Current Status of Cognition and Clinical Practice of Refractory Cancer Pain in Shanghai: A Questionnaire Survey.

Purpose: This study aimed to assess the current status of clinical practice of refractory cancer pain (RCP) among a sample of physicians specializing in cancer pain management in Shanghai. Methods: From 2019 to 2021, a questionnaire survey was conducted among physicians engaged in diagnosis and treatment of cancer pain through the questionnaire WJX network platform in Shanghai, China. Results: A total of 238 responses participated in the survey. This survey reports physicians' understanding and incidence rate of breakthrough cancer pain (BTCP). The choice of analgesics and satisfaction of analgesic effect were investigated. We also investigated doctors' knowledge of the diagnostic criteria for RCP and their tendency to choose analgesics. Oral immediate-release morphine and intravenous or subcutaneous morphine injection have been the common treatment approach for transient cancer pain exacerbations. The main barriers to pain management are lack of standardized treatment methods for RCP, lack of knowledge related to RCP, and single drug dosage form. Doctors believe the most necessary measures to improve the current situation of poor cancer pain control include improving medical staff's understanding and treatment techniques for RCP, updating treatment techniques and methods, and improving the configuration of drug types in medical institutions. Clinicians expect to improve understanding and treatment techniques through systematic training. Conclusion: Despite multiple available analgesic measures, the treatment of RCP remains challenging. Improving the understanding of medical staff towards RCP, improving treatment techniques, and increasing the accessibility of multiple drug types are important ways to improve the satisfaction of cancer pain management in the future.

Impacts of climate change and host plant availability on the potential distribution of Bradysia odoriphaga (Diptera: Sciaridae) in China.

BACKGROUND: Chinese chives (Allium tuberosum Rottler ex Sprengel) are favored by consumers because of its delicious taste and unique fragrance. Bradysia odoriphaga (Diptera: Sciaridae) is a main pest that severely harms Chinese chives and other Liliaceae's production. Climate change may change the future distribution of B. odoriphaga in China. In this study, the CLIMEX was employed to project the potential distribution of B. odoriphaga in China, based on China's historical climate data (1987-2016) and forecast climate data (2021-2100). RESULTS: Bradysia odoriphaga distributed mainly between 19.8° N-48.3° N and 74.8° E-134.3° E, accounting for 73.25% of the total mainland area of China under historical climate conditions. Among them, the favorable and highly favorable habitats accounted for 30.64% of the total potential distribution. Under future climate conditions, B. odoriphaga will be distributed mainly between 19.8° N-49.3° N and 73.8° E-134.3° E, accounting for 84.89% of China's total mainland area. Among them, the favorable and highly favorable habitats will account for 35.23% of the total potential distribution, indicating an increase in the degree of fitness. Areas with relatively appropriate temperature and humidity will be more suitable for the survival of B. odoriphaga. Temperature was a more important determinant of the climatic suitability of the pest B. odoriphaga than humidity. Host plants (Liliaceae) availability also had impact on climate suitability in some regions. CONCLUSIONS: These projected potential distributions will provide supportive information for monitoring and early forecasting of pest outbreaks, and to reduce future economic and ecological losses. © 2024 Society of Chemical Industry.

A good death from the perspective of healthcare providers from the internal medicine department in Shanghai: A qualitative study.

Objective: This study aimed to explore the understanding of healthcare providers working in the internal medicine department in Shanghai regarding a good death. Methods: The data of the study was collected using face-to-face semi-structured interviews. Through purposive sampling, 16 physicians and 13 nurses who had experiences of caring for adult patients with life-threatening illnesses at the end-of-life stage in Shanghai were interviewed. The interviews were analyzed using qualitative content analysis. Results: Six characteristics of a good death emerged: no suffering, companionship and care, no worries or concerns, dying with dignity, involvement and acceptance, and less impact on the family. Eighteen categories were identified: dying without experiencing suffering; being relieved of symptoms and suffering; being relieved of psychological suffering; avoiding the use of futile treatment and resuscitation; being cared for and accompanied by family; receiving good health care; having a meaningful life without regrets; making good arrangements for family issues; having a chance to say goodbye; having a quality life before death; dying in a decent environment; the personal will to be respected; maintaining the integrity of the body; death of the patient being accepted by the family and healthcare providers; the death occurred despite the best efforts to care for the patient; limited financial and care burden; shortly affected quality of life of the patient; and improved family cohesion. Conclusion: Family members' early involvement in caring for patients at the end-of-life stage helps achieve a good death. For patients with a terminal illness, avoiding unnecessary medical treatment and resuscitation could be the first step in achieving better patient death and promoting the development of advanced care planning in the mainland of China.

LncRNA ELF3-AS1 Promotes Non-Small Cell Lung Cancer Cell Invasion and Migration by Downregulating miR-212.

LncRNA ELF3-AS1 has been characterized as an oncogenic lncRNA in bladder cancer and oral cancer, whereas its role in non-small cell lung cancer (NSCLC) is unknown. In this study, the authors observed that ELF3-AS1 was upregulated in NSCLC tissues in comparison with that in paired nontumor tissues collected from 68 NSCLC patients. High expression levels of ELF3-AS1 predicted the poor survival of NSCLC patients. Expression levels of miR-212 were inversely and significantly correlated with the expression levels of ELF3-AS1 across NSCLC tissue samples. In NSCLC cells, overexpression of ELF3-AS1 led to downregulated miR-212 and increased methylation of miR-212 gene. In addition, overexpression of ELF3-AS1 inhibited the role of miR-212 in suppressing cancer cell invasion and migration. Therefore, ELF3-AS1 is upregulated in NSCLC and promotes cancer cell invasion and migration by downregulating miR-212 through methylation.

Value of Traditional Chinese Medicine syndrome differentiation in predicting the survival time of patients with advanced cancer.

OBJECTIVE: To prospectively study the accuracy of the palliative prognostic index (PPI) survival prediction model combined with Traditional Chinese Medicine (TCM) syndrome differentiation. METHODS: The PPI survival prediction model was used to predict survival time. Patients' real survival time was recorded. The survival time was calculated using the Kaplan-Meier method, and the logrank method was used to test the difference. RESULTS: The average PPI survival prediction score of 227 patients was 5.83 (95% CI: 5.29-6.37). There was a significant difference in the real-life period between the different PPI groups (P < 0.05). PPI group I (predicted survival of > 6 weeks) showed the highest predictive sensitivity and PPI group II (predicted survival of 3-6 weeks) showed the highest predictive specificity. According to TCM syndrome differentiation, 82 cases (36% ) were diagnosed with liver and kidney Yin deficiency (type IV). The actual survival time of type IV patients was significantly shorter than that of other types of patients (mean: 21.85 vs 28.70, P = 0.007). In group I, the median survival time of type IV patients and other types was 25 and 34 d, respectively (P < 0.001). The sensitivity and specificity of PPI prediction were improved in group II by TCM syndrome differentiation. For patients in group III whose predicted survival time was < 3 weeks, the specificity of PPI survival prediction was higher in type IV patients. CONCLUSION: This study shows that the PPI predictive tool for survival rate has important value. TCM syndrome differentiation and typing has certain significance for further classification and survival prediction.

Effect of the reignition characteristics on long-flame coal by oxidization and water immersion.

After a coal seam is mined, the coal remaining in the goaf is prone to flooding and spontaneous combustion accidents. To explore the reignition (secondary oxidation) characteristics of long-flame coal after oxidation and water immersion, the experimental methods of thermogravimetric analysis and infrared spectroscopy were used to analyze coal samples of oxidation first and then water immersion (FO) and samples of water immersion first and then oxidization (FI) at different pre-oxidation temperatures. The results showed that the content of main oxygen-containing functional groups (hydroxyl, carbonyl, and carboxyl groups) of the FO120 (oxidation 120 °C first and then water immersion) coal sample increased, and the FI 90 (water immersion first and then oxidization 90 °C) coal sample decreased. Pre-oxidation at 120 °C will slow down the decrease in the extent of low-temperature secondary oxidation TG, as the pre-oxidation temperature increases, the total heat release of the FO coal samples first increase and then decrease, and the heat released is high at 120 °C. The FI coal samples transfer active sites during the water immersion process, and the high pre-oxidation temperature leads to the rapid increase of the speed of the primary active site, which leads to the transformation between the secondary active site and the oxygen-containing group, resulting in the cleavage of the oxygen-containing group and increasing the heat production. Water immersion pre-oxidation performed under different conditions has the dual effects of promoting and inhibiting spontaneous coal combustion. This result provides a theoretical basis for preventing spontaneous combustion in coal-mined areas in shallow coal seams after soaking in water.

Risk stratification scores for hospitalization duration and disease progression in moderate and severe patients with COVID-19.

BACKGROUND: During outbreak of Coronavirus Disease 2019 (COVID-19), healthcare providers are facing critical clinical decisions based on the prognosis of patients. Decision support tools of risk stratification are needed to predict outcomes in patients with different clinical types of COVID-19. METHODS: This retrospective cohort study recruited 2425 patients with moderate or severe COVID-19. A logistic regression model was used to select and estimate the factors independently associated with outcomes. Simplified risk stratification score systems were constructed to predict outcomes in moderate and severe patients with COVID-19, and their performances were evaluated by discrimination and calibration. RESULTS: We constructed two risk stratification score systems, named as STPCAL (including significant factors in the prediction model: number of clinical symptoms, the maximum body temperature during hospitalization, platelet count, C-reactive protein, albumin and lactate dehydrogenase) and TRPNCLP (including maximum body temperature during hospitalization, history of respiratory diseases, platelet count, neutrophil-to-lymphocyte ratio, creatinine, lactate dehydrogenase, and prothrombin time), to predict hospitalization duration for moderate patients and disease progression for severe patients, respectively. According to STPCAL score, moderate patients were classified into three risk categories for a longer hospital duration: low (Score 0-1, median = 8 days, with less than 20.0% probabilities), intermediate (Score 2-6, median = 13 days, with 30.0-78.9% probabilities), high (Score 7-9, median = 19 days, with more than 86.5% probabilities). Severe patients were stratified into three risk categories for disease progression: low risk (Score 0-5, with less than 12.7% probabilities), intermediate risk (Score 6-11, with 18.6-69.1% probabilities), and high risk (Score 12-16, with more than 77.9% probabilities) by TRPNCLP score. The two risk scores performed well with good discrimination and calibration. CONCLUSIONS: Two easy-to-use risk stratification score systems were built to predict the outcomes in COVID-19 patients with different clinical types. Identifying high risk patients with longer stay or poor prognosis could assist healthcare providers in triaging patients when allocating limited healthcare during COVID-19 outbreak.

Chemotherapy and targeted therapy near the end of life affects aggressiveness of palliative care.

BACKGROUND: The purpose of this study was to explore the difference in quality indicators for chemotherapy or targeted therapy for patients with cancer in their last month of life. METHODS: A total of 585 patients who had received targeted therapy or palliative chemotherapy (PCT) from April 2007 to December 2018 at the Department of Integrated Therapy of Fudan University Shanghai Cancer Center were included in this retrospective study. The patients' social demographic and clinical data were collected, and variables judged to be independent predictors of PCT or targeted therapy were selected for univariate and multivariate analyses of differences. RESULTS: Treatment with PCT was independently associated with age (P<0.001) and performance status (PS) (P<0.001). Treatment with targeted therapy was independently associated with PS (P<0.001). Patients who received continued chemotherapy or cardiopulmonary resuscitation (CPR) within the last month of life were subjected to more intensive treatment in comparison with those who did not know when they were admitted to the intensive care unit (ICU) in the last month of life (P<0.001). Subgroup analysis showed that lung cancer was independently associated with targeted therapy (P<0.001), and admission to the ICU was independently associated with PCT (P<0.001). CONCLUSIONS: In the last month of life, approximately 14.9% of patients with cancer received PCT, which conformed to international recommendations. Lower CPR rates and admission to the ICU were positively correlated with targeted therapy versus those who received chemotherapy at the end of life (EOL).

Experimental Study on Organic Sulfur Removal in Bituminous Coal by a 1-Carboxymethyl-3-methyl Imidazolium Bisulfate Ionic Liquid and Hydrogen Peroxide Solution.

In order to improve the total sulfur removal rate in coal combustion, an acidic ionic liquid (IL) 1-carboxymethyl-3-methylimidazolium hydrogen sulfate ([HOOCCH2mim][HSO4]) as the extractant combined with the oxidant 30% hydrogen peroxide (H2O2) was applied to reduce the total sulfur content, and its microscopic mechanism of desulfurization was analyzed. The experimental results show that the desulfurization rate of the [HOOCCH2mim][HSO4]-H2O2 (1:10) solution was 45.12% and the organic sulfur removal rate was 16.26%, which were significantly higher than those of only H2O2 or pure [HOOCCH2mim][HSO4]. Fourier-transform infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy analyses showed that the mercaptan -SH and disulfide -S-S- in coal decreased after being treated with IL-H2O2. In particular, the results of FTIR spectroscopy indicated that the relative proportion of -S-S-and -SH treated with IL-H2O2 (1:10) decreased by 31.9 and 27.2%, respectively, compared with that of a pure IL. This is due to H2O2 oxidation; -SH and -S-S- were oxidized to sulfoxide and then the sulfoxide transferred from the coal phase to the IL phase, which improved organic sulfur removal from coal. Therefore, the combination of an ionic liquid and H2O2 could increase the total desulfurization rate. In addition, the thermogravimetric analysis of coal is divided into four different stages; the weight loss during the combustion stage and the residues show that the IL-H2O2 could improve the coal combustion because of good previous swelling and destruction of bridge bonds and hydrogen bonding of coal. Besides, the fewer residues in IL-H2O2-treated coals also indicate that a less amount of inorganic substance is left in coal after IL-H2O2 desulfurization, which is consistent with the desulfurization results.

Characteristics for Oxygen-Lean Combustion and Residual Thermodynamics in Coalfield-Fire Zones within Axial Pressure.

Coalfield fires during coal mining have become a major problem in the world today. To effectively prevent such disasters, we established an experimental platform to measure the spontaneous combustion characteristics of large-scale pressurized coal; thermal analysis experiments and microscopic analysis of briquettes under different axial pressures were carried out. It can be seen from the results that when the axial pressure is 4 MPa, the heating rate of the oxidative combustion of coal samples is accelerated, the crossing point temperature is lower (reduced by 71.09 °C), the activation energy is reduced (the second stage is decreased by 21.3 kJ/mol), and the oxidative combustion is more intense. Simultaneously, the porosity evolution process of briquettes under different axial pressures is simulated. Through calculation, it can be seen that the porosity and thermal conductivity show a linear increasing trend. The basis for the increase in the internal oxygen supply channels and increase in oxygen consumption when the axial pressure is 4 MPa is given. Through thermogravimetric-differential scanning calorimetry analysis, it is found that the maximum mass loss rate and maximum mass growth rate of residual coal after combustion under an axial pressure of 4 MPa are low, the residual rate after combustion is large, and the flammability rate is low when reoxidized, while complete combustion oxidation releases more heat. The application of axial pressure will change the combustion characteristics of briquettes, and the promotion effect is more obvious at 4 MPa. Analyzing the laws of the coal-oxygen composite reaction under different axial pressures provides theoretical guidance for the prevention and control of multistress coupling fields in coalfield-fire areas.

Use of palliative chemotherapy near the end of life: a retrospective cohort study.

BACKGROUND: For patients with metastatic cancer, treatment with palliative chemotherapy can lead to more aggressive end-of-life (EOL) care. This retrospective study aimed to assess the time from the last chemotherapy treatment to death and investigate the variables associated with the delivery of palliative chemotherapy near the end of life. METHODS: Data from patients who died from metastatic cancer after receiving palliative chemotherapy from April 2007 to June 2019 at the Department of Integrated Therapy of Fudan University, Shanghai Cancer Center were analyzed. Statistical analysis was performed to evaluate variables including the patient's age, Charlson comorbidities, caregivers, and the type of cancer. RESULTS: A total of 605 patients were included in the analysis, of whom 335 (58.7%) were treated with palliative chemotherapy during their last year of life and 16.2% were treated in their last month of life. Treatment with palliative chemotherapy in the last month was independently associated with age (P<0.001). In the last year of life, treatment with palliative chemotherapy differed significantly according to caregivers and age (P<0.001). The interval between the last chemotherapy treatment and death was the shortest for patients whose caregivers were adult children or those aged ≤50 years. CONCLUSIONS: In this study, palliative chemotherapy was used to treat 58.7% of patients in their last year, and 16.2% of patients in their last month, which is in line with international recommendations. In the last month, palliative chemotherapy was independently associated with age (P<0.001), whereas patients were more likely to receive palliative chemotherapy in their last year if their caregivers were adult children or if they were aged ≤50 years. Significant variations in EOL treatment strategies were observed according to caregivers and patient age during the last year of life.

Baicalein suppresses vasculogenic mimicry through inhibiting RhoA/ROCK expression in lung cancer A549 cell line.

Vasculogenic mimicry (VM) refers to a new tubular network of the blood supply system with abundant extracellular matrix. VM is similar to capillaries but does not involve endothelial cells. As a traditional herbal medicine commonly used in China, baicalein possesses anti-inflammatory and lipoxygenase activities. However, the effects of baicalein on the process of VM formation in non-small cell lung cancer (NSCLC) and the underlying mechanisms have remained poorly understood. In this study, baicalein was found to inhibit the viability and motility of A549 cells and induced the breakage of the cytoskeletal actin filament network. In addition, baicalein significantly decreased the formation of VM and downregulated the expressions of VM-associated factors, such as VE-cadherin, EphA2, MMP14, MMP2, MMP9, PI3K and LAMC2, similar to the effects of ROCK inhibitors. Indeed, baicalein inhibited RhoA/ROCK expression in vitro and in vivo, suggesting the underlying mechanisms of reduced VM formation. Collectively, baicalein suppressed the formation of VM in NSCLC by targeting the RhoA/ROCK signaling pathway, indicating that baicalein might serve as an emerging drug for NSCLC.

A validated LC-MS/MS method for the quantification of capivasertib in dog plasma: Application to its pharmacokinetics study.

In this study, a simple and reliable liquid chromatography tandem mass spectrometric method was first developed for the determination of capivasertib in dog plasma with ipatasertib as internal standard. The plasma samples were deproteinated using acetonitrile. An Acquity BEH C18 column (1.7 µm, 2.1 × 50 mm) maintained at 40°C was used for chromatographical separation, with water containing 0.1% formic acid and acetonitrile as mobile phase. Multiple reaction monitoring transitions were m/z 429.2 > 135.1 for capivasertib and m/z 458.2 > 387.2 for ipatasertib, respectively. Excellent linearity was achieved in the concentration range of 1-1,000 ng/ml with a correlation coefficient of >0.9981. The lower limit of quantification was 1 ng/ml. The extraction recovery of capivasertib from dog plasma was >85.81% and no significant matrix effect was found. The intra- and inter-day precision was <9.58% and the accuracy ranged from -10.60% to 12.50%. The validated method was further applied to the pharmacokinetic study of capivasertib in dog plasma after single oral (5 mg/kg) and intravenous (1 mg/kg) administrations. The results revealed that capivasertib was rapidly absorbed into plasma with good bioavailability (47.04%) and low clearance.

Long Noncoding RNA SNHG10 Sponges miR-543 to Upregulate Tumor Suppressive SIRT1 in Nonsmall Cell Lung Cancer.

Background: Long noncoding RNA SNHG10 has been reported to promote the development of liver cancer. While by analyzing The Cancer Genome Atlas (TCGA) dataset we observed the downregulation of SNHG10 in non-small cell lung cancer (NSCLC). This study aimed to investigate the roles of SNHG10 in NSCLC. Materials and Methods: This study included 60 pairs of NSCLC and nontumor tissue samples collected from 60 NSCLC patients (males and females, 39-66 years, 50.9 ± 5.5 years). Gene expression was detected by quantitative polymerase chain reaction and western blot. Overexpression experiments were used to analyze gene interactions. Effects of cell transfections on cell proliferation were analyzed by performing CCK-8 cell proliferation assays. Results: We confirmed the downregulation of SNHG10 in NSCLC. In addition, low expression level of SNHG10 predicted the poor survival of NSCLC patients. SNHG10 can directly interact with miR-543, while overexpression of miR-543 failed to downregulate SNHG10. However, SNHG10 overexpression led to upregulation of sirtuin 1 (SIRT1), a downstream target of miR-543. Cell proliferation assay showed that SNHG10 and SIRT1 overexpression led to the decreased proliferation rate of NSCLC cells. In contrast, miR-543 over-expression played an opposite role and reduced the effects of SNHG10 and SIRT1 overexpression. Conclusions: In conclusion, SNHG10 sponges miR-543 to upregulate tumor suppressive SIRT1 in NSCLC to suppress cell proliferation.

Improved SERS activity of non-stoichiometric copper sulfide nanostructures related to charge-transfer resonance.

The low enhancement factor of semiconductor SERS substrates is a major obstacle for their practical application. Therefore, there is a need to explore the facile synthesis of new SERS substrates and reveal the SERS enhancement mechanism. Here, we develop a simple, facile and low-cost two-step method to synthesize copper sulfide based nanostructures with different Cu7.2S4 contents. The as-synthesized sample is composed of nanosheets with the CuS phase structure. With the increase of the annealing temperature to 300 °C, the CuS content gradually decreases and disappears, and the content of Cu7.2S4 and CuSO4 appears and gradually increases. At the annealing temperature of 350 °C, only CuSO4 exists. Compared with pure CuS or pure CuSO4, the detection limit of R6G molecules is the lowest for the composite sample with a higher content of Cu7.2S4, indicating that the introduction of non-stoichiometric Cu7.2S4 can improve the SERS performance and the higher content of Cu7.2S4 leads to a higher SERS activity. Furthermore, to investigate the SERS mechanism, the energy band structures and energy-level diagrams of different probe molecules over CuS, Cu7.2S4 and CuxS are studied by DFT calculations. Theoretical calculations indicate that the excellent SERS behavior depends on charge transfer resonance. Our work provides a general approach for the construction of excellent metal compound semiconductor SERS active substrates.

Referral Characteristics of Palliative Care Service in Patients With Advanced Non-Small Cell Lung Cancer in a Tertiary Cancer Center.

BACKGROUND: The American Society of Clinical Oncology recently recommends patients with metastatic non-small cell lung cancer (NSCLC) should be offered palliative care services earlier. We sought to investigate the timing of palliative care referral of Chinese patients with NSCLC in our center. METHOD: Retrospective medical data including demographic characteristics and referral information were collected for analysis. Overall survival (OS) was calculated as the time since cancer diagnosis till patient's death. The time interval from palliative care (PC) referral to a patient's death (PC-D) was calculated. The PC-D/OS ratio was calculated to illustrate the comparison of the duration of PC in the overall length of disease. RESULTS: The mean age of 155 patients with advanced NSCLC was 62.83 years. Before referral to PC, 128 patients received anticancer treatment including surgeon (46.5%). Sixty-three (40.6%) patients died in palliative care unit. The median OS of 144 patients with end cutoff was 19 months (mean = 31.49, 95% confidence interval [CI] = 25.86-37.12). The median PC-D was 41 days (mean = 73.84, 95% CI = 60.37-87.40). The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22 (SD: 0.27, 95% CI: 0.17-0.26). The median interval was 0.089. More than half of patients (n = 75, 51.8%) underwent PC less than 1% time (PC-D/OS < 0.1) of their whole disease course. Patients who were indigenous to Shanghai (P = .013) and who had brain metastasis (P = .072) had the potential longer PC-D/OS ratio. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. CONCLUSION: This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a tertiary cancer center.

C-Reactive Protein/Albumin Ratio Is an Independent Prognostic Predictor of Survival in Advanced Cancer Patients Receiving Palliative Care.

Background: The C-reactive protein/albumin (CRP/Alb) ratio has been reported as a prognostic factor of survival for patients with a variety of cancers. However, its prognostic impact for advanced cancer patients receiving palliative care remains presently unknown. Objective: The present study assessed the prognostic value of the CRP/Alb ratio, and compared this with that of the Glasgow Prognostic Score (GPS) and Palliative Prognostic Index (PPI) in a cohort of advanced cancer patients receiving palliative therapy. Methods: The medical records of 262 eligible patients who died of advanced cancer from February 1, 2013 to December 30, 2017 in the palliative care unit of the Fudan University Shanghai Cancer Center were retrospectively reviewed for the analysis. Results: The present results revealed that a CRP/Alb ratio ≥1.31 (hazard ratio [HR], 2.33 [1.78-3.05], p < 0.001) can predict poor prognosis through univariate analysis. In addition, the multivariate analysis revealed that CRP/Alb (HR, 2.09 [1.54-2.84], p < 0.001), GPS (HR, 1.81 [1.07-3.07], p < 0.001), and PPI (HR, 3.35 [2.25-4.99], p < 0.001) were all independent prognosis factors. To compare the discriminatory performance of the CRP/Alb ratio with that of other established prognostic indexes in palliative care settings, the c-statistics, integrated discriminatory improvement index, net reclassification index, and receiver operating characteristic curves were generated, and it was demonstrated that the CRP/Alb ratio (c-statistics, 0.64 [0.61-0.68]) was able to discriminate advanced cancer patients with different survivals, with analogous discriminatory ability as GPS (c-statistics, 0.63 [0.59-0.66]) and PPI (c-statistics, 0.64 [0.60-0.68]). Notably, the combination of multiple prognostic indexes exerted higher discriminatory ability, compared with any single predictive index (c-statistics, 0.69 [0.66-0.73], p < 0.001). Conclusions: The present study suggests that the CRP/Alb ratio is a promising prognostic factor in predicting cancer patient survival in palliative care settings. Incorporating both objective parameters and the subjective index may improve the prediction accuracy of prognosis.

Nomogram-based parameters to predict overall survival in a real-world advanced cancer population undergoing palliative care.

BACKGROUND: Although palliative care has been accepted throughout the cancer trajectory, accurate survival prediction for advanced cancer patients is still a challenge. The aim of this study is to identify pre-palliative care predictors and develop a prognostic nomogram for overall survival (OS) in mixed advanced cancer patients. METHODS: A total of 378 consecutive advanced cancer patients were retrospectively recruited from July 2013 to October 2015 in one palliative care unit in China. Twenty-three clinical and laboratory characters were collected for analysis. Prognostic factors were identified to construct a nomogram in a training cohort (n = 247) and validated in a testing cohort (n = 131) from the setting. RESULTS: The median survival time was 48.0 (95% CI: 38.1-57.9) days for the training cohort and 52.0 (95% CI: 34.6-69.3) days for the validation cohort. Among pre-palliative care factors, sex, age, tumor stage, Karnofsky performance status, neutrophil count, hemoglobin, lactate dehydrogenase, albumin, uric acid, and cystatin-C were identified as independent prognostic factors for OS. Based on the 10 factors, an easily obtained nomogram predicting 90-day probability of mortality was developed. The predictive nomogram had good discrimination and calibration, with a high C-index of 0.76 (95% CI: 0.73-0.80) in the development set. The strong discriminative ability was externally conformed in the validation cohort with a C-index of 0.75. CONCLUSIONS: A validated prognostic nomogram has been developed to quantify the risk of mortality for advanced cancer patients undergoing palliative care. This tool may be useful in optimizing therapeutic approaches and preparing for clinical courses individually.

Palliative Chemotherapy Near the End of Life in Oncology Patients.

BACKGROUND: Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL. METHODS: This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy. RESULTS: Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001). CONCLUSION: The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.

Neutrophil count and percentage: potential independent prognostic indicators for advanced cancer patients in a palliative care setting.

The purpose of this study was to evaluate the count and percentage of neutrophils as prognostic indicators in advanced cancer patients undergoing palliative care. 378 consecutive patients receiving treatment at the palliative care unit of Fudan University Shanghai Cancer Center between July 2013 and October 2015 were reviewed. In 106 of these patients, the data were extended during the follow-up. The cut-off values selected for the neutrophil count and percentage were 8.0×109/L and 85%, respectively. Both a high pretreatment neutrophil count (HR = 1.828, 95% CI: 1.409∼2.371, P<0.001) and a high pretreatment neutrophil percentage (HR = 1.475, 95% CI: 1.106∼1.967, P=0.008) were independent prognostic factors for decreased overall survival. Furthermore, in the follow-up cohort of readmitted patients (n = 106), patients with a newly increased neutrophil count or percentage were respectively, 1.837 (95% CI: 1.096∼3.079) and 3.268 (95% CI: 1.848∼5.778) times more likely to have a poor prognosis compared with patients with low neutrophil conditions (P=0.021, P<0.001). In conclusions, both high pretreatment or newly increased count and percentage of neutrophils were confirmed as independent prognostic factors for adverse outcomes. These parameters may be used as stratification factors in identifying advanced cancer patients with poor prognosis in palliative care settings.