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Medical Complications and Supportive Care in Patients with Cancer

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: closed (1 July 2024) | Viewed by 13782

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Dr. Javier Marco-Hernández

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Department of Internal Medicine, Supportive and Palliative Care Unit in Cancer, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain
Interests: cancer; oncological emergencies; supportive care; autoimmune diseases; infectious diseases; critical care; vasculitis; immunotherapy; immune-related adverse events
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Special Issue Information

Dear Colleagues,

The prevalence of cancer is increasing due to the aging population, early diagnosis and the therapeutic novelties that have appeared in recent years (targeted therapies or different modalities of immunotherapy, among others) and have led to improvements in the survival of patients with oncological diseases. However, this has also caused an increase in the complexity in the management of these patients, who present classic complications of cancer (oncological emergencies, thromboembolic disease or infectious diseases) but also pose new challenges for the professionals who provide them with medical care (new treatment toxicities such as immune-related adverse events, the adverse effects of CAR-T cell therapies or the need for intensive care). In addition, other challenges arise in parallel: older patients may be candidates for oncologic treatment (oncogeriatrics), and the palliative needs of patients are becoming more complex and require specialized attention.

For all these reasons, we believe that this Special Issue will be of great interest to professionals who work with cancer patients and strive to provide the best care for those experiencing medical complications of cancer and receiving supportive or palliative care. Papers related to these areas are welcome to be submitted to this Special Issue, whether they are about oncological emergencies, infectious diseases in cancer patients, treatment toxicities, immune-related adverse events, supportive care, palliative care or thromboembolic disease, among others.

Dr. Javier Marco-Hernández
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

cancer
oncological emergencies
immune-related adverse events
immunotherapy
supportive care
palliative care
infectious diseases
thromboembolic disease
treatment toxicities
CAR-T cell therapy

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Published Papers (7 papers)

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12 pages, 1340 KiB

Open AccessArticle

Prior Advanced Care Planning and Outcomes of Cardiopulmonary Resuscitation in the Emergency Department of a Comprehensive Cancer Center

by Adriana H. Wechsler, Marcelo Sandoval, Jayne Viets-Upchurch, Maria Cruz Carreras, Valda D. Page, Ahmed Elsayem, Aiham Qdaisat and Sai-Ching J. Yeung

Cancers 2024, 16(16), 2835; https://doi.org/10.3390/cancers16162835 - 13 Aug 2024

Viewed by 921

Abstract

Cardiopulmonary resuscitation (CPR) outcomes vary for patients with cancer. Here, we characterized cancer patients who underwent CPR in the emergency department (ED), their outcomes, and the effects of advanced care planning (ACP). The hospital databases and electronic medical records of cancer patients at a comprehensive cancer center who underwent CPR in the ED from 6 March 2016 to 31 December 2022 were reviewed for patient characteristics, return of spontaneous circulation (ROSC), conversion to do-not-resuscitate (DNR) status afterward, hospital and intensive care unit (ICU) length of stay, mortality, cost of hospitalization, and prior GOC discussions. CPR occurred in 0.05% of all ED visits. Of the 100 included patients, 67 patients achieved ROSC, with 15% surviving to hospital discharge. The median survival was 26 h, and the 30-day mortality rate was 89%. Patients with and without prior ACP had no significant differences in demographics, metastatic involvement, achievement of ROSC, or in-hospital mortality, but patients with ACP were more likely to change their code status to DNR and had shorter stays in the ICU or hospital. In conclusion, few cancer patients undergo CPR in the ED. Whether this results from an increase in terminally ill patients choosing DNR status requires further study. ACP was associated with increased conversion to DNR after resuscitation and decreased hospital or ICU stays without an increase in overall mortality. Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

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14 pages, 636 KiB

Open AccessArticle

Impact of Real-World Outpatient Cancer Rehabilitation Services on Health-Related Quality of Life of Cancer Survivors across 12 Diagnosis Types in the United States

by Mackenzi Pergolotti, Kelley C. Wood, Tiffany D. Kendig and Stacye Mayo

Cancers 2024, 16(10), 1927; https://doi.org/10.3390/cancers16101927 - 18 May 2024

Cited by 1 | Viewed by 1571

Abstract

Compared to adults without cancer, cancer survivors report poorer health-related quality of life (HRQOL), which is associated with negative treatment outcomes and increased healthcare use. Cancer-specialized physical and occupational therapy (PT/OT) could optimize HRQOL; however, the impact among survivors with non-breast malignancies is unknown. This retrospective (2020–2022), observational, study of medical record data of 12 cancer types, examined pre/post-HRQOL among cancer survivors who completed PT/OT. PROMIS^® HRQOL measures: Global Health (physical [GPH] and mental [GMH]), Physical Function (PF), and Ability to Participate in Social Roles and Activities (SRA) were evaluated using linear mixed effect models by cancer type, then compared to the minimal important change (MIC, 2 points). Survivors were 65.44 ± 12.84 years old (range: 19–91), male (54%), with a median of 12 visits. Improvements in GPH were significant (p < 0.05) for all cancer types and all achieved MIC. Improvements in GMH were significant for 11/12 cancer types and 8/12 achieved MIC. Improvements in PF were significant for all cancer types and all achieved the MIC. Improvements in SRA were significant for all cancer types and all groups achieved the MIC. We observed statistically and clinically significant improvements in HRQOL domains for each of the 12 cancer types evaluated. Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

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12 pages, 1298 KiB

Open AccessArticle

End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study

by K. Brooke Russell, Caitlin Forbes, Siwei Qi, Claire Link, Linda Watson, Andrea Deiure, Shuang Lu, James Silvius, Brian Kelly, Barry D. Bultz and Fiona Schulte

Cancers 2024, 16(7), 1294; https://doi.org/10.3390/cancers16071294 - 27 Mar 2024

Cited by 1 | Viewed by 1586

Abstract

Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients’ lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231, p ≤ .001 to .002). Those in the MAID cohort reported significantly greater anxiety (β = −0.831, p = .044) and greater lack of appetite (β = −0.934, p = .039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care. Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

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10 pages, 456 KiB

Open AccessArticle

Bacteremia in Patients with Solid Organ Cancer: Insights into Epidemiology and Antibiotic Consumption

by Begoña de Dios-García, Guillermo Maestro, Carmen Díaz-Pedroche, Wagner Parra, Óscar Campos, María Ángeles Orellana, José Manuel Caro, Carlos Lumbreras and Manuel Lizasoain

Cancers 2023, 15(23), 5561; https://doi.org/10.3390/cancers15235561 - 24 Nov 2023

Cited by 1 | Viewed by 1188

Abstract

Epidemiology and risk factors associated to bacterial resistance in solid organ cancer (SOC) patients has been barely described. This retrospective monocentric study analyzed clinical variables in SOC patients who developed bacteremia between 1 January 2019 and 31 December 2022. We described rates of bacterial resistance in Gram negative bacteria (80.6%): E. coli-ESBL, K. pneumoniae-ESBL, Carbapenem-Resistant K. pneumoniae and Meropenem-Resistant P. aeruginosa, as well as antibiotic consumption, and compared these rates between the medical and oncology wards. In total, we included 314 bacteremias from 253 patients. SOC patients are frequently prescribed antibiotics (40.8%), mainly fluoroquinolones. Nosocomial bacteremia accounted for 18.2% of the cases and only 14.3% of patients were neutropenic. Hepatobiliary tract was the most frequent tumor (31.5%) and source of bacteremia (38.5%). Resistant bacteria showed a decreased rate of resistance during the years studied in the oncology ward. Both K-ESBL and K-CBP resistance rates decreased (from 45.8% to 20.0%, and from 29.2% to 20.0%, respectively), as well as MRPA, which varied from a resistance rate of 28% to 16.7%. The presence of a urinary catheter (p < 0.001) and previous antibiotic prescription (p = 0.002) were risk factors for bacterial resistance. Identifying either of these risk factors could help in guiding antibiotic prescription for SOC patients. Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

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12 pages, 276 KiB

Open AccessArticle

Stigma of Palliative Care among Patients with Advanced Cancer and Their Caregivers on Early Palliative Care

by Elena Bandieri, Eleonora Borelli, Fabio Gilioli, Sarah Bigi, Claudia Mucciarini, Umberto Ferrari, Sonia Eliardo, Lidia Pinto, Carlo Adolfo Porro, Fabio Efficace, Mario Luppi and Leonardo Potenza

Cancers 2023, 15(14), 3656; https://doi.org/10.3390/cancers15143656 - 18 Jul 2023

Cited by 11 | Viewed by 2438

Abstract

The early referral to palliative care (PC) represents a successful value-based model with proven benefits regarding the quality of life and clinical outcomes for advanced cancer patients and their caregivers. Yet, its provision remains typically confined to the last weeks of life as per the historical, late PC model. The stigma according to which PC represents end-of-life care has been identified as the root of the problem. To explore the presence and effects of the stigma in a clinical context, we surveyed 78 patients and 110 caregivers (mean age: 71.7 and 60.7, respectively) on early PC to study what their perception of PC was before their direct experience. The responses were analyzed through a qualitative descriptive approach. The participants explicitly mentioned a lack of knowledge about PC (53% of the sample), which they identified also among physicians and the population (13%); an identification of PC with the late PC model (53%); and a detrimental reaction to the proposal of an early PC referral (83%). However, the participants explicitly mentioned that a direct experience of early PC allowed for an acquired awareness of early PC meaning and benefits (52%), as well as a comprehension of its differences with late PC (34%); the regret for the delayed referral (8%); the perception of the word “palliative” as a barrier (21%); and the belief that early PC should be part of the cancer routine practice (25%). A comprehensive multi-level intervention is necessary for a widespread understanding of the essence of anticipated PC. Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

10 pages, 1346 KiB

Open AccessArticle

Analysis of Local Recurrence Risk in Ductal Carcinoma In Situ and External Validation of the Memorial Sloan Kettering Cancer Center Nomogram

by Gabriela Oses, Eduard Mension, Claudia Pumarola, Helena Castillo, León Francesc, Inés Torras, Isaac Cebrecos, Xavier Caparrós, Sergi Ganau, Belén Ubeda, Xavier Bargallo, Blanca González, Esther Sanfeliu, Sergi Vidal-Sicart, Reinaldo Moreno, Montserrat Muñoz, Gorane Santamaría and Meritxell Mollà

Cancers 2023, 15(8), 2392; https://doi.org/10.3390/cancers15082392 - 21 Apr 2023

Cited by 3 | Viewed by 2516

Abstract

Background: Adjuvant radiotherapy and hormonotherapy after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) have been shown to reduce the risk of local recurrence. To predict the risk of ipsilateral breast tumor relapse (IBTR) after BCS, the Memorial Sloan Kettering Cancer Center (MSKCC) developed a nomogram to analyze local recurrence (LR) risk in our cohort and to assess its external validation. Methods: A historical cohort study using data from 296 patients treated for DCIS at the Hospital Clínic of Barcelona was carried out. Patients who had had a mastectomy were excluded from the analysis. Results: The mean age was 58 years (42–75), and the median follow-up time was 10.64 years. The overall local relapse rate was 13.04% (27 patients) during the study period. Actuarial 5- and 10-year IBTR rates were 5.8 and 12.9%, respectively. The external validation of the MSKCC nomogram was performed using a multivariate logistic regression analysis on a total of 207 patients, which did not reach statistical significance in the studied population for predicting LR (p = 0.10). The expression of estrogen receptors was significantly associated with a decreased risk of LR (OR: 0.25; p = 0.004). Conclusions: In our series, the LR rate was 13.4%, which was in accordance with the published series. The MSKCC nomogram did not accurately predict the IBTR in this Spanish cohort of patients treated for DCIS (p = 0.10). Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

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19 pages, 660 KiB

Open AccessSystematic Review

Antitumoral Agent-Induced Constipation: A Systematic Review

by Agnès Calsina-Berna, Jesús González-Barboteo, Silvia Llorens-Torromé and Joaquim Julià-Torras

Cancers 2024, 16(1), 99; https://doi.org/10.3390/cancers16010099 - 24 Dec 2023

Cited by 1 | Viewed by 1926

Abstract

Background: Constipation is a common symptom in patients receiving antitumoral treatment. The mechanisms underlying antitumoral agent-induced constipation (ATAIC) are poorly defined. This systematic review aimed to analyze and synthesize the available information related to the prevalence, etiology, and treatment of ATAIC. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was conducted. The review included human studies written in English, French, or Spanish involving patients with cancer and containing information about the prevalence, etiology, and treatment of ATAIC. Results: A total of 73 articles were included. The reported prevalence ranged from 0.8% to 86.6%. Six studies reported an ATAIC prevalence of over 50%. The prevalence rates of constipation of grades 3 and 4 ranged between 0 and 11%. The importance of enteric neuronal integrity in gastrointestinal function was reported. The articles with the highest levels of evidence in relation to ATAIC treatment obtained in this systematic review studied treatments with acupuncture, sweet potato, osteopath, probiotics, and moxibustion. Conclusions: The prevalence of constipation in patients undergoing antitumoral treatment is very diverse. Studies specifically designed to report the prevalence of antineoplastic treatment-induced constipation are needed. The importance of enteric neuronal integrity in gastrointestinal function was described. Thus, neuroprotection could be an area of research for the treatment of chemotherapy-induced gastrointestinal disorders. Full article

(This article belongs to the Special Issue Medical Complications and Supportive Care in Patients with Cancer)

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