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1.
Maria E. Suarez-Almazor Prashanth Peddi Ruili Luo Hoang T. Nguyen Linda S. Elting 《Supportive care in cancer》2014,22(2):537-544
Background
Men with prostate cancer who undergo androgen deprivation therapy (ADT) are at risk for bone loss and fractures. Our objective was to determine if Medicare beneficiaries with prostate cancer in the state of Texas underwent DXA scans when initiating ADT.Methods
We identified men diagnosed with prostate cancer between 2005 and 2007 in the Texas Cancer Registry/Medicare linked database, and who received parenteral ADT or orchiectomy. We identified DXA claims within 1 year before or 6 months after starting ADT. We examined use of bone conservation agents in the subgroup of patients enrolled in Medicare Part D. Multivariate logistic regression models were used to examine determinants of DXA use.Results
The analysis included 2,290 men (2,262 parenteral ADT, 28 orchiectomy); 197 (8.6 %) underwent DXA within 1 year before and 6 months after starting ADT. Men aged 75 years or older were more likely to undergo DXA than men aged 66–74 years (OR 1.5; 95 % CI 1.1–2.1). Those living in small urban areas were less likely to undergo DXA than those in big areas (OR 0.40; 95 % CI 0.19–0.82). Of the 1,060 men enrolled in Medicare part D, 59 (5.6 %) received bone conservation agents when starting ADT; 134 (12.6 %) either received bone conservation agents or underwent DXA.Conclusions
Fewer than one in ten Medicare beneficiaries with prostate cancer initiating ADT underwent a DXA exam. Variation in utilization was also related to residence area size. Further research is needed to identify whether the use of DXA in patients with prostate cancer receiving ADT will result in fracture prevention. 相似文献2.
Benjamin A. Spencer Beverly J. Insel Dawn L. Hershman Mitchell C. Benson Alfred I. Neugut 《Supportive care in cancer》2013,21(5):1303-1311
Objectives
Palliative issues are an important but understudied issue for patients with advanced cancer. Ureteral obstruction is a complication of advanced prostate cancer, usually relieved with placement of retrograde ureteral stent (RUS) or percutaneous nephrostomy (PCN) to palliate symptoms associated with obstructive uropathy and/or renal failure. We investigated predictors of receipt of RUS and PCN and their association with survival for older advanced prostate cancer patients.Methods
Using the Surveillance, Epidemiology, and End Results–Medicare database, we identified patients aged 65 or older with stage IV (n?=?10,848) or recurrent (n?=?7,872) prostate cancer. We used multivariable analysis to compare those with ureteral obstruction treated with RUS or PCN to those not treated and to analyze the association between RUS, PCN, and survival.Results
Sixteen percent (n?=?2,958) of the sample developed ureteral obstruction. Compared to no treatment, African Americans were more likely to undergo placement of PCN [odds ratio 1.48, 95 % confidence intervals (CI) 1.03–2.13] than Whites, but equally likely to receive a stent. Subjects of >80 years were less likely to undergo RUS (ages 80–84, 0.41, 95 % CI 0.27–0.63; ages ≥85, 0.30, 95 % CI 0.16–0.54) compared to patients 65–69 years. Subjects who received a PCN were 55 % more likely to die than those who were untreated. There was no difference in survival among those receiving RUS vs untreated. Nine percent of subjects received RUS or PCN within 30 days of dying.Conclusions
This is the first population-based study to demonstrate a racial disparity in the palliative treatment of advanced prostate cancer. Reasons for disparate care need to be determined so that interventions may be developed. 相似文献3.
Justin P. Turner Sepehr Shakib Nimit Singhal Jonathon Hogan-Doran Robert Prowse Sally Johns J. Simon Bell 《Supportive care in cancer》2014,22(7):1727-1734
Purpose
Polypharmacy has been associated with drug–drug interactions, adverse drug events, hospitalisation and increased mortality. The purpose of this study was to investigate the prevalence and factors associated with polypharmacy in older people with cancer.Patients and methods
Patients aged ≥70 years (n?=?385) presenting to the medical oncology outpatient clinic at Royal Adelaide Hospital between January 2009 and July 2010 completed a structured data collection instrument. The instrument included domains related to medications, diagnoses, instrumental activities of daily living (IADLs), Karnofsky Performance Scale (KPS), physical function (SF-36), pain (ten-point visual analogue scale, VAS), weight loss (patient self-reported over previous 6 months), exhaustion (CES-D) and distress (ten-point VAS). Frailty was computed using Fried’s frailty phenotype. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the association between polypharmacy (defined as five or more self-reported daily medications) and clinical parameters.Results
Polypharmacy was present in 57 % (n?=?221) of patients. When adjusting for age, gender and Charlson Comorbidity Index (CCI), polypharmacy was associated with being pre-frail (OR?=?2.35, 95%CI?=?1.43–3.86) and frail (OR?=?4.48, 95%CI?=?1.90–10.54) compared to being robust. When adjusting for age, gender, exhaustion, KPS, IADLs, pain and distress, polypharmacy was associated with higher CCI scores (OR?=?1.58, 95%CI?=?1.29–1.94) and poorer physical function (OR?=?1.13, 95%CI?=?1.06–1.20).Conclusions
Polypharmacy is highly prevalent in older people with cancer and associated with impaired physical function and being pre-frail and frail compared to being robust. Research is needed to identify strategies to minimize patients’ medication regimens. 相似文献4.
Ingrid J. Rowlands Christina Lee Vanessa L. Beesley Penelope M. Webb On behalf of the Australian National Endometrial Cancer Study Group 《Supportive care in cancer》2014,22(10):2715-2723
Purpose
We examined whether sociodemographic, physical, reproductive, psychological and clinical factors at the time of diagnosis were related to women’s sexual well-being 3–5 years following treatment for endometrial cancer.Methods
Of the 1,399 women in the Australian National Endometrial Cancer Study, 644 completed a follow-up questionnaire 3–5 years after diagnosis. Of these, 395 women completed the Sexual-Function Vaginal Changes Questionnaire, which was used to assess sexual well-being. Based on two questions assessing worry and satisfaction with their sexuality, women were classified into lower and higher sexual well-being. Multivariable-adjusted logistic regression models were used to examine sexual well-being 3–5 years following cancer treatment and the factors associated with this at diagnosis and at follow-up.Results
Of the 395 women, 46 % (n?=?181) were categorized into the “higher” sexual well-being group. Women who were older (odds ratio [OR]?=?1.97; 95 % confidence limit [CI], 1.23–3.17), high school educated (OR?=?1.75; 95 % CI, 1.12–2.73), who reported good mental health at the time of diagnosis (OR?=?2.29; 95 % CI, 1.32–3.95) and whose cancer was treated with surgery alone (OR?=?1.93; 95 % CI, 1.22–3.07) were most likely to report positive sexual well-being. At 3–5 years post-diagnosis, women with few symptoms of anxiety (OR?=?2.28; 95 % CI, 1.21–4.29) were also most likely to report positive sexual well-being.Conclusions
Psychological, sociodemographic and treatment factors are important to positive sexual well-being post-cancer. Care that focuses on maintaining physical and psychosocial aspects of women’s lives will be more effective in promoting positive sexual well-being than care that focuses solely on physical function. 相似文献5.
Sina Vatandoust Rohit Joshi Kenneth B. Pittman Adrian Esterman Vy Broadbridge Jacqueline Adams Nimit Singhal Susan Yeend Timothy Jay Price 《Supportive care in cancer》2014,22(2):513-518
Background
Prolonged neurotoxicity after systemic chemotherapy has the potential to impact on quality of life. We explored the frequency of persistent peripheral neuropathy in patients who received oxaliplatin for colorectal cancer at two local centres.Patients and methods
Questionnaires were sent to patients who completed treatment with oxaliplatin for colorectal cancer at least 20 months prior to entering the study. Neuropathy questions were adapted from the FACT/GOG-Ntx (V.4) questionnaire.Results
Of the 56 eligible patients, 27 returned the questionnaire. Twenty-five patients (93 %) experienced neuropathic symptoms during their treatment; 11 had grade-2, and two had grade-3 symptoms. At the time of completing the questionnaire, 17 patients (63.0 %; 95%CI 43.9–79.4 %) were still symptomatic with 12 patients (44.4 %; 95%CI 26.8–63.3) having grade-2 or grade-3 symptoms and three patients (11.1 %; 95%CI 2.9–27.3) having grade-3 neuropathic symptoms. Participants who received more than 900 mg/m2 oxaliplatin had a significantly higher risk of persistent grade-2 or grade-3 neuropathy (p?=?0.031, RR?=?8.3 95%CI?=?1.2–57.4). There was a trend toward increased risk of persistent neuropathy of any grade among participants with a history of regular alcohol use (p?=?0.051; RR?=?1.7 95%CI 1.0–2.8).Conclusion
Persistent oxaliplatin-induced neuropathy is not as uncommon as previously suggested, and the rate of grade-2 and grade-3 symptoms could be considerably higher than previous reports. 相似文献6.
Yen-Nien Lin Yen-Jung Chang Yin-Huei Chen Po-Yen Ko Cheng-Li Lin Fung-Chang Sung Kuan-Cheng Chang Chia-Hung Kao 《Supportive care in cancer》2014,22(10):2707-2713
Aims/introduction
Patients with malignancy are suggestive of having a tendency toward an association with vascular thrombosis risk. The aim of this study was to evaluate the possible relationship between malignancy and the risk of acute coronary syndrome (ACS) in Taiwan.Materials and methods
We used data from the National Health Insurance (NHI) system of Taiwan to assess the issue. Cox proportional hazards regression analysis was conducted to estimate the effects of malignancy on the risk of ACS.Results
ACS risk in patients with malignancies was marginally significantly greater when adjusted for age, sex (hazard ratio (HR)?=?1.09, 95 % confidence interval (CI)?=?0.99–1.20), and comorbidities (HR?=?1.03, 95 % CI?=?0.93–1.13). A subgroup analysis indicated that patients with prostate cancer and head and neck cancer (HEENT) had a significantly higher risk of ACS (HR?=?1.30, 95 % CI?=?1.01–1.67; HR?=?3.03, 95 % CI?=?1.47–6.50).Conclusions
We suggest careful surveillance of ACS symptoms and regular electrocardiography during follow-up of these patients. However, further large-scale studies for patients with prostate and HEENT cancer and cancer survivors (especially from post-hormone or radiotherapy) are needed. 相似文献7.
8.
Robert R. Flavell Antonio C. Westphalen Carmin Liang Christopher C. Sotto Susan M. Noworolski Daniel B. Vigneron Zhen J. Wang John Kurhanewicz 《Abdominal imaging》2014,39(5):1027-1035
Purpose
To determine the ability of multiparametric MR imaging to predict disease progression in patients with prostate cancer managed by active surveillance.Methods
Sixty-four men with biopsy-proven prostate cancer managed by active surveillance were included in this HIPPA compliant, IRB approved study. We reviewed baseline MR imaging scans for the presence of a suspicious findings on T2-weighted imaging, MR spectroscopic imaging (MRSI), and diffusion-weighted MR imaging (DWI). The Gleason grades at subsequent biopsy were recorded. A Cox proportional hazard model was used to determine the predictive value of MR imaging for Gleason grades, and the model performance was described using Harrell’s C concordance statistic and 95% confidence intervals (CIs).Results
The Cox model that incorporated T2-weighted MR imaging, DWI, and MRSI showed that only T2-weighted MR imaging and DWI are independent predictors of biopsy upgrade (T2; HR = 2.46; 95% CI 1.36–4.46; P = 0.003—diffusion; HR = 2.76; 95% CI 1.13–6.71; P = 0.03; c statistic = 67.7%; 95% CI 61.1–74.3). There was an increasing rate of Gleason score upgrade with a greater number of concordant findings on multiple MR sequences (HR = 2.49; 95% CI 1.72–3.62; P < 0.001).Conclusions
Abnormal results on multiparametric prostate MRI confer an increased risk for Gleason score upgrade at subsequent biopsy in men with localized prostate cancer managed by active surveillance. These results may be of help in appropriately selecting candidates for active surveillance. 相似文献9.
Mazzotti E Antonini Cappellini GC Buconovo S Morese R Scoppola A Sebastiani C Marchetti P 《Supportive care in cancer》2012,20(10):2553-2557
Background
Cancer leads to a complicated pattern of change in quality of life (QoL).Objective
The aims of this study were to assess the impact of treatment-related side effects on QoL in cancer patients and to explore which other factors, and to what extent, contribute to explain low QoL scores.Methods
One hundred twenty-three cancer patients receiving chemotherapy completed the self-administered questionnaires (Medical Outcomes Short-Form-36 (SF-36) and 12-item General Health Questionnaire). Multiple regression analyses were conducted with the SF-36 physical component summary (PCS) and SF-36 mental component summary (MCS) scores as the dependent variables and demographic and clinical factors as independent variables.Results
Seventy-two percent of patients experienced treatment-related side effects, and 32% resulted positive for psychiatric diseases. Two multivariate analyses showed that worse PCS scores, like worse MCS scores, were significantly and independently predicted by treatment-related side effects (odds ratio (OR)?=?5.00, 95%CI 1.29–19.45; OR?=?8.08, 95%CI 2.03–32.22, respectively) and changes in health over the last 12?months (OR =2.34, 95%CI 1.47–3.76; OR?=?3.21, 95%CI 1.90–5.41, respectively), after adjustment for age, gender, years of school, time from cancer diagnosis, and psychiatric disease.Conclusions
Given the new emphasis on QoL, we suggest that physicians have a responsibility to openly discuss therapy efficacy, prognosis as well as the potential for adverse events with their patients. Changes in health, as perceived by patient, should also be monitored at follow-up. 相似文献10.
Ulrich Tebbe Matthias Hochadel Peter Bramlage Sebastian Kerber Rainer Hambrecht Eberhard Grube Karl E. Hauptmann Martin Gottwik Albrecht Elsässer Hans-Georg Glunz Tassilo Bonzel Jörg Carlsson Uwe Zeymer Ralf Zahn Jochen Senges 《Clinical research in cardiology》2009,98(11):701-707
Background
Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak.Objectives
The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB).Methods
Prospective German PCI registry in 36 hospitals throughout Germany. Consecutive procedures were collected and analyzed centrally.Results
In 2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in 11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without on-site cardiac SB. Both patient groups were well-balanced with regard to age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI 1.23–1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74–0.82) than non-SB hospitals. There was no indication of a clinically relevant differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither patients with ACS nor stable angina except for emergency CABG in ACS patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02–5.13).Conclusions
There was no evidence of an excess risk associated with PCI-procedures performed in non-SB hospitals. 相似文献11.
Peter Bramlage Alessandro Cuneo Uwe Zeymer Matthias Hochadel Gert Richardt Sigmund Silber Jochen Senges Christoph A. Nienaber Ulrich Tebbe Karl-Heinz Kuck 《Clinical research in cardiology》2013,102(4):289-297
Background
Atrial fibrillation (AF) is increasingly prevalent in elderly patients and adversely affects clinical outcomes after coronary artery bypass grafting, non-cardiac surgery or myocardial infarction. Aim of the present analysis was to investigate the prognostic impact of AF in patients undergoing drug eluting stent (DES) implantation during a 1-year follow-up.Patients and methods
5,772 consecutive patients undergoing percutaneous coronary intervention were enrolled into the German Drug Eluting Stent Registry (DES.DE) and were followed for 12 months. Of these 455 had AF and 5,317 in sinus rhythm served as controls. Univariate and multivariate logistic regression analyses were used to determine the risk of major adverse cardiac and cerebrovascular events (MACCE) and bleeding complications.Results
Patients with AF were older (71.3 ± 7.6 vs. 64.7 ± 10.5 years) and had a higher prevalence of diabetes, hypertension, renal insufficiency as well as more prior bypass surgery, stroke and peripheral arterial disease. Cardiogenic shock (2.9 vs. 1.4 %; p < 0.05), left ventricular ejection fraction ≤40 % (21.0 vs. 11.4 %; p < 0.0001) and triple vessel disease (44.4 vs. 37.9 %; p < 0.01) were more frequent in patients with AF than in controls. MACCE (OR 2.08, 95 % CI 1.56–2.77), total mortality (OR 3.27, 95 % CI 2.32–4.62) and non-fatal stroke (OR 2.03, 95 % CI 1.03–4.00) as well as bleeding complications (OR 1.88, 95 % CI 1.13–3.12) during the 1-year follow-up were more frequent in patients with AF (univariate analysis). In multivariate analyses adjusting for covariates determined to be relevant at baseline, the risk for total mortality remained elevated (OR 1.63, 95 % CI 1.05–2.52).Conclusions
AF is an important predictor of long-term mortality in patients undergoing DES implantation. 相似文献12.
Angelo Polito Cindy S. Barrett David Wypij Peter T. Rycus Roberta Netto Paola E. Cogo Ravi R. Thiagarajan 《Intensive care medicine》2013,39(9):1594-1601
Background
Neurologic complications in neonates supported with extracorporeal membrane oxygenation (ECMO) are common and diminish their quality of life and survival. An understanding of factors associated with neurologic complications in neonatal ECMO is lacking. The goals of this study were to describe the epidemiology and factors associated with neurologic complications in neonatal ECMO.Patients and methods
Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005–2010.Results
Of 7,190 neonates supported with ECMO, 1,412 (20 %) had neurologic complications. Birth weight <3 kg [odds ratio (OR): 1.3; 95 % confidence intervals (CI): 1.1–1.5], gestational age (<34 weeks; OR 1.5, 95 % CI 1.1–2.0 and 34–36 weeks: OR 1.4, 95 % CI 1.1–1.7), need for cardiopulmonary resuscitation prior to ECMO (OR 1.7, 95 % CI 1.5–2.0), pre-ECMO blood pH ≤ 7.11 (OR 1.7, 95 % CI 1.4–2.1), pre-ECMO bicarbonate use (OR 1.3, 95 % CI 1.2–1.5), prior ECMO exposure (OR 2.4, 95 % CI 1.6–2.6), and use of veno-arterial ECMO (OR 1.7, 95 % CI 1.4–2.0) increased neurologic complications. Mortality was higher in patients with neurologic complications compared to those without (62 % vs. 36 %; p < 0.001).Conclusions
Neurologic complications are common in neonatal ECMO and are associated with increased mortality. Patient factors, pre-ECMO severity of illness, and use of veno-arterial ECMO are associated with increased neurologic complications. Patient selection, early ECMO deployment, and refining ECMO management strategies for vulnerable populations could be targeted as areas for improvement in neonatal ECMO. 相似文献13.
Physicians declining patient enrollment in a critical care trial: a case study in thromboprophylaxis
D. Cook Y. Arabi N. D. Ferguson D. Heels-Ansdell A. Freitag E. McDonald F. Clarke S. Keenan G. Pagliarello W. Plaxton M. Herridge T. Karachi S. Vallance J. Cade T. Crozier S. Alves da Silva R. Costa Filho N. Brandao I. Watpool T. McArdle G. Hollinger Y. Mandourah M. Al-Hazmi N. Zytaruk N. K. J. Adhikari 《Intensive care medicine》2013,39(12):2115-2125
Purpose
To analyze the frequency, rationale and determinants of attending physicians requesting that their eligible patients not be approached for participation in a thromboprophylaxis trial.Methods
Research personnel in 67 centers prospectively documented eligible non-randomized patients due to physicians declining to allow their patients to be approached.Results
In 67 centers, 3,764 patients were enrolled, but 1,460 eligible patients had no consent encounter. For 218 (14.9 %) of these, attending physicians requested that their patients not be approached. The most common reasons included a high risk of bleeding (31.2 %) related to fear of heparin bioaccumulation in renal failure, the presence of an epidural catheter, peri-operative status or other factors; specific preferences for thromboprophylaxis (12.4 %); morbid obesity (9.6 %); uncertain prognosis (6.4 %); general discomfort with research (3.7 %) and unclear reasons (17.0 %). Physicians were more likely to decline when approached by less experienced research personnel; considering those with >10 years of experience as the reference category, the odds ratios (OR) for physician refusals to personnel without trial experience was 10.47 [95 % confidence interval (CI) 2.19–50.02] and those with less than 10 years experience was 1.72 (95 % CI 0.61–4.84). Physicians in open rather than closed units were more likely to decline (OR 4.26; 95 % CI 1.27–14.34). Refusals decreased each year of enrollment compared to the pilot phase.Conclusions
Tracking, analyzing, interpreting and reporting the rates and reasons for physicians declining to allow their patients to be approached for enrollment provides insights into clinicians’ concerns and attitudes to trials. This information can encourage physician communication and education, and potentially enhance efficient recruitment. 相似文献14.
Purpose
Percutaneous transhepatic biliary drainage (PTBD) is performed for the palliation of malignant biliary obstructions. The purpose of this study was to identify factors related to the occurrence of immediate cholangitis as a complication after PTBDMethods
We retrospectively assessed 409 apparently stable patients with malignant biliary obstruction who underwent PTBD between January 2008 and December 2010. New onset cholangitis was defined as fever (>38 °C) that arose within 24 h after the intervention. Variables significantly associated with the occurrence of immediate cholangitis were selected and their odds ratio and 95 % confidence interval were calculated using logistic regression analysis.Results
There were 106 (25.9 %) cases of immediate cholangitis following PTBD, and among those 106 cases, 45 (42.5 %) had sepsis. In multivariate analysis, history of cholangitis (OR 4.7, 95 % CI 2.45–9.18), biliary drainage within 6 months (OR 2.3, 95 % CI 1.26–4.15), CRP ≥5 mg/dL (OR 2.2, 95 % CI 1.23–4.03), and serum albumin <3 g/dL (OR 1.9, 95 % CI 1.023–3.40) were predictive of immediate cholangitis after PTBD for malignant biliary obstructions.Conclusions
Cholangitis is a common immediate complication after PTBD. Patients should always be given prophylactic antibiotics before the drainage procedures. The results of this study could highlight the patients who require closer follow-up in order to make PTBD a safer procedure. 相似文献15.
Graham J. Walkden Veerle Verheyden Rosalind Goudie Gavin J. Murphy 《Intensive care medicine》2013,39(10):1808-1817
Purpose
To evaluate the effect of aprotinin withdrawal in 2008 on patient outcomes, to assess the likely risks and benefits of its re-introduction, and to consider the relevance of existing evidence from clinical trials to ‘real-world’ practice.Methods
We performed a nested case–control study of two cohorts undergoing adult cardiac surgery in a single tertiary centre. The first group underwent surgery between 1 January 2005 and 30 July 2007 (n = 3,578), prior to aprotinin withdrawal; the second group underwent surgery between 1 January 2009 and 31 December 2010 (n = 3,030), after aprotinin withdrawal. Propensity matching was used to select patients matched for 24 covariates in both groups (n = 3,508). We also estimated the effect of aprotinin withdrawal on a subgroup of high-risk patients (n = 1,002). Results were expressed as adjusted odds ratios (OR) and 95 % confidence intervals (CI) for categorical data and hazard ratios (HR) for time-to-event data.Results
In propensity-matched cohorts, the withdrawal of aprotinin from clinical use was associated with more bleeding, higher rates of emergency re-sternotomy, OR 2.10 (1.04–4.25), and acute kidney injury (AKI), OR 1.86 (1.53–2.25). In high-risk patients, the increases in bleeding and AKI following aprotinin withdrawal were of a greater magnitude. Aprotinin withdrawal was also associated with a significant increase in 30-day mortality, HR 2.51 (1.00–6.29), in the high-risk group. The results were not altered by sensitivity analyses that adjusted for potential selection bias, time series bias and unmeasured confounders.Conclusions
Aprotinin withdrawal was associated with increased complication rates and patient deaths following cardiac surgery. These real-world findings are at odds with those of randomised trials and cohort studies that have considered the clinical role of aprotinin. 相似文献16.
Amanda Caissie Nanor Kevork Breffni Hannon Lisa W. Le Camilla Zimmermann 《Supportive care in cancer》2014,22(2):375-381
Purpose
Guidelines recommend documentation of care preferences for patients with advanced cancer upon hospital admission. We assessed end-of-life outcomes for patients who did or did not have code status (CS) documented within 48 h of admission.Methods
This was a retrospective cohort study of patients who died on an inpatient oncology ward between January 2004 and February 2009. Primary end-of-life outcomes were “code blues” and cardiopulmonary resuscitation (CPR) attempts; secondary outcomes included unsuccessful CPR attempts, intensive care unit (ICU), consultations, and ICU admissions. Using logistic regression, outcomes were compared between those with and without CS documentation ≤48 h from admission (full code or do-not-resuscitate), controlling for significant confounders.Results
The 336 patients had a median age of 61 years; 97 % had advanced cancer. The median time from admission to death was 12 days (range <1–197 days); 151 patients (45 %) had CS documentation ≤48 h from admission. Controlling for confounders of reason for admission and marital status, patients with CS documentation ≤48 h from admission had fewer “code blues” (2 vs. 15 %; adjusted odds ratio (AOR) 0.12, 95 % confidence interval (CI) 0.02–0.43), CPR attempts (1 vs. 11 %; AOR 0.12, 95 % CI 0.01–0.51), unsuccessful CPR attempts (0 vs. 11 %), ICU consultations (9 vs. 30 %; AOR 0.19, 95 % CI 0.08–0.40) and ICU admissions (2 vs. 5 %; AOR 0.18, 95 %CI 0.02–0.85).Conclusions
In patients who died on an oncology ward, CS documentation within 48 h of admission was associated with less aggressive end-of-life care, regardless of the reason for admission. 相似文献17.
Justin C. Brown Lilie L. Lin Saya Segal Christina S. Chu Ashley E. Haggerty Emily M. Ko Kathryn H. Schmitz 《Supportive care in cancer》2014,22(11):3017-3025
Purpose
We sought to quantify the proportion of uterine cancer survivors who self-report poor physical function. We then sought to quantify the association of poor physical function with physical activity (PA), walking, and lower limb lymphedema (LLL), among women with a history of uterine cancer.Methods
Physical function was quantified using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) questionnaire. PA, walking, and LLL were measured using self-report questionnaire. PA was calculated using metabolic equivalent hours per week (MET-h week?1), and walking was calculated using blocks per day (blocks day?1). Logistic regression estimated odds ratios (OR) and 95 % confidence intervals (95 % CI).Results
Among the 213 uterine cancer survivors in our survey (43 % response rate), 35 % self-reported poor physical function. Compared to participants who reported <3.0 MET-h week?1 of PA, participants who reported ≥18.0 MET-h week?1 of PA were less likely to have poor physical function (OR 0.03, 95 % CI 0.01–0.10; P trend ?0.0001). Compared to participants who reported <4.0 blocks day?1 of walking, participants who reported ≥12.0 blocks day?1 of walking were less likely to have poor physical function (OR 0.07, 95 % CI 0.03–0.19; P trend ?0.0001). Compared to participants who did not have LLL, participants with LLL were more likely to have poor physical function (OR 5.25, 95 % CI 2.41–11.41; P?0.0001).Conclusion
Higher levels of PA and walking associate with a lower likelihood of reporting poor physical function. The presence of LLL associates with a higher likelihood of reporting poor physical function. These findings are hypothesis-generating and should be evaluated in future prospective studies. 相似文献18.
Aliénor Xhaard Loic Epelboin David Schnell François Vincent Vincent Levy Marion Malphettes Élie Azoulay Michaël Darmon 《Supportive care in cancer》2013,21(7):1885-1891
Background
Although recent studies have demonstrated an improvement in the prognosis of critically ill cancer patients, little is known regarding the prognosis of patients with non-aggressive underlying malignancies. The aims of this study were to assess the prognosis of critically ill patients with chronic lymphocytic leukemia (CLL) and to evaluate risk factors for hospital mortality.Methods
In retrospective mono-center cohort study, consecutive adult patients with CLL requiring ICU admission from 1997 to 2008 were included.Results
Sixty-two patients of 67 years (62–75) were included. Median time interval between CLL diagnosis and ICU admission was 6.7 years (2.6–10.8). Nine patients (15 %) had stage C disease at the time of ICU admission, and seven patients (11 %) had Richter syndrome. Most ICU admissions were related to bacterial or fungal pulmonary infections (n?=?47; 76 %). ICU, in-hospital, and 90-day mortality were 35 % (n?=?22), 42 % (n?=?26), and 58 % (n?=?36), respectively. Only three factors were independently associated with in-hospital mortality: oxygen saturation lower than 95 % when breathing room air (odds ratio (OR) 5.80; 95 % confidence interval (CI) 1.23–27.33), need for vasopressors (OR 27.94; 95 % CI 5.37–145.4), and past history of infection (OR 6.62; 95 % CI 1.34–32.68). The final model did not change when disease-related variables (Binet classification, Richter syndrome, long-term steroids) or treatment-related variables (fludarabine, rituximab, or alemtuzumab) were included.Conclusion
Acute pulmonary infections remain the leading cause of ICU admission in patients with CLL. The severity at ICU admission and past history of infection were the only factors associated with hospital mortality. Neither disease characteristics nor previous cancer treatments were associated with outcome. 相似文献19.
Radhika Sreeraman Srinivasan Vijayakumar Allen M. Chen 《Supportive care in cancer》2013,21(12):3301-3306
Purpose
The purpose of this study is to identify factors predictive of treatment interruptions during radiation therapy (RT) for head and neck cancer.Methods and materials
The medical records of 280 consecutive patients who completed a 6- or 7-week course of RT for squamous cell carcinoma of the head and neck were reviewed. The number of missed treatment days, excluding those due to holidays or machine downtime, was determined for each patient. All patients were treated to a median dose of 63 Gy (range, 60 to 70 Gy).Results
The proportion of patients who missed 0, 3–5, 6–10, and greater than 10 days was 25, 59, 12, and 5 %, respectively. The percentage of patients who missed greater than 5 days was 62 % among the 39 patients with Karnofsky Performance Status (KPS) score of 70 or less compared to 10 % among those with a KPS score of greater than 70 (p?<?0.01). Among the 33 patients identified with a preexisting psychiatric condition, the percentage that subsequently missed greater than 5 days of treatment was 48 % compared to 13 % among those without a psychiatric condition. When missed RT days were analyzed as a continuous variable, the correlations with both KPS and preexisting psychiatric condition remained highly significant (p?<?0.01, for both).Conclusion
Poor performance status and preexisting psychiatric condition predicted for treatment interruptions during RT for head and neck cancer. In view of the possible detrimental effect on treatment outcome, appropriate social programs should be initiated to overcome potential barriers to RT for these particular populations. 相似文献20.
Debu Tripathy Brian G. M. Durie Beatrice Mautner Krag S. Ferenz Judd W. Moul 《Supportive care in cancer》2014,22(6):1601-1610