Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital

Abstract

Centre was created to allow the rapid banking of metastatic tumors from end-of-life patients to enhance our understanding of tumor development. Research tissue sampling is done on consented patients as soon as possible after death, but may be delayed for 24 hours or more. The purpose of this study was to determine the effect of time between patient death and tissue processing on RNA integrity. Design: RNA integrity number (RIN) scores were determined for primary tumors, metastatic lesions and normal uninvolved tissues from patients consenting to the Tissue Procurement Program. The time between patient death and tissue processing was recorded. RIN scores were determined on snap frozen tissue using a bioanalyzer (Agilent) and reported on a scale of 1-10, with 10 indicating fully intact RNA, 5 indicating partially degraded RNA, and 3 indicating fully degraded RNA. Results: RIN scores of the primary tumor, a liver metastasis and normal kidney from a patient with lung cancer sampled 5 hours post mortem were 5.6, 7.6 and 4.8 respectively. Tumor tissues collected from a second patient with lung cancer sampled 18 hours postmortem had RIN scores of 6.6 (primary) and 6.9 (liver metastasis). Normal kidney had a reading of N/A (completely degraded). RNA quality differed between tissue sites in one patient with pancreatic cancer, with RIN scores that ranged from 8.6 (peritoneum metastasis) to N/A (hepatic lymph node metastasis). A RIN analysis has since become routine QC for all patients in our rapid autopsy program (3-5 new patients per week). Conclusions: The results of this study indicate that RNA integrity of metastatic tumors can be maintained more than 18 hours after death, whereas normal tissues may be more sensitive to RNA degradation post mortem. Results also indicate that some tissue sites within the body preserve RNA quality better than others. Analysis of RNA from metastatic lesions of patients participating in the Tissue Procurement Program may provide valuable insights into tumor evolution and resistance to treatment. Background: January 2014 was a hallmark in autopsy registry in Portugal. A national electronic online-only death certificate platform was established. This led to the creation and implementation of a national standardized protocol, which could be used internationally, for reporting the clinical autopsy. In October 2014, this protocol was integrated in the electronic platform. Design: A national core panel of pathology residents, under the supervision of the Portuguese College of Pathologists, gathered to develop a reference database for adult clinical autopsy reporting. This online platform was aimed to be a user-friendly scheme, easy to fill, structured as a conventional autopsy report and divided by organ systems; it is pre-loaded with a minimal "normal" default data and a selectable pathology field, loaded with the most common pathological findings; however it always offers a free-text option, whenever necessary or as an alternative. In the end, the data is submitted to the death certificate re...

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