CONTEXT:Episodic breathlessness is a relevant aspect in patients with advanced cancer.\ud
OBJECTIVES:The aim of this study was to assess the different aspects of this clinical phenomenon.\ud
METHODS:A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated.\ud
RESULTS:Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness.\ud
CONCLUSION:This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures
Adherence and persistence to new oral biologic agents, which are linked to several side effects and whose use is constantly widening, should represent a main endpoint of clinical research in the nearest future.
Objectives
To assess the use of complementary alternative medicines (CAM) in advanced cancer patients followed at home.
Methods
A consecutive sample of advanced cancer patients admitted to a home palliative care program was invited to participate in the study in a period of two months. Demographic characteristics, religious belief, education level, diagnosis, and socio-economic condition were recorded. Patients were asked about the use of CAM, considered to be a health-related treatment practiced outside the established health services. Information about CAM indications and those who prescribed or suggested CAM were also collected.
Results
Two hundred and eighty-three advanced cancer patients followed at home were surveyed. Twelve patients (4.2%) were receiving CAM. The indication and type of CAM were variable, as well as the costs. Given the low number of patients taking CAM, no further analysis was performed.
Conclusion
A limited number of advanced cancer patients followed at home were using CAM. Further multicenter studies with a larger sample should be performed to provide information about such therapies, also including eventual benefits.
Background
The addition of targeted treatment to chemotherapy and first and second line treatment significantly improves patient outcomes, raising the response rate with an increase of resectability in patients with metastasis and improving the long-term survival, as demonstrated by several randomised clinical trials.
Purpose
To evaluate the cost and effectiveness of treatment with bevacizumab or cetuximab in patients with metastatic colorectal cancer, in particular in maintenance treatment.
Materials and Methods
A retrospective analysis was conducted in two Sicilian cancer centres, in patients treated between 01/01/2008 and 30/06/2012, to assess the median time to progression (TTP) and the corresponding cost of maintenance treatment with bevacizumab and cetuximab. Results were compared using the log-rank test.
Results Of 167 patients treated with bevacizumab plus chemotherapy, 41 (24.5%) responded and continued with maintenance treatment: 36 patients on first-line treatment (TTP 412.5 days) and 5 patients on second-line treatment (TTP 314.7 days). Of 71 patients treated with cetuximab plus chemotherapy, 15 (21.1%) responded and continued with maintenance treatment: 9 patients on first-line treatment (TTP 271.2 days), 6 patients on second-line treatment (TTP 366.5 days). Maintenance treatment showed an increase in TTP of 258.2 and 159.3 days on first-line treatment, 188.1 and 243 days on second-line treatment for bevacizumab and cetuximab, respectively. The additional cost of maintenance treatment with bevacizumab and cetuximab, for a standard 70 kg, 1.7 m² patient is €84/day and €118/day for each day of progression-free survival, respectively.
Conclusions
In patients responding to maintenance treatment, bevacizumab is more advantageous as TTP in first-line treatment gains about 100 days vs. cetuximab, while cetuximab is more advantageous as second-line treatment, with a gain of about 55 days in TTP vs. bevacizumab. From the economic analysis the most advantageous is bevacizumab, costing €34/day less than cetuximab. A study is in progress to consider the use of targeted treatment with different chemotherapy regimens.
No conflict of interest.
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