Chemotherapy at the End of Life Urvay, Semiha; Civelek, Burak; Özaslan, Ersin ...
Journal of palliative care,
04/2021, Letnik:
36, Številka:
2
Journal Article
Recenzirano
Background and Objectives:
The use of chemotherapy at the end of life in advanced cancer patients has increased and end of life care has become increasingly aggressive. The aim of this study is to ...evaluate patients receiving chemotherapy in the last 3 months of life and the aggressiveness of end-of-life support of these patients.
Methods:
All adult patients with solid tumors who received chemotherapy in their last 3 months of life and died in our hospital between January 2015 to June 2019 were included. Detailed information on chemotherapy and toxicity was collected in patient records.
Results:
A total of 182 patients included. Median age was 58,9 years. The median survival from the docementation of metastatic disease was 9,98 months (0,95-64,3). Of these 182 patients, 95 (52%) were treated with chemotherapy in the last month of life and 52 (29%) in the last 2 weeks of life. The median number of days between the last administration of chemotherapy and patient death was 29 (0-90). A new chemotherapy regimen was started in the last 3 months of life in 102 patients (56%), in the last month of life in 43 patients (23,6%) and in the last 2 weeks in 23 patients (12.6%).
Discussion and Implications:
There are many patients who received chemotherapy in the last 3 months of their life and the rates of chemotherapy initiation during this period are well above ideal rates. Whether such care has positive effects on survival or quality of life is questionable and deserves additional investigation.
Cancer is one of the most common causes of death all over the World (Rahib et al. in Cancer Res 74(11):2913–2921,
2014
; Silbermann et al. in Ann Oncol 23(Suppl 3):iii15–iii28,
2012
). It is crucial ...to diagnose this disease early by effective screening methods and also it is very important to acknowledge the community on various aspects of this disease such as the treatment methods and palliative care. Not only the oncologists but every medical doctor should be educated well in dealing with cancer patients. Previous studies suggested various opinions on the level of oncology education in medical schools (Pavlidis et al. in Ann Oncol 16(5):840–841,
2005
). In this study, the perspectives of medical students on cancer, its treatment, palliative care, and the oncologists were analyzed in relation to their educational status. A multicenter survey analysis was performed on a total of 4224 medical school students that accepted to enter this study in Turkey. After the questions about the demographical characteristics of the students, their perspectives on the definition, diagnosis, screening, and treatment methods of cancer and their way of understanding metastatic disease as well as palliative care were analyzed. The questionnaire includes questions with answers and a scoring system of Likert type 5 (absolutely disagree = 1, completely agree = 5). In the last part of the questionnaire, there were some words to detect what the words “cancer” and “oncologist” meant for the students. The participant students were analyzed in two study groups; “group 1” (
n
= 1.255) were phases I and II students that had never attended an oncology lesson, and “group 2” (
n
= 2.969) were phases III to VI students that had attended oncology lessons in the medical school. SPSS v17 was used for the database and statistical analyses. A value of
p
< 0.05 was noted as statistically significant. Group 1 defined cancer as a contagious disease (
p
= 0.00025), they believed that early diagnosis was never possible (
p
= 0.042), all people with a diagnosis of cancer would certainly die (
p
= 0.044), and chemotherapy was not successful in a metastatic disease (
p
= 0.003) as compared to group 2. The rate of the students that believed gastric cancer screening was a part of the national screening policy was significantly more in group 1 than in group 2 (
p
= 0.00014). Group 2 had a higher anxiety level for themselves or their family members to become a cancer patient. Most of the students in both groups defined medical oncologists as warriors (57% in group 1 and 40% in group 2;
p
= 0.097), and cancer was reminding them of “death” (54% in group 1 and 48% in group 2;
p
= 0.102). This study suggested that oncology education was useful for the students’ understanding of cancer and related issues; however, the level of oncology education should be improved in medical schools in Turkey. This would be helpful for medical doctors to cope with many aspects of cancer as a major health care problem in this country.
Objectives: Carcinoembrionic Antigen (CEA) and carbohydrateantigen 19-9 (CA 19-9) are the most commonly used tumor-associated antigens in the colorectal cancer. Several contradictory studies reported ...that patients with meta?static colorectal cancer (mCRC) with normal serum CEA and CA 19-9 levels survived significantly longer than patients with higher serum CEA and CA19-9 levels. Methods: 240 patients with mCRC were enrolled. The parameters evaluated were age, gender, tumor location, meta?static organs, resection of the primary tumor, metastasectomy, pretreatment serum concentrations of CEA and CA19-9, first line chemotherapy regimens and overall survival (OS). CEA and CA19-9 were divided into three groups as normal (CEA ?5 ng/mL, CA 19-9 ?35 U/mL) elavated (CEA: 5–50 ng/mL, CA19-9:35–350 U/mL) and high (CEA >50 ng/mL, and CA 19-9 >350 U/mL). Primary study endpoint was overall survival (OS). Results: Serum CA 19-9 level (p=0.040), primary tumor resection (p<0.001), metastasectomy (p=0.042) and tumor lo?cation (p=0.029) were independent predictors of survival in multivariate analysis. The survival was 29.5, 21.2 and 15.4 months for the patients with normal, elevated and high CA 19-9 levels. Conclusion: High pretreatment serum CA19-9 may be a useful predictive factor of survival rather then CEA in patients with stage IV CRC.
To evaluate radiological and clinical features in metastatic anaplastic lymphoma kinase+ non-small cell lung cancer patients and crizotinib efficacy in different lines. This national, ...non-interventional, multicenter, retrospective archive screening study evaluated demographic, clinical, and radiological imaging features, and treatment approaches in patients treated between 2013-2017. Totally 367 patients (54.8% males, median age at diagnosis 54 years) were included. Of them, 45.4% were smokers, and 8.7% had a family history of lung cancer. On radiological findings, 55.9% of the tumors were located peripherally, 7.7% of the patients had cavitary lesions, and 42.9% presented with pleural effusion. Pleural effusion was higher in nonsmokers than in smokers (37.3% vs. 25.3%, P = .018). About 47.4% of cases developed distant metastases during treatment, most frequently to the brain (26.2%). Chemotherapy was the first line treatment in 55.0%. Objective response rate was 61.9% (complete response: 7.6%; partial response: 54.2%). The highest complete and partial response rates were observed in patients who received crizotinib as the 2nd line treatment. The median progression-free survival was 14 months (standard error: 1.4, 95% confidence interval: 11.2-16.8 months). Crizotinib treatment lines yielded similar progression-free survival (P = .078). The most frequent treatment-related adverse event was fatigue (14.7%). Adrenal gland metastasis was significantly higher in males and smokers, and pleural involvement and effusion were significantly higher in nonsmokers-a novel finding that has not been reported previously. The radiological and histological characteristics were consistent with the literature data, but several differences in clinical characteristics might be related to population characteristics.
Whether primary tumor resection (PTR) should be performed in patients with asymptomatic colorectal cancer (CRC) and unresectable synchronous metastasis is controversial. The purpose of this study was ...to investigate the prognostic impact of initial primary tumor resection in patients with synchronous unresectable metastatic CRC.
The patients with unresectable synchronous metastatic CRC who had undergone primary tumor resection and then received chemotherapy were compared with the patients who received only palliative systemic chemotherapy.
Survival analysis showed that median overall survival (OS) for all patients was 22.37 months. Primary tumor resection was associated with a significant survival benefit on unadjusted analysis (median survival 29.56 months vs. 14.25 months; p<0.001). Two-year, 3-year and 5-year survival rates were 57%, 35%, 19% for the PTR group and 30%, 16%, 8% for the non-PTR group and all results were statistically significant and favored surgery.
Our study suggests that primary tumor resection improves the survival of patients with metastatic CRC and unresectable synchronous metastasis.
Aim: The objective of this study is to investigate prognostic factors affecting survival of patients undergoing concurrent or sequential chemoradiotherapy (CRT) for stage III non-small-cell lung ...cancer (NSCL). Methods and materials: We retrospectively reviewed the clinical records of 148 patients with advanced, inoperable stage III NSCLC, who were treated between 2007 and 2015. Results: The median survival was found to be 19 months and 3-year overall survival was 27%. Age (<65 vs ${\geq}65years$, p=0.026), stage (IIIA vs IIIB, p=0.033), dose of radiotherapy (RT) (<60 vs ${\geq}60Gy$, p=0.024) and treatment method (sequential chemotherapy+RT vs concurrent CRT, p=0.023) were found to be factors affecting survival in univariate analyses. Gender, histological subtype, weight loss during CRT, performance status, induction/consolidation chemotherapy and presence of comorbidities did not affect survival (p>0.050). Conclusion: Young age, stage IIIA, radiotherapy dose and concurrent chemoradiotherapy may positively affect survival in stage III NSCL cases.
The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment.
Retrospective analysis of ...T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey.
Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%).
The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Purpose
In the ToGA trial for HER2-positive advanced gastric cancer, cisplatin plus fluoropyrimidine was given for 6 cycles; trastuzumab was given until disease progression. However, there is a lack ...of real-life data about trastuzumab maintenance after 6 cycle chemotherapy. This study aims to present real-life data of trastuzumab ± capecitabine maintenance after 6 cycles of platinum, fluoropyrimidine, and trastuzumab in non-progressive patients.
Methods
This is a retrospective multicenter study of the Turkish Oncology Group. A total of 35 HER2-positive, inoperable locally advanced, recurrent, or metastatic gastric adenocarcinoma patients being non-progressive at the end of 6 cycle chemotherapy and being given trastuzumab ± capecitabine as maintenance treatment were included from sixteen oncology centers. Baseline characteristics, objective tumor responses, progression free and overall survival data, and toxicities were determined.
Results
About 68% of the patients were given CF, and 32% were given FOLFOX with trastuzumab as the first-line treatment. The best response in 6 cycle chemotherapy was complete 8 (22%), partial 24 (68%), and stable disease 3 (8%). All patients had trastuzumab maintenance (median cycle 13; range 7–51), and 49% of the patients had capecitabine with trastuzumab (median capecitabine cycle 6; range 2–30). The median PFS of the patients was 12.0 months (95% CI 10.3–13.7), and median OS was 17.4 months (95% CI 15.2–19.5). There were 2 patients with grade 1 cardiotoxicity.
Conclusion
Trastuzumab maintenance ± capecitabine after 6 cycles of trastuzumab plus combined chemotherapy treatment revealed efficacy and safety in non-progressive HER2-positive advanced gastric cancer.
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