End-stage Cancer Patients Research Articles

Exploring the ethical decision-making experience of caregivers of end stage cancer patients in Iran: a phenomenological study.

Ethical decision making is a complex issue because it strongly depends on the religion, beliefs, traditional laws and moral views of each society. The purpose of this study was to explore the experience of Iranian family caregivers of end stage cancer patients about ethical decision making. This qualitative study is based on van Manen's method of hermeneutic phenomenology. In-depth interviews were carried out to collect data. Participants were 12 caregiver. Audiotapes were transcribed and analyzed for common themes that represented the participants' experiences. Trustworthiness of the findings was established using the Lincoln and Guba's criteria. Three themes reflected the essence of caregivers' lived experience including; fluctuating between hope and despair, wandering dilemma, and ethical decision making. Each of these themes consisted of several subthemes. The present study revealed that, the caregivers of terminally ill cancer patients need different information about prognosis and end of life decision making process. Our perception of how families negotiate ethical issues in their decision-making is still developing. Opportunities should be created to empowering caregivers to talk about their uncertainties and concerns.

Comparison of quality-adjusted life years (QALYs) of end-stage patients with gastrointestinal cancers receiving conventional therapies with recipients of supportive-palliative care package.

This study aimed to compare the quality-adjusted life years (QALYs) of patients with gastrointestinal (GI) cancer after receiving palliative and supportive care. Conducted at Firoozgar Hospital in Tehran, Iran, this observational study included 500 end-stage gastrointestinal cancer patients. The study divided these patients into two groups: 250 utilized palliative medicine services, while the remaining 250 did not. The study compared the conditions of patients in both groups. Among those receiving palliative care, only 21% underwent chemotherapy, significantly lower than the 55% in the non-palliative care group (P < 0.001). Hospital mortality rates were considerably reduced in the palliative care group, with 115 patients (46%) compared to 200 patients (80%) in the non-palliative group (P < 0.001). The average hospital stay for patients receiving palliative care was 25.11 ± 5.12 days, significantly shorter than the 96.42 ± 14.15 days in the non-palliative group (P < 0.001). The EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire scores showed that patients in the palliative care group experienced significantly better outcomes in pain and mood symptoms, but no significant difference was observed in physical function compared to the non-palliative group. Palliative medicine is recommended for gastrointestinal cancer patients as it can significantly reduce unnecessary hospital referrals and length of hospitalization.

Evaluating end-stage cancer patients' preferences for spending their final days at home or in hospital

Introduction: This study aimed to explore the preferences of end-stage cancer patients regarding spending their final days at home or in a hospital, focusing on the impact of cancer types and symptoms necessitating palliative care admission during this period. Methods: The study was conducted with 274 patients diagnosed with end-stage cancer and admitted to the palliative service of Dr. İFC City Hospital in Tekirdağ province. Opinions were collected from all patients while they were fully conscious. The relationships between patients' preferences for their place of death and their age, gender, socioeconomic status, duration of stay in palliative care, admission complaints, and diagnoses were examined. A significance level of p&amp;lt;0.05 was considered statistically meaningful. Results: Approximately one-third of the participating patients preferred to die at home under home care supervision. It was found that these preferences were not influenced by the patients' age, gender, socioeconomic status, or duration of stay in palliative care but were affected by their cancer diagnoses and symptoms leading to admission. Patients with pancreatic cancer preferred to die in the hospital, while those with prostate and breast cancer were more likely to choose home death. Conclusion: If a system equipped with an effective planned home care program, managed by a multidisciplinary team in palliative care services, can be provided to meet the needs of patients and caregivers when they approach hospitals in their final stages, it could enable the right group of patients to spend their end-of-life at home, in accordance with their preferences.

Quantification of treatment-related time toxicity in patients with advanced stage cancer.

12137 Background: Treatment-related Time Toxicity (TrTT) in cancer patients is a recently proposed metric to describe the burden of time spent in pursuing medical care, including office/hospital visits, side effect management, lab tests, imaging scans, and travel time. Time toxicity is a valuable concept in patient-centered shared-decision making, especially in the palliative management of end-stage cancer patients with limited life expectancy. Despite tremendous progress in cancer treatment, most of the guideline-recommended treatment options convey short survival benefits of around 3-6 months when compared to supportive care. While medication toxicities are meticulously reviewed with patients, the cumulative burden and impact of time are rarely included in the discussion, partly due to the lack of standardized measurement of TrTT, and the absence of data from clinical trials. Thus, there is a compelling need for the quantification of time toxicity to guide clinical practice and patient preference. Methods: This was an observational analysis of the time toxicity from palliative treatment for patients with incurable solid tumors at a regional safety-net oncology office that focuses on underserved communities. Time toxicity is calculated as the number of days a patient spent with any healthcare-related encounters during a 3-month period from our medical record system. Results: The median age of the total 94 included patients was 57. 54% of the population were Hispanic. The ratios for mild, moderate, and severe time toxicity were 38%, 44%, and 18%, respectively. Immunotherapy was associated with significantly less time toxicity (TrTT = 8.5 days, 95% CI = 6.3-9.7) compared to chemotherapy (26.3 days, 95% CI = 18.3-34.4, P &lt; 0.001), while targeted therapy (13.4, 95% CI = 7.0-19.8, P = 0.01) and hormone therapy (11.9, 95% CI = 4.1-19.7, P &lt; 0.01) also has lower TrTT than chemotherapy. Patients with a worse performance status (ECOG PS 3-4, 30.1 days, 95% CI = 18.3-41.9) experienced higher time toxicity than fitter patients (PS 0-2, 16.7 days, 95% CI = 13.2-20.2, P &lt; 0.05). Among different cancer types, gastrointestinal malignancies were associated with the highest time toxicity with average TrTT of 30.2 days/3 months (95% CI =22.5-37.2). Conclusions: This is the first comprehensive study to quantify real-world Treatment-Related Time Toxicity across multiple cancer and therapy types in an underserved population. We found 18% of patients with incurable solid malignancies experienced severe time toxicity (&gt; 1 in 3 days). Higher TrTT was associated with cytotoxic chemotherapies, GI malignancies, and poor performance status. Time toxicity should be taken into account with other quality-of-life outcomes in treatment pathways and patient-centered oncology care.

Anticancer Activity of the Thai Herbal Formula “Kerra” Versus Afatinib and Doxorubicin In Vitro

One of the greatest challenges impeding the achievement of global health goals and afflicting millions of people each year is cancer. Prevailing cancer treatment options come with inherent risks, and significant adverse effects, and can result in financial burdens. Nowadays, many turn to alternative medicine, which have played an integral part in the treatment of a myriad of diseases especially when other approaches are ineffective or unable to be deployed. However, an opulent number of herbs seldom have reliable evidence derived from research to support their claims of phytochemical properties contributing to the alleviation of illnesses. Kerra is a Thai herbal formula that possesses immunomodulatory properties and anti-tumor activities which provides a safe, efficacious, and holistic treatment for cancer. Kerra offers therapeutic benefits without resulting in severe adverse effects, ameliorates overall welfare and quality of life for advanced care patients, and is cost-effective, allowing them to be vastly accessible for widespread use, particularly in areas facing disparities due to insufficient economic stability. This study explores the in vitro anticancer effect of the Kerra formula utilizing cytotoxicity assays on six cancer cell lines, compared to afatinib, a targeted therapy for non-small cell lung carcinoma, and doxorubicin, a chemotherapeutic agent. Anticancer activity was determined by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay and the half-maximal inhibitory concentrations (IC50) were calculated for the A431, A549, HepG2, HCT-116, NCI-H1975, MCF-7, and HeLa cell lines. Kerra showed the best effectiveness against HCT-116 and A431. The IC50 values showing inhibition of the growth of colorectal carcinoma (HCT-116 cell line) by Kerra, afatinib, and doxorubicin are 72.96, 3.574, and 63.39 µg/ml, respectively. The IC50 values for inhibition of epidermoid carcinoma (A431 cell line) by Kerra and afatinib are 96.1 and 2.449 µg/ml, respectively. The findings revealed the Kerra extract can inhibit the growth of different types of cancer cells. From our results, Kerra may be advantageous to use in conjunction with conventional cancer interventions, offer an economical solution, and improve the quality of life remarkably for end-stage cancer patients by mitigating severe adverse events.

Comparison of PET/CT-based eligibility according to VISION and TheraP trial criteria in end-stage prostate cancer patients undergoing radioligand therapy.

Two randomized clinical trials demonstrated the efficacy of prostate-specific membrane antigen (PSMA) radioligand therapy (PSMA RLT) in metastatic castration-resistant prostate cancer (mCRPC). While the VISION trial used criteria within PSMA PET/CT for inclusion, the TheraP trial used dual tracer imaging including FDG PET/CT. Therefore, we investigated whether the application of the VISION criteria leads to a benefit in overall survival (OS) or progression-free survival (PFS) for men with mCRPC after PSMA RLT. Thirty-five men with mCRPC who had received PSMA RLT as a last-line option and who had undergone pretherapeutic imaging with FDG and [68Ga]Ga-PSMA I&T or [18F]PSMA-1007 were studied. Therapeutic eligibility was retrospectively evaluated using the VISION and TheraP study criteria. 26 of 35 (74%) treated patients fulfilled the VISION criteria (= VISION+) and only 17 of 35 (49%) fulfilled the TheraP criteria (= TheraP+). Significantly reduced OS and PFS after PSMA RLT was observed in patients rated VISION- compared to VISION+ (OS: VISION-: 3 vs. VISION+: 12months, hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.0-9.1, p < 0.01; PFS: VISION-: 1 vs. VISION+: 5months, HR 2.7, 95% CI 1.0-7.8, p < 0.01). For patients rated TheraP-, no significant difference in OS but in PFS was observed compared to TheraP+ patients (OS: TheraP-: 5.5 vs. TheraP+: 11months, HR 1.6, 95% CI 0.8-3.3, p = 0.2; PFS: TheraP-: 1 vs. TheraP+: 6months, HR 2.2, 95% CI 1.0-4.5, p < 0.01). Retrospective application of the inclusion criteria of the VISION study leads to a benefit in OS and PFS after PSMA RL, whereas TheraP criteria appear to be too strict in patients with end-stage prostate cancer. Thus, performing PSMA PET/CT including a contrast-enhanced CT as proposed in the VISION trial might be sufficient for treatment eligibility of end-stage prostate cancer patients.

Self-Transcendence: Association with Spirituality in an Italian Sample of Terminal Cancer Patients.

Terminally ill cancer patients often experience demoralization and loss of dignity, which undermines their spiritual wellbeing, which could, however, be supported by the presence of other factors such as self-transcendence and religious coping strategies. To assess self-transcendence and religious coping strategies and how they influence spirituality, we studied 141 end-stage cancer patients (64.3% male; mean age 68.6 ± 14.6) with a Karnofsky Performance Status ≤ 50 and a life expectancy ≤ 4 months using the Self-Transcendence Scale, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-Sp-12), the Brief Religious COPE, and the Patient Dignity Inventory. To understand the effects of these variables on spirituality, hierarchical multiple regression was performed on FACIT-Sp-12. The final model predicted 67% of the variance in spiritual wellbeing. Demoralization was the strongest influencing factor (β = -0.727, p < 0.001), followed by self-transcendence (β = 0.256, p < 0.001), and positive religious coping (β = 0.148, p < 0.05). This study suggests that self-transcendence and positive religious coping may be protective factors for spirituality in terminal cancer patients. These factors should be considered in treatment to promote spiritual wellbeing and improve patients' quality of life at the end of life.

Deep Learning Prediction Model for Patient Survival Outcomes in Palliative Care Using Actigraphy Data and Clinical Information.

(1) Background: Predicting the survival of patients in end-of-life care is crucial, and evaluating their performance status is a key factor in determining their likelihood of survival. However, the current traditional methods for predicting survival are limited due to their subjective nature. Wearable technology that provides continuous patient monitoring is a more favorable approach for predicting survival outcomes among palliative care patients. (2) Aims and objectives: In this study, we aimed to explore the potential of using deep learning (DL) model approaches to predict the survival outcomes of end-stage cancer patients. Furthermore, we also aimed to compare the accuracy of our proposed activity monitoring and survival prediction model with traditional prognostic tools, such as the Karnofsky Performance Scale (KPS) and the Palliative Performance Index (PPI). (3) Method: This study recruited 78 patients from the Taipei Medical University Hospital's palliative care unit, with 66 (39 male and 27 female) patients eventually being included in our DL model for predicting their survival outcomes. (4) Results: The KPS and PPI demonstrated an overall accuracy of 0.833 and 0.615, respectively. In comparison, the actigraphy data exhibited a higher accuracy at 0.893, while the accuracy of the wearable data combined with clinical information was even better, at 0.924. (5) Conclusion: Our study highlights the significance of incorporating clinical data alongside wearable sensors to predict prognosis. Our findings suggest that 48 h of data is sufficient for accurate predictions. The integration of wearable technology and the prediction model in palliative care has the potential to improve decision making for healthcare providers and can provide better support for patients and their families. The outcomes of this study can possibly contribute to the development of personalized and patient-centered end-of-life care plans in clinical practice.

Feasibility and early clinical impact of precision medicine for late-stage cancer patients in a regional public academic hospital

AimOur goal was to describe a precision medicine program in a regional academic hospital, characterize features of included patients and present early data on clinical impact.Materials and methodsWe prospectively included 163 eligible patients with late-stage cancer of any diagnosis from June 2020 to May 2022 in the Proseq Cancer trial. Molecular profiling of new or fresh frozen tumor biopsies was done by WES and RNAseq with parallel sequencing of non-tumoral DNA as individual reference. Cases were presented at a National Molecular Tumor Board (NMTB) for discussion of targeted treatment. Subsequently, patients were followed for at least 7 months.Results80% (N = 131) of patients had a successful analysis done, disclosing at least one pathogenic or likely pathogenic variant in 96%. A strongly or potentially druggable variant was found in 19% and 73% of patients, respectively. A germline variant was identified in 2.5%. Median time from trial inclusion to NMTB decision was one month. One third (N = 44) of patients who underwent molecularly profiling were matched with a targeted treatment, however, only 16% were either treated (N = 16) or are waiting for treatment (N = 5), deteriorating performance status being the primary cause of failure. A history of cancer among 1st degree relatives, and a diagnosis of lung or prostate cancer correlated with greater chance of targeted treatment being available. The response rate of targeted treatments was 40%, the clinical benefit rate 53%, and the median time on treatment was 3.8 months. 23% of patients presented at NMTB were recommended clinical trial participation, not dependent on biomarkers.ConclusionsPrecision medicine in end-stage cancer patients is feasible in a regional academic hospital but should continue within the frame of clinical protocols as few patients benefit. Close collaboration with comprehensive cancer centers ensures expert evaluations and equality in access to early clinical trials and modern treatment.

Intravenous Infusion of High Dose Selenite in End-Stage Cancer Patients: Analysis of Systemic Exposure to Selenite and Seleno-Metabolites

Cancer is one of the main causes of human death globally and novel chemotherapeutics are desperately required. As a simple selenium oxide, selenite is a very promising chemotherapeutic because of pronounced its dose-dependent tumor-specific cytotoxicity. We previously published a first-in-man systematic phase I clinical trial in patients with cancer (from IV to end-stage) (the SECAR trial) showing that selenite is safe and tolerable with an unexpectable high maximum tolerated dose (MTD) and short half-life. In the present study, we analyzed the selenium species in plasma samples, from the patients participating in the SECAR trial and from various time points and dose cohorts using LC-ICP-MS. In conclusion, selenite, selenosugars, and 1-2 unidentified peaks that did not correspond to any standard, herein denoted ui-selenium, were detected in the plasma. However, trimethylated selenium (trimethylselenonoium) was not detected. The unidentified ui-selenium was eluting close to the selenium-containing amino acids (selenomethionine and selenocysteine) but was not part of a protein fraction. Our data demonstrate that the major metabolite detected was selenosugar. Furthermore, the identification of selenite even long after the administration is remarkable and unexpected. The kinetic analysis did not support that dosing per the body surface area would reduce interindividual variability of the systemic exposure in terms of trough concentrations.

Antibiotic Treatment in End Stage Cancer Patients; Advantages and Disadvantages

In this study our aim was to elucidate whether advanced cancer patients benefit from antibiotic treatment in the last days of life in addition to reviewing the relevant costs and effects. We reviewed medical records from 100 end-stage cancer patients and their antibiotic use during the hospitalization in Imam Khomeini hospital. Patient's medical records were analyzed retrospectively for cause and periodicity of infections, fever, increase in acute phase proteins, cultures, type and cost of antibiotic. Microorganisms were found in only 29 patients (29%) and the most microorganism among the patients was E. coli (6%). About 78% of the patients had clinical symptoms. The highest dose of antibiotics was related to Ceftriaxone (40.2%) and in the second place was Metronidazole (34.7%) and the lowest dose was related to Levofloxacin, Gentamycin and Colistin (1.4%). Fifty-one patients (71%) did not have any side effects due to antibiotics. The most common side effect of antibiotics among patients was skin rash (12.5%). The average estimated cost for antibiotic use was 7 935 540 Rials (24.4 dollars). Prescription of antibiotics was not effective in symptom control in advanced cancer patients. The cost of using antibiotics during hospitalization is very high and also the risk of developing resistant pathogens during admission should be considered. Antibiotic side effects also occur in patients, causing more harm to the patient at the end of life. Therefore, the benefits of antibiotic advice in this time is less than its negative effects.

Effect of Community-Based Health Education on Misconceptions Related to Caregiving for Cancer among Elderly in a Rural Area of Puducherry: A Pre-Post-Intervention Study.

Families are crucial in providing comprehensive support to cancer patients, including physical, psychological, spiritual, and financial assistance. Unfortunately, cancer-related myths and stigma can have detrimental effects on those affected and their caregivers. This study aims to remove the misconceptions prevailing in a rural population of Puducherry regarding caregiving for cancer among elderly through a health education campaign. A pre- and post-intervention study was conducted among 217 adults above 18 years of age in a rural area of Puducherry. The intervention was delivered through pamphlet distribution, health talks, and discussion. Attitude, beliefs, and knowledge regarding the misconceptions about cancer were assessed in a five-point Likert scale and then the difference in the proportion of subjects with misconceptions about cancer before and after the intervention was tested using the McNemar test. Among the respondents, 77% were females, 15% were illiterate, and 9.6% had a history of cancer in the family. About 23% felt cancer lends a bad name to the family and 24% considered palliative care as not necessary since end-stage cancer patients would die. Post-intervention, the perception that herbal items or diets may treat cancer declined from 45% to 18%, and that a cancer patient in the family lends bad name to the family declined from 23% to 3% (P < 0.001). Community-based intervention can effectively reduce misconceptions related to caregiving for cancer among elderly in rural areas. These interventions can also improve the quality of care and support provided to cancer patients.

Chronic grief experiences of nurses caring for the end-stage cancer patients: A mixed-method research.

: Caring patients with terminal illness is one of the most challenging and difficult experiences encountered by nurses. Though they face immense grief while preparing these patients and their families to accept the illness, the grief experienced by the nurse is reported to be an insignificant entity due to their professional role and commitment to duty. On the other hand, ignoring this caring relationship can foster emotional burden and physical exhaustion among nurses leading to ineffective quality care. The present study aimed to capture the chronic grief experiences and the coping strategies of nurses caring for patients with advanced cancers. : A sequential explanatory mixed-method design was adopted for the study. From September 2016 till March 2017, 50 nurses from three oncology care hospitals in Mangalore were selected using purposive sampling (homogeneous sampling). Modified grief experience inventory followed with in-depth interviews with the oncology nurses to identify their grief, work-related challenges, bereavement, and coping strategies was carried out. Quantitative analysis was carried out using SPSS version 16. Interviews were analyzed using Colaizzi's method of qualitative analysis, and a meta-matrix was developed to merge the results. : The mean numbers of nurses who experienced moderate level of grief are 83.24 (standard deviation: ± 17.4, range: 51-125). Six themes emerged from the interviews were grief over circumstances, sense of powerlessness, physical and emotional exhaustion, engaging in self-controlling behaviors, self-nurturance, and compassion satisfaction. : Nurses face unique challenges while caring for patients with end-stage cancer, but timely debriefing strategies could be further explored to improve these experiences and improve nurse's efficiency in providing quality care to these patients.

Next-Generation 3D Scaffolds for Nano-Based Chemotherapeutics Delivery and Cancer Treatment.

Cancer is the leading cause of death after cardiovascular disease. Despite significant advances in cancer research over the past few decades, it is almost impossible to cure end-stage cancer patients and bring them to remission. Adverse effects of chemotherapy are mainly caused by the accumulation of chemotherapeutic agents in normal tissues, and drug resistance hinders the potential therapeutic effects and curing of this disease. New drug formulations need to be developed to overcome these problems and increase the therapeutic index of chemotherapeutics. As a chemotherapeutic delivery platform, three-dimensional (3D) scaffolds are an up-and-coming option because they can respond to biological factors, modify their properties accordingly, and promote site-specific chemotherapeutic deliveries in a sustainable and controlled release manner. This review paper focuses on the features and applications of the variety of 3D scaffold-based nano-delivery systems that could be used to improve local cancer therapy by selectively delivering chemotherapeutics to the target sites in future.

General Ward Nurses' Self-Efficacy, Ethical Behavior, and Practice of Discharge Planning for End-Stage Cancer Patients: Path Analysis.

General ward nurses play a key role in discharge planning for end-stage cancer patients. It is necessary to assess the factors regarding their practice to promote discharge planning in accordance with end-stage cancer patients’ wishes. This study aimed to investigate the relationships between general ward nurses’ practice of discharge planning for end-stage cancer patients, self-efficacy, ethical behavior, attitude, knowledge and experience, perceived skills, and perceived barriers. A total of 288 general ward nurses from nine hospitals in a city in Japan completed the questionnaire. Path analysis was conducted to test the hypotheses. The results showed that nurses’ self-efficacy, ethical behavior (do-no-harm, do-good), knowledge (experience of attending home care seminars), and perceived skills (assertiveness) were positively and directly related to the practice of discharge planning. Nursing experience and perceived skills (assertiveness) were positively associated with discharge planning practice, while perceived barriers (death discussion) and attitude (degree of leaving it to discharge planning nurses (DPNs)) were negatively associated, with self-efficacy acting as a mediator. Thus, our findings show that it is important to enhance self-efficacy and nursing ethical behavior to improve the practice of discharge planning. Accordingly, education regarding home care, assertive communication skills, death discussion, and ethics is needed for general ward nurses.

PENGALAMAN PERAWATAN KANKER KOLON STADIUM AKHIR: CASE STUDY

Cancer is a non-communicable disease caused by the increase and growth of cells that grow abnormally in the body. Colon cancer is the third most common malignant cancer in the world. Problems that often arise in cancer patients include physical and non-physical problems. In addition to causing physical problems, cancer also causes psychological, social and economic problems. This study aims to describe the experiences of end-stage colon cancer patients. Qualitative research phenomenological study design, data collection method was in-depth interviews. The research site was at RSI Sultan Agung Semarang, the time of the study was from April to May 2020. The participants in this study were 3 end-stage colon cancer patients, with the criteria of participants suffering from end-stage colon cancer, adults over 18 years old, cooperative and able to communicate and communicate with each other. willing to be a participant. This study found 4 themes, namely when participants were diagnosed with colon cancer (1), the process of grieving colon cancer participants (2), changes in activities and social interactions experienced by participants (3), and participants' spiritual changes during illness (4). Conclusion: Initially, participants were diagnosed with colon cancer, namely signs of symptoms and chronology of participants being diagnosed, the grieving process for colon cancer participants consisted of feelings when diagnosed and considered it as destiny, changes in activities and social interactions experienced by participants, namely there were changes in the activities and relationships of participants' social interactions, and the spiritual changes of participants during illness consist of belief in healing from illness and changes in worship practices.

Investigation of the Attitude and Perceptions of Anesthesiologist and General Practitioners on Referring Patients to Palliative Care Centers: A Survey Study

Objective: Physicians’ approaches are important in refering patients to palliative care centers (PCC). We aimed to evaluate the perceptions and attitudes of general practitioners and anesthesiologist on patient referral. Methods: Anesthesiologist and general practitioners were included in a face to face or telephone interview method survey; predefined written forms were used to collect data and results were analyzed. Results: The research was completed with 207 participants. Groups were different regarding their knowledge about PC, most of the general practitioners responded “I know a litle” and anesthesiologists responded “I know what it is, I can explain it to someone else” (p=0.002). The answers to the question of which patients should be referred to PCC (“End-stage cancer patients” [p=0.018], “Patients referred home care services” [p=0.003] and “Patients having chronic ilness without adequate symptom control” [p=0.004], “Patients having total parenteral nutrition” [p=0.001], “Precence of pressure ulcer” [p&lt;0.001], “Patients refusing discharge” [p=0.037] ) were different between anesthesiologists and general practitioners. Conclusion: Anesthesiologists and general practitioners refer patients with different diagnoses and conditions to PCC and knowledge about patient referral to PC is different. Keywords: Palliative care, anesthesiologist, general practitioner, survey

Deep-Learning Approach to Predict Survival Outcomes Using Wearable Actigraphy Device Among End-Stage Cancer Patients.

Survival prediction is highly valued in end-of-life care clinical practice, and patient performance status evaluation stands as a predominant component in survival prognostication. While current performance status evaluation tools are limited to their subjective nature, the advent of wearable technology enables continual recordings of patients' activity and has the potential to measure performance status objectively. We hypothesize that wristband actigraphy monitoring devices can predict in-hospital death of end-stage cancer patients during the time of their hospital admissions. The objective of this study was to train and validate a long short-term memory (LSTM) deep-learning prediction model based on activity data of wearable actigraphy devices. The study recruited 60 end-stage cancer patients in a hospice care unit, with 28 deaths and 32 discharged in stable condition at the end of their hospital stay. The standard Karnofsky Performance Status score had an overall prognostic accuracy of 0.83. The LSTM prediction model based on patients' continual actigraphy monitoring had an overall prognostic accuracy of 0.83. Furthermore, the model performance improved with longer input data length up to 48 h. In conclusion, our research suggests the potential feasibility of wristband actigraphy to predict end-of-life admission outcomes in palliative care for end-stage cancer patients.Clinical Trial Registration: The study protocol was registered on ClinicalTrials.gov (ID: NCT04883879).

End-Stage Cancer Patients Diagnosed with a Femoral Pathological Fracture on Admission to Palliative Care Units.

Background:Femoral pathological fractures (PFs) due to bone metastasis result in exacerbation of pain, gait disturbance, and reduced general condition. Surgery may be considered depending on the situation, but is not suggested often, and treatment is difficult toward the end of life.Objective:Terminal cancer patients with a femoral PF admitted to a palliative care unit (PCU) were retrospectively evaluated.Measurement:Seven cancer patients diagnosed with a femoral PF at a PCU on admission, in Japan, were examined for clinical background, physical symptoms, and psychiatric symptoms. In addition, the responses of the patients' families and medical staff were examined. This study was approved by the ethics board of our hospital.Results:A total of 28.6% of patients were hospitalized from home, and the trigger for PF could not be confirmed in 85.7% of patients. In all cases, surgery was not recommended, given the poor prognosis. Opioid drugs were used for pain in all patients, and 85.7% of patients were able to relieve their symptoms. Delirium was observed in 71.4% of cases, and treatment with antipsychotics was required in all cases. Family grief also emerged as a problem, and the staff was burdened; hence, we addressed this at the death conference.Conclusions:Even for femoral PFs in cancer patients with a limited prognosis, it is necessary to perform tests and control pain. In addition, it is important to support the mental distress of patients and their families in a short period; medical staff should be trained to support the families after the patients' death.

First-In-Human Results on the Biodistribution, Pharmacokinetics, and Dosimetry of [177Lu]Lu-DOTA.SA.FAPi and [177Lu]Lu-DOTAGA.(SA.FAPi)2.

Recently, great interest has been gained regarding fibroblast activation protein (FAP) as an excellent target for theranostics. Several FAP inhibitor molecules such as [68Ga]Ga-labelled FAPI-02, 04, 46, and DOTA.SA.FAPi have been introduced and are highly promising molecular targets from the imaging point of view. FAP inhibitors introduced via bifunctional DOTA and DOTAGA chelators offer the possibility to complex Lutetium-177 due to an additional coordination site, and are suitable for theranostic applications owing to the increased tumor accumulation and prolonged tumor retention time. However, for therapeutic applications, very little has been accomplished, mainly due to residence times of the compounds. In an attempt to develop a promising therapeutic radiopharmaceutical, the present study aimed to evaluate and compare the biodistribution, pharmacokinetics, and dosimetry of [177Lu]Lu-DOTA.SA.FAPi, and [177Lu]Lu-DOTAGA.(SA.FAPi)2 in patients with various cancers. The FAPi agents, [177Lu]Lu-DOTA.SA.FAPi and [177Lu]Lu-DOTAGA.(SA.FAPi)2, were administered in two different groups of patients. Three patients (mean age—50 years) were treated with a median cumulative activity of 2.96 GBq (IQR: 2.2–3 GBq) [177Lu]Lu-DOTA.SA.FAPi and seven (mean age—51 years) were treated with 1.48 GBq (IQR: 0.6–1.5) of [177Lu]Lu-DOTAGA.(SA.FAPi)2. Patients in both the groups underwent serial imaging whole-body planar and SPECT/CT scans that were acquired between 1 h and 168 h post-injection (p.i.). The residence time and absorbed dose estimate in the source organs and tumor were calculated using OLINDA/EXM 2.2 software. Time versus activity graphs were plotted to determine the effective half-life (Te) in the whole body and lesions for both the radiotracers. Physiological uptake of [177Lu]Lu-DOTA.SA.FAPi was observed in the kidneys, colon, pancreas, liver, gall bladder, oral mucosa, lacrimal glands, and urinary bladder contents. Physiological biodistribution of [177Lu]Lu-DOTAGA.(SA.FAPi)2 involved liver, gall bladder, colon, pancreas, kidneys, and urinary bladder contents, lacrimal glands, oral mucosa, and salivary glands. In the [177Lu]Lu-DOTA.SA.FAPi group, the highest absorbed doses were noted in the kidneys (0.618 ± 0.015 Gy/GBq), followed by the colon (right colon: 0.472 Gy/GBq and left colon: 0.430 Gy/GBq). In the [177Lu]Lu-DOTAGA.(SA.FAPi)2 group, the colon received the highest absorbed dose (right colon: 1.160 Gy/GBq and left colon: 2.870 Gy/GBq), and demonstrated a significantly higher mean absorbed dose than [177Lu]Lu-DOTA.SA.FAPi (p < 0.011). [177Lu]Lu-DOTAGA.(SA.FAPi)2 had significantly longer median whole-body Te compared to that of [177Lu]Lu-DOTA.SA.FAPi [46.2 h (IQR: 38.5–70.1) vs. 23.1 h (IQR: 17.8–31.5); p-0.0167]. The Te of tumor lesions was significantly higher for [177Lu]Lu-DOTAGA.(SA.FAPi)2 compared to [177Lu]Lu-DOTA.SA.FAPi [86.6 h (IQR: 34.3–94.6) vs. 14 h (IQR: 12.8–15.5); p-0.0004]. The median absorbed doses to the lesions were 0.603 (IQR: 0.230–1.810) Gy/GBq and 6.70 (IQR: 3.40–49) Gy/GBq dose per cycle in the [177Lu]Lu-DOTA.SA.FAPi, and [177Lu]Lu-DOTAGA.(SA.FAPi)2 groups, respectively. The first clinical dosimetry study demonstrated significantly higher tumor absorbed doses with [177Lu]Lu-DOTAGA.(SA.FAPi)2 compared to [177Lu]Lu-DOTA.SA.FAPi. [177Lu]Lu-DOTAGA.(SA.FAPi)2 is safe and unveiled new frontiers to treat various end-stage cancer patients with a theranostic approach.