Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features.

PURPOSE: Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS: This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS: A total of 546 patients were included in the study. A KPS of <70 (P = .021), the number of brain metastases (P = .001), the lack of brain metastasectomy (P = .006), and the lack of systemic therapies after BrRT (P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 (P < .001), the lack of brain metastasectomy (P = .015), and the lack of systemic therapies after BrRT (P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days-120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION: Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.

Smoking among patients hospitalized at a university hospital in the south of Brazil: prevalence, degree of nicotine dependence, and motivational stage of change.

OBJECTIVE: To determine the prevalence and profile of smoking among hospitalized patients at a university hospital in the south of Brazil. METHODS: This was a descriptive cross-sectional study involving patients over 18 years of age hospitalized for over 24 h at the Federal University of Santa Catarina University Hospital, located in the city of Florianópolis, Brazil. The patients were interviewed on two distinct occasions. We collected demographic data, socioeconomic data, and data regarding smoking. RESULTS: We interviewed 235 patients: 44 (18.7%) were smokers; 77 (32.8%) were former smokers; 114 (48.5%) were nonsmokers; and 109 (46.7%) were passive smokers. The mean age of the smokers was 45.7 ± 15.2 years, and 29 (65.9%) were male. Among the smokers, the median age at smoking initiation was 15 years; the mean smoking history was 32 ± 30.2 pack-years; 36 (81.9%) smoked up to 20 cigarettes/day; 20 (45.4%) had a high or very high degree of nicotine dependence; 32 (72.7%) had already tried to quit smoking; 39 (88.7%) would like to quit smoking; 32 (72.7%) would accept smoking cessation treatment; 13 (29.5%) smoked during hospitalization; and 13 (29.5%) suffered withdrawal syndrome. Regarding the motivation to quit smoking, the number of patients in the "preparation" and "action" stages of change increased from admission to discharge (from 31.8% to 54.8%). CONCLUSIONS: The prevalence of smoking in this study was similar to that reported in other studies conducted in Brazil. The results suggest that our sample was significant regarding the population of hospitalized smokers, who are motivated to quit smoking during hospitalization and require a systematized approach for doing so.

Tabagismo entre pacientes internados em um hospital universitário no sul do Brasil: prevalência, grau de dependência e estágio motivacional / Smoking among patients hospitalized at a university hospital in the south of Brazil: prevalence, degree of nicotine dependence, and motivational stage of change

OBJETIVO: Avaliar a prevalência e o perfil do tabagismo em pacientes internados em um hospital universitário no sul do Brasil. MÉTODOS: Estudo descritivo transversal com pacientes maiores de 18 anos hospitalizados há mais de 24 h no Hospital Universitário da Universidade de Santa Catarina em Florianópolis. Os pacientes foram entrevistados em duas ocasiões distintas. Dados demográficos, socioeconômicos e ligados ao tabagismo foram coletados. RESULTADOS: Foram entrevistados 235 pacientes: 44 (18,7 por cento) eram tabagistas; 77 (32,8 por cento) eram ex-tabagistas; 114 (48,5 por cento) eram não tabagistas e 109 (46,7 por cento) eram tabagistas passivos. A média de idade dos fumantes foi de 45,7 ± 15,2 anos, e 29 (65,9 por cento) eram do sexo masculino. Entre os fumantes, a mediana da idade de início do tabagismo foi de 15 anos; a carga tabágica média foi de 32 ± 30,2 anos-maço; 36 (81,9 por cento) tinham consumo diário de até 20 cigarros; 20 (45,4 por cento) tinham grau de dependência à nicotina elevada ou muito elevada; 32 (72,7 por cento) já haviam tentado cessar, 39 (88,6 por cento) gostariam de cessar, 32 (72,7 por cento) aceitariam receber tratamento, 13 (29,5 por cento) fumaram durante a internação, e 13 (29,5 por cento) apresentaram síndrome de abstinência. Houve um aumento no número de pacientes nos estágios motivacionais de preparação e ação durante a internação (de 31,8 por cento para 54,8 por cento). CONCLUSÕES: A prevalência de tabagismo no estudo foi semelhante à encontrada em outros estudos no Brasil. Os resultados sugerem que nossa amostra foi significativa em relação à população de fumantes hospitalizados, que se encontra motivada à cessação do hábito tabágico durante a hospitalização, necessitando de uma abordagem sistematizada para a cessação.

OBJECTIVE: To determine the prevalence and profile of smoking among hospitalized patients at a university hospital in the south of Brazil. METHODS: This was a descriptive cross-sectional study involving patients over 18 years of age hospitalized for over 24 h at the Federal University of Santa Catarina University Hospital, located in the city of Florianópolis, Brazil. The patients were interviewed on two distinct occasions. We collected demographic data, socioeconomic data, and data regarding smoking. RESULTS: We interviewed 235 patients: 44 (18.7 percent) were smokers; 77 (32.8 percent) were former smokers; 114 (48.5 percent) were nonsmokers; and 109 (46.7 percent) were passive smokers. The mean age of the smokers was 45.7 ± 15.2 years, and 29 (65.9 percent) were male. Among the smokers, the median age at smoking initiation was 15 years; the mean smoking history was 32 ± 30.2 pack-years; 36 (81.9 percent) smoked up to 20 cigarettes/day; 20 (45.4 percent) had a high or very high degree of nicotine dependence; 32 (72.7 percent) had already tried to quit smoking; 39 (88.7 percent) would like to quit smoking; 32 (72.7 percent) would accept smoking cessation treatment; 13 (29.5 percent) smoked during hospitalization; and 13 (29.5 percent) suffered withdrawal syndrome. Regarding the motivation to quit smoking, the number of patients in the "preparation" and "action" stages of change increased from admission to discharge (from 31.8 percent to 54.8 percent). CONCLUSIONS: The prevalence of smoking in this study was similar to that reported in other studies conducted in Brazil. The results suggest that our sample was significant regarding the population of hospitalized smokers, who are motivated to quit smoking during hospitalization and require a systematized approach for doing so.