Characteristics and outcomes of patients with unresected early-stage non-small cell lung cancer

BACKGROUND: This study describes the characteristics, management, and outcomes of patients with unresected early-stage non-small cell lung cancer (NSCLC). METHODS: A retrospective review was conducted to identify all patients with unresected stage I or stage II NSCLC diagnosed between 1990 and 1998. RESULTS: Ninety-seven patients were identified who met our criteria. The median age at diagnosis was 68 years; 78% of patients were white, 81% were male, 81% had stage I disease, and 67% had squamous cell carcinoma. Cancer-specific treatment, including chemotherapy, radiation therapy, and combined chemotherapy and radiation therapy, was administered to only 27 patients. The median survival time was 22 months for the treated group and 11 months for the untreated group. CONCLUSION: The majority of patients with unresected early-stage NSCLC do not receive cancer therapy. They should be thoroughly considered for treatment, however, especially in light of recent advances in surgery and radiation therapy, and the development of more active, less toxic chemotherapeutic agents.     

Characteristics and outcomes of advanced cancer patients who miss outpatient supportive care consult appointments

Background

Missed appointments (MA) are frequent, but there are no studies on the effects of the first MA at supportive care outpatient clinics on clinical outcomes.

Methods

We determined the frequency of MA among all patients referred to our clinic from January–December 2011 and recorded the clinical and demographic data and outcomes of 218 MA patients and 217 consecutive patients who kept their first appointments (KA).

Results

Of 1,352 advanced-cancer patients referred to our clinic, 218 (16 %) had an MA. The MA patients’ median age was 57 years (interquartile range, 49–67). The mean time between referral and appointment was 7.4 days (range, 0–71) for KA patients vs. 9.1 days (range, 0–89) for MA patients (P?=?0.006). Reasons for missing included admission to the hospital (17/218 [8 %]), death (4/218 [2 %]), appointments with primary oncologists (37/218 [18 %]), other appointments (19/218 [9 %]), visits to the emergency room (ER) (9/218 [9 %]), and unknown (111/218 [54 %]). MA patients visited the ER more at 2 weeks (16/214 [7 %] vs. 5/217 [2 %], P?=?0.010) and 4 weeks (17/205 [8 %] vs. 8/217 [4 %], P?=?0.060). Median-survival duration for MA patients was 177 days (range, 127–215) vs. 253 days (range, 192–347) for KA patients (P?=?0.013). Multivariate analysis showed that MAs were associated with longer time between referral and scheduled appointment (odds ratio [OR], 1.026/day, P?=?0.030), referral from targeted therapy services (OR, 2.177, P?=?0.004), living in Texas/Louisiana regions (OR, 2.345, P?=?0.002), having an advanced directive (OR, 0.154, P?P?=?0.0003).

Conclusion

MA patients with advanced cancer have worse survival and increased ER utilization than KA patients. Patients at higher risk for MA should undergo more aggressive follow-up. More research is needed.     

Improving outcomes in lung cancer patients

Lung cancer is the leading cause of cancer mortality in the UK resulting in more than 33,500 deaths in 2008, 4,000 more than for bowel and breast cancer combined. Five-year survival figures are poor but have recently improved from around 5% to 7.5% in men and 8.5% in women. The key recommendations in the updated NICE guideline seek to ensure that: all multidisciplinary teams apply efficient methods to diagnose and stage patients accurately; fitness assessment is an objective process; as many patients as possible are offered treatment with curative intent; those with small cell lung cancer are offered the most effective treatment; and patients are referred early for endobronchial treatment. There are potentially more important and difficult challenges for primary and integrated care. Almost three quarters of patients with lung cancer have advanced disease atpresentation, and many of these have had symptoms for many months. Early diagnosis, awareness of warning symptoms and prompt referral are therefore major priorities. If we are to improve outcomes in lung cancer, more patients need to be sent for chest X-ray and referred urgently. If the chest X-ray is normal but there is a high suspicion of lung cancer the patient should still be referred urgently. To ensure that all patients have the best chance of being offered curative treatment, patients should be re-assessed by the surgeon and/or radiation oncologist after any optimisation. Patients should be encouraged to stop smoking, as this reduces postoperative complications, but surgery should not be postponed. Surgery that minimises loss of lung tissue is recommended. The latest radiotherapy techniques, such as stereotactic body radiotherapy, that minimise dose to normal lung are encouraged.     

Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs

OBJECTIVES: To describe the characteristics of a large cohort of cancer patients receiving mechanical ventilation for >24 hrs and to identify clinical features predictive of in-hospital death. DESIGN: Prospective cohort study. SETTING: Ten-bed oncologic medical-surgical intensive care unit. PATIENTS: A total of 463 consecutive patients were included over a 45-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were collected on the day of admission to the intensive care unit. The intensive care unit and hospital mortality rates were 50% and 64%, respectively. There were 359 (78%) patients with solid tumors and 104 (22%) with hematologic malignancies; 35 (8%) patients had leukopenia. Sepsis (63%), coma (15%), invasion or compression by tumor (11%), pulmonary embolism (7%), and cardiopulmonary arrest (6%) were the main reasons for mechanical ventilation. The independent unfavorable risk factors for mortality were older age (odds ratio, 3.09; 95% confidence interval, 1.61-5.93, for patients 40-70 yrs old, and odds ratio, 9.26; 95% confidence interval, 4.16-20.58, for patients >70 yrs old); performance status 3-4 (odds ratio, 2.51; 95% confidence interval, 1.40-4.51); cancer recurrence/progression (odds ratio, 3.43; 95% confidence interval, 1.81-6.53); Pao2/Fio2 ratio <150 (odds ratio, 2.64; 95% confidence interval, 1.40-4.99); Sequential Organ Failure Assessment score (excluding respiratory domain, each 4 points; odds ratio, 2.34; 95% confidence interval, 1.70-3.24); and airway/pulmonary invasion or compression by tumor as a reason for mechanical ventilation (odds ratio, 5.73; 95% confidence interval, 1.92-17.08). CONCLUSIONS: Severity of acute organ failures, poor performance status, cancer status, and older age were the main determinants of mortality. The appropriate use of such easily available clinical characteristics may avoid forgoing intensive care for patients with a chance of survival.     

Characteristics and functional outcomes of elderly rehabilitation patients

Sixty-seven patients admitted to a geriatric rehabilitation unit were assessed from admission to discharge by their primary nurses for functional outcomes and demographic characteristics. The patients had a mean age of 78.1 years and a mean length of stay of 58.6 days. Patients with an admitting diagnosis of a recent leg amputation were discharged more independent in ADL than those admitted following a recent stroke. Sixty-nine percent of the patients were discharged home. Patients sent home were significantly more independent in ADL than those who did not return home. Almost all patients continued to improve in physical ADL and felt they were managing adequately or well in the home setting.     

Risk factors and outcomes among delirium subtypes in adult ICUs: A systematic review

PurposeUse systematic review methodology to summarize risk factors and outcomes for each delirium subtype (hypoactive, hyperactive and mixed) in an adult ICU population.Materials and methodsWe searched the MEDLINE, Embase, CINAHL, SCOPUS, Web of Science and PsycINFO databases from database inception until August 13, 2018, with no restrictions.ResultsOf 9635 abstracts, 20 studies were included. Older age was not associated with any delirium subtype in 4/7 (57%) studies. Sex was not associated with any delirium subtype in 4/4 (100%) studies. Mortality was consistently associated with hypoactive delirium in 4/7 (57%) studies. The evidence supporting the association of APACHE-II score, mechanical ventilation, length of stay, duration of delirium and removal of tubes were inconsistent across studies.ConclusionsAlthough included studies reported on many subtype-specific risk factors and outcomes, heterogeneity in reporting and methodological quality limited the generalizability of the results and the evidence for many subtype-specific risk factors or outcomes is inconsistent across studies. Standardized methodology and the creation of a universal template for collecting data in ICU delirium studies are essential moving forward; helping to identify subtype-specific risk factors or outcomes and strengthen the association of potential risk factors or outcomes.     

Characteristics and outcomes of patients with Goodpasture's syndrome

BACKGROUND: Goodpasture's syndrome is a rare disorder characterized by pulmonary hemorrhage, glomerulonephritis, and antiglomerular basement membrane antibodies. METHODS: Case reports of Goodpasture's syndrome between 1993 and 2000 were identified using MEDLINE. Each case was reviewed for clinical manifestations, laboratory features, pathophysiology, treatment options, and outcomes. RESULTS: Eighty-five cases of Goodpasture's syndrome were reported in the English language literature. The mean age of patients in this review was 44 years. Most patients had multiple risk factors. Smoking was strongly associated with pulmonary hemorrhage. Most patients presented with hemoptysis and crackles. More than 90% had antiglomerular basement membrane antibodies, and 80% had crescenteric glomerulonephritis on renal biopsy. CONCLUSION: Most patients were treated with immunosuppression and plasma exchange and were alive at follow-up. Patients with either pulmonary or renal signs and symptoms should be evaluated for Goodpasture's syndrome, since early diagnosis allows prompt treatment and improved outcome.     

Characteristics and outcomes of elderly patients receiving transitional care

Transitional care programs are one method of providing care to elderly high-risk patients. The aims of this study were to determine if patient characteristics (including number of comorbidities, functional status, and length of stay during initial hospitalization) and social factors (including presence of a caregiver in the home and place of discharge disposition) were associated with increased hospital readmission and mortality for patients discharged from specialized transitional care.     

Exercise and quality of life outcomes in patients with cancer

OBJECTIVE: To review the evidence of the effects of exercise interventions in patients with cancer in each of four quality-of-life domains: physical, psychological, social, and spiritual. DATA SOURCES: Research articles, abstracts, literature review. CONCLUSION: There is strong evidence to support positive effects of exercise on physical and psychological well-being. Exercise improves physical function, muscle strength, emotional well-being, self esteem, decreases fatigue, anxiety, and depression, and helps maintain weight. Data suggest exercise fosters social functioning and more research is needed on the relationship of exercise and spiritual well-being. IMPLICATIONS FOR NURSING PRACTICE: There is sufficient evidence to support exercise as an intervention to enhance a cancer patient's physical functioning and psychological well-being. Nurses should be encouraged to integrate physical activity recommendations into practice, tailored to the individual's health condition and mutual goal setting.     

Intensive care unit outcomes in elderly cancer patients

As the number of elderly patients receiving oncologic therapies increases, the need for better outcome predictors for the critically ill elderly with cancer increases. Physicians should not view age as an indicator of poor ICU outcome, as many elderly patients with cancer will derive the same benefit from intensive care as their younger counterparts. Such a gain can be accomplished without overuse of valuable resources. Similar prognostic factors that are applied to the younger cancer patients should also be applied to the elderly. These parameters, in addition to clinical judgment, can be helpful in deciding who will benefit from ICU care regardless of age. Oncologists and critical care physicians will need to collaborate and change the paradigm of ICU care for the elderly.     

Characteristics and outcomes of critically ill patients with severe hyperammonemia

PurposeTo determine the etiology and outcomes of critically ill patients with severe hyperammonemia.Materials and methodsRetrospective observational study of adults (18 years or older) admitted to a MICU from 2007 to 2016 who had a serum ammonia level >180 μmol/L (3 times the upper limit of normal).ResultsThe 78 patients (45 male, 32 female) had a median age of 52 (interquartile range [IQR] 46–58) years. Hyperammonemia occurred most often with acute-on-chronic liver failure (ACLF) (49 %) or decompensated cirrhosis (27 %) and less often as a consequence of prior gastric bypass (9%), acute hepatic failure (6%), or valproic acid (3%). Median serum ammonia level was 201 μmol/L (IQR 126–265, range 18–736) on admission, with peak value of 245 μmol/L (IQR 205–336, range 185–842). Fifty (64%) patients died during the hospitalization. Cerebral edema was documented in 8 (10%) patients, only one of whom survived. Six of the 8 patients with cerebral edema had hyperammonemia related to ACLF, giving an incidence of 14% in this subset of patients. Neither mortality nor cerebral edema was associated with peak ammonia level.ConclusionsCritically ill patients with severe hyperammonemia have a high mortality rate and are at risk of developing cerebral edema.     

Characteristics and surgical outcomes of patients with atraumatic splenic rupture

ObjectiveAlthough rare, late-diagnosed atraumatic splenic rupture (ASR) may result in mortality. We investigated the occurrence of ASR cases at our centre over the previous six years.MethodsThis was a retrospective, cross-sectional study that included all patients who underwent emergency splenectomy due to ASR between January 01, 2015, and January 01, 2021.ResultsOf the 203 patients who underwent splenectomy, 15 met our criteria for ASR. Median age was 55 years (34–90), and 10 (67%) patients were male. Most common pre-existing diseases were diabetes mellitus (6, 40%) and heart valve disease (5, 33%). Ten (67%) patients had splenic rupture due to splenic infarction and abscess. There were two (13%) cases with diffuse large B cell lymphoma (DLBCL) and two (13%) cases with lung cancer and spleen metastasis. Median length of hospital stay was 6 days (2–24) and three (20%) patients died in hospital.ConclusionsMale sex, previous splenic infarctions, haematological malignancies, lung cancer spleen metastases, underlying cardiovascular disease and diabetes mellitus may increase the risk for ASR. Further prospective controlled studies are needed to confirm our results.     

Incidence and outcomes of secondary infections in septic patients with cancer

<正>Secondary infections,also called intensive care unit (ICU)-acquired infections,are defined as infections occurring 48 h after admission to the ICU.^[1] Critically ill patients are at a high risk of developing ventilatorassociated pneumonia (VAP) and bloodstream infections(BSIs),which are associated with increased ICU mortality.^[2]Cancer patients are susceptible to infections owing to multiple risk factors due to immunosuppression,including radiotherapy,systemic ther...