“Laboratory cachexia”.

<p>“Laboratory cachexia”.</p

CRP values, 0-30d.

<p>CRP values within the 0-30d period for all patients with available measurements for both CRP and s-albumin within this period.</p

The prevalence of deranged C-reactive protein and albumin in patients with incurable cancer approaching death

<div><p>Introduction</p><p>Amongst patients with incurable cancer approaching death, cachexia is common and associated with adverse outcomes. The term cachexia lacks a universally accepted definition and there is no consensus regarding which variables are to be measured. Furthermore, an elevated C-reactive protein is a common clinical challenge in this patient group. This study aims to add to the ongoing discussion regarding the definition of cancer cachexia and to study the role of C-reactive protein and s-albumin in this context.</p><p>Material and methods</p><p>A 1-year cohort, consisting of 155 cancer patients enrolled in a specialized palliative home care team in the city of Östersund, Sweden, that were deceased during the year of 2015 was studied. Laboratory measures were studied within 0–30 and 31–60 days prior to death. C-reactive protein >10 mg/L and coinciding s-albumin <30 g/L was referred to as “laboratory cachexia”. Also, the number of days from the first found “laboratory cachexia” until death was noted.</p><p>Results</p><p>The prevalence of “laboratory cachexia” was 85% 0–30 days prior to death compared to 66% 31–60 days prior to death <i>(p<0</i>.<i>01)</i>. The majority of patients (75%) had an onset of “laboratory cachexia” within 0–120 days prior to death, with a median of 47 days. The median values for C-reactive protein and s-albumin within 0–30 days prior to death were 84mg/L and 23g/L respectively.</p><p>Discussion</p><p>Could markedly deranged values of C-reactive protein and s-albumin, such as found in this study, signal a relatively short remaining survival time in patients with incurable cancer and no clinical signs of ongoing infection? The role of “laboratory cachexia” in this context as well as the cut off values for the laboratory measures included may be further discussed.</p></div

S-albumin values, 0-30d.

<p>S-albumin values within the 0-30d period for all patients with available measurements for both CRP and s-albumin within this period.</p

Median laboratory values (ICR).

<p>Median laboratory values (ICR).</p

Flow of selection process.

<p>Flow of selection process.</p

Laboratory cachexia.

<p>Number of days prior to death that the criteria for “laboratory cachexia” was first fulfilled for the 120 patients who at some point fulfilled the criteria.</p

A study of patients not registered in the Swedish cancer register but reported to the Swedish register of palliative care 2009 as deceased due to cancer

<div><p></p><p><i>Background.</i> The Swedish Cancer Register (SCR), an old and reputable health data register, contributes a large amount of data used in research. The quality of the research using SCR data depends on the completeness and validity of the register. In Sweden, every healthcare provider is obligated to report newly detected cases of cancer to the SCR regardless of the diagnostic basis. This study aimed to clarify whether there is an under-reporting of patients with cancer to the SCR or an over-reporting of cancer as cause of death to the SRPC as all patients do not appear in both registers. In addition, this study looked at the distribution of under-reporting or over-reporting related to age, sex, type of cancer, diagnostic basis, and department responsible for cancer diagnosis. <i>Material and methods.</i> Of the 10 559 patients whose cause of death was cancer as reported to the SRPC (2009), 1394 patients (13.2%) were not registered in the SCR (1958–2009). Medical records from a representative sample of 203 patients were collected and reviewed. <i>Results.</i> The medical records for 193 patients were obtained; of those, 183 (95%) patients should have been reported to the SCR. Among these, radiologic investigation was the most common basis for diagnosis and there was a significant over-representation of cancer of the pancreas, lung, liver, and bile ducts. <i>Discussion</i>. This study cannot quantify the completeness of the SCR. The findings indicate that 12.5% of patients dying of cancer in palliative care are not reported, that specialized hospital departments diagnose the vast majority of the unreported patients, and that routines for how to report patients to the SCR based on radiological findings should be revised.</p></div

Gender, age, place of death and cause(s) of death for the included 100 patients, according to their medical records (some patients had multiple causes of death).

<p>Gender, age, place of death and cause(s) of death for the included 100 patients, according to their medical records (some patients had multiple causes of death).</p

Cohen’s kappa values and 95% confidence intervals for 24 ELQ items.

<p>* Items used to calculate quality indicators. ** Items used to calculate quality indicators under development.</p