Cancer
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Based on an analysis of 1852 retrospectively evaluated patients with metastatic spinal cord compression (MSCC), a scoring system was developed to predict survival. This study was performed to validate the scoring system in a new data set. ⋯ In the current study, the difference in 6-month survival between the prognostic groups was found to be as significant as in the preceding study. Thus, this scoring system was considered valid to estimate survival of MSCC patients. The system could have been simplified by including only 3 instead of 5 prognostic groups.
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Hospital services are expectantly reduced over the weekend, which may result in a delay in treatment or in obtainment of medical procedures. The authors investigated quality of care and clinical outcomes of newly diagnosed acute myeloid leukemia (AML) patients who were hospitalized on weekends versus weekdays and treated with induction chemotherapy. ⋯ Weekend admissions significantly delayed placement of TLC without affecting other quality parameters or patient survival. This is likely because of immediate initiation of peripheral chemotherapy with cytarabine even before the placement of TLC for infusion of anthracyclines.
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Comparative Study
End-of-life care for older cancer patients in the Veterans Health Administration versus the private sector.
Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under fee-for-service Medicare arrangements. ⋯ Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in fee-for-service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes.