ABSTRACT
OBJECTIVE: Antitumour treatment in the last 2 weeks of death (ATT-W2) and a new regimen of ATT within 30 days of death (NATT-M1) are considered as aggressive end-of-life (EOL) care. We aimed to assess factors associated with inappropriate use of antitumour treatment (ATT) at EOL. METHODS: Data of patients with cancer who died in 2013, 2015, 2017 and 2019 in a single for-profit cancer centre were retrospectively analysed. ATT was divided into chemotherapy (CT), oral targeted therapy (OTT), hormonotherapy and immunotherapy (IMT). RESULTS: A total of 1282 patients were included. NATT-M1 was given to 197 (15.37%) patients, and 167 (13.03%) had an ATT-W2. Patients with a performance status of <2 and treated with CT had more both ATT- W2 (OR=2.45, 95% CI 1.65 to 3.65, and OR=10.29, 95% CI 4.70 to 22.6, respectively) and NATT-M1 (OR=2.01, 95% CI 1.40 to 2.90, and OR=8.41, 95% CI 4.46 to 15.86). Predictive factors of a higher rate of ATT-W2 were treatment with OTT (OR=19.08, 95% CI 7.12 to 51.07), follow-up by a medical oncologist (OR=1.49, 95% CI 1.03 to 2.17), miscellaneous cancer (OR=3.50, 95% CI 1.13 to 10.85) and length of hospital stay before death of <13 days (OR=1.92, 95% CI 1.32 to 2.79). Urinary tract and male genital cancers received less ATT-W2 (OR=0.38, 95% CI 0.16 to 0.89, and OR=0.40, 95% CI 0.16 to 0.99) and patients treated by IMT or with age <69 years more NATT-M1 (OR=19.21, 95% CI 7.55 to 48.8, and OR=1.69, 95% CI 1.20 to 2.37). Patients followed up by the palliative care team (PCT) had fewer ATT-W2 and NATT-M1 (OR=0.49, 95% CI 0.35 to 0.71, and OR=0.42, 95% CI 0.30 to 0.58). CONCLUSIONS: Most recent ATT and access to a PCT follow-up are the two most important potentially modifiable factors associated with aggressive EOL in patients with cancer. Early integrated palliative oncology care could help to decrease futile ATT at EOL.
ABSTRACT
Six species or subespecies of anurans; Bufo spinulosus trifolium (Tschudi); B. s. flavolineatus Vellart, 1959; B. s. arequipensis Vellard; B. marinus L. and Batrachophrynus macrostomus Peters, 1873 from several locaties of Peru were each found to be infected with one or more of the following helmints: Cylindrotaenis americana; Hedruris moniezi; Falacaustra mascula; F. condorcanqui; Falacaustra spp; Aplectana hylambatis; A. vellardi; Cosmocercoides dukae; Batacholandros spectatus and Rhabdias sphaerocephala. C. americana; A. hylambatis; A. vellardi and C. dukae are reported for the first time in Peru. New hosts are recorded also.
Las siguientes especies o subespecies de anuros: Bufo spinulosus trifolium (Tschudi); B. s. Limensis (Werner); B. s. flavolineatus Vellard, 1959; B.s. arequipensin Vellard; B. marinus L. y Batrachophynus macrostomus Peters, 1873 procedentes de varias localidades del Perú estuvieron infectados con uno varios de los siguientes helmintos: Cylindrotaenia americana; Hedruris moniezi; Falcaustra mascula; F. condorcanquii; Falcaustra spp; Aplectana hylambatis; A. vellardi; Cosmocercoides dukae; Batracholandros spectatus y Rhabdias sphaerocephala. Los nuevos registros para el Perú son: C. americana; A. Hylambatis; A. vellardi; Cosmocercoides dukae; Batracholalandros spectatus y Rhabdias sphaerocephala. Los nuevos registros para el Perú son: C. americana; A. hylambatis; A. vellardi y C. dukae. Tambien se registran nuevos huespedes.
Subject(s)
Animals , Amphibians , Helminths , Parasites , PeruABSTRACT
For the first time it is revealed to what extent the oceanic current changes in 1957 (El Niño phenomenon) have affected the guano bird populationalon the Peruvian coast. It is estimated that about 11 million adult and 21 million young birds have been extinguished.
Durante 1957 se produjeron alteraciones del medio ambiente marino frente al litoral peruano, a causa de la presencia del fenómeno oceanográfico conocido como "El Niño", que en el caso de las aves guaneras ocasionaron considerablees fluctuaciones y mortalidad durante la migración masiva en busca de mejores condiciones ambientales. En enero de 1957 el nivel poblacionanl de aves adultas fue de 28 millones y con más bajo nivel de agosto del mismo año de 4.3 millones, revolvieron en noviembre 1957 solamente 17 millones, habiendo ocurrido la muerte de 11 millones de aves adultas y 21 millones de polluelos resultantes del ciclo productivo 1956/57.
