ABSTRACT
PURPOSE: Brain metastases (BM) occur in 15-35% of patients with metastatic breast cancer, conferring poor prognosis and impairing quality of life. Clinical scores have been developed to classify patients according to their prognosis. We aimed to check the utility of the Breast Graded Prognostic Assessment (B-GPA) and its modified version (mB-GPA) and compare them in routine clinical practice. METHODS: This is an ambispective study including all patients with breast cancer BM treated in a single cancer comprehensive center. We analyzed the overall survival (OS) from BM diagnosis until death. The Kaplan-Meier method and Cox proportional hazard regression model were used in the analyses. ROC curves were performed to compare both scores. RESULTS: We included 169 patients; median age was 50 years. HER2-positive and triple negative patients were 33.7% and 20.7%, respectively. At the last follow-up, 90% of the patients had died. Median OS was 12 months (95% confidence interval 8.0-16.0 months). OS was worse in patients with > 3 BM and in patients with triple negative subtype. CONCLUSIONS: In our series, we confirm that B-GPA and mB-GPA scores correlated with prognosis. ROC curves showed that B-GPA and mB-GPA have similar prognostic capabilities, slightly in favor of mB-GPA.
Subject(s)
Brain Neoplasms/mortality , Brain Neoplasms/secondary , Breast Neoplasms/mortality , Breast Neoplasms/chemistry , Breast Neoplasms/classification , Breast Neoplasms/pathology , Confidence Intervals , Female , Humans , Kaplan-Meier Estimate , Middle Aged , Prognosis , Proportional Hazards Models , Quality of Life , ROC Curve , Receptor, ErbB-2 , Triple Negative Breast Neoplasms/mortality , Triple Negative Breast Neoplasms/pathologyABSTRACT
This study is based on our previous research showing that commercial probiotic fermented milk (PFM) intake mitigates respiratory allergy development to ovalbumin (OVA) in adult mice (6-weeks old) increasing specific immunoglobulin (Ig)G2a and interferon (IFN)-γ rather than IgE. The aim was to determine if PFM exerts a protective effect when an allergy model is induced 5 days after weaning and whether the mechanisms involved are similar to those previously reported. Before inducing allergy, a group of 21-day old BALB/c mice received PFM for 10 days to analyse the impact on intestinal epithelial cells (IECs) activation. Two more groups received PFM for 5 days and were sensitised with OVA; only one group continued taking PFM until the end of the experiment. Sensitisation scheme: 3 OVA injections 1% in phosphate buffered saline (PBS) plus 7 days OVA aerosol exposure and re-stimulus 15 days later. The contents of specific- IgE, IgG, total-secretory-IgA and Th1/Th2 balance in serum, bronchoalveolar lavage (BAL) and gut were measured at 7 and 15 days post-sensitisation (dPS) and 2 days post-re-stimulus (2dPR). Treg cells in lungs were also quantified. Results were compared with normal and sensitised controls. PFM induced mild activation of IECs increasing monocyte chemoattractant protein-1 (MCP-1 or CCL2) and interleukin (IL)-6 production. In sensitised mice, PFM controlled the response inducing IgG rather than IgE at 7 and 15-dPS and 2dPR (60 days old). Th1-balance (IFN-γ) was favoured by PFM in lungs at 7 dPS with low levels of IL-10 released to regulate the response. Total-S-IgA increased in lungs and gut; however, PFM intake did not affect Treg cells in lungs. PFM maintains controlled stimulation of the immune cells involved in Th1 response, favouring IgG at the respiratory mucosal site. Although the effect was not as strong as that reported previously, PFM promoted maturation and activation of gut immune cells preserving intestinal homeostasis and lung immune response.
Subject(s)
Fermented Foods , Immunoglobulin A/blood , Immunoglobulin G/blood , Intestinal Mucosa/physiology , Milk/microbiology , Probiotics/pharmacology , Animals , Cytokines/blood , Disease Models, Animal , Immunoglobulin E/blood , Mice , Mice, Inbred BALB C , Ovalbumin/immunology , Th1-Th2 Balance/drug effectsABSTRACT
Objetivo: validar el Palliative Prognostic (PaP) Score en pacientes con cáncer avanzado ingresados en un hospital de agudos, a cargo de una unidad de cuidados paliativos española. Pacientes y método: se calculó el PaP Score en una población de 100 pacientes consecutivos ingresados en la Unidad de Medicina Paliativa de Albacete. Se analizó la supervivencia, usando el método de Kaplan-Meier y el test de log-rank para comparar la distribución de la supervivencia en los tres grupos del PaP Score. Resultados: el PaP Score dividió la muestra de pacientes en tres categorías pronósticas, con 36 pacientes en el grupo A (con una probabilidad de supervivencia a 1 mes mayor del 70%), 35 pacientes en el grupo B (con una probabilidad del 30 al 70%) y 29 pacientes en el grupo C (con una probabilidad menor del 30%). La supervivencia a 1 mes en los grupos fue 89, 63 y 14% respectivamente. La mediana de supervivencia estimada fue 89 días (IC95%, de 64 a 114 días), 39 días (IC95%, de 18 a 60 días) y 6 días (IC95%, de 5 a 7 días), respectivamente. Estas diferencias fueron muy significativas (log-rank = 33,56; p < 0,0001). Conclusiones: el PaP Score es capaz de dividir correctamente a los pacientes en tres categorías pronósticas. Por tanto, esta herramienta ofrece una mejoría sobre la estimación clínica de la supervivencia en pacientes con cáncer avanzado, ingresados en una unidad de cuidados paliativos (AU)
Objetive: to validate the Palliative Prognostic (PaP) score in the acute care setting, in hospitalized patients with advanced cancer in a Spanish palliative care unit. Patients and method: the PaP score was calculated for a population of 100 consecutive patients hospitalized in a palliative care unit at Albacete (Spain). A survival analysis was performed; the Kaplan-Meier method and log-rank test were used to compare survival distributions for patients in three PaP score groups. Results: the PaP score split the patient sample into three prognostic categories, with 36 patients in group A (>70% chance of surviving for 1 month), 35 patients in group B (30-70% chance), and 29 patients in group C ( <30% chance). One-month survival for these three groups was 89%, 63% and 14%, respectively. The estimated median survival of these groups was 89 days (95% CI, 64 to 114 days), 39 days (95% CI, 18 to 60), and 6 days (95% CI, 5 to 7), respectively. These survival differences were highly significant (log-rank = 33.56; p < 0.0001). Conclusions: the PaP score can accurately assign patients to three prognostic categories. Therefore, this tool represents an improvement over clinical estimates of survival in patients on advanced care hospitalized in a palliative care unit (AU)
Subject(s)
Humans , Palliative Care , Prognosis , Terminally Ill , Oncology Service, Hospital , Neoplasms/diagnosis , Disease-Free SurvivalABSTRACT
No disponible
Subject(s)
Humans , Patient Rights/trends , Patient Discharge/trends , Patient Access to Records/trends , Prognosis , Personal Autonomy , Terminology , Physician-Patient RelationsABSTRACT
No disponible
Subject(s)
Middle Aged , Aged , Male , Humans , Hospital Mortality , Terminal Care , Treatment Outcome , Terminally Ill , Prednisone , Paraneoplastic Syndromes , Palliative Care , Carcinoma, Squamous Cell , Diagnosis, Differential , Dermatomyositis , Hospitals, General , Inpatients , Erythema , Glucocorticoids , Pharyngeal NeoplasmsABSTRACT
FUNDAMENTO: La agonía, que casi siempre precede a la muerte, es un proceso que ofrece una oportunidad de mejora, y de actuación. La descripción de este problema clínico es inusual. El tratamiento explícito de la agonía permitiría una muerte más digna. OBJETIVO.: Describir la muerte "real" en una serie de pacientes de un hospital general. PACIENTES Y MÉTODO: Estudio clínico observacional y prospectivo del proceso de la muerte en 56 pacientes asistidos -"en tiempo real y a la cabecera de la cama"- por diversas condiciones médicas irreversibles. Se trataba de 35 varones y 21 mujeres, con una edad media (DE) de 66,6 (17) años (mediana y moda, 70; rango, 16-91 años). Registramos el nivel de sedación/analgesia, el grado de instrumentación tecnológica, la información compartida entre médico, el paciente, la familia y la enfermería, y las órdenes documentadas de "no reanimar". RESULTADOS: Las causas de muerte eran: enfermedad crónica terminal (48,2 per cent), neoplasias diversas extendidas (42,8 per cent) y enfermedad aguda intratable (9 per cent). El 70 per cent de los pacientes agonizaban sin ayuda suficiente debido a dolor no controlado, disnea, angustia vital, vómitos, miedo o agotamiento. El 30 per cent no recibió sedación/analgesia alguna. Salvo un caso, todos tenían un catéter venoso: el 41 per cent la vejiga cateterizada y el 12,5 per cent una sonda nasogástrica. Aunque la disnea afectó a todos, sólo se suplementó oxígeno en el 76,8 per cent. En tres casos se llegó a la reanimación cardiopulmonar sin éxito. A pesar de lo inevitable de la muerte, se documentó orden de "no reanimar" en el 51,7 per cent. Sólo 4 pacientes conocían su situación. Este "pacto de silencio" no fue desvelado a la familia en el 42,9 per cent de los casos. Enfermería fue avisada de la muerte en el 51,7 per cent de los pacientes. CONCLUSIONES: La asistencia al moribundo es claramente mejorable. En la mayoría de los casos, la autonomía es usurpada por un paternalismo "bien intencionado". La información proporcionada al paciente fue casi nula e imperó el secretismo. Los pacientes deseaban alivio y se les ofreció tecnología invasiva. Detectamos una actitud "neutral", abandono o cierta indiferencia ante el último y mayor sufrimiento humano. Invocamos un cambio de actitud entre los clínicos (AU)