Determinants of place of death for terminal cancer patients

Approximately two-third of cancer patients, when asked about the preferred place of death, wish to die in their own homes. However, the majority of deaths from cancers in most western countries occur in a hospital. When a person dies from other than sudden or traumatic causes, the death appears to be a function of a complex interplay of personal and cultural values and physical and medical factors, as well as various health care systems forces. This article reviews the determinants of place of death for terminal cancer patients from published studies in hopes of shedding light on the difficulties of dying patients to realize their preferences for place of death. These insights may contribute to modification of hospice care systems so health professionals will be more responsive to the needs of their dying patients to retain control and die with dignity and help health professionals achieve the proposed outcome of hospice care.     

晚期肺癌并发肺部真菌感染的临床分析

目的:分析并探讨晚期肺癌患者并发肺部真菌感染的临床特点及危险因素.方法:采用回顾性调查方法,分析我科274例晚期肺癌患者中并发肺部真菌感染的58例的临床资料.结果:晚期肺癌患者肺部真菌感染率为21.2%(58/274).其中,男性36例,女性22例;年龄27～81岁,平均62.7岁;非小细胞肺癌47例,小细胞肺癌11例.真菌类型主要为白色念珠菌(70.7%),其它包括热带念珠菌(5.2%)、光滑念珠菌(3.4%)、隐球菌(15.5%)、毛霉菌(3.4%)和曲霉菌(1.7%).主要易感因素是年龄≥50岁、有吸烟史、ECOG评分≥2、多周期化疗、化疗联合胸部放疗和Ⅲ度以上白细胞减少.结论:减少易感因素、早期诊断、早期使用抗真菌药物以及加强免疫及支持治疗是降低晚期肺癌真菌感染率的有效措施.     

Chemotherapy and pattern of metastases in breast cancer patients

A retrospective analysis of all breast cancer patients who died of their disease at Harper Grace Hospital during 1962 to 1976, was conducted to determine the pattern of metastases and its relation to chemotherapy. The autopsy incidence of distant metastases, to all organ sites, was noted to be higher among patients who previously received cytotoxic therapy, compared with those who did not. Such incidence was unrelated to differences in patients' age, menopausal status, and disease-free interval. It is postulated that chemotherapy contributes to the wider metastases, especially to the central nervous system and meninges, in a breast cancer patient. This is possibly due to a longer survival of patients treated.     

支气管镜灌注术联合抗生素治疗肺癌术后感染的疗效观察

目的探讨支气管镜灌注术(BP)联合抗生素治疗肺癌术后感染的效果及对血清肿瘤坏死因子α(TNF-α)、白细胞介素-8(IL-8)、超敏C反应蛋白(hs-CRP)和降钙素原(PCT)水平的影响。方法选取2017年5月至2018年9月间西安市北方医院收治的80例肺癌术后感染患者,采用随机数表法分为观察组和对照组,每组40例。对照组患者采用常规抗感染治疗,观察组患者在常规治疗基础上应用BP联合局部灌注抗生素治疗,比较两组患者临床疗效、呼吸力学指标、血清TNF-α、IL-8、hs-CRP、PCT及不良反应情况。结果观察组患者临床治疗总有效率为92.5%,高于对照组患者的75.0%,差异有统计学意义(P<0.05)。治疗前,两组患者的气道峰压(PIP)、动态顺应性(Cdyn)、呼吸做功(WOB)和气道阻力(Raw)指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者的PIP、WOB和Raw指标均下降,且观察组均低于对照组,两组患者Cdyn指标均上升,且观察组高于对照组,差异均有统计学意义(均P<0.05)。治疗前,两组患者TNF-α、IL-8、hs-CRP和PCT指标比较,差异无统计学意义(P>0.05)。治疗后,两组患者TNF-α、IL-8、hs-CRP和PCT指标均下降,且观察组上述指标均低于对照组,差异均有统计学意义(均P<0.05)。治疗期间,对照组患者出现呛咳1例,低氧血症1例,发绀1例;观察组患者出现低氧血症1例,对症治疗后,两组患者症状均消失。两组患者不良反应情况比较,差异无统计学意义(P>0.05)。结论采用BP联合抗生素治疗肺癌术后感染患者疗效确切,可有效减轻炎症反应,提升呼吸功能。     

支原体感染与肿瘤

支原体是广泛存在于自然界的条件致病微生物,可能是唯一可以与真核生物共生,并可与哺乳动物细胞长期相互作用的原核生物。多种不同的肿瘤组织中可检测到支原体的存在,某些支原体的持续感染可导致哺乳动物细胞的转化、上调癌基因的表达并引起肿瘤细胞生物学行为的改变,提示支原体感染与肿瘤的发生有潜在的相关性。     

吗啡应用于终末期肿瘤患者呼吸困难的安全性研究

目的:回顾性分析使用吗啡治疗终末期肿瘤患者呼吸困难的安全性。方法:收集自 2010年1月至2014年8月间,于上海第三人民医院肿瘤内科住院且具有完整随访资料的病人170例。按治疗情况,将患者分为吗啡治疗组（90例）、非吗啡治疗组（80例）,记录吗啡治疗的不良反应,观察比较两组患者呼吸困难的改善情况、生存时间和不良反应。结果:两组患者的一般临床资料基本均衡。患者经吗啡治疗视觉模拟量表(VAS)值由治疗前（61.96±7.48）mm降低至治疗后（24.46±8.36）mm,差异有统计学意义(P<0.05),呼吸频率、心率及血氧饱和度治疗前后情况无差别（P>0.05）。吗啡组出现6例恶心、呕吐,11例便秘,1例呼吸抑制;非吗啡组出现3例恶心、呕吐,4例便秘。吗啡治疗组中位生存时间71.5天,非吗啡组中位生存时间为66.0天（P>0.05）,两组之间无统计学差异。结论:吗啡治疗终末期肿瘤患者呼吸困难是安全有效的,能显著改善呼吸困难且不减少患者的生存时间。     

Atypical cancer pattern in patients with Parkinson's disease

Among 14,088 patients, with a primary diagnosis of Parkinson's disease during the period 1977-98 identified from the National Register of Patients, 1282 cancers were subsequently recorded in the Danish Cancer Registry, compared with 1464 expected, with a standardised incidence ratio (SIR) of 0.88 (95% confidence interval (CI), 0.8-0.9). Significantly reduced risks were found for smoking-related cancers, for example, cancers of the lung (SIR, 0.38), larynx (0.47) and urinary bladder (0.52), although moderate reductions in risk were also seen for several nonsmoking-related cancers. In contrast, increased risks were seen for malignant melanoma (SIR, 1.95; 95% CI, 1.4-2.6), nonmelanocytic skin cancer (1.25; 1.1-1.4) and breast cancer (1.24; 1.0-1.5). The observed cancer pattern supports the hypothesis that constituents of tobacco smoke inhibit or delay the development of Parkinson's disease, but a low smoking prevalence appears to be only part of the explanation for the decreased cancer incidence. The increased relative risks of melanoma and nonmelanoma skin cancer are not likely to be artefactual, but further investigations of potential mechanisms are warranted.     

食管癌及贲门癌患者术后感染的原因分析及防治对策

目的:分析食管癌及贲门癌患者术后感染的原因和防治对策.方法:回顾性分析2010年9月-2013年12月进行手术治疗的86例食管癌及贲门癌患者.采用不同防治感染对策后,分别观察两组食管及贲门癌患者术后感染的情况,分析原因进行统计学分析.结果:分析食管及贲门癌术后感染的30例患者的感染部位,手术切口感染16.3％,肺部感染12.8％,胸腔感染3.5％,泌尿系统感染2.3％,总感染率34.9％;食管及贲门癌术后感染的部位主要常见于手术切口及肺部.单因素分析后发现,感染因素与吸烟、手术时间(＞2h)、术中失血量(＞200ml)均有关(P＜0.05).43例患者常规抗感染治疗后,感染者占53.5％,未感染者占46.5％;43例患者早期防治术后感染后,感染者占16.3％,未感染者占83.7％;试验组的感染状况明显低于对照组(P＜0.05).结论:食管及贲门癌患者术后感染主要分布在肺部和切口处,原因复杂,临床手术中早期抗感染治疗可显著降低感染风险.     

口服控释吗啡交替为芬太尼透皮贴剂的疗效分析

目的评价晚期癌痛患者由口服控释吗啡转换为芬太尼透皮贴剂止痛的疗效与不良反应。方法 40例口服控释吗啡镇痛不满意的晚期癌痛患者,交替为芬太尼透皮贴剂,吗啡与芬太尼贴剂的剂量换算比为100∶1。采用0～10视觉模拟评分法评价疼痛强度,评分降低≥2表示疼痛缓解有临床显著性差异;不良反应评估分为4级:无不良反应(0)、轻度(1)、中度(2)或重度(3)。结果药物交替后疼痛强度明显降低,转换前平均疼痛评分为5.7,转换后7 d降至3.4。发生至少一种不良反应的患者转换前为37例(92.5%),转换后降至25例(62.5%)。结论将口服控释吗啡交替为芬太尼透皮贴剂是一种安全有效的镇痛策略。     

海南地区宫颈癌病例的HPV感染状况

 目的　分析本地区宫颈癌患者的HPV感染情况。方法　收集 10 1例治疗前病例的颈管分泌物 ,用PCR荧光定量方法进行HPV6、11、16、18的检测。结果　HPV阳性者 4 4例 ,阳性率 4 3.6 % ,在 <4 0岁、4 0～ 5 0岁、>5 0岁 3个年龄段 ,HPV阳性率分别为 5 9.5 %、35 .9%、2 5 % (P <0 .0 5 )。近 2年与 2年前病例HPV感染率分别是 5 0 %、33.3%。宫颈鳞癌的HPV阳性率明显高于腺癌、腺鳞癌 (P <0 .0 1)。结论　HPV感染是宫颈癌的重要致病因素 ;鳞癌的发生与HPV感染的关系较腺癌更密切 ;在本地区极可能存在除上述 4型以外的已定或未定亚型的感染     

Failure of neutrophil chemotactic function in breast cancer patients treated with chemotherapy

Neutrophil migration is a key host event against infection. Chemotherapy may alter neutrophil function and favor increased risk of infection. Herein, we investigated the effect of chemotherapy on the migration capacity of circulating neutrophils obtained from breast cancer patients and mechanisms involved in this event. Breast cancer women (n=23) at disease stage I–III and healthy control women (n=25) were prospectively enrolled. No differences in the in vitro migratory responses towards the chemotactic stimuli N-formyl- L-methionyl- L-leucyl- L-phenylalanine (fMLP), leukotriene B₄ (LTB₄) and interleukin (IL)-8 were observed in purified neutrophils from controls and patients, in a microchemotaxis chamber assay. However, the migration capacity evaluated upon chemotherapy (5-fluoruracil, adriamycin and cyclophosphamide, 21-day intervals between cycles, total leukocyte count ≥2,000/mm³), on the day immediately before the beginning of the sixth cycle, showed that patient neutrophils (n=14) failed to migrate in response to fMLP compared to response observed upon diagnosis. Considering patients (n=8) with documented bacterial infection between cycles, the number of migrated neutrophils (mean±SD) compared to response at diagnosis was markedly reduced upon chemotherapy to either fMLP (30.1±8.26 vs. 2.81±1.28) or LTB₄ (15.72±4.8 vs. 2.8±1.64) stimuli respectively. Treatment of control neutrophils with sera of chemotherapy-treated patients with infective episodes, to test for the presence of circulating immunosuppressive factors, significantly reduced the migratory capacity of healthy neutrophils to fMLP, LTB₄ and IL-8, in a dose-dependent way. But no significant differences were found in the serum levels of nitric oxide (NO) metabolites, tumor necrosis factor (TNF)-α, IL-6, IL-8 and IL-10 collected at the same time as the collection of blood for neutrophil migration experiments. In conclusion, breast cancer patients showed suppressed neutrophil migratory response upon chemotherapy, accompanied by bacterial infection episodes. Circulating factors are involved, at least partially, in the inhibitory mechanism on neutrophil migration.     

The use of novel oral anticoagulants in cancer patients with venous thromboembolism

Venous thromboembolism (VTE) is not uncommon among patients with cancer and is one of the major causes of mortality and morbidity. Treatment with low-molecular-weight heparin (LMWH) is effective, yet accompanied by the need for daily administration of injections for a prolonged time and (even rarely) thrombocytopenia. The discovery of novel oral anticoagulants (NOACs) was based on an effort to improve the pharmacodynamic and pharmacokinetic properties of previous generation anticoagulants while maintaining efficacy without the need for daily subcutaneous administration and frequent laboratory monitoring. The MEDLINE database was searched using PubMed in order to find relevant studies on the use of NOACs in patients with active malignancy and VTE. Furthermore, critical reading of references in recently published studies and reviews was performed. NOACs appear to be at least equivalent to coumarin anticoagulants in terms of efficacy and safety and their administration is easier, but data specifically concerning patients with active malignancy or comparing them to LMWH in this specific clinical setting are not yet available. Furthermore, patients with active cancer present several unique characteristics and drawing conclusions from studies involving other patient groups may not be appropriate. Specific studies in cancer patients are still pending that will help decide if NOACs will be the drugs of choice in this group of patients in need of efficient and simple to administer treatments.     

125例三阴性复发转移乳腺癌首发转移模式的分析

目的：分析三阴性乳腺癌（TNBC）首次复发转移部位的特征,以指导复发转移性TNBC患者的治疗选择及管理。方法回顾性分析125例复发转移性TNBC患者的临床资料,对术后常见的复发转移部位和复发转移时间进行描述和统计,归纳其首次复发转移的模式。结果125例复发转移性TNBC患者中,首次单发转移部位以淋巴结和肺最为常见,分别占11.2%和5.6%;首发即为多发转移的比例高达79.2%,其中,含淋巴结、肺、骨、肝和脑转移的比例分别为52.8%、34.4%、27.1%、14.4%和6.4%,其他特殊部位（包含肾上腺等）转移32例（25.6%）。首发内脏转移（仅包含肝和肺）63例,占50.4%,其中6例同时有肝和肺转移;淋巴结转移比例最高,为64.0%;合并肺转移（40.0%）的患者明显多于肝转移（15.2%）的患者（P=0.000）。复发转移的时间多在术后2～3年,2年内复发者52例（41.6%）,2～3年复发者23例（18.4%）,3年以上复发者50例（40.0%）。结论 TNBC淋巴结、肺转移多见;脑转移作为首发部位也值得关注;TNBC多发转移比例高;多数在2～3年内复发。建议在辅助治疗后的随访中,除了关注淋巴结的检查外,还需关注肺部和颅脑的检查,以早期发现复发征象。     

Cirrhosis-like radiological pattern in patients with breast cancer

INTRODUCTION: Hepatic toxicity of breast cancer therapy is well known, usually consisting of elevation in the serum levels of hepatic enzymes or fatty infiltration of the liver. The chemotherapeutic agents most commonly linked to hepatotoxic effects are methotrexate, anthracyclines, taxanes and cyclophosphamide. There are few reports of patients with liver metastasis having radiological findings mimicking cirrhosis, both in the presence or the absence of prior systemic chemotherapy. Hepatotoxicity of antineoplastic drugs and cellular necrosis induced by response of liver metastases to chemotherapy may play a critical role in its physiopathology. MATERIALS AND METHODS: This article reports a series of ten women with breast cancer (nine with liver metastasis) treated with chemotherapy or hormonotherapy. RESULTS: They had low risk factors for hepatic disease, but developed a cirrhosis-like appearance in the computed tomography scan. The patient without liver metastasis is the second of this kind described in the literature. Relatively few reports have documented clinical sequelae of portal hypertension. In our series, three patients had oesophageal bleeding varices needing be hospitalised. To our knowledge, these are the first cases reported in the literature. CONCLUSIONS: This suggests that some manifestations of portal hypertension may develop in association with the cirrhosis- like pattern induced by breast cancer therapy.     

Chlamydia pneumoniae infection and lung cancer risk: a meta-analysis

Chlamydia pneumoniae (C. pneumoniae) is a common cause of acute respiratory infection and has been hypothesised to cause several chronic diseases, including lung cancer. Numbers studies were conducted to analyse the association between C. pneumoniae infection and risk of lung cancer, but no clear consensus had been found. To assess this relationship more precisely, a meta-analysis was performed. The electronic databases PubMed, Embase, Web of Science and CNKI were searched; Data were extracted and analysed independently by two investigators. Ultimately, 12 studies, involving 2595 lung cancer cases and 2585 controls from four prospective studies and eight retrospective studies were included. Overall, people exposed to C. pneumoniae infection had an odds ratio (OR) of 1.48 (95% confidence interval (CI), 1.32-1.67) for lung cancer risk, relative to those not exposed. C. pneumoniae infection was clearly identified as a risk factor for lung cancer in both prospective studies (OR, 1.16; 95% CI, 1.00-1.36) and retrospective studies (OR, 2.17; 95% CI, 1.79-2.63) and in both IgA ? 16 cutoff group (OR, 1.22; 95% CI, 1.06-1.41) and the IgA ? 64 cutoff group (OR, 2.35; 95% CI, 1.88-2.93). In conclusion, C. pneumoniae infection is associated with an increased risk for lung cancer, higher titre may be a better predictor of lung cancer risk.     

Chemotherapy-induced neutropenia in lung cancer patients: the role of antibiotic prophylaxis

Chemotherapy-induced neutropenia can cause fatal bacterial infections. Colony-stimulating factors (CSFs) are usually recommended as prophylaxis, while routine use of prophylactic antibiotics remains controversial. Based on our literature search in PubMed, quinolones and trimethoprim/sulfamethoxazole were the most frequently used prophylaxis, while CSFs were administered in 22.1% of patients. Lung cancer patients who received prophylactic antibiotics exhibited significantly fewer episodes of febrile neutropenia, fewer documented infections as well as shorter duration of related hospitalisations. Prophylactic use of wide spectrum antibiotics seems effective and should be considered as an alternative strategy in the prevention of chemotherapy-induced neutropenia in lung cancer patients.     

Zoledronic acid use in cancer patients

Bone is the most common site for metastasis from solid tumors, and the majority of patients will develop bone metastases during the natural course of their disease. Bisphosphonates are an effective treatment for preventing skeletal-related events in patients with bone metastases and may preserve functional independence and quality of life. Although several bisphosphonates have been investigated in patients with solid tumors, only zoledronic acid (ZOL) is approved by the US Food and Drug Administration and the European Medicines Agency for preventing skeletal-related events in patients across a broad range of solid tumors. In addition, bisphosphonates, notably ZOL, prevent cancer treatment-induced bone loss in breast and prostate cancer patients who are receiving endocrine therapy. It also has been demonstrated that ZOL directly and indirectly inhibits cancer cell growth in vitro and growth and tumorigenesis in animal model systems. These properties may produce clinically meaningful benefits. In recent clinical studies in patients with cancer, ZOL improved overall and prolonged disease-free survival. Ongoing clinical trials in patients with solid tumors will provide further insight into the potential of ZOL to prevent distant metastases and improve survival.