Prognosis Of Advanced Cancer Research Articles

Symptom clusters and prognosis in advanced cancer

Symptom clusters and prognosis in advanced cancer

P5-15-02: Patients' Views about How Oncologists Should Explain Prognosis in Advanced Cancer.

Abstract Background Many women with advanced breast cancer want information about their life expectancy. Understanding the type of information patients want will help oncologists improve their discussions about prognosis. We sought the attitudes of women previously diagnosed with breast cancer to using three scenarios for survival (best case, worst case and most likely) to explain prognosis to people with advanced cancer. Methods: Members of the Breast Cancer Network Australia (BCNA) review and survey group and oncology clinic attendees with a previous breast cancer diagnosis were invited to complete a questionnaire describing two options for explaining prognosis to a hypothetical patient with incurable cancer who wanted prognostic information: providing either 3 scenarios for survival or just the median survival time. Associations between respondent attitudes and their demographic and tumour characteristics were explored. Results: Characteristics of the 254 BCNA respondents and the 68 outpatient respondents respectively were: median age 56 years and 54 years; median years since breast cancer diagnosis 6 and 3; college/university educated 70% and 34%; self-report of cancer spread beyond the lymph nodes 10% and 26%. Significantly more respondents agreed that explaining 3 scenarios (vs just the median survival time) would: be easy to understand (92% v 71%), be helpful (94% v 63%), convey hope (68% v 36%), reassure (56% v 30%) and help family members (92% v 65%), with all p-values <0.001. The proportions of respondents agreeing that each of the 3 scenarios should be presented were: best case 92%, worst case 84% and most likely 93%. Although 53% agreed the worst case scenario on its own was likely to upset people, only 31% agreed that explaining all 3 scenarios together was likely to upset people. When asked how they would prefer information about their own prognosis, 92% wanted all 3 scenarios, either with (49%) or without (43%) the estimated median survival. Most respondents (88%) agreed it would be helpful to receive a printed summary of the scenarios for survival. No differences were seen between the BCNA respondents and breast cancer outpatients for attitudes to presenting all 3 scenarios; however, BCNA respondents were significantly less likely than breast cancer outpatients to agree that the median survival was helpful, reassuring or easy to understand. Women with more education were more likely to agree that presenting all 3 scenarios would be helpful (95% v 87%, p=0.04). Age, year of diagnosis, relationship status and extent of disease were not significantly associated with particular attitudes. Conclusion: Most respondents judged presentation of best case, worst case and most likely scenarios preferable, more helpful and more reassuring than presentation of just the median survival time when oncologists explain prognosis to people with advanced cancer. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-15-02.

Symptom Clusters and Prognosis in Advanced Cancer (414-B)

1.Discuss the prognostic impact of symptom clusters (SCs) on survival in advanced cancer.2.Evaluate the association between known SCs and subsequent survival. Background. The prognostic impact of symptom clusters (SCs) on survival in advanced cancer is unknown. Research objectives. We evaluated the association between known SCs and subsequent survival. Methods. We did a post-hoc analysis of previously reported data which identified seven SCs. A cluster was considered present if any patient had ≥ 50% of the symptoms in that cluster. Survival was measured from the time of referral to death. Among 831 patients with survival data, Cox proportional hazards and Stepwise Cox analyses assessed the prognostic effect of SCs on survival. Kaplan-Meier survival curves were constructed for three SCs that were significant in multivariable analysis. Results. Three SCs were associated with shorter survival in both univariable and multivariable analysis (p < .03 in all cases): the fatigue/anorexia-cachexia (easy fatigue, lack of energy, weakness, dry mouth, anorexia, early satiety, taste change, weight loss), the debility (edema, confusion), and the aero-digestive (cough, dyspnea, hoarseness, dysphagia) clusters. The hazard ratios (95% CI) from the multivariable analysis were 1.4 (1.2-1.6), 1.24 (1.1-1.4), and 1.2 (1.0-1.4), respectively. This suggested that those who had these SCs had a 17% to 37% increased risk of death compared to those who did not. Among persons with none of the three clusters, median survival was 3.4 (2.5-4.4) months but 1.7 (1.6-1.9) months among people with 1-2 clusters, and 1.0 (0.8-1.3) month among those with all three. Conclusion. Three SCs had a statistically and clinically important negative impact on survival in advanced cancer. Implications for research, policy, or practice. SCs appear important not only to clinical assessment, and therapeutic management, but may also improve prognostication. Physical Aspects of Care

Prognosis in Advanced Cancer

Journal of Palliative MedicineVol. 13, No. 6 Book and Media ReviewsFeature Editors: Juliet Jacobsen and Jane deLima ThomasPrognosis in Advanced CancerHeidi Blake and Rachelle BernackiHeidi BlakeSearch for more papers by this author and Rachelle BernackiSearch for more papers by this authorPublished Online:2 Jul 2010https://doi.org/10.1089/jpm.2010.9821AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Prognosis in Advanced Cancer." , 13(6), pp. 783–784FiguresReferencesRelatedDetails Volume 13Issue 6Jun 2010 InformationCopyright 2010, Mary Ann Liebert, Inc.To cite this article:Heidi Blake and Rachelle Bernacki.Prognosis in Advanced Cancer.Journal of Palliative Medicine.Jun 2010.783-784.http://doi.org/10.1089/jpm.2010.9821Published in Volume: 13 Issue 6: July 2, 2010PDF download

Prognostication Remains More an Art Than a Science

Prognostication Remains More an Art Than a Science

Clinical implications of DNA repair genetic alterations in cancer

The overall prognosis of advanced cancer remains poor. Whilst accumulation of genetic mutations drives the cancerous phenotype, it is well known that DNA damaging lesions that lead to such mutations are predominantly monitored and repaired by the highly conserved DNA repair machinery in cells. Though chemotherapy as well as radiotherapy remains the mainstay of treatment, it is clear that the cancer cell's ability to respond to DNA damaging lesions induced by cytotoxic agents has a major bearing upon therapeutic efficacy and normal tissue toxicity. In this article we provide an overview on the role of DNA repair factors as prognostic/predictive markers with a specific focus on genetic alterations that confer altered DNA repair capacity in cells.

Bioelectrical Impedance Phase Angle Changes During Hydration and Prognosis in Advanced Cancer

We wished to determine bioelectrical impedance (BIA) correlates before hydration or changes during hydration and determine if these changes were prognostically important. Fifty eligible patients underwent BIA measurements 3 consecutive days. Laboratory studies (electrolytes, creatinine, and hemoglobin) on day 1; weights and vital signs were recorded. Kaplan-Meier survival estimates were made at 30 and 60 days. Hazard ratios (HRs) based on Cox proportional hazards model were calculated. Weight loss was associated with shorter survival. A higher phase angle (PA) on day 1 predicted longer survival. Increased PA during hydration predicted shorter survival: increased weight during hydration predicted longer survival. Higher phase angle before hydration predicts poorer survival and, paradoxically, an increase in phase angle during hydration predicted poorer survival and preexisting intracellular dehydration, cachexia, or poor membrane function. Phase angle and weight during hydration predict survival in cancer.

Prognosis in Advanced Cancer

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Impact of negative lymph node number on prognosis advanced cancer of cardiac and stomach fundus

To analyze the impact of negative lymph node number on the prognosis of advanced cancer of the cardia and stomach fundus. 236 patients with advanced cancer of the cardia and stomach fundus underwent D2 radical resection. 5-year survival rate and recurrence rate were followed up and the relationships of lymph node (LN) number to 5-year survival rate and recurrence rate were analyzed respectively, according to LN count subgroups. The 5-year survival rate of the entire cohort was 37.5%. The number of metastasis negative LNs was positively correlated with the LNs examined (P < 0.05). For the cancer at the same stage, the higher the number of metastasis negative LNs the higher the 5-year survival rate (P < 0.05). Linear correlation analysis showed that along with the increase of the number of negative LNs the post-operative survival rate increased. In the cancers at the stages III and IV, the 5-year survival rate increased by 6.09% and 7.65% respectively compared to the predicted values (P = 0.013 and P = 0.035). The overall recurrence rate was 61.0% within 5 years after surgery. For the cancers at the stages III and IV, the more the number of negative LNs the higher the 5-year survival rates (P < 0.05). In the cancers at the stages II and IV there were significant differences in the recurrence rates among the subgroups with different numbers of negative LNs (all P < 0.002). Number of negative LNs has a close relation with stage-based survival prediction. Dissection of sufficient lymph nodes in the procedure of D2 dissection should be recommended so as to improve the long-term therapeutic effects and reduce the recurrence rate.

Gene expression analysis of early and advanced gastric cancers

Gastric carcinoma is one of the major causes of cancer mortality worldwide. Early detection results in excellent prognosis for patients with early cancer (EGC), whereas the prognosis of advanced cancer (AGC) patients remains poor. It is not clear whether EGC and AGC are molecularly distinct, and whether they represent progressive stages of the same tumor or different entities ab initio. Gene expression profiles of EGC and AGC were determined by Affymetrix technology and quantitative polymerase chain reaction. Representative regulated genes were further analysed by in situ hybridization (ISH) on tissue microarrays. Expression analysis allowed the identification of a signature that differentiates AGC from EGC. In addition, comparison with normal gastric mucosa indicated that the majority of alterations associated with EGC are retained in AGC, and that further expression changes mark the transition from EGC to AGC. Finally, ISH analysis showed that representative genes, differentially expressed in the invasive areas of EGC and AGC, are not differentially expressed in the non-invasive areas of the same tumors. Our data are more directly compatible with a progression model of gastric carcinogenesis, whereby EGC and AGC may represent different molecular stages of the same tumor. Finally, the identification of an AGC-specific signature might help devising novel therapeutic strategies for advanced gastric cancer.

Process and Content of Decision Making by Advanced Cancer Patients

Process and Content of Decision Making by Advanced Cancer Patients

Changes in circulating VEGF-A levels related to clinical response during biochemotherapy in metastatic malignant melanoma

7531 Background: high blood levels of vascular endothelial growth factor (VEGF) appear to be associated with a poor prognosis in advanced cancer, probably as a consequence of its angiogenic and immunosuppressive effects. The prognostic significance of serum VEGF levels and its variation during cancer treatment is still unknown. Objectives: The aim of this study is to evaluate the clinical usefulness of active serum vascular endothelial growth factor (sVEGF-A) levels in metastatic malignant melanoma patients and to investigate the possible relationship between sVEGF-A variations and clinical response during biochemotherapy. Patients and Treatment: The study included 73 patients with a fully documented history of metastatic malignant melanoma. Biochemotherapy consisted of Cisplatinum, rIL-2 and Alpha-interferon in two induction cycles. The assessment of clinical response was performed according to WHO criteria. Sixty seven patients were evaluable: 43 % (29/67) were responding (RC&RP) and 57 % were non-responding (13 SD and 25 PD). Methods: active serum VEGF-A concentrations were measured by an enzyme linked immunosorbent assay (ELISA) in the serum of 26 healthy controls and in 75 MMM patients, before and at the end of treatment. Results: pretreatment serum VEGF-A levels in MMM patients were significantly higher than those in controls (p=0.0017). No significant association was noted between sVEGF-A levels and gender, age and LDH level. Serum VEGF-A levels were higher in patients with high tumor burden as compared to patients with low tumor burden. Before treatment, the sVEGF-A level was not significantly different between R and NR patients; at the end of biochemotherapy, an increase of VEGF-A level was correlated to disease progression (r′=0.53,p=0.01) and a decrease of serum VEGF-A levels was correlated to the objective response to treatment (r′=0.43, p=0.02). Conclusion: these results suggest that changes in sVEGF-A levels may represent a useful biomarker to predict the effect of biochemotherapy in terms of clinical response in patients with metastatic malignant melanoma. No significant financial relationships to disclose.

Changes in circulating VEGF-A levels related to clinical response during biochemotherapy in metastatic malignant melanoma

7531 Background: high blood levels of vascular endothelial growth factor (VEGF) appear to be associated with a poor prognosis in advanced cancer, probably as a consequence of its angiogenic and immunosuppressive effects. The prognostic significance of serum VEGF levels and its variation during cancer treatment is still unknown. Objectives: The aim of this study is to evaluate the clinical usefulness of active serum vascular endothelial growth factor (sVEGF-A) levels in metastatic malignant melanoma patients and to investigate the possible relationship between sVEGF-A variations and clinical response during biochemotherapy. Patients and Treatment: The study included 73 patients with a fully documented history of metastatic malignant melanoma. Biochemotherapy consisted of Cisplatinum, rIL-2 and Alpha-interferon in two induction cycles. The assessment of clinical response was performed according to WHO criteria. Sixty seven patients were evaluable: 43 % (29/67) were responding (RC&RP) and 57 % were non-responding (13 SD and 25 PD). Methods: active serum VEGF-A concentrations were measured by an enzyme linked immunosorbent assay (ELISA) in the serum of 26 healthy controls and in 75 MMM patients, before and at the end of treatment. Results: pretreatment serum VEGF-A levels in MMM patients were significantly higher than those in controls (p=0.0017). No significant association was noted between sVEGF-A levels and gender, age and LDH level. Serum VEGF-A levels were higher in patients with high tumor burden as compared to patients with low tumor burden. Before treatment, the sVEGF-A level was not significantly different between R and NR patients; at the end of biochemotherapy, an increase of VEGF-A level was correlated to disease progression (r′=0.53,p=0.01) and a decrease of serum VEGF-A levels was correlated to the objective response to treatment (r′=0.43, p=0.02). Conclusion: these results suggest that changes in sVEGF-A levels may represent a useful biomarker to predict the effect of biochemotherapy in terms of clinical response in patients with metastatic malignant melanoma. No significant financial relationships to disclose.

Changes in circulating VEGF levels in relation to clinical response during chemotherapy for metastatic cancer.

Abnormally high blood levels of vascular endothelial growth factor (VEGF) appear to be associated with a poor prognosis in advanced cancer, probably as a consequence of its angiogenic and immunosuppressive effects. The prognostic significance of changes in VEGF secretion during cancer chemotherapy is still unknown. This study aimed to investigate the relation between VEGF variations and therapeutic results during chemotherapy in advanced malignancies. The study included 90 metastatic cancer patients, 59 with non-small cell lung cancer and 31 with colorectal carcinoma. Chemotherapy consisted of cisplatin plus etoposide for NSCLC and camptothecin for colorectal cancer. Abnormally high (> 2 SD with respect to values in healthy controls) pretreatment VEGF levels were found in 38/90 (42%) patients. The percentage of non-progressive disease in response to chemotherapy was significantly higher in patients with normal levels of VEGF prior to therapy than in those with elevated pretreatment values of VEGF (10/32 vs 4/27; p < 0.05). Moreover, the percentage of VEGF level normalization during chemotherapy was significantly higher in patients with objective tumor response or stable disease than in progressing patients (10/18 vs 0/20; p < 0.001). Finally, among patients with tumor response or disease stabilization, the one-year survival rate was significantly higher in patients with chemotherapy-induced normalization of VEGF than in those with persistently high VEGF blood levels (9/10 vs 3/8; p < 0.05). These results suggest that changes in VEGF levels during chemotherapy may represent a useful biomarker to predict the effect of chemotherapy in terms of tumor response and survival in patients with metastatic solid neoplasms.

Changes in circulating VEGF levels in relation to clinical response during chemotherapy for metastatic cancer

Abnormally high blood levels of vascular endothelial growth factor (VEGF) appear to be associated with a poor prognosis in advanced cancer, probably as a consequence of its angiogenic and immunosuppressive effects. The prognostic significance of changes in VEGF secretion during cancer chemotherapy is still unknown. This study aimed to investigate the relation between VEGF variations and therapeutic results during chemotherapy in advanced malignancies. The study included 90 metastatic cancer patients, 59 with non-small cell lung cancer and 31 with colorectal carcinoma. Chemotherapy consisted of cisplatin plus etoposide for NSCLC and camptothecin for colorectal cancer. Abnormally high (> 2 SD with respect to values in healthy controls) pretreatment VEGF levels were found in 38/90 (42%) patients. The percentage of non-progressive disease in response to chemotherapy was significantly higher in patients with normal levels of VEGF prior to therapy than in those with elevated pretreatment values of VEGF (10/32 vs 4/27; p < 0.05). Moreover, the percentage of VEGF level normalization during chemotherapy was significantly higher in patients with objective tumor response or stable disease than in progressing patients (10/18 vs 0/20; p < 0.001). Finally, among patients with tumor response or disease stabilization, the one-year survival rate was significantly higher in patients with chemotherapy-induced normalization of VEGF than in those with persistently high VEGF blood levels (9/10 vs 3/8; p < 0.05). These results suggest that changes in VEGF levels during chemotherapy may represent a useful biomarker to predict the effect of chemotherapy in terms of tumor response and survival in patients with metastatic solid neoplasms.

Assessment of nutritional status and prognosis in advanced cancer: interleukin-6, C-reactive protein, and the prognostic and inflammatory nutritional index

The Prognostic Inflammatory Nutritional Index (PINI) is a simple scoring system that has been used to evaluate nutritional status and prognosis in critically ill patients. The PINI has never been evaluated in advanced cancer. Fifty consecutive patients with advanced cancer, weight loss, and anorexia were studied. C-reactive protein (CRP), albumin, pre-albumin, interleukin-6 (IL-6), and alpha 1-acid glycoprotein (AAG) were evaluated. The individual values for AAG, CRP, and IL-6 were markedly elevated. In contrast to albumin and prealbumin, CRP levels were very high. The PINI was significantly elevated, and higher than reported in critically ill intensive care patients. Elevated IL-6 levels correlated with high PINI and CRP values. CRP, IL-6, and PINI should be considered in future research on nutritional status and prediction of prognosis in advanced cancer.

Symptoms and prognosis in advanced cancer.

As death from cancer approaches, the associated symptoms become more important. Not only do these symptoms impair quality of life and guide palliative management of the patient, but some also appear to have prognostic value in determining clinical course and survival. A comprehensive prospective analysis of symptoms in 1,000 patients on initial referral to the Palliative Medicine Program of the Cleveland Clinic was conducted. Data were evaluated to determine any relationship between demographic characteristics, symptoms and subsequent survival. Shorter survival after referral to the Palliative Medicine Program was associated with male gender, poor performance status, dysphagia and early satiety. Dysphagia and early satiety were independently associated with reduced survival. There was a gender difference in survival favoring women. The effects of dysphagia, early satiety and gender were equal and nearly of similar magnitude to performance status. Symptom and gender analysis should be included in all cancer treatment and symptom control studies.