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1.
Anticancer Res ; 41(4): 1971-1974, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813403

RESUMEN

BACKGROUND/AIM: Oncological care has faced several challenges during the COVID-19 pandemic, e.g. treatment delay and worsening symptoms. Patient-reported anxiety, depression and sleep quality might have changed due to these special circumstances. Therefore, we analyzed the symptom burden of patients treated with palliative radiotherapy at our center. PATIENTS AND METHODS: A retrospective study was performed of 50 consecutive patients and the results were compared to those obtained in a previous pre-COVID study. The Edmonton Symptom Assessment Scale was employed to assess the preradiotherapy symptoms. RESULTS: The highest mean scores were reported for pain in activity (3.2) and dry mouth (3.1). Regarding anxiety, sadness/depression and sleep, the corresponding scores were 1.5, 1.2 and 2.7, respectively. Compared to the previous study, no significant increases were found. Most items had numerically lower mean values, e.g. anxiety (1.5 vs. 2.7). Both study populations had comparable median age (70.5 vs. 70 years), gender distribution and proportion of patients with bone metastases. However, there were two significant imbalances, namely a lower proportion of patients with prostate cancer (12 vs. 30%, p=0.02) and breast cancer (0 vs. 12%, p=0.02). CONCLUSION: In patients who showed up for radiation treatment planning, the suspected increase in anxiety, sadness/depression and sleep disturbance was not demonstrable. It is not known whether or not patients with substantial worries chose to decline referral to palliative radiotherapy. Therefore, comprehensive large-scale studies of patterns of care are needed to fully understand the impact of COVID-19-related measures.


Asunto(s)
/epidemiología , Costo de Enfermedad , Neoplasias/radioterapia , Cuidados Paliativos/métodos , Pandemias , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Ansiedad/etiología , Neoplasias Óseas/epidemiología , Neoplasias Óseas/secundario , Dolor en Cáncer/diagnóstico , Dolor en Cáncer/epidemiología , Dolor en Cáncer/etiología , Depresión/epidemiología , Depresión/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/epidemiología , Neoplasias/patología , Noruega/epidemiología , Estudios Retrospectivos , Análisis de Supervivencia , Evaluación de Síntomas
2.
Anticancer Res ; 41(4): 2111-2115, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33813421

RESUMEN

BACKGROUND/AIM: It has been hypothesized that many, or even most cancers, utilize a unique immunomodulatory protein, called the progesterone induced blocking factor (PIBF) to allow spread of the cancer. Support for this concept has been provided by cancer cell line studies showing that PIBF is produced by these cancer cells and mifepristone suppresses this protein and inhibits proliferation of these cells. Furthermore, controlled murine studies with several spontaneous different types of cancer showed a clear beneficial effect of mifepristone over placebo control. Finally, there have been a variety of anecdotal reports showing efficacy of mifepristone in providing increased length and quality of life in patients with different types of advanced cancers. CASE REPORT: Single agent mifepristone was found to provide significant palliative benefit for a 51-year-old male whose metastatic advanced fibroblastic osteosarcoma progressed despite surgery, radiotherapy, multiagent chemotherapy, and targeted therapy. CONCLUSION: Thus, osteosarcoma can be added to the list of cancers, not necessarily associated with the classic nuclear progesterone receptor, that seem to respond to progesterone receptor antagonist therapy.


Asunto(s)
Neoplasias Óseas/tratamiento farmacológico , Mifepristona/administración & dosificación , Osteosarcoma/tratamiento farmacológico , Cuidados Paliativos/métodos , Administración Oral , Neoplasias Óseas/patología , Dolor en Cáncer/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Osteosarcoma/patología , Calidad de Vida , Tibia , Resultado del Tratamiento
3.
Emerg Med Clin North Am ; 39(2): 443-452, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33863471

RESUMEN

The incorporation of palliative care to address the needs of the older adult is a vital part of emergency medicine. Recognizing the trajectory of chronic diseases in older adults and the myriad of medical diseases amenable to palliative care is paramount. Early involvement of palliative care should be considered the cornerstone to overarching management of the older adult presenting to the emergency department.


Asunto(s)
Servicio de Urgencia en Hospital , Cuidados Paliativos/métodos , Anciano , Medicina de Emergencia , Humanos
4.
Sci Rep ; 11(1): 5282, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33674709

RESUMEN

In this study, we evaluated the effectiveness of palliative breast radiation therapy (RT), with single fraction RT compared with fractionated RT. Our study showed that both RT fractionation schemas provide palliation. Single fraction RT allowed for treatment with minimal interference with systemic therapy, whereas fractionated RT provided a more durable palliative response. Due to equivalent palliative response, at our institution we have increasingly been providing single fraction RT palliation during the COVID-19 pandemic.


Asunto(s)
Neoplasias de la Mama/radioterapia , Electrones/uso terapéutico , Recurrencia Local de Neoplasia/radioterapia , Cuidados Paliativos/métodos , Fotones/uso terapéutico , Radiodermatitis/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Mama/patología , Mama/efectos de la radiación , Neoplasias de la Mama/patología , /prevención & control , Fraccionamiento de la Dosis de Radiación , Relación Dosis-Respuesta en la Radiación , Electrones/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Control de Infecciones/normas , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Pandemias/prevención & control , Fotones/efectos adversos , Oncología por Radiación/normas , Radiodermatitis/etiología , Estudios Retrospectivos , Resultado del Tratamiento
5.
World J Pediatr Congenit Heart Surg ; 12(2): 213-219, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33684011

RESUMEN

BACKGROUND: Surgical pulmonary artery banding (PAB) has been limited in practice because of later requirement for surgical removal or adjustment. The aim of this study is to describe our experience creating a dilatable PAB via transcatheter balloon dilation (TCBD) in congenital heart disease (CHD) patients. METHODS: Retrospective chart review of adjustable PAB-outline anatomical variants palliated and patient outcomes. RESULTS: Sixteen patients underwent dilatable PAB-median age 52 days (range 4-215) and weight 3.12 kg (1.65-5.8). Seven (44%) of the patients were premature, 11 (69%) had ventricular septal defect(s) with pulmonary over-circulation, four (25%) atrioventricular septal defects, and four (25%) single ventricle physiology. Subsequent to the index procedure: five patients have undergone intracardiac complete repair, six patients remain well palliated with no additional intervention, and four single ventricles await their next palliation. One patient died from necrotizing enterocolitis (unrelated to PAB) and one patient required a pericardiocentesis postoperatively. Five patients underwent TCBD of the PAB without complication-Two had one TCBD, two had two TCBD, and another had three TCBD. The median change in saturation was 14% (complete range 6-22) and PAB diameter 1.7 mm (complete range 1.1-5.2). Median time from PAB to most recent outpatient follow-up was 868 days (interquartile range 190-1,079). CONCLUSIONS: Our institution has standardized a PAB technique that allows for transcatheter incremental increases in pulmonary blood flow over time. This methodology has proven safe and effective enough to supplant other institutional techniques of limiting pulmonary blood flow in most patients-allowing for interval growth or even serving as the definitive palliation.


Asunto(s)
Cardiopatías Congénitas/cirugía , Cuidados Paliativos/métodos , Arteria Pulmonar/cirugía , Circulación Pulmonar/fisiología , Procedimientos Quirúrgicos Vasculares/métodos , Femenino , Cardiopatías Congénitas/fisiopatología , Humanos , Lactante , Recién Nacido , Masculino , Arteria Pulmonar/fisiopatología , Estudios Retrospectivos , Resultado del Tratamiento
6.
Int Heart J ; 62(2): 441-444, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33731533

RESUMEN

We had a 58-year-old man with advanced heart failure and progressive end-organ dysfunction refractory to inotropes. Following detailed discussions, he decided not to receive ventricular assist device therapy considering his comorbidity of schizophrenia. A palliative care team initiated 2.5 mg of morphine together with low-dose anti-heart failure medications, which improved not only his heart failure symptoms but also the congestive heart failure itself. Aggressive commitments of the palliative care team might improve not only patients' quality of life but also advanced heart failure itself.


Asunto(s)
Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Cuidados Paliativos/métodos , Calidad de Vida , Esquizofrenia/complicaciones , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad
7.
Ned Tijdschr Geneeskd ; 1642021 01 04.
Artículo en Holandés | MEDLINE | ID: mdl-33651521

RESUMEN

METHOD: Registration system initiated by General Practice Research Consortium Netherlands (GPRC-NL). AIM: To obtain national estimates on clinically suspected Covid-19 mortality in general practice and on intensive and palliative covid-19 care provided by general practitioners (GPs) outside hospital, including palliative medication, availability of personal protective equipment, and reasons for not referring to hospital of vulnerable patients during the first three months of the Covid-19 pandemic in The Netherlands. DESIGN: Nationwide registration study, in which 2.331 GP practices in The Netherlands participated from March-June 2020. METHOD: Registration system initiated by General Practice Research Consortium Netherlands (GPRC-NL) through existing digital referral platform ZorgDomein, in which GPs could report PCR-proven and clinically suspected Covid-19 deceased patients to estimate the impact of the Covid-19 pandemic in primary care. RESULTS: GPs reported 1,566 Covid-19 deceased patients, of which 61% (949/1,566) were clinically suspected but not PCR-tested, with large regional differences, and most deaths being reported in the provinces of Brabant and Limburg. Patients had a median duration from onset of symptoms to death of 8 days and a median age of 87 years. GPs reported 1,030 patients for which they delivered intensive or palliative care, of which 56% had a Clinical Frailty Score higher or equal to six. Most mentioned reason for GPs and patients in the decision not going to hospital were the explicit wish of the patient (59%) and somatic vulnerability (52%). CONCLUSION: GPs provided palliative care to a large number of clinically suspected Covid-19 vulnerable patients with large regional differences across The Netherlands. Reported GPs' and patients' considerations to refrain from hospital care can be used to guide future primary care for vulnerable Covid-19 patients.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Cuidados Críticos , Medicina General , Cuidados Paliativos , Anciano de 80 o más Años , /mortalidad , Toma de Decisiones Clínicas , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Femenino , Medicina General/métodos , Medicina General/estadística & datos numéricos , Humanos , Masculino , Países Bajos/epidemiología , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Prioridad del Paciente , Derivación y Consulta/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , /aislamiento & purificación
8.
Ann R Coll Surg Engl ; 103(3): 197-202, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645283

RESUMEN

INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.


Asunto(s)
Ingestión de Alimentos , Derivación Gástrica/métodos , Obstrucción de la Salida Gástrica/cirugía , Tránsito Gastrointestinal , Neoplasias/complicaciones , Cuidados Paliativos/métodos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Neoplasias Duodenales/complicaciones , Femenino , Neoplasias de la Vesícula Biliar/complicaciones , Obstrucción de la Salida Gástrica/etiología , Humanos , Laparoscopía/métodos , Laparotomía/métodos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tempo Operativo , Neoplasias Pancreáticas/complicaciones , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Neoplasias Gástricas/complicaciones , Tasa de Supervivencia , Resultado del Tratamiento
9.
Anticancer Res ; 41(3): 1471-1474, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33788739

RESUMEN

BACKGROUND/AIM: The aim of this study was to analyze the survival predictions obtained from a web platform allowing for computation of the so-called Bone Metastases Ensemble Trees for Survival (BMETS). This prediction model is based on a machine learning approach and considers 27 prognostic covariates. PATIENTS AND METHODS: This was a retrospective single-institution analysis of 326 patients, managed with palliative radiotherapy for bone metastases. Deviations between model-predicted survival and observed survival were assessed. RESULTS: The median actuarial survival was 7.5 months. In total, 59% of patients survived for a period shorter than predicted. Twenty percent of the predictions of the median survival deviated from the observed survival by at least 6 months. Regarding actual survival <3 months (99 of 326 patients), the BMETS-predicted median survival was <3 months, i.e. correct in 67 of 99 cases (68%), whereas the model predicted a median of 4-6 months in 16 (16%) and of >6 months in another 16 cases. CONCLUSION: The model predicted survival with high accuracy in a large number of patients. Nevertheless, if the model predicts a low likelihood of 3-month survival, actual survival may be very poor (often 1 month or less). Also, in patients who died within 3 months from the start of radiotherapy, the model often predicted longer survival (16% had >6 months predicted median survival). It would, therefore, be interesting to feed the U.S. database utilized to develop the BMETS with additional poor-prognosis patients to optimize the predictions.


Asunto(s)
Neoplasias Óseas/radioterapia , Aprendizaje Automático , Cuidados Paliativos/métodos , Oncología por Radiación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Estudios Retrospectivos
11.
Am Fam Physician ; 103(4): 219-226, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33587574

RESUMEN

Frailty, which is a geriatric syndrome that affects 5% to 17% of older adults, is a state of increased vulnerability across multiple health domains that leads to adverse health outcomes. Frail older adults are at increased risk of falls, disability, hospitalizations, and death. Frailty may initially be overlooked or incorrectly identified as part of the normal aging process because of the variable nature of the presentation and diagnosis. Symptoms include generalized weakness, exhaustion, slow gait, poor balance, decreased physical activity, cognitive impairment, and weight loss. There is no current recommendation for routine screening. A comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty. Several validated frailty assessment tools can evaluate a patient for frailty. Patients are diagnosed as not-frail, prefrail, or frail. Patients with a larger number of frail attributes are at higher risk of poor outcomes. The management of frail patients must be individualized and tailored to each patient's goals of care and life expectancy. Physical activity and balance exercises may be suitable for patients who are less frail. Palliative care and symptom control may be appropriate for those who are more frail.


Asunto(s)
Personas con Discapacidad , Terapia por Ejercicio/métodos , Anciano Frágil/estadística & datos numéricos , Fragilidad/diagnóstico , Fragilidad/terapia , Evaluación Geriátrica/métodos , Cuidados Paliativos/métodos , Anciano , Anciano de 80 o más Años , Curriculum , Educación Médica Continua , Femenino , Humanos , Masculino , Factores de Riesgo , Estados Unidos
12.
J Med Internet Res ; 23(2): e21615, 2021 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-33595448

RESUMEN

BACKGROUND: The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients' values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient's wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. OBJECTIVE: To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center's EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. METHODS: We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab's main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. RESULTS: We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. CONCLUSIONS: It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.


Asunto(s)
/diagnóstico , Registros Electrónicos de Salud/organización & administración , Informática Médica/métodos , Cuidados Paliativos/métodos , Calidad de Vida/psicología , Humanos
13.
Anticancer Res ; 41(1): 385-389, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419835

RESUMEN

BACKGROUND/AIM: A combination therapy of esophageal stent and chemoradiotherapy (CRT) is currently considered risky for severe complications. The aim of this study was to assess the safety and efficacy of a fully covered self-expandable metallic stent (FCSEMS) placement in palliating incurable esophageal cancer before and/or after CRT. PATIENTS AND METHODS: We retrospectively reviewed clinical outcomes of 64 incurable advanced esophageal cancer patients with FCSEMS placement. Forty-two of 64 patients had FCSEMS placement with RT. RESULTS: The rate of all of stent-related complications tended to be higher in patients who had RT, although no significant difference was observed. The stent-related deaths occurred in one patient due to hemorrhage after FCSEMS placement in the RT-negative group. CONCLUSION: Palliation of dysphagia or fistulas with FCSEMS in patients with incurable esophageal cancer before and/or after RT is not associated with an increased risk of life-threatening complications.


Asunto(s)
Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Neoplasias Esofágicas/complicaciones , Cuidados Paliativos , Stents Metálicos Autoexpandibles , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Pronóstico , Radioterapia , Stents Metálicos Autoexpandibles/efectos adversos , Análisis de Supervivencia , Resultado del Tratamiento
14.
Anticancer Res ; 41(1): 459-466, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419844

RESUMEN

BACKGROUND/AIM: Currently, there are no standard guidelines for the waiting time from the diagnosis of gastric neoplasms to endoscopic submucosal dissection (ESD). PATIENTS AND METHODS: A total of 1,605 patients who had undergone ESD for early gastric cancer (EGC) or high-grade dysplasia (HGD) were enrolled. Waiting time for ESD was defined as the time from the first diagnosis to ESD. Multivariable logistic regression analysis was conducted. RESULTS: The curative resection rate was 86.8% and the mean waiting time was 36.8 days. In the multivariable model, longer waiting time did not significantly affect non-curative resection, whereas age >70 years, submucosal fibrosis, and initial cancer diagnosis were significantly associated with non-curative resection. Waiting time was still not identified as a risk factor for non-curative resection in EGC and HGD groups. CONCLUSION: A longer waiting time from diagnosis to ESD was not associated with non-curative resection.


Asunto(s)
Resección Endoscópica de la Mucosa , Cuidados Paliativos , Neoplasias Gástricas/cirugía , Tiempo de Tratamiento , Espera Vigilante , Anciano , Anciano de 80 o más Años , Manejo de la Enfermedad , Resección Endoscópica de la Mucosa/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/diagnóstico , Resultado del Tratamiento
15.
Support Care Cancer ; 29(5): 2255-2258, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33392774

RESUMEN

The outbreak of coronavirus disease 2019 (COVID-19) markedly affected the way healthcare professionals approach patients with cancer worldwide, not only in terms of therapeutic decision-making but also in terms of supportive care. With the rapid appearance of signs and symptoms and the need of close re-assessment, standard management of oral mucositis has been challenged by physical distancing and limited resources due to the global crisis. Building on the clinical experience developed during the acute phase by members of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO), the implications of COVID-19 on the prevention, assessment, and treatment of mucositis are critically reported. Inspired by the restructuring of supportive care measures in response to the pandemic, suggestions for new models of approaching acute side effects are also discussed.


Asunto(s)
/epidemiología , Estomatitis/terapia , Telemedicina/métodos , /virología , Humanos , Neoplasias/terapia , Cuidados Paliativos/métodos , Pandemias , /aislamiento & purificación
16.
Am J Hosp Palliat Care ; 38(5): 512-520, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33455418

RESUMEN

BACKGROUND: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. AIMS: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. DESIGN: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). RESULTS: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. CONCLUSION: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.


Asunto(s)
/complicaciones , Neoplasias/complicaciones , Cuidados Paliativos/métodos , Brasil/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Estudios Retrospectivos , Factores de Riesgo
17.
Ann Hematol ; 100(3): 601-606, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33388859

RESUMEN

While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.


Asunto(s)
Prestación Integrada de Atención de Salud , Neoplasias Hematológicas/terapia , Oncología Médica , Cuidados Paliativos , Grupo de Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Humanos , Comunicación Interdisciplinaria , Oncología Médica/métodos , Oncología Médica/organización & administración , Oncología Médica/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Cuidados Paliativos/normas , Grupo de Atención al Paciente/normas , Derivación y Consulta/organización & administración , Derivación y Consulta/normas
19.
BMC Palliat Care ; 20(1): 13, 2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33435925

RESUMEN

BACKGROUND: Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients' survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. METHODS: A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox's proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. RESULTS: There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. CONCLUSIONS: AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.


Asunto(s)
Deshidratación/terapia , Fluidoterapia , Neoplasias/terapia , Cuidado Terminal/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Proyectos Piloto , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Tasa de Supervivencia , Enfermo Terminal
20.
In Vivo ; 35(1): 649-652, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33402522

RESUMEN

BACKGROUND/AIM: The study aimed to evaluate practice changes in the time period of the early wave of the COVID-19 pandemic. PATIENTS AND METHODS: This was a retrospective single institution study. We defined palliative radiotherapy (PRT) initiated before Saturday, March 14th as pre-COVID and PRT initiated later as during-COVID (through June 30th). RESULTS: National COVID-19 recommendations led to a significant decrease in PRT with 10 or more fractions, while re-irradiation and radiotherapy during the final 30 days of life were equally common before and after these recommendations had been issued in March 2020. CONCLUSION: Rapid adoption of modified PRT regimens was feasible. However, the challenge of overtreatment in the final phase of the disease, due to inaccurate survival prediction, persisted.


Asunto(s)
/prevención & control , Neoplasias/radioterapia , Cuidados Paliativos/métodos , /aislamiento & purificación , Adulto , /virología , Femenino , Humanos , Masculino , Oncología Médica/métodos , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/clasificación , Pandemias , Guías de Práctica Clínica como Asunto , Radioterapia/métodos , Radioterapia/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo
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