Febrile neutropenia and grade 3/4 neutropenia in daily practice of adjuvant chemotherapy for non-small-cell lung cancer

Dopolnilna kemoterapija (KT) na bazi platine je srednje močan dejavnik tveganja za pojav febrilne nevtropenije (10- do 20-odstotna incidenca) pri operabilnem raku pljuč. Namen raziskave je bil preveriti pojavnost febrilne nevtropenije (FN) in nevtropenije višje stopnje (N G 3/4) v vsakodnevni klinični praksi napram izsledkom v kliničnih raziskavah ter opredeliti skupine bolnikov, ki imajo višje tveganje za pojav FN in N G 3/4. Metoda: V našo prospektivno, observacijsko raziskavo je bilo vključenih 150 bolnikov s postavljeno diagnozo operabilnega nedrobnoceličnega raka pljuč v obdobju od januarja 2010 do maja 2016 na Kliniki Golnik. Podatke o bolnikih in o zdravljenju smo povzeli iz bolnišničnega registra raka pljuč. Bolniki so bili zdravljeni z dopolnilno KT na bazi platine po radikalni kirurški odstranitvi primarnega pljučnega tumorja. V povprečju so bolniki prejeli 3,7 od predvidenih štirih ciklusov KT. Krvna slika je bila analizirana 1. in 8. dan vsakega cikla KT ter, če je bilo indicirano, kadarkoli v času prejemanja KT. Po presoji zdravnika so bolniki prejeli primarno profilakso z rastnimi dejavniki za nevtrofilne granulocite (pG-CSF). Za analizo dejavnikov tveganja za pojav FN in N G 3/4 smo uporabili logistično regresijo. Rezultati: Febrilno nevtropenijo je utrpelo 4 % (N = 6) bolnikov in N G 3/4 29 % (N = 43) bolnikov, nobeden od njih ni prejel pG-CSF. Od devetih opazovanih dejavnikov tveganja (starost, spol, histološki tip, stadij, stanje zmogljivosti, prisotnost pridruženih obolenj, tip operacije, vrsta KT in obdobje zdravljenja) se je v regresijskem modelu le obdobje zdravljenja izkazalo za statistično pomemben napovednik pojava FN in N G 3/4. Opazili pa smo tudi trend k višji pojavnosti FN pri bolnikih po pulmektomiji, s slabšim stanjem zmogljivosti in pri prejemanju karboplatina v citostatski shemi. Zaključek: V klinični praksi je pojavnost FN in N G 3/4 ob dopolnilni KT operabilnega nedrobnoceličnega raka pljuč primerljiva pojavnosti v kliničnih raziskavah. Bolniki po pulmektomiji, bolniki s slabšim stanjem zmogljivosti in ob prejemanju karboplatina imajo verjetno večjo korist od pG-CSF. Upad pojavnosti FN in N G 3/4 v drugem opazovanem časovnem obdobju (leta 2013-2016) verjetno odraža ustreznejšo uporabo pG-CSF na naši kliniki v tem obdobju.Based on clinical trial data, platinum-based adjuvant chemotherapy (Cht) is an intermediate risk factor for febrile neutropenia in patients with operable non-small-cell lung cancer (NSCLC). This study aims to assess the incidence of febrile neutropenia (FN) and high-grade neutropenia (G 3/4 N) in a group of patients treated in everyday clinical practice, and to determine the groups of patients that are at high risk of developing FN and G 3/4 N. Methods: This observational cohort study included 150 consecutive patient treatments with adjuvant Cht at the University Clinic Golnik, from January 2010 to May 2016. Complete blood counts ware taken on day 1 and day 8 of each cycle, and during each cycle of Cht if clinically indicated. Primary prophylaxis with G-CSF was used based on physician%s decision. The patients and treatment characteristics were collected from the hospital registry data. The average number of Cht cycles was 3.7 (range 1-4). To assess the risk factors, a logistic regression analysis was conducted. Results: Only 6/150 (4%) patients developed FN and 43/150 (29%) patients developed G 3/4 N. None of these patients received primary prophylaxis with G-CSF. Out of the nine risk factors assessed (age, gender, histologic type, stage, performance status, presence of comorbidities, type of surgery, Cht regimen, and year of treatment) only the year of treatment (before/after 2013) appeared to be a significant predictor of FN plus G 3/4 N incidence in the regression model. However, inspecting the frequency table indicates a tendency for higher incidence of FN in the subgroups of patients with pneumonectomy, higher PS, and in those receiving carboplatin. Conclusion: The incidence of FN and G 3/4 N during platinum- -based adjuvant Cht for NSCLC in our daily practice is comparable to the incidence reported in clinical studies. According to our observation, it seems that patients with pneumonectomy, higher performance status, and those receiving carboplatin are those who would benefit most from primary prophylaxis with G-CSF. The decline of FN and G 3/4 N incidence in the second treatment period (after the year 2013) is probably reflecting a more adequate usage of primary prophylaxis with G-CSF at our clinic

Febrilna nevtropenija in nevtropenija višje stopnje ob adjuvantnem zdravljenju nedrobnoceličnega raka pljuč v vsakodnevni praksi

Based on clinical trial data, platinum-based adjuvant chemotherapy (Cht) is an intermediate risk factor for febrile neutropenia in patients with operable non-small-cell lung cancer (NSCLC). This study aims to assess the incidence of febrile neutropenia (FN) and high-grade neutropenia (G 3/4 N) in a group of patients treated in everyday clinical practice, and to determine the groups of patients that are at high risk of developing FN and G 3/4 N. Methods: This observational cohort study included 150 consecutive patient treatments with adjuvant Cht at the University Clinic Golnik, from January 2010 to May 2016. Complete blood counts ware taken on day 1 and day 8 of each cycle, and during each cycle of Cht if clinically indicated. Primary prophylaxis with G-CSF was used based on physician%s decision. The patients and treatment characteristics were collected from the hospital registry data. The average number of Cht cycles was 3.7 (range 1-4). To assess the risk factors, a logistic regression analysis was conducted. Results: Only 6/150 (4%) patients developed FN and 43/150 (29%) patients developed G 3/4 N. None of these patients received primary prophylaxis with G-CSF. Out of the nine risk factors assessed (age, gender, histologic type, stage, performance status, presence of comorbidities, type of surgery, Cht regimen, and year of treatment) only the year of treatment (before/after 2013) appeared to be a significant predictor of FN plus G 3/4 N incidence in the regression model. However, inspecting the frequency table indicates a tendency for higher incidence of FN in the subgroups of patients with pneumonectomy, higher PS, and in those receiving carboplatin. Conclusion: The incidence of FN and G 3/4 N during platinum- -based adjuvant Cht for NSCLC in our daily practice is comparable to the incidence reported in clinical studies. According to our observation, it seems that patients with pneumonectomy, higher performance status, and those receiving carboplatin are those who would benefit most from primary prophylaxis with G-CSF. The decline of FN and G 3/4 N incidence in the second treatment period (after the year 2013) is probably reflecting a more adequate usage of primary prophylaxis with G-CSF at our clinic.Dopolnilna kemoterapija (KT) na bazi platine je srednje močan dejavnik tveganja za pojav febrilne nevtropenije (10- do 20-odstotna incidenca) pri operabilnem raku pljuč. Namen raziskave je bil preveriti pojavnost febrilne nevtropenije (FN) in nevtropenije višje stopnje (N G 3/4) v vsakodnevni klinični praksi napram izsledkom v kliničnih raziskavah ter opredeliti skupine bolnikov, ki imajo višje tveganje za pojav FN in N G 3/4. Metoda: V našo prospektivno, observacijsko raziskavo je bilo vključenih 150 bolnikov s postavljeno diagnozo operabilnega nedrobnoceličnega raka pljuč v obdobju od januarja 2010 do maja 2016 na Kliniki Golnik. Podatke o bolnikih in o zdravljenju smo povzeli iz bolnišničnega registra raka pljuč. Bolniki so bili zdravljeni z dopolnilno KT na bazi platine po radikalni kirurški odstranitvi primarnega pljučnega tumorja. V povprečju so bolniki prejeli 3,7 od predvidenih štirih ciklusov KT. Krvna slika je bila analizirana 1. in 8. dan vsakega cikla KT ter, če je bilo indicirano, kadarkoli v času prejemanja KT. Po presoji zdravnika so bolniki prejeli primarno profilakso z rastnimi dejavniki za nevtrofilne granulocite (pG-CSF). Za analizo dejavnikov tveganja za pojav FN in N G 3/4 smo uporabili logistično regresijo. Rezultati: Febrilno nevtropenijo je utrpelo 4 % (N = 6) bolnikov in N G 3/4 29 % (N = 43) bolnikov, nobeden od njih ni prejel pG-CSF. Od devetih opazovanih dejavnikov tveganja (starost, spol, histološki tip, stadij, stanje zmogljivosti, prisotnost pridruženih obolenj, tip operacije, vrsta KT in obdobje zdravljenja) se je v regresijskem modelu le obdobje zdravljenja izkazalo za statistično pomemben napovednik pojava FN in N G 3/4. Opazili pa smo tudi trend k višji pojavnosti FN pri bolnikih po pulmektomiji, s slabšim stanjem zmogljivosti in pri prejemanju karboplatina v citostatski shemi. Zaključek: V klinični praksi je pojavnost FN in N G 3/4 ob dopolnilni KT operabilnega nedrobnoceličnega raka pljuč primerljiva pojavnosti v kliničnih raziskavah. Bolniki po pulmektomiji, bolniki s slabšim stanjem zmogljivosti in ob prejemanju karboplatina imajo verjetno večjo korist od pG-CSF. Upad pojavnosti FN in N G 3/4 v drugem opazovanem časovnem obdobju (leta 2013-2016) verjetno odraža ustreznejšo uporabo pG-CSF na naši kliniki v tem obdobju

Mobile palliative care team of Oncology Institute of Ljubljana

Izhodišče: Del celostne obravnave bolnika z napredovalim rakom je tudi paliativna oskrba, ki bolniku in njegovim bližnjim omogoča kakovostno življenje. Paliativna oskrba se izvaja na dveh ravneh: osnovni in specializirani. Na Onkološkem inštitutu Ljubljana v okviru specializirane paliativne oskrbe izvajamo več dejavnosti: bolnišnično obravnavo bolnikov z najkompleksnejšimi težavami, ambulantno obravnavo za zgodnjo paliativno oskrbo, konziliarno (svetovalno) dejavnost in za bolnike doma telefonsko podporo ter obiske na domu. Mobilna paliativna enota je najnovejša dejavnost, ki se izvaja od septembra 2021. Metode: Analizirali smo podatke vseh bolnikov, vključenih v specializirano paliativno oskrbo med septembrom 2021, od pričetka delovanja mobilne paliativne enote, in koncem avgusta 2022. Opazovali smo starost, spol, kraj stalnega prebivališča, diagnozo ter kraj smrti in primerjali skupino bolnikov, ki so bili obravnavani v okviru specializirane paliativne oskrbe s podporo obiskov na domu, in skupino brez nje. Rezultati: Med opazovanim obdobjem je bilo v vse dejavnosti specializirane paliativne oskrbe Onkološkega inštituta vključenih 1086 bolnikov, od tega smo pri 347 bolnikih (32 % vseh) opravili 574 obiskov na domu (povprečno 1,7 obiska na bolnika (razpon 1–8)). 317 (91 %) bolnikov je imelo svoje stalno prebivališče v osrednjeslovenski regiji, 9 % obiskov je bilo izvedenih izven meja osrednjeslovenske regije. Primerjava skupin bolnikov, napotenih v specializirano paliativno oskrbo z vključitvijo mobilne paliativne enote ali brez nje, jasno kaže večji delež umrlih v domačem okolju, kadar podporo izvajamo tudi z obiski na domu (80 % v primerjavi z 62 %). Zaključek: Mobilna paliativna enota predstavlja pomemben element mreže paliativne oskrbe in zagotavlja pogostejše umiranje v domačem okolju.Backgound: Palliative care is a part of the holistic treatment of a patient with advanced cancer, which enables the patient and his or her relatives to live a quality life. In Slovenia, palliative care is provided at two levels: basic and specialized palliative care. As a specialized palliative care hospital, the Institute of Oncology Ljubljana provides care for patients with the most complex problems, an outpatient clinic for early palliative care, and a counselling service, as well as telephone support and home visits for patients at home. The mobile palliative care unit, which was implemented in September 2021, is the latest activity. Methods: We analyzed the data of all patients involved in specialized palliative care throughout the year, from the beginning of the operation of the mobile palliative unit until the end of August 2022. We observed age, gender, place of permanent residence, diagnosis, and place of death, and compared groups of patients who were monitored in the context of specialized palliative care with or without the support of the mobile palliative team. Results: Between September 2021 and August 2022 1,086 patients were included in all specialized palliative care activities at the Institute of Oncology Ljubljana, of which 347 patients (32%) received a total of 574 home visits (an average of 1.7 visits per patient (range 1-8)). 317 (91%) patients had their permanent residence in the Central Slovenia region, while 9% were visited outside the borders. A comparison of groups of patients referred to specialized palliative care with or without the activation of a mobile palliative unit clearly shows a higher proportion of those who died at home when support was provided by home visits (80% vs 62%) of the mobile palliative team. Conclusion: The mobile palliative care unit represents an important element of the palliative care network and ensures more frequent dying in the home environment

Priporočila za obravnavo bolnikov s pljučnim rakom

No abstract.Ni abstrakta

Priporočila za obravnavo bolnikov s pljučnim rakom

In 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered.Leta 2019 so bila objavljena Priporočila za obravnavo bolnikov s pljučnim rakom, ki so v slovenski prostor vnesla prepotrebno poenotenje diagnostike in zdravljenja z namenom izboljšanja preživetja bolnikov s pljučnim rakom. Posodobitev Priporočil tri leta po izidu izvirnika prinaša največ novosti v poglavju o sistemskem zdravljenju bolnikov s pljučnim rakom. To kaže na izjemen napredek na področju razumevanja onkogeneze in biologije pljučnega raka ter s tem razvoja novih zdravil. Breme pljučnega raka ostaja veliko, saj je pljučni rak pri nas in v svetu še vedno najpogostejši vzrok smrti zaradi raka. Za vsako peto smrt zaradi raka je odgovoren pljučni rak. Skoraj tretjina bolnikov s pljučnim rakom ne prejme specifičnega onkološkega zdravljenja, bodisi zaradi slabega stanja zmogljivosti, spremljajočih bolezni ali obsega bolezni. Polovica bolnikov ima ob diagnozi razsejano bolezen, zaradi česar izboljšanje preživetja z malimi koraki sledi napredku v zdravljenju bolnikov s pljučnim rakom. Ti podatki nas opominjajo, da se bomo morali za velike premike v obravnavi bolnikov s pljučnim rakom lotiti drugačnih pristopov. Kot najbolj obetavno se ponuja zgodnje odkrivanje bolezni, ko so možnosti ozdravitve pljučnega raka najboljše. Zapisana Priporočila so usmeritev za obravnavo bolnikov s pljučnim rakom. Le s sodobnim multidisciplinarnim pristopom obravnave lahko bolniku ponudimo zdravljenje, ki mu omogoča najboljši izhod prognostično neugodne bolezni