Palliative Benefit Research Articles

Impact of Environment and Milieu Therapy in Palliative Care.

The collaborative approach offered by palliative care benefits both patients and their caregivers. They provide a system of support that enables patients to lead as active a life as possible. This integrative review aimed to find out whether milieu and environment therapy has a significant impact on palliative care patients. Analyses and summaries of seventeen (17) papers were completed. There were three themes identified: environmental factors for quality of life, milieu therapy in forms of arts and music, and milieu therapy is safe, structured, and psychotherapeutic. This review demonstrates that milieu and environment therapy may also help to reduce physical symptoms, such as pain, and enhance quality of life. The study suggests that even if there are many interventions for palliative patients, more research is needed to generate a more thorough evaluation of the efficacy of various environmental control components and milieu therapies for palliative care patients.

Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer

Specialist palliative care benefits patients undergoing medical treatment of cancer; however, data are lacking on whether patients undergoing surgery for cancer similarly benefit from specialist palliative care. To determine the effect of a specialist palliative care intervention on patients undergoing surgery for cure or durable control of cancer. This was a single-center randomized clinical trial conducted from March 1, 2018, to October 28, 2021. Patients scheduled for specified intra-abdominal cancer operations were recruited from an academic urban referral center in the Southeastern US. Preoperative consultation with palliative care specialists and postoperative inpatient and outpatient palliative care follow-up for 90 days. The prespecified primary end point was physical and functional quality of life (QoL) at postoperative day (POD) 90, measured by the Functional Assessment of Cancer Therapy-General (FACT-G) Trial Outcome Index (TOI), which is scored on a range of 0 to 56 with higher scores representing higher physical and functional QoL. Prespecified secondary end points included overall QoL at POD 90 measured by FACT-G, days alive at home until POD 90, and 1-year overall survival. Multivariable proportional odds logistic regression and Cox proportional hazards regression models were used to test the hypothesis that the intervention improved each of these end points relative to usual care in an intention-to-treat analysis. A total of 235 eligible patients (median [IQR] age, 65.0 [56.8-71.1] years; 141 male [60.0%]) were randomly assigned to the intervention or usual care group in a 1:1 ratio. Specialist palliative care was received by 114 patients (97%) in the intervention group and 1 patient (1%) in the usual care group. Adjusted median scores on the FACT-G TOI measure of physical and functional QoL did not differ between groups (intervention score, 46.77; 95% CI, 44.18-49.04; usual care score, 46.23; 95% CI, 43.08-48.14; P = .46). Intervention vs usual care group odds ratio (OR) was 1.17 (95% CI, 0.77-1.80). Palliative care did not improve overall QoL measured by the FACT-G score (intervention vs usual care OR, 1.09; 95% CI, 0.75-1.58), days alive at home (OR, 0.87; 95% CI, 0.69-1.11), or 1-year overall survival (hazard ratio, 0.97; 95% CI, 0.50-1.88). This randomized clinical trial showed no evidence that early specialist palliative care improves the QoL of patients undergoing nonpalliative cancer operations. ClinicalTrials.gov Identifier: NCT03436290.

Abstract 3065: Increased longevity and quality of life with treatment with a progesterone receptor modulator in a patient with treatment resistant stage IV small cell lung cancer

Abstract The progesterone receptor modulator, mifepristone, has been found to provide extension of life by years and marked palliative benefits in several cases of non-small cell lung cancer (NSCLC) despite progression with platinum-based chemotherapy, check-point inhibitors, and third-generation tyrosine inhibitors. Presented here is a case of small cell lung cancer (SCLC) treated with mifepristone. This patient was diagnosed at age 58 with stage IV NSCLC with EGFR deletion 19 mutation. He was treated with single agent osimertinib 80mg once/day. Two months later his serial CT scan showed improvement. He was treated with stereotactic ablative radiotherapy for one persisting lesion. He was able to conduct a very active life. However, clinical symptoms started to return after 8 months, and CT of the chest showed slightly increased size of a the previously treated right upper lobe mass with increased small right effusion, increased pleural nodularity, and new interlobular septal thickening. Biopsy of the pleural mass showed transformation to SCLC. He failed a clinical trial. He began mifepristone orally 200mg/day. Within 1 month he was able to resume normal activity including strenuous sports. CT scans 2 months later showed no longer any pleural effusions, pleural nodularity, or growth of the persisting nodule that had been previously radiated. His absence of clinical symptoms continued for 10 more months but CT now showed slight growth of the persisting lesion. He assumed that with the growth that mifepristone was losing its effectiveness, and after consultation with another oncologist, elected to be treated in another clinical study for a new promising drug for SCLC that precluded him from continuing mifepristone. He died 5 months later. The main benefit of mifepristone is believed to be by blocking membrane rather than nuclear progesterone receptors (PRs) that are responsible for producing an immunosuppressive protein called the progesterone induced blocking factor which allows various cancers to spread. A previous case of stage IV NSCLC without any tumor markers treated with mifepristone had no growth and good health x 2 ½ years when 1 lesion begins to grow slowly. His oncologist suggested stopping mifepristone and try a check-point inhibitor. Instead, he continued mifepristone. He died 3 years later from pneumonia still feeling quite well while the one lesion continued to grow slowly. Another case of rapidly progressing lung cancer diagnosed by CT scan corrected her severe hypoxia (PO2 70 mmHg) and hyponatremia (serum Na+ of 118 mmol/L) after 1 month of taking mifepristone. Her lesions mostly disappeared and 5 years later she died of a myocardial infarction. Though clinically suspicious of SCLC, it was not biopsy proven. Hopefully this case will inspire a clinical trial of PR antagonists for SCLC. Citation Format: Jerome H. Check, Carrie Wilson, Diane Check, Trina Poretta, Maya Srivastava. Increased longevity and quality of life with treatment with a progesterone receptor modulator in a patient with treatment resistant stage IV small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3065.

Emergency medical services and palliative care: a scoping review

ObjectivesThe aim of this study was to map existing emergency medical services (EMS) and palliative care literature by answering the question, what literature exists concerning EMS and palliative care? The...

Lung Cancer - Standard Therapy and the Use of a Novel, Highly Effective, Well Tolerated, Treatment With Progesterone Receptor Modulators.

The most recent successful advances in lung cancer therapy have directly and increasingly focused on personalized tumor genetic/epigenetic/immunologic profiling, and the identification and development of novel pharmacologic agents aimed at those mutations [e.g., epidermal growth factor receptor (EGFR), Kristen rat sarcoma viral oncogene homolog (KRAS), anaplastic lymphoma kinase (ALK) and immunotherapy against programmed cell death protein 1 (PD-1) and its ligands] which have extended life and provided palliation for lung cancer-patients positive for these mutations. The objective of this study is to provide a review of the large number of drugs and their efficacy as of 2022, for lung cancer, but also introduce a novel treatment that has the potential, based on one controlled murine lung cancer study and 5 anecdotal human cases, that showed marked palliative and longevity benefits in very advanced lung cancer with no other treatment options, i.e., progesterone receptor (PR) antagonists targeting the immunosuppressive protein, the progesterone induced blocking factor (PIBF). Credibility, however, will only be provided when the efficacy can be demonstrated in a large series of lung cancer cases ideally with certain controls. Thus, the ultimate objective of the review is to interest oncologists with a large population of lung cancer patients to perform a well powered study to corroborate or refute the limited experience to date with PR antagonist therapy.

Evaluating a novel hospital-based online health community to address palliative and psychosocial care factors for chronically ill adolescent and young adult patients.

Chronically ill adolescent and young adult (AYA) patients experience barriers to accessing psychosocial care. AYAs who receive palliative and psychosocial care experience numerous benefits from these services. However, we still lack research investigating age-appropriate programs targeting AYAs' psychosocial needs that are delivered virtually and extend beyond the hospital setting. Streetlight is a palliative care program designed for chronically ill AYAs that offers the Streetlight Gaming League (SGL), an online health community (OHC) combining peer-based support, online gaming, and community events. We evaluated the usefulness, acceptability, and potential effectiveness of SGL through an assessment of chronically ill AYAs' lived experiences. We used a qualitative evaluation approach grounded in hermeneutic phenomenology. Questionnaires and interviews were conducted with 9 chronically ill AYAs to elicit in-depth accounts of their lived experiences of using SGL. Descriptive statistical analysis was performed on questionnaire data. Phenomenological data analysis, informed by hermeneutic analysis, was used to analyze interviews. AYAs reported positive experiences with SGL and valued the ability to engage in various content while having few participation expectations. They also described psychosocial benefits, including reprieve from illness, sense of community, and solidarity through mutual understandings and shared experiences. Findings highlight the usefulness and acceptability of a virtual palliative psychosocial care program for chronically ill AYAs. Findings also suggest the effectiveness of SGL and support using an OHC to meet the psychosocial needs of AYAs. This study can guide future programming and implementation of online palliative psychosocial care programs in other hospital settings, resulting in similar beneficial and meaningful experiences.

Nanoformulations as a strategy to overcome the delivery limitations of cannabinoids.

Medical cannabis has received significant interest in recent years due to its promising benefits in the management of pain, anxiety, depression and neurological and movement disorders. Specifically, the major phytocannabinoids derived from the cannabis plant such as (-) trans-Δ9 -tetrahydrocannabinol (THC) and cannabidiol (CBD), have been shown to be responsible for the pharmacological and therapeutic properties. Recently, these phytocannabinoids have also attracted special attention in cancer treatment due to their well-known palliative benefits in chemotherapy-induced nausea, vomiting, pain and loss of appetite along with their anticancer activities. Despite the enormous pharmacological benefits, the low aqueous solubility, high instability (susceptibility to extensive first pass metabolism) and poor systemic bioavailability restrict their utilization at clinical perspective. Therefore, drug delivery strategies based on nanotechnology are emerging to improve pharmacokinetic profile and bioavailability of cannabinoids as well as enhance their targeted delivery. Here, we critically review the nano-formulation systems engineered for overcoming the delivery limitations of native phytocannabinoids including polymeric and lipid-based nanoparticles (lipid nano capsules (LNCs), nanostructured lipid carriers (NLCs), nanoemulsions (NE) and self-emulsifying drug delivery systems (SEDDS)), ethosomes and cyclodextrins as well as their therapeutic applications.

Perceptions and Reality of Antimicrobial Prescribing During the Transition to Comfort Measures Only at an Academic Medical Center.

Little is known about antimicrobial prescribing when patient care is transitioned to comfort measures only (CMO). We used a multidisciplinary survey and retrospective cohort study to gain insight into antimicrobial prescribing in this population at an academic medical center to inform future antimicrobial stewardship interventions. A survey focusing on antimicrobial prescribing during the transition to CMO was electronically distributed to providers in medical subspecialities and responses were compared across specialties. A retrospective chart review was performed of patients admitted to an academic medical center in 2020 who were on antimicrobials in the 48 hours prior to CMO. We investigated the percentage of patients who remained on antimicrobials after the transition to CMO and rationale for continuing antimicrobials. We received 113 survey responses (35% response rate). Forty-one percent of respondents indicated that they "sometimes" or "often" continued antimicrobials during the transition to CMO. Patient/family preference and symptom palliation were the most common factors cited by respondents when deciding whether to continue antimicrobials in this population. Of the 546 patient charts reviewed, 140 (26%) patients were alive 48 hours after CMO order, and 19 (14%) of those patients remained on antimicrobials. Five of 19 (26%) patients had documentation that antimicrobials were continued due to patient/family preference and 5 of 19 (26%) patients had documentation that antimicrobials were continued for palliation of symptoms. Patient/family preference and symptom palliation are important factors in prescribing antimicrobials when patient care is transitioned to CMO. More evidence is needed regarding palliative benefits of antibiotics to inform provider discussions of benefits and harms of antimicrobial use in this setting.

Cancer palliative care referral: patients’ and family caregivers’ perspectives – a systematic review

BackgroundDespite the evidence of palliative care benefits, referrals are infrequent and delayed. Patients and their caregivers are essential stakeholders in the referral process with valuable perspectives. This review systematically explored...

Social position and economic system justification in Canada: Implications for advancing health equity and social justice from an exploratory study of factors shaping economic system justification.

Many socio-economic reforms that could reduce health disparities are not implemented because people justify existing systems and fear changes thereto. This study aimed to identify socio-demographic factors associated with system justifying beliefs to better understand how they are maintained in Canada. In doing so, we hypothesized that (1) systems justification is a default cognitive position, buttressed by the palliative benefits of system-justification, (2) lack of success in a given system generally motivates people to doubt the legitimacy of that system, and (3) system-justifying beliefs are rejected only when the costs of doing so are low enough and/or the benefits are high enough to outweigh the innate needs-fulfillment benefits of system-justification. Testing these hypotheses, we recruited participants living in Canada, aged 16+, to complete an online survey after being recruited via paid social media advertisements. Multivariable regression models identified factors associated with Economic System Justification Scale (ESJS) scores. Explanatory variables included demographic measures of social position, self-rated health, and patterns of social inclusion. Among 2,619 participants, system-justifying beliefs were wide-spread, with the average level of support across ESJS scale items exceeding 50%. Lower ESJS scores were associated with worse health, more loneliness, and lower socioeconomic status. Despite the pattern that marginalization erodes system-justification, several historically marginalized characteristics (e.g., non-white ethnicity and non-binary gender) were associated with relatively high system-justification, compared to matching privileged characteristics (e.g., white ethnicity; masculine gender). Supporting our hypotheses, we identify a general trend that social marginalization is associated with less system-justification. Those benefitting from the status quo (e.g., healthier, wealthier, less lonely) were more likely to hold system-justifying beliefs. However, some groups who are disadvantaged within the existing system reported higher system-justification-suggesting that system oppression may be a key moderator of the effect of social position on system justification.

The pyrethroid insecticide permethrin confers hepatotoxicity through DNA damage and mitochondria-associated apoptosis induction in rat: Palliative benefits of Fumariaofficinalis.

Permethrin (PER) is a pyrethroid pesticide that is extensively used as an insecticide in world because of its high activity and its low mammalian toxicity. The current study was conducted to investigate the protective action of Fumaria officinalis against PER-induced liver injury in male rats. However, HPLC-DAD showed the richness of 6 components in F. officinalis (F) including quercetin, ferulic acid, and naringenin which were the most abundant. Total polyphenols, total flavonoids, and condensed tannins were studied by phytochemical screening. In vitro, antioxidant properties showed that F. officinalis exhibited the highest DPPH radical, FRAP, and H2 O2 tests and total antioxidant capacity. Wistar rats were divided into four groups: negative control group (C), positive control group (F) (200 mg F. officinalis/kg BW), PER group (34.05 mg permethrin/kg BW), and PER + F group (34.05 mg permethrin/kg BW and 200 mgF. officinalis/kg BW). Oral administration of PER led to promote a decrease of body weight and Ca2+ -ATPases and Mg2+ -ATPases activities and an increase of plasma C-reactive proteinlevel, transaminases, and hepatic ϒ-GT activities as well as hepatic and mitochondrial oxidative stress. An increase in plasma lactate-to pyruvate ratio and a reduction in complexes enzymes I, III, and IV activities were also observed. In addition, histoarchitecture of liver in PER-treatedrats showed apoptosis and necrosis as confirmed by DNA fragmentation. F. officinalis significantly exerted hepatoprotective effect by modulating hepatic alteration and mitochondrial dysfunction as well as genotoxicity. This effect could be attributed to phenolics compounds such as polyphenols, condensed tannins, and flavonoids.

Abstract 1032: Progesterone receptor antagonist can provide marked palliative benefits and extend life by years in advanced lung cancer when no other treatment options are available

Abstract Metastatic lung cancer has a poor prognosis. The aim of chemotherapeutic agents, targeted therapies, or immunotherapies at this stage is to extend life and diminish suffering. Frequently the extension of life is for a few months, but amelioration of suffering is not always accomplished including side effects of medication. Mifepristone, a progesterone (P) receptor modulator/antagonist has been given to patients orally (200-300 mg/day) with Food and Drug Administration (FDA) approval to patients with advanced metastatic lung cancer that had no more treatment options. Several of these cases have been presented at the AACR and showed significant extension of a good quality of life with well tolerated mifepristone therapy (Case 1 - rapidly progressing probable small cell lung cancer (SCLC) with marked hypoxia and marked hyponatremia, AACR 2016; Case 2 - Stage IV non-small cell lung cancer (NSCLC) with brain metastasis with no tumor markers for targeted therapy, AACR 2017; Case 3 - NSCLC positive for programmed cell death protein 1 (PD-1), AACR 2018). In case 1 her PO2 and serum sodium normalized within 3 weeks of single agent mifepristone and her lung nodules were no longer detectable. At time of presentation in 2016 she was 3 ½ years on single agent mifepristone treatment. She died 5 years from treatment at age 85 from a myocardial infarction with no return of her lung cancer and normal serum sodium. Case 2 also received single agent mifepristone and had no new lung or brain lesions (predominantly stable disease), but he stated he felt perfectly normal. After 2 ½ years his primary lung lesion started growing slowly. He died 5 years later not from extensive lung cancer but from pneumonia complicating his chronic obstructive lung disease (COPD). Case 3 had progressed despite standard chemotherapy and nivolumab. With mifepristone her lung and brain metastases showed some regression, but she was enjoying a good quality of life. Her clinical status deteriorated after 1 year not from her cancer but worsening COPD and she died 1 ½ years after initiating mifepristone therapy. Two female cases (age 56 and 46) that were never presented at AACR were treated with mifepristone when their advanced lung cancer with brain metastases progressed despite the third-generation tyrosine kinase inhibitor osimertinib (they were positive for the EGFR mutation). These women had a good quality of life and are still alive after 4 years of treatment. Evidence suggests that mifepristone inhibits cancer by blocking membrane P receptors inhibiting the immunosuppressive protein called the progesterone induced blocking factor. The “parent” 90 kDa form helps the tumor to proliferate and invade normal tissue whereas smaller splice variants inhibit cellular immunity. Mifepristone may actually be more effective for cancers negative for the classical nuclear P receptor. Citation Format: Jerome H. Check, Diane Check, Trina Poretta. Progesterone receptor antagonist can provide marked palliative benefits and extend life by years in advanced lung cancer when no other treatment options are available [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1032.

Palliative radiation for bone metastases from hepatocellular carcinoma: practice patterns and the amount of remaining life spent receiving treatment.

Palliative radiation therapy (RT) for bone metastases (BMs) is a common practice. Wide variation exists in clinically used dose schema despite numerous studies demonstrating palliative equipoise between single and multifraction courses. We hypothesize that fraction scheme for palliating BMs for hepatocellular carcinoma (HCC) significantly affects how patients spend their remaining time. Patients with osseous HCC metastases who received RT were identified from the National Cancer Database [2004-2013]. The percentage of remaining life spent receiving radiation therapy (PRLSRT) and the number of incomplete RT courses were calculated. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate trends and predictors. A total of 1,331 patients met the inclusion criteria. Median overall survival (OS) was 3.3 months. Just 49 (3.7%) of patients received single fraction RT and 34% received >10 fractions. The mean and median PRLSRT were as follows: 1 fraction (8.9% and 3.0%), 2-5 fractions (32.9% and 24.3%), 6-10 fractions (27.2% and 15.9%), and >10 fractions (24.1% and 14.4%). Of the patients with PRLSRT >50%, 99.6% received multifraction RT. The proportion of incomplete RT courses increased as fraction size decreased from 17.6% with 4 Gy to 34% with 2 Gy. Single fraction palliative RT is vastly underutilized despite no additional palliative benefit with multifraction RT. PRLSRT significantly increased with multifraction RT. In the palliative treatment of painful BMs from HCC, single fraction treatment reduces time spent receiving radiation treatments and maximizes the number of patients who complete the prescribed treatment.

Vasoactive intestinal peptide secreting tumour: An overview.

Vasoactive intestinal peptide (VIP) secreting tumour (VIPoma) is a rare functional neuroendocrine tumour that typically arises from pancreatic islet cells. These present as sporadic, solitary pancreatic neoplasias with an estimated incidence of one in ten million individuals per year. Only around 5% of VIPomas are associated with multiple endocrine neoplasia type I syndrome. Excessive VIP secretion produces a clinical syndrome characterized by refractory watery diarrhoea, hypokalemia and metabolic acidosis. These coupled with elevated plasma levels of VIP are diagnostic. The majority of VIPomas are malignant and have already metastasized at the time of diagnosis (60%). Metastases occur most frequently in the liver, or regional lymph nodes, lungs, kidneys and bones. Some reports of skin metastases have been documented. Complete surgical resection continues to be the only potentially curative treatment. However, when the neoplasia cannot be excised completely, surgical debulking may provide palliative benefit. Other palliative options have included recently the peptide receptor radionuclide therapy which has shown to be effective and well-tolerated. This article will review all aspects of pancreatic VIPomas highlighting aspects such as clinical presentation, diagnosis and management.

Gastrointestinal Stromal Tumors: What Is the Best Sequence of TKIs?

In our practice, we evaluate the mutation status of advanced unresectable disease to guide decisions on use of tyrosine kinase inhibitor (TKI) therapy. This review focuses on management of GIST with KIT and PDGFRA mutations. Imatinib is first-line treatment for unresectable gastrointestinal stromal tumors (GISTs) unless they harbor a PDGFRA D842V mutation; it is recommended to escalate imatinib to twice daily dosing for KIT exon 9 mutant tumors. When patients progress on first-line treatment, treatment is changed to sunitinib followed by regorafenib; while the spectrum of activity against resistance mutations varies with these agents, routine biopsies provide data on one area of disease and ctDNA has not been validated prospectively. For those with a PDGFRA D842V mutation, avapritinib is the first TKI to lead to tumor response and disease control. Ripretinib is approved in the 4th line setting, with limited data on its benefit for PDGFRA D842V GIST. Avapritinib can be considered for treatment beyond ripretinib for KIT mutant disease. The efficacy of other TKIs tested in GIST is reviewed. Ongoing therapy provides palliative benefit and should be continued given rapid decline observed off of treatment.

Locoregional Treatments for Metastatic Gastrointestinal Stromal Tumor in British Columbia: A Retrospective Cohort Study from January 2008 to December 2017.

Simple SummaryIt is not known if surgery, radiation treatment (RT) or other types of locolregional treatment (LRT) may be beneficial for patients with metastatic gastrointestinal stromal tumor (mGIST) in addition to systemic treatment. Our study aims to address this question by analyzing a cohort of 127 mGIST patients in British Columbia over a decade (from January 2008 to December 2017). We showed that mGIST patients who underwent surgery and LRT seemed to have better survival when compared to patients who did not undergo surgery and LRT. However, this treatment strategy should only be considered in patients with limited volume metastatic disease or oligoprogression while the rest of the disease is well controlled with systemic treatment. In addition, RT can offer palliative benefits such as pain relief and bleeding control. Our study, consistent with other retrospective studies, supports LRT consideration in selected mGIST patients within a multidisciplinary setting. This approach is not considered as a “standard of care” due to lack of prospective clinical trials but may improve clinical outcome for some mGIST patients.Introduction: The role of surgery and non-surgical locoregional treatments (LRT) such as radiation therapy (RT) and local ablation techniques in patients with metastatic gastrointestinal stromal tumor (GIST) is unclear. This study examines LRT practice patterns in metastatic GIST and their clinical outcomes in British Columbia (BC). Methods: Patients diagnosed with either recurrent or de novo metastatic GIST from January 2008 to December 2017 were identified. Clinical characteristics and outcomes were analyzed in patients who underwent LRT, including surgical resection of the primary tumor or metastectomy, RT, or other local ablative procedures. Results: 127 patients were identified: 52 (41%) had de novo metastasis and 75 (59%) had recurrent metastasis. Median age was 67 (23–90 years), 58.2% were male, primary site was 33.1% stomach, 40.2% small intestine, 11% rectum/pelvis, and 15.7% others. 37 (29.1%) of patients received palliative surgery, the majority of which had either primary tumor removal only (43.3%) or both primary tumor removal and metastectomy (35.1%). A minority of patients underwent metastectomy only (21.6%). A total of 12 (9.5%) patients received palliative RT to metastatic sites only (58.3%) or primary tumors only (41.7%), mostly for symptomatic control (n = 9). A few patients (n = 3) received local ablation for liver metastatic deposits with 1 patient receiving microwave ablation (MWA) and 2 receiving radiofrequency ablation (RFA). Most patients (n = 120, 94.5%) received some type of systemic treatment. It is notable that prolonged progression free survival (PFS) was observed for the majority of patients who underwent surgery in the metastatic setting with a median PFS of 20.5 (95% confidence interval (CI): 14.29–40.74) months. In addition, significantly higher median overall survival (mOS) was observed in patients who underwent surgery (97.15 months; 95% CI: 77.7-not reached) and LRT (78.98 months; 95% CI: 65.58-not reached) versus no surgery (45.37 months; 95% CI: 38.7–64.69) and no LRT (45.27 months; 95% CI: 33.25–58.66). Almost all patients (8 out of 9) achieved symptomatic improvement after palliative RT. All 3 patients achieved partial response and 2 out of 3 patients had relatively durable responses of 1 year or more after local ablation. Discussion: This study is among the first to systematically examine the use of various LRT in metastatic GIST management. Integration of LRT with systemic treatments may potentially provide promising durable response and prolonged survival for highly selected metastatic GIST patients with low volume disease, limited progression and otherwise well controlled on systemic treatments. These observations, consistent with others, add to the growing evidence that supports the judicious use of LRT in combination with systemic treatments to further optimize the care of metastatic GIST patients.

A Review on Palliative Care Challenges and Benefits

Palliative care is a treatment strategy that aims to improve the quality of life of patients suffering from various serious illnesses. Palliative care is provided to these patients by experts from multidisciplinary fields utilising a holistic approach. It reduces the burden on families and patients by providing services related to pain management, early diagnosis and assessment, and by addressing their psychological, spiritual, ethical, and cultural issues. The aim of this narrative review is to cast light on the cost-effectiveness, evolution, and challenges of palliative care. Databases including Medline/PubMed and Google Scholar were searched to retrieve relevant studies including clinical trials, case studies, and meta-analyses and reviews. Information obtained from these studies includes cost-effectiveness, palliative care evolution, and palliative care-related social issues among patients and family members as well as healthcare professionals.The purpose of this narrative review is to summarise the barriers and recent advancements of palliative care in terminally ill patient care.

What Factors Are Associated With Local Metastatic Lesion Progression After Intramedullary Nail Stabilization?

What Factors Are Associated With Local Metastatic Lesion Progression After Intramedullary Nail Stabilization?

QOLP-03. OBSERVATIONS OF COMPLEMENTARY CANNABIS THERAPY IN MALIGNANT GLIOMA PATIENTS

Abstract INTRODUCTION As of 5/15/2021, medical marijuana programs exist in 37 states, and marijuana is legal for recreational use in 17 states. In Connecticut, the CT Medical Marijuana Program (MMP) was created in 2012 and I began certifying my patients with malignant glioma (brain cancer) for the program in 2014. I now provide data on my experience with complementary cannabis therapy. PART 1 Between 9/1/2014 and 6/1/2018, 23 patients with malignant glioma were registered in the CT MMP and received a card. Of these 23 patients, 15 patients took a daily cannabis oil supplement for at least 6 months during their treatment, and 7 patients used cannabis products only as needed. 3 patients are still alive, all in the daily cannabis oil group (41, 54 and 77 months). The median overall survival in the daily group was 22.0 months, versus 16.9 months in the as needed group. PART 2 Since 9/1/2014, 71 patients with malignant glioma were certified for the CT MMP. Of these 71 patients, 15 did not complete the patient registration process and did not receive a card for the MMP. As of 5/15/2021, of the 56 registered patients, there are 20 Active patients and 36 Inactive patients. Regarding the Inactive patients, 29 have died and 7 are alive but did not renew their card. Amongst Active patients, 4 are currently taking a daily cannabis oil supplement as a complementary therapy, and 16 are currently using cannabis products only as needed for symptoms. The 4 patients employing complementary therapy currently have a survival of 8, 31, 33, and 35 months. CONCLUSION In my experience, complementary cannabis treatment is well tolerated in malignant glioma patients, and can provide significant palliative benefit to treat insomnia and nausea. Serious adverse events attributed to cannabis products, or decreased survival, have not been observed.

First-line palliative chemotherapy clinical benefit is a key determinant of survival in metastatic uterine leiomyosarcoma

Aim: To evaluate whether obtaining a clinical benefit with first-line therapy in patients receiving palliative systemic therapy with a diagnosis of metastatic uterine leiomyosarcoma (ULMS) provides a survival benefit and the factors that may predict first-line therapy response.
 Material and Method: This study was a retrospective observational single-center analysis conducted with patients diagnosed with metastatic ULMS. Patients who received palliative chemotherapy with an ECOG PS of 0 or 1 at the time of diagnosis of metastatic disease were included in the study. Main patient characteristics, first-line palliative treatment responses, progression-free survival, and overall survival (OS) were reviewed retrospectively. Multivariate analyses were performed to determine the independent predictive factors of first-line palliative treatment response and overall survival.
 Results: Of the 36 patients whose medical records were evaluated retrospectively, 24 patients who were eligible for the study were included in the study. Gemcitabine plus docetaxel combination chemotherapy was the most commonly used treatment protocol (n=12, 50%) for first-line palliative treatment. While a complete response as a first-line treatment response could not be achieved, clinical benefit (partial remission and stable disease) and progressive disease were observed in 15 (62%) and 9 (37.5%) patients, respectively. Binary logistic regression analysis failed to detect any independent predictive factors for the clinical benefit of first-line palliative therapy. Median (OS) was 19.7 (95% CI, 4.1-35.3) months for all patients (N=24). Median OS was 25.6 (95% CI, 21.0-30.2) months and 6.9 (95% CI, 1.7-12.2) months for patients with and without the clinical benefit of first-line palliative chemotherapy (p=0.004). Cox-regression analysis revealed that increasing age at diagnosis of metastatic disease (HR=0.929, 95% CI 0.870-0.992, p=0.027), pulmonary metastasectomy (HR=0.162, 95%CI 0.031-0.863, p=0.033), and presence of first-line palliative chemotherapy clinical benefit (HR=0.195, 95% CI 0.063-0.606, p=0.005) were independent predictive factors for a better OS.
 Conclusion: In metastatic ULMS, for which the survival benefit is not clear with palliative chemotherapy, prolonged survival can be obtained in patients with clinical benefit with first-line palliative chemotherapy. There is a need for new studies to determine the factors that will predict the clinical benefit of first-line palliative chemotherapy.