[Effectiveness and challenges in cancer palliative home-care services: a retrospective cohort study.] / Efficacia e criticità nelle cure palliative domiciliari per il paziente oncologico: studio retrospettivo di coorte.

INTRODUCTION: Management by the palliative care network (RLCP) has been identified as one of the major determinants of clinical appropriateness and reduction of hospital admissions in cancer patient's end of life. The patient's transition process from hospital cancer care to palliative home care is particularly frail from both a clinical and organizational point of view, requiring a multidimensional assessment (VMD) and the draft of an individual care plan (PAI). The aim of this study was to assess the impact of appropriate home-based palliative care in reducing hospitalizations, and also to identify critical issues in the patient's transition to home palliative care. METHODS: Retrospective cohort study enrolling all 375 patients listed by the Local Health Authority No.8, Veneto Region (North-East Italy), as dying of cancer in 2017 and living at home during the last six months before death. RESULTS: Of the cohort considered, 40% patients had been taken into care by a palliative home-care team. These patients were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life than patients who were not taken into palliative network's care. Reporting of the oncologist to the Primary Care Doctor (MAP) for activation of home palliative care services takes place on average 120 days prior to death. 18.8% of these reports are not acknowledged and do not result in the MAP request for palliative home care. The time interval between the reporting of the need by the oncologist and the execution of the VMD is on average 36.8 days. The absence of the palliative care specialist during the VMD is associated with lower likelihood of being taken into care by palliative care teams (52.4% vs 97.3%) and a delay in their activation (56.3 vs 3.81 days), compared to cases in which the palliative care provider was present. DISCUSSION AND CONCLUSIONS: Our findings indicate that the access to a palliative care network enables more terminally ill consenting cancer patients to spend their last days at home with relatives, reducing end-of-life hospital utilization and in-hospital deaths. There's evidence of critical issues in coordination and integration of professionals operating within the palliative network, precluding or delaying access to appropriate palliative care. These results could be useful to palliative care providers in order to review their networks and make them accessible, effective, compliant with current legislation and sustainable over time.

Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

BACKGROUND: It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. AIM: The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. DESIGN: Retrospective cohort study. SETTING/PARTICIPANTS: We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. RESULTS: Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. CONCLUSIONS: Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

Efficacy of a leptin receptor antagonist peptide in a mouse model of triple-negative breast cancer.

Triple-negative breast cancers, which represent 10-20% of all mammary tumours, are characterised by the aggressive phenotype, are often found in younger women and have been associated with poor prognosis. Obesity increases the risk for triple-negative breast cancer development. Because triple-negative breast cancer patients are unresponsive to current targeted therapies and other treatment options are only partially effective, new pharmacological modalities are urgently needed. Here we examined if the leptin (obesity hormone) receptor is a viable target for the treatment of this cancer subtype. In human triple-negative breast cancer tissues, the leptin receptor was expressed in 92% (64/69) and leptin in 86% (59/69) of cases. In a model triple-negative breast cancer cell line MDA-MB-231, the leptin receptor antagonist peptide Allo-aca inhibited leptin-induced proliferation at 50 pM concentration. In an MDA-MB-231 orthotopic mouse xenograft model, Allo-aca administered subcutaneously significantly extended the average survival time from 15.4 days (untreated controls) to 24 and 28.1 days at 0.1 and 1mg/kg/day doses, respectively. In parallel, conventional treatment with 1mg/kg/day intraperitoneal cisplatin prolonged the average survival time to 18.6 days, while administration of 20mg/kg/day oral Tamoxifen (negative control) had no significant survival effects relative to controls. In normal CD-1 mice, Allo-aca produced no systemic toxicity up to the highest studied subcutaneous bolus dose of 50mg/kg, while, as expected, it induced a modest 6-10% body weight increase. Our results indicate that leptin receptor antagonists could become attractive options for triple-negative breast cancer treatment, especially in the obese patient population.

Leptin and its receptor are overexpressed in brain tumors and correlate with the degree of malignancy.

Although leptin and its receptor (ObR) have emerged as important cancer biomarkers, the role of the leptin system in brain tumor development remains unknown. We screened 87 human brain tumor biopsies using immunohistochemistry and detected leptin and ObR in 55.2% and 60.9% cases, respectively. In contrast, leptin and ObR were absent in 14 samples of normal brain tissue. The presence of leptin correlated with ObR with overall concordance 80.5%. The leptin/ObR system was highly expressed in glioblastomas and anaplastic astrocytomas, while lower expression of both markers was noted in low-grade astrocytomas and gangliogliomas. The association between leptin/ObR and the degree of tumor malignancy was highly significant (P < 0.001). Using double immunofluorescence of glioblastoma tissues, we found co-expression of leptin with ObR and with the proliferation marker Ki-67 in 87% and 64% of cells, respectively. The leptin/ObR-positive tissues also expressed activated forms of STAT3 and Akt. In line with this finding, ObR-positive glioblastoma cells responded to leptin with cell growth and induction of the STAT3 and Akt pathways as well as inactivation of the cell cycle suppressor Rb. In summary, our data demonstrate that the leptin/ObR system is expressed in malignant brain tumors and might be involved in tumor progression.