BackgroundRecent epidemiological studies indicate the rate of gastrointestinal (GI) malignancies among younger patients is increasing, mainly due to colorectal cancer. There is a paucity of data regarding the magnitude of treatment-related symptoms, psychosocial issues and potential unmet needs in this population. We aimed to characterize the needs of this population to evaluate whether unmet needs could be targeted by potential intervention.MethodsFemale and male patients diagnosed with cancer of the gastrointestinal tract <40y retrospectively completed a questionnaire to evaluate symptoms, daily function and unmet needs at pre-treatment, during and post-treatment. Comparisons were made by gender, disease stage and treatment modality. Multiple linear regression models evaluated effects of demographics, symptoms and needs on multiple domains of health-related-quality-of-life (using Short-Form Health Survey-12 and CARES).ResultsFifty patients were enrolled (52 % female) to a pilot study. Median age at diagnosis was 35.5y (range, 21-40y). The symptoms that significantly increased from baseline to during and post-treatment were: diarrhea (37 %), sleeping disorder (32 %) and sexual dysfunction (40 %). Patients also reported significant deterioration in occupational activities and coping with children compared with baseline. Female patients reported significant unmet need for nutritional counseling and psychosocial support compared to male patients (p < 0.05). Patients treated with multimodality-treatment presented higher rates of unmet needs (p = 0.03).ConclusionsYoung patients with GI cancers represent a group with unique characteristics and needs compared with published evidence on other young-onset malignancies. The distinctive symptoms and areas of treatment-related functional impairments indicate there are unmet needs, especially in the area of psychosocial support and nutritional counseling.
R-CHOP is the standard therapy for patients with diffuse large B-cell lymphoma (DLBCL). We evaluated the effect of reduced intensity R-CHOP on survival, and toxicity in patients 70 years or older with DLBCL. The retrospective analysis included 140 patients (median age 78 years). We showed that patients with a good performance status treated with reduced adriamycin dose had a statistically significant worse overall survival. In multivariable model, the HR with any 10% increase adriamycin-relative dose in the first cycle was, 0.81, 95% CI 0.70-0.94. Age, gender, albumin and IPI were also associated with overall survival. Hospitalizations of patients treated with reduced R-CHOP were longer; however, the rate of infection did not differ between the groups. Based on current data, the optimal treatment for elderly patients with DLBCL remains unclear, but it is apparent that the dose of chemotherapy should be tailored individually according to performance status.
Background and Aims Although glomerular diseases are the third most frequent cause of end-stage kidney disease worldwide (after diabetes and hypertension), little is known about their long-term risks and complications. Method Using data from the Swedish Renal Registry (SRR-CKD) 2005-2021, we compared clinical outcomes between patients with the four most frequent primary glomerular diseases (IgA nephropathy [IgAN], focal segmental glomerulosclerosis [FSGS], minimal change disease [MCD] and membranous nephropathy [MN]) and patients with CKD attributed to non-inflammatory etiologies (i.e. without systemic auto-immune, inflammatory, infectious, hematologic malignancy, genetic disease, or polycystic kidney disease). Poisson models were used to estimate adjusted incidence rate ratios (IRR) of all-cause and cause-specific hospitalizations (cardiovascular-, acute kidney injury-, thromboembolism- and infection-related). Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) of kidney replacement therapy (KRT), major adverse cardiovascular events (MACE) and death. Results We identified 2967 patients with primary glomerular disease (71% men, age 57 years, eGFR 28 mL/min/1.73 m2, uACR 63 mg/mmol) and 40026 patients with a non-inflammatory CKD (64% men, age 74 years, eGFR 22 mL/min/1.73 m2, uACR 20 mg/mmol). As compared to non-inflammatory CKD, patients with primary glomerular diseases were younger, had a lower prevalence of cardiovascular disease, higher eGFR but higher albuminuria. Over median follow-up of 6.3 [3.3;9.9] years, there were median 3.0 [1.0;7.0] hospitalizations per patient, 9890 (23%) KRT, 11708 (27%) MACE, and 21091 (49%) deaths. As compared to non-inflammatory CKD, patients with primary glomerular disease had a lower risk of all-cause (IRR 0.77 [0.75;0.79]), and all cause-specific hospitalizations, MACE (HR 0.56 [0.50;0.63]) and death (HR 0.57 [0.52;0.62], but a similar risk of KRT (HR 1.02 [0.95;1.10]) or AKI (HR 0.84 [0.70;1.02]) (Figure 1). Within primary glomerular diseases and as compared to IgAN, patients with FSGS had a higher risk of death (HR 1.29 [1.03;1.60]) and MACE (HR 1.49 [1.12;1.97]), and patients with MN and MCD had a lower risk of KRT. Conclusion In this nationwide analysis of patients with advanced CKD undergoing nephrologist-care, those with primary glomerular disease have an observed lower risk of adverse clinical events compared to non-inflammatory CKD diseases. However, their risks of AKI or KRT are similar, emphasizing the need of adequate treatment strategies in this population. We speculate that the long-term continuous exposure to comorbidities like diabetes and hypertension in patients with non-inflammatory CKD might explain these differences. Within single primary glomerular disease etiologies, FSGS is associated with the highest risk of cardiovascular and fatal complications. The study received grant support from CSL Vifor.
Sarcopenia is defined as reduced muscle mass and loss of strength or function and can be part of normal aging as well as a component of cachexia. Multiple studies found correlation between reduced muscle mass and negative outcomes in chronic diseases and solid tumors. Little research exist on similar relationship in hematological malignancies and no studies investigated impact of longitudinal muscle mass changes on clinical outcomes in elderly lymphoma patients undergoing treatment. To evaluate the muscle mass during the course of chemotherapy in patients 70 years or older with DLBCL and its effect on survival and toxicity, we performed a retrospective cohort study. We included patients diagnosed between the years 2007-2014, and treated with RCHOP at the Rabin Medical Center. We collected data on age, sex, performance status (PS), number of extranodal involvement sites, Ann Arbor stage, international prognostic index (IPI), Charlson comorbidity index (CCI), hemoglobin (Hb), LDH, neutrophil, lymphocyte, monocyte, and platelet count, creatinine, albumin, CRP, treatment date, response and survival. We evaluated muscle mass by adding bilateral psoas muscle cross-sectional areas measured at the level of the third lumbar vertebra in a semi-automated manner on standard PET CT images. The ratio of the total psoas area normalized to height square (expressed in cm2/m2) was defined as muscle index. The change in muscle index after vs. before treatment was estimated. Correlation was estimated in a non-parametric test. The effect of pre-treatment muscle mass index and the above mentioned variables was estimated in a univariate Cox regression analysis. Variables potentially associated with mortality were entered into a Cox regression multivariate analysis. Results: Ninety three patients treated with RCHOP with baseline PETCT were included in the cohort. Median age was 78 years (range 70-90). Half of patients were female. Sixty percent had an IPI score of 3 or more. Mean muscle index before treatment was 4.66 cm2/m2, median 4.4 cm2/m2. End of treatment PETCT was available for 76 patients. Mean post treatment index was 4.2 cm2/m2, median 3.92 cm2/m2. A decrease in muscle index was observed in 76% of patients. The change in index ranged from -7.5 to 0.8, with a mean change of -0.58, SE0.12. No statistically significant correlation between pre treatment index and dose intensity was shown (p = 0.46). A negative correlation was shown between pre treatment index and days of hospitalization in cycles 1-2 (p=0.007, r=-0.28). Pre-treatment muscle index was not associated with overall survival (p = 0.43). In a sub-group analysis by sex a higher muscle index was associated with a longer overall survival among men (HR 0.59, 95% CI 0.44 to 78, p<0.001), while such an association was not demonstrated among women. Factors associated with overall survival (p<0.05 unless otherwise specified) were dose of adriamycin and cyclophosphamide in the first cycle, low hemoglobin, albumin, lymphocyte count (p=0.08), and platelet count (p=0.052) and LDH level. In a multivariate model that included these variables, albumin and chemotherapy dose remained statistically significant. In a second model with these variables as well as age and gender, the variables that were associated with overall survival were albumin, age, and gender, while chemotherapy dose became of borderline significance (p=0.08). Conclusion: based on our data including 93 elderly patients with DLBCL a higher muscle mass before RCHOP was associated with longer overall survival among men, but not among women. No association was found between muscle mass measured as total psoas area corrected to height and dose intensity and infection. During the course of chemotherapy we observed a loss of muscle mass in most of the patients. Disclosures No relevant conflicts of interest to declare.
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