Patterns of Palliative Treatments in Stage IV Esophageal Cancer.

Background: The 5 year survival rate of esophageal cancer is under 20%. Studies have shown that early palliative treatments can improve patient quality of life and lower depressed mood without expediting mortality. Despite these benefits, few studies have analyzed factors associated with the national variation among patients who received palliative treatment for esophageal cancer. Methods: This is a retrospective study of adults diagnosed with stage IV esophageal cancer between 2004 and 2018 in the National Cancer Database (NCDB) who received palliative treatment or not (n = 43,599). Cross tabulation and binary logistic regression were performed and evaluated using SPSS. Exclusion criteria included concurrent tumors, patients under age 18, and missing data. Results: Of the 43,599 patients, 26.1% of patients received palliative interventions (n = 11,371). The majority of palliative treatment patients lived less than 6 months after diagnosis (54%) and received radiation (35.7%) or chemotherapy (34.5%) with palliative intent. The patients who received palliative treatment tended to be non-Hispanic (96.6%), white (87.2%), male (83.3%) patients between age 61 and 75 (43.8%) at a comprehensive community cancer program (38.7%) with adenocarcinoma histology (71.8%). Palliative treatment patients most commonly relied on Medicare as their primary payor (45.9%) and had a median household income over $48,000 (54.5%). Conclusion: We identified trends among stage IV esophageal cancer patients receiving palliative treatments. Patients receiving palliative treatments tended to be white, non-Hispanic men. Compared to patients who did not receive palliating treatments, this cohort was more likely to receive treatment at a comprehensive, academic, or integrated network facility.

Risperidone-Induced Sexual Dysfunction Case Report.

Treatment-emergent sexual dysfunctions are a common and distressing adverse effect of antipsychotic medication, particularly risperidone, which can result in medication noncompliance among patients with psychiatric disorders. In this case report, we present a 55-year-old male patient with a history of bipolar disorder type 1 who was admitted to an inpatient psychiatric facility due to a severe manic episode with psychotic features. The patient reported having previously taken risperidone for his bipolar symptoms but stopped taking it two months prior to hospitalization due to sexual side effects, including reduced libido and anejaculation. Comprehensive medical and psychiatric evaluations were performed during the patient's hospitalization, and his symptoms were treated with lurasidone instead of resuming risperidone. The patient's symptoms improved, and he was discharged with close outpatient follow-up for six months without symptoms of sexual dysfunction, depressive or manic symptoms, or adverse medication effects. This case adds to the growing body of literature on the adverse effects of risperidone, which is known to stimulate prolactin and contribute to sexual dysfunction in as many as 50-70% of patients, and highlights the potential benefits of switching to lurasidone, which has limited literature but as of this publication has not been associated with sexual dysfunction in clinical trials. However, more research is needed to fully understand the impact of antipsychotic switching on sexual side effects and the reluctance of patients to switch medications due to discomfort discussing these sensitive issues.

Utilization of Palliative Care in Osteosarcoma: A National Cancer Database Review.

Background: Osteosarcoma is the most common form of bone cancer, but the utilization of palliative care (PC) in patients with this cancer has not previously been investigated in the National Cancer Database (NCDB). Methods: Patients diagnosed with osteosarcoma (2004-2017) were identified within the NCDB. Cross tabulations with Chi-square analysis were performed to evaluate frequencies of palliative care use by patient, facility, and tumor characteristics. Multivariate logistic binary regression was performed to evaluate relationships between patient, treatment facility, and tumor characteristics and the use of palliative care. Results: A total of 7498 patients were analyzed with 2.8% of patients diagnosed having any form of palliative care utilization. Of this group, 53.37% received PC within the first 12 months after diagnosis. Of the 2.8% of patients receiving PC the most common forms of PC utilized were non-curative symptom-directed surgery, radiation, or chemotherapy, or a combination of these modalities (56.7%). Palliative care usage was increased in patients with greater tumor diameter, tumors in the bones of the midline, or stage IV tumors. Palliative care usage was decreased in patients living within 25-49 miles of their treatment facility, those living in pacific states, those with chondroblastic osteosarcoma, or those with private insurance. Conclusion: Palliative care use in patients with osteosarcoma increases with tumor stage, tumor size, or more proximal tumors, but overall utilization remains markedly low. Future studies should further define these patterns of care and help expand the utilization of PC.