Prognostic Tools in Patients with Advanced Cancer: A Systematic Review

Purpose: In 2005, the European Association for Palliative Care (EAPC) made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools. Methods: Medline, Embase Classic + and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer; >18 years; original studies; population n>100; published after 2003. Descriptive and quantitative statistical analyses were performed. Results: Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types and statistically assessed survival prediction. The (PPS) Palliative Performance Scale was the most studied (n=21,082), composed of 6 parameters (6 subjective), was externally validated and predicted survival. The Palliative Prognostic Score (PaP) composed of 6 parameters (4 subjective, 2 objective), the Palliative Prognostic Index (PPI) composed of 9 parameters (9 subjective), and the Glasgow Prognostic Score (GPS) composed of 2 parameters (2 objective), and were all externally validated in more than 2000 patients with advanced cancer and predicted survival. Conclusion: Various prognostic tools have been validated, but vary in their complexity, subjectivity and therefore clinical utility. The GPS would seem the most favourable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proven prognostic markers in a single cohort of patients with advanced cancer, are needed to determine the optimal prognostic tool

Prognosis in advanced lung cancer - a prospective study of examining key clinicopathological factors

AbstractObjectivesIn patients with advanced incurable lung cancer deciding as to the most appropriate treatment (e.g. chemotherapy or supportive care only) is challenging. In such patients the TNM classification system has reached its ceiling therefore other factors are used to assess prognosis and as such, guide treatment. Performance status (PS), weight loss and inflammatory biomarkers (Glasgow Prognostic Score (mGPS)) predict survival in advanced lung cancer however these have not been compared. This study compares key prognostic factors in advanced lung cancer.Materials and methodsPatients with newly diagnosed advanced lung cancer were recruited and demographics, weight loss, other prognostic factors (mGPS, PS) were collected. Kaplan–Meier and Cox regression methods were used to compare these prognostic factors.Results390 patients with advanced incurable lung cancer were recruited; 341 were male, median age was 66 years (IQR 59–73) and patients had stage IV non-small cell (n=288) (73.8%) or extensive stage small cell lung cancer (n=102) (26.2%). The median survival was 7.8 months. On multivariate analysis only performance status (HR 1.74 CI 1.50–2.02) and mGPS (HR 1.67, CI 1.40–2.00) predicted survival (p<0.001). Survival at 3 months ranged from 99% (ECOG 0–1) to 74% (ECOG 2) and using mGPS, from 99% (mGPS0) to 71% (mGPS2). In combination, survival ranged from 99% (mGPS 0, ECOG 0–1) to 33% (mGPS2, ECOG 3).ConclusionPerformance status and the mGPS are superior prognostic factors in advanced lung cancer. In combination, these improved survival prediction compared with either alone

"Dæ æ mange ungdomma som tållå klår oppdaleng ja, minj dæ æ mange som itj gjærre dæ au" - En sosiolingvistisk studie av samspillet mellom det tradisjonelle og det moderne i oppdalsmålet

Denne oppgaven er en sosiolingvistisk studie av oppdalsmålet. Med utgangspunkt i motsetningsparet tradisjon og det moderne har jeg sett på to familier som representerer ytterpunkter på det lingvistiske markedet i Oppdal. Målet med oppgaven var å finne ut hvor veien går for oppdalsmålet, og hvilke tendenser vi kan se illustrert, gjennom mine informanter, i oppdalsamfunnet. Med bakgrunn i mine analyser fant jeg to tendenser hos mine informanter. Den ene familien snakker en tradisjonell varietet og har generelt veldig positive og stolte holdninger til dialekten og hjemstedet. Medlemmene i denne familien er veldig bevisste på bruken av dialekt og det er viktig for dem å symbolisere tilhørighet gjennom språket. Den andre familien derimot har en høyere grad av modifisering i alle generasjonsledd. De har et mer ambivalent forhold til dialekten og hjembygda, og mener språk handler først og fremst om kommunikasjon. Disse to familiene representerer to ytterpunkt i det lingvistiske markedet i Oppdal, som lever side om side i en slags symbiose. Det blir interessant å se om en av disse tendensene overtar det lingvistiske markedet på ett eller annet tidspunkt i framtida

Chemotherapy use in end-of-life digestive cancer patients: a retrospective AGEO observational study

International audienceBACKGROUND: The use of chemotherapy (CT) near the end-of-life (EOL) is an important issue in oncology since it could degrade quality of life. CT near EOL is still poorly studied, with no dedicated study in gastrointestinal (GI) cancer patients. AIM: To analyze in GI cancer patients the factors associated with the use of CT within 3- and 1-month before patients’ death. METHODS AND PARTICIPANTS: All consecutive patients who died from a GI cancer in 10 French tertiary care hospitals during 2014 were included in this retrospective study. Clinical, demographical and biological data were collected and compared between patients receiving or not CT within 3- and 1-month before death. Variables associated with overall survival (OS) was also determined using of univariate and multivariate analyses with a Cox model. RESULTS: Four hundred and thirty-seven patients with a metastatic GI cancer were included in this study. Among them, 293 pts (67.0%) received CT within 3-months before death, and 121 pts (27.7%) received CT within 1-month before death. Patients receiving CT within 3-months before death were significantly younger (median age: 65.5 vs 72.8 years, p &lt; 0.0001), with a better PS (PS 0 or 1: 53.9 vs 29.3%, p &lt; 0.0001) and a higher albumin level (median: 32.8 vs 31.0 g/L, p = 0.048). Similar results were found for CT within 1 month before death. Palliative care team intervention was less frequent in patients who received CT in their last month of life (39.7% vs 51.3%, p = 0.02). In multivariate analysis, median OS from diagnosis was shorter in the group receiving CT within 1-month before death (HR = 0.59; 95% CI [0.48-0.74]). CONCLUSION: In GI-cancer patients, CT is administered within 3- and 1-month before death, in two and one third of patients, respectively. Patients receiving CT within 1-month before death, had more aggressive disease with poor OS. Palliative care team intervention was associated with less administration of CT in the last month of life. These results highlight the need to better anticipate the time to stop CT treatment in the end-of-life and the importance of an active collaboration between oncology and palliative care teams