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1.
Lung Cancer ; 162: 90-95, 2021 12.
Article in English | MEDLINE | ID: mdl-34763159

ABSTRACT

Value based Healthcare (VBHC) focuses on patient centered outcomes, by incorporating Patient Reported Outcome Measures (PROMS). Expectations on the benefits of VBHC are high, but few data are available that validate its routine use. We wanted to investigate if VBHC is feasible and beneficial for lung cancer patients in clinical practice. METHOD: We developed a digital transmural care pathway for lung cancer patients. During systemic therapy, patients digitally reported side effects weekly. Every six weeks, quality of life was reported trough EORTC questionnaires. Case-mix variables, treatment approaches and outcome indicators were systematically collected. We evaluated the compliance of the patients with the digitally reporting system and the impact of the care pathway on patient centered outcomes such as emergency department (ED) visits, time spent on the oncology day clinic, survival and quality of death. RESULTS: 221 lung cancer patients were included in the care pathway. 3091 weekly questionnaires were digitally collected. Compliance with the weekly digital follow-up was 92%: 2835 of 3091 questionnaires were completed. Patients in the care pathway had significantly less ED visits (3.5% vs 4.8%, p 0.04) and a shorter length of stay at the day clinic (2.5 h vs 4.1 h, p < 0,05) compared to routine clinical care. In stage IV lung cancer patients, overall survival was significantly higher in the care pathway (447 days (95% CI 379-663)) compared to routine care (286 days (95% CI 191-400)) (p = 0,025). CONCLUSION: Implementation of value based healthcare is feasible and beneficial in daily clinical care for lung cancer patients.


Subject(s)
Lung Neoplasms , Quality of Life , Delivery of Health Care , Humans , Lung Neoplasms/therapy , Patient Reported Outcome Measures , Surveys and Questionnaires
3.
Acta Clin Belg ; 75(5): 370-374, 2020 Oct.
Article in English | MEDLINE | ID: mdl-31423951

ABSTRACT

OBJECTIVES: Pulmonary lymphomatoid granulomatosis (PLG) is a rare angiocentric and angiodestructive EBV-associated lymphoproliferative disorder which almost always affects the lungs. PLG is more commonly diagnosed in patients with immunodeficiency and is associated with Epstein-Barr virus (EBV). 'Drug induced PLG' or 'iatrogenic immunodeficiency-associated lymphoproliferative disorder' is a special form of PLG described in patient with inflammatory bowel diseases treated with Azathioprine. METHODS: We report a case of drug-induced PLG in a 68-year-old patient with Crohn's disease presenting with pain at the right hemithorax, fatigue and shortness of breath with a pulmonary mass. RESULTS: Although initial diagnostic findings were misleading, an open lung biopsy eventually led to the diagnosis of drug-induced PLG. CONCLUSION: The diagnosis of PLG is challenging because the disease is rare and the histological features can be very subtle. Correct diagnosis relies on histopathology and immunohistochemical staining and EBV RNA in situ hybridization with sampling of large and different amounts of pathologic tissue in the hands of expert pathologists. In drug-induced PLG specifically, withdrawal of the immunosuppressive agent can lead to disease regression.


Subject(s)
Azathioprine/adverse effects , Crohn Disease/drug therapy , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Lung Neoplasms/chemically induced , Lymphomatoid Granulomatosis/chemically induced , Aged , Biopsy , Bronchoscopy , Chest Pain , Dyspnea , Endosonography , Female , Humans , Lung Neoplasms/immunology , Lymphomatoid Granulomatosis/immunology , Positron Emission Tomography Computed Tomography
4.
Clin Transplant ; 33(10): e13661, 2019 10.
Article in English | MEDLINE | ID: mdl-31286560

ABSTRACT

Lung transplantation remains the only curative treatment option for selected patients with end-stage interstitial lung disease (ILD). Candidate selection is impeded by patient heterogeneity, particularly in the subgroup of non-idiopathic pulmonary fibrosis (non-IPF) interstitial lung diseases. We performed a descriptive analysis of all non-IPF ILD patients who underwent lung transplantation in our center between July 1991 and November 2016 (n = 129) and searched for pre-transplant variables correlating with graft loss and chronic lung allograft dysfunction (CLAD). Our study cohort was characterized by a significantly affected medical condition, an extensive pre-transplant corticosteroid use (73.8%), and a high prevalence of pulmonary hypertension (55.7%). Earlier year of transplantation (P = .004), higher bilirubin level (P < .0001), older recipient age (P = .04), and smaller recipient height (P = .02) were found to be associated with earlier graft loss in multivariate analysis. Moreover, pre-transplant corticosteroid treatment tended to be related to earlier graft loss (P = .06), while pulmonary hypertension did not significantly correlate. None of the pre-transplant variables were shown to be associated with CLAD development. Ongoing research is required to further explore this diverse patient population and the pre-transplant variables determining their post-transplant outcome.


Subject(s)
Graft Rejection/mortality , Graft Survival , Lung Diseases, Interstitial/mortality , Lung Transplantation/mortality , Postoperative Complications/mortality , Adult , Cohort Studies , Female , Follow-Up Studies , Graft Rejection/etiology , Graft Rejection/pathology , Humans , Lung Diseases, Interstitial/surgery , Lung Transplantation/adverse effects , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/pathology , Prognosis , Risk Factors , Survival Rate
5.
Breathe (Sheff) ; 14(4): 311-316, 2018 Dec.
Article in English | MEDLINE | ID: mdl-30519297

ABSTRACT

Can you perform a robust histopathological diagnosis for this unusual case? http://ow.ly/40GB30mc5Th.

6.
J Geriatr Oncol ; 8(3): 196-205, 2017 May.
Article in English | MEDLINE | ID: mdl-28330581

ABSTRACT

OBJECTIVES: This study aims to evaluate the evolution of functional status (FS) 2 to 3months after initiation of chemotherapy, to identify factors associated with functional decline during chemotherapy treatment and to investigate the prognostic value of functional decline for overall survival (OS). PATIENTS AND METHODS: Patients ≥70years with a malignant tumor were included when chemotherapy was initiated. All patients underwent a geriatric assessment (GA) including FS measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). FS of patients was followed by repeating ADL and IADL to identify functional decline. RESULTS: From 10/2009 until 07/2011, 439 patients were included. At follow-up, ADL and IADL data were available for 387 patients. Functional decline in ADL and IADL was observed in 19.9% and 41.3% of the patients respectively. In multivariable logistic regression analysis, baseline factors associated with decline in ADL are abnormal nutritional status (OR:2.02) and IADL dependency (OR:1.76). Oncological setting (disease progression/relapse vs new diagnosis) (OR:0.59) is the only determinant of decline in IADL. Functional decline in ADL is strongly prognostic for OS (logrank p-value<.0001; Wilcoxon p-value<.0001) with HR 2.34 and functional decline in IADL is also prognostic for OS but less prominent with HR 1.25. CONCLUSIONS: Functional decline occurs in about a third of older patients with cancer receiving chemotherapy and is associated with GA components. It strongly predicts survival, the most prominent for ADL. This knowledge can be used to identify older persons with cancer receiving chemotherapy eligible for interventions to prevent functional decline.


Subject(s)
Activities of Daily Living , Antineoplastic Agents/adverse effects , Geriatric Assessment/methods , Neoplasms/drug therapy , Age Factors , Aged , Aged, 80 and over , Female , Humans , Male , Neoplasms/psychology , Nutritional Status , Prospective Studies , Regression Analysis
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