Administration of cytotoxic chemotherapy for patients with metastatic cancer and poor performance status is a daily clinical challenge. Guidelines only help to select a therapeutic regimen but do not offer a clear response whether or not the patients should be treated. We performed a prospective analysis in 139 metastatic patients with performance status > 1 according to the Eastern Cooperative Oncology Group scale. A decision was considered correct if patients treated with a medical anticancer treatment lived over 3 months or alternatively patients not treated had a survival under 3 months. The predominant tumor type was non-small cell lung cancer. Patients were chemotherapy naive in 87 cases (63 %). A new line of medical anticancer treatment was started in 107 cases (77 %). The median survival of the study population was 11 weeks (range, 1-53). 84 patients (60 %) died within 3 months while 55 patients (40 %) lived more than 3 months after decision. Treatment decisions were considered as appropriate in 81 cases (58 %). No patient was considered as undertreated. The analysis by pathology allowed to identify pathologies where decisions were correct in the majority of the cases (renal, urothelial and small cell lung cancers), pathologies where appropriate and inappropriate decisions were balanced (prostate, ovarian and breast cancers) and pathologies where decisions for treatment were excessive (non-small cell lung cancer and unknown primary). This prospective study was conducted as part of the evaluation of professional practices in our department. Administration of a medical anticancer treatment validated with patients with good performance status may be harmful for patients with poor performance status. The findings resulted in recommendations for daily practice in order to help physicians, especially for the "don't go" decisions. Until the identification of new prognostic factors for survival and/or the development of therapies making sensitive currently chemoresistant diseases, the initiation of a medical anticancer treatment outside standard situations should result from a consensual decision team or the inclusion in a clinical trial.
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http://dx.doi.org/10.1007/s12253-016-0111-4 | DOI Listing |
Health Aff (Millwood)
January 2025
Michael E. Chernew, Harvard University.
A core problem with the current risk-adjustment system in Medicare Advantage and accountable care organization (ACO) programs-the Hierarchical Condition Categories (HCC) model-is that the inputs (coded diagnoses) can be influenced for gain by risk-bearing plans or providers. Using existing survey data on health status (which provide less manipulable inputs), we found that the use of a hybrid risk score drawing from survey data and a scaled-back set of HCCs would, in addition to mitigating coding incentives, modestly lessen risk-selection incentives, strengthen payment incentives to deliver efficient care, allocate payment across ACOs more efficiently according to markers of population health that are not as affected by practice patterns or coding efforts, and redistribute payment in a manner that supports equity goals. Although sampling error and survey nonresponse present challenges, analyses suggest that these should not be prohibitive.
View Article and Find Full Text PDFClin Transplant
January 2025
Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
Background: Pleural effusion and ascites developing after allogeneic hematopoietic stem cell transplantation (allo-SCT) are generally associated with inferior overall survival (OS); however, the prognostic value of pretransplant effusion on transplant outcomes remained unclear.
Methods: We retrospectively evaluated minimal pleural effusion and ascites detected by computed tomography in 248 consecutive adult patients who underwent their first allo-SCT from January 2007 to December 2022.
Results: Forty-eight patients demonstrated minimal pleural effusion or ascites within 100 days before transplantation (Effusion group) and the other 200 had no effusion (No effusion group).
Issues Ment Health Nurs
January 2025
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
The need for belonging is a fundamental human motivation. Despite the significance of belonging, many people struggle to feel a sense of it. Healthcare organizations continue to experience workforce shortages.
View Article and Find Full Text PDFJ Clin Gastroenterol
January 2025
Department of Gastroenterology, Changhai Clinical Research Unit, Changhai Hospital.
Aims: ERCP training should adapt to the rapid development of ERCP technology and indications. China has a large population and vast land area, but ERCP training resources are insufficient. To make effective use of scarce ERCP training resources, the Standardized Training for ERCP Procedure (STEP) program was launched as a pilot trial.
View Article and Find Full Text PDFJMIR Public Health Surveill
December 2024
Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine, Chinese Academy of Sciences, 1 East Banshan Road, Hangzhou, 310022, China, 86 571-88122219.
Background: Liver cancer continues to pose a significant burden in China. To enhance the efficiency of screening, it is crucial to implement population stratification for liver cancer surveillance.
Objective: This study aimed to develop a simple prediction model and risk score for liver cancer screening in the general population, with the goal of improving early detection and survival.
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