Predicting survival in advanced hematologic malignancies: do patient-reported symptoms matter?

OBJECTIVE: To investigate whether patient-reported symptoms provide independent prognostic information for survival in patients with hematological malignancies. STUDY DESIGN AND SETTING: Overall 119 patients with various diagnoses were recruited in an observational study and symptoms were assessed with the M.D. Anderson Symptom Inventory (MDASI). Key potential socio-demographic, biomedical, and physician-reported prognostic candidates were also considered. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. Additional sensitivity analysis, based on 500 bootstrap-generated simulation datasets, was also performed to confirm the results obtained with the Cox regression model. RESULTS: The median survival of the entire cohort was 4.8 months (range 0-28 months). The MDASI was completed at baseline by 91% of patients. The final multivariate model retained two parameters as independent prognostic factors for survival: clinical prognostic group and patient's self-reported severity of drowsiness. The following hazard ratios (HR) were found for curable vs. terminal: 0.055 (95% CI, 0.022-0.136; P < 0.001) and 0.193 (95% CI, 0.103-0.362: P < 0.001) for advanced vs. terminal. Patient's self-reported severity of drowsiness independently predicted survival with a HR of 1.801 (95% CI, 1.044-3.107; P = 0.033). Additional sensitivity analysis confirmed the independent prognostic value of variables identified in this study. CONCLUSION: The results suggest that patients' self-reporting of symptoms provides independent prognostic information for survival in patients with hematologic malignancies. These findings underscore the value of collecting patient-reported symptom data in routine clinical practice.

[Acceptability and safety of transrectal prostatic 8-core biopsy]. / Accettabilità e sicurezza della biopsia prostatica TR per ottavi.

The safety of sextant prostate biopsy has already been documented since the end of the 90's. As a higher efficacy of biopsy has been proved when increasing the number of samples taken, we have tried to assess the safety and tolerability of prostatic 8-core biopsy. From January to December 2001, 204 patients, aged between 50 and 88 (average 70) with a PSA between 0.74 and 196 ng/ml (10 +/- 9.25), underwent in 8-core prostate biopsy. After biopsy, the patients were given an oral antibacterial for 3 days. After taking the samples, patients were interviewed about the tolerability of the biopsy, and especially about the following: I. A feeling of irritation (77 patients, 37.7%); 2. A slight pain (72 patients, 35.29%); 3. A moderate pain (32 patients, 15.68%); 4. Intense pain (23 patients 11.27%). After 20 days all patients came back and were interviewed again about possible complications (biopsy was Ca positive in 86 cases, 42.15%). 153 patients (75%) reported a slight hematuria for an average period of 5 days; 88 patients (43.13%) showed slight anal-rectal hematic discharges, mainly after defecation efforts. It was never necessary to hospitalize any patients because of complications. 71 patients (34.8%) reported a perineal pain which disappeared after 24-48 hours. 175 patients reported having had an ejaculation after biopsy and 158 (90.2%) of them showed hematospermia. 4 patients (2%) had a short period temperature and only 2 (0.98%) were hospitalized for hyperpyrexia with symptoms of genitourinary sepsis. It has been proved that TR prostate biopsy is almost exclusively followed by minor complications, major ones being an exception. A biopsy with more than six samples (8-10-12) shows a higher number of minor complications (hematospermia and hematuria). The fact that a higher number of samples proves this method to be significantly more suitable, pays off all the problems. Also, such a casistics makes us think that prostatic 8-core biopsy is generally well tolerated (73% of patients reported either irritation or slight pain) and fairly safe, as complications are mainly minor ones. We must therefore underline the suitability, good tolerability and safety of the TR prostatic 8-core biopsy.