Health resource utilization associated with skeletal-related events in patients with bone metastases: Results from a multinational retrospective - prospective observational study - a cohort from 4 European countries.

BACKGROUND: Skeletal-related events (SREs; pathologic fracture, radiation or surgery to bone, spinal cord compression) frequently occur in patients with advanced cancer with bone metastases/lesions. Limited data on the associated patient and economic burden are available to aid in resource planning and evaluating treatment options. METHODS: Patients with bone metastases/lesions secondary to breast, lung or prostate cancer or multiple myeloma; with at least one SRE within 97 days prior to enrollment; life expectancy of at least 6 months; and Eastern Cooperative Oncology Group performance status 0, 1 or 2 were recruited. Information on health resource utilization (HRU; including number/duration of hospitalizations, outpatient visits, procedures), attributed by investigators to be associated with a SRE, was collected retrospectively for up to 97 days prior to enrollment and prospectively for up to 18-21 months. RESULTS: A total of 631 patients contributing 1282 SREs, were enrolled across Germany, Italy, Spain and the United Kingdom. Approximately a third of all SREs required an inpatient stay. Mean duration of inpatient stay for patients with SREs requiring one ranged from 8.4 to 41.1 days across all countries and SRE types. CONCLUSION: All types of SREs are associated with substantial HRU burden. Preventing SREs by using the best therapeutic options available may help to reduce the burden to patients and healthcare systems.

Cost of skeletal-related events in European patients with solid tumours and bone metastases: data from a prospective multinational observational study.

OBJECTIVES: Patients with bone metastases often experience skeletal-related events (SREs: radiation or surgery to bone, pathologic fracture, and spinal cord compression). This study examined health resource utilization and costs associated with SREs. METHODS: Data presented are from the European cohort (Germany, Italy, Spain, and the UK) of patients with solid tumours enrolled in a multi-national, prospective, observational study in patients with solid tumours or multiple myeloma. Patients with Eastern Cooperative Oncology Group score 0-2 and life expectancy ≥6 months, who experienced an SRE up to 97 days before enrolment, were eligible. Health resource utilization associated with SREs (including number/length of inpatient stays, numbers of procedures and outpatient visits) were collected through chart review for up to 97 days before enrolment and prospectively during follow-up. Country-specific cost calculations were performed. RESULTS: In total, 478 eligible patients contributed 893 SREs to this analysis. Radiation to bone occurred most frequently (66% of total). Spinal cord compression (7%) and surgery to bone (10%) were the least common events, but most likely to require inpatient stays. The most costly SREs were also spinal cord compression (mean per SRE across countries, €4884-€12,082) and surgery to bone (€3348-€9407). Inpatient stays were the main cost drivers. LIMITATIONS: Health resource utilization used to calculate the costs associated with SREs may have been under-estimated as a result of exclusion of patients with low performance status or life expectancy; unavailable information and exclusion of resource consumption associated with pain. Thus, the estimate of associated costs is likely to be conservative. CONCLUSIONS: SREs result in considerable health resource utilization, imposing a substantial financial burden driven by inpatient stays. Treatments that prevent/delay SREs may help ease this burden, thereby providing cost savings across European healthcare systems.

Enfermedad tromboembólica en el paciente oncológico avanzado: revisión y propuesta terapéutica / No disponible

Objetivos: ofrecer información sobre el estado actual de la enfermedad tromboembólica en el paciente oncológico, la evidencia existente en situación avanzada de enfermedad y proponer un protocolo de tromboprofilaxis primaria en caso de hospitalización. Material y métodos: revisión de la literatura hasta marzo 2009 utilizando las palabras clave: neoplasia, heparina de bajo peso molecular, embolismo pulmonar, cuidados paliativos y tromboembolismo venoso. Asimismo se identificaron posibles fuentes bibliográficas suministradas en las referencias de los artículos obtenidos e información específica reciente conocida por los autores. Resultados: la enfermedad tromboembólica (ETE) es una grave complicación en el paciente oncológico. La morbilidad previa, presencia de mutaciones, tipo de neoplasia, enfermedad diseminada, uso de catéteres centrales, cirugía, hospitalización, tratamiento con quimioterapia (Qt) son algunos de los factores que elevan el riesgo de ETE. A pesar de ello la tromboprofilaxis primaria durante la hospitalización del paciente oncológico es baja, la del paciente paliativo aún lo es más y la mayoría de las unidades carecen de protocolo específico. Conclusiones: en base a la ausencia de recomendaciones específicas sobre tromboprofilaxis primaria en el paciente paliativo durante la hospitalización, proponemos un algoritmo de profilaxis basado en la situación pronóstica y existencia de factores de riesgo (AU)

Objectives: to provide information on the current status of deep vein thrombosis in cancer patients, and the existing evidence, and to propose a protocol for primary thromboprophylaxis in hospitalized palliative patients. Material and methods: a review till March 2009 using the key words: neoplasm, low molecular weight heparin, pulmonary embolism, palliative care, and venous thromboembolism. Potential sources provided by bibliographic references in reviewed articles were also identified, as well as recent and specific information known by the authors. Results: thromboembolic disease (TED) is a serious complication in cancer patients. It is a multifactorial disease associated with endothelial injury, blood stasis, and hypercoagulability. Pre-existing morbidity, presence of mutations, type of cancer, disease extension, use of a central venous access, surgery, hospitalization, and treatment with chemotherapy are some of the factors that increase TED risk. Despite this, primary thromboprophylaxis during hospitalization of cancer patients is low, which is more frequent in the case of palliative patients, and most palliative care units do not have a specific protocol. Conclusions: based on the absence of specific recommendations for primary thromboprophylaxis in palliative patients during hospitalization, we propose an algorithm for prophylaxis based on the existence of prognostic risk factors (AU)

Delirium en pacientes oncológicos avanzados ingresados en una unidad de hospitalización de cuidados paliativos / No disponible

Objetivo: determinar la frecuencia de delirium en una Unidad de Hospitalización de Cuidados Paliativos. Conocer las características de los pacientes con delirium, así como los factores desencadenantes, reversibilidad y pronóstico. Método: se incluyeron pacientes ingresados en un sector de la Unidad durante el trimestre febrero-abril 2008 que cumplían al ingreso o durante la hospitalización criterios CAM de delirium. Se revisó la historia clínica de los pacientes seleccionados recogiéndose datos demográficos, tipo de neoplasia y extensión, factores contribuyentes-precipitantes, reversibilidad del cuadro y necesidad de sedación para control sintomático. Resultados: de los 50 pacientes que ingresaron durante el periodo de estudio, 28 (56%) cumplían criterios CAM de delirium. La enfermedad neoplásica estaba diseminada en el 75% de los casos. La etiología metabólico-tóxica fue la más frecuente (82,1%). Fueron exitus 89,2% y la sedación para control sintomático fue necesaria en el 17,9%. Conclusiones: el delirium es un cuadro con elevada frecuencia entre los pacientes oncológicos avanzados. La etiología tóxico-metabólica es lamás frecuentemente identificada. Se asocia a alta mortalidad y baja reversibilidad (AU)

Aim: the aim of this study was to determine the frequency of delirium in a Palliative Care Unit, and to know the characteristics of patients with delirium, as well as its triggers, reversibility and prognosis. Method: we included patients admitted to an area of the Unit during the February-April 2008 quarter, who met the CAM criteria for delirium at admission or during hospitalization. Medical records were revised, collecting demographic data, type of cancer and extension, precipitating factors, reversibility, and need of sedation for symptomatic control. Results: out of 50 patients admitted during the study period, 28 (56%) met the CAM criteria for delirium. The neoplasm was disseminated in 75% of cases. A metabolic-toxic etiology was most frequent (82.1%); 89.2% died, and sedation for symptomatic control was necessary in 17.9%. Conclusions: delirium is highly prevalent among advanced cancer patients. A toxic-metabolic etiology is most frequently identified. It is associated with high mortality and low reversibility (AU)

Catéteres peritoneales / No disponible

La ascitis maligna refractaria al tratamiento médico es un problema frecuente (15-50% de los pacientes con cáncer), que conlleva limitaciones en la calidad de vida de nuestros pacientes y provoca ingresos de repetición. Nuestro objetivo es valorar la efectividad del drenaje permanente de dicha ascitis con un catéter de vía subclavia insertado en el espacio peritoneal. Explicamos nuestra experiencia en 3 casos. El resultado en los3 casos fue la mejora y control de la ascitis sin complicaciones importantes. La conclusión es que el drenaje peritoneal con catéter de vía subclavia permanente es efectivo, sencillo, seguro y barato. El número de casos es bajo y el resultado no se puede generalizar. Es necesaria más experiencia (AU)

Refractory malignant ascites is a common medical problem (15-50% of cancer patients) that impairs quality of life in our patients, and leads to multiple admissions. Our objective was assess the efficacy of permanent peritoneal drainage in this type of patient using a subclavian catheter. We discuss our experience with 3 cases. Ascitis was controlled in all 3 patients without important complications. In conclusion, this treatment seems to be easy, safe, cheap, and effective. Our experience is very limited, so we need further research before these results are generalized (AU)

Epidemiología del dolor oncológico: revisión / No disponible

Objetivo: ofrecer información del estado actual de la epidemiología del dolor oncológico, en base a los trabajos publicados y adecuados para este objetivo. Material y método: revisión sistemática MEDLINE hasta el 1 de octubre de 2007. Así mismo, se identificaron posibles fuentes bibliográficas suministradas en las referencias de los artículos obtenidos e información específica reciente conocida por los autores. Se excluyeron trabajos en que la epidemiología era marginal. Resultados: se obtuvieron 18 trabajos relevantes sobre dolor oncológico en general y pacientes adultos. Cinco para la edad pediátrica y 6 en pacientes geriátricos. Conclusiones: la prevalencia del dolor en cáncer depende de su estadio evolutivo; en estadios iniciales es de un 50%, mientras que en las fases avanzadas puede llegar hasta el 80%. No todos los tumores se relacionan por igual con la presencia de dolor; los que afectan al hueso se asocian con más dolor. La intensidad se afecta por factores tales como el significado que el paciente le otorga, siendo mayor si el paciente lo atribuye a la progresión del cáncer. Puntuaciones superiores a 4 en la escala numérico verbal se relacionan con una mayor interferencia en la vida del paciente. El síndrome doloroso y sus características son independientes del origen de la neoplasia. El dolor habitualmente se relaciona con la progresión tumoral pero se considera que un 20% de los dolores son secundarios al tratamiento oncológico, en la población pediátrica esta cifra alcanza el 66%. Los pacientes ancianos con déficits funcionales y cognitivos son el grupo con mayor riesgo de obtener un mal control del dolor (AU)

Objective: to offer current information about the epidemiology of cancer pain. Material y method: a systematic review using MEDLINE, and searching since October 1, 2007. From references obtained other bibliographic sources were looked for. Any other new information known by the authors was also used. Papers with marginal epidemiological data were excluded from analysis. Results: eighteen general papers on adult populations were reviewed. Five related to pediatric and 6 to geriatric populations. Conclusions: the prevalence of cancer pain is related to stage; in early stages it is around 50%, in advanced stages it is 80%. Bone tumours, primary or secondary, have the highest frequency. Severity as reported by patients was linked to pain significance -it is higher when patients suspect a relation to tumour progression. Using a numerical rating scale, a score above 4 is related to a higher interference with daily activities. Pain syndromes and characteristics are independent of primary tumours. Usually, pain is related to disease progression, but in 20% of cases pain is due to cancer treatment, with this figure reaching 66% in the pediatric population. Elderly patients with functional and cognitive deficits make up the group with the highest risk for inadequate pain relief (AU)