Palliative care use amongst patients with bladder cancer

Hugar, Lee A.; Lopa, Samia; Yabes, Jonathan G.; Yu, Jui‐Ling; Turner, Robert; Fam, Mina; Macleod, Liam C.; Davies, Ben; Smith, Angela; Jacobs, Bruce L.

doi:10.1111/bju.14708

Cited by 37 publications

(32 citation statements)

References 27 publications

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“…26,27 Independent predictors of PC referral revealed potential groups where PC services were underutilized. The lower PC referral utilization in younger patients, male, Hispanics, and lower income patient has been reported in the past 25,28 and requires measures to improve PC referral in these subgroups.…”

Section: Discussionmentioning

confidence: 91%

Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

et al. 2020

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We assessed the trend of palliative care (PC) referrals and its effect on hospitalization cost and length of stay (LOS) in ruptured aortic aneurysm (rAA). The Nationwide Inpatient Sample from 2005 to 2014 was used to identify admissions with age ≥50 and rAA. A total of 54 134 rAA admissions were identified and 5019 (9.3%) had PC referrals. During the study period, PC referral rate increased from 0.97% to 15.3% ( P trend < .0001). Length of stay (1.7 vs 2.8 days, adjusted mean ratio [aMR] = 0.62, 95% confidence interval [CI]: 0.58-0.66), and cost (US$7778 vs US$13 575, aMR = 0.57, 95% CI: 0.52-0.63) were significantly lower in rAA admissions that did not undergo interventions. In the percutaneous repair group, LOS was similar but the cost was higher (US$61 759 vs US$52 260, aMR = 1.18, 95% CI: 1.05-1.30), whereas in surgical repair group, LOS was shorter (4.6 vs 5.9 days, aMR = 0.77, 95% CI: 0.73-0.82) but the cost was higher (US$59 755 vs US$52 523, aMR = 1.14, 95% CI: 1.02-1.28). Palliative care could shorten LOS and save hospitalization cost in rAA admissions not a candidate for repair. Further studies are required to investigate the variable effects of PC on rAA.

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Section: Discussionmentioning

confidence: 91%

Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

et al. 2020

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“…Palliative care for BC is a still highly uncharacterized issue, with no precise guidelines and indications. American Society of Clinical Oncology recommends early palliative care for patients affected by advanced malignancies, late-stage disease, distant metastasis or life expectancy of 624 months [8, 18]. Hugar et al recently reported, though, that only 4% with patients affected by advanced BC or advanced comorbidities actually undergo palliative treatments among Medicare beneficiaries [8].…”

Section: Discussionmentioning

confidence: 99%

“…Palliative care has been widely described for other malignancies, but we still lack precise guidelines about palliation in BC patients [8, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience

Romagnoli

D’Agostino

Corsi

et al. 2019

Cent european J Urol

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Introduction The aim of this study was to assess surgical and functional outcomes of 17 consecutive patients undergoing robot- assisted radical cystectomy (RARC) with palliative intent in a monocentric single surgeon series. Material and methods We collected data from 17 consecutive patients who underwent RARC with palliative intent performed by a single surgeon at our institution. Patients undergoing palliative RARC were those with advanced bladder cancer (BC) or advanced comorbidities. Clinical, surgical and functional outcomes were prospectively collected. Patients completed a specific questionnaire (Functional Assessment of Cancer Therapy-Bladder Cancer, FACT-BL) before and after surgery to assess the role of palliative RARC in terms of quality of life improvement. Results Median age at surgery was 78 years, with median Charlson Comorbidity Index (CCI) and age-adjusted CCI of 3 and 7, respectively. Clinical stage was T2, T3 or T4 in 7, 8 and 2 patients respectively, with 52.9% and 29.4% with cN+ and cM+ disease. Median estimated blood loss was 200 ml, with 1 patient requiring intra-operative blood transfusion. Median hospital stay was 7 days. A total of 3 and 2 patients were re-hospitalized during the first 30 and 30–90 post-operative days, respectively. One major Clavien grade complication was recorded. At median follow-up of 8 months, 9 and 2 patients succumbed due to tumor progression and other causes. Pre-operative and post-operative FACT-BL scores improved significantly in each domain. Conclusions A RARC is a safe and feasible technique which could be offered as part of palliative care in patients with advanced BC or comorbidities. Precise guidelines for palliating BC patients should be better.

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“…So far, no targeted therapy is recommended to treat advanced and/or metastatic BC and palliative cystectomy is performed. The prognosis in metastatic BC is generally extremely poor …”

Section: Introductionmentioning

confidence: 99%

SWI/SNF chromatin remodeling complex and glucose metabolism are deregulated in advanced bladder cancer

et al. 2020

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Bladder cancer (BC) is a frequently diagnosed malignancy affecting predominantly adult and elderly populations. It is expected that due to the longer life time, BC will become even more frequent in the future; thus in consequence, it will represent serious health problem of older society part. The treatment of advanced BC is mostly ineffective due to its very aggressive behavior. So far, no effective targeted therapy is used for BC treatment. Here, we found that BC is characterized by lower protein levels of BRM, INI1, and BAF155 main subunits of SWI/SNF chromatin remodeling complex (CRC) which is involved in global control of gene expression and influences various important cellular processes like: cell cycle control, apoptosis, DNA repair, etc. Moreover, the expression of SMARCA2, a BRM encoding gene, strongly correlated with BC metastasis and expression of such metabolic genes as PKM2 and PRKAA1. Furthermore, the analysis of T24 and 5637 commonly used BC cell lines revealed different expression levels of metabolic genes including FBP1 gene encoding Frutose-1,6-Bisphosphatase, an enzyme controlling glycolysis flux and gluconeogenesis. The tested BC cell lines exhibited various molecular and metabolic alterations as well as differential glucose uptake, growth rate, and migration potential. We have shown that BRM subunit is involved in the transcriptional control of genes encoding metabolic enzymes.Moreover, we found that the FBP1 expression level and the SWI/SNF CRCs may serve as markers of molecular subtypes of BC. Collectively, this study may provide a new knowledge about the molecular and metabolic BC subtypes which likely will be of high importance for the clinic in the future.

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Palliative care use amongst patients with bladder cancer

Cited by 37 publications

References 27 publications

Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database

Is robotic approach useful to palliate advanced bladder cancer? A monocentric single surgeon experience

SWI/SNF chromatin remodeling complex and glucose metabolism are deregulated in advanced bladder cancer

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