Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

Abstract Incidental pulmonary embolisms (IPEs) are common in cancer patients. Examining the characteristics and outcomes of IPEs in cancer patients can help to ensure proper management, promoting better outcomes. To determine the clinical characteristics, management, and outcomes of IPEs for cancer patients, we conducted a 1:2 ratio case-control study and identified all consecutive patients with IPE who visited the emergency department at The University of Texas MD Anderson Cancer Center between 1 January 2006 and 1 January 2016. Each IPE case was matched with 2 controls using a propensity score obtained using logistic regression for IPE status with other factors affecting overall survival. A total of 904 confirmed cases were included in the analysis. IPE frequently occurred during the first year after cancer diagnosis (odds ratio [OR], 2.79; 95% confidence interval [95% CI], 2.37-3.29; P < .001). Patients receiving cytotoxic chemotherapy had a nearly threefold greater risk of developing IPE (OR, 2.87; 95% CI, 2.42-3.40; P < .001). In-hospital mortality was 1.9%. The 7- and 30-day mortality rates among the cases were 1.8% and 9.9%, respectively, which was significantly higher than in the control groups: 0.2% and 3.1%, respectively (P < .001). IPE was associated with reduced overall survival (hazard ratio [HR], 1.93; 95% CI, 1.74-2.14; P < .001). Concurrent incidental venous thromboembolism was identified in 189 of the patients (20.9%) and was also associated with reduced overall survival (HR, 1.65; 95% CI, 1.21-2.25; P = .001). Our results show that IPE events are associated with poor outcomes in cancer patients. Proper management plans similar to those of symptomatic pulmonary embolisms are essential.

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

Supportive Care in Cancer ◽

10.1007/s00520-021-06020-3 ◽

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

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Routine HIV Screening in Cancer Patients in the Emergency Department

Acute Medicine Journal ◽

10.52964/amja.0705 ◽

2018 ◽

Vol 17 (2) ◽

pp. 91-95

Author(s):

Terry W Rice ◽

◽

Patricia A. Brock ◽

Carmen Gonzalez ◽

Kelly W Merriman ◽

...

Keyword(s):

Emergency Department ◽

Hiv Testing ◽

Cancer Patients ◽

Linkage To Care ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Hiv Screening ◽

Immunodeficiency Virus ◽

Routine Hiv Screening ◽

Incident Cases

Treatment of human immunodeficiency virus(HIV) in cancer patients improves outcomes and reduces transmission of this oncogenic virus. HIV testing rates of cancer patients are similar to the general population (15-40%), despite the association with cancer. Our aim was to increase HIV screening in the Emergency Department(ED) of a comprehensive cancer center through a quality initiative. Testing increased significantly during the intervention (p<0.001; 0.15/day to 2.69/day). Seropositive HIV rate was 1.4% (12/852), with incidence of 0.3%. All patients were linked to care. Incident cases were between 36 and 55 years of age. Barriers encountered included confusion regarding the need for written consent for HIV testing, failure to consider ordering the test, and concerns regarding linkage to care.

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Viral associated diarrhea in immunocompromised and cancer patients at a large comprehensive cancer center: a 10-year retrospective study

Infectious Diseases ◽

10.1080/23744235.2016.1224384 ◽

2016 ◽

Vol 49 (2) ◽

pp. 113-119 ◽

Cited By ~ 6

Author(s):

Natasha Ghosh ◽

Farida A. Malik ◽

Roshni G. Daver ◽

Jakapat Vanichanan ◽

Pablo C. Okhuysen

Keyword(s):

Retrospective Study ◽

Cancer Patients ◽

Comprehensive Cancer Center ◽

Cancer Center

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Length of Survival in Hospice for Cancer Patients Referred From a Comprehensive Cancer Center

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909109333928 ◽

2009 ◽

Vol 26 (4) ◽

pp. 281-287 ◽

Cited By ~ 17

Author(s):

Tallal Younis ◽

Robert Milch ◽

Nawal Abul-Khoudoud ◽

David Lawrence ◽

Amy Mirand ◽

...

Keyword(s):

Cancer Patients ◽

Comprehensive Cancer Center ◽

Cancer Center

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Clinical characteristics and 3-month outcomes in cancer patients with incidental versus clinically-suspected and confirmed pulmonary embolism

European Respiratory Journal ◽

10.1183/13993003.02723-2020 ◽

2020 ◽

pp. 2002723

Author(s):

Marisa Peris ◽

Juan J. López-Nuñez ◽

Ana Maestre ◽

David Jimenez ◽

Alfonso Muriel ◽

...

Keyword(s):

Pulmonary Embolism ◽

Mortality Rate ◽

Cancer Patients ◽

Major Bleeding ◽

Management Strategies ◽

Multivariable Analysis ◽

Heparin Therapy ◽

Incidental Pulmonary Embolism ◽

All Cause Mortality ◽

Related Mortality

BackgroundCurrent guidelines suggest treating cancer patients with incidental pulmonary embolism (PE) similar to those with clinically-suspected and confirmed PE. However, the natural history of these presentations has not been thoroughly compared.MethodsWe used the data from the RIETE registry to compare the 3-month outcomes in patients with active cancer and incidental PE versus those with clinically-suspected and confirmed PE. The primary outcome was 90-day all-cause mortality. Secondary outcomes were PE-related mortality, symptomatic PE recurrences and major bleeding.ResultsFrom July 2012 to January 2019, 946 cancer patients with incidental asymptomatic PE and 2274 with clinically-suspected and confirmed PE were enrolled. Most patients (95% versus 90%) received low-molecular-weight heparin therapy. During the first 90 days, 598 patients died, including 42 from PE. Patients with incidental PE had a lower all-cause mortality rate than those with suspected and confirmed PE (11% versus 22%; odds ratio [OR]: 0.43; 95%CI: 0.34–0.54). Results were consistent for PE-related mortality (0.3% versus 1.7%; OR: 0.18; 95% CI: 0.06–0.59). Multivariable analysis confirmed that patients with incidental PE were at lower risk to die (adjusted OR: 0.43; 95%CI: 0.34–0.56). Overall, 29 patients (0.9%) developed symptomatic PE recurrences, and 122 (3.8%) had major bleeding. There were no significant differences in PE recurrences (OR: 0.62; 95%CI: 0.25–1.54) or major bleeding (OR: 0.78; 95%CI: 0.51–1.18).ConclusionsCancer patients with incidental PE had a lower mortality rate than those with clinically-suspected and confirmed PE. Further studies are required to validate these findings, and to explore optimal management strategies in these patients.

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Intrapersonal Factors Impact Advance Care Planning Among Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120962457 ◽

2020 ◽

pp. 104990912096245

Author(s):

Elizabeth Palmer Kelly ◽

Brent Henderson ◽

Madison Hyer ◽

Timothy M. Pawlik

Keyword(s):

Medical Treatment ◽

Cancer Patients ◽

Advance Care Planning ◽

Advance Directive ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Care Planning ◽

Power Of Attorney ◽

Intrapersonal Factors ◽

Advance Care

Background: Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. Objective: The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. Design: A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. Results: A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. Conclusions: Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.

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Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006–2014

BMC Infectious Diseases ◽

10.1186/s12879-019-4586-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Joumana Kmeid ◽

Prathit A. Kulkarni ◽

Marjorie V. Batista ◽

Firas El Chaer ◽

Amrita Prayag ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Cancer Patients ◽

Hematopoietic Cell Transplantation ◽

Average Rate ◽

Hematologic Malignancies ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Mycobacterium Tuberculosis Infection ◽

Patients With Cancer ◽

Disseminated Disease

Abstract Background Morbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer. Methods We retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014. Results A total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection. Conclusions Although not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

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