Characteristics and outcome of patients with newly diagnosed advanced or metastatic lung cancer admitted to intensive care units (ICUs)

BACKGROUND: Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. METHODS: A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013. RESULTS: Out of the 100 patients, 30 had small cell lung cancer (SCLC) and 70 had non-small cell lung cancer. (Thirty patients had already been treated with oncologic treatments.) Mechanical ventilation (MV) was performed for 81 patients. Seventeen patients received emergency chemotherapy during their ICU stay. ICU, hospital, 3- and 6-month mortality were, respectively, 47, 60, 67 and 71%. Hospital mortality was 60% when invasive MV was used alone, 71% when MV and vasopressors were needed and 83% when MV, vasopressors and hemodialysis were required. In multivariate analysis, hospital mortality was associated with metastatic disease (OR 4.22 [1.4-12.4]; p = 0.008), need for invasive MV (OR 4.20 [1.11-16.2]; p = 0.030), while chemotherapy in ICU was associated with survival (OR 0.23, [0.07-0.81]; p = 0.020). CONCLUSION: This study shows that ICU management can be appropriate for selected newly diagnosed patients with advanced lung cancer, and chemotherapy might improve outcome for patients with SCLC admitted for cancer-related complications. Nevertheless, tumors' characteristics, numbers and types of organ dysfunction should be taken into account in the decisional process before admitting these patients in ICU.Peer reviewe

The Impact of the COVID-19 Pandemic on Care Delivery and Quality of Life in Lung Cancer Surgery

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) pandemic and associated restrictions have altered the delivery of surgical care. The purpose of this study was to explore the impact of COVID-19 on care delivery and quality of life (QOL) from the perspectives of lung cancer surgery patients, family caregivers (FCGs), and thoracic surgery teams. Methods Patients/FCGs enrolled in a randomized trial of a self-management intervention for lung cancer surgery preparation/recovery were invited to participate in this qualitative study. Patients/FCGs data were collected separately 1-month postdischarge. Interviews were also conducted with thoracic surgery team members. Content analysis approaches were used to develop themes. Results Forty-one respondents including 19 patients, 18 FCGs, three thoracic surgeons, and one nurse practitioner participated in the study. Patient themes included isolation, psychological distress, delayed/impacted care, and financial impact. FCGs themes included caregiving challenges, worry about COVID-19, financial hardship, isolation, and physical activity limitations. Surgical team themes included witnessing patient/FCG\u27s distress, challenges with telehealth, communication/educational challenges, and delays in treatment. Conclusions COVID-19 had a varied impact on care delivery and QOL for lung cancer surgery dyads. Some dyads reported minimal impact, while others experienced added psychological distress, isolation, and caregiving challenges. Surgical teams also experienced challenges in the approach used to provide care

Prognostic Impact of Paraneoplastic Cushing’s Syndrome in Small-Cell Lung Cancer

Introduction:Paraneoplastic Cushing’s syndrome (CushingPS) in small-cell lung cancer is rare but severe.Methods:We studied 383 patients with small-cell lung cancer diagnosed between 1998 and 2012. Among them, 23 patients had CushingPS, 56 had other paraneoplastic syndrome (OtherPS), and 304 had no paraneoplastic syndrome (NoPS).Results:After comparison of the three groups, we observed that CushingPS patients had more extensive disease: 82.6% versus 67.8% versus 53.3% (p = 0.005), respectively, with more than two metastatic sites: 63.2% versus 15.8% and 24.1% (p ⩽ 0.001), a higher World Health Organization performance status (2–4): 73.9% versus 57.1% versus 43.7% (p = 0.006), greater weight loss (≥10%): 47.8% versus 33.9% versus 16.4% (p ⩽ 0.001), reduced objective response to first-line treatment: 47.6% versus 74.1% versus 71.1% (p = 0.04), and poorer sensitivity to first-line treatment: 19% versus 38.9% versus 48.6% (p = 0.01). NoPS patients, with World Health Organization performance status of 3–4, had extensive disease at diagnosis, with response, sensitivity to first-line treatment, and survival similar to the CushingPS group. At relapse, the CushingPS group had no objective response to second-line treatment versus 25% versus 42.8% in OtherPS and NoPS groups, respectively (p = 0.005). The median survival of CushingPS patients was 6.6 months versus 9.2 months for OtherPS and 13.1 months for NoPS patients (p ⩽ 0.001). CushingPS is a prognostic factor of death (hazard ratio, 2.31; p ⩽ 0.001).Conclusion:CushingPS is the worst form of the paraneoplastic syndromes with particularly extensive tumors. Reduced objective response and sensitivity to first-line treatment and no response to second-line treatment suggest starting palliative care early at first line and exclusively at relapse

Prise en charge en physiothérapie d’une clientèle aînée atteinte d'un cancer du poumon

Dans le cadre du cours PHT-6113Introduction: Le cancer du poumon est une pathologie fréquente et mortelle qui affecte plus particulièrement les aînés. Cette population présente une diminution de la fonction et une réduction de la qualité de vie secondaire à la pathologie elle-même ou aux divers traitements médicaux (chirurgie, radiothérapie, chimiothérapie). La préservation de la qualité de vie est souvent l’objectif principal des traitements chez cette clientèle. Objectifs: Recenser les données probantes sur le cancer du poumon afin de guider une prise en charge optimale, adaptée aux aînés et pour les professionnels de la physiothérapie. Méthodologie: Les évidences les plus récentes ont été recensées. Résultats: Les outils standardisés d’évaluation avec les meilleures qualités métrologiques et les diverses modalités de traitements ont été recensés en lien avec les déficiences et limitations principales des aînés atteints de cancer du poumon. Les traitements en physiothérapie doivent comprendre un programme d’exercices d’aérobie en période pré et postopératoire. Puis, pour les patients recevant des traitements de radiothérapie et de chimiotherapie, les programmes d’exercices doivent combiner des exercices respiratoires, d’aérobie et de renforcement musculaire afin d’améliorer les capacités à l’effort et de réduire les symptômes associés. Finalement, les divers moyens utilisés en soins palliatifs ont été recueillis. Conclusion: Il n’y a pas de consensus sur la prise en charge des aînés avec le cancer du poumon. Cependant, le physiothérapeute doit s’impliquer dans l’évaluation globale et adaptée aux aînés, comprenant des outils spécifiques à cette clientèle. Quant au traitement en physiothérapie, il doit mettre l’emphase sur l’état cardio-respiratoire de la personne

Cancer Rehabilitation Publications (2008–2018) With a Focus on Physical Function: A Scoping Review

Background: Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. Purpose: This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. Data Sources: PubMed and CINAHL were searched up to September 2018. Study Selection: Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. Data Extraction: Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. Data Synthesis: Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). Limitations: Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. Conclusions: This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function

Annual Report (2014): Cancer Center Statistical Report

https://scholarlyworks.lvhn.org/reports/1026/thumbnail.jp

Guide for ferrets lymphoma

Ferrets popularity as pets is increasing in North America and Europe and appear more frequently in veterinary practice. Therefore, it is important to study this specie in order to provide advanced medical care. After insulinoma and adrenocortical neoplasia, lymphoma is the third more common neoplasia in domestic ferrets, and this condition appears to be increasing in frequency. Lymphoma can be described as a proliferation of neoplastic lymphoid cells, and can occur in ferrets of all ages and in practically all organ systems. Despite various theories, the exact etiology of lymphoma remains unknown. Although the increased incidence of lymphoma, there are still difficulties in obtaining an accurate diagnose of this neoplasia, lack of uniformity in its classification, and protocols to ensure an appropriate treatment. This article aims to present guide that gathers the information published about lymphoma in ferrets, and to provide an orientation on the diagnosis and treatment of ferrets with this neoplasia.Os furões são cada vez mais populares como animais de companhia na América do Norte e Europa, surgindo mais frequentemente na prática veterinária. Portanto, é cada vez mais importante conhecer esta espécie e estar apto a prestar cuidados médicos avançados. Depois do insulinoma e da neoplasia adrenocortical, o linfoma é a terceira neoplasia mais comum nos furões domésticos, estando a sua frequência a aumentar. O linfoma pode ser descrito como uma proliferação de células linfóides neoplásicas, e pode ocorrer em todas as faixas etárias e em praticamente todos os sistemas de órgãos. Apesar das várias teorias, a verdadeira etiologia do linfoma permanece desconhecida. Apesar da elevada incidência do linfoma, há ainda dificuldades em obter um diagnóstico preciso desta neoplasia, falta de uniformidade na sua classificação, e de protocolos que assegurem um tratamento apropriado. Este artigo tem como objectivo apresentar um guia que reúna a informação publicada acerca de linfoma em furões, e fornecer uma orientação no diagnóstico e tratamento de furões com esta neoplasia