RESUMEN
BACKGROUND: Cancer is predominantly a disease in the population aged 65 years and older. Previous studies have suggested that older cancers patients seen in oncology departments are healthy with few comorbidities. Relatively little is known about the health and functional status of older cancer inpatients, especially outside oncology units. The purpose of this study is to compare the health and functional status of older cancer and noncancer inpatients admitted to a geriatric/internal medicine unit. METHODS: A retrospective chart review was conducted on inpatients 65 years old and older, who had been hospitalized during a period of 2 years in the geriatric/internal medicine unit. The health and functional status of 144 inpatients with active cancer was compared to that of 682 inpatients without active cancer. Eight domains were compared: functional status, comorbidity, medication, nutritional status, neurosensory deficits, cognition, mood, and mobility. The hospitalization measures (length of stay, death, need for palliative care) were also compared. RESULTS: We found that inpatients with active cancer were younger, had less comorbidity and less cognitive impairment, but were more depressed and at greater risk for malnutrition than patients without cancer. These two groups were similar in terms of functional status, neurosensory deficit, and mobility. Cancer patients had a significantly shorter length of stay, required more palliative care, and were more likely to die during hospitalization. CONCLUSION: These findings indicate that older cancer patients admitted to a geriatric/internal medicine unit present with multiple active geriatric problems, have characteristics distinct from those of traditional geriatric patients, and require specific care and management.
Asunto(s)
Cognición , Evaluación Geriátrica , Estado de Salud , Pacientes Internos , Neoplasias/epidemiología , Estado Nutricional , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Francia/epidemiología , Unidades Hospitalarias , Humanos , Tiempo de Internación , Masculino , Morbilidad/tendencias , Neoplasias/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: Patients age > or = 75 years with acute myeloid leukemia (AML) generally are offered palliative treatments instead of induction chemotherapy. The authors conducted a retrospective study comparing the outcomes among these elderly patients with the outcomes among younger patients to assess the impact of intensive treatment approaches in this age group. METHODS: One hundred ten consecutive patients age > or = 75 years with newly diagnosed AML (excluding patients with acute promyelocytic leukemia) were treated in the authors' center over 10 years. Initial treatment was comprised of anthracycline-based induction chemotherapy (i.e., intravenous idarubicin or daunorubicin for 3 days plus cytarabine [ARAC] for 7 days [3 + 7 regimen] or oral idarubicin) for 62 patients (56%), antimetabolite-based chemotherapy (including low-dose ARAC, oral 6-mercaptopurine plus methotrexate, or hydroxyurea) for 40 patients (36%), and supportive care only for 8 patients (7%). Results were compared with the results from 200 patients ages 65-74 years who were treated during the same period. RESULTS: A complete response (CR) to anthracycline-based induction therapy was achieved by 23 of 62 patients (37%), and the 2-year overall survival rate was 22% (which was not statistically different from the group of patients ages 65-74 years). In a multivariate analysis of the entire study group (310 patients), treatment (anthracycline-based vs. other) and age as continuous variable were found to affect survival significantly. In a Landmark analysis, the achievement of a CR translated into improved survival in patients age > or = 75 years. CONCLUSIONS: Patients age > or = 75 years should not be excluded systematically from intensive chemotherapy regimens. Decisions should be based on stratification systems that include functional status and comorbidity assessments as well as prognostic factors, such as cytogenetics.
Asunto(s)
Antraciclinas/uso terapéutico , Antimetabolitos Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Anciano , Femenino , Humanos , Masculino , Inducción de Remisión , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Inflammatory breast cancer (IBC) is a rare but very aggressive form of breast cancer. Its definition is based on clinical criteria, but a molecular definition could be useful when data are incomplete or features are missing. Recently, the identification of overexpression of E-cadherin in IBC has improved understanding of the molecular basis of this disease. Consequently, the aim of this study was to try to determine an immunophenotypic 'signature' of IBC. A series of 80 cases of IBC were compared with 552 non-IBC control cases and a model was elaborated to evaluate the probability of an inflammatory carcinoma being present in any clinical situation. Tissue microarrays (TMAs) were used to determine the immunohistochemical profile of eight proteins including E-cadherin, EGFR, oestrogen and progesterone receptor (ER and PR), MIB1, ERBB2, MUC1, and P53. All the parameters tested were differentially expressed between IBC and control cases in univariate analysis (p < 0.001). The five variables that were significantly associated with IBC in multivariate analysis were E-cadherin > or = 300 [HR = 5.64 (2.92-10.87)], ER negative [HR = 3.00 (1.67-5.51)], MIB1 > 20 [HR = 3.54 (1.87-6.71)], MUC1 cytoplasmic staining [HR = 2.72 (1.49-4.96)], and ERBB2 positive 2+ or 3+ [HR = 2.46 (1.26-4.78)]. The probability that a breast cancer with this full phenotype at diagnosis was an IBC was 90.5%. If any one of the five parameters was missing, this probability dropped to 75% and was less than 50% when one, two, or three parameters were present. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) of patients with IBC were not significantly different from those of the non-IBC control group that expressed four or five parameters (nIBC-1), but this nIBC-1 control group had a significantly worse outcome than the non-IBC control group (nIBC-2) with only 0-3 parameters (p = 0.0049 for OS and p < 0.0001 for DFS). In conclusion, an immunophenotypic signature was suggested for IBC. This could help to determine the worst cases, independent of clinical criteria.
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Biomarcadores de Tumor/análisis , Neoplasias de la Mama/química , Cadherinas/análisis , Carcinoma Ductal de Mama/química , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/mortalidad , Carcinoma Ductal de Mama/patología , Estudios de Casos y Controles , Supervivencia sin Enfermedad , Receptores ErbB/análisis , Femenino , Estudios de Seguimiento , Humanos , Inmunofenotipificación , Antígeno Ki-67/análisis , Metástasis Linfática , Persona de Mediana Edad , Mucina-1/análisis , Análisis Multivariante , Pronóstico , Receptor ErbB-2/análisis , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Tasa de Supervivencia , Proteína p53 Supresora de Tumor/análisisRESUMEN
In this prospective multicenter program, we investigated allogeneic stem cell transplantation (ASCT) from HLA-identical siblings following reduced-intensity conditioning (RIC) regimen for patients with refractory metastatic solid tumors (STs). Fifty-seven patients, of whom 39 had a progressive disease (PD) at time of ASCT, received an RIC ASCT combining fludarabine, antithymocyte globulin (ATG), and busulfan. Patients were analyzed in terms of engraftment, transplant-related mortality (TRM), disease response, and outcome. In this setting, RIC was associated with rapid engraftment and low overall TRM (9% [95% confidence interval (CI), 1%-16%]). The cumulative incidence of objective responses (ORs) reached 14% (95% CI, 6%-30%) with this being significantly higher in patients without PD (44% [95% CI, 21%-67%] versus 0; P <.0001) at time of ASCT. Achievement of OR translated into a significantly better overall survival (OS). In multivariate analysis, OS was significantly influenced by disease status at time of ASCT (odds ratio, 4.88; P <.001) and chronic graft-versus-host disease (GVHD) occurrence (odds ratio, 2.86; P <.01). Overall, these results showed that OR can occur after RIC ASCT for resistant ST with a relatively low TRM and potential benefit especially in patients with slowly progressive disease. Further studies are warranted in patients with less advanced ST.
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Neoplasias/terapia , Trasplante de Células Madre , Acondicionamiento Pretrasplante/métodos , Vidarabina/análogos & derivados , Enfermedad Aguda , Adulto , Suero Antilinfocítico/uso terapéutico , Trasplante de Médula Ósea/mortalidad , Busulfano/uso terapéutico , Enfermedad Crónica , Progresión de la Enfermedad , Femenino , Enfermedad Injerto contra Huésped/epidemiología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Neoplasias/clasificación , Neoplasias/patología , Neoplasias/cirugía , Hermanos , Trasplante de Células Madre/mortalidad , Análisis de Supervivencia , Donantes de Tejidos , Trasplante Homólogo , Resultado del Tratamiento , Vidarabina/uso terapéuticoRESUMEN
PURPOSE: To report complications, failure rate, and esthetic results in patients undergoing immediate breast reconstruction with a tissue expander and implant, with or without adjuvant treatment. METHODS AND MATERIALS: We reviewed the records of the 77 patients who underwent immediate breast reconstruction with an expander/implant between January 1999 and December 2000. Complications were assessed using the Common Toxicity Criteria, version 2, scale. Esthetic results were assessed by the physician using five criteria. RESULTS: Of the 77 patients, 55 had received adjuvant radiotherapy. The median follow-up was 25 months. Complications appeared to correlate with radiotherapy (14% for nonirradiated patients; 51% for irradiated patients; p = 0.006) and adjuvant chemotherapy (54% with chemotherapy [CHT] vs. 25% without CHT; p = 0.02). Breast reconstruction failed in 21% of patients (9% of nonirradiated patients and 24% of irradiated patients; p = 0.1), and chemotherapy was associated with a worse rate of failure (34% with CHT vs. 6% without CHT, p = 0.005). Adjuvant tamoxifen, however, correlated neither with complications (45% with tamoxifen vs. 39% without; p = 0.15) nor with failure (21% with tamoxifen and 23% without, p = 0.79). Esthetic results were acceptable in 60% of cases. CONCLUSION: Immediate breast reconstruction with an expander/implant can be considered even for patients requiring adjuvant treatment. However, the complication and failure rates are three times higher after postexpander radiotherapy.
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Implantes de Mama/efectos adversos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodos , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Falla de Prótesis , Calidad de Vida , Estudios Retrospectivos , Cirugía Plástica/efectos adversos , Cirugía Plástica/métodos , Dispositivos de Expansión Tisular/efectos adversos , Insuficiencia del TratamientoRESUMEN
Anemia is a frequent symptom encountered in hematological malignancies at diagnosis or in the course of the disease. Allogeneic transfusions were, until recently, the only treatment available and used only for severe anemia. Erythropoietin is currently an important alternative especially for treatment and even to prevent severe anemia. It has been assessed for the treatment of chemotherapy related anemia in NHL, myeloma and CLL with a significant reduction of blood transfusions and prevention of grade 3-4 anemia in 51% of patients. In myelodysplasia, the more effective regimen is the association of G-CSF and Epo. In the setting of allogeneic bone marrow transplantation, it reduces the time to red cell engraftment and probably the number of blood cell unit per patient in contrast with autologous stem cell transplant. All these studies assessed the efficacy of Epo in hematological malignancies but needs further trials including the assessment of the quality of life and economical parameters.
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Anemia , Eritropoyetina/uso terapéutico , Neoplasias Hematológicas/tratamiento farmacológico , Anemia/clasificación , Anemia/etiología , Anemia/terapia , Enfermedades Hematológicas/complicaciones , Factores de Crecimiento de Célula Hematopoyética/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Síndromes Mielodisplásicos/complicaciones , Proteínas RecombinantesRESUMEN
OBJECTIVE: To determine the direct treatment cost of lung cancer management from progression to death from the viewpoint of the hospital. METHODS: A retrospective descriptive study was performed. Data from 100 patients who died of lung cancer and who had received treatment from four different types of hospital were used; the hospitals were public hospitals (teaching and non-teaching), private not-for-profit cancer centres, and private hospitals. Resource utilisation/cost data collected included the cost of diagnosis of the recurrence, the cost of hospitalisations or day care treatments and ambulatory surgery. All resources were valued in 2001 euros. RESULTS: In France, the average cost per patient was euro12 518 for the whole group (78% with non-small cell lung cancer [NSCLC], and 22% with small cell lung cancer [SCLC]), euro13 969 for patients with NSCLC and euro7369 for patients with SCLC. The higher cost of treatment in patients with NSCLC is explained by longer survival and duration of chemotherapy. In patients with NSCLC, 51% of the total cost corresponded to terminal care, with up to seven lines of chemotherapy. In patients with SCLC, the costs of diagnosis and terminal care each represented 41% of the total cost. CONCLUSIONS: The cost of treatment of recurrence of lung carcinoma is high, and is related to the number of lines of chemotherapy and the use of radiotherapy and surgery.
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Carcinoma de Pulmón de Células no Pequeñas , Costo de Enfermedad , Neoplasias Pulmonares , Recurrencia Local de Neoplasia , Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/terapia , Francia , Humanos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Recurrencia Local de Neoplasia/economía , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/terapia , Radioterapia/economía , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Clinically very heterogeneous, breast cancer prognosis and treatment response are difficult to predict with the current prognostic histoclinical parameters. Mammary oncogenesis remains poorly understood. DNA array technology allows the simultaneous analysis of the mRNA expression levels of thousands of genes in biological samples. Applied to breast tumours, expression profiles will boost our knowledge of oncogenesis, will offer new potential therapeutic targets and new prognostic and predictive markers. Today, the most accessible approach for academic research teams is that of Nylon DNA arrays with radioactive detection, which in addition allows profiling of small clinical samples.
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Neoplasias de la Mama/genética , Perfilación de la Expresión Génica/métodos , Nylons , Análisis de Secuencia por Matrices de Oligonucleótidos/métodos , Neoplasias de la Mama/clasificación , Humanos , PronósticoRESUMEN
The aim of this study was to investigate the feasibility and acceptability of a repeated measurement of 5 major side effects (pain, nausea, vomiting, anxiety, and fatigue) experienced by patients during an entire course of chemotherapy. Forty-nine inpatients receiving intravenous chemotherapy in the Medical Oncology Department of the Institut Paoli-Calmettes (Marseilles, France) were included in the study. At the study entry and every 12 hours from beginning of chemotherapy course, nurses assessed symptoms using Visual Analogic Scales (except for vomiting measured in number of episodes). Patients' pretreatment characteristics and their degree of satisfaction with nursing assessment were also recorded. The mean number of symptom measures was 2.9 in courses of less than 3 days, 5.4 in courses of 3 days, and 7.5 in courses of more than 3 days. Symptom patterns varied according to length of course. Furthermore, patients' pretreatment characteristics (age, sex, marital status, education level, type of cancer) had an impact on symptom scores at baseline and during treatment. About 80% of patients judged the nursing assessment as not constraining and 55% considered that its impact on their care was positive. This study demonstrates that repeated measurement of chemotherapy side effects was feasible and provide useful information for symptom management that might increase patient treatment satisfaction.
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Antineoplásicos/efectos adversos , Monitoreo de Drogas/métodos , Evaluación en Enfermería/métodos , Adulto , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermería Oncológica , Estadísticas no ParamétricasRESUMEN
BACKGROUND: There is no standard treatment for inoperable recurrent or metastatic cancer of the uterine cervix. Retinoids and interferon, in combination with cytotoxic compounds, have been shown to be active in squamous cell carcinoma (SCC). This phase II trial sought to estimate the response rate and the tolerance to a 3-month treatment combining cisplatin, interferon-alpha (IFN-alpha) and all-trans-retinoic (tRA) or 13 cis retinoic acid (13Cis), in women with recurrent or metastatic cervical SCC. PATIENTS AND METHODS: Between November 1994 and October 1996, 33 patients, who had previously received aggressive treatment, and with metastatic and/or bulky disease were enrolled: 22 received tRA(40 mg/m(2)/day), 11 received 13Cis (1 mg/kg/day) in combination with IFN-alpha (6.106 UI/day SC) for 84 days plus cisplatin (40 mg/m(2)IV, days 1, 28 and 56). RESULTS: All patients were evaluable for response and/or toxicity. Toxicities were easily manageable and were never life-threatening, with major grade 3/4 vomiting (54%) and asthenia (54%). Seventeen patients (52%) stopped or reduced treatment because of toxicity or progression. Six objective responses (18%) were observed. No complete response was recorded. Median response duration was 4 months. Time to progression was 9 months [range 3.3 to 20.9] for responders and 7 months [range 1.7 to 32] for all patients. CONCLUSIONS: Regarding toxicity, this regimen should no longer be recommended in previously treated, advanced uterine SCC. However, the consistent response rate reported here may warrant further investigations in an early setting. Retinoid-based treatment with cytokines remains a promising field of research.