scholarly journals Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate

2021 ◽  
Vol 8 ◽  
Author(s):  
René López ◽  
Rodrigo Pérez-Araos ◽  
Fernanda Baus ◽  
Camila Moscoso ◽  
Álvaro Salazar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Lower Survival Rate ◽  
Lower Survival ◽  
And Performance ◽  
Lactate Levels ◽  
Definition Of ◽  
Sepsis And Septic Shock

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

Development and validation of a risk prediction model for poor performance status and severe symptoms among cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12097-12097
Author(s):  
Hsien Seow ◽  
Peter Tanuseputro ◽  
Lisa Catherine Barbera ◽  
Craig Earle ◽  
Dawn Guthrie ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Index Date ◽  
Performance Status ◽  
Poor Performance ◽  
Population Based ◽  
Assessment System ◽  
Poor Performance Status ◽  
Secondary Outcomes ◽  
And Performance ◽  
Over Time

12097 Background: Existing cancer predictive tools focus on survival, but few incorporate patient-reported outcomes to predict quality-of-life domains, such as symptoms and performance status. The objective was to develop and validate a predictive cancer model (called PROVIEW) for poor performance status and severe symptoms over time. Methods: We used a retrospective, population-based, cohort study of patients, with a cancer diagnosis, in Ontario, Canada between 2008-2015. We randomly selected 60% of patients for model derivation and 40% for validation. Using the derivation cohort, we developed multivariable logistic regression models with baseline characteristics, using a backward stepwise variable selection process. The primary outcome was odds of having poor performance status six months from index date, as measured by a score < = 30 out of 100 on the Palliative Performance Scale. The index date for each model was diagnosis (Year 0), which was then re-calculated at each of 4 annual survivor marks after diagnosis (up to Year 4). Secondary outcomes included having severe pain, dyspnea, well-being, or depression, as measured by a score of > = 7 out of 10 on the Edmonton Symptom Assessment System. Covariates included demographics, clinical information, current symptoms and performance status, and healthcare utilization. Model performance was assessed by AUC statistics and calibration plots. Results: Our population-based cohort identified 125,479 cancer patients for the performance status model in Year 0. The median diagnosis age was 64 years, 57% were female, and the most common cancers were breast (24%), lung (13%), and prostate (9%). 32% had Stage 3 or 4 disease. In Year 0 after backwards selection, the odds of having a poor performance status in 6 months was increased by more than 10% when the patient had: COPD, dementia, diabetes; radiation treatment; a hospital admission in the prior 3 months; high pain or depression; a current performance status < = 30; any issues with appetite; or received end-of-life homecare. Generally, these variables were also associated with a > 10% increased odds in other years and for the secondary outcomes. The average AUC across all 25 models is 0.7676 which indicates high model discrimination. Conclusions: The PROVIEW model accurately predicts risk of having a poor performance status or severe symptoms over time among cancer patients. It has the potential to be a useful online tool for patients to integrate earlier supportive and palliative care.

scholarly journals Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies.

1986 ◽  
Vol 4 (9) ◽  
pp. 1348-1355 ◽  
Author(s):  
J A Levi ◽  
R M Fox ◽  
M H Tattersall ◽  
R L Woods ◽  
D Thomson ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Performance Status ◽  
Single Agent ◽  
Locally Advanced ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Measurable Disease ◽  
Duration Of Response ◽  
And Performance

A multi-institutional cooperative study of patients with locally advanced, recurrent, or metastatic gastric adenocarcinoma who had not previously received chemotherapy was conducted, prospectively randomizing patients to receive either doxorubicin or the three-drug combination, 5-fluorouracil (5-FU), doxorubicin (Adriamycin; Adria Laboratories, Columbus, Ohio), and BCNU (FAB). The 187 evaluable patients were initially stratified according to the presence of measurable or evaluable disease and performance status. There was a significantly higher response rate observed for FAB (40%) compared with doxorubicin (13%) among the 145 measurable-disease patients. Duration of response and survival were significantly longer for FAB in the measurable-disease group, but for the total patient population an early advantage for FAB in time to disease progression and survival was lost with continued follow-up. Median survival was 33 weeks for patients receiving FAB and 19 weeks for those receiving doxorubicin. Significant pretreatment factors adversely affecting survival included poor performance status, weight loss of greater than 10%, and more than two sites of metastases. Toxicity was not severe in either treatment arm, and only thrombocytopenia occurred significantly more often with FAB. It is contended that in the treatment of advanced gastric cancer, chemotherapy only exerts a relatively short-term and modest beneficial effect, most apparent in patients with intermediate tumor bulk. 5-FU remains the most active single agent, and combination chemotherapy has not yet proven its overall worth. Further studies are indicated comparing the most active combinations with 5-FU using optimal doses and schedules, and consideration must be given to the incorporation of no-treatment controls.

scholarly journals Efficacy of lorlatinib treatment in ALK-rearrangement lung cancer with severe symptomatic central nervous system metastases and poor performance status

2020 ◽  
Author(s):  
Tomoyo Taketa ◽  
Takahito Nakamura
Keyword(s):  
Kinase Inhibitor ◽  
Performance Status ◽  
Poor Performance ◽  
Small Cell ◽  
Poor Performance Status ◽  
Cns Metastases ◽  
Alk Rearrangement ◽  
Anaplastic Lymphoma ◽  
Central Nervous System Metastases ◽  
And Performance

Lorlatinib is a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) designed to penetrate the blood brain barrier. We report 2 cases of patients with ALK-rearrangement non-small cell carcinoma associated with severe symptomatic CNS metastases and poor performance status. Treatment with lorlatinib improved their neurological condition and performance status.

scholarly journals COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic

2021 ◽  
Author(s):  
Alvin J. X. Lee ◽  
Karin Purshouse
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Poor Performance ◽  
Cancer Registries ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Poor Performance Status ◽  
International Studies ◽  
Patients With Cancer ◽  
Increased Risk

AbstractThe SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT—chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.

scholarly journals Clinical indicators for the incidence of postoperative ileus after elective surgery for colorectal cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yosuke Namba ◽  
Yuzo Hirata ◽  
Shoichiro Mukai ◽  
Sho Okimoto ◽  
Seiji Fujisaki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Body Weight ◽  
Postoperative Ileus ◽  
Elective Surgery ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Clinical Indicators ◽  
Patient Morbidity ◽  
Two Factors

Abstract Background The occurrence of postoperative ileus leads to increased patient morbidity, longer hospitalization, and higher healthcare costs. No clear policy on postoperative ileus prevention exists. Therefore, we aim to evaluate the clinical factors involved in the development of postoperative ileus after elective surgery for colorectal cancer. Methods We retrospectively analyzed patients who underwent elective surgery involving bowel resection with or without re-anastomosis for colon cancer between April 2015 and March 2020. The primary readout was the presence or absence of postoperative ileus. Univariate and multivariate analyses were used to identify pre- and intraoperative risk factors, and the incidence of postoperative ileus was assessed using independent factors. Results Postoperative ileus occurred in 48 out of 356 patients (13.5%). In multivariate analysis, male sex poor performance status, and intraoperative in–out balance per body weight were independently associated with postoperative ileus development. The incidence of postoperative ileus was 2.5% in the cases with no independent factors; however, it increased to 36.1% when two factors were observed and 75.0% when three factors were matched. Conclusions We discovered that male gender, poor performance status, and intraoperative in–out balance per body weight were associated with the development of postoperative ileus. Of these, intraoperative in–out balance per body weight is a controllable factor. Hence it is important to control the intraoperative in–out balance to lower the risk for postoperative ileus.

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