4 Non-hematologic toxicities include diarrhea (12%), fatigue (4%), renal failure (2%), hepatic toxicity (4%). Grade 3-4 hematologic toxicities include neutropenia (30%), anemia (2%) and thrombocytopenia (10%). The median OS and DFS in pancreatic cancer is 17 and 9 months. The OS and DFS in ampullary cancer and gallbladder cancer is 27 and 14.4 months respectively. Conclusions: Adjuvant gemcitabine plus docetaxel followed by concurrent 5FU-CRT is feasible and tolerable. However, outcomes for pancreatic cancer patients appeared to be inferior compared to CONKO and RTOG studies. This regimen may be a reasonable adjuvant option for high risk biliary tract cancers. Clinical trial information: NCT00660699.

Molecular tumor profiling ordering trends in cancer patients.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 165-165
Author(s):  
Joseph D. Ma ◽  
Winnie S Wang ◽  
Warren Yau ◽  
Chelsea Hagmann ◽  
Carolyn Revta ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Primary Objective ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Palliative Care Consultation ◽  
The Difference ◽  
Diagnosis Date ◽  
Tumor Profiling

165 Background: Molecular tumor profiling may provide information as to whether to initiate or not initiate a targeted therapy. As to the timing of when the tumor profiling is ordered relative to date of diagnosis, date of death, and palliative care (PC) consultations are unknown. The primary objective of this study was to examine molecular tumor profiling ordering trends in the course of cancer illness. Methods: A preliminary, retrospective chart review was conducted in a cohort of patients with a confirmed diagnosis of cancer at an academic, NCI-designated comprehensive cancer center. Patients were identified from a tumor registry and then matched to a next generation sequencing molecular tumor profiling database. The date of palliative care consultation was collected from the electronic medical record. Differences in the date of when tumor profiling was ordered and date of diagnosis, date of PC consultation, and/or date of death were determined. Data were compiled into a single database and descriptive statistical analyses were performed. Results: A cohort of 397 (205 women) cancer patients was included. Metastatic disease was present in 108 (27.2%) patients, with mean±SD age of 58.7 ± 13.5 yrs. One-hundred and nine (27.6%) patients received a PC consultation (n=60 inpatient, n = 49 outpatient). As of February 2016, 119 (30%) patients died, with 58 (48.7%) out of 119 receiving a PC consultation. The difference between date of cancer diagnosis and date of tumor profiling ordered was 2467.4 ± 6865.7 days (n = 376), while the difference between date of tumor profiling ordered and date of death was 229.1 ± 185.7 days (n = 111). The difference between date of cancer diagnosis and date of death was 1507.5 ± 2002.1 days (n = 119). In patients were the tumor profiling was ordered before the PC consultation (n = 29), the difference between date of PC consultation and date tumor profiling ordered was 157.3 ± 258.1 days. In contrast, in patients were the tumor profiling was ordered after the PC consultation (n = 76), the difference was 194.6 ± 168 days. Conclusions: This analysis suggests that molecular tumor profiling is ordered at the end and not at the beginning of a cancer illness. PC consultations are not routinely performed in patients who participate in tumor profiling.

scholarly journals Effect of Comorbidity on Lung Cancer Diagnosis Timing and Mortality: A Nationwide Population-Based Cohort Study in Taiwan

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Shinechimeg Dima ◽  
Kun-Huang Chen ◽  
Kung-Jeng Wang ◽  
Kung-Min Wang ◽  
Nai-Chia Teng
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Population Based ◽  
Physician Visits ◽  
Lung Cancer Patients ◽  
Lung Cancer Diagnosis ◽  
Kaplan Meier ◽  
Diagnosis Of Lung Cancer

The effect of comorbidity on lung cancer patients’ survival has been widely reported. The aim of this study was to investigate the effects of comorbidity on the establishment of the diagnosis of lung cancer and survival in lung cancer patients in Taiwan by using a nationwide population-based study design. This study collected various comorbidity patients and analyzed data regarding the lung cancer diagnosis and survival during a 16-year follow-up period (1995–2010). In total, 101,776 lung cancer patients were included, comprising 44,770 with and 57,006 without comorbidity. The Kaplan–Meier analyses were used to compare overall survival between lung cancer patients with and without comorbidity. In our cohort, chronic bronchitis patients who developed lung cancer had the lowest overall survival in one (45%), five (28.6%), and ten years (26.2%) since lung cancer diagnosis. Among lung cancer patients with nonpulmonary comorbidities, patients with hypertension had the lowest overall survival in one (47.9%), five (30.5%), and ten (28.2%) years since lung cancer diagnosis. In 2010, patients with and without comorbidity had 14.86 and 9.31 clinical visits, respectively. Lung cancer patients with preexisting comorbidity had higher frequency of physician visits. The presence of comorbid conditions was associated with early diagnosis of lung cancer.

Intraperitoneal paclitaxel and cisplatin compared with dose-dense paclitaxel and carboplatin for patients with stage III ovarian cancer

2020 ◽  
Vol 26 (7) ◽  
pp. 1566-1574 ◽  
Author(s):  
Madison Murphy ◽  
Grace Martin ◽  
Zahra Mahmoudjafari ◽  
Cory Bivona ◽  
Dennis Grauer ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Final Analysis ◽  
Primary Objective ◽  
Stage Iii ◽  
Free Survival ◽  
Intraperitoneal Therapy ◽  
Dose Dense

Introduction Patients diagnosed with stage III ovarian cancer are at high risk of recurrence and optimal adjuvant therapy is often debated. There is limited literature that directly compares intraperitoneal paclitaxel and cisplatin with dose-dense paclitaxel and carboplatin. Objectives The primary objective was to compare progression-free survival, overall survival, and tolerability of adjuvant intraperitoneal paclitaxel and cisplatin to dose-dense paclitaxel and carboplatin in stage III ovarian cancer patients. Methods A retrospective, IRB-approved, single center chart review was conducted reviewing adult patients with stage III ovarian cancer undergoing adjuvant intraperitoneal therapy or dose-dense therapy between 2010 and 2018. Results Eighty-two patients were included in the final analysis; 44 in the intraperitoneal group and 38 in the dose-dense group. Intraperitoneal therapy was not associated with a longer progression-free survival (35.4 vs. 31.1 months; P = 0.97). The duration of overall survival did not differ between intraperitoneal and dose-dense (56.3 vs. 54.5 months; P = 0.55). Dose reductions were less frequent with intraperitoneal than dose-dense (11.36% vs. 31.58%; P = 0.02). No difference in treatment delays (45.5% vs. 65.8%; P = 0.07), dose cancellations (59.1% vs. 57.9%; P = 0.91), supportive care additions (95.5% vs. 84.2%; P = 0.09), or therapy discontinuation (59.1% vs. 39.5%; P = 0.07) between groups was noted. Conclusions Intraperitoneal therapy with paclitaxel and cisplatin, as compared with dose-dense paclitaxel and carboplatin, did not prolong progression-free or overall survival in the adjuvant setting among stage III ovarian cancer patients. A trend towards decreased tolerability was noted with intraperitoneal therapy.

Randomized phase III trial on niraparib-TSR-042 (dostarlimab) versus physician’s choice chemotherapy in recurrent ovarian, fallopian tube, or primary peritoneal cancer patients not candidate for platinum retreatment: NItCHE trial (MITO 33)

2021 ◽  
Vol 31 (10) ◽  
pp. 1369-1373
Author(s):  
Lucia Musacchio ◽  
Vanda Salutari ◽  
Sandro Pignata ◽  
Elena Braicu ◽  
David Cibula ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Recurrent Ovarian Cancer ◽  
Primary Objective ◽  
Phase Iii ◽  
Polymerase Inhibitors

BackgroundPlatinum-resistant ovarian cancer patients have a poor prognosis and few treatment options are available. Preclinical and clinical data demonstrated that the combination of poly-ADP ribose polymerase inhibitors with immune checkpoint inhibitors could have a synergistic antitumor activity in this setting of patients.Primary ObjectiveThe primary objective is to assess the efficacy of niraparib plus dostarlimab compared with chemotherapy in recurrent ovarian cancer patients not suitable for platinum treatment.Study HypothesisThis trial will assess the hypothesis that niraparib plus dostarlimab therapy is effective to increase overall survival, progression-free survival, and time to first subsequent therapy respect to chemotherapy alone, with an acceptable toxicity profile.Trial DesignThis is a phase III, multicenter trial, where recurrent ovarian cancer patients not eligible for platinum re-treatment will be randomized 1:1 to receive niraparib plus dostarlimab vs physician’s choice chemotherapy until disease progression, intolerable toxicity, or withdrawal of patient consent. The study will be performed according to European Network for Gynaecological Oncological Trial groups (ENGOT) model B and patients will be recruited from 40 sites across MITO, CEEGOG, GINECO, HeCOG, MANGO, and NOGGO groups.Major Inclusion/Exclusion criteriaEligible patients must have recurrent epithelial ovarian cancer not eligible for platinum retreatment. Patients who received previous treatment with poly-ADP ribose polymerase inhibitors and/or immune checkpoint inhibitors will be eligible. No more than two prior lines of treatment are allowed.Primary EndpointThe primary endpoint is overall survival defined as the time from the randomization to the date of death by any cause.Sample Size427 patients will be randomized.Estimated Dates for Completing Accrual and Presenting ResultsJune 2024Trial Registration NumberNCT04679064.

Cancer patients’ information needs in Nigeria.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19572-e19572
Author(s):  
Kenneth Chima Nwankwo ◽  
Emmanuel Ezeome
Keyword(s):  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Information Needs ◽  
Prognostic Information ◽  
Abnormal Growth ◽  
Diagnosis And Prognosis ◽  
Nigeria Teaching Hospital ◽  
Cancer Diagnosis And Prognosis ◽  
The Individual ◽  
The University

e19572 Background: The attitudes of Nigerian cancer patients on cancer diagnosis and prognosis were studied to ascertain what diagnostic and prognostic information were disclosed to them by their physicians, and what they wanted to know about their cancer diagnosis and prognosis. Methods: Structured questionnaires were administered on all consenting cancer patients that were managed at the University of Nigeria Teaching Hospital Enugu (UNTH-E) between July and October 2011. The data collected were analyzed with Statistical Package for Social Sciences (SPSS) software version 18. Results: Two hundred and forty four (244) patients participated in the study. While 95% of the participants wanted to know the nature of their diagnosis, only76.7% admitted to being informed of the diagnosis by their doctors. Nearly 54% of participants will like to be informed of a bad prognosis when death is imminent. The word “cancer” was used to disclose the diagnosis to 69.4% of the patients. Hundred and eight (44.3%) of the patients did not have any idea what “cancer” meant or did not know how to explain it while 39.8% knew it as a deadly, incurable or a painful disease and 8.6% described it as a tumour or abnormal growth. The nature of the disease was explained to 155(66.0%) of the patients among whom 114(76%) felt they received adequate or more than adequate explanation of their cancer to enable them undergo treatment. Patient factors that significantly improved the disclosure of diagnostic information were education (p=0.044) and site of the cancer (p=0.043). There was no statistically significant association between the desire for diagnostic and prognostic information and the patients’ age, gender, educational attainment or site of the cancer. Conclusions: Most of the surveyed cancer patients in Nigeria desire to know the truth about the diagnosis of their disease and more than 50% of them desire to know when the cancer stage becomes terminal and death imminent. Physicians in Nigeria should consider the information needs of the individual patients and satisfy them.

The Student Room Survey: Changes in the Post Graduate Study for Cardiothoracic Surgery

2020 ◽  
Vol 23 (2) ◽  
pp. 71-74
Author(s):  
Md Faizus Sazzad ◽  
Mohammed Moniruzzaman ◽  
Dewan Iftakher Raza Choudhury ◽  
Arif Ahmed Mohiuddin ◽  
Raafi Rahman ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Retrospective Analysis ◽  
Primary Objective ◽  
Graduate Study ◽  
Postgraduate Students ◽  
Depth Interview ◽  
Secondary Objective ◽  
Cardio Vascular ◽  
The University ◽  
Day By Day

Background: The number of postgraduate students in Cardiac surgical discipline is increasing day by day with incremental proportion are measurably suffering from the unnecessary lingering of the present course curriculum. The primary objective of this study was to find out the last 5 years’ of results of Masters in Surgery course under the University of Dhaka from a student room survey. A secondary objective was to find out positive changes that could show us the way of a step toward up-gradation. Methods: It is a retrospective analysis of all examination results of Cardio-vascular & Thoracic Surgery published since January 2008 to January 2013 from the University of Dhaka with in depth interview of 11 participants. Results: 85.24% students failed to pass part-I of Masters in Surgery for Cardio-vascular & Thoracic Surgery course while, 82.18% in part-II and 71.28% failed to pass the final part. Average 2.51 attempts needed to complete each part of the designed course resulted into lingering of course duration for 42.18 months/student. In the thoracic surgery discipline the number of students alarmingly reduced up to 0% in the recent academic sessions. Conclusions: Masters in Surgery is resulting in unnecessary prolongation of the course. We should step forward to meet the next generation challenge. Journal of Surgical Sciences (2019) Vol. 23(2): 71-74

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