According to the WHO guideline, palliative care is an integral component of COVID-19 management. The relief of physical symptoms and the provision of psychosocial support should be practiced by all healthcare workers caring for COVID-19 patients. In this review, we aim to provide a simple outline on COVID-19, suffering in COVID-19, and the role of palliative care in COVID-19. We also introduce 3 principles of palliative care that can serve as a guide for all healthcare workers caring for COVID-19 patients, which are (1) good symptom control, (2) open and sensitive communication, and (3) caring for the whole team. The pandemic has brought immense suffering, fear and death to people everywhere. The knowledge, skills and experiences from palliative care could be used to relieve the suffering of COVID-19 patients.
Background Gefitinib and erlotinib are superior to chemotherapy in terms of progression-free-survival (PFS), objective response rate (ORR) and disease control rate (DCR)in patients with epidermal growth factor receptor (EGFR) mutant advanced lung adenocarcinoma. However, studies comparing the treatment efficacy of gefitinib versus erlotinib are lacking. Aims To compare the PFS, overall survival (OS), ORR and DCR of patients with EGFR mutant advanced lung adenocarcinoma receiving first-line gefitinib versus erlotinib in a real-world setting. Methods A retrospective study of patients with EGFR mutant advanced lung adenocarcinoma treated with first-line gefitinib 250 mg once daily versus erlotinib 150mg once dailyat the University of Malaya Medical Centre from 1 August 2010 to 31 July 2014. Results 80 patients (81.6%) received gefitinib and 18 patients (18.4%) received erlotinib as first-line treatment. There was no significant difference in terms of PFS [7.13 versus 6.03 months (HR, 0.73; 95% CI, 0.39-1.38; p=0.335)] or OS [10.97 versus 8.67 months (HR, 0.57; 95% CI, 0.27-1.22; p=0.148)] between the two treatment groups. Patients on first-line gefitinib had better ORR [45.0% versus 33.3% (OR, 1.94; 95% CI, 0.63-6.00; p=0.251)] but worse DCR [76.3% versus 94.4% (OR, 0.23; 95% CI, 0.03-1.93; p=0.175)] compared to patients on first-line erlotinib, but the differences were not statistically significant. Conclusions In a real-world setting, patients with EGFR mutant advanced lung adenocarcinoma treated with first-line gefitinib or erlotinib appeared to have similar PFS, OS, ORR and DCR. However, the apparent lack of st th ○ Previous differences could have been due to the small sample size.
Background Randomised control trials (RCTs) show good overall survival (OS) for advanced lung adenocarcinoma patients is much dependent on subsequent-line of treatment upon disease progression on first-line treatment. However, not many studies look into such outcome in real-world setting. Aims To determine the impact of second-line treatment on OS for advanced lung adenocarcinoma patients who failed first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) or chemotherapy in the real world-setting. Methods A retrospective analysis of advanced lung adenocarcinoma patients who developed disease progression on first-line EGFR-TKI or chemotherapy treatmentat the University of Malaya Medical Centre from 1 August 2010 to 31 July 2014. Results Of 78 patients with EGFR mutant tumours and failed first-line EGFR-TKI, 23 patients (29.5%) received second-line chemotherapy while remaining 56 patients (70.5%) had best supportive care (BSC). Subgroup analysis showed that patients who received second-line chemotherapy had numerically better median OS (12.60 months) than those received BSC (9.03 months) (HR, 0.53; 95% CI, 0.24-1.21; p=0.134). Of 79 patients with EGFR wild-type tumours and failed first-line chemotherapy, 36 patients (45.6%) received second-line chemotherapy and 43 patients (54.4%) had BSC-the median OS for the former was 11.50 months and the latter was 5.47 months (HR, 0.58; 95% CI, 0.34-0.98; p=0.043). st th ○ Previous Conclusions In the real-world setting, second-line active treatment significantly prolonged the OS. The OS in this study was shorter than that in RCTS due to presence of co-morbidities, poorer ECOG performance at diagnosis and lower rate of second-line treatment.
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