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1.
J Registry Manag ; 46(1): 4-14, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31490916

RESUMO

PURPOSE: As survival rates for individuals with HIV/AIDS diagnoses increase, cancer is becoming a more prevalent disease in this population. Data regarding the concurrent diagnoses of HIV/AIDS and cancer has not previously been examined and analyzed in the state of Iowa. METHODS: The Iowa Cancer Registry and Iowa Department of Public Health's HIV/AIDS surveillance databases were linked, and matches were identified. Characteristics of Iowans with HIV/AIDS later diagnosed with cancer between 1991 and 2015 were compared to Iowans without HIV/AIDS using proportional incidence ratios (PIRs). RESULTS: 490 patients met inclusion criteria; 91% had AIDS and 9% had HIV only. Compared to individuals without HIV/AIDS, significantly higher PIRs for cancer were found in younger persons, males, African Americans, metropolitan (metro) residents, and Iowans with Medicaid or the uninsured. Specifically, PIRs associated with the following cancers were higher in the population with HIV/AIDS: Kaposi sarcoma, non-Hodgkin lymphomas (NHLs), and squamous cell neoplasms of the anus. When stratified by AIDS-defining cancers and non-AIDS-defining cancers, the main differences were individuals with AIDS-defining cancers had elevated PIRs among those diagnosed between 1991-1998 and had Kaposi sarcoma or Burkitt lymphoma, while those with non-AIDS-defining cancers were diagnosed between 2007-2015 and were diagnosed with anal, male or female genital, lymphoma other than NHL, liver, lung, or other squamous cell neoplasm cancers. When comparing nonmetropolitan (nonmetro) vs metro Iowans with HIV/AIDS, PIRs for nonmetro patients were elevated in those diagnosed with cancer between 50-59 years old, whites, and individuals diagnosed with squamous cell neoplasms. CONCLUSION: Our results indicate Iowans with HIV/AIDS have higher proportions of certain types of cancers compared to the general population and provide baseline information for future initiatives aimed at preventing or detecting cancer among those living with HIV/AIDS.


Assuntos
Infecções por HIV/epidemiologia , Neoplasias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Infecções por HIV/complicações , Humanos , Incidência , Lactente , Recém-Nascido , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Adulto Jovem
2.
Medicine (Baltimore) ; 98(37): e17181, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517875

RESUMO

In this single-center, retrospective study, we aimed to report the clinical outcomes, among Asian comorbid cancer patients with venous thromboembolism (VTE), and compare them with those of VTE patients without cancer.Between January 2013 and December 2017, a total of 322 consecutive patients-diagnosed with acute VTE involving the leg, pelvis, or lung-were screened for inclusion. Comorbid cancer patients with VTE (n = 135, 41.9%) were included in this study and analyzed in comparison with VTE patients without cancer (n = 187, 58.1%). The study outcomes were the composite incidence of symptomatic and radiologically confirmed recurrence of VTE, or any-cause mortality.The study outcome incidence was 62.2% (n = 84) during a mean follow-up period of 10 months: VTE recurrence in 7 patients and any-cause mortality in 83. Upon multivariate analysis, higher body mass index, diabetes mellitus, cancer stage IV, and radiotherapy were independently associated with study outcome incidence. VTE involving the inferior vena cava (hazard ratio [HR], 12.1; 95% confidence interval [CI], 1.20-120.80; P = .034), lung cancer (HR, 16.5; 95% CI, 2.32-117.50; P = .005), and use of vitamin K antagonists (HR, 36.4; 95% CI, 3.00-442.70; P = .005) were independent predictors of VTE recurrence. Compared with VTE patients without cancer, the study outcome incidence was significantly higher among comorbid cancer patients with VTE (62.2% vs 7.5%, P < .001), although there was no significant difference in VTE recurrence between the 2 groups (5.2% in patients with cancer vs 3.7% in patients without cancer, P = .531).We found that various cancer-related and patient-related factors were associated with outcomes among comorbid cancer patients with VTE. The composite incidence of VTE recurrence or any-cause mortality was significantly higher among cancer patients with VTE than among VTE patients without cancer.


Assuntos
Neoplasias/complicações , Neoplasias/terapia , Tromboembolia Venosa/complicações , Tromboembolia Venosa/terapia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias/epidemiologia , Recidiva , República da Coreia , Estudos Retrospectivos , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/epidemiologia
3.
Anticancer Res ; 39(9): 4619-4625, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519559

RESUMO

Cancer patients are at risk for both venous and arterial thrombotic events. Accumulating evidence suggests a link between cancer and arterial thrombosis events. The pathophysiology of arterial thrombosis in cancer is complex and multifactorial. The risk of arterial thrombosis in cancer patients relies on individual risk factors, on cancer-related hypercoagulability, on anticancer drugs and radiotherapy often via a common underlying mechanism of endothelial dysfunction. This review describes the mechanisms involved in the development of arterial thrombotic events and their clinical manifestations. Furthermore, it provides an overview on therapeutic agents associated with arterial thrombosis.


Assuntos
Artérias/patologia , Neoplasias/complicações , Trombose/etiologia , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gerenciamento Clínico , Humanos , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Neovascularização Patológica , Radioterapia/efeitos adversos , Radioterapia/métodos , Avaliação de Sintomas , Trombose/diagnóstico , Trombose/epidemiologia
4.
Surg Clin North Am ; 99(5): 899-919, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446917

RESUMO

Palliative wound care is a philosophy of wound management that prioritizes comfort over healing and attends to the emotional distress these wounds can cause. Intervention strategies focus on management of symptoms such as pain, odor, bleeding, and exudate. Historic treatments such as honey, chlorine, and vinegar have gained renewed interest, and although well suited to the palliative setting, there is an increasing amount of research exploring their efficacy in other contexts. The lived experience of patients and caregivers facing these wounds is often stressful and isolating, and any treatment plan must address these issues along with the physical aspects of care.


Assuntos
Cuidados Paliativos/métodos , Lesão por Pressão/terapia , Ferimentos e Lesões/terapia , Desbridamento , Humanos , Neoplasias/complicações , Radioterapia/efeitos adversos , Ferimentos e Lesões/etiologia
5.
Presse Med ; 48(7-8 Pt 2): e251-e256, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447338

RESUMO

Cancer patients quite commonly will report different types of pain associated with the disease substrate. Systemic analgesia and radiotherapy provide only partial pain relief in the majority of these patients. Interventional Oncology techniques for pain management and mobility improvement in cancer patients include percutaneous techniques such as neurolysis, ablation and augmentation (both in the spine and peripheral skeleton) as well as trans-arterial embolization. Percutaneous neurolysis acts indirectly providing regional anesthesia whilst the rest of the aforementioned techniques act directly upon the tumor either by inhibiting local growth or by providing stability and skeletal augmentation. Whenever possible, techniques such as ablation and trans-arterial embolization apart from pure palliation may add to the principle of local tumor control. The aim of this review is to provide details concerning the Interventional Oncology techniques used for cancer pain management and to address the necessity for a tailored-based approach applying different techniques or combinations of them in different cases and locations.


Assuntos
Dor do Câncer/terapia , Oncologia/métodos , Neoplasias/terapia , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Anestesia por Condução , Osso e Ossos/cirurgia , Ablação por Cateter/métodos , Embolização Terapêutica/métodos , Humanos , Oncologia/tendências , Neoplasias/complicações , Bloqueio Nervoso/métodos , Cuidados Paliativos/tendências , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos
6.
Rev Bras Enferm ; 72(3): 640-645, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269127

RESUMO

AIM: To demonstrate the relationship between religious/spiritual coping and hope in cancer patients undergoing chemotherapy. METHOD: This is a cross-sectional, descriptive study with a quantitative approach performed in a reference outpatient clinic in Caruaru, PE, between August and October 2017. A total of 82 cancer patients undergoing chemotherapy were included in the study, using the brief religious/spiritual coping scale (RCOPE-Brief) and the Herth Hope Scale (HHS). RESULTS: The sample presented mean positive RCOPE scores (3.03 ± 0.41) and the level of hope was considered high (42.7 points ± 3.67). Patients who had a high RCOPE score were found to have a higher mean of Herth's level of hope (44.12 points). CONCLUSION: This study becomes relevant to nursing professionals by encouraging care that takes into account the patient's spiritual dimension in order to stimulate positive mechanisms of religious coping and, consequently, raise the levels of hope.


Assuntos
Adaptação Psicológica , Esperança , Neoplasias/complicações , Espiritualidade , Adulto , Estudos Transversais , Tratamento Farmacológico/métodos , Tratamento Farmacológico/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários
7.
Cancer Treat Res ; 179: 1-9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317477

RESUMO

"The frequent concurrence of phlegmasia alba dolens with an appreciable cancerous tumor, led me to the inquiry whether a relationship of cause and effect did not exist between the two, and whether the phlegmasia was not the consequence of the cancerous cachexia." (translated from the original French). This famous quote, delivered in a lecture by Armand Trousseau in 1865, is widely recognized as the initial and insightful understanding of the relationship of thrombosis and cancer.Although the association of thrombosis with cancer has been recognized for over 150 years, only recently has there been meaningful advances in our understanding of the relationship. Contemporary translational research tools have greatly enhanced our understanding the unique aspects of the pathophysiology of the relationship; how cancer cells exploit multiple aspects of the coagulation system for primary and metastatic growth leading, leading to an increased thrombotic risk. Further, there has been a growing appreciation of the complexity of the treatment of cancer-associated thrombosis. The superiority of low molecular weight heparin over warfarin, published in 2003, represented the first important divergence from the approach to management of thrombosis in the non-cancer population. With the introduction of the new generation of anticoagulants, the direct oral anticoagulants, there has been continued evolution of management guidelines.This text presents a much needed and comprehensive update of the field of thrombosis and hemostasis in cancer. We are fortunate to have so many leading authorities contribute their expertise and insight into this work. In the following chapters, the reader will find insight and guidance that will enhance scholarship, as well as patient care.


Assuntos
Hemostasia , Neoplasias/fisiopatologia , Trombose/etiologia , Anticoagulantes/uso terapêutico , Hemostasia/efeitos dos fármacos , Hemostasia/fisiologia , Humanos , Neoplasias/complicações , Trombose/tratamento farmacológico
8.
Cancer Treat Res ; 179: 11-36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317478

RESUMO

Thrombosis is a major cause of morbidity and mortality in cancer patients. The pathogenesis of blood coagulation activation in oncological patients is complex and involves both clinical and biological factors. Abnormalities in one or more coagulation test are common in cancer patients, even without thrombotic manifestations, indicating an ongoing hypercoagulable condition. Moreover, venous thromboembolism (VTE) can be the first symptom of an occult malignancy in an otherwise healthy individual. The levels of laboratory markers of activation of blood coagulation parallel the development of malignancy, being the coagulant mechanisms important for both thrombogenesis and tumor progression. Besides general clinical risk factors for VTE, also disease-specific clinical factors, i.e., type and stage of the tumor, and anticancer therapies increase the thrombotic risk in these patients. Furthermore, biological factors, including the cancer cell-specific prothrombotic properties together with the host cell inflammatory response to the tumor, are relevant as well as unique players in the pathogenesis of the cancer-associated hypercoagulability. Cancer cells produce and release procoagulant and fibrinolytic proteins, inflammatory cytokines, and procoagulant microparticles. They also express adhesion molecules binding to the receptors of host vascular cells (i.e., endothelial cells, platelets, and leukocytes), thereby stimulating the prothrombotic properties of these normal cells, including the shed of cell-specific microparticles and neutrophil extracellular traps. Of interest, several genes responsible for the cellular neoplastic transformation drive the programs of hemostatic properties expressed by cancer tissues. A better understanding of such mechanisms will help the development of novel strategies to prevent and treat the Trousseau's syndrome (i.e., cancer-associated thrombosis).


Assuntos
Neoplasias/fisiopatologia , Trombose/fisiopatologia , Coagulação Sanguínea/fisiologia , Humanos , Neoplasias/complicações , Trombose/etiologia
9.
Cancer Treat Res ; 179: 37-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317479

RESUMO

For over 100 years, a link has been recognized between thrombosis and cancer. However, whether this was a causal or correlational relationship was debated. It is now well established that cancer and thrombosis are mechanistically related in intricate ways and can directly fuel each other. Here, we present an historical perspective of platelets and how their physiological function in hemostasis can contribute to tumor development and metastasis. This emerging field has garnered great interest as aspirin therapy has been proposed as a prevention strategy for some malignancies. We highlight the advances that have been made, presenting platelets as a key component that supports many of the hallmarks of cancer that have been described and conclude with future directions and studies that are needed to clarify the role of platelets in cancer and solidify platelet modulating therapies within oncology.


Assuntos
Plaquetas/fisiologia , Hemostasia/fisiologia , Neoplasias/fisiopatologia , Trombose/fisiopatologia , Plaquetas/efeitos dos fármacos , Hemostasia/efeitos dos fármacos , Humanos , Neoplasias/complicações , Neoplasias/prevenção & controle , Trombose/etiologia , Trombose/prevenção & controle
10.
Cancer Treat Res ; 179: 55-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317480

RESUMO

Cancer and its treatments are commonly complicated by venous thromboembolism (VTE), but there is a substantial variation in risk between individual cancer patients. The risk of VTE in cancer patients is influenced by multiple risk factors including primary site of cancer, stage, comorbidities, use of specific antineoplastic agents. Several biomarkers have been associated with subsequent VTE including D-dimer and tissue factor, although no single risk factor or biomarker accurately is predictive of VTE on its own. The risk of VTE is best predicted by a validated risk assessment score. Cancer patients at risk of VTE benefit from thromboprophylaxis, supported by evidence in the setting of hospitalization for acute medical illness and surgery, and emerging data from two large randomized trials in the outpatient setting. This chapter focuses on approaches to identifying risk of VTE and approaches to reducing this risk with appropriate thromboprophylaxis.


Assuntos
Neoplasias/complicações , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/uso terapêutico , Quimioprevenção , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Trombose/etiologia , Trombose/prevenção & controle , Tromboembolia Venosa/etiologia
11.
Cancer Treat Res ; 179: 87-101, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317482

RESUMO

Cancer patients have an increased risk of thrombosis. The development of cancer thrombosis is dependent on a number of factors including cancer type, stage, various biologic markers, and the use of central venous catheters. In addition, cancer treatment itself may increase thrombotic risk. Tamoxifen increases the risk of venous thromboembolism (VTE) by two- to sevenfold, while an impact on risk of arterial thrombosis is uncertain. Immunomodulatory imide drugs (IMiDs) such as thalidomide and lenalidomide increase the risk of VTE in patients with multiple myeloma (MM) by about 10-40% when given in combination with glucocorticoids or other chemotherapy agents; the risk of VTE in MM patients treated with IMiD-containing regimens necessitates that such patients receive thromboprophylaxis with aspirin, low-molecular-weight heparin, or warfarin. Among cytotoxic chemotherapy agents, cisplatin, and to a lesser extent fluorouracil, has been described in association with thrombosis. L-asparaginase in treatment of acute lymphoblastic leukemia is significantly associated with increased thrombosis particularly affecting the CNS, which may be due to acquired antithrombin deficiency; at some centers, plasma infusions or antithrombin replacement is used to mitigate this. Bevacizumab, an inhibitor of vascular endothelial growth factor, increases arterial and possibly venous thrombotic risk, although the literature is conflicting about the latter. Supportive care agents in cancer care, such as erythropoiesis-stimulating agents, granulocyte colony stimulating factor, and steroids, also have some impact on thrombosis. This review summarizes the mechanisms by which these and other therapies modulate thrombotic risks and how such risks may be managed.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Trombose/tratamento farmacológico , Anticoagulantes/uso terapêutico , Antineoplásicos/uso terapêutico , Humanos , Neoplasias/complicações , Fatores de Risco , Trombose/etiologia , Trombose/prevenção & controle , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle
12.
Cancer Treat Res ; 179: 69-85, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317481

RESUMO

Venous thromboembolism is known to be associated with an increase in morbidity and mortality in patients with malignancy. Predictive laboratory biomarkers of venous thromboembolism (VTE) have long been sought after to improve outcomes and help guide clinical decision making. Previously studied biomarkers include C reactive protein (CRP), tissue factor expressing microparticles (TF MP), D-dimer, soluble P-selectin (sP-selectin), plasminogen activator inhibitor 1 (PAI-1), factor VIII, platelet count, and leukocyte counts. This chapter will focus on these possible biomarkers for cancer-associated thrombosis (CAT) with particular emphasis on the pathophysiology behind thrombosis formation as well as data from clinical studies in patients with malignancy. The incorporation of the above biomarkers into risk assessment tools to predict CAT will also be reviewed, as will risk factors for recurrent VTE in patients with malignancy. Further studies are ongoing to develop readily available biomarkers that can be incorporated into future risk assessment models with the goal of reducing morbidity and mortality due to cancer-associated thrombosis.


Assuntos
Biomarcadores/análise , Neoplasias/complicações , Tromboembolia Venosa/sangue , Biomarcadores/sangue , Humanos , Neoplasias/sangue , Neoplasias/fisiopatologia , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/fisiopatologia
13.
Cancer Treat Res ; 179: 117-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317484

RESUMO

Central venous access devices are a critical instrument in the treatment and supportive care delivery for oncology patients. Catheter-related thrombosis (CRT) is a common complication of central venous access devices in oncology patients. Risk factors for CRT include patient-, device-, and treatment-related risk factors. Treatment of CRT is indicated to reduce symptoms, prevent catheter malfunction, prevent recurrent DVT or thromboembolic pulmonary embolism, and minimize the risk of post-thrombotic syndrome. Minimal prospective data exist on the prevention and treatment of catheter-related thromboses in cancer patients. As such recommendations largely are derived from data in the lower-extremity DVT and PE studies in cancer and non-cancer patients. Based on the available literature, primary pharmacologic prophylaxis against CRT is not recommended in cancer patients. Treatment options for CRT include catheter removal, anticoagulation, catheter-directed thrombolysis, or surgical thrombectomy. Current evidence-based guidelines recommend LMWH as the anticoagulant of choice. However, recent data showing efficacy and safety of DOACs in cancer-related VTE may be extrapolated to treatment of CRT in cancer patients. In patients with CRT, catheter removal should be pursued if continued vascular access is no longer needed, the catheter is dysfunctional, a catheter-associated infection is present, or if CRT symptoms do not resolve with anticoagulation alone. Catheter-directed thrombolysis is reserved for rare severe cases of CRT. Herein we discuss the pathophysiology, clinical presentation, diagnosis, and general management of CRT in cancer patients.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Neoplasias/complicações , Trombose/terapia , Humanos , Trombose/diagnóstico , Trombose/etiologia
14.
Cancer Treat Res ; 179: 103-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317483

RESUMO

The management of cancer-associated thrombosis (CAT) is complex, and treatment strategies have been evolving over the past 15 years. It is well recognized that oral vitamin K antagonists are difficult to use in cancer patients, with higher rates of treatment failure and bleeding complications than in non-cancer patients. Low-molecular-weight-heparin (LMWH) became the widely accepted standard of care for treatment of cancer-associated thrombosis, following the CLOT study comparing dalteparin with warfarin in 2003. LMWH remains widely used for the treatment of CAT. However, in the past two years, several studies have served to validate direct oral anticoagulants as a safe and effective alternative to LMWH. Two randomized clinical trials comparing edoxaban and rivaroxaban with dalteparin, and several retrospective studies have shown the efficacy of edoxaban and rivaroxaban for the treatment of CAT. However, there is an evidence of increased bleeding with the DOACs, particularly gastrointestinal or urinary tract bleeding in patients with lesions within the gastrointestinal or urinary tracts. This chapter discusses the ongoing development of optimal treatment strategies for cancer-associated thrombosis.


Assuntos
Anticoagulantes/administração & dosagem , Inibidores do Fator Xa/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Neoplasias/complicações , Tromboembolia Venosa/tratamento farmacológico , Administração Oral , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Tromboembolia Venosa/etiologia
15.
Cancer Treat Res ; 179: 139-150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317485

RESUMO

Chemotherapy-induced thrombocytopenia (CIT) is a frequent complication of cancer therapy, leading to increased risk of bleeding, when the thrombocytopenia is severe (<10,000/mcL). However, the major clinical relevance of CIT is the subsequent delay or dose reduction in chemotherapy. CIT, therefore, leads to reduced relative dose intensity (RDI) of cancer therapy. Reduced RDI has been shown in several studies to impact progression-free survival and other cancer outcomes. While there are a number of factors leading to reduced RDI, CIT is a common cause. We review the causes and clinical manifestations of CIT, the current recommendations for management, and the status of research to develop targeted therapies to treat CIT.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias/tratamento farmacológico , Trombocitopenia/terapia , Antineoplásicos/uso terapêutico , Humanos , Neoplasias/complicações , Estudos Retrospectivos , Trombocitopenia/induzido quimicamente , Trombocitopenia/etiologia
16.
Cancer Treat Res ; 179: 151-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317486

RESUMO

Thrombotic microangiopathy (TMA) is a syndrome involving fragmentation haemolysis, thrombocytopenia, and thrombosis. A range of disorders including cancer may have TMA as a clinical manifestation. TMA in cancer may be caused by several mechanisms, including systemic microvascular metastases, but may also be due to extensive bone marrow involvement with cancer or secondary necrosis. Chemotherapeutic agents may also cause associated TMA through a range of different mechanisms. Gemcitabine, platinum-based drugs, mitomycin C, and proteasome inhibitors are known to cause TMA in cancer patients. Transplant-associated TMA (TA-TMA) may affect either solid organ or HSCT patients. TA-TMA remains a difficult complication to address due to its high mortality rate, lack of standard diagnostic criteria, and limited therapeutic options. The challenge of cancer-associated TMA is furthered by the fact that plasma exchange is ineffective in its management.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias/complicações , Microangiopatias Trombóticas/terapia , Antineoplásicos/uso terapêutico , Humanos , Neoplasias/tratamento farmacológico , Microangiopatias Trombóticas/etiologia
17.
Cancer Treat Res ; 179: 191-203, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317489

RESUMO

Cancer can be associated with several distinct coagulation defects which can lead to bleeding complications. The primary hyperfibrinolytic syndrome associated with acute promyelocytic leukemia has been well recognized and is one of the most severe bleeding disorders. Acquired hemophilia, while rare and not only seen in the oncology setting, can be triggered by a malignancy and must be promptly recognized in order to prevent catastrophic hemorrhage. Other, less serious coagulopathic states have been linked to cancer, including acquired von Willebrand disease. Finally, several anti-neoplastic drugs can alter hemostasis and increase the risk of bleeding. A good understanding of this field can help mitigate the risk of complications in the cancer patient.


Assuntos
Antineoplásicos/efeitos adversos , Transtornos da Coagulação Sanguínea/etiologia , Neoplasias/complicações , Antineoplásicos/uso terapêutico , Transtornos da Coagulação Sanguínea/induzido quimicamente , Hemorragia/induzido quimicamente , Hemorragia/etiologia , Hemostasia/efeitos dos fármacos , Humanos , Neoplasias/tratamento farmacológico
18.
Expert Opin Investig Drugs ; 28(8): 733-740, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347405

RESUMO

Introduction: Cachexia is frequent in chronic diseases and especially during cancer development. Multiple definitions of cachexia have been proposed; it may be considered a multifactorial complex syndrome that presents with progressive unintentional weight loss and wasting of muscle mass and adipose tissue. Area covered: This article covers phase-I and phase-II clinical trials of investigational drugs for cancer cachexia. We performed a search on PubMed with keywords as cancer cachexia, phase-I/phase-II trial, drug, identifying articles relevant to this review. Studies were conducted using compounds, including anabolic agents such as ghrelin analogs, selective androgen receptor modulators, as well as anti-inflammatory drugs such as thalidomide, OHR, anti-interleukin antibody, cannabinoids, and omega-3 supplements. We also describe the mechanisms of action of these molecules and their phase-I and phase-II study design. The major outcomes were appetite stimulation, weight gain, improvement of muscle mass and function, modulation of inflammation, and quality of life. Expert opinion: The molecules discussed act on molecular pathways involved in cancer cachexia; they modulate appetite, anabolic effects, inflammation and direct interaction with muscle. Considering the multifactorial aspects of the cachexia syndrome, the combination of these drugs with metabolic and nutritional interventions may represent the most promising therapeutic approach to cancer cachexia.


Assuntos
Caquexia/tratamento farmacológico , Drogas em Investigação/uso terapêutico , Neoplasias/complicações , Apetite/efeitos dos fármacos , Caquexia/etiologia , Caquexia/fisiopatologia , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Drogas em Investigação/farmacologia , Humanos , Inflamação/tratamento farmacológico , Inflamação/patologia , Apoio Nutricional/métodos , Qualidade de Vida , Projetos de Pesquisa
19.
Ther Adv Cardiovasc Dis ; 13: 1753944719860676, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319783

RESUMO

BACKGROUND: The role of cancer-specific factors for ischemic stroke and mortality in patients with cancer and atrial fibrillation (AF) is unknown. We evaluated the utility of a previously validated risk tool for venous thromboembolism (VTE) in cancer outpatients [Khorana score (KS)] in predicting stroke and mortality in cancer patients with AF. METHODS: We conducted a retrospective cohort study of patients with cancer and AF at the Cleveland Clinic from 2008 to 2014. Outcomes, CHADS2, CHA2DS2-VASc, and KS scores were calculated from date of cancer diagnosis. Prognostic factors were identified with Fine and Gray regression (for stroke) or Cox proportional hazards analysis (for mortality). RESULTS: The study population comprised 1181 patients. Genitourinary (19%), lung (18%), and gastrointestinal (13%) were the most frequent cancers. Overall, 67% had CHADS2 ⩾ 2, 57% had an intermediate KS (1-2), and 7% high KS (⩾3). Median follow up was 26.5 months (range 0.03-76). At a median of 8.2 months (range 0-61), 45 patients (3.8%) developed a stroke and 418 (35%) died. In multivariable analysis a high KS (HR 4.5, 95% CI 3.2-6.3, p < 0.001) was associated with a quadruple risk of death and every point increase in CHADS2 score had a 20% increased risk of death (HR 1.19, 95% CI 1.1-1.2, p < 0.001). The addition of KS did not improve risk stratification for ischemic stroke to CHADS2. CONCLUSION: In patients with cancer and AF, CHADS2 and CHA2DS2-VASc but not KS were predictive of ischemic stroke. A high KS represented a unique predictor of mortality beyond traditional risk scores.


Assuntos
Fibrilação Atrial/complicações , Isquemia Encefálica/etiologia , Técnicas de Apoio para a Decisão , Neoplasias/complicações , Acidente Vascular Cerebral/etiologia , Tromboembolia Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/mortalidade , Ohio , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/mortalidade
20.
Chirurgia (Bucur) ; 114(3): 343-351, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264572

RESUMO

Background: Malignant intestinal obstruction is a frequent complication in advanced stages cancer patients. The prognosis is poor, with mean survival rate beneath 3 months. Clinical treatment, endoscopic or surgical procedures are options for malignant intestinal obstruction management. There is no generally accepted management strategy. Objectives: To evaluate prognostic factors of patients with malignant intestinal obstruction who underwent surgical treatment. Methods: A retrospective analysis was performed including patients of a single institution with diagnosis of malignant intestinal obstruction. Demographic data, in-hospital stay, postoperative complications, and overall survival were assessed. Logistic regression was used to evaluate associated prognostic factors. Results: Two hundred thirty-three surgeries were performed due to suspicion for malignant intestinal obstruction over a seven-year period. This diagnosis was confirmed in 210 operations (90.1%). The main causes of malignant obstruction were colorectal (49.5%) and gynecological cancer (21.9%). The rate of severe complications was 11.42%. In-hospital mortality rate was 40.95% (CI 95%: 34.16-47.74%). Functional status impairment,high serum urea, and low albumin levels were associated to higher mortality rate. Conclusion: Malignant intestinal obstruction implies poor prognosis, with high in-hospital mortality rate and severe postoperative complications. The decision regarding management of malignant intestinal obstruction must be multimodal and individualized, according to individual prognostic factors.


Assuntos
Neoplasias Colorretais/cirurgia , Neoplasias dos Genitais Femininos/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias Colorretais/complicações , Feminino , Neoplasias dos Genitais Femininos/complicações , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Neoplasias/complicações , Prognóstico , Estudos Retrospectivos
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