Characteristics of Breakthrough Pain and Its Impact on Quality of Life in Terminally Ill Cancer Patients

Purpose. This study aimed to characterize breakthrough pain (BTP) and investigate its impact on quality-of-life (QoL) in terminally-ill cancer patients. Similarities and differences between high and low predictable BTP were also tested. Methods. Secondary analysis of a multicenter longitudinal observational study included 92 patients at their end-of-life. BTP was assessed with a short form of the Italian version of the Alberta Breakthrough Pain Assessment Tool. QoL was assessed with the Palliative Outcome Scale (0-40). Patients were stratified by self-reported BTP predictability into unpredictable BTP (never or rarely able to predict BTP) and predictable BTP (sometimes to always able to predict BTP). Results. In all, 665 BTP episodes were recorded (median 0.86 episodes/day). A median duration of 30 minutes and a median peak intensity score of 7 out of 10 were reported. Time to peak was <10 minutes, 10 to 30 minutes, and 6530 minutes in 267 (41.1%), 259 (39.9%), and 30 (4.6%) of the episodes, respectively. Onset of relief occurred after a median of 30 minutes. Time to peak (P <.001) and duration (P =.046) of BTP was shorter in patients with predictable pain (n = 31), who usually were younger than those with unpredictable pain (P =.03). The mean (SD) QoL score was 14.6 (4.6). No difference in QoL between patients with predictable and unpredictable BTP was found (P =.49). Conclusions. In terminally-ill cancer patients, BTP is a severe problem with a negative impact on QoL and has different characteristics according to its predictability

Incidence and prevalence analysis of non-small-cell and small-cell lung cancer using administrative data

Treatment of lung cancer depends on the stage of the tumor and the histological type. In recent years, the histological confirmation of lung non-small-cell lung cancer has become crucial since the availability of selective target therapeutic approaches. The aim of the study was to develop a validated procedure to estimate the incidence and prevalence of non-small-cell and small-cell lung cancer from healthcare administrative data. A latent class model for categorical variables was applied. The following observed variables were included in the analysis: ICD-9-CM codes in the Hospital Discharge Registry, ATC codes of medications dispensed present in the Drugs Prescriptions Registry, and the procedure codes in the Outpatient Registry. The proportion of non-small-cell lung cancer diagnoses was estimated to be 85% of the total number of lung cancer on the cohort of incident cases and 89% on the cohort of prevalent cases. External validation on a cohort of 107 patients with a lung cancer diagnosis and histological confirmation showed a sensitivity of 95.6% (95%CI: 89–98.8%) and specificity of 94.1% (95%CI: 71.3–99.9%). The procedure is an easy-to-use tool to design subpopulation-based studies on lung cancer and to better plan resource allocation, which is important since the introduction of new targeted therapies in non-small-cell lung carcinoma

Gastric adenocarcinoma cutaneous metastasis arising at a previous surgical drain site: a case report

<p>Abstract</p> <p>Introduction</p> <p>Skin metastasis from internal carcinoma rarely occurs. It has an incidence of 0.7 to 9% and it may be the first sign of an unknown malignancy. However, it can also occur during follow-up.</p> <p>Case presentation</p> <p>A 90-year-old female patient was admitted to our surgical division with a diagnosis of anemia from a bleeding gastric adenocarcinoma. She underwent a gastric resection and Billroth II retrocolic Hofmeister/Finsterer reconstruction. She developed an enteric fistula, which needed a permanent abdominal drain until the 60^thpostoperative day. After 12 months she was readmitted to our division with subacute small bowel obstruction and an erythematous swelling on the right side of the abdomen. Biopsies characterized it as a cutaneous metastasis from the gastric adenocarcinoma. No surgical therapy was performed given her poor clinical condition.</p> <p>Conclusion</p> <p>Skin metastasis from carcinomas of the upper gastrointestinal tract is very rare. Persisting erythematous nodules must be biopsied in order to diagnose cutaneous metastases and to recognize them early and start prompt therapy with anti-tumour agents before the occurrence of massive visceral metastases.</p