Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research.

OBJECTIVES: Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. METHODS: This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme. RESULTS: 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001). CONCLUSIONS: There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01362816.

Cerebral metastasis from ovarian cancer treated with a multidisciplinary approach. Case report and review of literature.

Brain metastases from ovarian cancer are rare. A review of five autopsy studies reported brain metastases in 4% of 712 patients who died with a diagnosis of ovarian cancer. The prognosis is very poor and a consensus on the standard treatment is not available. We report the case of a patient who developed a solitary brain metastasis as single evidence of relapse, 26 months after the first diagnosis of ovarian cancer. A temporo-parietal craniotomy with excision of the mass and whole brain radiotherapy were performed. The patient is free of disease five months after radiotherapy completion. Also in patients suffering from neoplasms that rarely metastasize to CNS, a careful clinical examination may help to diagnose uncommon sites of disease relapse.

[A case of scleroderma associated with total medullary aplasia]. / Su di un caso di sclerodermia associato ad aplasia midollare globale.

A case of scleroderma associated with pancytopenia is reported. The Authors point out that the severe haematological defect was not caused by autoimmune mechanisms and/or by iron, B12 or folic acid deficiency but it was related to bone marrow aplasia. The microangiopathy of scleroderma is taken into consideration as a possible factor responsible of the bone marrow failure.

[Evaluation of the proliferative activity of hematopoietic cells in preleukemic syndromes]. / Valutazione dell'attività proliferativa delle cellule emopoietiche nelle sindromi preleucemiche.

The Authors have studied bone marrow CFUc and CLFC of 8 cases affected by idiopathic myelofibrosis, 7 by chronic granulocytic leukemia, 6 by polycythemia, and 3 by sideroblastic anemia. The authors studied also C.S.F. activity in peripheral blood of 8 cases. The method of Pike and Robinson for in agar culture was utilized. The results indicated a correlation between increase of clusters/colonies fraction, growth of blasts-like clusters, reduction of C.S.F. activity in peripheral blood and transformation in acute leukemia of preleukemic syndromes.