On the predictability of postoperative complications for cancer patients: a Portuguese cohort study

Funding Information: This work was supported by the FCT, through IDMEC, under LAETA project (UIDB/50022/2020), IPOscore project with reference DSAIPA/DS/0042/2018, and Data2Help (DSAIPA/DS/0044/2018). This work was further supported by the Associate Laboratory for Green Chemistry – LAQV which is financed by national funds from FCT/MCTES (UIDB/50006/2020, UIDP/50006/2020), INESC-ID pluriannual (UIDB/50021/2020), and the contract CEECIND/01399/2017. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.Postoperative complications are still hard to predict despite the efforts towards the creation of clinical risk scores. The published scores contribute for the creation of specialized tools, but with limited predictive performance and reusability for implementation in the oncological context. This work aims to predict postoperative complications risk for cancer patients, offering two major contributions. First, to develop and evaluate a machine learning-based risk score, specific for the Portuguese population using a retrospective cohort of 847 cancer patients undergoing surgery between 2016 and 2018, for 4 outcomes of interest: (1) existence of postoperative complications, (2) severity level of complications, (3) number of days in the Intermediate Care Unit (ICU), and (4) postoperative mortality within 1 year. An additional cohort of 137 cancer patients from the same center was used for validation. Second, to improve the interpretability of the predictive models. In order to achieve these objectives, we propose an approach for the learning of risk predictors, offering new perspectives and insights into the clinical decision process. For postoperative complications the Receiver Operating Characteristic Curve (AUC) was 0.69, for complications’ severity AUC was 0.65, for the days in the ICU the mean absolute error was 1.07 days, and for 1-year postoperative mortality the AUC was 0.74, calculated on the development cohort. In this study, predictive models which could help to guide physicians at organizational and clinical decision making were developed. Additionally, a web-based decision support tool is further provided to this end.publishersversionpublishe

EXPERIÊNCIA RELATADA PELOS DOENTES COM CANCRO COLORRETAL SOBRE OS CUIDADOS RECEBIDOS AO LONGO DO TEMPO. COMO TRADUZI-LOS NUM PROGRAMA DE APOIO A DOENTES E FAMILIARES?

Background: Patient-focused interventions recognize the role of patients as active participants in the process of delivering effective, safe and responsible healthcare. When equipped with appropriate knowledge, patients can play an important role in their own care by early diagnosing self-limiting conditions and establishing a beneficial relationship with the healthcare team. The purpose of this study was to identify the main changes in bodily processes and their impact on dependency and self-care during colorectal cancer multimodal treatment to further develop a consistent patient-focused intervention protocol. Methods: A prospective longitudinal design was chosen to describe the evolution of the health condition of colorectal cancer patients during multimodal treatment. Patients were assessed (N = 129) in three separate moments, namely: T1 – after multi-disciplinary-team treatment decision; T2 – three months after T1; and T3 – six months after T1. Results: The results of this study show that, during treatment, patients with colon or rectal cancer experience significant changes in their health condition. They present a negative evolution on health status related with impairment in the gastrointestinal, circulatory and nervous systems and in psychological, neurovascular and resting processes. Chemotherapy adverse effects significantly reduce the ability to self-care. These patients reveal a higher dependency level in self-care areas, such as: instrumental activities of daily life (IADL) “bathing”, “to dress and undress”, “rising”, “taking medication” and “colostomy”. Conclusion: The results of this study pose a challenge to health care providers in the sense that these professionals are in a privileged position to help with an appropriate program, patients with colorectal cancer and their family in transition from dependence to supported self-care.Introdução: Os doentes quando munidos do conhecimento necessário podem desempenhar um papel importante no seu percurso terapêutico, quer pelo reconhecimento precoce das alterações na sua condição de saúde, quer pela relação que podem estabelecer com os profissionais de saúde. Assim, a prescrição de intervenções focadas no doente e nas suas necessidades individuais torna-os mais participativos no processo de prestação de cuidados, tornando-os mais eficazes e seguros. O objetivo deste estudo foi identificar as principais alterações nos processos corporais e o seu impacto na dependência para o autocuidado durante o tratamento do cancro coloretal para desenvolver um protocolo de intervenção consistente com foco no doente. Métodos: Estudo prospetivo longitudinal. Os doentes foram avaliados (N = 129) em três momentos distintos, a saber: T1 – após decisão do tratamento da equipe multidisciplinar; T2 – três meses após T1; e T3 – seis meses após T1. Resultados: Os resultados deste estudo mostram que, durante o tratamento, os doentes com cancro do cólon ou reto experienciam mudanças significativas no seu estado de saúde. Apresentam uma evolução negativa da condição de saúde de saúde relacionada com compromissos nos sistemas gastrointestinal, circulatório, nervosa, nos processos psicológicos, neurovasculares e regulador. Os efeitos adversos da quimioterapia reduzem significativamente a capacidade para o autocuidado. Esses doentes revelam maior grau de dependência nas áreas de autocuidado, tais como: atividades instrumentais de vida diária (AIVD) “tomar banho”, “vestir-se e despir-se”, “levantar-se”, “tomar medicamentos” e “colostomia”. Conclusão: Os resultados deste estudo representam um desafio para os profissionais de saúde no sentido de que esses profissionais estão numa posição privilegiada para ajudar com um programa de intervenção, adequado aos doentes com cancro coloretal e sua família na transição da dependência para o autocuidado com suporte

Treatment of Head and Neck Cancer with Photodynamic Therapy with Redaporfin: A Clinical Case Report

Advanced head and neck squamous cell carcinoma, after locoregional treatment and multiple lines of systemic therapies, represents a great challenge to overcome acquired resistance. The present clinical case illustrates a successful treatment option and is the first to describe the use of photodynamic therapy (PDT) with Redaporfin, followed by immune checkpoint inhibition with an anti-PD1 antibody. This patient presented an extensive tumor in the mouth pavement progressing after surgery, radiotherapy, and multiple lines of systemic treatment. PDT with Redaporfin achieved the destruction of all visible tumor, and the sequential use of an immune checkpoint inhibitor allowed a sustained complete response. This case is an example of the effect of this therapeutic combination and may provide the basis for a new treatment modality

ESTADO NUTRICIONAL PRÉ-OPERATÓRIO E COMPLICAÇÕES CIRÚRGICAS EM DOENTES COM CANCRO DIGESTIVO E DA CABEÇA E PESCOÇO

Introduction: Malnutrition is present in 40-50% of surgical patients upon hospital admission and is one of the most important factors influencing post-surgical morbidity and mortality. It is important to establish routines to identify and monitor patients at nutritional risk nutritional, to start early nutritional therapy, ideally in the pre-surgical phase. The aim of this study was to evaluate the association between pre-surgical nutritional status and postoperative complications and assess the nutritional assessment tool with the best prognostic value for post-surgical complications, in patients referred to surveillance in intermediate and intensive care units during surgical planning. Methods: We recruited patients at the Digestive Pathology and Head and Neck Units, referred for surgery and signaled at the anesthesia consultation for post-surgical surveillance in Intermediate or Intensive Care, from August to December 2016, at the Portuguese Institute of Oncology of Porto, Francisco Gentil, EPE. Clinical and demographic data were collected from the clinical process of the patients. Risk and nutritional status assessment was performed in the first 24 hours of patient’s admission to hospital using the PG-SGA and NRI. Data analysis was performed using the SPSS 23.0 statistical program. Results: We included 97 patients, 62 with digestive malignancies and 35 with head and neck malignant tumors. The prevalence of pre-surgical malnutrition was 51.2% and 33%, as assessed by NRI and PG-SGA, respectively. Nutritional status, as assessed by NRI was associated with postoperative complications and length of hospital stay. Nutritional status and lack of nutritional support were also associated with greater odds of prolonged hospitalizations (>10 days). Conclusion: The odds of developing post-surgical complications was about 3 times higher if the patient is malnourished or at risk of malnutrition, as assessed by NRI.Introdução: A desnutrição está presente em 40-50% dos doentes cirúrgicos no momento da admissão hospitalar, sendo considerada um dos fatores que mais influencia a morbimortalidade pós-cirúrgica. É importante estabelecer rotinas para identificar e monitorizar os doentes em risco nutricional, para iniciar a terapia nutricional precocemente, idealmente na fase pré-cirúrgica. O objetivo do presente trabalho foi avaliar a associação entre estado nutricional pré-cirúrgico e as complicações pós-cirúrgicas e verificar qual o instrumento de avaliação nutricional com melhor valor prognóstico para complicações pós-cirúrgicas, em doentes encaminhados para vigilância para as unidades de cuidados intermédios e intensivos durante o planeamento cirúrgico. Métodos: Foram recrutados doentes nas Unidades de Patologia Digestiva e de Cabeça e Pescoço, que tinham sido encaminhados para cirurgia e sinalizados na consulta de anestesia para vigilância pós-cirúrgica em Terapia Intermediária ou Intensiva, de agosto a dezembro de 2016, no Instituto Português de Oncologia do Porto, Francisco Gentil, EPE. Dados clínicos e demográficos foram recolhidos através de consulta ao processo clínico. A avaliação do risco e do estado nutricional foi realizada através do PG-SGA e do NRI, nas primeiras 24 horas da admissão do doente para internamento hospitalar. A análise dos dados foi realizada através do programa estatístico SPSS 23.0. Resultados: Foram incluídos 97 doentes, 62 com neoplasias digestivas e 35 com neoplasias malignas de cabeça e pescoço. A prevalência de desnutrição pré-cirúrgica avaliada foi de 51,2% e 33%, avaliada pelo NRI e PG-SGA, respetivamente. O estado nutricional, avaliado pelo NRI, foi associado a complicações pós-operatórias e maior tempo de hospitalização. O estado nutricional e a falta de suporte nutricional também foram associados a maior risco de hospitalização prolongada (> 10 dias). Conclusão: O risco de desenvolver complicações pós-cirúrgicas foi cerca de 3 vezes maior em doentes desnutridos ou em risco de desnutrição avaliados pelo NRI