Physicians’ views on palliative care and assessment of symptoms of non-small cell lung cancer patients

This study examined physicians’ views on palliative care and assisted dying and assessed non-small cell lung cancer (NSCLC) patients’ symptoms and quality of life (QOL) during chemotherapy. Finnish physicians expressed uncertainty about the management of end-of-life (EOL) situations and advanced cancer symptoms. Additional training needs were recognized. At the time the survey was carried out, 10% of oncologists and 19% of other physicians supported the legalization of euthanasia. Most physicians believed that proper palliative care might reduce requests for euthanasia. A six-month symptom survey was conducted among NSCLC patients receiving chemotherapy. The patients had several comorbidities, most frequently cardiovascular diseases and lung diseases. The most severe symptoms were pain, cough, dyspnea, fatigue and insomnia. The lowest scores for functional scales were at the baseline for physical and role functioning. The patients' global QOL was relatively low at the baseline. Women had a better QOL and suffered less from pain than men during the study. Pain intensity increased during the study, especially in men, and physical functioning deteriorated. A high level of pain and low social and role functioning predicted poorer survival. The Edmonton Symptom Assessment Scale (ESAS) was found to be a reliable tool to accomplish frequent symptom assessment for real time use. In conclusion, symptom assessment and control and quality-of-life issues are an important focus in the treatment of advanced lung cancer. The quality of care could be improved with better training of health care professionals, and symptom assessment could improve the awareness and recognition of the symptoms.Lääkäreiden näkemyksiä palliatiivisesta hoidosta ja oireiden arviointi ei-pienisoluista keuhkosyöpää sairastavilla potilailla Tämä tutkimus kartoitti lääkäreiden näkemyksiä palliatiivisesta hoidosta ja eutanasiasta sekä ei-pienisoluista keuhkosyöpää sairastavien potilaiden oireita ja elämänlaatua solunsalpaajahoidon aikana. Suomalaiset lääkärit kokivat epävarmuutta syöpään liittyvien oireiden hoidossa ja elämän loppuvaiheen kysymysten käsittelemisessä. Oirehoidon toteuttamiseen toivottiin lisäkoulutusta. Eutanasian laillistamista kannatti 10% syöpätautien erikoislääkäreistä ja 19% muista tutkimuskyselyyn vastanneista lääkäreistä. Suurin osa lääkäreistä arvioi asianmukaisen palliatiivisen hoidon vähentävän mahdollisia eutanasiapyyntöjä. Ei-pienisoluista keuhkosyöpää sairastavien potilaiden oireita kartoitettiin kuuden kuukauden tutkimusjaksolla solunsalpaajahoidon aikana. Osalla potilaista oli myös muita sairauksia, joista yleisimpiä olivat sydän- ja verenkierto- sekä keuhkosairaudet. Kipu, yskä, hengenahdistus, väsymys ja unettomuus olivat potilaiden merkittävimmät oireet. Fyysinen ja roolillinen toiminnallisuus olivat toiminnallisuuden osa-alueista matalimmalla tasolla tutkimuksen alussa. Potilaiden kokonaiselämänlaatu oli myös heikentynyt tutkimuksen alkuvaiheessa. Naisilla elämänlaatu oli tutkimusjakson aikana parempi ja kipua oli vähemmän kuin miehillä. Kivun voimakkuus lisääntyi tutkimusjakson aikana, erityisesti miehillä, ja fyysinen toimintakyky laski. Huono roolillinen ja sosiaalinen toiminnallisuus ja voimakkaampi kipu olivat yhteydessä lyhentyneeseen elinaikaan. Edmonton Symptom Assessment Scale (ESAS) -kyselyn todettiin mittaavan luotettavasti oireita ja soveltuvan kliiniseen käyttöön. Keuhkosyövän hoitoa tulisi arvioida elinaikahyödyn lisäksi oireiden lievittymisen ja elämänlaadun näkökulmasta. Hoidon laatua voitaisiin parantaa lääkäreiden koulutuksen lisäämisellä ja säännöllisen oirekartoituksen avulla

Treatment Patterns and Outcomes in a Cohort of Finnish NSCLC Patients with ALK Rearrangement Reflect Rapid Evolution in Treatment Practices

Background: In Finland approximately 2,500 people are diagnosed with lung cancer annually. A small proportion of non-small cell lung cancer (NSCLC) patients (3–7%) have tumorigenic rearrangement of the anaplastic lymphoma kinase (ALK) gene (ALK-positive). ALK tyrosine kinase inhibitors (TKI) are the standard of care for these patients, showing superior efficacy compared to traditional chemotherapy (CT). Due to the rapid development of novel next-generation ALK TKIs, treatment practices have undergone substantial changes. In Finnish real-life clinical practice the choice of treatment is largely determined by the reimbursement status of available drugs. We set out to assess the prevailing treatment practices and outcomes for NSCLC patients harbouring ALK rearrangement. Materials and methods: This was a retrospective, non-interventional, two-centre study. Adult NSCLC patients from the Hospital District of Southwest Finland and ALK-positive NSCLC patients from the Hospital District of Helsinki and Uusimaa diagnosed between 2013–2017 were included. Patients were followed until death or until the end of study period (May 2018). Data were extracted retrospectively from electronic health records from University Hospital data lakes. Results: A total of 1,260 patients were included, of which 60 were ALK-positive. ALK TKI regimens were mainly received in second and later lines of treatment. Median time-to-next treatment (TTNT) during ALK TKI treatment was 11.0 months (95% CI; 5.0–35.0) and during CT treatment 7.0 months (5.0–11.0) when assessed irrespective of treatment line (p=0.08). Patients who received at least one ALK TKI treatment regimen during the follow-up had median overall survival (OS) of 33.6 months (16.9–NR) from diagnosis vs. 11.5 months (4.6–NR) in patients who were treated with CT regimens only (p=0.054). Conclusions: ALK-positive patients benefit from treatment with ALK targeting agents in real-world clinical practice. </p

Persistent human bocavirus 1 infection and tonsillar immune responses

Background Persistent human bocavirus 1 (HBoV1) infection is a common finding in patients suffering from chronic tonsillar disease. However, the associations between HBoV1 infection and specific immune reactions are not completely known. We aimed to compare in vivo expression of T-cell cytokines, transcription factors, and type I/III interferons in human tonsils between HBoV1-positive and -negative tonsillectomy patients. Methods Tonsil tissue samples, nasopharyngeal aspirate (NPA), and serum samples were obtained from 143 immunocompetent adult and child tonsillectomy patients. HBoV1 and 14 other respiratory viruses were detected in NPAs and tonsil tissues by polymerase chain reaction (PCR). Serology and semi-quantitative PCR were used for diagnosing HBoV1 infections. Expression of 14 cytokines and transcription factors (IFN-alpha, IFN-beta, IFN-gamma, IL-10, IL-13, IL-17, IL-28, IL-29, IL-37, TGF-beta, FOXP3, GATA3, RORC2, Tbet) was analyzed by quantitative reverse-transcription (RT)-PCR in tonsil tissues. Results HBoV1 was detected by PCR in NPA and tonsils from 25 (17%) study patients. Serology results indicated prior nonacute infections in 81% of cases. Tonsillar cytokine responses were affected by HBoV1 infection. The suppression of two transcription factors, RORC2 and FOXP3, was associated with HBoV1 infection (p Conclusions Our study shows distinctively decreased T-helper(17) and T-regulatory type immune responses in local lymphoid tissue in HBoV1-positive tonsillectomy patients. HBoV1 may act as a suppressive immune modulator.</p

Reasons for Treatment Discontinuation and Their Effect on Outcomes of Immunotherapy in Southwest Finland: A Retrospective, Real-World Cohort Study

Immune checkpoint inhibitors (ICI) have improved survival in several cancer types. Still, most patients develop disease progression during or after treatment. We evaluated the reasons for treatment discontinuation and their effect on treatment outcomes in adult patients with advanced cancer with ICI in the first or later treatment lines in Southwest Finland between 1 January 2015 and 31 December 2021. Baseline characteristics and treatment outcomes were retrospectively obtained from the electronic medical records. There were 317 patients with 15 different cancer types, most commonly non-small cell lung cancer, melanoma, and kidney cancer, treated with ICI outside clinical trials. During follow-up, 94% of the patients had discontinued treatment. A total of 62% was due to disease progression, 17% due to immune-related adverse events (irAEs), 12% after achieving disease control or radiological response, and 9% due to poor performance status. The median progression-free survival (mPFS) was 5.4 months and the median overall survival (mOS) was 20.3 months in the whole cohort. Longer mPFS and mOS were observed in patients who discontinued ICI due to irAEs (24.3 and 49.2 months) and after disease control (49.7 months and not reached). In total, 46% of the patients who discontinued ICI after irAEs or disease control remained alive and progression-free during follow-up

Persistent human bocavirus 1 infection and tonsillar immune responses

Background Persistent human bocavirus 1 (HBoV1) infection is a common finding in patients suffering from chronic tonsillar disease. However, the associations between HBoV1 infection and specific immune reactions are not completely known. We aimed to compare in vivo expression of T-cell cytokines, transcription factors, and type I/III interferons in human tonsils between HBoV1-positive and -negative tonsillectomy patients. Methods Tonsil tissue samples, nasopharyngeal aspirate (NPA), and serum samples were obtained from 143 immunocompetent adult and child tonsillectomy patients. HBoV1 and 14 other respiratory viruses were detected in NPAs and tonsil tissues by polymerase chain reaction (PCR). Serology and semi-quantitative PCR were used for diagnosing HBoV1 infections. Expression of 14 cytokines and transcription factors (IFN-alpha, IFN-beta, IFN-gamma, IL-10, IL-13, IL-17, IL-28, IL-29, IL-37, TGF-beta, FOXP3, GATA3, RORC2, Tbet) was analyzed by quantitative reverse-transcription (RT)-PCR in tonsil tissues. Results HBoV1 was detected by PCR in NPA and tonsils from 25 (17%) study patients. Serology results indicated prior nonacute infections in 81% of cases. Tonsillar cytokine responses were affected by HBoV1 infection. The suppression of two transcription factors, RORC2 and FOXP3, was associated with HBoV1 infection (p < 0.05). Furthermore, intratonsillar HBoV1-DNA loads correlated negatively with IFN-lambda family cytokines and IL-13. Conclusions Our study shows distinctively decreased T-helper(17) and T-regulatory type immune responses in local lymphoid tissue in HBoV1-positive tonsillectomy patients. HBoV1 may act as a suppressive immune modulator.Peer reviewe

Antibiotic Treatment is an Independent Poor Risk Factor in NSCLC But Not in Melanoma Patients Who had Received Anti-PD-1/L1 Monotherapy

Peer reviewe

Trends in cost of treatment of lung cancer patients in 2014–2019 in Finland – a descriptive register study

The aim of this descriptive study is to analyze the cost for the treatment of NSCLC and SCLC patients (2014–2019) in Finland. The primary objective is to understand recent (2014–2019) cost developments. The study is retrospective and based on hospital register data. The study population consists of NSCLC and SCLC patients diagnosed in four out of the five Finnish university hospitals. The final sample included 4047 NSCLC patients and 766 SCLC patients. Cost of the treatment in lung cancer is increasing. Both the average cost of the first 12 months as well as the first 24 months after diagnosis increases over time. For patients diagnosed in 2014, the average cost of the first 24 months was 19,000 €and for those diagnosed in 2015 22,000 €. The annual increase in the nominal 24-month costs was 10.4% for NSCLC and 7.3% for SCLC patients. The average cost per patient has increased annually for both NSCLC and SCLC. Possible explanations to the cost increase are increased medicine costs (especially in NSCLC), and the increased percentage of patients being actively treated.</p