Advance directives: Cancer patients’ preferences and family-based decision making.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 18-18
Author(s):  
Xing Li ◽  
Zhi-Huan Lin ◽  
Ying-Fen Hong ◽  
Xiao-kun Ma ◽  
Dong-hao Wu ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Advance Directives ◽  
Correlational Analysis ◽  
Invasive Treatment ◽  
Medical Decisions ◽  
Anti Cancer ◽  
Family Based ◽  
Chinese Cancer Patients

18 Background: Advance directives (ADs) are a sensitive issue among traditional Chinese people, who usually refrain from mentioning this topic until it is imperative. Medical decisions for cancer patients are made by their families, which might violate patients’ personal will. This study was aimed to examine the acceptance of ADs among Chinese cancer patients and their families and patient participation in this procedure. Finally, to analyze the moral risk involved. Methods: Participants included 412 adult cancer patients from 9 leading hospitals across China. An AD was introduced to the main decision makers for each patient; if they wished to sign it, the AD would be systematically discussed. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between families and patients, patients’ awareness of their disease, and participation in an AD. Results: A total of 246 patients and their family members rejected systematic discussion of AD, the majority (95.5%) of whom were under anti-cancer treatment. An additional 166 patients or their families accepted the concept of an AD and signed an AD to give up invasive treatment. This decision was make shortly after termination of anti-cancer therapy. Correlational analysis revealed that patients living in villages and who were subordinate members in their families tended to accept an AD. Of these, only 24 patients participated in the decision making. Correlational analysis revealed that patients with a better financial situation, living in cities, and superordinate status in their families tended to participate in the AD discussion, as well as those who usually made medical decisions themselves. Nearly all the patients deciding their own AD knew their entire situation, including diagnosis and prognosis. For 101 patients, anti-cancer therapy was ended prematurely, with as many as 37 patients not told about their potential loss of health interests. Conclusions: ADs were widely accepted among Chinese cancer patients when anti-cancer therapy was terminated. Most cancer patients were excluded from the discussion of an AD. Thus, AD could be formally introduced to the family of Chinese cancer patients after termination of anti-cancer therapy.

scholarly journals Advance directives: cancer patients' preferences and family-based decision making

Oncotarget ◽  
2017 ◽  
Vol 8 (28) ◽  
pp. 45391-45398 ◽  
Author(s):  
Yan-Fang Xing ◽  
Jin-Xiang Lin ◽  
Xing Li ◽  
Qu Lin ◽  
Xiao-Kun Ma ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Advance Directives ◽  
Family Based

Medical Information, Decision-Making and Use of Advance Directives by Chinese Cancer Patients in Hong Kong

2016 ◽  
Vol 8 (2) ◽  
pp. 109-133 ◽  
Author(s):  
Edwin C. Hui ◽  
Rico K. Liu ◽  
Ashley C. Cheng ◽  
Enoch Hsu ◽  
Dorian Wu
Keyword(s):  
Decision Making ◽  
Hong Kong ◽  
Cancer Patients ◽  
Advance Directives ◽  
Medical Information ◽  
Chinese Cancer Patients

scholarly journals Immune Responses to COVID-19 mRNA Vaccines in Patients with Solid Tumors on Active, Immunosuppressive Cancer Therapy

2021 ◽  
Author(s):  
Rachna T Shroff ◽  
Pavani Chalasani ◽  
Ran Wei ◽  
Daniel Pennington ◽  
Grace Quirk ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Immune Responses ◽  
Cancer Patients ◽  
Neutralizing Antibodies ◽  
Fold Increase ◽  
Control Cohort ◽  
Tumor Patients ◽  
Specific Memory ◽  
Anti Cancer ◽  
B Cell Subsets

Vaccines against SARS-CoV-2 have shown high efficacy, but immunocompromised participants were excluded from controlled clinical trials. We evaluated immune responses to the Pfizer/BioNTech mRNA vaccine in solid tumor patients (n=52) on active cytotoxic anti-cancer therapy. These responses were compared to a control cohort that also received the Pfizer/BioNTech vaccine (n=50). Using live SARS-CoV-2 assays, neutralizing antibodies were detected in 67% and 80% of cancer patients after the first and second immunizations, respectively, with a 3-fold increase in median titers after the booster. Similar trends were observed in serum antibodies against the receptor-binding domain (RBD) and S2 regions of Spike protein, and in IFN𝛾+ Spike-specific T cells. The magnitude of each of these responses was diminished relative to the control cohort. We therefore quantified RBD- and Spike S1-specific memory B cell subsets as predictors of anamnestic responses to viral exposures or additional immunizations. After the second vaccination, Spike-specific plasma cell-biased memory B cells were observed in most cancer patients at levels similar to those of the control cohort after the first immunization. These data suggest that a third immunization might elevate antibody responses in cancer patients to levels seen in healthy individuals after the second dose. Trials should be conducted to test these predictions.

Important Legal Concerns Faced by Informal Cancer Caregivers

2019 ◽  
pp. 307-323
Author(s):  
Debra Wolf ◽  
Cristina Pejoves Gorman
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Advance Directives ◽  
Informal Caregivers ◽  
Job Security ◽  
Family Conflicts ◽  
Cancer Caregivers ◽  
Financial Challenges

This chapter examines various laws that may affect cancer caregivers. Informal caregivers, whether family or friends, often face emotional and financial challenges when taking on caregiving responsibilities for their loved ones. Common concerns may include job security and the financial implications of time off, as well as family conflicts regarding caregiving decisions. As a result, caregivers may experience an increase in stress and obstacles that can interfere with their ability to carry out caregiving responsibilities. This chapter reviews the laws that may be of interest to informal cancer caregivers, including legal protections for caregivers who may need to take time off from work and possible avenues for compensation. The chapter also explores the role that caregivers play in healthcare and other decision-making and the importance of advance directives for cancer patients.

scholarly journals Do checkpoint inhibitors compromise the cancer patients’ immunity and increase the vulnerability to COVID-19 infection?

Immunotherapy ◽  
2020 ◽  
Author(s):  
Joseph Kattan ◽  
Clarisse Kattan ◽  
Tarek Assi
Keyword(s):  
Cancer Therapy ◽  
Severe Acute Respiratory Syndrome ◽  
Cancer Patients ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Survival Outcomes ◽  
Toxicity Profile ◽  
Anti Cancer ◽  
Acquired Immunodeficiency ◽  
Improvement In Survival

The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has been declared a pandemic by the WHO that claimed the lives of thousands of people within a few months. Cancer patients represent a vulnerable population due to the acquired immunodeficiency associated with anti-cancer therapy. Immune checkpoint inhibitors have largely impacted the prognosis of a multitude of malignancies with significant improvement in survival outcomes and a different, tolerable toxicity profile. In this paper, we assess the safety of ICI administration in cancer patients during the coronavirus pandemic in order to guide the usage of these highly efficacious agents.

Monitoring oral anti-cancer therapy adherence in cancer patients using web based application guided communication compared with nurse counseling in a community cancer center.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 88-88
Author(s):  
Milana V. Dolezal ◽  
Vivian Leong ◽  
Rajesh Behl
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Effective Communication ◽  
Smart Device ◽  
Cancer Center ◽  
Free Text ◽  
Communication Tools ◽  
Web Based ◽  
Electronic Alerts ◽  
Anti Cancer

88 Background: Smart phone web based applications (apps) can be effective communication tools for monitoring compliance and increasing adherence to oral anti-cancer therapy in the outpatient setting. Methods: Cancer patients age 18-90 treated with various oral anti-cancer therapies were recruited to this prospective, 3 month observational trial at our large community cancer center to determine feasibility of using an app for oral anti-cancer therapy compliance. Enrolled patients are randomized to either Arm 1 App arm and nurse counseling or Arm 2 nurse counseling only. The free apps MyMeds and Medisafe incorporate medication reminders and record doses. Patients complete the validated RAND 36- item quality of life (QOL) questionnaire and a free text feedback. Results: 91 patients were screened between 11/2015 to 9/2016 (45 declined enrollment due to various factors). 46 patients were randomized with 25 to Arm 1 and 21 to Arm 2. Demographics included 10 men (various tumor types but mostly multiple myeloma) and 36 women; 22 with breast cancer. MyMeds app lacked the necessary real-time communication so patients were switched to the MediSafe app which features email alerts. 15 patients have completed the study through Month 3. Four patients on Arm 1 missing their monthly visit or were non-compliant with the app. 23 patients remain active in the study. Differences are a higher QOL score in Arm 1 vs Arm 2 in measured domains of Energy/Fatigue (56% in Arm 1 compared to 44% for Arm 2) and Pain (72% in Arm 1 compared to 58% in Arm 2). Patients randomized to the app found the electronic alerts very helpful. Conclusions: Our limited pilot study demonstrated the potential of smart device apps as effective communication tools for improving patients’ adherence to oral anti-cancer therapy and QOL. Ultimately, convenient ways to monitor patients’ compliance with anti-cancer therapy will impact survival and facilitate provider-patient communication.

scholarly journals Anti-Mullerian hormone levels in female cancer patients of reproductive age in Indonesia: A cross-sectional study

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 159
Author(s):  
Achmad Kemal Harzif ◽  
Budi Wiweko ◽  
Putri Addina ◽  
Kartika Iswaranti ◽  
Melisa Silvia ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Reproductive Function ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Cancer Treatments ◽  
Cross Sectional ◽  
Cancer Group ◽  
Anti Cancer ◽  
Female Cancer Patients

Background: Efforts in reproductive preservation for cancer patients have become one of the important aspects of cancer management. In fact, decline in reproductive function is known to occur after exposure to anti-cancer treatments. Measuring anti-Müllerian hormone (AMH) levels is known to be the best parameter in predicting ovarian reserves, which indicates reproductive function. In total, 68% of cancer survivors of reproductive age who underwent anti-cancer treatments suffer from infertility. Meanwhile, ovarian reserves also decrease with increasing age. There is ongoing debate on whether the ovarian reserves of cancer patients could be reduced long before exposure to anti-cancer therapy. Therefore, it is important to know whether ovarian reserves in cancer patients decrease before or after anti-cancer therapy. This can help predict the reproductive function in such cases and the effectiveness of ovarian preservation efforts. Methods: A cross-sectional study was conducted, comparing the AMH levels of 44 female cancer patients of reproductive age before cancer therapy, to 44 non-cancer patients of reproductive age (age matched). The biological ages from both groups were adjusted using the Indonesian Kalkulator of Oocytes. Results: The median age in both groups was 28 years old. The AMH levels in the cancer group were found to be significantly lower in contrast to those in the non-cancer group (1.11 [0.08-4.65] ng/ml vs. 3.99 [1.19- 8.7]; p- value <0.001). Therefore, the biological age in the cancer group was 10 years older than that of the non-cancer group, indicating that ovarian aging occurs earlier in cancer patients. Conclusions: AMH levels of cancer patients of reproductive age were already reduced before cancer therapy, given an older biological age, in contrast to that of the non-cancer patients. Proper counseling and implementation of fertility-preserving methods is highly recommended in this group of patients.

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