scholarly journals CASE OF TREATMENT OF A PATIENT WITH AN AGGRESSIVE FORM OF METASTATIC MELANOMA OF THE SKIN

2018 ◽  
Vol 23 (3-6) ◽  
pp. 171-175
Author(s):  
Sergei A. Yargunin ◽  
A. F Lazarev ◽  
S. V Sharov
Keyword(s):  
Life Expectancy ◽  
Metastatic Melanoma ◽  
Good Health ◽  
Personalized Therapy ◽  
Treatment Standards ◽  
Genetic Profiling ◽  
Treatment Regimens ◽  
Great Achievement ◽  
Total Life Expectancy ◽  
Clinical Scenarios

Metastatic melanoma of the skin today remains a difficult task. A revolution in treatment was the emergence of new classes of drugs: inhibitors of regulatory molecules of the key stages of the immune response and tyrokinase receptors, which in mono-mode showed an advantage compared to standard treatment regimens, and their combination is objectively better result compared to mono-mode. Genetic profiling was indispensable for choosing personalized treatment approaches. In the absence of treatment standards for patients with advanced MK, local doctors rely on individual clinical cases, trying to classify them into similar clinical scenarios, which differ in each case. Some authors recommend that these scenarios be included in clinical trials, either as inclusion criteria or stratification factors. Thus, this approach may be a way of personalizing the treatment of patients with MMC. Materials and methods. A 29-year-old patient with MK back surgery was operated on with subsequent adjuvant immunotherapy. When the disease progressed, the patient was prescribed sequentially immuno-, chemo- and combination therapy with anti-CTL4 + PD-1 inhibitors, sanitary excision of soft tissue metastases, a combination of BRAF + MEK inhibitors, polychemotherapy. Results. The personalized therapy of the patient with MMC has led to an increase in the overall duration and quality of life. Conclusion. Despite the consistent application of the majority of the known available treatment regimens to the patient, stabilization of the condition was only possible for a short time. To achieve a complete or partial response to any of the types of treatment failed. But this case can be considered a variant of personalized therapy, which allowed to slow down the development of the disease, keep the patient in good health and a long time, an active lifestyle, improve its quality, which is already a great achievement. The life expectancy without progression in this patient was 9 months, the total life expectancy from the start of treatment was 44 months.

scholarly journals Ageing and COVID-19: What Is the Role for Elderly People?

Geriatrics ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 25 ◽  
Author(s):  
Donatella Rita Petretto ◽  
Roberto Pili
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Elderly People ◽  
Well Being ◽  
Good Health ◽  
Complex Situation ◽  
Risk Of Death ◽  
Age Related ◽  
Total Life Expectancy ◽  
Very High

Italy is one of the oldest countries in Europe and in the world and now it is also one of the first countries that are fighting against COVID-19. In our country, the increasing life expectancy (80.5 for males and 84.9 for females, with a total life expectancy of 82.9) has led to very positive consequences for health and the well-being of elderly people: a very high number of older adults lives and acts independently in their daily life, even if they have one or more than one chronic disease. In the time of COVID-19′s outbreak in Italy, the focus of the media was on elderly people for two main reasons. First, many older people demonstrated a very high civic sense and they were helping society to fight against the pandemic. Second, also in Italy, like in China, the older adults are at higher risk in being infected with COVID-19 and if they get ill, they have a higher risk of death. The balance previously achieved between age-related disorders and a good quality of life and good health is now under high pressure. It is very important to protect elderly people from infection, but also it is important to respect them and to support them in this complex situation. There is a great risk of “ageism”. In agreement with Lloyd-Sherlock and colleagues (2020), in this editorial we propose some hints of analysis, starting from the ongoing experience in Italy.

Decennial trends and inequalities in healthy life expectancy: The HUNT Study, Norway

2017 ◽  
Vol 46 (1) ◽  
pp. 124-131 ◽  
Author(s):  
Siri H. Storeng ◽  
Steinar Krokstad ◽  
Steinar Westin ◽  
Erik R. Sund
Keyword(s):  
Life Expectancy ◽  
Good Health ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Self Rated Health ◽  
Total Life Expectancy ◽  
Life Years ◽  
Educational Groups ◽  
Hunt Study ◽  
Total Life

Aims: Norway is experiencing a rising life expectancy combined with an increasing dependency ratio – the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups. Methods: Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects. Results: During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased. Conclusions: The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.

scholarly journals BMI and healthy life expectancy in old and very old women

2016 ◽  
Vol 116 (4) ◽  
pp. 692-699 ◽  
Author(s):  
L. Leigh ◽  
J. E. Byles ◽  
C. Jagger
Keyword(s):  
Weight Loss ◽  
Life Expectancy ◽  
Good Health ◽  
Normal Weight ◽  
Healthy Life Expectancy ◽  
Obese Women ◽  
Healthy Life ◽  
Conflicting Evidence ◽  
Total Life Expectancy ◽  
State Models

AbstractThere is conflicting evidence for the effect of BMI on mortality at older ages, and little information on its effect on healthy life expectancy (HLE). Longitudinal data were from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health (n 11 119), over 18 years of follow-up. Self-rated health status was measured at each survey, and BMI was measured at baseline. Multi-state models were fitted to estimate the effect of BMI on total life expectancy (TLE) and HLE. Compared with women of normal weight, overweight women at the age of 75 years had similar TLE but fewer years healthy (−0·79; 95 % CI −1·21, −0·37) and more years unhealthy (0·99; 95 % CI 0·56, 1·42). Obese women at the age of 75 years lived fewer years in total than normal-weight women (−1·09; 95 % CI −1·77, −0·41), and had more unhealthy years (1·46; 95 % CI 0·97, 1·95 years). Underweight women had the lowest TLE and the fewest years of healthy life. Women should aim to enter old age at a normal weight and in good health, as the slight benefit on mortality of being overweight is offset by spending fewer years healthy. All outcomes were better for those who began in good health. The relationship between weight and HLE has important implications for nutrition for older people, particularly maintenance of lean body mass and prevention of obesity. The benefit of weight loss in obese older women remains unclear, but we support the recommendation that weight-loss advice be individualised, as any benefits may not outweigh the risks in healthy obese older adults.

scholarly journals Changing Educational Gradients in Life Expectancy With and Without Disease Among U.S. Older Adults From 2000 to 2010

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 505-505
Author(s):  
Matthew Farina ◽  
Phillip Cantu ◽  
Mark Hayward
Keyword(s):  
Older Adults ◽  
Life Expectancy ◽  
Chronic Diseases ◽  
Population Aging ◽  
Good Health ◽  
Vital Statistics ◽  
Healthy Life Expectancy ◽  
Healthy Life ◽  
Education Group ◽  
Education Groups

Abstract Recent research has documented increasing education inequality in life expectancy among U.S. adults; however, much is unknown about other health status changes. The objective of study is to assess how healthy and unhealthy life expectancies, as classified by common chronic diseases, has changed for older adults across education groups. Data come from the Health and Retirement Study and National Vital Statistics. We created prevalence-based life tables using the Sullivan method to assess sex-specific life expectancies for stroke, heart disease, cancer, and arthritis by education group. In general, unhealthy life expectancy increased with each condition across education groups. However, the increases in unhealthy life expectancy varied greatly. While stroke increased by half a year across education groups, life expectancy with diabetes increased by 3 to 4 years. In contrast, the evidence for healthy life expectancy provides mixed results. Across chronic diseases, healthy life expectancy decreased by 1 to 3 years for respondents without a 4-year degree. Conversely, healthy life expectancy increased for the college educated by .5 to 3 years. While previous research shows increases in life expectancy for the most educated, trends in life expectancy with chronic conditions is less positive: not all additional years are in lived in good health. In addition to documenting life expectancy changes across education groups, research assessing health of older adults should consider the changing inequality across a variety of health conditions, which will have broad implications for population aging and policy intervention.

scholarly journals Quality of care for people with multimorbidity: a focus group study with patients and their relatives

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047025
Author(s):  
Nadine Janis Pohontsch ◽  
Josefine Schulze ◽  
Charlotte Hoeflich ◽  
Katharina Glassen ◽  
Amanda Breckner ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Focus Groups ◽  
Healthcare System ◽  
Qualitative Content Analysis ◽  
Coordinated Care ◽  
Treatment Standards ◽  
Focus Group Study ◽  
Treatment Regimens ◽  
Quality Aspects

BackgroundPrevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.MethodsWe conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.ResultsWe created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.ConclusionWe show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.Trial registration numberGerman clinical trials registry (DRKS00015718), Pre-Results.

scholarly journals Healthy life expectancy in Brazil: applying the Sullivan method

2005 ◽  
Vol 21 (suppl 1) ◽  
pp. S7-S18 ◽  
Author(s):  
Dalia Elena Romero ◽  
Iúri da Costa Leite ◽  
Célia Landmann Szwarcwald
Keyword(s):  
Life Expectancy ◽  
Functional Limitation ◽  
Good Health ◽  
World Health ◽  
Healthy Life Expectancy ◽  
State Of Health ◽  
World Health Survey ◽  
Healthy Life ◽  
Mortality And Morbidity ◽  
Sullivan Method

The objective of this study is to present the method proposed by Sullivan and to estimate the healthy life expectancy using different measures of state of health, based on information from the World Health Survey carried out in Brazil in 2003. By combining information on mortality and morbidity into a unique indicator, simple to calculate and easy to interpret, the Sullivan method is currently the one most commonly used for estimating healthy life expectancy. The results show higher number of healthy years lost if there is a long-term disease or disability that limits daily activities, regardless of the difficulty in performing such activities or the severity of the functional limitations. The two measures of healthy life expectancy adjusted by the severity of functional limitation show results very similar to estimates based on the perception of state of health, especially in advanced age. It was also observed, for all measures used, that the proportion of healthy years lost increases significantly with age and that, although females have higher life expectancy than males, they live proportionally less years in good health.

scholarly journals Neighborhood Disadvantage and Active, Disabled and Total Life Expectancy Among Community-living Older Persons

2021 ◽  
Author(s):  
Thomas M. Gill ◽  
Emma X. Zang ◽  
Terrence E. Murphy ◽  
Linda Leo-Summers ◽  
Evelyne A. Gahbauer ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Life Expectancy ◽  
Older Persons ◽  
Neighborhood Disadvantage ◽  
Community Living ◽  
Remaining Life ◽  
Disadvantaged Group ◽  
Individual Level ◽  
Total Life Expectancy ◽  
Total Life

AbstractBackgroundNeighborhood disadvantage is a novel social determinant of health that could adversely affect the functional well-being and longevity of older persons. We evaluated whether estimates of active, disabled and total life expectancy differ on the basis of neighborhood disadvantage after accounting for individual-level socioeconomic characteristics and other prognostic factors.MethodsWe used data on 754 community-living older persons from South Central Connecticut, who completed monthly assessments of disability from 1998 to 2020. Scores on the area deprivation index were dichotomized at the 80th state percentile to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80).ResultsWithin 5-year age increments from 70 to 90, active and total life expectancy were consistently lower in participants from neighborhoods that were disadvantaged versus not disadvantaged, and these differences persisted and remained statistically significant after adjustment for individual-level race/ethnicity, education, income, and other prognostic factors. At age 70, adjusted estimates (95% CI) for active and total life expectancy (in years) were 12.3 (11.5-13.1) and 15.0 (13.8-16.1) in the disadvantaged group and 14.2 (13.5-14.7) and 16.7 (15.9-17.5) in the non-disadvantaged group. At each age, participants from disadvantaged neighborhoods spent a greater percentage of their projected remaining life disabled, relative to those from non-disadvantaged neighborhoods, with adjusted values (SE) ranging from 17.7 (0.8) vs. 15.3 (0.5) at age 70 to 55.0 (1.7) vs. 48.1 (1.3) at age 90.ConclusionsLiving in a disadvantaged neighborhood is associated with lower active and total life expectancy and a greater percentage of projected remaining life disabled.

scholarly journals VGH-TAYLOR: Comprehensive precision medicine study protocol on the heterogeneity of Taiwanese breast cancer patients

2021 ◽  
Author(s):  
Chun-Yu Liu ◽  
Chi-Cheng Huang ◽  
Yi-Fang Tsai ◽  
Ta-Chung Chao ◽  
Pei-Ju Lien ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Recurrence ◽  
Cell Receptor ◽  
Breast Cancer Patients ◽  
Genetic Profiling ◽  
Treatment Regimens ◽  
Diagnosis And Prognosis ◽  
Receptor Repertoire ◽  
Cell Receptor Repertoire ◽  
Selection Of

Heterogeneity in breast cancer leads to diverse morphological features and different clinical outcomes. There are inherent differences in breast cancer between the populations in Asia and in western countries. The use of immune-based treatment in breast cancer is currently in the developmental stage. The VGH-TAYLOR study is designed to understand the genetic profiling of different subtypes of breast cancer in Taiwan and define the molecular risk factors for breast cancer recurrence. The T-cell receptor repertoire and the potential effects of immunotherapy in breast cancer subjects is evaluated. The favorable biomarkers for early detection of tumor recurrence, diagnosis and prognosis may provide clues for the selection of individualized treatment regimens and improvement in breast cancer therapy.

Analysis of metastatic melanoma treated with immune checkpoint inhibitors and the rates of adverse events of colitis and hepatitis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21591-e21591
Author(s):  
Emily Horan ◽  
Melissa Arneil ◽  
Wen Xu ◽  
Victoria Atkinson
Keyword(s):  
Metastatic Melanoma ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Immune Therapy ◽  
Complete Response ◽  
Treatment Regimens ◽  
Organ Systems ◽  
Oral Steroids ◽  
Intravenous Steroids

e21591 Background: Immune checkpoint inhibitors (CPI) are widely used in metastatic melanoma (MM), where it has markedly improved survival outcomes. ICI induced autoimmune adverse reactions (irAE) manifest in all organ systems and are due to over-activation of the immune system. Clinically relevant irAE are colitis and hepatitis as drivers of morbidity and mortality. Methods: Data was collected from a single centre (Princess Alexandra Hospital) from the electronic medical records system and immunotherapy prescribing software. Patient demographics, treatments, complications and outcomes were recorded from 2016-2019. Eligible patients had to have received immunotherapy (pembrolizumab, ipilimumab, or nivolumab) and experienced colitis or hepatitis toxicity. Trial patients were excluded. Results: The cohort of 337 patients who had received immune therapy, 18% (n = 61) had hepatitis or colitis, mean age was 56 years, 64% male. The majority were stage 4d 28% (n = 17). Braf wildtype accounted for 56% (n = 34). The highest rates of irAE occurred on combination ipilimumab and nivolumab 56% (n = 34), 10% nivolumab (n = 6), 3% (n = 2) ipilimumab, and 31% (n = 19) pembrolizumab monotherapy. Colitis affected 61% of patients (n = 37), 30% (n = 18) were grade 3 severity. Hepatitis affected 48% (n = 29), 18% (n = 32) were grade 1. The majority required oral steroids (80%, n = 49), followed by intravenous steroids (51%, n = 31), infliximab (18%, n = 11) and mycophenolate in 5% (n = 3). Hospitalisation occurred in 56% (n = 34), 20% (n = 12) requiring treatment cessation. Progressive disease occurred in 62% (n = 38), and 13% (n = 8) had a complete response. Conclusions: The findings of this analysis mirror current literature with immunotherapies used, rates and severity of irAE. The management of irAE also aligned with current guidelines. Further research is required to investigate patient factors increasing the risk of developing irAE, and ideal treatment regimens. Analysing this large cohort, the incidence of toxicity was 17%, predominantly colitis followed by hepatitis. Patients were severely impacted requiring significant interventions to manage toxicity, hospitalisation and morbidity.

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