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Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study.

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Are emergency admissions in palliative cancer care always necessary? Results from a descriptive study.

BMJ Open. 2013;3(5)

Authors: Hjermstad MJ, Kolflaath J, Løkken AO, Hanssen SB, Normann AP, Aass N

Abstract
OBJECTIVES: Patients with advanced cancer are often admitted to hospital as emergency cases. This may not always be medically indicated. Study objectives were to register the reasons for the emergency admissions, to examine interventions performed during hospitalisation and self-reported symptom intensity at admission and discharge, and to assess patients' opinions about the admission.
DESIGN: This was a descriptive before-and-after study. Participating patients completed the Edmonton Symptom Assessment System (ESAS) twice, upon hospital admission and prior to discharge. All patients underwent a structured interview assessing their opinion about the emergency admission. Medical data were obtained from the hospital records.
SETTING: The study was performed in two Norwegian acute care secondary hospitals with urban catchment areas.
PARTICIPANTS: 44 patients with cancer (men 27 and women 17; mean age 69.2, SD 9.2) representing 50 emergency admissions were included.
RESULTS: Median length of stay was 7 days (95% CI 7.4 to 11.4). Median survival was 50 days (95% CI 51 to 115). 90% were admitted from home, and 46% had been hospitalised less than 1 month earlier. Lung and gastrointestinal symptoms and pain were the most frequent reasons for admissions. Mean pain scores on ESAS were reduced by 50% from admission to discharge (p<0.01). Simple interventions such as hydration, bladder catheterisation and oxygen therapy were most frequent. Nearly one-third would have preferred treatment at another site, provided that the quality of care was similar. Home visits by the family doctor and specialised care teams were perceived by patients as important to prevent hospitalisation.
CONCLUSIONS: In most emergency admissions, relatively simple medical interventions are necessary. Specialised care teams with palliative care physicians, easier access to the family doctor and better lines of cooperation between hospitals and the primary care sector may make it possible to perform more of these procedures at home, thereby reducing the need for emergency admissions.

PMID: 23793662 [PubMed]

Occupational Exposure and Thoracic Mal¡gnancies, Is There a Relationship?

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Occupational Exposure and Thoracic Mal¡gnancies, Is There a Relationship?

J Occup Health. 2013 Jun 24;

Authors: Baser S, Duzce O, Evyapan F, Akdag B, Ozkurt S, Kiter G

Abstract
The aim of this study was to evaluate the effect of occupational exposure in the occurrence of lung cancer. Method: Three-hundred lung cancer cases diagnosed between September 1, 1999, and September 31, 2007, and 300 healthy controls were enrolled in this case-control study. Life-long occupational history, gender, age, exposure to asbestos, comorbidities, and smoking status were collected. Results: The mean age of the 300 lung cancer cases was 60.3 ± 9.9 yr (91.7% male and 8.3% female), and the mean age of healthy control group was 60.4 ± 10.5 yr (95.0% male and 5.0% female). The most frequent histological types were squamous (172, 57.3%), adeno (69, 23.1%), and small cell (37, 12.3%). There was an increased risk of lung cancer occurrence among agriculture workers (OR = 1.89, 95% Cl = 1.17-2.98) (p = 0.009). Inorganic dust exposure (OR = 1.81, 95% Cl = 1.0-3.25) (p = 0.049) and organic dust exposure (OR = 1.89, 95% Cl = 1.0-3.59) (p = 0.05) were found to be related with high frequency of having lung cancer. Conclusion: Workers who had occupational exposure to organic and inorganic dust, especially in the agricultural field, had higher risk of lung cancer occurrence when compared with office workers.

PMID: 23796595 [PubMed - as supplied by publisher]

Serum markers in small cell lung cancer: opportunities for improvement.

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Serum markers in small cell lung cancer: opportunities for improvement.

Biochim Biophys Acta. 2013 Jun 21;

Authors: Harmsma M, Schutte B, Ramaekers FC

Abstract
Lung cancer is one of the leading causes of death from malignancy worldwide. In particular small cell lung cancers, which comprise about 15-20% of all lung cancers, are extremely aggressive and cure rates are extremely low. Therefore, new treatment modalities are needed and detection at an early stage of disease, as well as adequate monitoring of treatment response is essential in order to improve outcome. In this respect, the use of non-invasive tools for screening and monitoring has gained increasing interest and the clinical applicability of reliable, tumor-related substances that can be detected as tumor markers in easily accessible body fluids is subject of intense investigation. Some of these indicators, such as high LDH levels in serum as a reflection of the disease, have been in use for a long time as a general tumor marker. To allow for improved monitoring of the efficacy of new therapeutic modalities and for accurate subtyping, there is a strong need for specific and sensitive markers that are more directly related to the biology and behavior of small cell lung cancer. In this review the current status of these potential markers, like CEA, NSE, ProGRP, CK-BB, SCC, CgA, NCAM and several cytokeratins will be critically analyzed with respect to their performance in blood based assays. Based on known cleavage sites for cytoplasmic and extracellular proteases, a prediction of stable fragments can be obtained and used for optimal test design. Furthermore, insight into the synthesis of specific splice variants and neo-epitopes resulting from protein modification and cleavage, offers further opportunities for improvement of tumor assays. Finally, we discuss the possibility that detection of SCLC related autoantibodies in paraneoplastic disease can be used as a very early indicator of SCLC.

PMID: 23796706 [PubMed - as supplied by publisher]

Treatment of Medically Inoperable Non-small-cell Lung Cancer with Stereotactic Body Radiation Therapy Versus Image-guided Tumor Ablation: Can Interventional Radiology Compete?

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Treatment of Medically Inoperable Non-small-cell Lung Cancer with Stereotactic Body Radiation Therapy Versus Image-guided Tumor Ablation: Can Interventional Radiology Compete?

J Vasc Interv Radiol. 2013 Jun 21;

Authors: Dupuy DE

Abstract
Patients with medically inoperable stage IA non-small-cell lung cancer have treatment options that include image-guided tumor ablation or stereotactic body radiation therapy. Literature to date with both techniques suggests similar overall survival; however, local control rates appear to be higher with SBRT. It is important for interventional radiologists to understand the differences and similarities between these two techniques. Future research is important to determine which patients would benefit from these therapies. This review summarizes the two techniques and available clinical literature, provides relevant commentary, and suggests future directions for research in this area.

PMID: 23796858 [PubMed - as supplied by publisher]

Association of epidermal growth factor receptor mutations with human papillomavirus 16/18 E6 oncoprotein expression in non-small cell lung cancer.

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BACKGROUND: Lung cancers in women, in nonsmokers, and in patients with adenocarcinoma from Asia have more prevalent mutations in the epidermal growth factor receptor (EGFR) gene than their counterparts. However, the etiology of EGFR mutations in this population remains unclear. The authors hypothesized that the human papillomavirus (HPV) type 16/18 (HPV16/18) E6 oncoprotein may contribute to EGFR mutations in Taiwanese patients with lung cancer.

METHODS: One hundred fifty-one tumors from patients with lung cancer were enrolled to determine HPV16/18 E6 and EGFR mutations using immunohistochemistry and direct sequencing, respectively. Levels of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) in lung tumors and cells were evaluated using immunohistochemistry and liquid chromatography-mass spectrometry/mass spectrometry. An supF mutagenesis assay was used to determine H2 O2 -induced mutation rates of lung cancer cells with or without E6 expression.

RESULTS: Patients with E6-positive tumors had a greater frequency of EGFR mutations than those with E6-negative tumors (41% vs 20%; P = .006). Levels of 8-oxo-dG were correlated with EGFR mutations (36% vs 16%; P = .012). Two stable clones of E6-overexpressing H157 and CL-3 cells were established for the supF mutagenesis assay. The data indicated that the cells with high E6 overexpression had higher H2 O2 -induced SupF gene mutation rates compared with the cells that expressed lower levels of E6 and compared with vector control cells.

CONCLUSIONS: HPV16/18 E6 may contribute in part to EGFR mutations in lung cancer, at least in the Taiwanese population. Cancer 2013. © 2013 American Cancer Society.

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