Currently, more than 40000 patients undergo allogeneic hematopoietic SCT (HSCT) annually throughout the world, and the numbers are increasing rapidly. Long-term survival after allogeneic-HSCT ...(allo-HSCT) has also improved significantly since its inception over 40 years ago due to improved supportive care and early recognition of long-term complications. In long-term follow-up after transplantation, the focus of care moves beyond cure of the original disease to late effects and quality of life. Nearly one-fourth of the long-term survivors are likely to have chronic consequences of HSCT, which require frequent help by caregivers, particularly informal caregivers such as spouses, partners or children. The physical and psychosocial consequences for patients undergoing HSCT have been extensively reported. There has, however, been far less investigation into the long-term follow-up of caregivers of HSCT recipients. This article provides an overview on addressing caregiver issues after HSCT. The rapidly growing population of long-term HSCT survivors creates an obligation not only to educate patients and physicians about the late complications observed in patients but also to follow up caregivers for their psychosocial support needs.
Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus ...2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.
Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).
A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.
Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.
NCT04354701
•Among 4966 patients with COVID-19 and a history of or active cancer, 58% were hospitalized and 14% died within 30 days.•Older age, male sex, obesity, comorbidities, non-Hispanic black race, and Hispanic ethnicity were associated with higher COVID-19 severity.•Worse performance status, hematologic malignancy, and recent cytotoxic chemotherapy were associated with more severe COVID-19.•Low or high absolute lymphocyte count, high absolute neutrophil count, low platelets, abnormal creatinine, troponin, lactate dehydrogenase, or C-reactive protein were associated with more severe COVID-19.•Specific anticancer therapies were associated with high 30-day all-cause mortality.
We aim to review the benefits of palliative care, describe why a palliative approach to care is needed for patients with advanced penile squamous cell carcinoma and propose ways in which oncology ...nurses can improve access to and provision of palliative care.
A review of the literature was performed and identified a range of randomized trials and systematic reviews regarding the benefits of palliative care in this patient group. Cohort studies of patients with penile cancer were used to describe the psychosocial and physical disease burden of penile cancer.
Throughout each phase of penile cancer and its treatment, oncology nurses can engage in care that goes beyond cancer-directed treatments to address the whole person, thereby improving quality of life by delivering person-centered palliative care in line with individual needs.
Oncology nurses are in key positions to explore many concerns that patients with penile cancer have for themselves or their caregivers. Through speaking directly with patients and caregivers, oncology nurses can uncover sources of distress, assess for unmet needs, and advocate for improved primary palliative care or early referral to specialty palliative care teams.
Background
COVID‐19 can have a particularly detrimental effect on patients with cancer, but no studies to date have examined if the presence, or site, of metastatic cancer is related to COVID‐19 ...outcomes.
Methods
Using the COVID‐19 and Cancer Consortium (CCC19) registry, the authors identified 10,065 patients with COVID‐19 and cancer (2325 with and 7740 without metastasis at the time of COVID‐19 diagnosis). The primary ordinal outcome was COVID‐19 severity: not hospitalized, hospitalized but did not receive supplemental O2, hospitalized and received supplemental O2, admitted to an intensive care unit, received mechanical ventilation, or died from any cause. The authors used ordinal logistic regression models to compare COVID‐19 severity by presence and specific site of metastatic cancer. They used logistic regression models to assess 30‐day all‐cause mortality.
Results
Compared to patients without metastasis, patients with metastases have increased hospitalization rates (59% vs. 49%) and higher 30 day mortality (18% vs. 9%). Patients with metastasis to bone, lung, liver, lymph nodes, and brain have significantly higher COVID‐19 severity (adjusted odds ratios ORs, 1.38, 1.59, 1.38, 1.00, and 2.21) compared to patients without metastases at those sites. Patients with metastasis to the lung have significantly higher odds of 30‐day mortality (adjusted OR, 1.53; 95% confidence interval, 1.17–2.00) when adjusting for COVID‐19 severity.
Conclusions
Patients with metastatic cancer, especially with metastasis to the brain, are more likely to have severe outcomes after COVID‐19 whereas patients with metastasis to the lung, compared to patients with cancer metastasis to other sites, have the highest 30‐day mortality after COVID‐19.
Patients with metastatic cancer have more severe outcomes than patients without metastasis, with those with metastasis to the brain having the highest odds of severe COVID‐19. When adjusting for initial COVID‐19 severity, patients with metastasis to the lung, compared to patients with metastasis sites other than the lung, have the highest odds of 30‐day mortality.
High-intensity end-of-life (EoL) care can be burdensome for patients, caregivers, and health systems and does not confer any meaningful clinical benefit. Yet, there are significant knowledge gaps ...regarding the predictors of high-intensity EoL care. In this study, we identify risk factors associated with high-intensity EoL care among older adults with the four most common malignancies, including breast, prostate, lung, and colorectal cancer.
Using SEER-Medicare data, we conducted a retrospective analysis of Medicare beneficiaries aged 65 and older who died of breast, prostate, lung, or colorectal cancer between 2011 and 2015. We used multivariable logistic regression to identify clinical, demographic, socioeconomic, and geographic predictors of high-intensity EoL care, which we defined as death in an acute care hospital, receipt of any oral or parenteral chemotherapy within 14 days of death, one or more admissions to the intensive care unit within 30 days of death, two or more emergency department visits within 30 days of death, or two or more inpatient admissions within 30 days of death.
Among 59,355 decedents, factors associated with increased likelihood of receiving high-intensity EoL care were increased comorbidity burden (odds ratio OR:1.29; 95% confidence interval CI:1.28–1.30), female sex (OR:1.05; 95% CI:1.01–1.09), Black race (OR:1.14; 95% CI:1.07–1.23), Other race/ethnicity (OR:1.20; 95% CI:1.10–1.30), stage III disease (OR:1.11; 95% CI:1.05–1.18), living in a county with >1,000,000 people (OR:1.23; 95% CI:1.16–1.31), living in a census tract with 10%–<20% poverty (OR:1.09; 95% CI:1.03–1.16) or 20%–100% poverty (OR:1.12; 95% CI:1.04–1.19), and having state-subsidized Medicare premiums (OR:1.18; 95% CI:1.12–1.24). The risk of high-intensity EoL care was lower among patients who were older (OR:0.98; 95% CI:0.98–0.99), lived in the Midwest (OR:0.69; 95% CI:0.65–0.75), South (OR:0.70; 95% CI:0.65–0.74), or West (OR:0.81; 95% CI:0.77–0.86), lived in mostly rural areas (OR:0.92; 95% CI:0.86–1.00), and had poor performance status (OR:0.26; 95% CI:0.25–0.28). Results were largely consistent across cancer types.
The risk factors identified in our study can inform the development of new interventions for patients with cancer who are likely to receive high-intensity EoL care. Health systems should consider incorporating these risk factors into decision-support tools to assist clinicians in identifying which patients should be referred to hospice and palliative care.
Abstract Rapid, accurate diagnosis of community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae is compromised by low sensitivity of culture and serology. Polymerase chain reaction (PCR) has ...emerged as a sensitive method to detect M. pneumoniae DNA in clinical specimens. However, conventional real-time PCR is not cost-effective for routine or outpatient implementation. Here, we evaluate a novel microfluidic real-time PCR platform (Advanced Liquid Logic, Research Triangle Park, NC) that is rapid, portable, and fully automated. We enrolled patients with CAP and extracted DNA from nasopharyngeal wash (NPW) specimens using a biotinylated capture probe and streptavidin-coupled magnetic beads. Each extract was tested for M. pneumoniae -specific DNA by real-time PCR on both conventional and microfluidic platforms using Taqman probe and primers. Three of 59 (5.0%) NPWs were positive, and agreement between the methods was 98%. The microfluidic platform was equally sensitive but 3 times faster and offers an inexpensive and convenient diagnostic test for microbial DNA.
Rapid, accurate diagnosis of community-acquired pneumonia (CAP) due to
Mycoplasma pneumoniae
is compromised by low sensitivity of culture and serology. PCR has emerged as a sensitive method to detect
...M. pneumoniae
DNA in clinical specimens. However, conventional real-time PCR is not cost-effective for routine out-patient or implementation. Here, we evaluate a novel microfluidic real-time PCR platform (Advanced Liquid Logic, Inc.) that is rapid, portable, and fully automated. We enrolled patients with CAP and extracted DNA from nasopharyngeal wash (NPW) specimens using a biotinylated capture probe and streptavidin-coupled magnetic beads. Each extract was tested for
M. pneumoniae
-specific DNA by real-time PCR on both conventional and microfluidic platforms using Taqman probe and primers. Three of 59 (5.0%) NPWs were positive, and agreement between the methods was 98%. The microfluidic platform was equally sensitive but three times faster and offers an inexpensive and convenient diagnostic test for microbial DNA.
PDF
