A combined treatment approach for cachexia and cancer-related anemia in advanced cancer patients: A randomized placebo-controlled trial.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 189-189 ◽  
Author(s):  
Clelia Madeddu ◽  
Giulia Gramignano ◽  
Luciana Tanca ◽  
Maria Cristina Cherchi ◽  
Carlo Aurelio Floris ◽  
...  
Keyword(s):  
Energy Metabolism ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Cancer Progression ◽  
Iron Metabolism ◽  
Combined Treatment ◽  
Advanced Cancer Patients ◽  
Tnf Α ◽  
Cancer Related Anemia ◽  
The Impact

189 Background: Cancer progression is characterized by specific energy metabolism alterations and by symptoms including fatigue, anorexia, nausea, depression, which results in cachexia syndrome and compromised quality of life (QL). This condition is often associated to anemia (cancer-related anemia, CRA), which negatively impacts patient QL and disease outcome. Methods: Adult advanced cancer patients with cachexia (i.e., weight loss > 5% in the previous 6 months) and CRA were randomly assigned (1:1 by computer generated list) to receive 3 months of a combined approach consisting of celecoxib (200 mg/day), L-carnitine (2 g/day), curcumin (Meriva) (4 g/day) and lactoferrin (200 mg/day) or placebo. The rationale for selecting these agents was: L-carnitine for modulating cell energy metabolism; celecoxib for counteracting inflammation, which is a key feature of cachexia; curcumin for its antiinflammatory and antioxidant action, without disregarding its action on the NF-kB and JAK-STAT pathway and the related synthesis of proinflammatory cytokines; lactoferrin for its ability to regulate iron metabolism in anemic cancer patients. Primary endpoints were improvement of lean body mass (LBM), appetite, fatigue and anemia. Additionally, we assessed the impact of treatment on the main metabolic/inflammatory and iron metabolism parameters: C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, leptin, reactive oxygen species (ROS), glutathione peroxidase, serum iron, ferritin, hepcidin and erythropoietin (EPO). Results: From January 2013 to March 2014, 66 patients have been enrolled. The combination arm was more effective than placebo arm in improving body weight, LBM, appetite, fatigue, and anemia. Among secondary parameters IL-6, TNF-α, CRP, ROS, ferritin, hepcidin and EPO decreased, while leptin increased significantly in the combination arm. No significant changes were observed in the placebo arm. Conclusions: To date a standard effective treatment of cancer cachexia is lacking. Our combined multitargeted approach was able to improve the nutritional and immunometabolic alterations of cachexia, ameliorate patient QL and correct CRA.

scholarly journals Dynamics of Neutrophils-to-Lymphocyte Ratio Predict Outcomes of PD-1/PD-L1 Blockade

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Michele Moschetta ◽  
Mario Uccello ◽  
Benjamin Kasenda ◽  
Gabriel Mak ◽  
Anissa McClelland ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Phase 1 ◽  
Prognostic Score ◽  
Single Agent ◽  
Significant Prognostic Factor ◽  
Advanced Cancer Patients ◽  
Lymphocyte Ratio ◽  
Phase 1 Trials ◽  
The Impact

Introduction. Baseline neutrophil-to-lymphocyte ratio (NLR) has been repeatedly reported as a significant prognostic factor in advanced cancer patients. We explored whether changes in NLR may predict outcome of advanced cancer patients enrolled into phase 1 trials and treated with PD-1/PD-L1 inhibitors. Patients and Methods. Advanced cancer patients enrolled into phase 1 trials between September 2013 and May 2016 and treated with anti-PD-1/PD-L1 agents were included in this retrospective study. NLR was calculated at baseline and after 2 cycles of treatment. Royal Marsden Hospital (RMH) prognostic score and Eastern Cooperative Group (ECOG) performance status (PS) were determined at baseline. Kaplan-Meier estimation and Cox regression analyses were used to assess the impact of NLR dynamics on PFS. Results. Among the 55 patients eligible, 26 (47%) were treated with anti-PD-L1 monotherapy, 22 (40%) received single agent anti-PD-1, and 7 (13%) were given a tyrosine kinase inhibitor (TKI) plus a PD-1 inhibitor. Neither ECOG PS nor RMH prognostic score was significantly associated with PFS in our cohort, whereas changes in NLR significantly impacted on PFS. Conclusion. Changes in the NLR may be a useful predicting factor in advanced cancer patients treated with anti-PD-1/PD-L1 agents. Further prospective trials are needed to verify these findings.

Impact of an outpatient interdisciplinary team (IDT) consultation on symptom clusters in advanced cancer patients seen at a supportive care outpatient clinic (OSC) in a tertiary cancer center

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20542-e20542
Author(s):  
S. Yennurajalingam ◽  
D. L. Urbauer ◽  
R. Chacko ◽  
D. Hui ◽  
Y. A. Amin ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Interdisciplinary Team ◽  
Well Being ◽  
Symptom Clusters ◽  
Advanced Cancer Patients ◽  
Edmonton Symptom Assessment Scale ◽  
Cluster Composition ◽  
The Impact

e20542 Background: Advanced cancer patients develop severe physical and psychosocial symptom clusters. There is limited data on the impact of an outpatient interdisciplinary team (IDT) consultation lead by palliative care specialists on symptom clusters. Cluster composition and consistence, response rate and predictors of response are unknown. Methods: 914 consecutive patients with advanced cancer presenting in the OSC from Jan 2003 to Oct 2008 with a complete Edmonton symptom assessment scale at the initial and follow-up visit (median 14 days, range 1–4 wks), and CAGE status (alcohol screening) were reviewed. Wilcoxon ranked sign test was used to determine whether symptoms changed over time. Principal components factor analysis with varimax rotation was used to determine clusters of symptoms at baseline and at follow-up. The number of factors calculated was determined based upon the number of eigen values that were greater than one. Results: Median age was 59 yrs, female were 46%. The most common primary cancer was Lung (19%). Baseline and follow-up visit scores (mean, SD) were: fatigue 5.7 (2.1) and 5.2 (2.2, p<0.0001), pain 4.9 (2.6) and 4.1 (2.6 p<0.0001), nausea 1.8 (2.4) and 1.7 (2.3, p=0.1), depression 2.6 (2.5) and 2.2(2.4,p<0.0001), anxiety 2.9 (2.7) and 2.4 (2.4, p<0.0001), drowsiness 3.2 (2.8) and 3.2 (2.6, p=0.7), dyspnea 2.6 (2.7) and 2.4 (2.6), p=0.0027), appetite 4.2(2.7) and 3.9 (2.7, p<0.0001), sleep 4.2 (2.6) and 3.8 (2.6, p<0.0001) and well being 4.3 (2.5) and 3.9 (2.3, p<0.0001). During the follow- up the symptom clusters varied from a 3 factor to a 2 factor model, reflecting the impact of the IDT on symptom burden. CAGE positive and CAGE negative patients had a significantly different symptom cluster model. Conclusions: Cluster composition differs when patients are assessed and managed by an IDT and among patients who screen positive for alcoholism. [Table: see text] No significant financial relationships to disclose.

Does coaching goals of care discussion skills make a difference?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6586-6586
Author(s):  
Nina A. Bickell ◽  
Kerin B. Adelson ◽  
Jason Parker Gonsky ◽  
Sofya Pintova ◽  
Benjamin Philip Levy ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Skills Training ◽  
Cancer Prognosis ◽  
Advanced Cancer Patients ◽  
Goals Of Care ◽  
Coaching Model ◽  
Model C ◽  
The Impact

6586 Background: Advanced cancer patients often have a poor understanding of their cancer prognosis. Goals of Care (GoC) discussions provide information about the cancer, its treatment & prognosis and elicit patient values. Little is known about the best ways to enhance patient understanding, clarify values and move GoC discussions earlier in the disease process. We report the effect of coaching oncologists on GoC discussions. Methods: We recruited oncologists & their advanced cancer patients with < 2 year prognosis to a RCT testing a coaching model communication skills training. Patients were surveyed after their post-imaging visit. We define GoC discussions as patient report that their doctor talked about their cancer prognosis and clarified things most important to them given their disease. Outcome variables assess the impact of GoC on patients’ knowledge on what to expect and clarity of values. Results: We enrolled 22/25 (88%) oncologists and 70% of eligible patients of whom 96 (55%) completed a survey. On average, doctors were 44 yrs old (32-66) and in practice 14.5 yrs (5-40). Patients’ mean age was 62 yrs (20-95), 40% females, 58% white, 24% Latino & 22 % black. Overall, 2/3 of patients reported their treatment’s goal was to cure their cancer; 14% reported cure to be unlikely. Patients felt more knowledgeable (79% vs 21%; p = 0.02) when their doctors discussed treatments, side effects & quality of life. When patients were asked about things important to them, they report being a bit clearer about their values (65% vs 35%; p = 0.16). Compared to controls, intervention patients felt more knowledgeable (78% v 63%; p = 0.17) but did not feel clearer about their values (60% v 54%; p = 0.59). Multivariate modeling found that poor health literacy (OR = 0.2; 95%CI: 0.07-0.82), having a GoC discussion (OR = 10.2; 1.7-63.1) and being in the intervention group (OR = 8.8; 1.4-55.2) significantly affected knowledge (model c = 0.88; p < 0.01). However, discussing what’s important to patients did not help patients feel clearer about their values (OR = 2.7; 0.6-12.2; model c = 0.82; p < 0.05). Conclusions: Using a coaching model to teach oncologists communication skills may improve patients’ understanding of what to expect with their cancer but does not impact their clarity of values. Clinical trial information: NCT02374255.

Modes of relating to contingency: An exploration of experiences in advanced cancer patients

2016 ◽  
Vol 15 (4) ◽  
pp. 444-453 ◽  
Author(s):  
Renske Kruizinga ◽  
Iris D. Hartog ◽  
Michael Scherer-Rath ◽  
Hans Schilderman ◽  
Hanneke Van Laarhoven
Keyword(s):  
Cancer Patients ◽  
Life Events ◽  
Advanced Cancer ◽  
Controlled Trial ◽  
Comparative Method ◽  
Real Life ◽  
Advanced Cancer Patients ◽  
Individual Care ◽  
Constant Comparative Method ◽  
The Impact

ABSTRACTObjective:Throughout their lives, people are confronted with unexpected life events, which can be difficult to incorporate into their life narratives. Such a confrontation can result in an experience of contingency. Different ways of relating to contingency have been described by Wuchterl: denying, acknowledging, and “encounter with the Other.” In the present article, we aim to trace these theoretical distinctions in real-life experiences of patients.Method:We analyzed 45 interviews using the constant comparative method with a directed content analysis approach in the Atlas.ti coding program. The interviews originated from a randomized controlled trial evaluating an assisted reflection on life events and ultimate life goals. Seven spiritual counselors from six hospitals in the Netherlands conducted the interviews from July of 2014 to March of 2016. All 45 patients had advanced cancer.Results:We found four different modes into which relating to contingency can be classified: denying, acknowledging, accepting, and receiving. With denying, patients did not mention any impact of the life event on their lives. In acknowledging, the impact was recognized and a start was made to incorporate the event into their life. In accepting, patients went through a process of reinterpretation of the event. In receiving, patients talked about receiving insights from their illness and living a more conscious life.Significance of results:Our study is the first to investigate the different ways of relating to contingency in clinical practice. The defined modes will improve our understanding of the various ways in which cancer patients relate to their disease, allowing caregivers to better target and shape individual care.

The impact of home palliative care on symptoms in advanced cancer patients

2000 ◽  
Vol 8 (4) ◽  
pp. 307-310 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Fabio Fulfaro ◽  
Alessandra Casuccio
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients ◽  
The Impact

Multidisciplinary tumor board for improvement of oncology collaboration in advanced cancer patients.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 175-175
Author(s):  
Sanders Chang ◽  
Amish Doshi ◽  
Cardinale B. Smith ◽  
Bethann Scarborough ◽  
Stelian Serban ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Tumor Board ◽  
Cancer Site ◽  
Primary Cancer ◽  
Advanced Cancer Patients ◽  
Primary Cancer Site ◽  
Supportive Oncology ◽  
The Impact

175 Background: The Palliative and Supportive Oncology Tumor Board was developed in 2015 to provide an interdisciplinary forum for discussion and management of patients with complex or refractory symptoms from advanced cancer. The board meets monthly and consists of medical, surgical, and radiation oncologists, interventional radiologists, pain management, palliative care specialists, residents, and fellows. Here, we assess the impact of the tumor board on the care of these patients. Methods: Electronic records of advanced cancer patients discussed at the tumor board from January 2015 to December 2015 were analyzed. We extracted data regarding sociodemographics, primary cancer site, pain interventions delivered, palliative care services utilized, and readmissions. Results: Thirty-two patients were presented at the tumor board over twelve months. The median age was 60 years (range 26-89); 47% were male. Primary cancer site included multiple myeloma (n = 11), gastrointestinal (n = 9), genitourinary (n = 5), breast (n = 2), lung (n = 2), skin (n = 1), and unknown origin (n = 2). At the time of discussion, 16 patients were hospitalized and 18 were in the ambulatory setting. Recommendations from the tumor board included altering medication regimen (n = 4), discussing eligibility to receive an anesthetic block (n = 7), undergoing vertebroplasty (n = 9), and planning palliative radiation treatment (n = 19). Patients were seen by specialists from pain (n = 21), interventional radiology (n = 14), neurosurgery (n = 9), palliative care (n = 20), radiation oncology (n = 21), or medical oncology (n= 32) within one day of their case presentation at the tumor board. Seven patients were transferred to the inpatient palliative care unit within a day of their tumor board discussion. Five patients were readmitted to the hospital within 30 days due to uncontrolled pain or other symptoms. Conclusions: The palliative and supportive oncology tumor board was well received by clinicians overall. It fostered interdisciplinary collaboration and supported comprehensive management of pain and other symptoms, as evidenced by the mix of cases discussed and the short time within which patients were seen after presentation by the participating specialists.

Does oncologist productivity impact goals of care discussions?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21675-e21675
Author(s):  
Sofya Pintova ◽  
Cardinale B. Smith ◽  
Kerin B. Adelson ◽  
Jason Parker Gonsky ◽  
Natalia Egorova ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Skills Training ◽  
Study Patient ◽  
Advanced Cancer Patients ◽  
High Quality ◽  
Goals Of Care ◽  
Imaging Results ◽  
Time Required ◽  
The Impact

e21675 Background: Oncologists are pressed to care for higher volumes of advanced cancer patients. Interviews with oncologists revealed their concern that goals of care (GoC) discussions take time. We studied the impact of oncologists’ productivity on their conduct of meaningful GOC discussions with patients. Methods: At academic, municipal and rural hospitals, we recruited & randomized solid tumor oncologists & their newly diagnosed advanced cancer patients with <2 year prognosis to participate in a RCT testing a coaching model of communication skills training. All oncologists were encouraged to have GoC discussions at the visit after imaging to restage. Patients are surveyed after that post-imaging visit. We define GoC discussions as patient report that their doctor talked about preferences for cancer treatment and clarified things most important to them given their illness. We measure quality of GoC discussions by patients’ rating. Productivity was measured by work revenue value units (wRVUs) per hour for the day each oncologist saw the study patient post-imaging. Results: We enrolled 22/25 oncologists (88%); to date 77 patients completed surveys. Productivity did not vary significantly by hospital though oncologists generated greater wRVUs at the municipal hospital (p=0.2203). Overall, 36% of patients report having a high quality GoC discussion. There was no significant relationship between level of productivity and conduct of high quality GoC discussion. Multivariate model controlling for hospital and intervention found no relationship between productivity and conduct of high quality GoC discussion. Conclusions: Despite concerns about the time required to conduct GoC discussions, we found that productivity did not affect oncologists’ ability to conduct high quality GoC discussions nor did conduct of a GoC reduce productivity. The prevalence of high quality GoC discussions was low. [Table: see text]

Relationships between distress and sleep in advanced cancer patients and spouse caregivers.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 195-195
Author(s):  
Maija Reblin ◽  
Brian Gonzalez ◽  
Richard E Heyman ◽  
Lee Ellington ◽  
Susan Thomas Vadaparampil
Keyword(s):  
Psychological Distress ◽  
Sleep Disturbance ◽  
Cancer Patients ◽  
Sleep Duration ◽  
Advanced Cancer ◽  
Anxiety And Depression ◽  
Advanced Cancer Patients ◽  
Longitudinal Effects ◽  
Spouse Caregivers ◽  
The Impact

195 Background: Sleep disturbance is a common problem among individuals with advanced cancer. Distress and sleep disturbance are highly interdependent in spouses. Little research has examined dyadic effects of psychological distress on sleep in patient-caregiver spouses, most of whom sleep together. The goal of this study was to determine how anxiety and depression impact one’s own sleep and partner’s sleep in advanced cancer patients and their spouse caregivers. Methods: As part of a larger study, 86 advanced cancer patients and their spouse caregivers completed surveys on demographics and self-reported health, including sleep duration, and the HADS measure of anxiety and depression. A path analysis was conducted to determine the impact of patient and caregiver anxiety and depression on their own and their partner’s sleep. Results: The majority of dyads were white (n = 79) and all were heterosexual. The patient was female in 25 couples. The average age for patients was 67 and 65 for caregivers; couples had been together an average of 35 years. Patients reported sleeping 7.2 hours/night (SD = 1.7) and caregivers reported sleeping 6.72 hours/night (SD = 1.3). Patient and caregiver sleep was significantly correlated (r = .42, p < .01). Controlling for age, sex, and general health, one’s own anxiety was negatively associated with one’s own sleep duration (patient B = -.12, p = .04; caregiver B = -.13, p < .01), but patients’ anxiety was not associated with caregivers’ sleep duration or vice versa. Individuals’ depression was not associated with their own sleep duration, but patient depression was positively associated with caregiver sleep duration (B = .10, p = .05). Conclusions: This is one of the first dyadic explorations of psychological distress and sleep duration in advanced cancer patients and spouse caregivers. The increase in the caregivers’ reported sleep duration associated with patient depression may be an early indicator of caregiver depression. These findings strongly support further research of the dyadic effects of distress on sleep to identify longitudinal effects on holistic sleep outcomes for spouses coping with cancer.

Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer

2021 ◽  
pp. 104990912098680
Author(s):  
Paige E. Sheridan ◽  
Wendi G. LeBrett ◽  
Daniel P. Triplett ◽  
Eric J. Roeland ◽  
Andrew R. Bruggeman ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Healthcare Expenditure ◽  
Advanced Cancer Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: There is inconsistent evidence that palliative care intervention decreases total healthcare expenditure at end-of-life for oncology patients. This inconsistent evidence may result from small sample sizes at single institution studies and disparate characterization of costs across studies. Comprehensive studies in population-based datasets are needed to fully understand the impact of palliative care on total healthcare costs. This study analyzed the impact of palliative care on total healthcare costs in a nationally representative sample of advanced cancer patients. Methods: We conducted a matched cohort study among Medicare patients with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation on factors related to both the receipt of palliative care and end of life costs. We compared direct costs between matched patients to determine the per-patient economic impact of a palliative care consultation. Results: Patients who received a palliative care consultation experienced an average per patient cost of $5,834 compared to $7,784 for usual care patients (25% decrease; p < 0.0001). Palliative care consultation within 7 days of death decreased healthcare costs by $451, while palliative care consultation more than 4 weeks from death decreased costs by $4,643. Conclusion: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditure among advanced cancer patients. Earlier palliative care consultation results in greater cost reductions than consultation in the last week of life.

Sign in / Sign up

Export Citation Format

Share Document