Sex Differences in Presentation, Treatment, and Survival in Patients Receiving Palliative (Chemo)Radiotherapy for Non-Small Cell Lung Cancer.

BACKGROUND/AIM: The aim of this study was to analyze sex differences in a real-world cohort of patients who received palliative thoracic radiotherapy or chemoradiotherapy for non-small cell lung cancer. PATIENTS AND METHODS: Retrospectively, baseline, treatment, toxicity, and survival data from a single institution were analyzed. The study included 181 patients (82 females, 99 males). RESULTS: Despite borderline significant differences in disease presentation (T and N stage), final assignment to stage II, III or IV was similar. The same was true for target volume size. Neither radiotherapy parameters nor systemic treatment approaches were significantly different. Toxicity profiles and survival were similar too. Less than 1 out of 3 patients experienced high-grade toxicity, largely esophagitis. Median survival was 8.1 (males) versus 7.8 months (females) and the corresponding 2-year survival rates were 16 and 15%, respectively (p=0.78). CONCLUSION: Relevant sex differences were not observed in this study of common radiotherapy regimes such as 10 fractions of 3 Gy or 15 fractions of 2.8 Gy, the latter often combined with carboplatin/vinorelbine chemotherapy.

Days at home in the last three months of life: patterns-of-care analysis in patients with non-small cell lung cancer.

Introduction: To calculate the number of days patients with terminal non-small cell lung cancer (NSCLC) spent at home in the last 3 months of life, and to identify factors that predict a lower proportion of days at home. Material and methods: Retrospective study of 434 deceased patients with NSCLC. The number of days spent in a hospital or nursing home was identified from electronic health records. Results: Most patients received primary chemotherapy. Only 45% received palliative care provided by a dedicated palliative care team (PCT). In the last 3 months of life, only 39 patients (9%) were not hospitalized. The median number of days spent in hospital was 17, range 0-61. Hospital death occurred in 48%. Admission to a nursing home was recorded in 45%. Overall, the patients spent a median of 64 days at home. Both, older patients and females spent fewer days at home. Family network and aspects of palliative care, possibly reflecting the symptom duration or burden, also impacted days at home. Conclusions: Long-lasting need for PCT support (not just the final 3 months) and earlier necessity for opioid analgesics were predictive for a reduced number of days at home. However, modifiable factors such as sex were identified too.

30-day mortality in patients treated for brain metastases: extracranial causes dominate.

BACKGROUND: Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortality model may be relevant. We hypothesized that in-depth evaluation of a carefully defined cohort with short survival, arbitrarily defined as a maximum of 3 months, may provide signals and insights, which facilitate the development of a 30-day mortality model. METHODS: Retrospective analysis (2011-2021) of patients treated for brain metastases with different approaches. Risk factors for 30-day mortality from radiosurgery or other primary treatment were evaluated. RESULTS: The cause of death was unrelated to brain metastases in 61%. Treatment-related death (grade 5 toxicity) did not occur. Completely unexpected death was not observed, e.g. accident, suicide or sudden cardiac death. Logistic regression analysis showed 9 factors associated with 30-day mortality (each assigned 3-6 points) and a point sum was calculated for each patient. The point sum ranged from 0 (no risk factors for death within 30 days present) to 30. The results can be grouped into 3 or 4 risk categories. Eighty-three percent of patients in the highest risk group (> 16 points) died within 30 days, and none survived for more than 2 months. However, many cases of 30-day mortality (more than half) occurred in intermediate risk categories. CONCLUSION: Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture. We were able to develop a multifactorial prediction model. However, the model's performance was not fully satisfactory and it is not routinely applicable at this point in time, because external validation is needed to confirm our hypothesis-generating findings.

Survival and Early Death Within Three Months from the Start of Immune Checkpoint Inhibitors in Patients With Different Types of Cancer.

BACKGROUND/AIM: Implementation of new anticancer treatments in rural healthcare might not always result in identical survival outcomes as those seen in the randomized trials leading to approval. Therefore, the survival of patients treated with immune checkpoint inhibitors (ICI) in Nordland county was analyzed. PATIENTS AND METHODS: Retrospective analysis of 199 patients, mainly treated in adjuvant or palliative settings, e.g, for non-small cell lung cancer (NSCLC) or malignant melanoma (from 2018 to 2021). Overall survival and death within 3 months from start of ICI were evaluated. RESULTS: All patients who received (neo)adjuvant treatment were alive at the time of this analysis. Median survival was not reached for patients treated with consolidation durvalumab for NSCLC. Twenty-five patients died within 3 months [none after (neo)adjuvant or consolidation ICI]. Among these 25 patients, none had performance status (PS) 0 and only 7 had PS 1. Among 13 patients aged ≥80 years, 5 (38%) died within 3 months. Four of five patients treated on an individual basis outside of generally accepted indications died within 3 months. CONCLUSION: The overall survival outcomes observed after limited follow-up appear satisfactory. Death within 3 months was typically caused by cancer progression and mostly related to reduced PS (≥2) and/or advanced age (≥80 years).

Palliative non-small cell lung cancer treatment and end-of-life care stratified by sex and childlessness: an important interplay in unmarried patients?

PURPOSE: To analyze the interplay of sex and presence of children in unmarried patients with non-small cell lung cancer, because previous studies suggested sex-related disparities. Adult children may participate in treatment decisions and provision of social support or home care. METHODS: Retrospective single-institution analysis of 186 unmarried deceased patients, managed according to national guidelines outside of clinical trials. Due to the absence of other oncology care providers in the region and the availability of electronic health records, all aspects of longitudinal care were captured. RESULTS: Eighty-eight female and 98 male patients were included, the majority of whom had children. Comparable proportions in all four strata did not receive active therapy. Involvement of the palliative care team was similar, too. Patients without children were more likely to receive systemic therapy (39% utilization in women with children, 67% in women without children, 41% in men with children, 52% in men without children; p = 0.05). During the last 3 months of life, female patients spent significantly more days in hospital than their male counterparts. Place of death was not significantly different. Home death was equally uncommon in each group. In the multivariate analysis, survival was associated with age and cancer stage, in contrast to sex and presence of children. CONCLUSION: In contrast to studies from other healthcare systems, unmarried male patients were managed in a largely similar fashion to their female counterparts and with similar survival outcome. Unexpectedly, patients without children more often received systemic anti-cancer treatment.

A man in his 50s with neurological symptoms during cancer treatment. / En mann i 50-årene med nevrologiske symptomer under kreftbehandling.

Posterior reversible encephalopathy syndrome (PRES) is a rare clinicoradiographic disorder characterized by acute neurological symptoms with typical neuroimaging findings of vasogenic edema in posterior regions of the brain. This complication is linked to a number of medical conditions, and is increasingly being documented as a side effect associated with a number of therapeutic agents. We present a case of PRES as a result of treatment with the vascular endothelial growth factor (VEGF) multikinase inhibitor, regorafenib. A man in his 50's with known metastatic colorectal cancer presented with headache, vomiting, altered mental state, reduced hand coordination and dexterity, and a homonymous inferior quadrantanopia. Symptoms developed soon after completion of the 3rd regorafenib therapy cycle. Cerebral MRI demonstrated signs indicative of PRES with bilateral vasogenic edema in the occipitotemporal regions. Regorafenib was subsequently discontinued and the patient's condition improved gradually, with normalization of his neurological symptoms within a month. Albeit rare, PRES has been linked to VEGF treatments, particularly sorafenib, sunitinib and pazopanib, however this is the second reported case linking regorafenib with PRES. PRES is usually associated with good prognosis. However, delayed diagnosis and treatment may lead to permanent neurological symptoms, higher morbidity and in rare cases mortality. Therefore increased awareness of this condition is vital.

[Routines for first prescription of oral contraceptives]. / Rutiner ved førstegangsforskrivning av p-piller.

BACKGROUND: There is an increasing awareness about the risk of thromboembolic disease caused by combination oral contraceptives. This study assesses routines associated with prescription of an oral contraceptive, with an emphasis on venous thromboembolic disease. MATERIAL AND METHODS: A questionnaire requesting information about medical history, examinations, and general routines when an oral contraceptive was prescribed for the first time was sent to general practitioners, public health nurses and midwives in two Norwegian counties in 2008. A slightly different questionnaire was distributed to a group of female medical students. They were requested to describe the queries, procedures and information they were subjected to when oral contraceptives was first prescribed for themselves. RESULTS: In total, 99-100% of the prescribers reported that they asked about smoking habits and venous thromboembolic disease in the family. 94% of the doctors and 100% of the public health nurses/midwives informed about the risk of venous thromboembolic disease (p=0.028). The students reported that they had been asked, examined and informed less often than that reported by health professionals. 54% of the physicians and 11% of the public health nurses /midwives most often prescribed third generation oral contraceptives (p < 0.001). INTERPRETATION: Doctors, midwives and public health nurses seem to examine and inform their patients thoroughly about the risk of venous thromboembolic complications when prescribing combination oral contraceptives for the first time. Public health nurses and midwives seem to have a more rational prescription pattern of combined oral contraceptives than doctors.