Mortality In Cancer Patients Research Articles

Deep Vein Thrombosis and Cancer: Survival, Recurrence, and Anticoagulant Choices

pproximately one-quarter of all cases of venous thromboembolism VTE) are related to underlying malignancy. In patients with newly iagnosed VTE, about 20% already have cancer, while in patients with diopathic VTE, about 10% are diagnosed with malignancy within the ext 12 months. Consequently, many physicians are faced with the hallenging task of managing VTE in cancer patients, in whom the risks f recurrent thrombosis and serious bleeding are high. Furthermore, given hat the life expectancy of cancer patients with VTE is significantly horter than similar cancer patients without this complication, quality f life is a particularly important consideration when treating these atients. The reasons for the higher mortality rate in cancer patients with TE are unknown, but possible explanations include premature death rom fatal pulmonary embolism (PE); VTE being a paraneoplastic marker of ggressive malignancies; or activation of coagulation promoting tumor rowth. Evidence is now emerging that low-molecular-weight heparins LMWHs) may be able to interrupt this latter process and improve patient urvival. nitial Therapy of VTE ow-Molecular-Weight Heparin or Unfractionated eparin

Carcinoembryonic antigen (CEA) as an independent prognostic factor in colorectal carcinoma

CEA is widely used in the follow up of patients with colorectal carcinoma. To study the value of preoperative CEA as an independent prognostic factor in colorectal carcinoma. Analysis of 373 operated patients (204 females, age range 21-92 years) with colorectal carcinoma and a mean follow up of 53 months. The cutoff value for CEA was 5 ng/ml. Ninety four percent of patients had an excisable tumor, 79% had involvement of perirectal/pericolonic adipose tissue and 46% had lymph node involvement. Staging was done using Dukes-Turnbull and TNM classifications. CEA was normal in 61% of cases, over 5 ng/ml in 39% and over 15 ng/ml in 22%. There was a strong correlation between mean preoperative CEA and tumor stage, depth and lymph node involvement. During the follow up, 140 patients died, 57 with normal and 83 with elevated CEA. Cancer mortality in patients subjected to a curative excision of the tumor (Dukes A-C2/TNM I-III) was 9% for colonic tumors and 36% for rectal tumors (p < 0.001). There were no survival differences in patients with Dukes B/TNM II tumors according to preoperative CEA. Among Dukes C/TNM III tumors, survival difference was only significant for rectal tumors. A Cox model disclosed tumor stage, location and preoperative CEA as independent prognostic factors for survival. CEA is an independent prognostic factor for survival in colorectal carcinoma and high levels suggest an advanced disease.

Low-Molecular-Weight Heparin and Cancer Survival: Review of the Literature and Pooled Analysis of 1,726 Patients Treated for at Least Three Months

Background: Heparin has been the main subject of intensive investigation and clinical use because of its therapeutic anticoagulant properties. It also exhibits many other biological activities, and it was claimed that it shows a beneficial effect on cancer spreading. Searching for papers investigating the effect of low-molecular-weight heparin (LMWH) on cancer mortality we found clinical trials and meta-analyses which showed a reduction in the mortality rate in cancer patients. However, the biological rationale of this effect for a short treatment with LMWH remains unclear. We wanted to check if similar results were achieved in cancer patients treated with LMWH for a longer period of time. Aim: To evaluate the effect on cancer mortality of a 3-month treatment with LMWH by performing a meta-analysis of published studies comparing LMWH and oral anticoagulants (OA) in the prevention of recurrent venous thromboembolism (VTE). Materials and Methods: Computerized searches of Medline and Embase were performed; clinical trials were also located through colleagues and hand scanning of meeting proceedings. Eligibility of the studies and extraction of data were performed by two authors using a standard form. The meta-analysis was performed assuming a fixed-effect model. Results: Eight studies were identified that fulfilled our predefined criteria for a total of 1,726 patients. After a mean of 8.6 months of follow-up, 327 patients had died of cancer, 160 in the LMWH group and 167 in the OA control group (OR 0.95, 95% CI 0.73–1.23; z = 0.42; p = 0.67). Considering cancer mortality in 948 cancer patients the figures were 160/472 in the LMWH group and 167/476 in the OA control group (OR 0.96, 95% CI 0.73–1.25; z = 0.33; p = 0.74). Conclusions: In 1,726 patients randomized to receive a long-term course of at least 3 months of LMWH or OA for the treatment of VTE, no effect on cancer mortality was found.

Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control study

Background—Colonoscopic surveillance is a standard procedure in many patients with long standing, extensive ulcerative colitis (UC), in order to avoid death from colorectal cancer. No conclusive proof of its benefits...

Venous Thromboembolism and Gancer: a Two-Way Clinical Association

Venous thromboembolism and cancer are linked by a two way clinical association: venous thromboembolism may be the presenting feature of an occult cancer and patients with clinically overt cancer may develop a venous thromboembolic complication at any stage of their disease. Patients with venous thromboembolism in the absence of conventional risk factors have a 10% likelihood of having cancer. However, the value of investigating for underlying malignant disease in patients with idiopathic venous thrombosis who are otherwise well is still undefined: intensive diagnostic screening versus routine management is under evaluation in a randomised prospective clinical trial. Patients with cancer are at a high risk of developing postoperative venous thromboembolism. Therefore, they require prophylactic measures comparable to those usually recommended for major orthopaedic surgery. Both retrospective and prospective studies have recently focused attention on the thromboembolic risk associated with chemo- and/or hormone therapy in cancer patients. A prospective, double-blind, randomised study showed that very-low-dose warfarin is an effective and safe method for the prevention of thromboembolism in patients with metastatic breast cancer receiving chemotherapy. The evidence of lowered cancer mortality in patients receiving low molecular weight heparins has renewed interest in the antithrombotic agents as antineoplastic drugs. A multicentre study aimed at investigating this fascinating hypothesis is now being carried out.

Prostate Cancer Mortality in Patients Surviving More Than 10 Years After Diagnosis

Prostate Cancer Mortality in Patients Surviving More Than 10 Years After Diagnosis

Prostate Cancer Mortality in Patients Surviving More Than 10 Years After Diagnosis

Purpose We investigated the long-term outcome of prostate cancer. Materials and Methods Causes of death were examined in 490 patients diagnosed with prostate cancer in Goteborg between 1960 and 1979 who survived for longer than 10 years. Results Of the patients 75 were alive and 415 died, including 62 percent as a direct or indirect consequence of prostate cancer. Conclusions Early prostate cancer is a slow growing but progressive malignant disease that will, if the patient survives long enough, kill the host.

Prophylactic colectomy or surveillance for chronic ulcerative colitis? A decision analysis

Background & Aims : The treatment of patients with long-standing ulcerative colitis involving the entire colon is controversial. The aim of this study was to examine the effectiveness of surveillance colonoscopy or prophylactic colectomy on colon cancer mortality in patients with chronic ulcerative colitis. Methods : Using decision analysis, computer cohort simulation of patients with ulcerative colitis was performed to evaluate 17 strategies including no colonoscopic surveillance, surveillance at varying intervals, and prophylactic proctocolectomy with ileal pouch-anal anastomosis. The model examined which biopsy results (low-grade dysplasia, high-grade dysplasia, or cancer) should lead to proctocolectomy and ileal pouch-anal anastomosis. Published data on the incidence of cancer with ulcerative colitis, the sensitivity and specificity of colonoscopy with biopsy, the risks of colonoscopy and surgery, and the prognosis with colon cancer were used. Results : For a 30-year-old patient with pancolitis for 10 years, the model suggests that prophylactic colectomy would increase life expectancy by 2–10 months compared with surveillance and by 1.1−1.4 years compared with no surveillance. Surveillance would improve life expectancy by 7 months to 1.2 years compared with no surveillance. In sensitivity analysis, results were most affected by the cumulative incidence of cancer in patients with chronic ulcerative colitis. Conclusions : Either surveillance or prophylactic colectomy should increase life expectancy in patients with ulcerative colitis.

Cancer incidence and mortality in patients with heart disease. Effect of oral anticoagulant therapy.

Cancer incidence and mortality were reviewed in patients (683) who, during the period 1969-1988, had been attending the Cardiological Center of Pisa University for more than 1 year for valvular (494), ischemic (183), or myocardial (6) disease. Oral anticoagulant therapy (tromexan, acenocoumarol or warfarin) was administered to 312 of these 693 patients and regulated to prolong prothrombin time to a value between 20% and 40% of normal controls. The duration of treatment ranged from 1 to 14 years, with a mean of 4 years. As clinical and radiological controls were performed on all the patients at regular intervals (2-12 months), cancer incidence and mortality were recorded. Cancer incidence and mortality in the 312 patients treated with anticoagulants were compared with that of the 381 patients who did not receive this therapy. Furthermore, cancer mortality in the patients on anticoagulants was compared to that expected on the basis of national tumor registry rates. The age of the patients varied from 20 or under to 80 or over in both groups. The total observation period was 1415 patient-years (555 for males and 860 for females) in the former and 1617 patient-years (735 males and 882 females) in the latter. The proportion of the patient-years of the men over 45 (with the highest risk of cancer mortality) was higher in the group treated with anticoagulants (83%) than in the controls (72%) (p < .001). The proportion of the patient-years of the women over 45 was also higher in the former (84% vs 62%; p < .001). Six cancers were observed in the patients treated with oral anticoagulants (3 men, 3 women), while 12 cancers occurred in the control group (9 men, 3 women). There were 3 deaths in the former (1 man, 2 women) and 6 in the latter (5 men, 1 woman). On the basis of the national tumor registry rates, deaths expected in men and women on oral anticoagulants were 3 and 2. These data are compatible with the hypothesis that oral anticoagulants might reduce cancer incidence and mortality in humans.