Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

Association between "Malnutrition Inflammation Score" and airway obstruction in patients awaiting renal transplantation: a preliminary study.

BACKGROUND: A chronic inflammatory state is a prominent feature in patients with end-stage renal disease (ESRD) who are undergoing maintenance hemodialysis (MHD). "Malnutrition Inflammation Score" (MIS) is a comprehensive scoring system that measures nutrition and inflammation in MHD patients. Inflammation and malnutrition are important risk factors in ESRD patients with pulmonary diseases. The aim of the study was to determine if pulmonary dysfunction, as assessed by airway obstruction, was associated with malnutrition and inflammatory factors in ESRD patients awaiting renal transplantation (RT). METHODS: Patients with ESRD who were on MHD and had pulmonary function tests (PFTs) were retrospectively enrolled in the study. Patients' renal function tests, albumin, C-reactive protein (CRP) levels, white blood cell count, and PFTs (forced expiratory flow rate in one second [FEV1], forced vital capacity [FVC], forced expiratory flow at 25%-75% [FEF25%-75%], and peak expiratory flow [PEF]) were recorded. MIS was calculated for each patient. RESULTS: A total of 81 patients (male=54; mean age: 50.6±13 years) were recruited. Mean body mass index (BMI) was 22.5±4.4 kg/m2, mean MIS was 7.1±3.3, mean CRP level was 24.9±48.1 mg/L, mean FEV1% was 94±22, and mean FEF25%-75% was found to be 72.3±30.3. Mean duration of MHD was 10.5±5.2 years. There was a negative correlation between FEV1, FVC, FEF25%- 75%, PEF, and MIS (r=-0.3, P=.00; r=-0.32, P=.00; r=-0.22, P=.04; r=-0.30, P=.00, respectively). Nevertheless, FEV1 values significantly correlated with BMI (P=.03) and the MIS (P=.00). CONCLUSION: Impaired pulmonary function could be a marker of inflammation and malnutrition in ESRD patients awaiting RT. Prospective studies are needed to investigate the relationship between pulmonary function, inflammation, and malnutrition in larger populations of ESRD patients. Treatment geared towards malnutrition and inflammation markers may help maintain PFTs within normal range, which may prevent pulmonary complications following RT.

Diagnostic utility of flexible bronchoscopy in recipients of solid organ transplants.

BACKGROUND: Solid organ transplant (SOT) recipients are prone to develop pulmonary complications (PC) due to their immunocompromised state. Flexible bronchoscopy (FB) is frequently performed to diagnose the nature of these complications. The aim of this study was to evaluate the diagnostic utility of FB in SOT recipients with suspected PC. METHOD: We examined the medical records of patients who underwent FB between 2000 and 2010; patients who received SOT were included patient demographics, transplantation type, primary diagnoses, thorax computed tomography results, total blood count and chemistries, immunosuppressant therapies, indication, results, specimen cultures, as well as suspected and final diagnoses were recorded. RESULTS: Among 1368 either liver or kidney transplant recipients 61 subjects including 49 male patients of overall mean age 42.8±12 years underwent FB. FB was performed for lung infiltrates (n=42), lung nodules (n=2), atelectasis (n=1), bronchopleural fistula (n=1), stridor (n=1), mediastinal lymphadenopathy (n=2), pleural effusion (n=1), fever (n=9), and/or hemoptysis (n=2). FB was unremarkable in 17. Other findings were as follows: increased secretions (n=24), chronic mucosal changes (n=7), endobronchial lesion (n=1), edematous mucosa (n=3), submucosal narrowing (n=1), necrotic plaque (n=2), hemorrhage (n=2), tracheal stenosis (n=1), and/or friable mucosa (n=3). We performed bronchial washings (n=56) and/or bronchoalveolar lavage (n=5). In 24 patients the microorganisms were Mycobacterium tuberculosis, Staphylococcus aureus, Moraxella catharralis, Candida albicans, Klebsiella pneumonia, Escherichia coli, Streptococcus pneumonia, Stenotrofomonas maltofilia, Aspergillus fumigatus, and Pseudomonas aerigunosa. In 34 patients a final diagnosis was established using FB (diagnostic yield, 55.7%). Thirty-one patients had received tacrolimus (10.5±5.3 ng/ng/mL); 22 cyclosporine (187.1±79.3 ng/mL); and 8, sirolimus (6.2±2.2 ng/mL). No significant difference was observed between high versus low drug levels and the culture results (P>.05). CONCLUSION: Suspected pulmonary infection is the most common indication for FB in SOT recipients. It may identify the causative organism in more than 30% of patients and should be considered in the presence of a lung infection.

Pulmonary complications in renal recipients after transplantation.

BACKGROUND: Renal transplantation is the most common type of solid organ transplantation. Recipients are susceptible to a variety of pulmonary complications, in particular during intense immunosuppression therapy. OBJECTIVE: To evaluate pulmonary complications during the first year after renal transplantation. MATERIALS AND METHODS: Medical records were reviewed retrospectively for all patients who underwent renal transplantation between 2007 and 2010. Data pertinent to pulmonary complications were obtained including patient demographics, findings at chest radiography and pulmonary function testing, concentrations of C-reactive protein and albumin, and white blood cell count. RESULTS: The study included 136 patients (71.3% men), with mean (SD) age of 36.3 (12.2) years. The most frequently prescribed immunosuppression therapy included prednisolone plus cyclosporine, tacrolimus, or rapamycin. Fifteen patients developed complications during the first year after surgery including respiratory infections in 12 (80%), namely, bacterial pneumonia in 10 (66.6%), and tuberculosis (caused by Mycobacterium tuberculosis) in 2 (33.3%). Pneumonia developed within the first 5 months after transplantation in 6 patients, and tuberculosis after the third month. Microbiologic agents were detected in 3 of the 6 patients (20%), and empyema, postoperative atelectasis, and pulmonary embolism, respectively, in the other 3 patients. No association was observed between complications and baseline pulmonary function test results. C-reactive protein concentration was significantly increased in patients with pulmonary complications. No invasive procedures were performed to diagnose complications, all of which resolved with appropriate treatment. CONCLUSION: Pulmonary infections are a primary complication in renal transplant recipients, and are observed most frequently in the first 6 months after surgery. Immunosuppression therapy is the most likely cause of these complications, and rigorous monitoring of drug concentrations is essential. An invasive diagnostic approach may not always be necessary to determine the early specific therapy.