Frequent emergency department visits (EDVs) by patients with terminal cancer indicates aggressive care. The pattern and causes of EDVs in 154 patients with terminal cancer were investigated. The EDVs that started during working hours and ended by home discharge were considered avoidable. During the last 3 months of life, 77% of patients had at least 1 EDV. In total, 309 EDVs were analyzed. The EDVs occurred out of hour in 67%, extended for an average of 3.6 hours, and ended by hospitalization in 52%. The most common chief complaints were pain (46%), dyspnea (13%), and vomiting (12%). The EDVs were considered avoidable in 19% of the visits. The majority of patients with terminal cancer visit the ED before death, mainly because of uncontrolled symptoms. A significant proportion of EDVs at the end of life is potentially avoidable.
Low mammographic BD, low BMI and early clinical stage were associated with improved pCR rate and lower pathological stage after neoadjuvant chemotherapy. BD had more pronounced association with response to chemotherapy after adjustment with BMI.
Our study revealed that antibiotic therapy for terminal cancer patients should be on a clear rationale. We need further study to clarify if there is survival effect with antibiotic use or not.
Breast density is a modifiable trait linked with breast cancer predisposition. However, the relation between mammographic breast density and survival outcome is not yet clarified. The present study aims to study the prognostic value of mammographic density in patients diagnosed with metastatic breast cancer. In this observational study, breast cancer patients with metastatic disease at diagnosis were enrolled. Two-view mammograms were performed at diagnosis, and breast density was quantitatively assessed. Progression-free survival (PFS) was correlated with breast density and other prognostic variables in univariate and multivariate analyses. PFS, stratified by different prognostic factors, was assessed in low compared to high density patients to check for possible differential survival outcome in patients' subgroups. Among the sixty enrolled patients, median PFS in low density patients was significantly better than those with high density (18.4 months, 95 % CI 14.88-22.15 vs. 9.3 months, 95 % CI 8.51-13.60, respectively, p = 0.002). Significant correlation of breast density with PFS persisted after adjustment by body mass index (p = 0.003) and after multivariate analysis incorporating other prognostic variables (HR 6.16, 95 % CI (2.17-17.48), p = 0.001). PFS was better in low density patients older than 40 years at diagnosis (p = 0.001), with HER2-negative disease (p = 0.015), hormonal receptor-positive phenotype (p = 0.020), patients with single site of metastasis (p = 0.006), and patients with bone-only metastases (p = 0.042). Breast density assessed at the time of diagnosis was significantly correlated with PFS of metastatic breast cancer patients. Survival outcome is improved in certain patients' subgroups with low breast density.
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