Comorbidity In Cancer Patients Research Articles

Abstract 4138212: Efficacy of Left Atrial Appendage Occlusion in Reducing Mortality and Major Bleeding Events in Cancer Patients with Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is a common comorbidity in cancer patients, increasing their risk of stroke and mortality. Cancer patients are often excluded from anticoagulation and AF intervention trials due to the nature of their disease, and risk scores such as HAS-BLED, CHADS2/CHADS2-VASc often underpredict the high risk of AF and related complications for these patients. Research Question: Does left atrial appendage occlusion (LAAO) reduce mortality, major bleeding events (MBE), and stroke in cancer patients with AF? Methods: Using TriNetX, an international health research network with data from over 100 million patients, cancer patients with AF, with and without LAAO were identified between 2015 and 2022. Equal cohorts of 147 patients were created after propensity score matching for demographics, diabetes, hypertension, and heart failure. Measures of Association and Survival Analysis were conducted between 3-months and 5-years. The primary outcome was mortality. The secondary outcomes were MBE and stroke. Results: The study included 294 cancer patients with AF, with 147 having received LAAO. The risk of mortality at 3 months was 6.8% in the LAAO+ group compared to 15% in the LAAO- group (p-value= 0.025). At 6 months, the mortality risk was 8.8% in the LAAO+ group and 18.4% in the LAAO- group (p-value= 0.017). At 1 year, the mortality risk was 12.2% in the LAAO+ group and 23.8% in the LAAO- group (p-value=0.010). At 5 years, the mortality risk was 28.6% in the LAAO+ group and 49.7% in the LAAO- group (p-value<0.0001). The MBE risk was 20.4% for the LAAO+ group and 32% for the LAAO- group at 3 months (p-value= 0.024). At 6 months, the MBE risk was 25.9% in the LAAO+ group and 40.1% in the LAAO- group (p-value=0.009). Although there was no significant difference in risk of MBE at 1 year and 5 years, survival was higher among the LAAO+ group than the LAAO- group (64.92% vs 52.76%; p-value= 0.038 at 1 year and 52.67% vs 39.23%; p-value=0.029 at 5 years). However, there was no difference between stroke risk or survival probability across all measured time points. Conclusion: LAAO in cancer patients with AF was associated with significantly reduced mortality and major bleeding events over a 5-year period compared to those without LAAO. These findings suggest that LAAO may be a beneficial intervention for improving survival and reducing bleeding complications in cancer patients with AF.

Diagnostic pathways and outcomes by comorbidity in cancer patients: a study in Northern Italy

Abstract Background Pre-existing chronic conditions can influence cancer diagnosis and outcomes. The study aimed to examine variations in diagnostic pathways and outcomes in colorectal cancer (CRC) patients by comorbidity status and socio-demographic characteristics in the provinces of Milan and Lodi, Northern Italy. Methods A population-based cohort study using linked administrative health data from the Agency for Health Protection (ATS) of Milan was conducted on individuals aged ≥18 years diagnosed with CRC in 2014-2017. We examined pathways to cancer diagnosis, stage at diagnosis and short-term mortality by specific comorbidities and sociodemographic factors. Results Among the 5,272 colon cancer and 2,120 rectal cancer patients, 43.9% and 61.5%, respectively, had at least one pre-existing comorbidity, most frequently hypertension (52.7% and 49.9%) and cardiovascular disease (CVD, 23.2% and 18.5%). Cancer diagnostic pathways included screening (4.1% colon and 4.4% rectal cancer patients), EP (22.8% and 12.6%) and inpatient/outpatient admission (73.1% and 82.9%). At multivariable logistic regression, patients with pre-existing cerebrovascular or neurological diseases had significantly higher odds of EP for CRC. In the multinomial logistic regression analysis, the odds of EP were significantly higher for patients aged <50 or ≥ 80 (vs 60-69), belonging to the highest deprivation group and being widowed (vs married). The odds of screen-detected CRC were lower for patients with multimorbidity (2 vs 0 comorbidities: adjusted OR = 0.32, 95% CI 0.14-0.75). 30-day and one-year mortality were higher in colon cancer patients with EP vs inpatient/outpatient (aOR=2.46, 95%CI 1.95-3.09; aOR=2.02, 95%CI 1.74-2.35 respectively). As the number of chronic conditions increased, mortality increased especially at one year. One-year mortality was also higher for rectal cancer patients with 3+ comorbidities (vs no comorbidities). Key messages • Patients with pre-existing chronic conditions had a lower likelihood of screening, higher odds of emergency CRC diagnosis and higher mortality. EPs occur in one in five CRC patients. • Tailored interventions might be needed to facilitate CRC screening, reducing emergency diagnoses and improving health outcomes for the large number of patients with chronic conditions.

Red cell size factor is a sensitive index in the early diagnosis of nondigestive tract cancer-related anemia: An observational study.

Cancer-related anemia (CRA) is a common comorbidity in cancer patients, and it can lead to a worse prognosis. The aim of this cross-sectional study is to investigate the clinical value of the red cell size factor (Rsf) in the early diagnosis of nondigestive tract CRA. A total of 231 patients with nondigestive tract solid cancer were included, and they were divided into anemic and nonanemic subjects according to the hemoglobin (Hb) levels. A BC-7500 blood analyzer was used to detect the indices of red blood cell and reticulocyte, and the mean corpuscular volume (MCV), mean reticulocyte volume (MRV), reticulocyte hemoglobin (RHE) content, and reticulocyte production index were observed. Subsequently, the Rsf was calculated. Receiver operating characteristic curve analysis was used to evaluate the identifying power of Rsf for anemia diagnosed by the combination of RHE and reticulocyte production index. The adjusted-multivariate analysis and quartiles were used to assess the relation of reduced Rsf level with the risk and incidence of anemia diagnosed by combining the MCV, MCH, and mean corpuscular hemoglobin concentration (MCHC), respectively. Rsf levels showed no statistical differences between anemia and nonanemia subjects grouped by Hb (P > .05). Rsf has a high correlation with the RHE level (R > 0.900, P < .001), or MCV, mean corpuscular hemoglobin (MCH), and MCHC in anemia patients (r: 0.435-0.802, P < .001). Receiver operating characteristic curves showed that Rsf had the highest overall area under curve of 0.886 (95% confidence interval: 0.845-0.927) in identifying anemia of cancer patients (P < .001). When the optimal cutoff values of Rsf were set at 97.05 fl in males and 94.95 fl in females, the sensitivity and specificity were 0.94 and 0.76, and 0.98 and 0.75, respectively. Being treated as a categorical variable, Rsf had a highest odds ratio value of 30.626 (12.552-74.726; P < .001) for the risk of anemia. The increment of Rsf quartiles was highly associated with the decreased incidence of overall anemia (P trend < 0.001). The study suggests that decreased Rsf level is a potentially powerful predictor of overt anemia in nondigestive tract cancer, and it can be used as a convenient, practical, cost-free, and sensitive index in early diagnosis of nondigestive tract CRA.

General population normative values for the EORTC QLQ-C30 by age, sex, and health condition for the French general population

BackgroundGeneral population normative values for the widely used health-related quality of life (HRQoL) measure EORTC QLQ-C30 support the interpretation of trial results and HRQoL of patients in clinical practice. Here, we provide sex-, age- and health condition-specific normative values for the EORTC QLQ-C30 in the French general population.MethodsFrench general population data was collected in an international EORTC project. Online panels with quota samples were used to recruit sex and age groups. Number and type of comorbidities were assessed. Descriptive statistics were used to calculate general population values for each QLQ-C30 scale, separately for sex, age, and presence of one- and more chronic health conditions. A multivariate linear regression model has been developed to allow estimating the effect of sex, age, and the presence for one- and more chronic health conditions on EORTC QLQ-C30 scores. Data was weighted according to United Nation statistics adjusting for the proportion of sex and age groups.ResultsIn total, 1001 French respondents were included in our analyses. The weighted mean age was 47.9 years, 514 (51.3%) participants were women, and 497 (52.2%) participants reported at least one health condition. Men reported statistically significant better scores for Emotional Functioning (+9.6 points, p = 0.006) and Fatigue (−7.8 point; p = 0.04); women reported better profiles for Role Functioning (+8.7 points; p = 0.008) and Financial Difficulty (−7.8 points, p = 0.011). According to the regression model, the sex effect was statistically significant in eight scales; the effect of increasing age had a statistically significant effect on seven of the 15 EORTC QLQ-C30 scales. The sex- and age effect varied in its direction across the various scales. The presence of health conditions showed a strong negative effect on all scales.ConclusionThis is the first publication of detailed French normative values for the EORTC QLQ-C30. It aims to support the interpretation of HRQoL profiles in French cancer populations. The strong impact of health conditions on QLQ-C30 scores highlights the importance of considering the impact of comorbidities in cancer patients when interpreting HRQoL data.

A Study on Suicidal Intent, Quality of Life, Medical and Psychiatric Comorbidity in Cancer Patients at a Tertiary Care Hospital in Puducherry

Background- Cancer is now widely recognised as a new epidemic globally which accounts for nearly 10 million deaths in year 2020. Aims and Objectives-The aim of the study was to estimate suicidal ideation among cancer patients and to evaluate the association between suicidal intent with the quality of life, medical and psychiatric comorbidities. Methods-The study group included 70 cancer patients who were surgically treated in the Department of Surgical Oncology in a tertiary care hospital in South India. The sample size was calculated using Open Epi Version 3.0. Sampling was done using consecutive sampling method. The study was conducted from March 2021 to September 2022. A socio-demographic information form, HADS (Hospital Anxiety Depression Scale), Beck Suicide Intent Scale and WHO-QOL BREF (WHO Quality of Life BREF) were used. Results- In our study 12.9% reported having attempted suicide in the recent past, 18.6% scored abnormal on anxiety scale and 40% scored depression level on HADS. Conclusions- Cancer patients are at increased risk of developing many psychiatric illnesses including anxiety, depression and suicidal attempts. The QOL of cancer patients are affected by these psychiatric comorbidities. Timely assessment and intervention can improve their QOL and also reduce the risks of suicide. There is a significant correlation between anxiety, depression and suicide attempt. Keywords: Suicide, Anxiety, Quality of Life, Cancer .

Prevalence of obstructive sleep apnoea syndrome in oncological patients: A systematic review and meta-analysis.

Obstructive sleep apnoea syndrome (OSAS) has garnered increasing attention in recent years due to its potential association with cancer. This systematic review and meta-analysis aimed to assess the prevalence of OSAS in cancer patients through a comprehensive analysis of existing literature. This systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, aimed to evaluate the prevalence of OSAS in cancer patients. A comprehensive search of electronic databases was performed to identify relevant studies published up to September 2021. Eligible studies reporting on the prevalence of OSAS in cancer patients, encompassing various study designs, were included in the analysis. Pooled estimates of the odds ratios (OR) with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity among the studies was assessed using the I2 statistic. Seventeen studies fulfilled the inclusion criteria and were subsequently included in the review. The prevalence of OSAS in cancer patients was estimated to have an overall OR of 0.80 (95% CI: 0.75-0.85). In comparison with non-cancer patients, cancer patients had a statistically significant greater risk of OSAS, as indicated by the total estimated RR for the prevalence of OSAS in cancer patients, which was 0.89 (95% CI: 0.86-0.92). Nonetheless, there was a significant amount of heterogeneity (I2 = 96%) among the studies. The overall data analysed in this review indicates that patients with cancer had far reduced likelihood of developing OSAS than individuals without cancer. However, the significant variation across the included studies highlights the need for additional investigation to fully clarify the complex association between OSAS and cancer incidence. These results emphasise how critical it is to identify OSAS as a possible comorbidity in cancer patients, one that should be taken into account for clinical management and ongoing research.

Medication-Related Osteonecrosis of the Jaw – 2024 Update

As the global number of patients with osteoporosis and malignant diseases such as breast cancer, multiple myeloma, and prostate cancer increases every year, there is an associated rise in the use of antiangiogenic medications and antiresorptive medications. With increasing frequencies in the use of antiangiogenic and antiresorptive medications, there is an associated increase in the number of medication-related osteonecrosis of the jaw (MRONJ) cases reported from patients. MRONJ has emerged as a significant comorbidity in cancer patients treated with antiangiogenics or high doses of potent antiresorptive agents, such as bisphosphonates (BPs) or denosumab. MRONJ first emerged from BP-treated cancer patients who presented with a spectrum of dental problems, including delayed wound healing following a dental extraction or oral surgery, exposed bone, soft tissue infection and inflammation, anesthesia, paresthesia, odontalgia, sinus pain, and aching bone pain in the mandible, which continues to be a significant source of problems for dentists, physicians, and patients today. A significant number of MRONJ cases secondary to osteoporosis have also been reported in osteoporotic patients receiving antiresorptive medications. The American Association of Oral and Maxillofacial Surgeons (AAOMS) has established diagnostic standards for MRONJ based on pharmacological history, clinical signs, and radiographic findings. However, as the expertise and knowledge base for MRONJ continues to evolve, revisions and refinements for MRONJ pathogenesis and treatment strategies are necessary to reflect the current research status of the disease correctly. This review highlights current scientific information associated with MRONJ to identify and summarize preventative measures, and treatment interventions for reading the impact of this debiliating disorders.

The effect of prothrombin, the precursor of thrombin, on the proliferation and migration of colorectal cancer cells

Thrombotic disorders are some of the main comorbidities in cancer patients. So far, research has indicated that thrombin, a key regulator of hemostasis, contributes to cancer progression. However, data on its origin in tumor microenvironments remain elusive. Based on previous research, we analyzed the RNA and protein expression of prothrombin, a precursor of thrombin, in selected colorectal cancer (CRC) cell lines. Since the effect of prothrombin in cancer development has not been previously reported, we treated the cells for 24 h and 48 h with different prothrombin concentrations and assessed the effect on cell proliferation and migration. Our results show that the tested CRC cell lines expressed prothrombin and that prothrombin inhibited proliferation and migration. The presented results suggest that prothrombin may contribute to CRC etiopathology and could serve as a potential diagnostic biomarker and therapeutic target. The mechanisms underlying prothrombin expression in cancer cells, potential prothrombin activation, and the underlying processes driving the described effects warrant further investigation.

The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis

BackgroundEsophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer.MethodsWe performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots.ResultsThe meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10).ConclusionPreoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.

Insights into the Impact of Hesitancy on Cancer Care and COVID-19.

World Health Organization findings indicate that the COVID-19 pandemic adversely affected cancer diagnosis and management. The COVID-19 pandemic disrupted the optimal management of outpatient appointments, scheduled treatments, and hospitalizations for cancer patients because of hesitancy among patients and health-care providers. Travel restrictions and other factors likely affected medical, surgical, and radiation treatments during the COVID-19 pandemic. Cancer patients were more likely to be affected by severe illness and complications if they contracted COVID-19. A compromised immune system and comorbidities in cancer patients may have contributed to this increased risk. Hesitancy or reluctance to receive appropriate therapy or vaccination advice might have played a major role for cancer patients, resulting in health-care deficits. The purpose of this review is to evaluate the impact of COVID-19 on screening, entry into clinical trials, and hesitancy among patients and health-care professionals, limiting adjuvant and metastatic cancer treatment.

Preexisting hypertension and cancer therapy: evidence, pathophysiology, and management recommendation.

Cancer is considered one of the leading causes of mortality worldwide. At the same time, hypertension is recognized as one of the most common comorbidities in cancer patients. Antineoplastic therapies, mainly tyrosine kinase and vascular endothelial growth factor inhibitors, have been associated with new-onset hypertension by activation of different pathophysiological pathways. However, the role of preexisting hypertension in cancer patients under treatment has not been thoroughly studied. According to this review, preexisting hypertension is an independent risk factor for increased blood pressure during anticancer therapy. Therefore, physicians should recognize hypertension and its phenotypes (i.e., masked hypertension) as an important modifiable risk factor that should be properly managed prior to the initiation of cancer therapy to avoid premature chemotherapy cessation. The development of onco-hypertension will help establish specific guidelines for managing hypertension in cancer patients.

NAD+ repletion with niacin counteracts cancer cachexia

Cachexia is a debilitating wasting syndrome and highly prevalent comorbidity in cancer patients. It manifests especially with energy and mitochondrial metabolism aberrations that promote tissue wasting. We recently identified nicotinamide adenine dinucleotide (NAD+) loss to associate with muscle mitochondrial dysfunction in cancer hosts. In this study we confirm that depletion of NAD+ and downregulation of Nrk2, an NAD+ biosynthetic enzyme, are common features of severe cachexia in different mouse models. Testing NAD+ repletion therapy in cachectic mice reveals that NAD+ precursor, vitamin B3 niacin, efficiently corrects tissue NAD+ levels, improves mitochondrial metabolism and ameliorates cancer- and chemotherapy-induced cachexia. In a clinical setting, we show that muscle NRK2 is downregulated in cancer patients. The low expression of NRK2 correlates with metabolic abnormalities underscoring the significance of NAD+ in the pathophysiology of human cancer cachexia. Overall, our results propose NAD+ metabolism as a therapy target for cachectic cancer patients.

Primena nivolumaba kod bolesnice sa mukozalnim melanomom i sistemskim lupusom - prikaz slučaja sa pregledom literature

Introduction. Systemic lupus erythematosus (SLE) represents a multisystemic disease characterized by antibody production, complement activation, and immune complexes deposition. Certain types of malignancies occur more often, and conversely, some of them occur less often in SLE patients. Mucosal melanoma of the anorectal region represents a rare form of melanoma occurring in 1.5% of all melanoma patients, predominantly female. The introduction of novel agents dramatically changed the outcome in melanoma patients and introduced different adverse events, diverse contraindications, and drug interactions. Immune checkpoint inhibitors have a role in the maintenance of immunologic homeostasis. Patients with underlying autoimmune diseases were often excluded from clinical trials, for fear of possible autoimmune disease exacerbation or high-grade immune-related adverse events. Due to that, data regarding this subgroup of patients is limited, with no clear recommendations. Given the fact that prevalence among the general population is high (5-10%), autoimmune diseases represent common comorbidity in cancer patients. Having that in mind, it is of utmost importance to personalize the approach and individualize the SLE treatment and enable the use of PD-1 antibody in the safest and most useful way while keeping the SLE in control. Case report. Herein we present a 79-year-old with primary mucosal melanoma of the anorectal region, with lung metastasis and preexisting SLE in remission. Hydroxychloroquine was the only treatment for SLE. Nivolumab treatment was initiated in the standard dosing schedule. After the first and second follow-up, no further progression of melanoma was detected, with no SLE exacerbation and immune-related adverse events. Conclusion. PD-1 treatment in a patient with an underlying autoimmune disease represents a viable choice with a necessity for a multidisciplinary approach and close monitoring.

The Impact of a Mediterranean-like Diet with Controlled Protein Intake on the Onco-Nephrological Scenario: Time for a New Perspective.

Chronic kidney disease (CKD) represents a frequent comorbidity in cancer patients, especially for patients affected by urological cancers. Unfortunately, impaired kidney function may limit the choice of adequate oncological treatments for their potential nephrotoxicity or due to contraindications in case of a low glomerular filtration rate. For these patients, tailored nephrological and nutritional management is mandatory. The K-DIGO guidelines do not define whether the nutritional management of CKD could be useful also in CKD patients affected by urological cancer. In fact, in clinical practice, oncological patients often receive high-protein diets to avoid malnutrition. In our study, we investigated the nutritional and nephrological impact of a Mediterranean-like diet with a controlled protein intake (MCPD) on a cohort of 82 stage III-IV CKD patients. We compared two cohorts: one of 31 non-oncological CKD patients and the other of 51 oncological patients with CKD. The use of an MCPD had a favorable impact on both the oncological and non-oncological CKD patients with an amelioration in all the investigated parameters and with a better quality of life, with no cases of malnutrition or AKI.

Clinical use of lenvatinib in patients with previous renal and/or hepatic impairment and radioiodine-refractory differentiated thyroid cancer.

Lenvatinib is one the most active drugs in radioiodine‐refractory differentiated thyroid cancer (RR‐DTC) such that it has become an important therapeutic tool in tumor control and survival. Renal and hepatic impairments are common comorbidities in cancer patients. Treating these patients is a challenge that requires careful consideration. As a first approach to patients with RR‐DTC and renal or hepatic impairment, Summary of Product Characteristics recommendations for lenvatinib use and dose adjustments should be strictly followed. Close clinical and blood monitoring is the gold standard approach to optimizing lenvatinib's use during the whole course of treatment.

MANAGEMENT OF DRUG INTERACTIONS IN COLON CANCER PATIENTS

Objective: Colon cancer is the third most common cancer type globally and usually occurs at advanced ages. Since the risk of comorbid diseases may also increase with age, colon cancer patients have an increased risk of polypharmacy. Hypertension, chronic obstructive pulmonary disease, diabetes, and cardiovascular disease are the frequently seen comorbidities in cancer patients. Patients who are elderly, have comorbid conditions, and are taking two or more medications are at higher risk for drug-drug interactions (DDIs). Additionally, cancer patients frequently use many drugs such as supportive care drugs for the treatment of side effects of cytotoxic drugs. DDIs may cause therapeutic failure or potentially serious adverse events. determination and evaluation of DDI levels identify the most suitable rational therapy for cancer patients. Result and Discussion: This study has reviewed the drugs used to treat colon cancer (Capecitabine, Fluorouracil, Irinotecan, Oxaliplatin, Bevacizumab, Ziv-Aflibercept, Nivolumab, Pembrolizumab, Ramucirumab, Regorafenib, Larotrectinib, Dabrafenib, Trametinib, Trifluridine and tipiracil, and Encorafenib) and determined the possible drug-drug interactions. This study will help the pharmacists and clinicians to evaluate possible interactions.

EORTC QLQ-C30 general population normative data for Italy by sex, age and health condition: an analysis of 1,036 individuals

BackgroundGeneral population normative values for the widely used health-related quality of life (HRQoL) measure, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), are available for a range of countries. These are mostly countries in northern Europe. However, there is still a lack of such normative values for southern Europe. Therefore, this study aims to provide sex-, age- and health condition-specific normative values for the general Italian population for the EORTC QLQ-C30.Material and methodsThis study is based on Italian EORTC QLQ-C30 general population data previously collected in an international EORTC project comprising over 15,000 respondents across 15 countries. Recruitment and assessment were carried out via online panels. Quota sampling was used for sex and age groups (18‍–‍39, 40–49, 50–59, 60–69 and ≥ 70 years), separately for each country.We applied weights to match the age and sex distribution in our sample with UN statistics for Italy. Along with descriptive statistics, linear regression models were estimated to describe the associations of sex, age and health condition with the EORTC QLQ-C30 scores.ResultsA total of 1,036 respondents from Italy were included in our analyses. The weighted mean age was 49.3 years, and 536 (51.7%) participants were female. Having at least one health condition was reported by 60.7% of the participants. Men reported better scores than women on all EORTC QLQ-C30 scales but diarrhoea. While the impact of age differed across scales, older age was overall associated with better HRQoL as shown by the summary score. For all scales, differences were in favour of participants who did not report any health condition, compared to those who reported at least one.ConclusionThe Italian normative values for the EORTC QLQ-C30 scales support the interpretation of HRQoL profiles in Italian cancer populations. The strong impact of health conditions on EORTC QLQ-C30 scores highlights the importance of adjusting for the impact of comorbidities in cancer patients when interpreting HRQoL data.

Antihypertensive Drugs and Cancer Risk.

Hypertension is the most prevalent comorbidity in cancer patients. Consequently, many cancer patients are prescribed antihypertensive drugs before cancer diagnosis or during cancer treatment. However, whether antihypertensive drugs affect the incidence, treatment efficacy, or prognosis of cancer remains unanswered. For instance, renin-angiotensin and β-adrenergic signaling may be involved not only in blood pressure elevation but also in cell proliferation, angiogenesis, and tissue invasion. Therefore, the inhibition of these pathways may have beneficial effects on cancer prevention or treatment. In this article, we reviewed several studies regarding antihypertensive drugs and cancer. In particular, we focused on the results of clinical trials to evaluate whether the use of antihypertensive drugs affects future cancer risk and prognosis. Unfortunately, the results are somewhat inconsistent, and evidence demonstrating the effect of antihypertensive drugs remains limited. We indicate that the heterogeneity in the study designs makes it difficult to clarify the causal relationship between antihypertensive drugs and cancer. We also propose that additional experimental studies, including research with induced pluripotent cells derived from cancer patients, single-cell analyses of cancer cell clusters, and clinical studies using artificial intelligence electronic health record systems, might be helpful to reveal the precise association between antihypertensive drugs and cancer risk.

Malnutrition management of hospitalized patients with diabetes/hyperglycemia and cancer cachexia

Diabetes is a frequent comorbidity in cancer patients, since they share common risk factors. In cancer, the concurrence of cachexia represents a poor prognostic factor, which is aggravated by poor nutritional status. Clinically, cancer cachexia manifests as a significant reduction in body weight, accompanied by changes in body composition and alterations in the balance of the biological system, and causes progressive dysfunction. This document describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with cancer cachexia.

The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study

It is well known that malnutrition is a frequent co-morbidity in cancer patients, especially in those with head and neck neoplasms. This may be due both to the presence of dysphagia symptoms and to the appearance of adverse effects on chemotherapy and / or radiotherapy. The aim of this retrospective observational multicentric study is to evaluate the nutritional status between dysphagia cancer patients and non-dysphagia cancer patients. Data from 60 patients were analysed, 31 of which without dysphagia and 29 with dysphagia. Results highlight that patients with dysphagia had higher involuntary body weight loss than non-dysphagia ones (p < 0.001). By analysing the entire population, it stands out a weight loss rate of 12 ± 9% compared to the usual weight was observed and a prevalence of moderate / severe malnutrition diagnosis of 53%. Furthermore, 76% of the population who manifested the symptom of dysphagia presented severe malnutrition already at the first visit, compared to 32% of non-dysphagia subjects.