Clinical associations for traditional and complementary medicine use among norwegian cancer survivors in the seventh survey of the Tromsø study: a cross-sectional study.

BACKGROUND: Cancer survivors are a diverse group with varying needs that are patient-, disease-, and/or treatment-specific. Cancer survivors have reported supplementing conventional anti-cancer treatment with Traditional and Complementary Medicine (T&CM). Although female cancer survivors are reported to have more severe anticancer adverse effects, little is known about the association between anticancer treatment and T&CM use among Norwegian cancer survivors. The aims of this study are therefore to investigate (1) associations between cancer diagnosis characteristics and T&CM utilization and (2) associations between anticancer treatment and T&CM utilization among cancer survivors in the seventh survey of the Tromsø study. METHODS: Data was collected from the seventh survey of the Tromsø Study conducted in 2015-16 among all inhabitants of Tromsø municipality aged 40 and above (response rate 65%), where inhabitants received online and paper form questionnaires. Data from the data linkage to the Cancer Registry of Norway for cancer diagnosis characteristics was also used. The final study sample was made up of 1307 participants with a cancer diagnosis. Categorical variables were compared using Pearson's Chi-square test or Fisher's exact test while independent sample t-test was used to compare continuous variables. RESULTS: The use of T&CM the preceding 12 months was reported by 31.2% of the participants with natural remedies as the most reported modality of T&CM (18.2%, n = 238), followed by self-help practices of meditation, yoga, qigong, or tai chi, which was reported by 8.7% (n = 114). Users of T&CM were significantly younger (p = .001) and more likely to be female (p < .001) than the non-users, with higher use of T&CM among female survivors with poor self-reported health and being 1-5 years post-diagnosis. Lower use of T&CM was found among female survivors who received a combination of surgery with hormone therapy and those who received a combination of surgery with hormone therapy and radiotherapy. Similar usage was seen in male survivors, but not at a significant level. For both male and female survivors, T&CM was most frequently used by those with only one cancer diagnosis (p = .046). CONCLUSION: Our results indicate that the profile of the Norwegian cancer survivor who uses T&M is slightly changing compared to previous findings. Additionally, compared to male survivors, more clinical factors are associated with use of T&CM among female cancer survivors. These results should serve as a reminder to conventional health care providers to discuss the use of T&CM with patients across the entire cancer survivorship continuum to promote safe use, especially among female survivors.

Etiological factors of bloodstream infections in oncological patients, who was hospitalized at the National Institute of Maria Sklodowska-Curie - National Research Institute in Warsaw in 2020-2022.

Aim of the study: The purpose of the study was the microbiological analysis of bloodstream infections in patients hospitalized at the National Institute of Oncology, Maria Sklodowska-Curie - National Research Institute in the period from 01/01/2020 to 31/10/2022. Material and methods: In the period from 01/01/2020 to 31/10/2022, 18,420 blood cultures obtained from patients hospitalized at the NIO-PIB were analysed in the Department of Clinical Microbiology (total for the presence of bacteria and fungi). Culture for the presence of bacteria was carried out in the BactAlert automatic system by bioMerieux, and for fungi in the Bactec FX automatic system by Becton Dickinson. Results: 1,184 strains of bacteria and 32 strains of fungi considered to be the etiological factor of the infection were cultured from clinical samples. Gram-positive bacteria accounted for 61.57%, while Gram-negative bacteria accounted for 32.26% of all isolated bacterial strains. The most frequently cultured strains were Escherichia coli - 13.77% (including 22.1% of ESBL strains), Klebsiella penumoniae - 4.6% (44.4% of ESBL strains, 1.85% of NDM strains), Enterobacter cloacae - 2 .7% (including 40.6% of multi-resistant strains: ESBL (15.6%) or with AmpC derepression (25%), among the non-fermenting bacilli, Pseudomonas aeruginosa was the most frequently cultured - 4.18% (including 3.8% MBL) and Acinetobacter baumannii - 0.8% (including CRAB strains 50%, MBL 10%). Anaerobic microorganisms were responsible for 3.46% of blood infection cases. Yeast- like fungi were a factor in 2.7% of all fungemia cases. From blood samples taken Staphylococci were more frequently isolated directly from a vein or through a central venous catheter than aerobic Gram-negative bacilli (44.7% and 25.3% and 55.6% and 12.5%, respectively). The opposite situation occurred in the case of samples taken simultaneously directly from vein and through a central venous catheter, in which a higher share of aerobic Gram-negative bacilli (46.6%) than staphylococci (32.8%) in causing blood infections was observed. Conclusions: Gram-positive bacteria are the major contributors to bloodstream infections in cancer patients. There is a growing tendency to develop BSI caused by multi-resistant strains.

Muscular Ultrasonography in Morphofunctional Assessment of Patients with Oncological Pathology at Risk of Malnutrition.

Background: Muscular ultrasonography is a technique that allows assessing the amount and quality of muscle in a specific body region. The aim of the study was to compare the value of muscle ultrasonography in diagnosis of malnutrition with techniques such as anthropometry, handgrip strength and impedanciometry in patients with oncological pathology. Methods: Cross-sectional study in 43 patients with oncological pathology and high nutritional risk. Classical anthropometry (body mass index (BMI), arm circumference (AC), calf circumference (CC) and estimated appendicular muscle mass index (ASMI)) was performed. Body composition was measured with impedanciometry (BIA), phase angle (PA) and fat-free mass index (FFMI) and muscle ultrasonography of quadriceps rectus femoris (muscle area (MARA) and circumference (MCR) in section transverse). Malnutrition was diagnosed using the GLIM criteria and sarcopenia was assessed using EWGSOP2 criteria. Results: The mean age was 68.26 years (±11.88 years). In total, 23/20 of the patients were men/women. The BMI was 23.51 (4.75) kg/m2. The ASMI was 6.40 (1.86) kg/m2. The MARA was 3.31 cm2 in ultrasonography. In impedanciometry, phase angle was 4.91 (0.75)°; the FFMI was 17.01 kg/m2 (±2.65 kg/m2). A positive correlation was observed between the MARA with anthropometric measurements (AC: r = 0.39, p = 0.009; CC: r = 0.44, p < 0.01; ASMI: r = 0.47, p < 0.001); and with BIA (FFMI: r = 0.48, p < 0.01 and PA: r = 0.45, p < 0.001). Differences were observed when comparing the MARA based on the diagnosis of sarcopenia (Sarcopenia: 2.47 cm2 (±0.54 cm2); no sarcopenia: 3.65 cm2 (±1.34 cm2); p = 0.02). Conclusions: Muscle ultrasonography correlates with body composition measurement techniques such as BIA and anthropometry in patients with cancer.

Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate.

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998-24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402-5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

Palliative dental care: Ignored dimension of dentistry amidst COVID-19 pandemic.

Palliative care (PC) represents an approach that encompasses the procedures to relieve pain and distressing symptoms and maintain function as much as possible in the terminally ill patient until death. PC dentistry (PCD) is an approach for providing supportive and palliative dental care in patients with serious life-threatening illness (cancer, chronic heart failure, chronic obstructive pulmonary disease and cognitive impairment). The care is provided at different time points of diseases (i.e., from in-therapy care to survivorship care to end-of-life care). Dentists have a significant role to play in the multidisciplinary team of PC. Oral health problems (ulcers, mucositis, pulpitis and abscess) have a negative impact on general health and quality of life and can be acutely debilitating in these patients. These patients with existing comorbidities are at increased risk of developing oral complications. Furthermore, social isolation can cause an increase in anxiety, hopelessness, psychosocial and existential suffering amongst these patients. It is essential to incorporate PCD in the guidelines of critical dental care during the COVID-19 pandemic to decrease the suffering of these patients by symptom management. Teledentistry can be used with caution to provide at-home care to such patients during the pandemic.

Histopathology of COVID-19 pneumonia in two non-oncological, non-hospitalised cases as a reliable diagnostic benchmark.

In lung cancer patients infected with COVID-19, pathological features are not easy to distinguish. This report presents detailed histopathological findings in two non-neoplastic subjects whose out-of-hospital deaths were caused by COVID-19 infection. These 'pure' cases differ in the time of presentation of symptoms, the phase of lung anatomopathological patterns (acute lung injury versus diffuse alveolar damage) and the mechanism of death. The results provide a valid diagnostic benchmark for evaluating the evolution of COVID-19 pneumonia.

Tratamiento quirúrgico de úlceras por presión en pacientes oncológicos terminales / Surgical treatment of pressure ulcers in terminal oncological patients

Este artículo hace consideraciones sobre el tratamiento quirúrgico de las úlceras por presión en pacientes oncológicos. Se recomienda que, en el paciente con patología neoplásica avanzada, la indicación y el tipo de tratamiento quirúrgico dependa mayormente de su estado general que del estadio de la úlcera.

This article refers to the surgical treatment of pressure ulcers in cancer patients. It is recommend that in patients with advance neoplastic disease, surgical treatment depend mostly on their general condition than the stage of the ulcer.

Evaluation of the quality of life after surgical removal of lung cancer.

INTRODUCTION: Morbidity and mortality attributed to lung cancer remain at high levels, especially where men are concerned. The surgery for lung cancer involves removing neoplastic lesions in order to save the largest possible part of the healthy lung. Of importance is also pre- and post-surgical rehabilitation. The aim of this thesis is to gauge the quality of life of the patients who have had their lung cancer surgically removed. MATERIAL AND METHODS: The study was conducted on 72 patients (52 men and 20 women) after surgical removal of lung cancer. The subjects were examined prior to, a week after and six months following surgery. The investigation employed the standardised questionnaires to assess the quality of life, i.e. EORTC QLQ-C30 and EORTC QLQ-LC13, as well as the visual analogue pain scale (VAS). Statistical analyses were performed using the Anova Friedman test and Dunna test, and p-value calculated in multiple comparisons with significance level assumed at p < 0.05. RESULTS: During six months after the operation, the quality of life deteriorated in relation to the one before operation as evidenced by the functioning scale at the level of p < 0.001. Overall symptom scale, as well as symptomatic scale and the VAS scale showed that some symptoms increased significantly in the early period after surgery p < 0.001, then with the passage of time, the patients felt improvement, however, some of them, e.g. pain sensations can persist till six months after surgery. CONCLUSIONS: Surgical removal of lung cancer is associated with a significant deterioration of the quality of life in the early period after surgery and can persist till six months later.

Características de la alimentación del paciente oncológico en cuidados paliativos / Characteristics of the diet of oncological patients in palliative care

Introducción y objetivo: es escaso lo que se conoce acerca de las características de la alimentación del paciente oncológico en cuidados paliativos. En el presente estudio se realizó un análisis detallado para describir las características alimentarias del paciente oncológico en cuidados paliativos. Materiales y método: estudio descriptivo, observacional y transversal. Se incluyeron 50 pacientes que asistieron al consultorio externo del servicio de oncología del Hospital Juan A. Fernández. Los datos se obtuvieron a partir de encuestas dirigidas semiestructuradas. Se analizaron los siguientes parámetros: número de comidas diarias, presencia de apetito, sentimiento de presión y dificultades a la hora de comer, máxima consistencia tolerada, temperatura mejor aceptada, sabor de preferencia, preferencias alimentarias actuales, incorporación y eliminación de alimentos, realización de dieta específica, propiedades especiales atribuidas a alimentos, consumo de suplementos nutricionales orales, persona encargada de la preparación de los alimentos, compañía, asistencia, lugar y posición al comer. Resultados: el 26% (IC 95% 15,08-40,61) refirió no tener apetito a la hora de comer y un 38% (IC 95% 24,99-52,83) se sentía presionado por parte de familiares/amigos para alimentarse. El 80% (IC 95% 65,85-89,49) presentaba dificultades al comer. Un 60% (IC 95% 45,20-73,26) eliminó alimentos a partir del diagnóstico y un 28% (IC 95% 16,66-42,71) incorporó nuevos. Porcentajes similares preferían sabores dulces y salados, 30% (IC 95% 18,28-44,78) y 32% (IC 95% 19,92-46,83), respectivamente. La consistencia mejor aceptada fue la blanda (16% IC 95% 7,16-40,95). El consumo de suplementos nutricionales orales se observó en el 32% (IC 95% 19,92-46,83). Un 78% (IC 95% 63,66-88,00) indicó comer en el comedor/cocina y el 82% (IC 95% 68,07-90,95) sentado en una silla. Conclusiones: la alimentación del paciente oncológico en cuidados paliativos debe ser individualizada para realizar recomendaciones nutricionales adecuadas(AU).

Introduction and objective: there is little known about the characteristics of the diet of the oncological patient in palliative care. In this study, a detailed analysis to describe the alimentary characteristics of the oncological patient in palliative care was carried out. Materials and method: descriptive, observational and transversal study. Fifty patients who attended the outpatient clinic of the oncology service of the Juan A. Fernández Hospital were included. Data obtained from semi-structured directed surveys. The following parameters were analyzed: number of daily meals, presence of appetite, feeling of pressure and difficulties at the time of eating, maximum tolerated consistency, best accepted temperature, preferred taste, current food preferences, incorporation and elimination of food, realization of specific diet, special properties attributed to food, consumption of oral nutritional supplements, person in charge of preparing food, company, assistance, place and position when eating. Results: 26% (95% CI 15,08-40,61) reported no appetite at mealtimes and 38% (95% CI 24.99-52.83) felt pressured to eat by family/friends. 80% (95% CI 65.85-89.49) presented difficulties when eating. 60% (95% CI 45.2- 73.26) eliminated food as of diagnosis and 28% (CI 95% 16.66-42.71) incorporated new ones. Similar percentages preferred sweet and salty flavors, 30% (95% CI 18.28-44.78) and 32% (95% CI 19.92-46.83), respectively. The best accepted consistency was the soft one (16% CI 95% 7.16-40.95). The consumption of oral nutritional supplements was observed in 32% (95% CI 19,92-46,83). 78% (95% CI 63.66-88.00) indicated eating in the dining room/kitchen and 82% (95% CI 68.07-90.95) sitting on a chair. Conclusions: the diet of the oncologic patient in palliative care must be individualized to make adequate nutritional recommendations(AU).

Influencia de la gastroparesia en el logro de la meta calórica y proteica en pacientes neurocríticos / Influence of gastroparesis on achieving the caloric and protein goal in neurocritical patients

La lesión cerebral induce a la aparición de complicaciones gastrointestinales, especialmente gastroparesia, la cual es considerada uno de los pilares de la intolerancia digestiva alta. Se mide por el aumento en el residuo gástrico, reflujo gastroesofágico, vómitos, distención abdominal y/o diarrea. Como consecuencia, la nutrición enteral (NE) se inicia de manera tardía o ineficientemente, impidiendo lograr la meta calórico-proteica, aumentando el riesgo de neumonía aspirativa, prolongándose la estadía hospitalaria e incrementando la mortalidad. Se realizó una revisión bibliográfica con el objetivo de actualizar y describir el rol de la gastroparesia en el alcance de la meta calórica-proteica en el paciente neurocrítico. Se consultaron bases de datos electrónica: MEDLINE, EMBASE, LILACS, Cochrane, desde el 2007 a 2017. Se incluyeron 8 estudios, cuatro ensayos controlados y aleatorizados (ECA), dos observacionales y dos revisiones sistemáticas y metaanálisis. En tres ECA cuando la NE es postpilórica se logra un mayor aporte calórico y proteico. Dos estudios no encontraron diferencias en las calorías recibidas entre los pacientes alimentados a estómago o yeyuno. Dos revisiones y metaanálisis confirman menor riesgo de neumonía aspirativa pero no presentan diferencias en el porcentaje de adecuación a la NE por ambas vías. La mortalidad, días de asistencia respiratoria mecánica, estancia en la unidad de cuidados intensivos (UCI) y hospitalaria no fue diferente cuando la NE fue a estómago o intestino. En conclusión, la persistencia del retraso del vaciamiento gástrico favorece al déficit energético y proteico, debido a la intolerancia a la NE lo que dificulta la progresión. A la fecha, pocos estudios recomiendan la vía postpilórica para mejorar la eficiencia nutricional. Futuros estudios deberán valorar las implicancias de alcanzar la meta calórica-proteica en los resultados clínicos de acuerdo a la vía de la NE, en esta población de pacientes(AU).

The brain injury induces the appearance of gastrointestinal complications, especially gastroparesis, which is considered one of the pillars of high digestive intolerance. It is measured by the increase in gastric residue, gastroesophageal reflux, vomiting, abdominal distension and / or diarrhea. As a consequence, enteral nutrition (EN) begins late or inefficiently, preventing the caloric-protein goal from being achieved, increasing the risk of aspiration pneumonia, prolonging the hospital stay and increasing mortality. A literature review was carried out with the objective of updating and describing the role of gastroparesis in the scope of the caloric-protein goal in the neurocritical patient. Electronic databases were consulted: MEDLINE, EMBASE, LILACS, Cochrane, from 2007 to 2017. 8 studies were included, four randomized controlled trials (RCTs), two observational studies and two systematic reviews and meta-analyzes. In three RCTs when the EN is post-pyloric, a greater caloric and protein intake is achieved. Two studies found no difference in the calories received between patients fed via stomach or jejunum. Two reviews and meta-analyzes confirm a lower risk of aspiration pneumonia, but there are no differences in the percentage of adaptation to the EN by both routes. Mortality, days of mechanical ventilation, stay in the intensive care unit (ICU) and hospital stay were not different when the EN was via stomach or intestine. In conclusion, the persistence of delayed gastric emptying favors protein and energy deficit, due to intolerance to EN, which hinders progression. To date, few studies recommend the postpyloric route to improve nutritional efficiency. Future studies should evaluate the implications of reaching the caloric-protein goal in clinical results according to the EN route, in this patient population(AU).

[Atypical metastasis from a colorectal cancer : the pons is undermined !] / Métastase atypique d'un cancer colo-rectal : le pont est miné !

Brain metastases occur in 1 to 4 % of patients with colorectal cancer and are unique in 0.5 % of them. Because of their infrequent nature, brain imaging is not recommended in the systematic follow-up of these patients. We report here an exceptional case of a unique brain metastasis in a very unusual position. An 82-year-old patient with a colorectal cancer of the splenic angle that was treated with surgery and adjuvant chemotherapy, developed a series of neurological symptoms over four to six weeks: difficulty swallowing, loss of strength in the four limbs and balance disorders. These symptoms urged the performance of a nuclear magnetic resonance to exclude a central neurological lesion. MRI revealed a nodular tumor of 20 millimeters in the major transverse axis and 17 millimeters in the cerebro-caudal axis, located on the ventral portion of the protuberance. Because of its localization, surgery was not possible and the lesion was treated with Cyberknife radiosurgery. Thanks to the treatment, the lesion decreased in size and the symptoms improved significantly. Despite an initially very poor prognosis in view of the localization of the metastasis, the patient is alive and in excellent general condition more than eight months after the diagnosis of recurrence.

Les métastases cérébrales surviennent chez 1 à 4 % des patients atteints de cancer colo-rectal et sont uniques chez 0,5 % d'entre eux. De par leur caractère peu fréquent, une imagerie cérébrale n'est pas recommandée dans le suivi systématique de ces patients. Nous rapportons ici un cas exceptionnel de métastase cérébrale unique de localisation atypique. Un patient de 82 ans, suivi pour un cancer de l'angle splénique du côlon traité par chirurgie de résection et chimiothérapie adjuvante, a développé en quatre à six semaines une série de symptômes neurologiques : troubles de la déglutition, perte de force des quatre membres et troubles de l'équilibre. Ces symptômes ont motivé la réalisation d'une résonance magnétique nucléaire afin d'exclure une lésion neurologique centrale. L'IRM a mis en évidence une lésion tumorale nodulaire de 20 millimètres de grand axe transverse et 17 millimètres d'axe céphalo-caudal, située sur la portion ventrale de la protubérance. Inaccessible à la chirurgie, la lésion a été traitée par radiothérapie stéréotaxique CyberknifeTM. Grâce au traitement, la lésion a régressé et les symptômes se sont nettement améliorés. Malgré un pronostic initial extrêmement mauvais au vu de la localisation de la métastase, le patient est vivant et en excellent état général à plus de huit mois du diagnostic de récidive.

[The identification and sensitivity to antibiotics of clostridia, including Clostridia difficile isolated under infectious complications in oncologic patients.]

The 76 strains of Clostridium related to 14 species including 28 strains of C.difficile, were isolated from 74 samples of biological material taken out of oncologic patients. The species identification of strains was implemented by MALDI-TOF mass spectrometry using technique of direct application without extraction. The 74 strains (97.4%) were identified up to specie with reliability evaluation 2.0-2.5. Among C.non-difficile the most frequently were separated C.perfringens (42%), group of C.clostridioforme (24%). The sensitivity of separated strains to anti-microbial preparations was established with E-tests technique. The different species of Clostridia had different sensitivity to antibiotics. The strains C.perfringens are sensitive to all testing antibiotics whereas species related to group C.clostridioforme are resistant to fluoroquinolones (100%)б penicillin (67%). The resistance to fluoroquinolones was observed in C.scindens, C.ramosum, C.symbiosum. The strains C.scindens, C.tertium are resistant to penicillin. Among C.difficile, 93% of strains were resistant to penicillin, 57% - to imipenem and 100% - to fluoroquinolones.

Acolhimento e acesso aos direitos sociais: assistência a pacientes em cuidados paliativos oncológicos / Reception and access to social rights: assistance to patients on oncological palliative care

Este trabalho apresenta os resultados de um estudo sobre a prática do acolhimento como instrumento de acesso aos direitos sociais. O objetivo foi o de analisar a influência do acolhimento realizado pelo assistente social no que concerne ao acesso a direitos sociais a pacientes em cuidados paliativos oncológicos. A pesquisa foi realizada na Clínica de Cuidados Paliativos Oncológicos do Hospital Ophir Loyola (Belém-PA), sendo pautada pelo método qualitativo, subsidiada pelas pesquisas bibliográfica, documental e de campo, com a utilização de entrevistas semiestruturadas realizadas com 12 participantes (pacientes ou seus responsáveis). Os resultados mostraram a influência do acolhimento enquanto ferramenta de ação assistencial e diretriz operacional da Política Nacional de Humanização (PNH) ao acesso a direitos sociais, assim como as principais consequências, econômicas e sociais, que os pacientes encontram durante o processo de tratamento, tanto os que tiveram acesso a direitos sociais quanto os que não tiveram acesso a eles.

This paper submits the research about reception as a tool of accessing social rights. It was aimed to analyze the influence of reception carried out by social worker on what concerns the access of social rights to patients on oncological palliative care. The research was done in the Clinic of Palliative Care of Ophir Loyola Hospital (Belém-PA), being based on the qualitative method, subsidized by bibliographical research, documental and field, using semi-structured interviews made with 12 participants (patients or guardians). The results demonstrated the influence of reception as a tool and operational guideline of National Humanization Policy (NHP) to access to social rights. As well as, the main consequences, economic and social, that patients find during the treatment process. As much as who had access to social rights as those who did not have access to those rights.