Background: Hospice care is perceived as enhancing life quality for patients with advanced, incurable illness, but cost comparisons to nonhospice patients are difficult to make. Several studies demonstrated that palliative hospice care reduced medical expenditure in terminally ill patients compared with that of nonhospice care. Methods: Patients with terminal cancer who were registered in Hospice Care Program (HCP) by the written consent and died during same admission period in Seoul Veterans Hospital, Seoul, Korea, between January 2009 and December 2009 were included. We compared medical expenditure according to the ward type (hospice ward and general ward) in patients who received palliative hospice care in Seoul Veterans Hospital, Korea. Results: The daily total average expenditure for each inpatient was ₩193 930 and ₩266 161 in the hospice and general ward, respectively ( P = .001). Daily expenditure of parenteral nutrition and laboratory blood tests/X-ray was also significantly lower in hospice ward compared with general ward ( P = .002 and P = .006), respectively; 12 (17%) of 72 patients had been admitted in the intensive care unit during hospice care period in general ward ( P = .014); 1 (3%) of 32 patients received blood products in hospice ward, but 13 (18%) patients received blood products in general ward during palliative hospice care ( P = .039). Conclusion: Hospice ward type in palliative hospice therapy may contribute to reduce economic medical costs as well as to more specific total care for terminally ill patients with cancer.
Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of morbidity and mortality worldwide.GARFIELD-VTE is a prospective, non-interventional observational study of real-world treatment practices. We aimed to capture the 36-month clinical outcomes of 10,679 patients with objectively confirmed VTE enrolled between May 2014 and January 2017 from 415 sites in 28 countries.A total of 6582 (61.6 %) patients had DVT alone, 4097 (38.4 %) had PE ± DVT. At baseline, 98.1 % of patients received anticoagulation (AC) with or without other modalities of therapy. The proportion of patients on AC therapy decreased over time: 87.6 % at 3 months, 73.0 % at 6 months, 54.2 % at 12 months and 42.0 % at 36 months. At 12-months follow-up, the incidences (95 % confidence interval [CI]) of all-cause mortality, recurrent VTE and major bleeding were 6.5 (7.0-8.1), 5.4 (4.9-5.9) and 2.7 (2.4-3.0) per 100 person-years, respectively. At 36-months, these decreased to 4.4 (4.2-4.7), 3.5 (3.2-2.7) and 1.4 (1.3-1.6) per 100 person-years, respectively. Over 36-months, the rate of all-cause mortality and major bleeds were highest in patients treated with parenteral therapy (PAR) versus oral anti-coagulants (OAC) and no OAC, and the rate of recurrent VTE was highest in patients on no OAC versus those on PAR and OAC. The most frequent cause of death after 36-month follow-up was cancer (n = 565, 48.6 %), followed by cardiac (n = 94, 8.1 %), and VTE (n = 38, 3.2 %). Most recurrent VTE events were DVT alone (n = 564, 63.3 %), with the remainder PE, (n = 236, 27.3 %), or PE in combination with DVT (n = 63, 7.3 %).GARFIELD-VTE provides a global perspective of anticoagulation patterns and highlights the accumulation of events within the first 12 months after diagnosis. These findings may help identify treatment gaps for subsequent interventions to improve patient outcomes in this patient population.
Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.
e19031 Background: Treatment strategy for elderly patients older than 80 years with diffuse large B cell lymphoma (DLBCL) has not been established because of treatment intolerability and lack of the data. Methods: This multicenter retrospective study was conducted to investigate clinical characteristics, treatment patterns and outcome of patients older than 80 years at the diagnosis of DLBCL from 19 institutions in Korea between 2005 and 2016. Results: A total of 194 patients were identified (men: women 93:101). Median age was 83.3 years (range 80.1-95.7). 114 (59.3%) patients had an age-adjusted international prognostic index (aaIPI) score of 2-3 and 48 (24.7%) had Charlson index with a score 4 or more. R-CHOP was given in 124 (63.9%) cases, R-CVP in 13 cases, other chemotherapy in 17 cases, radiation alone in 9 cases, and surgery alone in 2 cases. 29 (14.9%) patients did not receive any treatment. The median cycle of chemotherapy was three (range 1-10). Only 43 patients completed planed cycles of treatment. The overall response rate of 105 evaluable patients was 91.4% (CR 41.9%, PR 49.5%). 29 patients died due to treatment-related toxicity (TRT) such as pneumonia and sepsis. 13 patients died due to TRT just after 1 st cycle. Median overall survival was 14.0 months. Main causes of death were disease progression (30.8%) and treatment-related toxicities (27.1%). In multivariate analyses, overall survival was affected by aaIPI, hypoalbuminemia, elevated creatinine, and treatment. Conclusions: Age itself should not be a contraindication to treatment. However, since elderly patients show higher TRT due to infection, careful monitoring and dose modification of chemotherapeutic agents would be needed.
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