Inpatient chemotherapy for patients with advanced solid tumors: A single-center observational study.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 158-158
Author(s):  
Tara Soumerai ◽  
Matthew Lei ◽  
Therese Marie Mulvey
Keyword(s):  
Solid Tumors ◽  
Solid Tumor ◽  
Readmission Rate ◽  
Stage Iv ◽  
Free Survival ◽  
Patient Demographics ◽  
Chemotherapy Administration ◽  
Standards Of Practice ◽  
Stage Iv Cancer ◽  
Single Center Observational Study

158 Background: We sought to identify a population of patients with advanced-stage solid tumor diagnoses for whom inpatient chemotherapy is appropriate. In so doing, we endeavor to define standards of practice in addressing prognostic awareness and goals of therapy prior to treatment. Methods: We identified 124 patients with Stage IV solid tumors who were given at least one dose of inpatient chemotherapy in 2019. We performed manual chart review to collect information on patient demographics, details of cancer diagnosis and chemotherapy regimen, and dates of admission, chemotherapy administration, discharge, readmission, and death. Results: Ninety-four percent of patients studied were admitted for cancer-related reasons. The 30-day mortality for patients with Stage IV cancer given inpatient chemotherapy was 20.2%, including 12 patients (9.7%) who died during the same admission. The 30-day readmission rate was 40.2%. Median overall survival and readmission-free survival were both 15 days (range, 3-510 and 3-642, respectively). Among patients who died within 30 days, 18.2% (4/22) had a serious illness conversation documented prior to chemotherapy administration. Conclusions: This study demonstrates that there is a high mortality and readmission rate among patients with advanced solid tumor malignancies who receive inpatient chemotherapy. Standardizing the expectation of informed consent and/or goals of care discussion prior to treatment is necessary. This may prevent administration of futile chemotherapy to patients requiring hospitalization for advanced cancer.

Same Day Dosing of Pegfilgrastim in Elderly Patients Receiving Fractionated Dose Chemotherapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2215-2215
Author(s):  
Larry Y. Watt ◽  
Istvan Redei ◽  
Robert D. Levin ◽  
Joel Granick ◽  
Rakhshanda Neelam ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Statistical Significance ◽  
Stage Iv ◽  
Severe Neutropenia ◽  
Control Group ◽  
P Value ◽  
Concurrent Administration ◽  
Patient Demographics ◽  
Stage Iv Cancer ◽  
Age Range

Abstract Background: We have previously reported that same day dosing (SDD) of pegfilgrastim (PG) did not result in an increased incidence of negative outcomes as compared to filgrastim (G) administered the next day. (Watt et al. Pharmacotherapy. 2003;23:406. #105). Age (≥ 65 years) is known to be a risk factor for febrile neutropenia in patients undergoing myelosuppressive chemotherapy. Purpose/Methods: This study aims to assess the efficacy and safety of SDD of PG among older cancer patients for severity of neutropenia (grade 4), infection/neutropenia- related hospitalization, incidence of delayed administration (or dose reduction) of chemotherapy or any unplanned MD visits due to leukopenia (table). G administered subsequent to chemotherapy served as the control group. Patients ≥ 65 years with solid tumors who received fractionated dose chemotherapy at our institution between January 2001 and March 2004 were reviewed retrospectively. Patients who received chemotherapy initially at substandard doses were excluded. Results: Patient demographics indicated that the two groups were evenly matched, with similar mean baseline absolute neutropenic counts (ANC). Distribution of cancer diagnoses is as follows: PG: breast (7), lung (8), GI (18) and others (2); G: breast (5), lung (9), GI (7) and others (4). Twenty-six (87%) and 21 (84%) patients had stage IV cancer in the PG and G groups, respectively. The mean ANC nadirs for PG and G were 2790±2190 cells/mm³ and 1820±1930 cells/mm³, respectively (p=0.01). For the outcome endpoints, although certain trends seemed to favor SDD of PG, none of the odd ratios (OR) performed reached statistical significance. Doses of PG and G were generally well-tolerated by all patients. Conclusion: Concurrent administration of PG showed safety and efficacy at least comparable to G in elderly patients receiving fractionated dose chemotherapy. Such administration schedule has the potential to further simplify the outpatient management of chemotherapy-induced neutropenia, providing the needed convenience for elderly patients as well as caregivers. However, further prospective study is warranted. PG G p-value; OR (95% CI) data were analyzed based on cycles No. patients 30 25 No. cycles 59 54 Age (range) 68.8 (65–79) 68.3 (65–72) Gender (female) 18 (60%) 15 (60%) ANC before chemo±SD(cells/mm³) 4530±1850 4790±2600 p=0.539 ANC nadir±SD (cells/mm³) 2790±2190 1820±1930 p=0.01 Severe Neutropenia (grade IV) 9 (15%) 15 (28%) OR=0.47; (0.19, 1.18) Unplanned MD visit 7 (12%) 3 (5.6%) OR=2.28; (0.56, 9.34) Chemo delayed/dose reduced 9 (15%) 11 (20%) OR=0.70; (0.27, 1.86) Hospitalization 7 (12%) 5 (9.3%) OR=1.32; (0.39, 4.44)

Interaction between route of intra-CSF chemotherapy administration and efficacy of therapy in patients wtih neoplastic meningitis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1530-1530 ◽  
Author(s):  
M. J. Glantz ◽  
M. C. Chamberlain ◽  
T. Batchelor ◽  
W. Eric ◽  
F. Cavalli ◽  
...  
Keyword(s):  
Sustained Release ◽  
Solid Tumor ◽  
Progression Free Survival ◽  
Intraventricular Administration ◽  
Tumor Patients ◽  
Acute Leukemias ◽  
Free Survival ◽  
Chemotherapy Administration ◽  
Significant Difference ◽  
And Control

1530 Background: NM is a devastating complication of solid tumor and hematologic malignancies. Although controversial, the current standard of care for patients with this disease includes intra-CSF chemotherapy. The importance of route of chemotherapy administration, however, remains controversial. Methods: 124 patients with NM from solid tumors (100 patients) or lymphoma (24 patients) were randomized to receive either sustained-release cytarabine—the study arm; or conventional intra-CSF chemotherapy (methotrexate for solid tumor patients; non-sustained-release cytarabine for lymphoma patients)—the control arm. The route of administration (lumbar vs. ventricular) was not specified. Results: Patients in the study and control arms were well-balanced for factors of known prognostic importance, including age, KPS, and extent of systemic tumor. Progression-free survival was identical between the study and control treatment arms for all patients (35 vs. 43 days, p = 0.73), for solid tumor patients alone (35 vs. 37.5 days, p = 0.79), and for lymphoma patients alone (34 vs. 50 days, p = 0.82). When outcome was examined in solid tumor patients as a function of route of chemotherapy administration, there was no difference in progression-free survival for patients treated with DepoCyt by the ventricular vs. lumbar routes (29 vs. 43 days, p = 0.35). For patients treated with methotrexate, there was a statistically significant difference favoring patients receiving intraventricular therapy (43 vs. 19 days, p = 0.048). Conclusions: Both the pharmacokinetic profile of the intra-CSF chemotherapeutic agent and the site of administration influence the outcome of patients treated for NM. Intraventricular administration, or the use of sustained-release chemotherapeutic agents if the lumbar route is used, appears to be critical to the success of treatment. The implications of this finding may also extend to patients (e.g. those with acute leukemias, high-risk NHL, or her2/neu-positive breast cancer) receiving prophylactic intra-CSF chemotherapy since, in the prophylactic setting, intra-lumbar chemotherapy administration is almost always employed. [Table: see text]

scholarly journals Impact of High Cost Anticancer Drugs´ Indications Throughout Time in Noncurative Advanced (Stage IV) Cancer Patients With Solid Tumors

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 85s-85s
Author(s):  
J. Lacava ◽  
V. Geist ◽  
D. Ortiz
Keyword(s):  
Health Care ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Anticancer Drugs ◽  
Health Care Systems ◽  
Significant Proportion ◽  
Stage Iv ◽  
Standard Of Care ◽  
Advanced Stage ◽  
Stage Iv Cancer

Background: Most high cost anticancer drugs (HCAD) are indicated in noncurative advanced (stage IV) cancer patients (NCP) for palliative reasons with variable impacts on quality of life and survival. HCAD challenge health care systems because of their high prices specially in nonhigh income countries. Aim: To evaluate the proportional impact (HDCA indications/overall survival) in NCP throughout years. To analyze causes of HDCA discontinuation. To calculate time elapsed from end of HCDA treatment to end of life (ETEL index). Methods: We reviewed charts of 268 NCP treated in a Patagonian cancer institution between 2009 to 2017 with an HCDA (either alone or in combinations) according to standard of care. Mean age was 58 y (26-84), sex (m/f) 126/142, primary tumor: GI 106 (40%), GU 27 (10%), GYN 20 (7%), BR 58 (22%), LG 43 (16%), others 14 (5%). 29 different HCAD were indicated in 402 treatments (small targets therapies 35%, Moabs 60%, others 5%): 1st line 268 (100%), 2nd line 89 (33%), 3rd line 34 (13%), thereafter 11 (4%). Results: Median OS for the entire population was 26 m (1-120), while it was: GI 20 m, GU 28 m, GYN 27 m, BR 47 m, LG 18 m, Others 21 m. Proportion of OS with HCAD indications: 50% (1-100) in the whole population, while it was: GI 49% (25-100), GU 62% (5-100), GYN 39% (6-93), BR 50% (3-100), LU 45% (6-93), others 61% (25-100). HDAC indications increased over time: 26% (2009-11), 33% (2012-14), 40% (2015-17), with a more than 2% of new NCP increment per year. Additionally proportion (HCAD/OS) was: 43% (2009-11), 47% (2012-14), 52% (2015-17). Median time of HCAD according to line of therapy was: 1st line 6 m, 2nd line 4 m, 3rd line 6 m, 4th+ lines 4.5 m. Causes of discontinuation of HCAD were: disease progression in 87% of cases and 13% for toxicity/others. Median ETEL index (days) was 80 d (1-340). Conclusion: 1) HCAD are indicated during a significant proportion of life (50%) in stage IV NCP with many solid tumors. 2) Its use is increasing over years with a rate of 2% of NCP per year and for more proportion of time. 3) A great number of HCAD treatments are discontinued due to failure reasons, while it is expected more than 10% of adverse events causes. 4) ETEL index is proposed as a measurement indicator of GCP. 5) Impact of HCAD treatments is a major issue in health care policies.

Clinical outcomes of patients with stage IV cancer receiving immune checkpoint inhibitors in the inpatient setting.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6634-6634
Author(s):  
Sienna Durbin ◽  
Leyre Zubiri ◽  
Andrzej Niemierko ◽  
Laura A Petrillo ◽  
Aditya Bardia ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Immune Checkpoint ◽  
Readmission Rate ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Stage Iv ◽  
Tumor Type ◽  
Single Institution ◽  
Post Discharge ◽  
Tumor Types

6634 Background: Immune checkpoint inhibitors (ICI) represent a major leap in the treatment of many cancers. Use has rapidly expanded in recent years, yet it is unknown whether hospitalized patients, who are often sicker than those who were studied in clinical trials, derive benefit from ICI. The primary objectives of this study were to characterize the clinical features and outcomes of inpatients receiving ICI at a single institution, and to identify predictors of survival. Methods: After IRB approval, we conducted a retrospective chart review of inpatients with Stage IV solid tumors receiving ICI between 2015 – 2018 at a tertiary care referral hospital. Patients receiving ICI on clinical trial were excluded. We examined the clinical characteristics, readmission rate, and post-discharge survival. We then conducted a Cox multivariable regression analysis to identify predictors of post-discharge survival. Results: A total of 103 patients with Stage IV solid tumors were treated with ICI as inpatients between 2015 – 2018. Average age was 57 years (range = 26 to 85); 57% were male; 27% had ECOG performance status (PS) 3-4; average Charlson Comorbidity Index score was 8.3. Most common tumor types were melanoma (35%) and lung (22%). Seventy-six percent began ICI as an inpatient and 24% received ICI as continuation of outpatient therapy. Seventeen percent experienced an immunotherapy related adverse event, most commonly colitis and pneumonitis. The 30 day readmission rate was 41%. The median post-discharge survival was 31 days; 47% of patients died during admission or within 30 days of discharge; 14% survived more than 6 months. Factors predictive of shorter post-discharge survival were PS of 3-4 relative to PS 0-2 (HR 2.0, p < 0.004), and lung cancer (HR 2.0, p < 0.024) and other tumor types (HR 2.1, p < 0.004) relative to melanoma. Conclusions: While the majority of inpatients receiving ICI died during admission or within 30 days of discharge, a subset of patients with stage IV disease were alive at 6 months. Tumor type and ECOG PS predict post-discharge survival and may be used to identify inpatients more likely to benefit from ICI. These novel findings, which are unique to a single institution, require additional validation.

Multimodality treatment in stage IV squamous cell carcinoma of the head and neck. A long-term follow-up

1992 ◽  
Vol 106 (3) ◽  
pp. 234-237 ◽  
Author(s):  
A. Klima ◽  
I. Bergmann ◽  
S. Szepesi
Keyword(s):  
Head And Neck ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Multimodality Treatment ◽  
Complete Response ◽  
Free Survival ◽  
Long Term Follow Up ◽  
Stage Iv Cancer

AbstractWe treated 114 patients with advanced inoperable head and neck cancer with a combined-modality protocol that included two cycles of chemotherapy followed by radiotherapy or three cycles of chemotherapy and in 18 patients with a radiosensitizing agent. At the beginning of the treatment all but one patient presented with a stage IV cancer. With a follow-up of 42–58 months, four patients are alive (three from the radiosensitizing group and one of the chemotherapy group). Complete response after the radiosensitizing agent correlated with superior prolonged disease-free survival in comparison to complete responses after chemotherapy at the level of p<0.009.

Prevalence and characteristics of patients with stage IV solid tumors who receive no anticancer therapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6065-6065
Author(s):  
Alexander C. Small ◽  
Che-Kai Tsao ◽  
Erin L. Moshier ◽  
Benjamin Adam Gartrell ◽  
Juan P. Wisnivesky ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Stage Iv ◽  
Anticancer Therapy ◽  
Small Cell ◽  
Patients With Cancer ◽  
Income Insurance ◽  
Cancer Types ◽  
Stage Iv Cancer ◽  
Poor Functional Status ◽  
Estimate Prevalence

6065 Background: Clinicians caring for patients with cancer are well aware that a subset of patients who present with metastatic solid tumors never receive anticancer therapy for reasons including poor functional status, comorbidities, and patient preference. The prevalence and characteristics of this population have not previously been described. Methods: The National Cancer Database was queried for patients diagnosed with metastatic (stage IV) solid tumors including breast, cervix, colon, kidney, small-cell and non-small cell lung [NSCLC and SCLC], prostate, rectum and uterus. Patients who received neither radiation therapy nor systemic therapy were identified. Other factors such as age, race, income, insurance status, and diagnosis year were assessed. In an exploratory analysis, log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of untreated stage IV to treated stage IV cancer cases according to these factors. Results: From 2000-2008, 773,233 patients with stage IV cancer were identified of whom 159,284 (21%) received no anticancer therapy (Table). Patients with NSCLC accounted for 55% of untreated patients. Across all cancer types, older age (PR range 1.37-1.49, all p<0.001), black race (PR range 1.05-1.32, all p<0.001), lack of medical insurance (PR range 1.47-2.46, all p<0.001), and lower income (except uterus) (PR range 0.91-0.98 for every $10,000 income, all p<0.001) were associated with increased prevalence of not receiving treatment. Conclusions: Approximately 20% of patients who present with stage IV solid tumors never receive anticancer therapy. These findings have potential implications with regards to healthcare policy and access to care. [Table: see text]

scholarly journals Integrative Approach to Heal the Cancer at 5 Layers

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 248s-248s
Author(s):  
M. Govindasamy
Keyword(s):  
Cancer Patient ◽  
Cancer Patients ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Integrative Approach ◽  
Global Level ◽  
Free Survival ◽  
Simplified Approach ◽  
Stage Iv Cancer ◽  
The Cost

Amount raised: $25,000 Background and context: As a cancer patient, the approach to integrative approach concepts from entire world to heal myself and the cancer patients across United States, India, Columbia, Honduras, Belarus, European and other Asian regions. Diagnosed with Stage IV (cancer survivor story) and incorporated in the daily, weekly routines. Established integrative approach is very effective in the personal settings. Aim: How do we move the above personalized integrative approach to the cancer across the global community? Caring is sharing, sharing is caring, helping is healing, healing is helping. Create a personalized integrative healing approaches to cancer patients across the world. Strategy/Tactics: Strategy is precare (before cancer - behavioral) and postcare (palliative, pain relief approach). Incorporate appropriate integrative concepts to any cancer patient. Program process: Identify the integrative approach Analyze and adapt the specified approach Create a approach specific details for the cancer patient Implement and record results Conclude and report findings. Costs and returns: Each patient the cost could vary from $5000 to $25,000 What was learned: To heal or cure or help the cancer patient’s journey, integrative healing approach to all levels (5 layers of human body) is very effective and proven to provide overall survival and progression-free survival to increase majority of the cancer patients. The overall simplified approach was implemented to record the results. The overall results are proven and ready to be implemented to global level.

Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors

2021 ◽  
pp. 1-7
Author(s):  
Jonathan M. Hyak ◽  
Mayar Al Mohajer ◽  
Daniel M. Musher ◽  
Benjamin L. Musher
Keyword(s):  
Solid Tumors ◽  
Solid Tumor ◽  
Cardiopulmonary Arrest ◽  
Tertiary Care ◽  
Organ Transplant ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Tumor Patients ◽  
Binomial Regression ◽  
Sirs Criteria

Abstract Objective: To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. Design, setting, and participants: We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. Methods: Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. Results: Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31–2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10–1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56–2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09–2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09–2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). Conclusions: SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.

Exploratory Study of Advance Care Discussions Among Chinese American and White Stage IV Cancer Patients at an American Tertiary Medical Center

2021 ◽  
pp. 104990912110126
Author(s):  
Avery Caz Glover ◽  
Courtney Schroeder ◽  
Emma Ernst ◽  
Tamara Vesel
Keyword(s):  
Cancer Patients ◽  
Exploratory Study ◽  
Stage Iv ◽  
Chinese American ◽  
Chinese Americans ◽  
Do Not Resuscitate ◽  
Essential Components ◽  
Advance Care ◽  
Stage Iv Cancer ◽  
White Patients

Purpose: Timely advance care discussions are essential components of quality care for diverse populations; however, little is known about these conversations among Chinese American cancer patients. This exploratory study describes differences in advance care discussions and planning between Chinese American and White advanced cancer patients. Methods: We collected data for 63 Chinese American and 63 White stage IV cancer patients who died between 2013 and 2018. We compared: frequency and timing of prognosis, goals of care (GOC), and end-of-life care (EOLC) discussions in the final year of life; family inclusion in discussions; healthcare proxy (HCP) identification; do not resuscitate (DNR) order, do not intubate (DNI) order, and other advance directive (AD) completion. We did not conduct statistical tests due to the study’s exploratory nature. Results: Among Chinese American and White patients, respectively, 76% and 71% had prognosis, 51% and 56% had GOC, and 89% and 84% had EOLC discussions. Prognosis, GOC, and EOLC discussions were held a median of 34.0, 15.5, and 34.0 days before death among Chinese American and 17.0, 13.0, and 24.0 days before death among White patients. Documentation rates among Chinese American and White patients were 79% and 76% for DNRs, 81% and 71% for DNIs, 79% and 81% for HCPs, and 52% and 40% for other ADs. Conclusions: Findings suggest that Chinese Americans had similar rates of advance care discussions, completed conversations earlier, and had similar to higher rates of AD documentation compared to White patients. Further studies are needed to confirm our preliminary findings.

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