Neurological hypertensive emergencies: Correlation of blood pressure values with in-hospital outcomes in ischemic stroke.

BACKGROUND: Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the role of BP and its trend as possible determinants of in-hospital mortality (primary outcome), discharge disabilities and hospitalization length (secondary outcomes) in ischemic stroke patients presented with Hypertensive Emergencies (HE). METHODS: We retrospectively evaluated patients presented to Niguarda Hospital, Emergency Department (ED), from 2015 to 2017 with a neurological ischemic HE. BP at ED presentation (T0), its management in ED (T1) and its values at the stroke unit admission (T2) were evaluated. RESULTS: 267 patients were included (0.13 % of all ED accesses and 17.9 % of all ischemic strokes). In the whole population, BP values were not associated with in-hospital mortality while T0 and T2 SBP result were associated to discharge disability and hospitalization length. In pre-specified subgroup analysis these associations were confirmed only in untreated subjects (not anti-hypertensive nor thrombolysis). In fact, no significant relationship can be found between BP values and any secondary outcome in thrombolysis and anti-hypertensive treated patients. CONCLUSIONS: BP values and its management can not be related to in-hospital mortality in stroke patients, presented with HE, while they are associated to discharge disability and hospitalization length. In subgroup analysis, results were confirmed only in untreated (not anti-hypertensive therapies nor thrombolytic).

Modulated chemotherapy according to modified comprehensive geriatric assessment in 100 consecutive elderly patients with diffuse large B-cell lymphoma.

Chemotherapy is associated with toxicity in elderly patients with potentially curable malignancies, posing the dilemma of whether to intensify therapy, thereby improving the cure rate, or de-escalate therapy, thereby reducing toxicity, with consequent risks for under- or overtreatment. Adequate tools to define doses and combinations have not been identified for lymphoma patients. We conducted a prospective trial aimed to evaluate the feasibility and efficacy of chemotherapy modulated according to a modified comprehensive geriatric assessment (CGA) in elderly (aged ≥70 years) patients with diffuse large B-cell lymphoma (DLBCL). In June 2000 to March 2006, 100 patients were stratified using a CGA into three groups (fit, unfit, and frail), and they received a rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone modulated in dose and drugs according to comorbidities and activities of daily living (ADL) and instrumental ADL scores. Treatment was associated with a complete response rate of 81% and mild toxicity: grade 4 neutropenia in 14%, anemia in 1%, and neurological and cardiac toxicity in 2% of patients. At a median follow-up of 64 months, 51 patients were alive, with 5-year disease-free, overall, and cause-specific survival rates of 80%, 60%, and 74%, respectively. Chemoimmunotherapy adjustments based on a CGA are associated with manageable toxicity and excellent outcomes in elderly patients with DLBCL. Wide use of this CGA-driven treatment may result in better cure rates, especially in fit and unfit patients.

The revised piper fatigue scale (PFS-R) for Italian cancer patients: a validation study.

BACKGROUND AND AIM: Fatigue is one of the most frequently reported symptoms by cancer patients. In recent years, much effort has been directed to designing fatigue measures which are psychometrically appropriate as well as easily administered. Among these, the Revised Piper Fatigue Scale (PFS-R) is widely used in assessing fatigue in cancer patients and other populations. Despite its large utilization in different national contexts and with different populations, its structure appears to vary across cultures, suggesting the need for its validation before use. The main aim of the present work was to verify the validity (i.e., dimensional structure and construct validity) and reliability (i.e., internal consistency) of an Italian translation of the PFS-R to reassure Italian oncology practitioners about its appropriate usage in practice and research. METHODS AND STUDY DESIGN: One-hundred ten Italian oncological inpatients were administered an Italian translation of the PFS-R together with a form for the collection of personal identification and clinical data and other fatigue and quality of life measures (POMS and EORTC QLQ-C30) already validated for Italy. RESULTS: Principal component exploratory factor analysis revealed a four-factor structure quite similar to (although not overlapping) the original described by Piper and colleagues; all four factors proved to be reliable and to correlate with one another and with previous validated measures of fatigue and quality of life. Preliminary descriptive statistics were also provided for data comparisons. CONCLUSIONS: Despite the discussed limitations, PFS-R seems a valid and reliable multidimensional fatigue measure also adequate in Italian oncological settings.

Assessing cancer-related fatigue: the psychometric properties of the Revised Piper Fatigue Scale in Italian cancer inpatients.

GOALS OF WORK: Fatigue is the most distressing untreated symptom for many cancer patients, and its measurement is of great topical interest. The aim of the present study was to assess psychometric properties of Revised Piper Fatigue Scale (PFS-r) in Italian cancer patients. PATIENTS AND METHODS: From January to June 2007, 115 histologically confirmed cancer inpatients (age >or=18 years; Eastern Cooperative Oncology Group [ECOG] performance status or=0.97) for all subscales. Exploratory factor analysis revealed three dimensions instead of four in the US questionnaire; 68.2% of the common variance was explained. Internal consistency was satisfactory (Cronbach's alpha >0.80) as was the test-retest reliability. Good correlations between PFS-r subscale and POMS subscales confirmed criterion validity. CONCLUSIONS: The psychometric properties of the Italian version of PFS-r, as evaluated in cancer patients ongoing chemotherapy, were satisfactory. We suggest the possible implementation of the Italian PFS-r in the assessment of fatigue particularly when it has been more fully validated on a wider range of cancer patients.

Cancer in the elderly: the caregivers' perception of senior patients' informational needs.

The aim of our study was to explore the caregivers' perception of the informational needs of Italian elderly cancer patients at the time of diagnosis. We asked the senior cancer patients naïve for treatments and their caregivers, admitted to our National Cancer Centre, to take a written self-administered questionnaire exploring the patient's information needs and his/her information-seeking behavior. The questionnaire was completed by 112 elderly cancer patients (median age 72 years) and their caregivers (median age 54 years). Patients were mostly affected by genital-urinary (27%) or breast/gynecological (25%) cancer. Caregivers were usually females (71%), daughters/sons (45%) and/or partners (41%). One-third of the senior patients showed a desire to receive extensive information regarding diagnosis and gravity, while 44.6% wanted to know about recovery. Caregivers showed improper recognition of the real needs for information of the their own patients (kappa tests showed unsatisfactory or poor agreement). Caregivers cannot be considered the preferred spokespersons of the oncologist when the patient is elderly or his/her needs for information again remain unmet. Interventions, both to help senior patients express their needs and to improve the patient-to-doctor-to-caregiver communication about cancer diseases, are necessary.

Can the caregiver replace his/her elderly cancer patient in the physician-patient line of communication?

UNLABELLED: GOALS OF WORKS: Only few studies have focussed on the information needs of senior cancer patients. The aim of this study was to evaluate to what extent caregivers perceive their elderly cancer patients' informational needs. MATERIALS AND METHODS: Between June 2004 and February 2005, at the National Cancer Institute of Aviano (northern Italy), we asked 112 elderly cancer patients naïve for treatments (age >65 years) and their 112 accompanying family members to fill in a self-administered questionnaire exploring the patient's information needs and his/her information-seeking behaviour. MAIN RESULTS: Elderly patients (60 males and 52 females, mean age 72 years) were mostly affected by genital-urinary (27%) or breast/gynaecological (25%) cancer. Caregivers were usually females (71%), daughters/sons (45%) and/or partners (41%). The interobserver agreement for the information request regarding cancer diagnosis and disease management, for the selected information sources consulted to acquire knowledge and for the reasons for seeking further information between the elderly patients and their caregivers were unsatisfactory to poor. CONCLUSIONS: Our results show that caregivers misunderstand the informational needs of their patients. Therefore, elderly patient information preferences cannot be predicted accurately by talking to relatives. The recommendation to oncologists is to be more responsive to the needs of both elderly cancer patients and their family members.

What elderly cancer patients want to know? Differences among elderly and young patients.

THE AIMS OF OUR STUDY WERE: (1) to evaluate the information needs of Italian elderly cancer patients (age > or =65 years), (2) to compare them with those of young patients (age 18-40 years). Between June 2004 and February 2005 we asked 122 elderly (mean age 72 years) and 52 young (mean age 33 years) cancer patients naïve for treatment to fill in two self-administered questionnaires exploring their needs for information and their psychological distress. The needs for information of elderly patients differed significantly from those of the young patients (p<0.0001); on contrast, both groups showed a similar psychological distress and the same reasons for seeking further information. Our results demonstrate that, more frequently than expected, Italian elderly cancer patients do not want complete information on their disease. Assessing to what extent elderly patients require information is essential for giving them tailored information.