End-of-life care pathway of head and neck cancer patients : single-institution experience

Studies on palliative care of head and neck cancer (HNC) patients are scarce although the affected patient population is quite large. To evaluate the role of a specialised palliative-care pathway of HNC patients. Data on all HNC patients who were treated at the Helsinki University Hospital Palliative Care Center during 1 year were retrospectively reviewed. The analysis comprised 60 patients (49 males; mean age 67 years; range 28-88). All patients had a minimum follow-up of 1 year or until death. Fifty-nine (98%) out of the 60 patients died during the follow-up period. Median survival after diagnosis was 11 months (range 3 weeks-11.9 years) and after withholding disease-specific therapies 3 months (range 0-16). Thirty-three (55%) patients received palliative radiotherapy, 27 (45%) had PEG tube and 17 (28%) tracheostomy. Thirty-seven (66%) patients visited an emergency department (ED) (median 1.3 visits; range 0-6) and 21 (35%) were hospitalised at the university hospital during the palliative period. The most common severe complications were infection (also the most common reason for ED visits and hospitalisation), bleeding (four massive airway bleedings with one death), delirium and airway obstruction (one emergency tracheostomy). Twelve (35%) out of the 34 patients who were referred to specialised home care died at home as compared with three (12%) out of the 26 patients not supported by a specialised home-care team. Severe complications leading to an emergency unit visit and hospitalisation are common among HNC patients in their relatively short palliative period reflecting the need for early-integrated palliative care. Collaboration with a specialised palliative home-care team seems to increase end-of-life care at home.Peer reviewe

A Nordic survey of the management of palliative care in patients with head and neck cancer

Background The five Nordic countries with a population of 27M people form a rather homogenous region in terms of health care. The management of Head and Neck Cancer (HNC) is centralized to the 21 university hospitals in these countries. Our aim was to survey the current status of organization of palliative care for patients with HNC in the Nordic countries as the field is rapidly developing. Materials and methods A structured web-based questionnaire was sent to all the Departments of Otorhinolaryngology-Head and Neck Surgery and Oncology managing HNC in the Nordic countries. Results All 21 (100%) Nordic university hospitals responded to the survey. A majority (over 90%) of the patients are discussed at diagnosis in a multidisciplinary tumor board (MDT), but the presence of a palliative care specialist is lacking in 95% of these MDT's. The patients have access to specialized palliative care units (n = 14, 67%), teams (n = 10, 48%), and consultants (n = 4, 19%) in the majority of the hospitals. Conclusion The present results show that specialized palliative care services are available at the Nordic university hospitals. A major finding was that the collaboration between head and neck surgeons, oncologists and palliative care specialists is not well structured and the palliative care pathway of patients with HNC is not systematically organized. We suggest that early integrated palliative care needs to be included as an addition to the already existing HNC care pathways in the Nordic countries.Peer reviewe

Non-curative treatment of patients with oral tongue squamous-cell carcinoma

PurposeLate-stage OTSCC is associated with poor overall survival (OS). Non-curative treatment approach aims to improve quality of life and prolong survival of patients deemed incurable. The purpose of this study was to investigate the used non-curative treatment modalities for OTSSC and patient survival.MethodsAll patients diagnosed with OTSCC and treated with non-curative intent at the HUS Helsinki University Hospital (Helsinki, Finland) during the 12-year period of 2005-2016 were included. Survival analysis after the non-curative treatment decision was conducted using the Kaplan-Meier method in this population-based study.ResultsEighty-two patients were identified. A non-curative treatment decision was made at presentation without any previous treatment in 26 patients (7% of all patients diagnosed with OTSCC during the study period). Palliative radiotherapy was administered to 24% of all patients. The average survival time after the non-curative treatment decision was 3.7months (median 2 and range 0-26).ConclusionsDue to the short mean survival time after decision for treatment with non-curative intent, and the notable symptom burden in this patient population, a prompt initiation of all non-curative measures is warranted.Peer reviewe

Incorporation of pollen data in source maps is vital for pollen dispersion models

Information about distribution of pollen sources, i.e. their presence and abundance in a specific region, is important especially when atmospheric transport models are applied to forecast pollen concentrations. The goal of this study is to evaluate three pollen source maps using an atmospheric transport model and study the effect on the model results by combining these source maps with pollen data. Here we evaluate three maps for the birch taxon: (1) a map derived by combining land cover data and forest inventory; (2) a map obtained from land cover data and calibrated using model simulations and pollen observations; (3) a statistical map resulting from analysis of forest inventory and forest plot data. The maps were introduced to the Enviro-HIRLAM (Environment – High Resolution Limited Area Model) as input data to simulate birch pollen concentrations over Europe for the birch pollen season 2006. 18 model runs were performed using each of the selected maps in turn with and without calibration with observed pollen data from 2006. The model results were compared with the pollen observation data at 12 measurement sites located in Finland, Denmark and Russia.We show that calibration of the maps using pollen observations significantly improved the model performance for all three maps. The findings also indicate the large sensitivity of the model results to the source maps and agree well with other studies on birch showing that pollen or hybrid-based source maps provide the best model performance. This study highlights the importance of including pollen data in the production of source maps for pollen dispersion modelling and for exposure studies

Biomonitoring of Indoor Air Fungal or Chemical Toxins with Caenorhabditis elegans nematodes

Bad indoor air quality due to toxins and other impurities can have a negative impact on human well-being, working capacity and health. Therefore, reliable methods to monitor the health risks associated with exposure to hazardous indoor air agents are needed. Here, we have used transgenic Caenorhabditis elegans nematode strains carrying stress-responsive fluorescent reporters and evaluated their ability to sense fungal or chemical toxins, especially those that are present in moisture-damaged buildings. Liquid-based or airborne exposure of nematodes to mycotoxins, chemical agents or damaged building materials reproducibly resulted in time- and dose-dependent fluorescent responses, which could be quantitated by either microscopy or spectrometry. Thus, the C. elegans nematodes present an easy, ethically acceptable and comprehensive in vivo model system to monitor the response of multicellular organisms to indoor air toxicity.Peer reviewe

Incorporation of pollen data in source maps is vital for pollen dispersion models

Information about distribution of pollen sources, i.e. their presence and abundance in a specific region, is important, especially when atmospheric transport models are applied to forecast pollen concentrations. The goal of this study is to evaluate three pollen source maps using an atmospheric transport model and study the effect on the model results by combining these source maps with pollen data. Here we evaluate three maps for the birch taxon: (1) a map derived by combining a land cover data and forest inventory, (2) a map obtained from land cover data and calibrated using model simulations and pollen observations, and (3) a statistical map resulting from analysis of forest inventory and forest plot data. The maps were introduced to the Enviro-HIRLAM (Environment – High Resolution Limited Area Model) as input data to simulate birch pollen concentrations over Europe for the birch pollen season 2006. A total of 18 model runs were performed using each of the selected maps in turn with and without calibration with observed pollen data from 2006. The model results were compared with the pollen observation data at 12 measurement sites located in Finland, Denmark, and Russia. We show that calibration of the maps using pollen observations significantly improved the model performance for all three maps. The findings also indicate the large sensitivity of the model results to the source maps and agree well with other studies on birch showing that pollen or hybrid-based source maps provide the best model performance. This study highlights the importance of including pollen data in the production of source maps for pollen dispersion modelling and for exposure studies.</p

Meta-analysis of clodronate and breast cancer survival

Clinical trials have reported conflicting results on whether oral clodronate therapy improves survival in breast cancer patients. This study was undertaken to evaluate further the effect of oral clodronate therapy on overall survival, bone metastasis-free survival and nonskeletal metastasis-free survival among breast cancer patients. An extensive literature search was undertaken for the period 1966 to July 2006 to identify clinical trials examining survival in breast cancer patients who received 2 or 3 years of oral clodronate therapy at 1600 mg day−1 compared with those without therapy. Meta-analyses were carried out separately for patients diagnosed with advanced breast cancer and early breast cancer. Our meta-analysis found no evidence of any statistically significant difference in overall survival, bone metastasis-free survival or nonskeletal metastasis-free survival in advanced breast cancer patients receiving clodronate therapy or early breast cancer patients receiving adjuvant clodronate treatment compared with those who did not receive any active treatment

Incorporation of pollen data in source maps is vital for pollen dispersion models (Discussion Paper)

Information about distribution of pollen sources, i.e. their presence and abundance in a specific region, is important especially when atmospheric transport models are applied to forecast pollen concentrations. The goal of this study is to evaluate three pollen source maps using an atmospheric transport model and study the effect on the model results by combining these source maps with pollen data. Here we evaluate three maps for the birch taxon: (1) a map derived by combining land cover data and forest inventory; (2) a map obtained from land cover data and calibrated using model simulations and pollen observations; (3) a statistical map resulting from analysis of forest inventory and forest plot data. The maps were introduced to the Enviro-HIRLAM (Environment – High Resolution Limited Area Model) as input data to simulate birch pollen concentrations over Europe for the birch pollen season 2006. 18 model runs were performed using each of the selected maps in turn with and without calibration with observed pollen data from 2006. The model results were compared with the pollen observation data at 12 measurement sites located in Finland, Denmark and Russia.We show that calibration of the maps using pollen observations significantly improved the model performance for all three maps. The findings also indicate the large sensitivity of the model results to the source maps and agree well with other studies on birch showing that pollen or hybrid-based source maps provide the best model performance. This study highlights the importance of including pollen data in the production of source maps for pollen dispersion modelling and for exposure studies