Current Issue : October - December Volume : 2020 Issue Number : 4 Articles : 6 Articles
Formulae of estimated glomerular filtration rate (eGFR) based on serum creatinine (Scr) are routinely\nused in oncology patients, however, they are inaccurate in some populations. Our aim was to assess the agreement\nof eGFR formulae and thereby build a nomogram to predict the reliability of estimates.\nMethods: Measured GFR (mGFR) using isotope from 445 oncology patients were compared with eGFR from six\nformulae (Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD), modified MDRD formulae for Chinese (CMDRD),\nChronic Kidney Disease Epidemiology (CKD-EPI) Collaboration, Wright and full age spectrum (FAS)). Bias,\nprecision and accuracy of eGFR formulae were examined. We also evaluated statistics of agreement: the total\ndeviation index (TDI), the concordance correlation coefficient (CCC) and the coverage probability (CP). Multivariate\nlogistic regression was applied to identify characteristics associated with inaccurate eGFR and construct a predictive\nnomogram.\nResults: All eGFR formulae tended to overestimate the eGFR. The percentage of patients with eGFR within 30% the\nmGFR ranged from 38.0 to 62.8%. Cockcroft-Gault and MDRD showed low bias and high precision. The MDRD\nformula exhibited lowest TDI, meaning that 90% of estimations ranged from -36 to 36% of mGFR. Multivariate\nlogistic regression showed that inaccuracy of MDRD was found in elderly patients or in patients with eGFR greater\nthan 120 ml/min. A nomogram was constructed to help oncologists to predict the risk of inaccuracy of eGFR. The\ncalibration curve showed good agreement.\nConclusions: Our results suggest that the error of eGFR by any formulae was common and wide in Chinese\noncology patients. Our nomogram may assist oncologists in decision-making when mGFR is needed....
Although palliative care providers, patients, and their families rely heavily on accurate prognostication,\nthe prognostic value of electrolyte imbalance has received little attention.\nMethods: As a retrospective review, we screened inpatients with terminal cancer admitted between January 2017\nand May 2019 to a single hospice-palliative care unit. Clinical characteristics and laboratory results were obtained\nfrom medical records for multivariable Cox regression analysis of independent prognostic factors.\nResults: Of the 487 patients who qualified, 15 (3%) were hypernatremic upon admission. The median survival time\nwas 26 days. Parameters associated with shortened survival included male sex, advanced age..................
Cancer impacts on patients and their families across a range of different domains. For that reason,\noptimal cancer care has moved away from a disease-centric focus to a more holistic approach in order to\nproactively support people with their individual needs and concerns. While international policy clearly advocates\nthis agenda, implementation into routine care is limited. Therefore, relevant interventions that measurably improve\npatient outcomes are essential to understand if this ideal is to become routine multidisciplinary practice. The aim of\nthis study was to analyse the impact of a proactive, holistic, community-based intervention on health-related quality\nof life in a cohort of people diagnosed with cancer. Secondary aim was to explore the relationship between\nchanges in health status and: cancer type, cancer stage, number of concerns expressed and change in severity of\nconcerns pre and post intervention.\nMethod: Prospective observational cohort study. A convenience sample of 437 individuals were referred to the\nservice â??Improving the Cancer Journey (ICJ) in the UK. Each completed the Euroqol EQ-5D-3 L and visual analogue\nscale (VAS) and a Holistic Needs Assessment (HNA) during initial visit to the service and again at follow-up review,\nmedian 84 days later. Change between scores was tested with paired t-tests and relationships between variables\nwith multiple regression models with heteroscedasticity-consistent standard errors...............
French legislation about sedation in palliative medicine evolved in 2016 with the introduction of a\nright to deep and continuous sedation, maintained until death. The objective was to describe midazolam sedation\nat the COL (Centre Oscar Lambret [Oscar Lambret Center], French regional center for cancer control), in order to\nestablish a current overview before the final legislative changes.\nMethods: Descriptive, retrospective and single-center study, concerning major patients in palliative care hospitalized\nfrom 01/01/2014 to 12/31/2015, who had been sedated by midazolam. The proven sedations (explicitly named) and\nthe probable sedations were distinguished.\nResults: A total of 54 sedations were identified (48 proven, 6 probable). Refractory symptoms accounted for 48.1% of\nindications, complications with immediate risk of death 46.3%, existential suffering 5.6%. Titration was performed in\n44.4% of cases. Sedation was continuous until death for 98.1% of the cases. Probable sedation had a higher failure rate\nthan proven sedation. Significant differences existed for the palliative care unit compared to other units regarding\ninformation to the patient, their consent, anticipation, mention by correspondence and carrying out titrations. When\npatients had already been treated with midazolam, the induction doses, initial maintenance doses, and doses at the\ntime of death were significantly higher. For those receiving opioids, the maintenance dose at the time of death was\nhigher. No comparison found a difference in overall survival.\nConclusions: After a sufficient follow-up has enabled teams to familiarize with this new legislation, reflection on\nsedation should be conducted to adapt to final recommendations....
Recent approvals of second-generation androgen receptor inhibitors (SGARIs) have changed the\ntreatment landscape for non-metastatic castration-resistant prostate cancer (nmCRPC). These SGARIs have similar\nefficacy but differ in safety profiles. We used a discrete choice experiment to explore how United States physicians\nmake treatment decisions between adverse events (AEs) and survival gains in nmCRPC, a largely asymptomatic\ndisease.\nMethods: Treating physicians (n = 149) participated in an online survey that included 14 treatment choice\nquestions, each comparing 2 hypothetical treatment profiles, which varied in terms of 5 safety and 2 efficacy\nattributes. We described safety attributes (fatigue, skin rash, cognitive problems, falls, and fractures) in terms of\nseverity and frequency, and efficacy attributes (overall survival [OS] and time to pain progression) in terms of\nduration of effect. We used a random parameters logit model to estimate preference weights and importance\nscores for each attribute. We also estimated the amount of survival gain physicians were willing to trade for a\nreduction in specific AEs between treatment options.\nResults: Physicians placed more importance on survival than on time to pain progression, and viewed a reduction\nin cognitive problems from severe to none, a reduction in risk of a serious fracture from 8% to none, and a\nreduction in fatigue from severe to none as the most important safety attributes. Physicians were willing to forego\n9.1 and 6.6 months of OS, respectively, to reduce cognitive problems and fatigue from severe to mild-to-moderate.\nTo reduce the risk of a serious fracture from 8 to 5% and 5% to none, physicians were willing to trade 3.9 and 5.3\nmonths of OS, respectively.\nConclusions: Physicians were willing to trade substantial amounts of survival to avoid AEs between hypothetical\ntreatments. These results emphasize the importance of carefully balancing therapiesâ?? benefits and risks to ultimately\noptimize the overall quality of nmCRPC patientsâ?? survival. Nonetheless, it is noted that the results from the study\nsample of 149 physicans may not be representative of the viewpoints of all nmCRPC-treating physicians....
Financial toxicity of cancer has so far been discussed primarily in the US health care system and is\nassociated with higher morbidity and mortality. In European health care systems, the socio-economic impact of\ncancer is poorly understood. This study investigates the financial burden and patient-reported outcomes of\nneuroendocrine (NET) or colorectal (CRC) cancer patients at a German Comprehensive Cancer Center.\nMethods: This prospective cross-sectional study surveyed 247 advanced stage patients (n = 122 NET/n = 125 CRC)\nat the National Center for Tumor Diseases, in Germany about cancer-related out-of-pocket costs, income loss,\ndistress, and quality of life. Multiple linear regression analysis was performed to demonstrate the effects of\neconomic deterioration on patientsâ?? quality of life and distress...............
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