Geriatric screening and comprehensive geriatric assessment during initial oncology appointments.

INTRODUCTION: Geriatric oncology underscores the significance of assessing functional age in guiding medical decisions, endeavouring to delineate practical and efficacious methodologies for evaluating functionality, adapting therapeutic regimens and attenuating the risks of treatment-related deterioration. OBJECTIVES AND METHODS: In this prospective study, we aimed to delineate the characteristics of older patients presenting for their initial oncology appointment by using geriatric screening (G8 score) and comprehensive geriatric assessment (CGA), while also assessing the feasibility of these evaluations. Secondary objectives included comparing the initial Eastern Cooperative Oncology Group (ECOG) performance status and any deviations from standard therapeutic strategies against the identified frailty in geriatric assessment. RESULTS: Most patients exhibited a G8 score ≤14 and underwent comprehensive geriatric assessment. While oncologists typically perceive patients' general conditions, CGA enables a systematic assessment, providing a comprehensive characterisation of elderly patients to inform therapeutic decisions and address identified fragilities. The CGA highlighted vulnerabilities across all primary domains. Notably, even among patients with ECOG scores of 0 and 1, the application of G8 score and CGA revealed numerous fragilities. Consistent with existing literature, these scales offered additional insights beyond ECOG evaluation alone, suggesting their potential to guide therapeutic adaptations for this demographic. CONCLUSION: Ongoing research and continuous evaluation are imperative to refine and broaden the implementation of geriatric-focused interventions.

Factors That Influence the Prescription of Antibiotic Therapy at the End-of-Life: Construction and Validation of a Scale.

INTRODUCTION: End-of-life care is frequently discussed in clinical practice. Non-beneficial treatments and the need for decision-making regarding therapeutic institutions are increasingly addressed. There are no guidelines regarding prescribing or de-prescribing antibiotic therapy at the end of life, which depends on clinical decisions. In this study, we developed a scale to assess the factors influencing clinicians' decisions when prescribing antimicrobial agents. METHODS: This is a quantitative, exploratory, and descriptive study. After the literature review, the scale was constructed with an analysis of internal consistency and temporal stability. It was applied online together with a sociodemographic and clinical questionnaire. Statistical analysis of the scale, its construction, and final validation were performed. RESULTS: A total of 196 physicians participated in this study (76.5% female, 78.6% aged <40 years), 60.2% specialists, and 35.7% without palliative care training. Almost all of the participants (89.9%) reported having end-of-life care concerns with a high frequency. In this study, a scale was developed to assess factors associated with the prescription of antibiotic therapy in end-of-life patients. This scale revealed the presence of 3 factors: infection, patient/illness, and symptoms. Together, the three factors explain 57.4% of the clinician's decisions. The factors associated with symptoms were the most predominant in decision-making compared to those associated with infection. CONCLUSIONS: Among the multiple factors that may influence the institution of antibiotic therapy at the end of life, symptomatic control is the most important factor.

End-of-Life Antibiotherapy: Factors Associated With Prescription.

Introduction Most cancer patients spend their last days of life in the hospital, often receiving invasive and non-palliative interventions. These patients are particularly susceptible to infections, which are a major cause of death. The decision to use antimicrobials in a palliative context is difficult, given the lack of guidelines. Objectives To characterize patients who received antimicrobials at the end of life and analyze factors associated with their prescription decisions. Methods A retrospective analysis of patients who died in the Medical Oncology Service from January to December 2017 was done. In addition, the use of antibiotics in the last 15 days of life was considered. Clinical, therapeutic, and Eastern Corporative Oncology Group Performance Status Scale (ECOG PS) variables were analyzed using SPSS v23. Results There were a total of 116 deaths, of which 48.3% (n = 56) received antimicrobials in their last 15 days of life. The median age of the patients was 64.5 years. Most patients (55.4%) had an ECOG PS 4, of which 82.1% were stage IV tumors. The most frequent tumors were colorectal adenocarcinomas (21.3%), digestive non-colorectal (predominantly gastric or esophageal adenocarcinomas) (20.5%), and invasive breast carcinomas (16.4%). Asthenia (33.6%) and dyspnea (19.8%) were the main complaints, and most patients (55.4%) had respiratory infections. Fever was present in 51.8% of patients on antibiotics and was related to their use (p < 0.001). The use of antimicrobials is also related to higher C-reactive protein (CRP) values (p = 0.015). Conclusions The decision to institute antimicrobials at the end of life is related to clinical and analytical aspects suggestive of infection without considering the patient's general condition and the oncological disease's prognosis. Deprescription of antibiotic therapy is not yet a current clinical practice.

Calidad de vida relacionada con la salud en pacientes con déficit de alfa1 antitripsina: estudio transversal / Health-related quality of life in patients with alpha1 antitrypsin deficency: a cross sectional study

Introducción: Las medidas de calidad de vida relacionada con la salud (CVRS) pueden ayudar a determinar los efectos de la enfermedad de los pacientes con déficit de α1-antitripsina (DAAT) y proporcionar una perspectiva valiosa de los resultados de las intervenciones. Este tema se ha abordado poco en la literatura, y el objetivo de este estudio fue evaluar si existe alguna relación entre la CVRS y el sexo, los parámetros funcionales y los antecedentes de hospitalización de los pacientes con DAAT. Métodos: Para este estudio transversal se reclutaron 26 pacientes con DAAT grave que eran atendidos en las consultas externas de neumología de un hospital terciario. Se registraron parámetros sociodemográficos, clínicos y funcionales, y se evaluó la CVRS mediante la versión portuguesa del cuestionario de salud SF-36. Resultados: Los pacientes de mayor edad, de sexo femenino y los que habían sido hospitalizados por enfermedad respiratoria al menos una vez durante el año anterior mostraron puntuaciones más bajas en algunas dimensiones del cuestionario SF-36. Los valores más altos de FEV1 y distancias recorridas más largas en la prueba de la marcha de 6min tuvieron una influencia positiva sobre varias dimensiones del cuestionario, mientras que las puntuaciones más altas en la escala MRCm influyeron negativamente en la CVRS. Conclusiones: Los resultados muestran que la CVRS de los pacientes de mayor edad y las mujeres con DAAT es peor. Las hospitalizaciones y los marcadores funcionales de progresión de la enfermedad respiratoria tuvieron una influencia negativa sobre la CVRS, lo que indica que el cuestionario SF-36 podría ser de utilidad como medida de resultados de los pacientes con DAAT y afectación pulmonar

Background: Measures of health related quality of life (HRQoL) in patients with α1-antitrypsin deficiency (AATD) can help to determine the impact of the disease and provide an important insight into the intervention outcomes. There is few data regarding this issue in the literature. The aim of this study is to assess the relationship between HRQoL and gender, functional parameters and history of hospitalizations in patients with AATD. Methods: This is a cross-sectional study of 26 patients with severe AATD recruited in the pulmonology outpatient clinic at a tertiary care medical center. Social-demographic, clinical and functional parameters were recorded and HRQoL was assessed with the Portuguese version of the medical outcome study short form-36 (SF-36) self-administered questionnaire. Results: Older patients, females and patients with at least one hospitalization in the previous year due to respiratory disease had statistical lower scores in some dimensions of the SF-36 questionnaire. Superior FEV1 and higher distance mark in the 6-min walking test distance influenced positively several dimensions of the questionnaire. Higher scores in the mMRC scale influenced negatively the HRQoL. Conclusions: These data suggests that older and female patients with AATD have worse HRQoL. Hospitalizations and functional markers of respiratory disease progression influenced negatively the HRQoL, suggesting that the SF-36 questionnaire could be useful as an outcome for AATD patients with lung involvement

Health-Related Quality of Life in Patients With α1 Antitrypsin Deficency: A Cross Sectional Study. / Calidad de vida relacionada con la salud en pacientes con déficit de α1 antitripsina: estudio transversal.

BACKGROUND: Measures of health related quality of life (HRQoL) in patients with α1-antitrypsin deficiency (AATD) can help to determine the impact of the disease and provide an important insight into the intervention outcomes. There is few data regarding this issue in the literature. The aim of this study is to assess the relationship between HRQoL and gender, functional parameters and history of hospitalizations in patients with AATD. METHODS: This is a cross-sectional study of 26 patients with severe AATD recruited in the pulmonology outpatient clinic at a tertiary care medical center. Social-demographic, clinical and functional parameters were recorded and HRQoL was assessed with the Portuguese version of the medical outcome study short form-36 (SF-36) self-administered questionnaire. RESULTS: Older patients, females and patients with at least one hospitalization in the previous year due to respiratory disease had statistical lower scores in some dimensions of the SF-36 questionnaire. Superior FEV1 and higher distance mark in the 6-min walking test distance influenced positively several dimensions of the questionnaire. Higher scores in the mMRC scale influenced negatively the HRQoL. CONCLUSIONS: These data suggests that older and female patients with AATD have worse HRQoL. Hospitalizations and functional markers of respiratory disease progression influenced negatively the HRQoL, suggesting that the SF-36 questionnaire could be useful as an outcome for AATD patients with lung involvement.