The application of the Glasgow prognostic score to predict the survival in patients with metastatic pancreatic carcinoma.

Objectives: Thither is a more pressing effort to think about chemotherapy (CTx) in second-line and beyond in patients with metastatic pancreatic cancer (mPC). The current work aimed to evaluate the value of the Glasgow prognostic score (GPS) and modified Glasgow prognostic score (mGPS) to predict the survival in patients receiving second-line CTx protocol. Material and Methods: We retrospectively reviewed the patients' medical files with mPC who received second-line CTx protocol between September 2013 and December 2017. The GPS/mGPS graded from 0 to 2 based on C-reactive protein and serum albumin. Results: One hundred and sixty-nine patients with mPC were eligible. Survival of patients with Score 0 (GPS/mGPS) was better than that of Score 1 (GPS/mGPS) or Score 2 (GPS/mGPS), which was statistically significant (P < 0.001). Of 78 patients who died, only 16 patients belonged to Score 0 (GPS/mGPS), compared to 30 patients belonged to Score 1 (GPS/mGPS) and 32 patients belonged to Score 2 (GPS/mGPS). Univariate analysis showed that high GPS/mGPS (P < 0.000) as well as poor Eastern Cooperative Oncology Group Performance Status (P < 0.000) and metastasis either to the liver (P < 0.01) or lung (P < 0.04) were linked with worse prognosis. A statistically significant association was detected between the two scores. Cohen's Kappa coefficient (k) was 0.9, SD = 0.03; 95% CI (0.787-0.922; P < 0.001). Conclusion: Our data suggested that GPS/mGPS is an easy and applicable index that may be used in daily practice and may help in the prognostic stratification of mPC patients to avert overtreatment in frail patients and raise the best supportive treatment concept.

Prediction of Survival Outcome Using Chuang's Prognostic Scale in Metastatic Breast Cancer.

BACKGROUND: For physicians and patients, survival estimation is vital for the treatment plan, especially with frequent use of new therapeutic agents in metastatic breast cancer (MBC). The Chuang's Prognostic Scale (CPS) is a validated prognostic score that may be useful in the avoidance of unnecessary palliative systemic treatment. AIM: The present study aimed to evaluate the CPS in survival prediction in patients with MBC after at least two lines of palliative systemic chemotherapy protocols (PSCPs). METHODS: CPS was prospectively measured in 221 patients with MBC. The total score ranged from 0 to 8.5; the lower score refers to a good prognosis. The survival assessment was made by the Kaplan-Meier curve and the survival difference among the groups was estimated by log-rank test. RESULTS: Using the cutoff value of CPS 5.7, the patients were classified into two groups: Group A had score ≤5.7 (174 patients, 78.7%) and Group B had CPS score >5.7 (47 patients, 21.3%). About 86.2% of the patients in Group A survived >3 months (median survival was 165 days, 95% confidence interval [CI]: 77-261) compared with 21.3% of patients survived in Group B (median survival was 81 days, 95% CI: 55-123) (P = 0.00). The sensitivity, specificity, positive predictive value, and negative predictive value were 97.6% (95% CI: 87.4-99.9), 98.3% (95% CI: 95.2-99.7), 93.2% (95% CI: 81.6-97.7), and 99.4% (95% CI: 96.2-99.9), respectively, for the 3-month mortality prediction. CONCLUSION: CPS could be helpful in estimating the survival outcome in patients with MBC who received at least two PSCPs.

Outcomes of multidisciplinary team interventions in the management of sickle cell disease patients with opioid use disorders. A retrospective cohort study.

OBJECTIVES: To identify the magnitude of opioid use disorder (OUD) among sickle cell disease (SCD) patients; emphasize on multidisciplinary team (MDT) role; estimate cost-effectiveness following the proper use of therapeutic guidelines; and facilitate the reduction of emergency room (ER) visits and the length of stay (LOS). METHODS: This retrospective cohort study included SCD patients aged 14 years and above, who have OUD. Data was collected between January 2016 and December 2018. Data included ER visits, hospital LOS, opioid consumption, and narcotic prescription tracking. The target group was followed with a set of interventions for pain management and healthcare resource utilization. Results: Twenty one SCD patients were identified with OUD. Following the interventions, there was a statistically significant decrease in ER visits of these OUD patients (from 8709 visits in 2016 to only 94 in 2018). Morphine consumption decreased by 82% and meperidine by 60%, over the 3-year period. Moreover, there was a huge reduction in both ER and LOS costs for this cohort of patients. CONCLUSION: Establishing an MDT and a series of interventions for SCD patients with OUD, including educational activities for caregivers and patients; establishing a palliative/pain clinic and a SCD addiction clinic; and implementing an adequate opioid prescription tracking system resulted in a significant reduction in both the cost and number of ER visits and hospital LOS and dramatically decreased opioid consumption.

Impact of Prognostic Nutritional Index on Terminal Cancer Patients.

BACKGROUND: In terminal cancer patients (TCPs), one of the most important things is to define the survival to help the main responsible physicians, patients, and main caregivers make decisions, set goals, and work across the end-of-life strategies. PATIENTS AND METHODS: We retrospectively reviewed the medical files of TCPs, who died during September 2011 and December 2017, to recognize the correlation between prognostic nutritional indices (PNIs) and survival in those subtypes of patients. The receiver operating characteristic (ROC) curve was used to identify the cutoff value of PNI. RESULTS: A total of 858 TCPs were eligible and included, the median age was 62 years (range: 18-107). The most common primary cancer sites were colorectal cancer in 151 patients (17.6%), hepatobiliary in 129 (15%), lung cancer in 115 (13.4%), breast cancer in 114 (13.3%), and genitourinary in 80 (9.3%). The mean value of PNI for all cancer types was 32.9 ± 6.7. The values showed different levels across cancer types. For patients who lived >2 weeks, PNI was 36.7 compared with that who died within 2 weeks was 29.3, which was a statistically significant (P < 0.001). By the ROC curve, the cutoff value of PNI was 32.3 and area under the curve was 0.888. The sensitivity, specificity, positive predictive value, and negative predictive value were 91.28% (95% confidence interval [CI]: 88.2-93.8), 71.09% (95% CI: 66.5-75.4), 76.5% (95% CI: 73.7-79.2), and 88.8% (95% CI: 85.3-91.5), respectively. CONCLUSION: The PNI is an easy and an applicable biomarker to estimate life expectancy in TCPs.

Aggressive Care at the End of Life; Where Are We?

BACKGROUND: Although, efforts to encourage palliative care only for terminal patients, aggressive end-of-life care (EOL) care still common for those probably to die shortly. AIM: Multicenter experiences to investigate where did we stand in this era? PATIENTS AND METHODS: A retrospective study included patients with advanced solid tumors. The presence of one or more of the following indicators in the last month of life (LM) referred to aggressive EOL care: emergency department (ED) visits ≥ twice, admission to the hospital through ED, death in critical care units (CCUs), and palliative chemotherapy (PC) at the past 2 weeks before death. RESULTS: A total of 435 patients, 51.5% were men with a median age of 62 years (range: 17-108), were included in the study. Most of the patients (89.2%) belonged to Group II; they had attended ED at least twice (60%), approximately 53% admitted to the hospital through ED, 31% received PC-LM with 41% of them had at the past 2 weeks before death, 13% died in the CCUs, and more than half of them (53%) survived <2 weeks. Kaplan-Meier estimator revealed that median survival was 30 days in Group I versus 13 days in Group II (odds ratio: 1.63; 95% confidence interval: 1.20-2.21; P = 0.002). The median survival was statistically significantly associated with PC-LM ≥14 days and the admission mode. There was no statistically significant association with age, sex, and primary cancer sites. CONCLUSION: The majority of our patients continue with anticancer treatments they possibly do not need and associated with poor survival.

Systematic psychiatric assessment of patients with sickle cell disease.

OBJECTIVES: To determine the level of the psychological problems such as depression and anxiety in sickle cell disease (SCD) patients in Tabuk region, northwestern Saudi Arabia. Methods: In this cross-sectional study, 89 patients with SCD was assessed in the outpatient clinics of King Salman Armed Forces Hospital,   Tabuk, Saudi Arabia between March 2017 and August 2017. Two validated Arabic translated questionnaires, the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7), were used to assess the type and degree of psychopathology (anxiety or depression) each patient suffered.  Chi-square test was used to assess the differences between anxiety and depression levels according to the different sociodemographic characteristics of the participants. Results: The values were computed by analyzing the Cronbach's alphas for the GAD-7 (0.83) and PHQ-9 (0.81) questionnaires. The rate of depression was 36% and anxiety was 29%. Female patients with SCD reported a higher incidence of depression and anxiety than males (p greater than 0.05). Patients with a higher level of education were significantly more anxious about their illness than those with a lower level education (p=0.02). CONCLUSION: A statistically insignificant association was reported between depression and anxiety with regard to gender; however, female patients reported a higher incidence of depression and anxiety than male patients. A significant association with anxiety was reported among patients with higher levels of education.

Prevalence and severity of pain in cancer patients in an outpatient palliative care setting in Saudi Arabia.

BACKGROUND: The prevalence and severity of cancer pain in the outpatient palliative care (PC) setting have not been explored previously in Saudi Arabia (SA). Exploration of this basic information may help in evaluating pain severity in patients new to PC as compared to those with previous PC exposure. OBJECTIVE: This paper aims to determine the prevalence and severity of cancer pain among new and follow-up patients attending a PC outpatient clinic. METHODS: In a PC outpatient setting in a major tertiary hospital in SA, we interviewed adult patients with cancer during their attendance to the clinic. Patients were requested to score the severity of their pain on a 0 to 10 numerical scale. RESULTS: A total of 124 patients were interviewed, of whom 73 (59%) were females. The majority of patients (82.3%) had metastatic disease. The most common cancers were breast (27.4%) and head and neck (15.3%). The majority of patients (85.5%) reported pain, with a median intensity score of 5 and a mean of 4.6. Of those who reported pain, 54 (51%) scored above 4. The mean pain score did not differ between groups of patients according to various characteristics such as age, sex, performance status, type of cancer or encounter type. CONCLUSION: Pain is a prevalent symptom in new and follow-up cancer patients seen in a PC outpatient setting in SA. Further research on a larger scale is needed to evaluate the magnitude of the problem more comprehensively with emphasis on detailed pain assessment and exploration of the adopted management approaches.

Nonpain Symptoms of New and Follow-up Cancer Patients Attending a Palliative Care Outpatient Clinic in Saudi Arabia.

BACKGROUND: Epidemiology of cancer-related nonpain symptoms receives less attention in literature as compared with cancer pain. OBJECTIVE: This paper aims at exploring the prevalence and severity of nonpain symptoms in cancer patients attending a palliative care (PC) outpatient clinic. MATERIALS AND METHODS: Over a 5 months period, consecutive adult cancer patients attending PC outpatient clinic at a tertiary hospital were evaluated for the presence and severity of 10 nonpain symptoms. Patients were grouped to new or follow-up cases and were also grouped according to performance status and cancer type. Prevalence and severity of symptoms were compared between groups using t test or analysis of variance as appropriate. RESULTS: Fifty-one males and 73 females were interviewed. The most common cancer is female breast (27.4%) followed by head and neck (15.3%). Majority of patients (67%) were new to PC clinic. Patients had 5.1 nonpain symptoms on average, with most common symptoms being tiredness (79.8%), loss of appetite (71.8%), dry mouth (69.4%), anxiety (60.5%), and depression (50.8%). The least common symptoms were confusion and nausea (22.6% each). The median scores of severity were highest for tiredness, loss of appetite, dry mouth, and insomnia (5 points each). Symptoms were fewer among patients with good performance status (P = 0.002), whereas age, gender, cancer type, and encounter type were not associated with difference in symptom prevalence. Younger patients, females and those with poor performance status have shown a tendency toward higher severity scores for several symptoms. CONCLUSION: The significant prevalence and severity of nonpain symptoms among new and follow-up cancer patients seen in a PC outpatient clinic emphasizes the need for comprehensive assessment and routinely audited symptom management plans.

Prevalence and severity of suffering among patients with advanced cancer.

BACKGROUND: Suffering is an expression commonly used to describe distressing experience of cancer patients. Suffering experience among patients with advanced cancer has not been studied before in Saudi Arabia. OBJECTIVE: The objective of this study is to determine the pattern of suffering and the feasibility of measuring its severity on a numerical scale for cancer patients attending a palliative care outpatient clinic. METHODS: This is part of a larger survey studying the pattern of symptomatology in an outpatient palliative care clinic. Over a 5-month period, cancer patients attending an outpatient palliative care clinic were requested to rate their suffering as well as 11 listed symptoms on a 0-10 numerical scale. RESULTS: Of the 124 patients interviewed, 73 (59 %) were females. Only 15 patients (12 %) reported no suffering. For those who were suffering (88 %), the median score is 5. Suffering scores did not differ based on sex, age, or type of cancer. Patients with a Palliative Performance Scale of ≤50 % had significantly higher mean suffering score (6.8) compared to those with better performance status (4.8; P = 0.003). Multivariate analysis resulted in three independent variables showing a significant relationship to suffering score, namely pain (P = 0.018), tiredness (P = 0.022), and depression (P = 0.022). CONCLUSION: Patients with advanced cancer were able to easily rate their suffering on a numerical scale. Pain, tiredness, and depression were associated with the suffering scores. Suffering scores might help in tracing the trend of suffering in the individual patient over time.