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2.
Support Care Cancer ; 27(4): 1255-1261, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30406916

ABSTRACT

PURPOSE: Hyponatremia and bone metastasis (BMs) are known as negative prognostic factors in patients affected by metastatic non-small cell lung cancer (NSCLC). Hyponatremia is associated with higher risk of osteoporosis and bone fracture, but no data are available about the relationship between hyponatremia and bone metastasis. This study aims to analyze the prognostic impact of hyponatremia in NSCLC patients with bone metastases. METHODS: We retrospectively collected data about advanced NSCLC patients. Survival curves were estimated using Kaplan-Meier method, and comparisons were made using chi-square test. RESULTS: Six hundred forty-seven patients were enrolled into the study. BMs were present in 264 patients (41%) at diagnosis, while hyponatremia appeared in 237 (37%) patients during the first-line treatment. Patients without BMs had a median overall survival (mOS) of 15.9 months (95% CI 14.1-17.9) versus 11.4 months (95% CI 9.4-13.4) for patients with BMs (p = 0.001). Eunatremic patients had a better outcome (mOS 16.3 months, 95% CI 14.6-18.0 vs 10.3 months, 95% I 7.6-12.8, p = 0.003). Considering the two variables, patients with BMs and hyponatremia had a mOS of 10.1 months (95% CI 4.3-15.9), patients with hyponatremia without BMs 11.9 months (95% CI 11.4-12.4), while mOS was 13.1 months (95% CI 12.0-14.2) for eunatremic patients with BMs versus 17.1 months (95% CI 15.2-19.1) in eunatremic patients without BMs (p = 0.0020). Hyponatremic patients developed metachronous BMs significantly earlier (3.73 vs 5.76 months, p = 0.0187). CONCLUSIONS: Our study showed that hyponatremia is an important prognostic factor and it should be necessarily considered to enhance the management of NSCLC patients with BMs.


Subject(s)
Bone Neoplasms/secondary , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/pathology , Hyponatremia/diagnosis , Hyponatremia/etiology , Lung Neoplasms/complications , Lung Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/complications , Bone Neoplasms/diagnosis , Bone Neoplasms/therapy , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/therapy , Disease Progression , Female , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , Male , Middle Aged , Molecular Targeted Therapy , Neoadjuvant Therapy , Predictive Value of Tests , Prognosis , Retrospective Studies
4.
Ann Oncol ; 23(1): 141-147, 2012 Jan.
Article in English | MEDLINE | ID: mdl-21444358

ABSTRACT

BACKGROUND: Despite the advent of highly active antiretroviral therapy, anal cancer remains a significant health problem in human immunodeficiency virus (HIV) patients. We present the clinical features and treatment outcomes of anal cancer in 60 HIV-positive patients over a 20-year period. PATIENTS AND METHODS: A prospective database of all HIV-positive individuals managed in a specialist unit since 1986 includes 11 112 patients (71 687 person-years of follow-up). Sixty patients with anal cancer were identified. Their clinicopathological and treatment details were analysed. RESULTS: At anal cancer diagnosis, the mean age was 44 years (range: 28-75 years) and the median CD4 cell count was 305 mm(-3) (range: 16-1252 mm(-3)). Fifty (83%) had chemoradiotherapy (CRT). Forty-six (92%) responded, of whom 10 (22%) subsequently relapsed with locoregional (70%), metastatic disease (10%) or both (20%). The overall 5-year survival is 65% (95% confidence interval 51% to 78%). The median CD4 count fell from 289 mm(-3) before CRT to 132 mm(-3) after 3 months and to 189 mm(-3) after 1 year (P<0.05). Six patients in remission of anal cancer died of acquired immunodeficiency syndrome defining illnesses. CONCLUSIONS: The management of anal cancer with CRT achieves similar outcomes as the general population. CRT is associated with significant prolonged CD4 suppression that may contribute to late deaths of patients in remission.


Subject(s)
Anus Neoplasms/therapy , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/radiation effects , Chemoradiotherapy , HIV Infections/complications , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Anus Neoplasms/mortality , Anus Neoplasms/virology , CD4 Lymphocyte Count , Capecitabine , Cell Survival/radiation effects , Chemoradiotherapy/adverse effects , Chemoradiotherapy/methods , Deoxycytidine/administration & dosage , Deoxycytidine/adverse effects , Deoxycytidine/analogs & derivatives , Female , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Fluorouracil/analogs & derivatives , HIV Infections/mortality , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Mitomycin/administration & dosage , Mitomycin/adverse effects
5.
QJM ; 102(5): 311-9, 2009 May.
Article in English | MEDLINE | ID: mdl-19299249

ABSTRACT

OBJECTIVES: To determine oncology patients' pattern and rationale of complementary and alternative medicine (CAM) use, and canvass their views on the relative merits of allopathic and alternative medicine. DESIGN: Observational study of opinions from a cohort of patients using self-completion questionnaires. SETTING: Oncology departments of two UK teaching hospitals. PARTICIPANTS: Voluntary participation of 200 oncology patients attending clinic. MAIN FINDINGS: Twenty-two percent of patients used CAM, with a preponderance towards younger, female patients. The commonest reasons for CAM use is to make the patient feel better and to help with their cancer. However, patients seldom believe there is more evidence for CAM or that CAM will cure them, indeed often noticing no benefits from the treatment. CAM users do not resort to complementary medicine due to dissatisfaction with their doctor but instead have considerable trust in their physicians. Only a minority believes their doctor knows about their CAM use. CONCLUSION: CAM use by oncology patients in the UK is less common than that reported elsewhere. Although patients try CAM in the hope that it will help with their treatment, they are realistic about its likely benefits. It uptake is not as an indication of lack of faith in doctors, yet physicians are frequently unaware of use. Therefore, the medical profession should not feel threatened by patients resorting to CAM but instead focus on understanding the reasons behind it.


Subject(s)
Complementary Therapies , Neoplasms/therapy , Physician-Patient Relations , Adult , Age Factors , Aged , Aged, 80 and over , Complementary Therapies/psychology , Complementary Therapies/statistics & numerical data , Female , Humans , Male , Middle Aged , Mind-Body Relations, Metaphysical , Neoplasms/psychology , Quality of Life/psychology , Sex Factors , Surveys and Questionnaires , United Kingdom , Young Adult
6.
HIV Med ; 7(5): 291-3, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16945073

ABSTRACT

OBJECTIVE: Since the introduction of highly active antiretroviral therapy (HAART) there has been a dramatic reduction in the incidence of Kaposi sarcoma (KS) and an improvement in survival. We wished to examine whether the outcome in pulmonary KS (pKS) has also altered. METHODS: In a single-institution cohort of 1140 HIV-positive patients with KS, 305 patients were diagnosed in the HAART era (1996-2004). We examined the clinicopathological features and outcomes of these patients, of whom 25 had pKS and 280 did not. RESULTS: Patients with pKS had lower CD4 cell counts at the time of KS diagnosis (Mann-Whitney U-test P=0.005). The incidence of pKS was higher in African patients than in non-African patients in this sample (Fisher's test, P=0.001). There were no significant differences in age, gender, plasma HIV-1 viral load or prior HAART treatment at the time of KS diagnosis. Five-year overall survival in the pKS group was 49% [95% confidence interval (CI) 26-73%] as compared with 82% (95% CI 76-87%) for the non-pKS group (log rank, P<0.0001). CONCLUSION: PKS remains an ominous diagnosis in the era of HAART, with a median survival of just 1.6 years.


Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , HIV Infections/epidemiology , HIV-1 , Lung Neoplasms/epidemiology , Sarcoma, Kaposi/epidemiology , AIDS-Related Opportunistic Infections/complications , Adult , Aged , Antiretroviral Therapy, Highly Active , Black People , CD4 Lymphocyte Count , Female , HIV Infections/complications , Humans , London/epidemiology , Lung Neoplasms/complications , Male , Middle Aged , Prospective Studies , Sarcoma, Kaposi/complications , Survival Analysis
7.
J Clin Oncol ; 23(22): 5224-8, 2005 Aug 01.
Article in English | MEDLINE | ID: mdl-16051964

ABSTRACT

PURPOSE: A proportion of patients with HIV infection who subsequently receive highly active antiretroviral therapy (HAART) exhibit a deterioration in their clinical status, despite control of virologic and immunologic parameters. This clinical response, known as the immune reconstitution inflammatory syndrome (IRIS), occurs secondary to an immune response against previously diagnosed pathogens. PATIENTS AND METHODS: From our cohort of 5,832 patients treated in the HAART era, we identified 150 therapy-naive patients with a first presentation of Kaposi's sarcoma (KS). Their clinicopathologic features and progress were recorded prospectively. RESULTS: After commencing HAART, ten patients (6.6%) developed progressive KS, which we identify as IRIS-associated KS. In a comparison of these individuals with those whose KS did not progress, we found that IRIS-KS occurred in patients with higher CD4 counts (P = .03), KS-associated edema (P = .01), and therapy with both protease inhibitors and non-nucleosides together (P = .03). Time to treatment failure was similar for both groups, although the CD4 count declined more rapidly at first, in those patients with IRIS-associated KS. Despite this initial decline, in our clinical experience HAART could be successfully continued in those with IRIS-associated KS. CONCLUSION: We have identified IRIS-KS in a cohort of HIV patients with KS who start HAART.


Subject(s)
Antiretroviral Therapy, Highly Active , Inflammation , Sarcoma, Kaposi/complications , Sarcoma, Kaposi/immunology , Adult , CD4 Lymphocyte Count , Cohort Studies , Disease Progression , Female , Humans , Male , Middle Aged , Syndrome
8.
Br J Cancer ; 89(3): 457-9, 2003 Aug 04.
Article in English | MEDLINE | ID: mdl-12888811

ABSTRACT

The objectives of the study are to assess the impact of HIV status on the outcome of patients with non-small-cell lung cancer (NSCLC) in the era of highly active antiretroviral therapy (HAART). Patients diagnosed with HIV-related NSCLC in the HAART era (since January 1996) were identified from a prospective single-centre lung cancer database. The clinicopathological characteristics and outcome of each HIV-positive patient were compared to three age- and stage-matched HIV-negative controls with NSCLC who were diagnosed over the same time period and treated in an identical manner. The results showed that the two groups had similar disease characteristics and received a similar amount of chemotherapy. The median overall survival of the two groups was the same (4 months, log rank P=0.55). None of the HIV-positive patients developed an AIDS defining illness or died of HIV during treatment or follow-up. In conclusion, in this cohort, HIV status does not influence the prognosis of advanced NSCLC. This suggests that the survival of patients with HIV-related NSCLC may have improved since the introduction of HAART, and this may be due to a decrease in HIV-related deaths.


Subject(s)
Antiretroviral Therapy, Highly Active , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/virology , HIV Infections/complications , HIV Infections/drug therapy , Lung Neoplasms/drug therapy , Lung Neoplasms/virology , Adult , Databases, Factual , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Analysis , Treatment Outcome
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