Survival prediction of patients with advanced cancer: the predictive accuracy of the model based on biological markers.

To determine whether the addition of biological markers to performance status (PS) and physical symptoms would improve survival prediction among patients with advanced cancer, we developed two prediction models with a scoring system based on 294 consecutive patients with advanced cancer (training set), and then tested its validity on another 93 patients (testing set). We assessed the predictive accuracy of the models using receiver-operating characteristic analysis. Albumin (ALB), lactate dehydrogenase (LDH), and lymphocyte percentage (Lymp%) were significantly and independently associated with survival length. For prediction of 60-day survival, the predictive accuracy of Model 2, based on the above biological markers in addition to PS and symptoms, was significantly better than that of Model 1, based on PS and symptoms alone (area under the curve [AUC] for Model 2, 0.80+/-0.03; AUC for Model 1, 0.69+/-0.04; P<0.001). Addition of ALB, LDH, and Lymp% to PS and physical symptoms improved prediction accuracy, especially for longer survival.

[Use of propofol for painful procedures in cancer pain management].

BACKGROUND: Patients with intractable cancer pain often require non-pharmacological analgesic treatment that is accompanied by procedure-related pain. Previous works have shown that propofol infusion in adjunction to regional anesthesia provides appropriate sedation during such painful procedures. However, there are a few reports of its use to reduce procedure-related pain in terminal cancer patients. We report cases of propofol sedation during percutaneous vertebroplasty (PVP) in patients with metastatic vertebral compression fracture. METHODS: Propofol was infused during PVP in eleven cancer patients after obtaining written informed consent. The infusion rate of propofol was adjusted using a target-controlled infusion pump to achieve appropriate sedation levels under monitoring bispectral index of the electroencepharogram. Hepatic and renal functions were evaluated using common serum markers, which were determined using standard hospital laboratory methods. RESULTS: The duration of the procedure was 65.5 +/- 5.5 (mean +/- SD) min. The required infusion rate was 8.66 +/- 1.50 mg.kg-1.hr-1. The interval from the termination of the infusion until emergence was 10.7 +/- 4.2 min. No life-threatening complications or significant changes in liver and renal functions were observed. CONCLUSIONS: Propofol can be used effectively and safely for sedation during PVP in terminal cancer patients.

[The attempt to standardize treatment protocols for cancer-related hypercalcemia: developing a data-based flowchart].

We developed a flowchart for the treatment of cancer-related hypercalcemia based on the review of previous reports. The treatment protocols were standardized in each group of four different ranges of serum calcium concentration (< 12, 12-14, 14-16, < 16 mg/dl). In each Ca range, specific treatment was adjusted according to the clinical evaluation of symptoms and progression of illness of the patients.