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OBJECTIVE: To explore the expectations of Brazilian and German patients regarding metastatic cancer and palliative chemotherapy. METHODS: Interviews with 48 metastatic cancer patients from Brazil and Germany were conducted. The interviews were transcribed and analyzed using the thematic analysis approach to identify common themes. The sociodemographic data were collected using an instrument developed by the authors. RESULTS: A total of 48 patients participated in the study (58% were Brazilian and 42% were German). Of all participants, 35% were men and 65% were women. The participants' mean age was 41 years. The general idea captured from the interviewees' speech was that their diseases were curable or "while there is chemotherapy, there is life"; thus, the data analysis enabled the elaboration of the central theme, entitled "Mistaken expectations of metastatic cancer patients regarding palliative chemotherapy: While there is chemotherapy, there is life," with 5 subthemes, namely: (1) communication and expectations; (2) normal life; (3) the person behind the disease; (4) religiosity and spirituality; and (5) the fortitude to choose between continuing or discontinuing treatment. SIGNIFICANCE OF RESULTS: Regardless of cultural aspects, patients with metastatic cancer on palliative chemotherapy tend to believe in the healing potential of treatments. Dividing expectations only into curable or incurable is insufficient, as even patients who have acknowledged the incurability of their disease expect to live, as long as they remain under treatment as if the disease did not exist.
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Neoplasias , Cuidados Paliativos , Masculino , Humanos , Feminino , Adulto , Brasil , Motivação , Neoplasias/tratamento farmacológico , Comunicação , Pesquisa QualitativaRESUMO
INTRODUCTION: Gallbladder cancer is the most common malignancy of the biliary tract. Given the lack of therapeutic alternatives for advanced stage patients studies have suggested that palliative chemotherapy could benefit these patients. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified two systematic reviews including two studies overall, of which one was a randomized trial. We concluded that palliative chemotherapy may increase survival in advanced gallbladder cancer patients. However, palliative chemotherapy probably increases adverse effects. In addition, it is essential to carry out a new systematic review, since methodological errors were identified in the analysis and there is new evidence that has not been included in the previous reviews.
INTRODUCCIÓN: El cáncer de vesícula es el cáncer más frecuente de la vía biliar. Debido a la escasez de alternativas terapéuticas para pacientes con etapas avanzadas de la enfermedad, se ha planteado que quimioterapia paliativa puede ser beneficiosa para estos pacientes. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos dos revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, de los cuales, uno corresponde a un ensayo aleatorizado. Concluimos que la quimioterapia paliativa podría aumentar la sobrevida en cáncer de vesícula biliar avanzado. Sin embargo, probablemente aumenta los efectos adversos. Además, es imprescindible realizar una nueva revisión sistemática, ya que se identificaron errores metodológicos importantes en el análisis realizado y existe nueva evidencia que no ha sido incluida en revisiones previas.
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Antineoplásicos/uso terapêutico , Neoplasias da Vesícula Biliar/tratamento farmacológico , Cuidados Paliativos/métodos , Antineoplásicos/administração & dosagem , Neoplasias da Vesícula Biliar/patologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do TratamentoRESUMO
PURPOSE: Patients with diagnosis of diffuse large B-cell lymphoma, who relapse after stem cell transplant (SCT) or are no candidates to SCT, have a poor prognosis and no current treatment is available. Thus, we conduct a rotatory chemotherapy schedule that employed low doses of chemotherapy agents to assess efficacy and toxicity in this setting of patients; the end point was the improved outcome. METHODS: Retrospectively we revised an analysis of 461 patients who were treated with a low-doses regimen of cytotoxic agents, who were treated in a single institution, all patients has been treated with at least two salvage regimens, including SCT, > 18 years, performance status < 3, and that were informed about the possibility of severe toxicities,, were considered candidates to the study. They received a weekly rotatory scheme including low doses of cytotoxic agents during 2 years. RESULTS: Overall response rate was achieved in 314 patients (68%, 95% Confidence interval (CI) 59-76%) and complete response was achieved in 151 cases (32%, 95% CI 25-38%); actuarial curves at 10 years show that progression-free survival was 58% (95% CI 51-66%) and OS was 50% (95% CI 43-57%). Dose reduction was not necessary; toxicity was minimal and well controlled. No death related to acute or late toxicities has been observed. CONCLUSION: Low doses of cytotoxic agents for continuous, prolonged periods, with minimal drug-free intervals, represent a novel, active, and easily tolerated approach to management of patients with DLBCL in a terminal phase and improved outcome.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Citotoxinas/uso terapêutico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Terapia de Salvação , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: The role of mean platelet volume (MPV) as a predictor of outcomes in various cancer entities including colorectal cancer (CRC) has already been analyzed. However, data on the prognostic and predictive value of MPV in CRC over multiple lines of systemic therapy are missing. METHODS: In this retrospective single-center cohort study, 690 patients with UICC stage II, III or IV CRC receiving adjuvant and/or palliative chemotherapy were included. Primary endpoints in the adjuvant, palliative and best supportive care (BSC) setting were 3-year recurrence-free survival (RFS), 6-months progression-free survival (PFS), and 6-months overall survival (OS), respectively. Kaplan-Meier estimators, log-rank tests, and uni- and multivariable Cox models were used to analyze RFS, PFS and OS. A cut-off defining patients with low MPV was chosen empirically at the 25th percentile of the MPV distribution in the respective treatment setting. RESULTS: Three-year RFS was 76%. Median 6-month PFS estimates in 1st, 2nd and 3rd line therapy were 59, 37 and 27%, respectively. Median 6-month OS in BSC was 31%. Small platelets as indicated by low MPV did not predict for shorter RFS. In the first 3 palliative treatment lines a consistent association between low MPV and decreased 6-month PFS was not observed. In the BSC setting, patients with low MPV had numerically but not significantly shorter OS. Higher MPV levels did not consistently predict for ORR or DCR across the first 3 palliative treatment lines. CONCLUSION: Small platelets are not predicting CRC outcomes, and thus are hardly useful for influencing clinical decision making.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Plaquetas/patologia , Neoplasias Colorretais/sangue , Volume Plaquetário Médio/estatística & dados numéricos , Recidiva Local de Neoplasia/sangue , Idoso , Biomarcadores Tumorais , Plaquetas/efeitos dos fármacos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
PURPOSE: Although patients with incurable disease and Eastern Cooperative Oncology Group performance status (ECOG-PS ≥ 2) are underrepresented in clinical trials, they are frequently offered palliative chemotherapy (pCT) in daily clinical practice in order to improve symptoms and quality of life. In this case-control retrospective analysis, our goal was to identify factors associated with poorer survival and lack of benefit of pCT in this population. PATIENTS AND METHODS: We evaluated 2,514 patients who died between August 2011 and July 2012 in an academic cancer care institution and its hospice. A total of 301 patients with solid tumours and ECOG-PS ≥ 2 at prescription of pCT were selected for this case-control retrospective analysis. Cases were defined as patients who survived less than 90 days after the first cycle of first line pCT, and controls were those who had a longer survival. RESULTS: 142 cases and 159 controls were included. Cases were more likely to experience grade ≥ 3 toxicity (43% versus 28%; p = 0.005), die of toxicity (16% versus 6%; p < 0.001) and not be offered best supportive care (BSC) only (47% versus 71%; p < 0.001). Median overall survival was 204 among controls and 34 days in cases (hazard ratio = 0.177; 95%, confidence interval = 0.015-0.033, p < 0.001). Logistic regression analysis identified ECOG-PS > 2 (odds ratio (OR) = 2.3, p = 0.044) and serum creatinine (sCr) > 1 mg/dL (OR = 11.2, p < 0.001) as independent predictors of 90-day mortality. CONCLUSIONS: The independent predictors of short survival (less than 3 months) after initiation of pCT in this population were ECOG-PS > 2 and elevated sCr. Therefore, patient selection is crucial, as pCT may be deleterious in ECOG-PS ≥ 2 pts.
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The treatment of endometrial cancer (EC) is challenging. There is no standard of care for patients who progressed after carboplatin and paclitaxel (CT) and all available drugs show a small response and poor long-term survival in this scenario. The objective of this study was to evaluate the efficacy and toxicity profile of palliative doxorubicin after progression to CT therapy in advanced or recurrent EC. A retrospective review of the Brazilian National Cancer Institute database between 2009 and 2013 was performed, and all patients with recurrent and advanced EC treated with palliative doxorubicin after progression on CT were included. Progression-free survival (PFS), overall survival (OS), objective response rates as well as toxicity were evaluated. A total of 33 patients were enrolled, with a median age of 65.7 years. Objective responses were documented in 12.1% (3.0% of complete responses and 9.1% of partial responses). The median PFS was 4.4 months, and the median OS was 8.1 months for patients exposed to doxorubicin. The most common adverse event was anemia observed in 60.6% of patients. This retrospective study suggests that doxorubicin has a modest activity in patients with advanced or recurrent EC after treatment with CT.
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Adenocarcinoma de Células Claras/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cistadenocarcinoma Seroso/tratamento farmacológico , Neoplasias do Endométrio/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Adenocarcinoma de Células Claras/patologia , Idoso , Carboplatina/administração & dosagem , Cistadenocarcinoma Seroso/patologia , Doxorrubicina/administração & dosagem , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Paclitaxel/administração & dosagem , Prognóstico , Estudos Retrospectivos , Terapia de Salvação , Taxa de SobrevidaRESUMO
INTRODUCTION: The treatment of some early-stage and most locally advanced disease cervical cancer patients consists of concurrent chemoradiation, while almost all with advanced disease require palliative chemotherapy. AREAS COVERED: This review is aimed to analyze the safety issues emerging from trials of chemoradiation for early-stage high-risk disease and locally advanced stages, as well as safety issues of trials of palliative chemotherapy for advanced disease. Safety issues on fertility preservation are also discussed. EXPERT OPINION: Cisplatin chemoradiation produces higher toxicity as compared to radiation alone, yet it is well-tolerated. Further advances would require (i) the development of more effective and tolerated combination chemoradiation regimens, (ii) demonstration of the efficacy and tolerability of adjuvant chemotherapy after cisplatin chemoradiation, and (iii) incorporation of targeted therapies into radiosensitizing regimens. A major problem continues to be the population of patients with advanced disease. The recent incorporation of bevacizumab into chemotherapy regimens represents a step forward; however, toxicity as well as economic issues may impede its wide acceptance worldwide. Preserving fertility in young women with cervical cancer is an issue that must be fully addressed. In this setting, neoadjuvant chemotherapy seems to increase fertlity rate without compromising oncological outcomes.
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Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Preservação da Fertilidade/métodos , Neoplasias do Colo do Útero/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Cisplatino/administração & dosagem , Feminino , Humanos , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Neoplasias do Colo do Útero/patologiaRESUMO
Dentre os diversos tipos de câncer, o câncer da mama é o que mais acomete as mulheres em todo o mundo. Apesar de existirem diversas modalidades de tratamento para o câncer de mama, muitos casos apresentam-se como fora de possibilidades terapêuticas atuais para a cura. Sendo assim, quando a cura já não puder ser alcançada, a quimioterapia paliativa pode ser utilizada como opção terapêutica. No entanto, o uso desnecessário da quimioterapia pode piorar a qualidade de vida da mulher, devido às toxicidades relacionadas ao tratamento.Desta forma, diante da decisão em realizar a quimioterapia paliativa, deve-se atentar para as necessidades de cuidado que a paciente pode apresentar no decorrer do tratamento. A adequada gerência do cuidado de enfermagem facilita o atendimento destas necessidades, e a consulta de enfermagem é uma estratégia eficaz nesse processo, pois possibilita a aproximação e estabelece uma relação interpessoal de ajuda. Em assim sendo, o estudo tem como objeto: a gerência do cuidado de enfermagem a paciente com câncer de mama avançado em quimioterapia paliativa no contexto ambulatorial. Foram objetivos do estudo: compreender a visão dos enfermeiros acerca da gerência do cuidado de enfermagem a paciente com câncer de mama avançado em quimioterapia paliativa; analisar a gerência do cuidado de enfermagem a paciente com câncer de mama avançado em quimioterapia paliativa no contexto ambulatorial; e construir uma matriz teórica explicativa da gerência do cuidado de enfermagem que retrate esta realidade. Estudo exploratório com abordagem qualitativa que teve como participantes oito enfermeiras e dez pacientes do ambulatório de quimioterapia do Hospital do Câncer III, uma das unidades do Instituto Nacional de Câncer, Rio de Janeiro, Brasil. Para a coleta de dados foi utilizada a técnica da entrevista semi estruturada. O estudo foi viabilizado por meio da utilização do referencial metodológico da Teoria Fundamentada nos Dados (TFD)...
Among the various types of cancer, breast cancer is the one that most commonlyaffects women in the whole world. Although there are different types of treatment forbreast cancer, many cases are presented as out of current therapeutic possibilitiesfor healing. Palliative chemotherapy can be used as an additional resource for controlof advanced disease, with the possibility of favorable responses regarding thepromotion of comfort and the patient's quality of life; however, its unnecessary usecan worsen her condition due to unwanted toxicities and adverse reactions related tothe treatment. Following the decision to use the palliative chemotherapy, attentionshould be paid to the care needs that the patient may present during treatment, andthe nurse has an important role to manage care. The management of nursing care,when performed properly, considering the individual, integral and humanizedapproach, facilitates meeting the needs of patients. That being so, the study has theobject: the management of the patient nursing care with advanced breast cancer inpalliative chemotherapy in the outpatient setting. The objectives of the study were:understanding the view of nurses about the nursing care management to the patientwith advanced breast cancer in palliative chemotherapy; analyze the management ofthe nursing care to the patient with advanced breast cancer in palliativechemotherapy in the outpatient setting; and build an explanatory theoreticalframework of nursing care management that portrays this reality. Exploratoryqualitative study that was attended by eight nurses and ten patients in thechemotherapy clinic of the Cancer Hospital III, one of the units of the National CancerInstitute, Rio de Janeiro, Brazil. For data collection was used the technique of semistructuredinterview. The study was made possible through the use of themethodological framework of Grounded Theory (GT)...
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Feminino , Humanos , Neoplasias da Mama , Neoplasias da Mama/enfermagem , Enfermagem Oncológica , Cuidados Paliativos , Qualidade de Vida , Saúde da MulherRESUMO
OBJECTIVE: Bone metastasis is frequently associated with nasopharyngeal carcinoma. The diagnosis and follow-up of bone metastatic patients usually relies on skeletal X-ray and bone scintigraphy, which are time-consuming and costly. This study aimed to evaluate whether serum alkaline phosphatase offers clinical value in predicting the clinical response and survival outcome for skeletal metastatic nasopharyngeal carcinoma. METHODS: Serum alkaline phosphatase was measured at baseline and then before each cycle of treatment in 416 nasopharyngeal carcinoma patients with bone metastasis. The correlations between the pre-treatment and post-treatment alkaline phosphatase levels and the treatment efficacy were analyzed using the chi-square test. Survival was analyzed using the Kaplan–Meier method and then compared using the log-rank test. RESULTS: Patients with elevated pre-treatment alkaline phosphatase (>110 IU/L) had significantly worse progression-free survival (P<0.001) and overall survival (P<0.001) than those with a normal level of this marker (≤110 IU/L). Patients with elevated post-treatment alkaline phosphatase had worse progression-free survival (P<0.001) and overall survival (P<0.001) compared with those with a normal level. Patients with normal pre-treatment and post-treatment alkaline phosphatase showed the most favorable prognosis. The Cox multivariate analysis revealed that only the pre-treatment and post-treatment alkaline phosphatase levels were independent prognostic factors for progression-free survival (HR ϝ 1.656, P<0.001; HR ϝ 2.226, P<0.001) and for overall survival (HR ϝ 1.794, P<0.001; HR ϝ 2.657, P<0.001). CONCLUSIONS: Serum alkaline phosphatase appears to be a significant independent prognostic index in patients with skeletal metastatic nasopharyngeal carcinoma, which could reflect the short-term treatment response ...