Characteristics and outcomes of advanced cancer patients admitted to an acute palliative care unit (PCU) with severe dyspnea receiving high flow oxygen (HFO).

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 247-247 ◽  
Author(s):  
Marvin Omar Delgado-Guay ◽  
Alfredo Rodriguez-Nunez ◽  
Oluwatobi O Adegboyega ◽  
Amy Newton ◽  
Maria Gabriela Hernandez-Azmitia ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Median Time ◽  
Advanced Cancer ◽  
Hospital Death ◽  
Advanced Cancer Patients ◽  
Symptomatic Management ◽  
High Flow Oxygen ◽  
Significant Difference ◽  
Possible Cause

247 Background: Dyspnea is very complex and distressing symptom in patients with advanced cancer. The therapeutic goal of its symptomatic management is to relieve the patient’s breathlessness sensation. Limited literature has addressed the characteristics and clinical outcomes of advanced cancer patients with severe dyspnea receiving HFO admitted to PCU. Methods: We reviewed the records of 101 advanced cancer patients with dyspnea receiving HFO and 110 matched PCU inpatients with dyspnea receiving regular O2 flow (NoHFO) between January 1 to December 31, 2012. Demographics, frequency and intensity of symptoms at PCU admission and follow-up, and outcomes were recorded. Results: Median age: 60 years, range (51, 69). 56% were Male. White(71%), Hispanic(13%), African American(10%), Asian (4%). Primary cancer: Lung (27%), Gastrointestinal (19%), Hematological (18%), Breast (13%), Gynecological (6%). Dyspnea was present in all cases and it was related mainly to: lung involvement by cancer (53%), pneumonia (40%), Congestive Heart Failure (6%), COPD (8%). ECOG: 4. No significant difference in age, ethnicity and type of cancer, ECOG, and possible cause of dyspnea among both groups. HFO and NoHFO were started the same day of admission. Median ESAS symptoms (Interquartile range: IQR) for HFO was Pain 4.5 (2, 7) vs. 5 (3, 7) for NoHFO, p = 0.1423; fatigue [7(5, 8) vs. 7 (5, 8), p = 0.450]; depression [3 (1, 5) vs. 3.5 (2, 5), p = 0.81]; anxiety 7 (4, 9) vs. 6 (3, 8), p = 0.01; dyspnea [7.5( 6, 9) vs. 5 (3, 8), p < 0.0001]. Memorial Delirium Scale 5 (2, 15) vs. 7(2, 15), p = 0.77). Morphine Equivalent Daily Dose: 48 (36, 120) vs. 55 (30, 120), p = 0.72. The median difference among first and follow up ESAS was Pain 0 (-3, 1) vs. -1(-2, 1), p = 0.62; fatigue[(-2, 1) vs. 0 (-2, 0), p = 0.63]; depression [0 (-1, 1) vs. 0 (-1, 2), p = 0.93]; anxiety [0 (-2, 2) vs. 0 (-2, 2), p = 0.94; dyspnea [0( -1, 1) vs. -1 (-2, 1), p = 0.18]. Memorial Delirium Scale 0 (-1.5, 5.5) vs. 0 (-2, 3), p = 0.21).The median time (IQR) from HFO started to discharge was 10 days (6, 15) vs. 8.5 (5, 14) days for NoHFO, p = 0.07). The median time(IQR) from HFO started to Death was 10.5 (7, 19) vs. 13.5 (7, 26) days for NoHFO, p = 0.18. 77/101(76%) HFO patients vs. 56/110 (51%) NoHFO died at the hospital, p = 0.002. 24/101(23%) HFO patients were discharged alive weaned off HFO. The Odd ratio for hospital death in patients with HFO vs. NoHFO was 4.83 (95% CI: 1.72 – 13.59), p = 0.003. Conclusions: Severe dyspnea is significant at the end of life of advanced cancer patients. Patients with HFO require similar MEDD than NoHFO patients. Inpatient mortality is higher in patients with HFO. More research is needed.

Exploring the preferences for place of death among cancer patients and their family caregivers.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 40-40 ◽  
Author(s):  
Marieberta Vidal
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Place Of Death ◽  
Hospital Death ◽  
Advanced Cancer Patients ◽  
Home Death ◽  
Significant Difference ◽  
The Uk ◽  
At Home

40 Background: Understanding the preferred place of death (POD) for advanced cancer patients (Pts) is very important when they are approaching the end of life. Meeting the preferences of Pts is considered an important palliative care (PC) outcome. Prior studies reported that more than 80% of Pts with terminally ill cancer prefer to die at home. In many countries such as the UK, Italy, Greece, South Korea and Japan home deaths have been falling, but in some states of the US and Canada there are indications of a reversal of trends. Dying at home may be more difficult for Pts in severe physical and psychosocial distress, or when there are social or financial difficulties. The purpose of this study was to determine POD preference among PC Pts in the outpatient center (OC) and the palliative care unit (PCU). Methods: A sectional anonymous questionnaire was administered to advanced cancer Pts and caregivers (PCU patients and OC) between August 2012 and September 2014. PCU Pts responded when there was no delirium and the primary caregiver responded when the patient was unable to respond. In the case of outpatients dyads (patient and caregiver) were assessed. Results: Overall 141/216 (65%) preferred home death. PCU patients preferred home death less than outpatients. Patient and caregiver agreement regarding preferred place of death was 86% (p <0.001). The preferred POD was the same as one month ago for 82/99 (83%) PCU Pts and 111/116 (96%) outpatients, with significant difference between groups (p=0.002). Conclusions: Although home is the preferred POD in advanced cancer Pts, a substantial minority prefer hospital death or no difference. Patients admitted to the PCU have a higher preference for hospital death in comparison to the outpatients, likely reflecting more severe distress because they already tried home care. Pts and caregivers agree on POD in most cases. Personalized assessment of POD preference for both patient and caregiver is needed. [Table: see text]

scholarly journals Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months—a comparative study

2021 ◽  
Author(s):  
J. Frikkel ◽  
M. Beckmann ◽  
N. De Lazzari ◽  
M. Götte ◽  
S. Kasper ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Physical Functioning ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Psychological Conditions ◽  
Patient Reported

Abstract Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017

The Importance of a Home Care Program for Patients with Advanced Cancer Pain

1985 ◽  
Vol 71 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Vittorio Ventafridda ◽  
Marcello Tamburini ◽  
Silvana Selmi ◽  
Luigi Valera ◽  
Franco De Conno
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Care Program ◽  
Pain Clinic ◽  
Advanced Cancer Patients ◽  
Sample Group ◽  
Significant Difference ◽  
Quality Of Life Index

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

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.

Advanced cancer patients’ changes in terminal illness understanding (TIU) and their psychological well-being.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11617-11617
Author(s):  
Login S. George ◽  
Megan Johnson Shen ◽  
Paul K. Maciejewski ◽  
Andrew S. Epstein ◽  
Holly Gwen Prigerson
Keyword(s):  
Life Expectancy ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Psychological Symptoms ◽  
Treatment Decision ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Psychological Well Being ◽  
Change Scores

11617 Background: Although accurate TIU is necessary for informed treatment decision-making, clinicians worry that patients’ recognition of the terminal nature of their illness may lower psychological well-being. This study examines if such recognition is associated with lowered psychological well-being, that persists over time. Methods: Data came from 87 advanced cancer patients, with a life expectancy of less than 6 months. Patients were assessed pre and post an oncology visit to discuss cancer restaging scan results, and again one month later (follow-up). TIU was assessed at pre and post as the sum of four indicator variables — understanding of terminal nature of illness, curability, stage, and life-expectancy — and a TIU change score was computed (post minus pre). Psychological well-being (psychological symptoms subscale, McGill questionnaire) was assessed at pre, post, and follow-up, and two change scores were computed (post minus pre; follow-up minus post). Results: Changes toward more accurate TIU was associated with a corresponding decline in psychological well-being ( r = -0.33, p < .01), but thereafter was associated with subsequent improvements in psychological well-being ( r = .40, p < .001). This pattern persisted even after adjustment for relevant demographic factors, prognostic discussion, scan results, and physical well-being change. TIU change scores ranged from positive to negative, with some participants showing improvements in TIU ( n = 19), some showing decrements in TIU ( n = 14), and others showing stable TIU ( n = 54). Among patients with improved TIU, psychological well-being initially decreased, but subsequently recovered [7.03 (2.23) to 6.30 (1.80), to 7.63 (2.08)]; the stable TIU group showed relatively unchanged well-being [7.34 (2.37) to 7.45 (2.32), to 7.36 (2.66)], and the less accurate TIU group showed an initial improvement followed by a subsequent decline [6.30 (2.62) to 7.36 (2.04), to 5.63 (3.40)]. Conclusions: Improved TIU may be associated with initial decrements in psychological well-being, followed by patients rebounding to baseline levels. Concerns about psychological harm may not need to be a deterrent to having prognostic discussions with patients.

Digitally captured step counts for evaluating performance status in advanced cancer patients: A single cohort, prospective trial (Digi-STEPS).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS6651-TPS6651
Author(s):  
Gillian Gresham ◽  
Andrew Eugene Hendifar ◽  
Jun Gong ◽  
Arash Asher ◽  
Christine S. Walsh ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Advanced Cancer Patients ◽  
Step Counts ◽  
Wide Range ◽  
Ecog Ps ◽  
Single Cohort

TPS6651 Background: Advanced cancer patients undergo dynamic changes in their functionality and physical activity over the course of their treatment. Monitoring patient function is important because it can inform treatment decisions and allow for timely and appropriate intervention. Current scales that assess patient function, such as the ECOG Performance Status (PS), are limited in their ability to capture the wide range in activity that cancer patients can experience on a daily basis outside of the clinic setting. Given recent technological advances in wearable activity monitors, we can collect real-time, objective information about a patient’s daily activity including steps, stairs, heart rate, sleep, and activity intensity. Thus, the primary objective of this study is to determine whether longitudinal changes in objectively-assessed activity are associated with change in physician-rated ECOG PS. Methods: This is a prospective, single cohort trial being conducted at Cedars-Sinai Medical Center. Stage 3/4 cancer patients who are English or Spanish-speaking, ambulatory (assistive walking devices are allowed) and expected to be seen for treatment or follow-up with their oncologist at least every 8 weeks are eligible for study. Consenting patients will be asked to wear a Fitbit Charge HR continuously for 8 weeks during the study period and for one week prior to the 6 month and 1 year follow-up visits. Primary outcomes are change in average daily step counts and ECOG PS at 8 weeks from baseline. Secondary outcomes include: 1) Change in NIH PROMIS patient-reported outcomes (physical function, pain, sleep, emotional distress, and fatigue), 2) Change in frailty status at 8 weeks, 3) Occurrence of adverse events, and 4) 6-month and 1-year survival outcomes. Baseline assessments include a physical exam, medical history, and frailty assessment. The attending oncologist will rate the patient's ECOG PS at baseline and at the end-of-study visit. Weekly NIH PROMIS questionnaires will be administered online over the 8-week study and again at 6 months and 1 year follow-up. The occurrence of serious cancer-related adverse events, chemotherapy-associated toxicities, and hospitalizations will be documented up to 12 weeks from baseline. Survival will be assessed at 6 months and 1 year. Accrual is ongoing with 20 patients currently enrolled of a target sample size of 60 patients. Clinical trial information: NCT03757182.

scholarly journals Effect of Hemoglobin on the Prognosis of Patients with Advanced Cancer in Palliative Care Settings

2021 ◽  
Author(s):  
xinghe liao ◽  
Cihang Bao ◽  
Minghui Liu ◽  
Menglei Chen ◽  
Xiaoli Gu ◽  
...  
Keyword(s):  
Survival Time ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Median Survival ◽  
Median Survival Time ◽  
Palliative Treatment ◽  
Treatment Center ◽  
Cancer Center ◽  
Advanced Cancer Patients

Abstract Background: Hemoglobin is a prognostic factor for many cancer patients. However, its effect on the prognosis of patients with advanced cancer receiving palliative treatment is still unclear.Objective: The aim of this study was to assess whether hemoglobin can be used as a prognostic indicator for patients with advanced cancer receiving palliative treatment.Methods: From July 2013 to October 2015, 368 consecutive patients were treated in the palliative treatment center of the Shanghai Cancer Center of Fudan University. The data for 105 patients were extended in the follow-up. The cut-off value selected for hemoglobin was 100 g/L.Results: The median survival time of patients with low hemoglobin was shorter than that of patients with high hemoglobin (41 days vs. 84 days). In the follow-up readmission cohort (n = 105), the median survival time for patients with high hemoglobin (HHb → HHb) was 3.44 times longer than that of patients with low hemoglobin (HHb → LHb). Thus, both low hemoglobin and decreased hemoglobin were identified as independent prognostic factors for poor prognosis.Conclusions: In palliative treatment, hemoglobin can be used as a stratification factor to determine the prognosis of advanced cancer patients.

Perceptions of the working alliance among medical staff and cancer patients

2015 ◽  
Vol 14 (3) ◽  
pp. 199-203 ◽  
Author(s):  
Gil Bar-Sela ◽  
Inbal Mitnik ◽  
Doron Lulav-Grinwald
Keyword(s):  
Cancer Patients ◽  
Working Alliance ◽  
Advanced Cancer ◽  
Medical Staff ◽  
Medical Setting ◽  
Advanced Cancer Patients ◽  
Staff Members ◽  
Working Alliance Inventory ◽  
Significant Difference ◽  
Staff Interactions

ABSTRACTObjective:A working alliance (WA) is considered an essential factor in therapeutic relationships, relating to the mutual and interactive aspects of the relationship. In the medical setting, a WA has been found to be related to various positive outcomes; however, it has previously been investigated solely from the patient's perspective. The aim of the current study was to measure the concept from both sides of the patient–medical staff interaction.Method:Physicians, nurses, and advanced cancer patients completed the Working Alliance Inventory–Short Revised.Results:Some 32 physicians, 39 nurses, and 52 advanced cancer patients completed the study. Senior staff members rated the WA higher than trainees, both among physicians and nurses. Physicians and nurses rated the “bonds” subscale highest, while patients rated “goals” at the highest level. In addition, a significant difference was demonstrated between physicians and patients, with patients rating the WA higher.Conclusions:These preliminary findings demonstrate different perspectives among advanced cancer patients and medical staff interactions. Future studies should investigate the interactive aspects of the WA concept in the medical setting.Significance of results:Awareness of the working alliance in patient–staff interactions may improve the quality of treatment given to patients confronting cancer.

Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death

2021 ◽  
pp. 104990912110487
Author(s):  
Julia Fee Voon Ho ◽  
Nur Syafiqah Marzuki ◽  
Nur Syuhadah Monica Meseng ◽  
Viknaswary Kaneisan ◽  
Yin Khek Lum ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Place Of Death ◽  
Hospital Death ◽  
Advanced Cancer Patients ◽  
Home Death ◽  
Factors Associated ◽  
Symptom Prevalence

Objectives: Achievement of patients’ preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death. Methods: In this retrospective review of 287 patient deaths, we examined patients’ symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression. Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death. Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.

Early changes in lymphocyte/monocyte ratio on-treatment as a prognostic marker to predict overall survival in patients with advanced cancer treated with immune checkpoint inhibitors

2021 ◽  
Author(s):  
Sandip H. Patel ◽  
Songzhu Zhao ◽  
Mingjia Li ◽  
Lai Wei ◽  
Marium Husain ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Predictive Biomarker ◽  
Advanced Cancer Patients ◽  
High Baseline

Abstract Background A low absolute lymphocyte/monocyte ratio (LMR) in the peripheral blood is associated with poor prognosis in various cancers; however, its role as a predictive biomarker has not been well defined in the era of treatment with immune checkpoint inhibitors (ICI). Methods We queried a database of advanced cancer patients treated with at least one dose of ICI from 2011 to 2017 to study the association of LMR with overall survival (OS). We calculated LMR at baseline and a median of 21 days after the first cycle of ICI (on-treatment LMR), and defined low if < 2 and high if ≥ 2. OS was calculated from the initiation of ICI to date of death or censored at last follow-up. Results 1077 patients met the criteria for this study. Patients with low baseline LMR had a shorter median OS compared to patients with a high baseline LMR (8.5 vs 18.1 months, p < 0.01). In patients with a low baseline LMR, who on-treatment LMR increased to high had longer median OS compared to those whose on-treatment LMR remained low (16.8 vs 7.8 months, p < 0.001). Patients with a high baseline LMR and in whom on-treatment LMR remained high had longer median OS compared to patients with low on-treatment LMR (23.9 vs 9.2 months, p < 0.001). In multivariate analysis, high on-treatment LMR was most strongly associated with longer survival compared to low on-treatment LMR, regardless of baseline LMR. Conclusions Higher baseline and early changes in on-treatment LMR are associated with improved OS in cancer patients receiving ICI.

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