Cancer medicine
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The aim of this study was to obtain insight into which proportion of cancer patients is admitted to an Intensive Care Unit (ICU) and how their survival, demographic, and clinical characteristics relate to cancer patients not admitted to the ICU. Data from patients registered with cancer between 2006 and 2011 in four hospitals in the Netherlands were linked to the Dutch National Intensive Care Evaluation registry. About 36,860 patients with cancer were identified, of whom 2,374 (6.4%) were admitted to the ICU. ⋯ Although more women (54.0%) than men were registered with cancer, the proportion of male cancer patients admitted to an ICU was much higher (9.3 vs. 4.0%, P < 0.001). Five-year survival of cancer patients admitted to the ICU was substantial (41%) although median survival was much lower (1,104 days) than in patients not admitted to the ICU (median survival time not reached, P < 0.001). These results show that one out of 16 cancer patients was admitted to an ICU and that ICU support for this group should not be considered futile.
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The association between neutrophil:lymphocyte ratio (NLR) and poor long-term outcomes in patients with non-small-cell lung cancer (NSCLC) has been demonstrated in numerous studies. The benefit of perioperative administration of anti-inflammatory drugs on these outcomes has not been well established. Our aim in this retrospective study was to investigate the effects of postoperative nonsteroidal anti-inflammatory drug (NSAID) administration and NLR on tumor recurrence and survival in patients' undergoing surgical resection for NSCLC. ⋯ However, after accounting for tumor stage, NLR ≥ 5 was a predictor of RFS and OS only in patients with stage I NSCLC. To conclude, preoperative NLR was demonstrated to be an independent predictor of RFS and OS in a subset of patients with early stage NSCLC. Ketorolac administration was not found to be an independent predictor of survival.
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Meta Analysis
Development and validation of the functional assessment of cancer therapy-antiangiogenesis subscale.
The Functional Assessment of Cancer Therapy (FACT)-Antiangiogenesis (AntiA) Subscale was developed and validated to enhance treatment decision-making and side effect management for patients receiving anti-angiogenesis therapies. Side effects related to anti-angiogenesis therapies were identified from the literature, clinician input, and patient input. Fifty-nine possible patient expressions of side effects were generated. ⋯ The total score, subscale scores, and all single items (except nosebleeds) significantly differentiated between groups defined by level of side effect bother. Evaluation of responsiveness to change in this study was not conclusive, suggesting an area for further research. The AntiA is a reliable and valid measure of side effects from anti-angiogenesis therapy.
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Melanoma remains a critical public health problem worldwide. Patients with stage IV disease have very poor prognosis and their 1-year survival rate is only 25%. Until recently, systemic treatments with a positive impact on overall survival (OS) had remained elusive. ⋯ In clinical studies, AEs were managed according to guidelines that emphasized close clinical monitoring and early use of corticosteroids when appropriate. Preliminary results have taught us the potential greater toxicity when in combination with vemurafenib, and the greater antitumor efficacy when combined with nivolumab, a monoclonal antibody directed against programmed death receptor-1 (PD-1), another immune checkpoint inhibitor. Future challenges include the optimization of dosing and toxicities when used as a single agent, and studying the safety and efficacy of combinations with targeted small molecules and other monoclonal antibodies to treat patients with melanoma and other malignancies.
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Observational Study
Sequential occurrence of dyspnea at the end of life in palliative care, according to the underlying cancer.
Dyspnea is a symptom that severely affects the quality of life of terminally ill patients. Its frequency differs considerably between studies. We aimed to characterize the frequency of dyspnea in a palliative care hospital (PCH) and to identify factors predisposing to dyspnea, particularly during the very last days of life, as a function of the underlying disease. ⋯ The data for cancer patients staying for more than 6 days who subsequently died indicated that 8% of patients experienced dyspnea exclusively during the last 4 days of the life, independently of the site of the primary cancer. Dyspnea during the last few days of life requires systematic assessment. Exclusively terminal dyspnea should be distinguished from more precocious dyspnea, as the pathophysiological mechanisms and treatments of these two forms are probably different.