scholarly journals Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study

2020 ◽  
Author(s):  
Minseok Seo ◽  
In Cheol Hwang ◽  
Jaehun Jung ◽  
Hwanhee Lee ◽  
Jae Hee Choi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cox Regression ◽  
Performance Status ◽  
Poor Performance ◽  
Electrolyte Imbalance ◽  
Poor Performance Status ◽  
Terminal Cancer ◽  
Care Providers ◽  
Cox Regression Analysis ◽  
Male Sex

Abstract Background Although palliative care providers, patients, and their familes rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention. Methods As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to one hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independant prognostic factors. Results Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. Median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatermia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR]=1.53, 95% confidence interval [CI]: 1.15–2.04), poor performance status (HR=1.45, 95% CI: 1.09–1.94), leukocytosis (HR=1.98, 95% CI: 1.47–2.66), hypoalbuminemia (HR=2.06, 95% CI: 1.49–2.73) and hypernatremia (HR=1.55, 95% CI: 1.18–2.03) emerged as significant predictors of poor prognosis. Conclusion Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further corroborative studies of large scale and prospective design are needed.

scholarly journals Hypernatremia predicts poor survival in patients with terminal cancer: a retrospective cohort study

2019 ◽  
Author(s):  
Minseok Seo ◽  
In Cheol Hwang ◽  
Jaehun Jung ◽  
Hwanhee Lee ◽  
Jae Hee Choi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cox Regression ◽  
Performance Status ◽  
Poor Performance ◽  
Electrolyte Imbalance ◽  
Poor Performance Status ◽  
Terminal Cancer ◽  
Care Providers ◽  
Cox Regression Analysis ◽  
Male Sex

Abstract Background: Although palliative care providers, patients, and their familes rely heavily on accurate prognostication, the prognostic value of electrolyte imbalance has received little attention.Methods: As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017 and May 2019 to one hospice-palliative care unit. Clinical characteristics and laboratory results were obtained from medical records for multivariable Cox regression analysis of independant prognostic factors.Results: Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. Median survival time was 26 days. Parameters associated with shortened survival included male sex, advanced age (> 70 years), lung cancer, poor performance status, elevated inflammatory markers, azotemia, impaired liver function, and hypernatermia. In a multivariable Cox proportional hazards model, male sex (hazard ratio [HR]=1.53, 95% confidence interval [CI]: 1.15–2.04), poor performance status (HR=1.45, 95% CI: 1.09–1.94), leukocytosis (HR=1.98, 95% CI: 1.47–2.66), hypoalbuminemia (HR=2.06, 95% CI: 1.49–2.73) and hypernatremia (HR=1.55, 95% CI: 1.18–2.03) emerged as significant predictors of poor prognosis.Conclusion: Hypernatremia may be a useful gauge of prognosis in patients with terminal cancer. Further corroborative studies of large scale and prospective design are needed.

Chromosome 1 abnormalities and clinical outcomes in multiple myeloma in the era of novel agents.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8044-8044
Author(s):  
Smith Giri ◽  
Scott F. Huntington ◽  
Rong Wang ◽  
Amer Methqal Zeidan ◽  
Nikolai Alexandrovich Podoltsev ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Real World ◽  
Cox Regression ◽  
Performance Status ◽  
Poor Performance ◽  
Total Sample ◽  
Chromosome 1 ◽  
Poor Performance Status ◽  
Cox Regression Analysis ◽  
Entire Cohort

8044 Background: Abnormalities of chromosome 1 (C1A) are common genetic mutations in patients (pts) with Multiple Myeloma (MM). While several small studies have reported worse outcomes for C1A, the prevalence, real-world treatment and outcomes for pts with C1A are unknown. Methods: We used the Flatiron Health Electronic Health Record (EHR)-derived database to identify pts with newly diagnosed MM from 01/2011 to 03/2018 with Fluorescence In situ Hybridization (FISH) testing within 90 days of diagnosis and defined lines of therapy. We identified pts with C1A and other high-risk mutations (HRM; 17p deletion, t14;16 and t4;14). Pts were followed until 3/31/2018 or death. The primary outcome was overall survival (OS). We used Kaplan Meier methods and compared OS for pts with/without C1A using log-rank tests stratified for HRM. We used Cox regression analysis to compare OS across groups, adjusting for age, gender, performance status, stage, HRM and treatment (triple regimen vs other). Results: The total sample included 3,578 pts: median age at diagnosis was 69 yrs (IQR 31-85), with 54% males and 60% whites. IgG(57%) and IgA(22%) were the most common M-protein subtypes. At baseline, 844 (24%) had C1A. Pts with C1A had higher stage (ISS III 35% vs 26%; p < 0.01) and other HRM (27% vs 14%, p < 0.01). Common first line-therapies included bortezomib(V), lenalidomide(R) and dexamethasone (D) (35%), RD (20%) followed by VD(15%). Use of VRD was higher with C1A vs without (40% vs 33% respectively, p < 0.01). Median OS was 66.9 months for the entire cohort and was lower for pts with C1A vs without (median OS 46.6 vs 70.1 months; log rank p < 0.01). Multivariable Cox survival analysis showed that C1A was independently associated with worse OS (adjusted HR 1.64; 95% CI 1.23-2.19); p < 0.01). Other predictors of worse survival included older age, black ethnicity, higher ISS stage, poor performance status and HRM. Conclusions: In this large study of real-world practice, C1A was associated with inferior OS independent of other HRM, despite higher use of VRD. Future studies are needed to assess whether specific regimens improve outcomes for C1A compared to patients without HRM.

Should all patients (pts) with advanced biliary cancers receive first-line treatment with cisplatin and gemcitabine (GC)?

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 244-244
Author(s):  
Vanessa Costa Miranda ◽  
Luiza Dib-Faria ◽  
Maria Ignez Freitas Melro Braghiroli ◽  
Jorge Sabbaga ◽  
Daniel Fernandes Saragiotto ◽  
...  
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Poor Performance ◽  
Median Number ◽  
Poor Performance Status ◽  
Poor Survival ◽  
First Line ◽  
Dismal Prognosis

244 Background: GC is considered the standard of care for pts with advanced biliary tract cancer (BTC), providing median survival of nearly one year. (Valle J et al. NEJM 2010) Nevertheless, many pts experience poor outcomes, leading to a growing interest to identify pts who might benefit from such treatment. Here we aimed to investigate clinical and laboratory factors associated with poor survival among BTC pts treated with GC. Methods: We retrospectively evaluated all consecutive pts with advanced/metastatic BTC who received first line GC at the Instituto do Cancer do Estado de Sao Paulo, Brazil, in a 2 year-period. Clinical and laboratory variables that could influence pts’ outcomes were gathered from medical charts. Cox regression proportional hazard model was used to investigate the following prognostic factors for death: pre-treatment biliary deobstruction, baseline Ca 19.9, any GC interruptions or dose reductions, baseline ECOG status, Charlson Comorbidity Index (CCI) and age. P values < 0.05 in multivariable analysis were considered significant. Results: From January/2009 to July/2011, 72 pts were identified. The median age was 60 years (range 30-80 years), 45 pts (62.5%) were female and 50 (69.4%) presented baseline ECOG 0-1. The median number of cycles of CG was 4 (range 1-9). Grade 3 /4 neutropenia and thrombocytopenia occurred in 16.6% and 12.5% of pts, respectively. Median survival of the whole cohort was 9.53 months (95% CI: 6.2 - 11.4). Median survival in pts with ECOG 0/1 was 13.5 months (95% CI: 9,5 – NR) and among pts with ECOG 2/3 3,5 months (95% CI: 1-7). In the Cox multivariable model, ECOG 2 /3 versus 0/1 (HR: 8.4, 95% CI: 3.4 to 20.7; p<0.001) and CCI score ≥ 2 (HR: 9.5 95% CI: 1.6 to 55.3; p= 0.012) significantly predicted for poor survival. There was a trend for improved survival among pts who had biliary drainage before starting GC (HR: 2.3 95% CI: 1.0 - 5.3; p= 0.051). Conclusions: In this retrospective cohort of unselected pts with advanced BTC treated with first line GC, poor performance status and multiple comorbid illnesses were associated with dismal prognosis. Treatment with GC should be carefully discussed before being offered to these pts.

scholarly journals Evaluation of the prognostic benefit of identifying the probable primary site in cancer of unknown primary

2015 ◽  
Vol 6 (3) ◽  
pp. 22-28
Author(s):  
Joyutpal Das ◽  
Shahid Gilani
Keyword(s):  
Median Survival ◽  
Cox Regression ◽  
Performance Status ◽  
Disease Onset ◽  
Significant Proportion ◽  
Poor Performance ◽  
Primary Site ◽  
University Hospital ◽  
Unknown Primary ◽  
Poor Performance Status

Abstract With the development of site-specific cancer therapy, identifying the primary origin allows the oncologist to personalise therapy for patients with the cancer of unknown primaries (CUPs). At present, immunohistochemistry (IHC) screening is the standard method used to postulate the primary site in CUP. In this retrospective study, we evaluated the prognostic benefit of identifying the primary site in CUP. All 84 patients who presented with suspected CUP to the Royal Stoke University Hospital between 2011 and 2012 were included in our study. Forty-eight percent (40/84) of these patients were unable to undergo necessary investigations to identify primary sites because of poor performance status. IHC screening was able to postulate the primary site in 59% (26/44) of the remaining patients with confirmed CUP. Therefore, the primary site was not identified in a significant proportion of patients with CUP. The median survival of confirmed CUP with probable primary site was 2.0 months (95% confidence interval (CI): 1.2 to 2.9 months), whereas the median survival of confirmed CUP with no probable primary site was 4.1 months (95% CI: 1.5 to 9.7 months). This difference in survival time was statistically significant. In addition, using the Cox regression model, we found that patients with confirmed CUP with primary sites had prognostically unfavourable diseases with a shorter median survival, regardless of the age of disease onset, gender, sites of metastases or number of metastases. One approach to improve the survival would be to start systemic therapy at the earliest possible opportunity rather than waiting for all investigation results, such as IHC.

scholarly journals Palliative care and end-of-life measure outcomes: Experience of a tertiary care institute from South India

2018 ◽  
Vol 07 (03) ◽  
pp. 210-213
Author(s):  
Praveen Adusumilli ◽  
Lingaraj Nayak ◽  
Vidya Viswanath ◽  
Leela Digumarti ◽  
Raghunadha Rao Digumarti
Keyword(s):  
Palliative Care ◽  
Median Time ◽  
Performance Status ◽  
Tertiary Care ◽  
Quality Criterion ◽  
Poor Performance ◽  
Primary Objective ◽  
Unknown Primary ◽  
Poor Performance Status ◽  
Terminally Ill Cancer Patients

Abstract Introduction: Desisting from disease directed treatment in the past weeks of life is a quality criterion in oncology service. Patients with advanced cancer have unrealistic expectations from chemotherapy and hold on to it as a great source of hope. Many oncologists continue futile and unnecessary treatments, instead of conveying to the patients the lack of benefit, resulting in delayed referral for palliative care (PC). Materials and Methods: This is a retrospective analysis of case records from June 2014 to December 2015. The primary objective was to study, how far back in time terminally ill cancer patients received definitive cancer directed therapy (DCDT). Apart from patient demographics, the diagnosis, stage, and details of DCDT, and death were captured. PC referral data were recorded. DCDT to death was taken as treatment-free interval (TFI). Analysis was performed using IBM SPSS Statistics for Windows, Version 20. Results: A total of 292 case records were evaluated. Seventy-three had inadequate treatment details. Hence, 219 records were analyzed. PC referral was done in 78.5% of patients. Only best supportive care (BSC) without any DCDT was given in 27 patients. The most common reason for BSC was a poor performance status in 92.5%. The median time from PC referral till death was 43.5 days (range: 1–518 days). Chemotherapy was the most common DCDT in 52.9% of patients. The median time from DCDT and death was 49 days (range: 0–359 days). Cervical and ovarian cancers patients had the longest TFI ; shortest in unknown primary. Most patients died at home (70.4%). Patients receiving PC preferred home or hospice as place of death. Of the 80 patients given hospice care, 39 (36.5%) died in the hospice. Conclusion: While DCDT needs to be started at the right time, it should also be discontinued when futile. Early involvement of the PC team, even while patients are on DCDT makes the transition smoother and more meaningful.

scholarly journals Advanced cancer

2018 ◽  
Vol 51 (3) ◽  
pp. 167-176
Author(s):  
Josiane Cheli Vettori ◽  
Andre Filipe Junqueira Santos ◽  
Fernanda Maris Peria
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Clinical Laboratory ◽  
Performance Status ◽  
Poor Performance ◽  
Nutritional Therapy ◽  
Oral Route ◽  
Poor Performance Status ◽  
Nutritional Care ◽  
End Stage

Background: Cancer patients usually require palliative care. One of the reasons for this is malnutrition, which is common in these patients, affecting their prognosis and quality of life. Data on nutritional care in palliative care are still scarce. Objective: To characterize the diagnosis and nutritional care in palliative care cancer patients hospitalized in a public health setting. Methods: Descriptive retrospective cohort study on clinical, laboratory, and nutritional data obtained from medical records of cancer patients in palliative care. Results: A total of 128 admissions of cancer patients in palliative care were analyzed. Main primary cancer sites were in digestive, urologic and pulmonary systems. Mean age was 64.3±16.6 years. Patients were clinically and nutritionally compromised – mean performance status of 17.77±7.15, hemoglobin 9.6±2.37U/dL, albumin 2.64±0.64g/dL, C-reactive protein 125.37±68.37ml/L, and 60.8% of malnutrition (mean BMI of 20.19±5.57kg/m2). Oral route was the main route of administration (62.5%) and analysis of agreement revealed nutritional provision in excess of estimated daily requirements. No association was found between fasting condition, hospitalization outcome (death) and nutritional diagnosis (p=0.51). Conclusions: These cancer patients received palliative care just at the end stage of life, when most of them were malnourished, symptomatic, without specific oncologic treatment, and with a poor performance status. There was a preference for oral nutritional therapy, however, energy and protein supply were higher than the estimated nutritional requirements. The realization of fasting during hospitalization in the moments before death was not associated with the patient’s outcome.

scholarly journals Role of Radiation Therapy in Palliative Care of the Patient With Cancer

2014 ◽  
Vol 32 (26) ◽  
pp. 2913-2919 ◽  
Author(s):  
Stephen T. Lutz ◽  
Joshua Jones ◽  
Edward Chow
Keyword(s):  
Palliative Care ◽  
Performance Status ◽  
Symptom Relief ◽  
Palliative Radiotherapy ◽  
Poor Performance ◽  
Poor Response ◽  
Cost Effective ◽  
Poor Performance Status ◽  
National Quality ◽  
Oncology Care

Radiotherapy is a successful, time-efficient, well-tolerated, and cost-effective intervention that is crucial for the appropriate delivery of palliative oncology care. The distinction between curative and palliative goals is blurred in many patients with cancer, requiring that treatments be chosen on the basis of factors related to the patient (ie, poor performance status, advanced age, significant weight loss, severe comorbid disease), the cancer (ie, metastatic disease, aggressive histology), or the treatment (ie, poor response to systemic therapy, previous radiotherapy). Goals may include symptom relief at the site of primary tumor or from metastatic lesions. Attention to a patient's discomfort and transportation limitations requires hypofractionated courses, when feasible. Innovative approaches include rapid response palliative care clinics as well as the formation of palliative radiotherapy specialty services in academic centers. Guidelines are providing better definitions of appropriate palliative radiotherapy interventions, and bone metastases fractionation has become the first radiotherapy quality measure accepted by the National Quality Forum. Further advances in the palliative radiation oncology subspecialty will require integration of education and training between the radiotherapy and palliative care specialties.

Attendance at National Cancer Institute Cancer Centers (NCI-CC) by older adults with myeloma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18020-e18020
Author(s):  
Tanya Marya Wildes ◽  
Mark A Fiala
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Performance Status ◽  
Tertiary Care ◽  
Community Setting ◽  
Poor Performance ◽  
Lower Mortality ◽  
Mortality Data ◽  
Poor Performance Status ◽  
Nationally Representative

e18020 Background: Older adults with myeloma (MM) have poorer survival than younger patients. NCI-CC attendance is associated with superior outcomes in many cancers. Studies show that older adults are reluctant to be treated in university settings and are more likely to be treated in the community setting. We aimed to define the factors associated with NCI-CC attendance in older adults with mm from a nationally representative sample and its association with survival. Methods: We identified all mm cases in the SEER-Medicare linked database from 2000-2011. Included cases were enrolled in Medicare Part A and B > 1 year prior to diagnosis; we excluded those enrolled at age < 65. Any center designated a NCI-clinical or -comprehensive center in 2002, 2005, or 2010 was considered an NCI-CC; attendance was defined as ≥2 separate claims from an NCI-CC in the 1-year after mm diagnosis. CM were calculated using the Charlson Comorbidity (CM) Index (CCI). Poor performance status indicators (PSi) were coded as present or absent. Logistic regression was performed to determine if age was associated with NCI-CC attendance. Cox regression was determined the association of NCI-CC attendance with survival. Results: 21,843 cases were included; median age was 77 years. Overall 10.6% of the cohort attended an NCI-CC. Increasing age was associated with decreasing NCI-CC attendance rates: 18.6% (age 65-69), 13.9% (age 70-74), 9.0% (age 75-79) and 6.0% (age ≥80). After controlling for race, gender, socioeconomic status, and urban/rural regions, increasing age, poor PSi and CCI were each associated with lower odds of NCI-CC attendance [Age: OR 0.925/year (95% CI 0.92-0.93); Poor PSi: OR 0.87 (CI 0.76-1.00); CM: 0.94/CCI point (CI 0.90-0.97)]. After controlling for sociodemographics, PS and CCI, NCI-CC attendance was associated with lower mortality [HR 0.74 (95% CI 0.70-0.78)]. Conclusions: With increasing age, poor PS indicators and CM, pts are less likely to attend an NCI-CC. After controlling for other prognostic factors, attendance at an NCI-CC was associated with lower mortality. Data from trials in older mm pts from NCI-CC or other tertiary care centers must be viewed with caveat that pts tend to have better PS and fewer CM.

scholarly journals Lipid and lipoprotein predictors of functional outcomes and long-term mortality after surgical sepsis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Faheem W. Guirgis ◽  
Christiaan Leeuwenburgh ◽  
Lyle Moldawer ◽  
Gabriela Ghita ◽  
Lauren Page Black ◽  
...  
Keyword(s):  
Cox Regression ◽  
Performance Status ◽  
Density Lipoprotein ◽  
Poor Performance ◽  
Lipid Biomarkers ◽  
Surgical Intensive Care Unit ◽  
Poor Performance Status ◽  
Surgical Intensive Care ◽  
Long Term Mortality

Abstract Rationale Sepsis is a life-threatening, dysregulated response to infection. Lipid biomarkers including cholesterol are dynamically regulated during sepsis and predict short-term outcomes. In this study, we investigated the predictive ability of lipid biomarkers for physical function and long-term mortality after sepsis. Methods Prospective cohort study of sepsis patients admitted to a surgical intensive-care unit (ICU) within 24 h of sepsis bundle initiation. Samples were obtained at enrollment for lipid biomarkers. Multivariate regression models determined independent risk factors predictive of poor performance status (Zubrod score of 3/4/5) or survival at 1-year follow-up. Measurements and main results The study included 104 patients with surgical sepsis. Enrollment total cholesterol and high-density lipoprotein (HDL-C) levels were lower, and myeloperoxidase (MPO) levels were higher for patients with poor performance status at 1 year. A similar trend was seen in comparisons based on 1-year mortality, with HDL-C and ApoA-I levels being lower and MPO levels being higher in non-survivors. However, multivariable logistic regression only identified baseline Zubrod and initial SOFA score as significant independent predictors of poor performance status at 1 year. Multivariable Cox regression modeling for 1-year survival identified high Charlson comorbidity score, low ApoA-I levels, and longer vasopressor duration as predictors of mortality over 1-year post-sepsis. Conclusions In this surgical sepsis study, lipoproteins were not found to predict poor performance status at 1 year. ApoA-I levels, Charlson comorbidity scores, and duration of vasopressor use predicted 1 year survival. These data implicate cholesterol and lipoproteins as contributors to the underlying pathobiology of sepsis.

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