The Role of Palliative Chemotherapy in Hospitalized Patients

Wheatley‐Price, Paul; Ali, Maria; Balchin, Katelyn; Spencer, Jennifer; Fitzgibbon, Edward; Cripps, C.

doi:10.3747/co.21.1989

Cited by 24 publications

(29 citation statements)

References 28 publications

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“…In a retrospective trial of 199 inpatients with advanced incurable cancers of whom 18 (9%) had mCRC, palliative chemotherapy was administered in all the included patients, and 77% had improved symptoms and were discharged from hospital; 72% even received further chemotherapy, but their median survival was 4.5 months. This study did not present the results separately for mCRC patients 21 .…”

Section: Resultsmentioning

confidence: 95%

“…In these situations, other scales can help to make treatment decisions, such as the Edmonton Symptom Assessment System (ESAS) 23 , which summarizes symptom burden, the Palliative Performance Scale 24 , the prognostic Charlson Comorbidity Index 25 , and scales that predict the probability of severe toxicities due to chemotherapy. 21 , 26 Last but not least, clinical judgment should prevail when the scientific evidence is lacking.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Rocha¹,

Riechelmann²

2018

Clinics

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Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.

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Section: Resultsmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Rocha¹,

Riechelmann²

2018

Clinics

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“…Several studies have shown that palliative chemotherapy generally does not prolong survival in patients with solid malignancies who have a poor ECOG PS [2] [3]. The American Society of Clinical Oncology advocates withholding palliative chemotherapy from patients with solid tumors and an ECOG PS of 3-4, and instead recommends best supportive care (BSC) [4].…”

Section: Trajectories Of Hospitalization In Three Groups Of Patients mentioning

confidence: 99%

Trajectories of hospitalization in three groups of patients with incurable gastric cancer identified by hierarchical clustering: A retrospecitve analysis

Murakawa

Sakayori

Otsuka

2020

Preprint

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Purpose: The therapeutic goal for advanced solid malignancies is not to achieve cure but to prolong survival and maintain quality of life (QOL). To date, no study has reported the trajectory of the QOL throughout the clinical course of a patient with advanced malignancy. As hospitalization is considered a predictor of QOL, we retrospectively analyzed the trajectory of hospitalization in patients with incurable gastric cancer throughout the clinical course. Methods: The data of 85 patients with incurable gastric cancer were collected, including age, sex, Eastern Cooperative Oncology Group (ECOG) Performance Status (PS), treatment, histology, sites of metastases at first consultation, planned and unplanned hospitalization throughout the clinical course , and overall survival (OS). We ranked the patients by OS and hospitalization using a hierarchical clustering analysis. Results: Three clusters were identified corresponding to short, intermediate, and long OS/hospitalization (Clusters 1, 2, and 3, respectively). Patients in Cluster 3 were more likely to have an ECOG PS of 0–2 and receive palliative chemotherapy than the other clusters. No other differences in histology, age, sex, and or extra-peritoneal metastasis sites were observed between the three groups. In Cluster 3, planned hospitalization accumulated gradually during the early clinical phase, while unplanned hospitalization accumulated rapidly in later phases. Conclusions: No specific characteristics were associated with short, intermediate, and long OS/hospitalization. Patients in the long OS/hospitalization group exhibited a rapid accumulation of unplanned hospitalization during the latter clinical course. Further research is needed to identify specific predictors of and measures to avoid a long OS/hospitalization.

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“…Wheatley-Price et al 6 examine survival outcomes and the proportions of patients well enough for discharge home and for receiving further (presumably outpatient) chemotherapy in a convenience cohort of 199 hospitalized patients receiving palliative Early in clinical training, medical oncologists are taught that the goals of any palliative oncologic therapy include symptom control, quality-of-life improvement through disease stabilization, and prolongation of progression-free survival. Ideally, achieving those goals translates into an overall survival benefit, as has been observed in two pivotal clinical trials with symptom-directed primary endpoints-although that benefit is more the exception than the rule 1,2 .…”

Section: Rayson Md* and Da Kain Ma MD †mentioning

confidence: 99%

Reflecting on Inpatient Palliative Chemotherapy—Is There Ever a “Right Place” at the “Right Time”?

Rayson

Kain

2014

Current Oncology

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The Role of Palliative Chemotherapy in Hospitalized Patients

Abstract: ConclusionsDespite a short median survival, many patients are well enough to be discharged home and to receive further chemotherapy. The development of risk models to predict a higher chance of efficacy will have practical clinical utility.

Cited by 24 publications

References 28 publications

Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Trajectories of hospitalization in three groups of patients with incurable gastric cancer identified by hierarchical clustering: A retrospecitve analysis

Reflecting on Inpatient Palliative Chemotherapy—Is There Ever a “Right Place” at the “Right Time”?

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