Optimization of treatment for postoperative peritonitis in patients with stage IV cancer

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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Incidence of Severe Pain in Newly Diagnosed Ambulatory Patients with Stage IV Cancer

Pain Research and Management ◽

10.1155/2012/542354 ◽

2012 ◽

Vol 17 (5) ◽

pp. 347-352 ◽

Cited By ~ 5

Author(s):

Thomas Isaac ◽

Sherri O Stuver ◽

Roger B Davis ◽

Susan Block ◽

Jane C Weeks ◽

...

Keyword(s):

Head And Neck ◽

Severe Pain ◽

Stage Iv ◽

Initial Visit ◽

Newly Diagnosed ◽

Ambulatory Oncology ◽

Ambulatory Patients ◽

Stage Iv Cancer ◽

One Year ◽

Thoracic Malignancies

BACKGROUND: Pain is common among cancer patients.OBJECTIVE: To characterize the incidence of severe pain among newly diagnosed patients with stage IV cancer in ambulatory care.METHODS: A retrospective cohort of 505 ambulatory oncology patients with newly diagnosed stage IV solid tumours at a comprehensive cancer centre (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) was followed from January 1, 2004, to December 31, 2006. Pain intensity scores were extracted from electronic medical records. The incidence of severe pain was calculated using the maximum monthly pain scores reported at outpatient visits.RESULTS: Of the 505 patients included in the present study, 340 (67.3%) were pain-free at the initial visit, 90 (17.8%) experienced mild pain, 48 (9.5%) experienced moderate pain and 27 (5.4%) experienced severe pain. At least one episode of severe pain within one year of diagnosis was reported by 29.1% of patients. Patients with head and neck, gastrointestinal and thoracic malignancies were more likely to experience severe pain compared with patients with other types of cancer (52.6%, 33.9% and 30.5%, respectively). In the multivariable model, patients whose primary language was not English (OR 2.90 [95% CI 1.08 to 7.80]), patients who reported severe pain at the initial visit (OR 9.30 [95% CI 3.72 to 23.23]) and patients with head and neck (OR 10.17 [95% CI 2.87 to 36.00]) or gastrointestinal (OR 4.05 [95% CI 1.23 to 13.35]) cancers were more likely to report severe pain in the following year.CONCLUSIONS: The incidence of severe pain was high in ambulatory patients with newly diagnosed stage IV cancer.

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Stage at cancer diagnosis during the COVID-19 pandemic in western Washington state.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.145 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 145-145

Author(s):

Catherine R. Fedorenko ◽

Karma L. Kreizenbeck ◽

Li Li ◽

Laura Elizabeth Panattoni ◽

Veena Shankaran ◽

...

Keyword(s):

Medical Care ◽

Early Stage ◽

Stage Iv ◽

Washington State ◽

Stage I ◽

Tumor Type ◽

Stage At Diagnosis ◽

Stage Iv Cancer ◽

Using Data ◽

The Impact

145 Background: The COVID-19 pandemic disrupted medical care, including routine cancer screening for breast, colorectal, lung and cervical cancers. We aimed to investigate the impact of the pandemic on stage at diagnosis for cancer patients. Methods: Using data from the Washington State SEER records we compared AJCC stage for patients diagnosed with cancer in 2017-2019 to 2020 for two time periods, March to June (initial pandemic months) and July to December (later pandemic months). Patients were included if they were age 18+, diagnosed with a solid tumor, and not diagnosed at autopsy. Results: In the early phase of the pandemic, March – June 2020, there was a shift to cancers being diagnosed at a later stage compared to the same time period in 2017-2019 (Stage III: 13.5% to 14.9%, Stage IV: 16.2% to 19.7%). There was also a decrease in cancer diagnoses for cancers that are often detected through routine screening. As a percentage of all cancer diagnoses, both melanoma (13.2% to 9.8%) and colon cancer diagnoses (7.2% to. 6.7%) decreased during the early pandemic. In the later phase of the pandemic, July to December 2020, the stage at diagnosis showed an indication of returning to pre-pandemic levels with an increase in the proportion of early stage cancers (In situ: 16.6% to 19.3%, Stage I: 38.8% to 41.1%). Stage at diagnosis trends varied by tumor type. For colorectal cancer, the overall number of diagnoses decreased during the initial pandemic months. Stage I diagnoses decreased and Stage IV cancer diagnoses increased in both early and late stages of the pandemic. Conclusions: In Washington State, the COVID-19 pandemic had an impact on stage at diagnosis potentially caused by delays or interruptions in medical care. Additional studies are needed to understand how this shift in stage at diagnosis impacted treatment and outcomes for patients.

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Perubahan Status Koagulasi Pasien Kanker Padat Pasca Kemoterapi di Indonesia: Sebuah Studi Prospektif

Jurnal Penyakit Dalam Indonesia ◽

10.7454/jpdi.v7i1.387 ◽

2020 ◽

Vol 7 (1) ◽

pp. 2

Author(s):

Noorwati Sutandyo ◽

Lyana Setiawan

Keyword(s):

Cancer Patients ◽

Prospective Cohort ◽

Stage Iv ◽

Stage Iii ◽

Solid Cancer ◽

Significant Difference ◽

Before And After ◽

Coagulation Status ◽

Stage Iv Cancer ◽

D Dimer

Pendahuluan. Hiperkoagulasi merupakan faktor yang mendasari tingginya mortalitas akibat kejadian tromboemboli vena pada pasien kanker. Kemoterapi merupakan salah satu faktor yang diduga berkontribusi terhadap status hiperkoagulasi pada pasien kanker. Studi ini bertujuan untuk mengevaluasi perubahan status koagulasi yang ditandai dengan kadar D-dimer pada pasien kanker yang menjalani kemoterapi.Metode. Studi ini merupakan studi kohort prospektif di Pusat Kanker Nasional Indonesia yang melibatkan pasien kanker yang sudah terkonfirmasi melalui pemeriksaan histopatologi, dan memulai kemoterapi pada periode Mei hingga Juli 2018. Perubahan status koagulasi dinilai melalui kadar D-dimer plasma. Kadar D-dimer diukur sebelum dan 7 hari setelah kemoterapi. Analisis statistik menggunakan uji t berpasangan untuk menilai kemaknaan perubahan kadar D-dimer plasma sebelum dan setelah kemoterapi.Hasil. Sejumlah 89 pasien memenuhi kriteria inklusi, yang mana 74,2% adalah perempuan dan hampir separuh dari keseluruhan subjek terdiagnosis kanker payudara (44,9%). Mayoritas subjek (69,6%) terdiagnosis pada stadium III atau IV. Sejumlah 12,4% dari subjek mendapatkan kemoterapi berbasis cisplatin. Terdapat perbedaan yang bermakna antara kadar D-dimer sebelum dan setelah kemoterapi (p = 0,05). Studi ini juga menemukan perbedaan bermakna kadar D-dimer sebelum dan sesudah kemoterapi pada pasien kanker stadium III (t(35) = 2,48, p = 0,02) dan stadium IV (t(25) = 2,14, p = 0,04). Tidak terdapat perbedaan bermakna antara kadar D-dimer sebelum dan setelah kemoterapi pada pasien stadium I dan II. Analisis lanjutan berdasarkan kelompok kemoterapi menunjukkan bahwa terdapat perubahan kadar D-dimer yang bermakna pada kelompok yang mendapatkan kemoterapi cisplatin (t(10) = 2,31, p = 0,04), namun tidak pada kelompok yang mendapat kemoterapi non-cisplatin (t(77) = 1,50, p = 0,14).Simpulan. Terdapat perbedaan bermakna status koagulasi yang ditandai dengan kadar D-dimer 7 hari pasca mendapatkan kemoterapi, khususnya pada pasien kanker stadium III atau IV dan mendapatkan kemoterapi berbasis cisplatin. Kata Kunci: Cisplatin, kanker, kemoterapi, status koagulasiChange of Coagulation Status in Solid Cancer Patients Undergoing Chemotherapy in Indonesia: A Prospective Cohort StudyIntroduction. Cancer-associated hypercoagulability was an underlying factor of high mortality of cancer due to venous thromboembolism. Chemotherapy is proposed as one of the contributing factors of the hypercoagulable state. We aim to evaluate the change of coagulation status, which was marked by D-dimer level, in cancer patients receiving chemotherapy.Methods. This is a prospective cohort study in Indonesian national cancer center which involves all adult histologically-confirmed-cancer patients who started chemotherapy between May and July 2018. The coagulation status is assessed by plasma of D-dimer level. We measured D-dimer before chemotherapy and one week after chemotherapy. Paired t-test was performed to assess the significant difference in D-dimer levels before and after chemotherapy.Results. A total of 89 patients fulfilled the eligibility criteria, of whom 74.2% were female and almost half of total subjects (44.9%) were breast cancer patients. Majority of subjects (69.6%) were stage III or stage IV cancer. There were 12.4% of subjects received cisplatin-based chemotherapy. There was a marginally significant difference in plasma level of D-dimers before and after chemotherapy (p = 0.05). We also found significant differences between D-dimer level before and after chemotherapy in stage III patients (t(35) = 2.48, p = 0.02) and stage IV patients (t(25) = 2.14, p = 0.04). There was no significant difference between D-dimer level before and after chemotherapy in stage I and stage II patients. Subgroup analyses based on chemotherapy agents showed that there was significant D-dimer change in cisplatin-based chemotherapy subjects (t(10) = 2.31, p = 0.04), but not in non-cisplatin-based chemotherapy subjects (t(77) = 1,50, p = 0.14).Conclusion. Compared to before chemotherapy, there is a significant difference of coagulation status marked by plasma D-dimer level one week after chemotherapy, particularly in patients with stage III or stage IV cancer and in patients receiving cisplatin-based chemotherapy.

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Comprehensive molecular and phenotypic profiling of end-stage IV cancer identifies treatable targets and improves survival in individual patients

Annals of Oncology ◽

10.1093/annonc/mdx511.026 ◽

2017 ◽

Vol 28 ◽

pp. vii22

Author(s):

A. Samsen ◽

S. Schneider ◽

S. Von Der Heyde ◽

W. Saeger ◽

B. Grebenstein ◽

...

Keyword(s):

Stage Iv ◽

Stage Iv Cancer ◽

End Stage

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Comparison of common risk stratification indices to predict outcomes among stage IV cancer patients with bowel obstruction undergoing surgery

Journal of Surgical Oncology ◽

10.1002/jso.24866 ◽

2017 ◽

Vol 117 (3) ◽

pp. 479-487 ◽

Cited By ~ 8

Author(s):

Sarah B. Bateni ◽

Richard J. Bold ◽

Frederick J. Meyers ◽

Daniel J. Canter ◽

Robert J. Canter

Keyword(s):

Risk Stratification ◽

Cancer Patients ◽

Bowel Obstruction ◽

Stage Iv ◽

Stage Iv Cancer

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How, when, and why individuals with stage IV cancer seen in an outpatient setting are referred to palliative care: a mixed methods study

Supportive Care in Cancer ◽

10.1007/s00520-020-05492-z ◽

2020 ◽

Vol 29 (2) ◽

pp. 669-678 ◽

Cited By ~ 1

Author(s):

Ellis C. Dillon ◽

Amy Meehan ◽

Jinnan Li ◽

Su-Ying Liang ◽

Steve Lai ◽

...

Keyword(s):

Palliative Care ◽

Mixed Methods ◽

Stage Iv ◽

Outpatient Setting ◽

Mixed Methods Study ◽

Stage Iv Cancer

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Increase in Carbohydrate Antigen 19-9 Levels without Tumor Progression after Polaprezinc Administration that Induced Deep Vein Thrombosis in a Colon Cancer Patient

Chemotherapy ◽

10.1159/000503221 ◽

2019 ◽

Vol 64 (3) ◽

pp. 163-166 ◽

Cited By ~ 1

Author(s):

Masahito Naito ◽

Ryota Torii ◽

Yuki Hashimoto ◽

Yuki Kawamoto ◽

Kenichi Hayashi ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Progressive Disease ◽

Reference Range ◽

Stage Iv ◽

Carbohydrate Antigen ◽

Vein Thrombosis ◽

Stage Iv Cancer ◽

Third Line ◽

Deep Vein ◽

Resistance To Chemotherapy

Carbohydrate antigen 19-9 (CA 19-9) is a well-known tumor marker of adenocarcinoma (reference range, 37 U/mL). It can also be used, together with computed tomography, to monitor responses and resistance to chemotherapy in cancer patients. False elevation of CA 19-9 levels is often seen in conditions such as biliary tract obstruction and cholangitis. However, whether medication might induce false elevation of CA 19-9 levels has not yet been reported. A 74-year-old man was treated with third-line CPT-11 (irinotecan) plus panitumumab for stage IV cancer of the ascending colon. The patient developed chemotherapy-induced dysgeusia and was treated with polaprezinc. After polaprezinc administration, his CA 19-9 levels gradually increased from 18.9 to 1,699.4 U/mL. He developed deep vein thrombosis (DVT), although it was not associated with progressive disease or metastasis. Upon discontinuation of polaprezinc, CA 19-9 levels gradually decreased. This case demonstrates that polaprezinc may not only induce false elevation of CA 19-9 levels but also cause development of DVT induced by increased CA 19-9 levels, both of which are very rare events.

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Association between chronic kidney disease and mortality in stage IV cancer

International Journal of Clinical Oncology ◽

10.1007/s10147-020-01715-9 ◽

2020 ◽

Vol 25 (9) ◽

pp. 1587-1595

Author(s):

Taisuke Ishii ◽

Takuya Fujimaru ◽

Eriko Nakano ◽

Osamu Takahashi ◽

Masaaki Nakayama ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Stage Iv ◽

Stage Iv Cancer

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Advance Directive and Do-Not-Resuscitate Status among Advanced Cancer Patients with Acute Care Surgical Consultation

The American Surgeon ◽

10.1177/000313481808401005 ◽

2018 ◽

Vol 84 (10) ◽

pp. 1565-1569

Author(s):

Lobsang Marcia ◽

Zane W. Ashman ◽

Eric B. Pillado ◽

Dennis Y. Kim ◽

David S. Plurad

Keyword(s):

Length Of Stay ◽

Cancer Patients ◽

Acute Care ◽

Metastatic Cancer ◽

Stage Iv ◽

Acute Care Surgery ◽

Do Not Resuscitate ◽

Stage Iv Cancer ◽

Care Surgery ◽

Dnr Orders

Formal communication of end-of-life preferences is crucial among patients with metastatic cancer. Our objective is to describe the prevalence of advance directives (AD) and do-not-resuscitate (DNR) orders among stage IV cancer patients with acute care surgery consultations, and the associated outcomes. This is a single institution retrospective review over an eight-year period. Two hundred and three patients were identified; mean age was 55.3 ± 11.4 years and 48.8 per cent were male. Fifty (24.6%) patients underwent exploratory surgery. Nineteen (10.6%) patients had another type of surgery. Twenty-one (10.3%) patients had a DNR order, and none had an AD on-admission. Fifty-four (26.6%) patients had a DNR order placed and four (2%) patients completed an AD postadmission. DNR postadmission was associated with the highest mortality at 42.6 per cent compared with 14.3 per cent for DNR on-admission and 1.56 per cent for full-code patients ( P < 0.001). Compared with patients that remained full-code and those with DNR on-admission, DNR postadmission was associated with longer length of stay (19.6 days; P < 0.001) and ICU length of stay (7.72 days; P < 0.001). The prevalence of AD and DNR orders among stage IV cancer patients is low. The higher in-hospital mortality of patients with DNR postadmission reflects the use of DNR orders during clinical decline.

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