“Talking through a Fog”: The Impact of Hearing Dysfunction Related to Patulous Eustachian Tube on Hospice Patients with Advanced Cancer

Abstract Purpose The main aim of the study was to assess the impact of individualized management of breakthrough cancer pain (BTcP) on quality of life (QoL) of patients with advanced cancer in clinical practice. Methods A prospective, observational, multicenter study was conducted in patients with advanced cancer that were assisted by palliative care units. QoL was assessed with the EORTC QLQ-C30 questionnaire at baseline (V0) and after 28 days (V28) of individualized BTcP therapy. Data on background pain, BTcP, comorbidities, and frailty were also recorded. Results Ninety-three patients completed the study. Intensity, duration, and number of BTcP episodes were reduced (p < 0.001) at V28 with individualized therapy. Transmucosal fentanyl was used in 93.8% of patients, mainly by sublingual route. Fentanyl titration was initiated at low doses (78.3% of patients received doses of 67 μg, 100 μg, or 133 μg) according to physician evaluation. At V28, mean perception of global health status had increased from 31.1 to 53.1 (p < 0.001). All scales of EORTC QLQ-C30 significantly improved (p < 0.001) except physical functioning, diarrhea, and financial difficulties. Pain scale improved from 73.6 ± 22.6 to 35.7 ± 22.3 (p < 0.001). Moreover, 85.9% of patients reported pain improvement. Probability of no ≥ 25% improvement in QoL was significantly higher in patients ≥ 65 years old (OR 1.39; 95% CI 1.001–1.079) and patients hospitalized at baseline (OR 4.126; 95% CI 1.227–13.873). Conclusion Individualized BTcP therapy improved QoL of patients with advanced cancer. Transmucosal fentanyl at low doses was the most used drug. Trial registration This study was registered at ClinicalTrials.gov database (NCT02840500) on July 19, 2016.

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Outcomes Related to Percutaneous Nephrostomies (PCN) in Malignancy-Associated Ureteric Obstruction: A Systematic Review of the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10112354 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2354

Author(s):

Francesca J. New ◽

Sally J. Deverill ◽

Bhaskar K. Somani

Keyword(s):

Quality Of Life ◽

Advanced Cancer ◽

Previous Treatment ◽

Cochrane Library ◽

Cancer Type ◽

Ureteric Obstruction ◽

Survival Times ◽

Advanced Malignancies ◽

The Impact

Background: Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the outcomes of PCN in patients with advanced cancer and the impact on the patients’ lifespan and quality of life. Materials and Methods: A literature review was carried out for articles from 2000 to 2020 on PCN in patients with advanced malignancies, using MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library, clinicaltrials.gov, and Google Scholar. All English-language articles reporting on a minimum of 20 patients who underwent PCN for malignancy-associated ureteric obstruction were included. Results: A total of 21 articles (1674 patients) met the inclusion criteria with a mean of 60.2 years (range: 21–102 years). PCN was performed for ureteric obstruction secondary to urological malignancies (n = −633, 37.8%), gynaecological malignancies (n = 437, 26.1%), colorectal and GI malignancies (n = 216, 12.9%), and other specified malignancies (n = 205, 12.2%). The reported mean survival times varied from 2 to 8.5 months post PCN insertion, with an average survival time of 5.6 months, which depended on the cancer type, stage, and previous treatment. Conclusions: Patients with advanced malignancies who need PCN tend to have a survival rate under 12 months and spend a large proportion of this time in the hospital. Although the advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient.

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Eustachian Tube Dysfunction in Children With Adenoid Hypertrophy: The Role of Adenoidectomy for Improving Ear Ventilation

Ear Nose & Throat Journal ◽

10.1177/0145561321989455 ◽

2021 ◽

pp. 014556132198945

Author(s):

Alessandra Manno ◽

Giannicola Iannella ◽

Vincenzo Savastano ◽

Tommaso Vittori ◽

Serena Bertin ◽

...

Keyword(s):

Eustachian Tube ◽

Otitis Media With Effusion ◽

Preoperative Evaluation ◽

Mean Value ◽

Eustachian Tube Dysfunction ◽

Adenoid Hypertrophy ◽

Before And After ◽

Middle Ear Ventilation ◽

Tube Dysfunction ◽

The Impact

Introduction: To our knowledge, few papers have addressed preoperative evaluation of the impact of adenoid hypertrophy (AH) on the pathogenesis of eustachian tube dysfunction (ETD) in children with otitis media with effusion (OME). Aim: The aim of this study was 2-fold: first, to evaluate ETD using tubomanometry and Eustachian Tube Score 7 (ETS-7), in a group of children having AH; second, to assess the clinical impact of adenoidectomy on the ETD of these patients. Methods: Fifty patients, aged 4 to 15 years, underwent adenoidectomy based on various parameters: size of the adenoids causing canal obstruction (grades 1-4), the presence of OME, and recurrent episodes of rhinosinusitis. The function of the eustachian tube was evaluated using ETS-7 before and after surgical treatment. The patients were followed up for 6 months. Results: Forty children presented ETD. Of these, 36 had a grade 4 AH. The preoperative mean value for ETS-7 was 6.62. The mean postoperative ETS-7 score showed a value of 9.60 with a statistical difference compared to the preoperative value ( P = .0015). Conclusions: Adenoid hypertrophy has a high impact on the frequency of ETD. In the patients observed in the present study, the ETS-7 score appeared to be a valid tool for assessing ETD both preoperatively and postoperatively. Adenoidectomy seemed to be effective in improving ETD as well as middle ear ventilation.

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Salvage Eustachian Tube Cartilage Chip Insertion After Multiple Transnasal Shim Operations in Intractable Patulous Eustachian Tube

Ear Nose & Throat Journal ◽

10.1177/0145561321995009 ◽

2021 ◽

pp. 014556132199500

Author(s):

Wei-Ting Lee ◽

Heng-Jui Hsu

Keyword(s):

Surgical Technique ◽

Eustachian Tube ◽

Middle Ear ◽

Repeat Surgery ◽

Ear Infection ◽

Middle Ear Infection ◽

Tube Lumen ◽

Management Method ◽

Patulous Eustachian Tube

This article presents 2 cases of extremely intractable patulous Eustachian tube following multiple transnasal shim insertion. These cases highlight the disadvantages of repeat transnasal shim operations, including enlargement of the Eustachian tube lumen, frequent dislocation, repeat surgery, recurrent middle ear infection, and shim misswallowing. The patients in these cases were successfully treated with Eustachian tube cartilage chip insertion through a postauricular approach. We describe the surgical technique and advantages of this promising management method.

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Compounded trauma: A qualitative study of the challenges for refugees living with advanced cancer

Palliative Medicine ◽

10.1177/02692163211000236 ◽

2021 ◽

pp. 026921632110002

Author(s):

Ping Guo ◽

Sawsan Alajarmeh ◽

Ghadeer Alarja ◽

Waleed Alrjoub ◽

Ayman Al-Essa ◽

...

Keyword(s):

Social Support ◽

Qualitative Study ◽

Advanced Cancer ◽

Psychosocial Support ◽

Large Population ◽

Community Support ◽

Support Network ◽

Psychosocial Needs ◽

Physical And Mental Health ◽

The Impact

Background: Although palliative care is now an essential health service under Universal Health Coverage, ensuring access and appropriate care for refugees is a specific challenge for this large population. Aim: To identify the needs and experiences of adult refugees in Jordan with advanced cancer and informal caregivers. Design: A qualitative study using semi-structured interviews. Setting/participants: Participants were purposively sampled at two Jordanian hospitals to achieve heterogeneity by age, gender, country of origin, and primary diagnosis. Results: Twenty-nine refugees (22 patients, 7 caregivers) participated, and four themes were generated: (1) Psychological distress and sustaining social support. Refugees often experienced unmet psychosocial needs. However, psychosocial support was reported either absent or limited. (2) Knowledge and uncertainty. Lack of information and poor communication between healthcare providers and patients caused significant distress due to uncertainty. (3) Family anxiety and support roles. Being away from the home country cut patients and caregivers off from their wider social support network, which added increased anxiety and responsibilities to caregivers. (4) Compounded trauma and poverty. Many refugees have experienced trauma related to war that may affect their physical and mental health. They faced serious financial crises caused by the rising cost of medicines and treatment. Conclusions: This study reveals the impact of fractured families and networks on social support in advanced cancer, and the compounding trauma of the disease for refugees. Detailed person-centred assessment and emphasis on psychosocial support is essential, and home-based care should not presume community support for patients to remain at home.

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Seasonal variation of patulous Eustachian tube diagnoses using climatic and national health insurance data

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001596 ◽

2021 ◽

pp. 1-7

Author(s):

S Lee ◽

S-W Choi ◽

J Kim ◽

H M Lee ◽

S-J Oh ◽

...

Keyword(s):

Relative Risk ◽

Eustachian Tube ◽

Climatic Factors ◽

Data Sets ◽

National Data ◽

Health Insurance Data ◽

Number Of Patients ◽

Autumn And Winter ◽

Insurance Data ◽

Patulous Eustachian Tube

Abstract Objectives This study aimed to analyse if there were any associations between patulous Eustachian tube occurrence and climatic factors and seasonality. Methods The correlation between the monthly average number of patients diagnosed with patulous Eustachian tube and climatic factors in Seoul, Korea, from January 2010 to December 2016, was statistically analysed using national data sets. Results The relative risk for patulous Eustachian tube occurrence according to season was significantly higher in summer and autumn, and lower in winter than in spring (relative risk (95 per cent confidence interval): 1.334 (1.267–1.404), 1.219 (1.157–1.285) and 0.889 (0.840–0.941) for summer, autumn and winter, respectively). Temperature, atmospheric pressure and relative humidity had a moderate positive (r = 0.648), negative (r = –0.601) and positive (r = 0.492) correlation with the number of patulous Eustachian tube cases, respectively. Conclusion The number of patulous Eustachian tube cases was highest in summer and increased in proportion to changes in temperature and humidity, which could be due to physiological changes caused by climatic factors or diet trends.

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Analysis of the Impact of Personalized Nursing Service and Hospice Care on the Quality of Life of Elderly Cancer Patients

Tobacco Regulatory Science ◽

10.18001/trs.7.4.24 ◽

2021 ◽

Vol 7 (4) ◽

pp. 469-473

Author(s):

Ting Fang ◽

Nian Wang ◽

Meng Chen ◽

Hongmei Ma

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Hospice Care ◽

Pain Treatment ◽

Control Group ◽

Study Group ◽

The Difference ◽

The Impact

Objective Explore the impact of personalized nursing services and hospice care on the quality of life of elderly patients with advanced cancer. Method We selected 80 elderly cancer patients admitted to our hospital from September 2020 to May 2021, and divided these patients into a study group and a control group using a random number table method. The patients in the control group used conventional nursing methods to treat and care for the patients, and the patients in the study group used hospice care measures and combined personalized nursing measures. The quality of life and pain treatment effects of the two groups of patients before and after treatment were compared. Result Before treatment, the quality-of-life scores of the two groups of patients were low, and there was no statistical difference (P>0.05); After treatment, the quality of life of the two groups of patients improved, but compared with the control group, the improvement was more obvious in the study group, and the difference was statistically significant (P<0.05). In terms of pain treatment effect, the total effective rate of pain treatment in the study group was 87.5%, which was significantly better than the 62.5% in the control group. The difference was statistically significant (P<0.05). Conclusion Personalized nursing services and hospice care are conducive to improving the survival and treatment of elderly patients with advanced cancer, and can be used as a clinical application program for the care of advanced cancer patients.

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Age affects the efficacy of immune checkpoint inhibitors in patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.2638 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 2638-2638

Author(s):

Yongjie Wang ◽

Ronghua Yang ◽

Dong Wang ◽

Donghua Zhao ◽

Peng Li ◽

...

Keyword(s):

Lung Cancer ◽

Advanced Cancer ◽

Immune Checkpoint ◽

Older Patients ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Sign Test ◽

Patients With Cancer ◽

The Impact ◽

Effect Of Age

2638 Background: Immune checkpoint inhibitors (ICIs), such as programmed death(ligand)1 (PD-(L)1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitors, have dramatic effects on treatment in patients with various malignancies. High tumor mutation burden (TMB) is predictive of clinical response to ICI in multiple cancer types. Although age-related immune dysfunction might induce difference on the efficacy of ICIs between younger and older patients, the potential effect of age on the efficacy of ICIs remains little known and controversial. Herein, we aimed to analysis the association between age and the efficacy of ICIs based on MSKCC cohort. Methods: We screened out 1661 patients having complete information with advanced cancer, whose tumors underwent next-generation sequencing (NGS) detection and who were treated with at least one dose of ICI in MSKCC cohort. All patients were divided into two groups according to age, the younger group (age ≤50-year old) and the older group (age > 50-year old). We further analyzed the differences in overall survival (OS) and TMB between the two groups. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated via Cox regression model for OS and P-values were calculated via the Wilcoxon sign test for TMB. We analyzed the effect of age on ICI in lung cancer using the same way. Results: In 1661 patients with cancer in our study, 312 (19%) younger and 1349 (81%) older patients were found. The pooled HRs for OS was 1.28 (95% CI: 1.09-1.52) in younger group compared with older group. In 1661 patients with cancer, there was 350 (21%) patients with lung cancer, including 30 (9%) younger and 320 (91%) older patients. The pooled HRs for OS was 1.45 (95% CI: 0.95-2.23) in younger group compared with older group in lung cancer. In addition, TMB in older group was higher than in younger group and significant difference of TMB was found via the Wilcoxon sign test (p = 2.6e-10) between the two groups, especially in lung cancer (p = 1e-4). Conclusions: Our study assessed the impact of age on the efficacy of ICIs using the threshold of 50 years old for the first time and we founded that patients in older group had higher TMB and longer OS than younger group.

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Adaptation and Psychometric Evaluation of the Parenting Concerns Questionnaire—Advanced Disease

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211049801 ◽

2021 ◽

pp. 104990912110498

Author(s):

Eliza M. Park ◽

Mian Wang ◽

Savannah M. Bowers ◽

Anna C. Muriel ◽

Paula K. Rauch ◽

...

Keyword(s):

Functional Status ◽

Advanced Cancer ◽

Internal Consistency ◽

Convergent Validity ◽

Advanced Disease ◽

Full Range ◽

Psychometric Evaluation ◽

Face Validity ◽

Concept Elicitation ◽

The Impact

Purpose: When patients with advanced cancer have minor children (age < 18), their health-related quality of life is closely linked to their concerns about the impact of progressive illness and death on their children. The Parenting Concerns Questionnaire (PCQ), a validated measure for parents with cancer, does not capture the full range of concerns in advanced cancer. The aim of this was study was to adapt and establish psychometrics for the PCQ for advanced disease (PCQ-AD). Methods: After generating an initial item-bank, we conducted concept elicitation interviews with clinicians (n = 8) and cognitive interviews with patients (n = 23) for face validity. New items addressed concerns about impact of parental death, making every moment count, communication, and financial impact of cancer on children. We administered 21 candidate items to 151 parents with advanced cancer. We conducted confirmatory factor analysis (CFA), calculated internal consistency, and assessed convergent and known-groups validity. Results: We removed 8 redundant items due to residual covariation between items. CFA of the 13-item PCQ-AD demonstrated satisfactory fit (CFI = 0.971, TLI = 0.966, RMSEA = 0.081) and high internal consistency (Cronbach’s alpha = 0.94, composite reliability = 0.95). The PCQ-AD demonstrated convergent validity and known-groups validity; patients with poor functional status reported higher scores than patients with better functional status (Cohen’s d = 0.56, p = 0.002). Conclusion: Adaptation of the PCQ yielded the addition of constructs important in advanced cancer. The PCQ-AD appears to be a reliable and valid measure of parenting concerns in advanced cancer, but future studies are needed to examine measure performance in diverse populations and responsiveness of the PCQ-AD to interventions.

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