Acute myeloid leukemia (AML) patients' understanding of prognosis and treatment goals: A mixed-methods study.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 221-221
Author(s):  
Thomas William LeBlanc ◽  
Catherine T Bloom ◽  
Debra M. Davis ◽  
Susan C. Locke ◽  
Karen E. Steinhauser ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Induction Chemotherapy ◽  
Treatment Options ◽  
Specific Treatment ◽  
Treatment Recommendation ◽  
Treatment Goals ◽  
Recommended Treatment ◽  
Complex Information ◽  
Relapsed Disease ◽  
Face Complex

221 Background: Patients with AML face complex information about the risks and rewards of pursuing treatments of varying intensity. Little is known about what patients understand or value in the decision-making process. Methods: AML inpatients receiving induction chemotherapy completed weekly electronic surveys about their prognosis and treatment goals, along with a baseline semi-structured, qualitative interview exploring their understanding of illness. Their oncologists (MDs) completed baseline surveys about prognosis and treatment goals. We followed a mixed-methods approach to analysis, applying standard statistical methods to survey data, and a constant-comparative qualitative approach to the interview data to enrich our understanding of survey results. Results: We enrolled 13 dyads (a patient and MD pair). Mean patient age was 65.5, and all had high-risk disease due to either age >60, complex cytogenetics, secondary AML, or relapsed disease. At baseline, mean MD-rated chance of cure was 27% (SD 17.6), while patients’ rating was 54% (SD 34.7; p=0.02). Only 2 patients’ estimates of cure matched their MD’s rating, yet MDs rated their patients’ prognostic understanding as high (mean 7.2 on an 11-point scale). MDs reported an average of 3.1 available treatment options, but patients recalled just 1.5. Most MDs gave a specific treatment recommendation (11 of 13), and most patients received the recommended treatment (10 of 11). Agreement about treatment goal was markedly worse than expected by chance (kappa -0.41; 95% CI -0.88-0.07). Qualitative analysis suggests that patients often viewed treatment decisions as binary “life-or-death” propositions, rather than choices between options with differing goals and intensities. Patients also significantly underestimated the risks of induction chemotherapy. Conclusions: AML patients receiving induction chemotherapy have a poor understanding of their prognosis, treatment goals, and risks of induction chemotherapy, but their oncologists are not aware of this. These findings suggest the need for an intervention to improve patient understanding of their illness and treatment options.

Prospective evaluation of patients for stereotactic radiosurgery/radiotherapy (SRS/SRT) by an experienced SRS/SRT radiation oncologist at a hospital-based cancer center lacking SRS/SRT capability.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14043-e14043
Author(s):  
Don Stacy ◽  
Christopher Rucker ◽  
Kimberly Cottongame ◽  
Lester Combs ◽  
Chad Jones ◽  
...  
Keyword(s):  
Practice Guidelines ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Treatment Options ◽  
Specific Treatment ◽  
Treatment Recommendation ◽  
Cancer Center ◽  
Radiation Oncologist ◽  
Prospective Evaluation ◽  
Oncology Patient

e14043 Background: To prospectively determine the need for SRS/SRT at a hospital-based cancer center lacking SRS/SRT capability. Methods: An experienced SRS/SRT radiation oncologist prospectively evaluated new and established patients for radiation treatment at a hospital-based cancer center from July 30, 2018 through September 20, 2019. All radiation treatment options (per the NCCN Practice Guidelines in Oncology) were explained in detail to each patient. The radiation oncologist’s specific treatment recommendation to each patient was based on the radiation oncologist’s expertise. Cases for which the radiation oncologist recommended SRS/SRT were recorded. Results: From August 06, 2018 through September 25, 2019 an experienced SRS/SRT radiation oncologist evaluated 177 new or established patients for radiation treatment and recommended SRS/SRT for 23 patients (6 lung, 2 adrenal, 9 brain, 3 spine, 1 pituitary, 1 bone, and 1 prostate). Conclusions: To provide comprehensive radiation oncology patient services, SRS/SRT capability is required at a hospital-based cancer center evaluated by an experienced SRS/SRT radiation oncologist in this report, as SRS/SRT was recommended for twenty-three of one hundred seventy-seven (13%) patients evaluated for radiation treatment in a fourteen-month period.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

scholarly journals Patterns of care for prostate cancer radiotherapy—results from a survey among German-speaking radiation oncologists

2021 ◽  
Author(s):  
Marco M. E. Vogel ◽  
Sabrina Dewes ◽  
Eva K. Sage ◽  
Michal Devecka ◽  
Jürgen E. Gschwend ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Online Survey ◽  
Treatment Options ◽  
Equivalent Dose ◽  
Patterns Of Care ◽  
Treatment Recommendation ◽  
Published Data ◽  
Prostate Bed ◽  
Radiation Oncologists ◽  
German Speaking

Abstract Background Emerging moderately hypofractionated and ultra-hypofractionated schemes for radiotherapy (RT) of prostate cancer (PC) have resulted in various treatment options. The aim of this survey was to evaluate recent patterns of care of German-speaking radiation oncologists for RT of PC. Methods We developed an online survey which we distributed via e‑mail to all registered members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 109 participants between March 3 and April 3, 2020. For evaluation of radiation dose, we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy, equivalent dose (EQD2 [1.5 Gy]). Results Median EQD2(1.5 Gy) for definitive RT of the prostate is 77.60 Gy (range: 64.49–84.00) with median single doses (SD) of 2.00 Gy (range: 1.80–3.00), while for postoperative RT of the prostate bed, median EQD2(1.5 Gy) is 66.00 Gy (range: 60.00–74.00) with median SD of 2.00 Gy (range: 1.80–2.00). For definitive RT, the pelvic lymph nodes (LNs) are treated in case of suspect findings in imaging (82.6%) and/or according to risk formulas/tables (78.0%). In the postoperative setting, 78.9% use imaging and 78.0% use the postoperative tumor stage for LN irradiation. In the definitive and postoperative situation, LNs are irradiated with a median EQD2(1.5 Gy) of 47.52 Gy with a range of 42.43–66.00 and 41.76–62.79, respectively. Conclusion German-speaking radiation oncologists’ patterns of care for patients with PC are mainly in line with the published data and treatment recommendation guidelines. However, dose prescription is highly heterogenous for RT of the prostate/prostate bed, while the dose to the pelvic LNs is mainly consistent.

scholarly journals Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients: Impact on Survival and Concerns

2021 ◽  
Vol 10 (5) ◽  
pp. 1073
Author(s):  
Patricia Martínez-Botía ◽  
Ángel Bernardo ◽  
Andrea Acebes-Huerta ◽  
Alberto Caro ◽  
Blanca Leoz ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Clinical Management ◽  
Cox Regression ◽  
Angiotensin Receptor Blockers ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Hospitalized Patients ◽  
Thrombosis Prophylaxis ◽  
The Impact

The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.

Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM?

2020 ◽  
Author(s):  
Danielle Brazel ◽  
Brooke Kulp ◽  
Geoanna Bautista ◽  
Andrew Bonwit
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Treatment Options ◽  
Specific Treatment ◽  
Corticosteroid Treatment ◽  
Stevens Johnson Syndrome ◽  
First Case ◽  
Johnson Syndrome ◽  
Vesicular Rash ◽  
Recurrent Aphthous Ulcers ◽  
Definition Of

Abstract Introduction A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM. Case Presentation A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered. Discussion Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient’s symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.

scholarly journals Cellular and mitochondrial mechanisms of atrial fibrillation

2020 ◽  
Vol 115 (6) ◽  
Author(s):  
Fleur E. Mason ◽  
Julius Ryan D. Pronto ◽  
Khaled Alhussini ◽  
Christoph Maack ◽  
Niels Voigt
Keyword(s):  
Atrial Fibrillation ◽  
Nicotinamide Adenine Dinucleotide ◽  
Molecular Mechanisms ◽  
Treatment Options ◽  
Specific Treatment ◽  
Nicotinamide Adenine Dinucleotide Phosphate ◽  
Nicotinamide Adenine ◽  
Mitochondrial Activity ◽  
Atp Production

AbstractThe molecular mechanisms underlying atrial fibrillation (AF), the most common form of arrhythmia, are poorly understood and therefore target-specific treatment options remain an unmet clinical need. Excitation–contraction coupling in cardiac myocytes requires high amounts of adenosine triphosphate (ATP), which is replenished by oxidative phosphorylation in mitochondria. Calcium (Ca2+) is a key regulator of mitochondrial function by stimulating the Krebs cycle, which produces nicotinamide adenine dinucleotide for ATP production at the electron transport chain and nicotinamide adenine dinucleotide phosphate for the elimination of reactive oxygen species (ROS). While it is now well established that mitochondrial dysfunction plays an important role in the pathophysiology of heart failure, this has been less investigated in atrial myocytes in AF. Considering the high prevalence of AF, investigating the role of mitochondria in this disease may guide the path towards new therapeutic targets. In this review, we discuss the importance of mitochondrial Ca2+ handling in regulating ATP production and mitochondrial ROS emission and how alterations, particularly in these aspects of mitochondrial activity, may play a role in AF. In addition to describing research advances, we highlight areas in which further studies are required to elucidate the role of mitochondria in AF.

Management of Plantar Keratodermas

2017 ◽  
Vol 107 (5) ◽  
pp. 428-435 ◽  
Author(s):  
Rebecca M. Porter ◽  
Albert A. Bravo ◽  
Frances J.D. Smith
Keyword(s):  
Gene Therapy ◽  
Salicylic Acid ◽  
Alternative Treatment ◽  
Autosomal Dominant ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Inherited Mutations ◽  
Pachyonychia Congenita

Plantar keratodermas can arise due to a variety of genetically inherited mutations. The need to distinguish between different plantar keratoderma disorders is becoming increasingly apparent because there is evidence that they do not respond identically to treatment. Diagnosis can be aided by observation of other clinical manifestations, such as palmar keratoderma, more widespread hyperkeratosis of the epidermis, hair and nail dystrophies, or erythroderma. However, there are frequent cases of plantar keratoderma that occur in isolation. This review focuses on the rare autosomal dominant keratin disorder pachyonychia congenita, which presents with particularly painful plantar keratoderma for which there is no specific treatment. Typically, patients regularly trim/pare/file/grind their calluses and file/grind/clip their nails. Topical agents, including keratolytics (eg, salicylic acid, urea) and moisturizers, can provide limited benefit by softening the skin. For some patients, retinoids help to thin calluses but may lead to increased pain. This finding has stimulated a drive for alternative treatment options, from gene therapy to alternative nongenetic methods that focus on novel findings regarding the pathogenesis of pachyonychia congenita and the function of the underlying genes.

scholarly journals Global Spread of Mutant PfCRT and Its Pleiotropic Impact on Plasmodium falciparum Multidrug Resistance and Fitness

mBio ◽  
2019 ◽  
Vol 10 (2) ◽  
Author(s):  
Satish K. Dhingra ◽  
Stanislaw J. Gabryszewski ◽  
Jennifer L. Small-Saunders ◽  
Tomas Yeo ◽  
Philipp P. Henrich ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Multidrug Resistance ◽  
Treatment Options ◽  
Specific Treatment ◽  
Whole Genome Sequence ◽  
Content Type ◽  
Allelic Distribution ◽  
Population Structures ◽  
Allele Specific ◽  
Specific Parasite

Our study defines the allelic distribution of pfcrt, an important mediator of multidrug resistance in Plasmodium falciparum, in Africa and Asia. We leveraged whole-genome sequence analysis and gene editing to demonstrate how current drug combinations can select different allelic variants of this gene and shape region-specific parasite population structures. We document the ability of PfCRT mutations to modulate parasite susceptibility to current antimalarials in dissimilar, pfcrt allele-specific ways. This study underscores the importance of actively monitoring pfcrt genotypes to identify emerging patterns of multidrug resistance and help guide region-specific treatment options.

Goals of care and treatment in terminal delirium: A qualitative study of the views and experiences of healthcare professionals caring for patients with cancer

2018 ◽  
Vol 17 (04) ◽  
pp. 403-408
Author(s):  
Megumi Uchida ◽  
Tatsuya Morita ◽  
Yoshinori Ito ◽  
Kazuko Koga ◽  
Tatsuo Akechi
Keyword(s):  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Specific Treatment ◽  
Clinical Psychologist ◽  
Treatment Goals ◽  
Goals Of Care ◽  
Symptom Alleviation ◽  
Qualitative Interview Study ◽  
Care And Treatment ◽  
Views Of Healthcare Professionals

AbstractObjectiveThis study explores the views of healthcare professionals regarding care and treatment goals in irreversible terminal delirium and their effect on patients and caregivers.MethodWe conducted a qualitative interview study of healthcare professionals (palliative care physician, oncologist, psycho-oncologist, and clinical psychologist) engaged in the treatment of terminally ill cancer patients. We assessed the views of healthcare workers regarding treatment goals in terminal delirium and their effect on patients and their families.ResultOf the 21 eligible healthcare professionals, 20 agreed to participate in this study. Three of the professionals had experience with treating terminal delirium as family caregivers. We identified five important aspects of treatment goals in terminal delirium based on the views of healthcare professionals: (1) adequate management of symptoms/distress, (2) ability to communicate, (3) continuity of self, (4) provision of care and support to families, and (5) considering a balance (between symptom alleviation and maintaining communication; between symptom alleviation and family preparations for the death of patients; balance between specific treatment goals for delirium and general treatment goals).Significance of resultsAccording to the views of healthcare workers questioned in this study, goals of care and treatment in terminal delirium are multidimensional and extend beyond simply controlling patient symptoms.

scholarly journals Surgical candidacy and treatment uptake among women with cervical cancer at public referral hospitals in Kampala, Uganda

2020 ◽  
Author(s):  
Megan L Swanson ◽  
Miriam Nakalembe ◽  
Lee-may Chen ◽  
Stefanie M Ueda ◽  
Jane Namugga ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Phone Call ◽  
Treatment Recommendation ◽  
Advanced Stage ◽  
Multivariate Statistical ◽  
Recommended Treatment ◽  
Treatment Uptake ◽  
Referral Hospitals

AbstractPurposeCervical cancer is the most common malignancy among women in Uganda. Most present with advanced disease, when hysterectomy is not possible and cure is less likely. This study reports the proportion recommended for hysterectomy and associated factors, recommended treatments by stage, and treatment uptake.MethodsWe conducted a prospective study among patients seeking care for cervical cancer at public referral hospitals in Uganda. In-person surveys were followed by a phone call. Descriptive and multivariate statistical analyses examined associations between predictors and outcomes.ResultsAmong 268 participants, 76% were diagnosed at an advanced stage (IIB-IVB). In total, 12% were recommended for hysterectomy. In adjusted analysis, living within 15 kilometers of Kampala (OR 3.10, 95% CI 1.20-8.03) and prior screening (OR 2.89, 95% CI 1.22-6.83) were significantly associated with surgical candidacy. Radiotherapy availability was not significantly associated with treatment recommendations for early-stage (IA-IIA) disease, but was associated with recommended treatment modality (chemo-radiation versus primary chemotherapy) for locally advanced stage (IIB-IIIB). Most (67%) had started treatment. No demographic or health factor, treatment recommendation, or radiation availability was associated with treatment initiation. Among those recommended for hysterectomy, 55% underwent surgery. Among those who had initiated treatment, 82% started the modality that was actually recommended.ConclusionWomen presented to public referral centers in Kampala with mostly advanced-stage cervical cancer and few were recommended for surgery. Lack of access to radiation did not significantly increase the proportion of early-stage cancers recommended for hysterectomy.

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