Johan Menten
Catholic University Leuven (Belgium), Oncology, Faculty Member
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Purpose Patients with a benign meningioma often have a long survival following the treatment of their meningioma. Since radiotherapy is frequently part of the treatment, long - term side effects are of considerable concern. A... more
Purpose Patients with a benign meningioma often have a long survival following the treatment of their meningioma. Since radiotherapy is frequently part of the treatment, long - term side effects are of considerable concern. A controversial long-term side effect of radiotherapy is stroke. Due to its severity, it is important to know the frequency of this side effect. The aim of this study was to assess the stroke incidence and risk factors among patients receiving radiotherapy for their benign meningioma. Methods We performed a retrospective database study of patients who underwent primary or adjuvant radiotherapy for their benign meningioma at University Hospitals Leuven from January 2003 to December 2017. Results We included 169 patients with a median age of 51 years (range 22–84). Every patient received fractionated radiotherapy using photons with a median dose of 56 Gy (range 54–56) in fractions of 2 Gy (range 1.8–2). The median follow-up was 5.3 years (range 0.1–14). The cumulative stroke incidence function showed an incidence of 11.6% after 9 years of follow-up, translating to a stroke incidence per year of 1.29%. We found two significant risk factors for stroke: medically treated arterial hypertension (p = 0.005) and history of previous stroke or transient ischemic attack (p < 0.001). 5-year local control and overall survival rates were respectively 97.4% and 91.2%. Other late grade III/IV toxicities occurred in 16.0% (27/169) of patients. Conclusion Our study shows a higher incidence of stroke in patients who received radiotherapy for their benign meningioma compared to the general population.
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1560 Background: Temozolomide (TemodalR, TMZ) is an active alkylating agent for the treatment of gliomas. Conventional dosing of TMZ consists of an oral dose of 150–200 mg/m2/day for 5 consecutive days every 28 days. Extended daily dosing... more
1560 Background: Temozolomide (TemodalR, TMZ) is an active alkylating agent for the treatment of gliomas. Conventional dosing of TMZ consists of an oral dose of 150–200 mg/m2/day for 5 consecutive days every 28 days. Extended daily dosing of TMZ might be more active because of the depletion of the AGAT repair protein. TMZ administered for 21 consecutive days (at a dose of 100 mg/m2/day) every 28 days, is being tested in a multicenter Belgian phase II study for the treatment of recurrent anaplastic (oligo)astrocytoma. We report the toxicity that was associated with this regimen at the occasion of the first interim monitoring of the adverse events. Methods: For the monitoring of toxicity (CTCAEv3.0), the protocol requested a weekly clinical and hematological evaluation during the first 8 wks and every 2 wks thereafter. An interim analysis was carried out for the toxicity seen during the first 67 administered treatment cycles. Results: 17 patients (pts) were recruited into this study (4 F, 13 M; median age 4...
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LBA2 Background: The EORTC (26981-22981)/NCIC CTG (CE.3) RCT in newly diagnosed glioblastoma (GB) showed increased overall survival (OS) with concomitant and adjuvant temozolomide (TMZ) added to radiotherapy (RT). Pts were 18-71 (median... more
LBA2 Background: The EORTC (26981-22981)/NCIC CTG (CE.3) RCT in newly diagnosed glioblastoma (GB) showed increased overall survival (OS) with concomitant and adjuvant temozolomide (TMZ) added to radiotherapy (RT). Pts were 18-71 (median 56) years; however, a trend of decreasing benefit from the addition of TMZ with increasing age was noted. Recent RCTs in elderly GB detected non-inferiority of 40 Gy/15 v 60 Gy/30 RT and superior survival was noted for MGMT-methylated pts treated with TMZ alone. However, whether the addition of TMZ to RT improves survival in elderly pts remained unanswered. Methods: We conducted a global randomized phase III clinical trial for patients ≥ 65 yrs with histologically confirmed newly diagnosed GB, ECOG 0-2, randomized 1:1 to receive 40Gy/15 RT v 40Gy/15 RT with 3 weeks of concomitant TMZ plus monthly adjuvant TMZ until progression or 12 cycles. Stratification was by centre, age (65-70, 71-75, or 76+), ECOG 0,1 vs 2, and biopsy vs resection. Results: 562 pts were randomized, 281 on each arm; median age 73 yrs (range 65-90), male 61%, PS 0/1 77%, resection 68%. RT+TMZ significantly improved OS over RT alone (median 9.3m v 7.6m, HR 0.67, 95%CI 0.56-0.80, p &lt; 0.0001) and significantly improved PFS (median 5.3m v 3.9m, HR 0.50, 95%CI 0.41 – 0.60, p &lt; 0.0001). Tissue from 462 pts was provided and adequate for MGMT analysis in 354 to date. In MGMT methylated patients (n = 165) OS for RT+TMZ v RT was 13.5 m and 7.7m respectively (HR: 0.53 (95% C.I. 0.38, 0.73, p = 0.0001). In MGMT unmethylated patients (n = 189) OS for RT + TMZ v RT was 10.0m vs 7.9m respectively (HR 0.75 (95% C.I. 0.56 – 1.01, p = 0.055). QoL analyses showed no differences in functional domains of QLQC30 and BN20 but were worse in the RT/TMZ arm for nausea, vomiting, and constipation. Systemic therapy after PD was reported in 39% on RT+TMZ v 41% on RT. Conclusions: The addition of concomitant and adjuvant TMZ to hypofractionated RT for elderly pts with GB significantly improves OS and PFS in all patients and is well tolerated. Patients with MGMT methylated tumors benefit the most from the addition of TMZ to RT where median OS is nearly doubled. Clinical trial information: NCT00482677.
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To evaluate the cognitive status and quality of life (QOL) in a cohort of 19 consecutive patients treated in a prospective European Organization for Research and Treatment of Cancer study (20962) for primary CNS lymphoma (PCNSL). All... more
To evaluate the cognitive status and quality of life (QOL) in a cohort of 19 consecutive patients treated in a prospective European Organization for Research and Treatment of Cancer study (20962) for primary CNS lymphoma (PCNSL). All patients were in complete remission after combined modality treatment with IV and intrathecal high-dose methotrexate (MTX)-based chemotherapy followed by whole brain radiotherapy (WBRT). An extensive neuropsychological assessment, including QOL measures, was conducted in 19 patients with PCNSL. The results were compared with matched control subjects with systemic hematologic malignancies treated with systemic chemotherapy or non-CNS radiotherapy. In addition, a neuroradiologic evaluation was carried out in 18 patients with PCNSL. Cognitive impairment was found in 12 patients with PCNSL (63%) despite a complete tumor response. Four patients (21%) showed severe cognitive deficits, and the percentage of impaired test indices correlated with age. In comparison, only two control subjects (11%) showed cognitive dysfunction (p = 0.002). Forty-two percent of the patients with PCNSL, in contrast to 81% of the control subjects, resumed work. White matter abnormalities were observed in 14 patients with PCNSL, and 14 had cortical atrophy. Cortical atrophy correlated with cognitive functioning, age, and Karnofsky performance score. Group differences in cognitive status and QOL could not be explained by anxiety, depression, or fatigue. Combined modality treatment for primary CNS lymphoma is associated with cognitive impairment even in patients aged &lt;60 years.
Research Interests: Cognitive Science, Chemotherapy, Medicine, Brain, Humans, and 15 moreInternal Medicine, Female, Male, Clinical Sciences, Atrophy, Adult, Methotrexate, Cognition disorders, Case Control Studies, Cohort Studies, Cerebral White Matter, Combined Modality Therapy, Methylprednisolone, Hospital Anxiety, and hydrocortisone
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2547 Background: Lymphopenia (LMP) may lead to worse outcomes for patients with glioblastoma (GBM). This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on LMP, as well as the... more
2547 Background: Lymphopenia (LMP) may lead to worse outcomes for patients with glioblastoma (GBM). This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on LMP, as well as the association of LMP with overall survival. Methods: CCTG clinical trial CE.6 randomized elderly GBM patients (≥ 65 yrs) to short course radiation alone (RT) or short course radiation with temozolomide (RT + TMZ). In this study LMP (mild-mod: grade 1-2; severe: grade 3-4) was defined per CTCAE v3.0 criteria, and measured at baseline, 1 wk and 4 wks post-RT. Pre-selected key factors for the analysis included age, sex, ECOG, extent of resection, MGMT methylation, MMSE, and steroid use. Multinomial logistic regression models were used to identify factors associated with LMP and multivariable Cox regression models were used to study effect of LMP on survival. Results: A total of 562 patients were included for analysis (281 RT vs 281 RT+TMZ). At baseline, both ...
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Introduction Breast cancer patients with a high-risk tumor (for example Triple Negative Breast Cancer) who achieve a pathological complete response (pCR) following neoadjuvant chemotherapy (NACT) have a better outcome compared to patients... more
Introduction Breast cancer patients with a high-risk tumor (for example Triple Negative Breast Cancer) who achieve a pathological complete response (pCR) following neoadjuvant chemotherapy (NACT) have a better outcome compared to patients with residual disease at surgery. This study investigated Breast Cancer Free Survival (BCFS) and predictors for distant relapse despite pCR. Methods Monocentric retrospective study of 243 consecutive breast cancer patients who achieved pCR (ypT0/is ypN0/N0(i+)) after treatment with NACT in UZ Leuven between 01/2000 and 08/2017. 58% had stage III breast cancer, 40% Triple Negative Breast Cancer (TNBC) and 47% HER2 pos breast cancer. BCFS was defined as any breast cancer related event (local, contra-lateral, regional, metastatic) that first appeared. Primary endpoints were frequency of BCFS and predictors for metastatic relapse: patient demographics (age, body mass index (BMI)) and tumor characteristics (TNM stage, histological type, hormonal receptor status). Secondary endpoints were breast cancer specific survival (BCSS) and overall survival (OS). Statistical analysis was performed using the Statistical Package for the Social Sciences software (SPSS, version 25). The Kaplan Meier method was used for survival analysis. Results Of 1167 breast cancer patients undergoing neoadjuvant treatment, 243 patients (20,8%) achieved pCR and were included. Median follow up was 57 months (range 9-252 months). 22 (9.1%) developed tumor progression; 20 (8.2%) metastatic and 2 (0.8%) contralateral. First metastatic site was the brain in 11/20 patients (55%) and 14/22 (64%) died of breast cancer. Higher clinical tumor stage at diagnosis predicted metastatic relapse (stage I-II 2.9%; stage III 12.1%). Patients with a BMI ≤25 kg/m2 had less metastatic relapse than patients with BMI &gt;25kg/m2 (3.8% versus 12.0%), better OS (94.6% vs 88.0%) and BCSS (97.7 vs 91.7%). Neither tumor type (TNBC 8.2%; HER2-pos 8.1%; HR-pos/HER2 neg 9.3%) nor younger age &lt; 36yrs (3.3% versus 8.9%) was prognostic for post-pCR relapse. There is a lower OS (mean 174m versus 231m, 95% CI 158-190m, median 208m) and BCSS (mean 191m versus 253m, 95% CI 182-200m) in cN1-3 versus cN0 disease at diagnosis. Conclusion Despite NACT-induced pCR, a small proportion (9.1%) will develop a metastatic relapse after a median follow-up of 57 months. We found that a higher stage at diagnosis and a higher BMI were prognostic for worse BCFS while age &lt;36 y and negative hormonal receptor status were not prognostic. cN+ at diagnosis and a BMI &gt;25 predict worse OS and BCSS. Citation Format: Borremans K, Berteloot P, Van Nieuwenhuysen E, Han S, Hoste G, Wildiers H, Punie K, Smeets A, Nevelsteen I, Floris G, Van Ongeval C, Keupers M, Prevos R, Van Limbergen E, Menten J, Weltens C, Janssen H, Vergote I, Neven P. Breast cancer recurrence and predictors for recurrence despite pathologic complete response following neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-04.
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ObjectivesPalliative sedation for existential suffering (PS-ES) is considered a controversial practice to control refractory suffering at the end of life. This study aims to explore Belgian palliative care physicians’ perceptions... more
ObjectivesPalliative sedation for existential suffering (PS-ES) is considered a controversial practice to control refractory suffering at the end of life. This study aims to explore Belgian palliative care physicians’ perceptions regarding the ethics of PS-ES.MethodsThis nationwide qualitative study follows a Grounded Theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 23 Belgian hospitals and hospices (Flanders, Brussels, Wallonia). We analysed the data using the Qualitative Analysis Guide Of Leuven and we followed the Consolidated Criteria for Reporting Qualitative Research guidelines.ResultsThe data revealed that Belgian palliative care physicians have difficulty characterising ES and distinguishing it from other types of suffering. They express mixed attitudes towards PS-ES and employ a wide range of ethical arguments in favour and against it, which are mainly linked to the four principles of biomedical ethics.ConclusionSince the...
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Case description: We report on an 72-year-old male patient with a history of treated RCC who presented after 40 months with a classic but severe triad of Hakim and Adams due to hydrocephalus related to a choroid plexus mass in the... more
Case description: We report on an 72-year-old male patient with a history of treated RCC who presented after 40 months with a classic but severe triad of Hakim and Adams due to hydrocephalus related to a choroid plexus mass in the trigonum of the both lateral ventricles. Because of the severity of symptoms we decided to first treat the symptoms of normal pressure hydrocephalus. Follow-up imaging showed clear disease progression unilateral in the right sided trigonum. Consequently the patient was referred to surgery to remove the right-sided lesion. The left-sided lesion was not resected. The histopathological examination was consisted with a RCC metastasis. The patient was referred for additional systemic treatment.
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Background:Advance care planning (ACP) is not well implemented in hospital. Implementation theory stresses the importance of knowing what hospitalised palliative patients and their families experience as barriers or as facilitators in the... more
Background:Advance care planning (ACP) is not well implemented in hospital. Implementation theory stresses the importance of knowing what hospitalised palliative patients and their families experience as barriers or as facilitators in the uptake of ACP with their treating physician.Aims:This study aimed to gain an in-depth understanding of what hospitalised palliative patients and their families experienced as barriers or facilitators for having ACP conversations.Methods:We used a tape-assisted recall procedure to conduct 29 videotaped interviews with hospitalised patients and their families. We used content analysis based on grounded theory principles.Results:Four major fields of tension were discovered: not knowing what to expect from the treating physician; not being sure the treating physician can be a trusted partner; daring to speak about ACP; and staying loyal to one's own wishes.Conclusions:Patients and families need physicians who are accessible and can be trusted ACP p...
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Background: Invalidating hot flushes and night sweats leading to sleep dysfunction and poor quality of life are difficult to treat, especially in postmenopausal breast cancer patients likely to take an anti-estrogen. Lipov et al. (Lancet... more
Background: Invalidating hot flushes and night sweats leading to sleep dysfunction and poor quality of life are difficult to treat, especially in postmenopausal breast cancer patients likely to take an anti-estrogen. Lipov et al. (Lancet Oncology 2008; 9: 523-32) recently reported on the therapeutic value of the ganglion stellatum block (GSB) in 13 patients. We here report results from a pilot and prospectively planned study using the GSB in symptomatic breast cancer patients.Methods and Patients: Both studies were approved by our ethical committee and included postmenopausal women with severe hot flushes and/or night sweats and no contra-indication for GSB. Patients had to sign a consent form after information and were recruited from the follow-up breast cancer clinic. Hot flushes were recorded in a daily diary by use of the hot-flash score (Lipov et al.) and night awakenings by use of the Pittsburgh Sleep Quality Index. Improvement was estimated by the patient from 0-100 %. The pi...
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As part of the Palliative Sedation project funded by the European Union’s Horizon 2020 programme (grant no. 825700) entitled Palliative Sedation (SC1-BHC-23-2018 A) (https://palliativesedation.eu), the aim of our study was to revise... more
As part of the Palliative Sedation project funded by the European Union’s Horizon 2020 programme (grant no. 825700) entitled Palliative Sedation (SC1-BHC-23-2018 A) (https://palliativesedation.eu), the aim of our study was to revise and update the 2009 European Association for Palliative Care (EAPC) framework on palliative sedation. For this framework as for other guidelines on palliative sedation the general weakness of its methodological development and the lack of consensus on terminology and concepts has been criticized, and issues such as the complexity of assessing refractory symptoms or the differentiation between somatic, psychological and existential suffering have remained under controversial debate. For the new framework a rigid consensus methodology with a four-step Delphi procedure involving international experts and a European cancer patient organisation has been used. The development of the recommendations addressed all relevant methodological and content aspects ...
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Background Palliative sedation involves the intentional lowering of consciousness at the end of life. It can be initiated to relieve a patient’s burden caused by refractory symptoms at the end of life. The impact of palliative sedation... more
Background Palliative sedation involves the intentional lowering of consciousness at the end of life. It can be initiated to relieve a patient’s burden caused by refractory symptoms at the end of life. The impact of palliative sedation needs to be clinically monitored to adjust the proper dose and regimen of sedative medication to ensure that patients are at ease and comfortable at the end of their lives. Although there is consensus among health care professionals and within guidelines that efficacy of palliative sedation needs to be closely monitored, there is no agreement about how, when, and by whom, this monitoring should be performed. The aim of this study is to evaluate the effects of palliative sedation by measuring the discomfort levels and sedation/agitation levels of the patients at regular timepoints. In addition, the clinical trajectories of those patients receiving palliative sedation will be monitored and recorded. Methods The study is an international prospective non-...
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Background: Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory... more
Background: Patients at the end-of-life may experience refractory symptoms of which pain, delirium, vomiting and dyspnea are the most frequent. Palliative sedation can be considered a last resort option to alleviate one or more refractory symptoms. There are only a limited number of (qualitative) studies exploring the experiences of relatives of sedated patients and their health care professionals (HCPs). The aims of this study protocol are: 1) to elicit the experiences of bereaved relatives and health care professionals of patients treated with palliative sedation and 2) to explore the understanding of the decision-making process to start palliative sedation across care settings in 5 European countries.
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... Borgermans, Liesbeth AD; Goderis, Geert; Ouwens, Marielle; Wens, Johan; Heyrman, Jan; Grol, Richard PTM (International journal of integrated ... de zorg voor diabetes type 2-patiënten in België: analyse van een bevraging bij achttien... more
... Borgermans, Liesbeth AD; Goderis, Geert; Ouwens, Marielle; Wens, Johan; Heyrman, Jan; Grol, Richard PTM (International journal of integrated ... de zorg voor diabetes type 2-patiënten in België: analyse van een bevraging bij achttien belangengroepen. Bastiaens, Hilde; Sunaert ...
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Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their... more
Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. Further, develop a generic framework that will consist of the basis for the design of future models for integrated PC in Europe. Cochrane, PubMed, EMBASE, CINAHL, AMED, BNI, Web of Science, NHS Evidence. Five journals and references from included studies were hand-searched. Two reviewers screened the search results. Studies with adult patients with advanced cancer/chronic disease from 1995 to 2013 in Europe, in English, French, German, Dutch, Hungarian or Spanish were included. A narrative synthesis was used. 14 studies were included, 7 models for chronic disease, 4 for integrated care in oncol...
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Research Interests: Communication, Rehabilitation, Palliative Care, Medicine, Thematic Analysis, and 13 moreHeart Failure, Lung Cancer, End of life care, People, Attitudes, Needs, Prevalence, Public health systems and services research, Science Technology, Chronic obstructive pulmonary disease, Pulmonary disease, Life Sciences & Biomedicine, and Quality of health care
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Objectives This study aims to provide an in-depth understanding of the content and process of decision-making about palliative sedation for existential suffering (PS-ES) as perceived by Belgian palliative care physicians. Methods This... more
Objectives This study aims to provide an in-depth understanding of the content and process of decision-making about palliative sedation for existential suffering (PS-ES) as perceived by Belgian palliative care physicians. Methods This Belgian nationwide qualitative study follows a grounded theory approach. We conducted semistructured interviews with 25 palliative care physicians working in 19 Belgian hospital-based palliative care units and 4 stand-alone hospices. We analyzed the data using the Qualitative Analysis Guide of Leuven, and we followed the Consolidated Criteria for Reporting Qualitative Research Guidelines (COREQ). Results Analysis of the data identified several criteria that physicians apply in their decision-making about PS-ES, namely, the importance of the patient’s demand, PS-ES as a last resort option after all alternatives have been applied, the condition of unbearable suffering combined with other kinds of suffering, and the condition of being in a terminal stage....
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e19564 Background: Transdermal buprenorphine has also proven effect on neuropathic pain and is of interest for the management of pain in palliative cancer patients. An expert panel found that the use of higher doses than those recommended... more
e19564 Background: Transdermal buprenorphine has also proven effect on neuropathic pain and is of interest for the management of pain in palliative cancer patients. An expert panel found that the use of higher doses than those recommended in the prescribing information may be warranted though there is insufficient evidence. The need and value of high dose buprenorphine are assessed. METHODS Prospective observational study. Patients attending the department of oncology and/or the department palliative care who suffer pain and would normally be offered transdermal treatment with buprenorfine. 36 patients were given full information and asked to sign informed consent. The primary outcome parameter was the patient's report of pain intensity, and side effects. Where possible the need for breakthrough medication was documented. RESULTS 36 patients signed the informed consent. 5 patients never started buprenorfine treatment and 3 patients stopped immediately after the first application of the patch. 28 patients received buprenorfine for at least 3 days. Pain control was achieved in 21 out of 28 evaluable patients. In two patients, the dose was increased to 210 and 175 µg/hr. Two patients were switched to fentanyl TDD when the 140 µg/hr dose buprenorfine did not provide a satisfactory outcome. Transdermal buprenorfine is an efficient analgesic achieving adequate pain control in the majority of patients. In this observational prospective study that represents daily practice, 1/7 patients required doses higher than 140 µg/h. 36 patients signed the informed consent. 5 Patients never started buprenorfine treatment and 3 patients stopped immediately after the first application of the patch. 28 patients received buprenorfine for at least 3 days. Pain control was achieved in 21 out of 28 evaluable patients. In two patients, the dose was increased to 210 and 175 µg/hr. Two patients were switched to fentanyl TDD when the 140 µg/hr dose buprenorfine did not provide a satisfactory outcome. CONCLUSIONS Transdermal buprenorfine is an efficient analgesic achieving adequate pain control in the majority of patients. In this observational prospective study that represents daily practice, 1/7 patients required doses higher than 140 µg/h.
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... Marianne Desmedt, Myriam Deveugele UGent, Johan Menten, Steven Simoens, Johan Wens, Lisette Borgermans, Laurence Kohn, Bram Spinnewijn, Ann Cardinael UGent, Betty Kutten, Paul Vanden Berghe, Bart Van den Eynden and Dominique Paulus... more
... Marianne Desmedt, Myriam Deveugele UGent, Johan Menten, Steven Simoens, Johan Wens, Lisette Borgermans, Laurence Kohn, Bram Spinnewijn, Ann Cardinael UGent, Betty Kutten, Paul Vanden Berghe, Bart Van den Eynden and Dominique Paulus Publishing year 2011 ...
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... Title: Communicating at the end of life, challenging for GPs? Authors: Deveugele, Myriam × Beguin, Claire Cardinael, Ann Menten, Johan Simoens, Steven Keirse, Emmanuel Vanden Berghe, Paul Desmedt, Marianne Paulus, Dominique. Issue... more
... Title: Communicating at the end of life, challenging for GPs? Authors: Deveugele, Myriam × Beguin, Claire Cardinael, Ann Menten, Johan Simoens, Steven Keirse, Emmanuel Vanden Berghe, Paul Desmedt, Marianne Paulus, Dominique. Issue Date: 2010. ...
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Display of the Emmanuelâ s criteria per study. (DOCX 25Â kb)
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A PHASE III RANDOMIZED CONTROLLED TRIAL OF SHORT-COURSE RADIOTHERAPY WITH OR WITHOUT CONCOMITANT AND ADJUVANT TEMOZOLOMIDE IN ELDERLY PATIENTS WITH GLIOBLASTOMA (NCIC CTG CE.6, EORTC 26062-22061, TROG 08.02, NCT00482677) James R. Perry... more
A PHASE III RANDOMIZED CONTROLLED TRIAL OF SHORT-COURSE RADIOTHERAPY WITH OR WITHOUT CONCOMITANT AND ADJUVANT TEMOZOLOMIDE IN ELDERLY PATIENTS WITH GLIOBLASTOMA (NCIC CTG CE.6, EORTC 26062-22061, TROG 08.02, NCT00482677) James R. Perry MD, FRCPC, Christopher J. O’Callaghan, Keyue Ding, Wilson Roa, Warren P. Mason, J. Gregory Cairncross, Alba Ariela Brandes, Johan Menten, Claire Phillips, Michael F. Fay, Ryo Nishikawa, Chad Winch, and Normand Laperriere; University of Toronto, Odette Cancer Centre
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Background Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience... more
Background Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. Aims The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. Methods A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. Results Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characterist...
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BackgroundPalliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians’ perceptions do not converge in a clear position and current clinical practice guidelines do not... more
BackgroundPalliative sedation for existential suffering (PS-ES) is a controversial clinical intervention. Empirical studies about physicians’ perceptions do not converge in a clear position and current clinical practice guidelines do not agree either regarding this kind of intervention.AimTo gain deeper insight into physicians’ perceptions of PS-ES, the factors influencing it, the conditions for implementing it and the alternatives to it.DesignSystematic review of qualitative, quantitative and mixed-methods studies following the Peer Review Electronic Search Strategies and Preferred Reporting Items for Systematic Reviews and Meta-analyses protocols; quality appraisal and thematic synthesis methodology.Data sourcesSeven electronic databases (PubMed, CINAHL, Embase, Scopus, Web of Science, PsycINFO, PsycARTICLES) were exhaustively searched from inception through March 2019. Two reviewers screened paper titles, abstracts and full texts. We included only peer-reviewed journal articles p...
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Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes... more
Policy makers and health care payers are concerned about the costs of treating terminal patients. This study was done to measure the costs of treating terminal patients during the final month of life in a sample of Belgian nursing homes from the health care payer perspective. Also, this study compares the costs of palliative care with those of usual care. This multicenter, retrospective cohort study enrolled terminal patients from a representative sample of nursing homes. Health care costs included fixed nursing home costs, medical fees, pharmacy charges, other charges, and eventual hospitalization costs. Data sources consisted of accountancy and invoice data. The analysis calculated costs per patient during the final month of life at 2007/2008 prices. Nineteen nursing homes participated in the study, generating a total of 181 patients. Total mean nursing home costs amounted to 3,243 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; per patient during the final month of life. Total mean nursing home costs per patient of 3,822 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; for patients receiving usual care were higher than costs of 2,456 &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;euro&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; for patients receiving palliative care (p = 0.068). Higher costs of usual care were driven by higher hospitalization costs (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). This study suggests that palliative care models in nursing homes need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients.
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Due to the ageing of the European population, the burden of non-acute dying on society is expected to increase. The aim of this study is to estimate the number of persons dying of cancer and chronic disease in Europe, including regional... more
Due to the ageing of the European population, the burden of non-acute dying on society is expected to increase. The aim of this study is to estimate the number of persons dying of cancer and chronic disease in Europe, including regional differences. Death certificates of deceased persons in the European Union (EU)-27 countries in 2007 (some countries 2006 or 2004) were analysed and primary death causes were listed. These data were prepared for the general population and for the population of 65 years and older. Crude death rates (CDRs) were calculated for both groups and for all included countries. Of 480 million deceased European people, 202 million died of cancer and chronic disease in 2007 (42%). The CDR of the EU-27 countries was 409 (95% CI 370 to 451) for cancer and other chronic diseases per 100 000 inhabitants in 2007. For the 65+ population, the CDR for the EU-27 was 1783 (95% CI 1701 to 1868) for cancer and chronic disease. Large differences across countries appeared. An inverse relationship was shown for country-specific CDRs for cancer and chronic disease versus CDRs for other death causes (R=-0.41; p=0.04). Dying of cancer and chronic diseases involves a considerable burden on the European society. Future research should relate this information to the prevalence of symptoms and the use of palliative care services. European policy makers should take into account regional variations in developing long- and short-term palliative care strategies.
Research Interests: Palliative Care, European Union, Medicine, Humans, Europe, and 9 moreChronic Disease, Female, Male, Aged, Prevalence, Neoplasms, BMJ, Cost of Illness, and Cause of death
Background: Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the... more
Background: Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. Aim: To develop and validate a set of structure and process indicators for palliative care settings in Europe. Design: A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators. Setting/participants: In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries. Results: In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality i...
Research Interests: Education, Documentation, Palliative Care, Quality of Mental Health Care, Medicine, and 13 morePalliative Medicine, Safety, Humans, Europe, Delphi, Patient Care Team, Public health systems and services research, Delphi method, Delphi Technique, Health Services Accessibility, Symptom assessment, quality assurance in health care, and Quality of health care
Background According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how... more
Background According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. Methods In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the i...
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Background According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how... more
Background According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. Methods In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the i...
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Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study... more
Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory sympto...
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Introduction Tumor-related epilepsy may respond to chemotherapy. In a previously-published multi-centre randomized clinical trial of 562 elderly glioblastoma patients, temozolomide plus short-course radiotherapy conferred a survival... more
Introduction Tumor-related epilepsy may respond to chemotherapy. In a previously-published multi-centre randomized clinical trial of 562 elderly glioblastoma patients, temozolomide plus short-course radiotherapy conferred a survival benefit over radiotherapy alone. Seizure outcomes were not reported. Methods We performed an unplanned secondary analysis of this trial’s data. The trial design has been previously reported. Seizures were recorded by clinicians as adverse events and by patients in quality of life questionnaires. A Chi-square test of seizure rates between the two groups (α = 0.05) and a Kaplan–Meier estimator of time-to-first self-reported seizure were planned. Results Almost all patients were followed until they died. In the radiotherapy alone group, 68 patients (24%) had a documented or self-reported seizure versus 83 patients (30%) in the temozolomide plus radiotherapy group, Chi-square analysis showed no difference (p = 0.15). Patients receiving radiotherapy alone ten...
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Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. This review aims to give an overview on what hospitalists... more
Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations. A systematic synthesis of the qualitative literature was conducted. A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken. Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that dec...
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In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are... more
In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are physicians, nurses, social workers, and psychologists. First, this study wants to understand what the characteristics are of ACP in hospital, according to professionals. Second, this study aims to give an insight in the experienced value of ACP. Third, the experienced barriers to have ACP conversations are explored. Twenty-four interviews were taken and analyzed with Content Analysis based on Grounded Theory. Three independent external auditors surveilled the analysis. ACP in hospital exists by the grace of the initiative of the actors involved in the case. Professionals perceive fields of tension between one another; barriers to ACP communication. ACP is mainly considered valuable because it is a process that creates time for exploration and reflection.
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There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of... more
There is a notable inequity in access to palliative care (PC) services between cancer and Chronic Heart Failure (CHF)/Chronic Obstructive Pulmonary Disease (COPD) patients which also translates into discrepancies in the level of integration of PC. By cross-examining the levels of PC integration in published guidelines/pathways for CHF/COPD and cancer in Europe, this study examines whether these discrepancies may be attributed to the content of the guidelines. A quantitative evaluation was made between integrated PC in published guidelines for cancer and CHF/COPD in Europe. The content of integrated PC in guidelines/pathways was measured using an 11 point integrated PC criteria tool (IPC criteria). A statistical analysis was carried out to detect similarities and differences in the level of integrated PC between the two groups. The levels of integration between CHF/COPD and cancer guidelines/pathways have been shown to be statistically similar. Moreover, the quality of evidence utili...
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Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of... more
Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative ...
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Family carers manage a wide range of responsibilities in the lives and care of patients receiving palliative care. They fulfil multiple roles and perform activities within different settings. This has immediate consequences on family... more
Family carers manage a wide range of responsibilities in the lives and care of patients receiving palliative care. They fulfil multiple roles and perform activities within different settings. This has immediate consequences on family carers' every-day lives. According to literature, family carers in palliative care are both part of the formal and informal care network, but also persons in need of support. This article aims to investigate 1) burdens and rewards associated with family caregiving and 2) what family carers find helpful in their contact with professionals from integrated palliative care initiatives (IPC-i) and other services. Family carers looking after patients with cancer, chronic obstructive pulmonary disease or chronic heart failure were purposefully recruited at 22 IPC-i in Belgium, Germany, Hungary, the Netherlands and the United Kingdom in the course of the project "Patient-centred palliative care pathways in advanced cancer and chronic disease" (InS...
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Background Glioblastoma is associated with a poor prognosis in the elderly. Survival has been shown to increase among patients 70 years of age or younger when temozolomide chemotherapy is added to standard radiotherapy (60 Gy over a... more
Background Glioblastoma is associated with a poor prognosis in the elderly. Survival has been shown to increase among patients 70 years of age or younger when temozolomide chemotherapy is added to standard radiotherapy (60 Gy over a period of 6 weeks). In elderly patients, more convenient shorter courses of radiotherapy are commonly used, but the benefit of adding temozolomide to a shorter course of radiotherapy is unknown. Methods We conducted a trial involving patients 65 years of age or older with newly diagnosed glioblastoma. Patients were randomly assigned to receive either radiotherapy alone (40 Gy in 15 fractions) or radiotherapy with concomitant and adjuvant temozolomide. Results A total of 562 patients underwent randomization, 281 to each group. The median age was 73 years (range, 65 to 90). The median overall survival was longer with radiotherapy plus temozolomide than with radiotherapy alone (9.3 months vs. 7.6 months; hazard ratio for death, 0.67; 95% confidence interval...
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Overall survival (OS) of patients with diffuse intrinsic pontine glioma (DIPG) is poor. The purpose of this study is to analyse benefit and toxicity of re-irradiation at first progression. At first progression, 31 children with DIPG, aged... more
Overall survival (OS) of patients with diffuse intrinsic pontine glioma (DIPG) is poor. The purpose of this study is to analyse benefit and toxicity of re-irradiation at first progression. At first progression, 31 children with DIPG, aged 2-16 years, underwent re-irradiation (dose 19.8-30.0 Gy) alone (n = 16) or combined with systemic therapy (n = 15). At initial presentation, all patients had typical symptoms and characteristic MRI features of DIPG, or biopsy-proven high-grade glioma. An interval of ≥3 months after upfront radiotherapy was required before re-irradiation. Thirty-nine patients fulfilling the same criteria receiving radiotherapy at diagnosis, followed by best supportive care (n = 20) or systemic therapy (n = 19) at progression but no re-irradiation, were eligible for a matched-cohort analysis. Median OS for patients undergoing re-irradiation was 13.7 months. For a similar median progression-free survival after upfront radiotherapy (8.2 versus 7.7 months; P = .58), a s...
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Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving... more
Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care (PC) services. The purpose of this study is to identify literature on IPC in the Spanish context, either in cancer or other advanced chronic diseases. Systematic review of the literature about IPC published in Spain between 1995 and 2013. Sources searched included PubMed, Cochrane Library, Cinahl, the national palliative care Journal (Medicina Paliativa), and Google. Evidence on IPC in care models, pathways, guidelines and other relevant documents were searched. Additionally, data were included from expert sources. Elements of IPC were considered based on the definition of IPC and the Emmanuel´s IPC tool. The main inclusion criterion was a comprehensive description of PC integration. Out of a total of 2,416 titles screened, 49 were included....
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Complete resection of a locally advanced oesophageal carcinoma is not always feasible when invading mediastinal structures. The use of induction therapy prior to surgical exploration in patients with these clinical T4 tumours is... more
Complete resection of a locally advanced oesophageal carcinoma is not always feasible when invading mediastinal structures. The use of induction therapy prior to surgical exploration in patients with these clinical T4 tumours is anticipated to improve the resectability rate. Patients, 18, who presented with a carcinoma of the thoracic oesophagus with clinical invasion into the carina (n = 6), trachea (n = 5), aorta (n = 4), lung (n = 2) and diaphragm (n = 1) were treated with concurrent chemotherapy and radiotherapy followed by surgical exploration. Follow-up was complete (mean of 17 +/- 3 months in all patients and 27 +/- 2 months in surviving patients). All patients completed the induction therapy with acceptable toxicity and no mortality. Subjective improvement in dysphagia was substantial in 11 patients (in 8/11 patients (73%) however, there was still viable tumour in the resected specimen), it was minimal in six patients and absent in one patient. Objective response on imaging was complete in one patient, partial in eight patients and minimal in nine patients [in two of these nine patients (22%) nevertheless, the primary tumour had disappeared completely in the resected specimen (pT0)]. Resection was complete (R0) in 14 patients (78%) and incomplete (R1) in one patient (5%). Resection of the primary tumour was impossible (R2) in three patients (17%) because of macroscopic airway (n = 2) and hilar (n = 1) invasion on exploration. In these three patients the tumour was bypassed using a retrosternal split stomach. One patient was proven at the time of surgery to have a previously unidentified lung metastasis. In three patients (17%), no residual tumour cells were found in the resected oesophagus nor in the lymph nodes (pT0N0M0). There have been no in-hospital deaths. Actuarial 3 year survival was 43% in all patients, 55% in completely resected patients and 100% in sterilized patients (pT0N0M0). Median survival was 18 months in all patients. Chemo/radiotherapy followed by surgery in patients with a clinical T4 oesophageal carcinoma is feasible with acceptable toxicity and no treatment-related mortality. Operability and resectability rate were high (100 and 83%, respectively) compared with historical controls. The primary tumour disappeared completely (pT0N0-1M0-1) in 28%. Tumour sterilization rate was 17%. Survival looks promising compared with historical controls. Subjective neither objective response following induction therapy clearly correlated with the final pTNM staging. This indicates that, in the absence of tumour progression, neither the patient nor the treating physician should jeopardize the chance for ultimate cure by denying surgical exploration following induction therapy.
Research Interests: Humans, Female, Feasibility Studies, Male, Sterilization, and 14 moreEuropean, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Neoplasm Invasiveness, Esophagus, Survival Rate, Lymph Node, Thoracic Surgery, Adenocarcinoma, Case Control Studies, Combined Modality Therapy, esophagectomy, Neoplasm staging, and Cardiovascular medicine and haematology
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LBA2 Background: The EORTC (26981-22981)/NCIC CTG (CE.3) RCT in newly diagnosed glioblastoma (GB) showed increased overall survival (OS) with concomitant and adjuvant temozolomide (TMZ) added to radiotherapy (RT). Pts were 18-71 (median... more
LBA2 Background: The EORTC (26981-22981)/NCIC CTG (CE.3) RCT in newly diagnosed glioblastoma (GB) showed increased overall survival (OS) with concomitant and adjuvant temozolomide (TMZ) added to radiotherapy (RT). Pts were 18-71 (median 56) years; however, a trend of decreasing benefit from the addition of TMZ with increasing age was noted. Recent RCTs in elderly GB detected non-inferiority of 40 Gy/15 v 60 Gy/30 RT and superior survival was noted for MGMT-methylated pts treated with TMZ alone. However, whether the addition of TMZ to RT improves survival in elderly pts remained unanswered. Methods: We conducted a global randomized phase III clinical trial for patients ≥ 65 yrs with histologically confirmed newly diagnosed GB, ECOG 0-2, randomized 1:1 to receive 40Gy/15 RT v 40Gy/15 RT with 3 weeks of concomitant TMZ plus monthly adjuvant TMZ until progression or 12 cycles. Stratification was by centre, age (65-70, 71-75, or 76+), ECOG 0,1 vs 2, and biopsy vs resection. Results: 562 pts were randomized, 281 on each arm; median age 73 yrs (range 65-90), male 61%, PS 0/1 77%, resection 68%. RT+TMZ significantly improved OS over RT alone (median 9.3m v 7.6m, HR 0.67, 95%CI 0.56-0.80, p &amp;amp;amp;lt; 0.0001) and significantly improved PFS (median 5.3m v 3.9m, HR 0.50, 95%CI 0.41 – 0.60, p &amp;amp;amp;lt; 0.0001). Tissue from 462 pts was provided and adequate for MGMT analysis in 354 to date. In MGMT methylated patients (n = 165) OS for RT+TMZ v RT was 13.5 m and 7.7m respectively (HR: 0.53 (95% C.I. 0.38, 0.73, p = 0.0001). In MGMT unmethylated patients (n = 189) OS for RT + TMZ v RT was 10.0m vs 7.9m respectively (HR 0.75 (95% C.I. 0.56 – 1.01, p = 0.055). QoL analyses showed no differences in functional domains of QLQC30 and BN20 but were worse in the RT/TMZ arm for nausea, vomiting, and constipation. Systemic therapy after PD was reported in 39% on RT+TMZ v 41% on RT. Conclusions: The addition of concomitant and adjuvant TMZ to hypofractionated RT for elderly pts with GB significantly improves OS and PFS in all patients and is well tolerated. Patients with MGMT methylated tumors benefit the most from the addition of TMZ to RT where median OS is nearly doubled. Clinical trial information: NCT00482677.
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Pain is a prevalent condition in patients with cancer, particularly in advanced stages of cancer. Although strong opioids are the mainstay of cancer pain management protocols, patients are often undertreated. Transdermal buprenorphine is... more
Pain is a prevalent condition in patients with cancer, particularly in advanced stages of cancer. Although strong opioids are the mainstay of cancer pain management protocols, patients are often undertreated. Transdermal buprenorphine is currently available for the treatment of moderate to severe cancer pain and severe pain which does not respond to nonopioid analgesics; patch doses of 35, 52.5 and 70 µg/h are available (applied for up to 96 h), with no more than 2 transdermal patches at the same time, regardless of the strength. To date, there are no published reports in the literature of the use of high-dose transdermal buprenorphine (>140 µg/h). Herein, we present 2 cases of palliative cancer patients who received transdermal buprenorphine at doses titrated up to 210 and 175 µg/h, respectively, for the management of pain. Transdermal buprenorphine titrated to doses >140 µg/h provided adequate pain control and was well tolerated. Future studies to confirm these initial obser...
We review the sensitivity of different diagnostic tests for breast cancer management based on recent experience in a 34-year-old patient. False-negative tests at diagnosis of early disease and of relapse resulted in diagnostic and... more
We review the sensitivity of different diagnostic tests for breast cancer management based on recent experience in a 34-year-old patient. False-negative tests at diagnosis of early disease and of relapse resulted in diagnostic and therapeutic delays. Initial mammography and breast ultrasonography were falsely negative despite a palpable breast lump. Clinical examination and axillary ultrasound missed macroscopically involved lymph nodes. At relapse, metastatic lesions were missed despite symptoms, three years after primary treatment. CA 15-3 was normal; bone and liver metastases were missed by standard and more advanced imaging techniques including liver ultrasonography, nuclear bone scan and PET -CT scan. Worsening of clinical symptoms, lab results and abnormal tissue biopsies finally led to the diagnosis of extensive metastatic disease. Genetic screening showed an abnormality within the BRCA-1 region of unknown clinical importance. This review highlights 1) that diagnostic te...
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ABSTRACT Essentieel in de palliatieve zorg is het streven naar een zo goed mogelijke kwaliteit van leven voor iedere patiënt met een terminale ziekte en zijn familie. Om dit te realiseren is het belangrijk dat de voor de patiënt meest... more
ABSTRACT Essentieel in de palliatieve zorg is het streven naar een zo goed mogelijke kwaliteit van leven voor iedere patiënt met een terminale ziekte en zijn familie. Om dit te realiseren is het belangrijk dat de voor de patiënt meest hinderlijke fysieke, psychische, psychosociale en spirituele problemen zo veel mogelijk worden verlicht.
Despite guidelines and recommendations, a large proportion of patients with cancer still have inadequate pain control. Transdermal opioid administration can overcome problems such as swallowing and compliance, because only one application... more
Despite guidelines and recommendations, a large proportion of patients with cancer still have inadequate pain control. Transdermal opioid administration can overcome problems such as swallowing and compliance, because only one application every three days is needed. Transdermal buprenorphine was documented to provide effective pain relief in cancer and non-cancer patients. A ceiling effect was described in animals at supratherapeutic dose levels. This prospective observational pilot study was designed to explore the need for doses of transdermal buprenorphine beyond the recommended maximum dose of 140 microg/h, in a cohort of palliative patients with cancer pain. 36 consecutive palliative patients with uncontrolled cancer pain were prescribed transdermal buprenorphine after having received adequate information on the disease, its evolution, the pain and the drug. They gave written informed consent for participation in this observational study. Pain intensity and use of breakthrough medication were registered by the patient and the health care provider. Pain was judged to be satisfactory controlled, by the patient and the health care providers, in 21 of 28 evaluable patients at a dose lower than or equal to 140 microg/h. The success rate was higher in the hospitalized patient group. The observation of adequate pain control in two patients treated with doses up to 210 microg/h supports the hypothesis that buprenorphine dose titration above 140 microg/h can be clinically effective and well tolerated. This also refutes the assumption of a clinically relevant ceiling effect. Transdermal buprenorphine control cancer pain in the majority of palliative patients.
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Research Interests: Radiotherapy, STEROIDS, Prospective studies, Humans, Glioblastoma, and 15 moreFemale, Feasibility Studies, Male, Follow-up studies, Nausea, Middle Aged, Time Factors, Survival Rate, Glioblastoma Multiforme, Prognosis, X ray Computed Tomography, Vomiting, Prospective Study, Brain Neoplasms, and Neurologic Examination
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Background: The Delirium Observation Screening Scale (DOS) is designed to detect delirium by nurses’ observations and has shown good psychometric properties. Its use in palliative care unit patients has not been studied. Aim: To determine... more
Background: The Delirium Observation Screening Scale (DOS) is designed to detect delirium by nurses’ observations and has shown good psychometric properties. Its use in palliative care unit patients has not been studied. Aim: To determine diagnostic and concurrent validity, internal consistency, and user-friendliness of the Delirium Observation Screening Scale administered by bedside nurses in palliative care unit patients. Design: In this descriptive study, psychometric properties of the Delirium Observation Screening Scale were tested by comparing the performance on the Delirium Observation Screening Scale (bedside nurses) to the algorithm of the Confusion Assessment Method and the Delirium Index (DI) (researchers). Paired observations were collected on three time points. Afterward, the user-friendliness of the Delirium Observation Screening Scale was determined by bedside nurses using a questionnaire. Setting/participants: In total, 48 patients were recruited from one palliative ...
Research Interests: Algorithms, Psychometrics, Palliative Care, Social Class, Palliative Medicine, and 15 moreDelirium, Observation, Prospective studies, Humans, Chronic Disease, Female, Male, Aged, Questionnaires, Public health systems and services research, Neoplasms, Reproducibility of Results, Case Control Studies, mass Screening, and hospital units
The authors investigated the results of PCV chemotherapy within a cohort of 24 patients treated within the EORTC study 26971 on temozolomide chemotherapy in recurrent oligodendroglioma. The genotype of the tumors was assessed with... more
The authors investigated the results of PCV chemotherapy within a cohort of 24 patients treated within the EORTC study 26971 on temozolomide chemotherapy in recurrent oligodendroglioma. The genotype of the tumors was assessed with fluorescent in situ hybridization with locus specific probes for the region 1p36. Four of the 24 patients responded (17%). Fifty percent of patients were still free from progression at 6 months and 21% were free from progression at 12 months. Although a clear relation existed between loss of 1p and response to temozolomide chemotherapy, this relation was absent in salvage PCV chemotherapy.
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✓ This paper presents a rare case of intradural chordoma which involved the pons but had no radiological or surgical evidence of bone involvement. The appearance of this tumor on nuclear magnetic resonance imaging is presented.
Research Interests: Neurosurgery, Magnetic Resonance Imaging, Nuclear Magnetic Resonance, Magnetic Resonance Spectroscopy, Case Report, and 14 moreHumans, Female, Male, Clinical Sciences, Middle Aged, Neoplasm Invasiveness, Adult, Chordoma, X ray Computed Tomography, Laminectomy, Neurosciences, Brain Neoplasms, Reoperation, and Dura mater
Research Interests: Clinical Trial, Belgium, Multivariate Analysis, Humans, Glioblastoma, and 15 moreFemale, Male, Aged, Middle Aged, Adult, Survival Rate, Adverse Event, Glioblastoma Multiforme, Retrospective Studies, Retrospective Study, Overall Survival, Neurosciences, Brain Neoplasms, Low Grade Glioma, and Progression Free Survival
Delivery rates and plasma concentrations vary among patients treated with fentanyl patches. Absorption and urinary excretion characteristics of fentanyl were studied in patients undergoing palliative care. Almost 500 patches were analyzed... more
Delivery rates and plasma concentrations vary among patients treated with fentanyl patches. Absorption and urinary excretion characteristics of fentanyl were studied in patients undergoing palliative care. Almost 500 patches were analyzed for residual fentanyl content. Fentanyl and norfentanyl levels were determined in the urine of 50 patients. General and mixed effects linear regression models were established for the relationship between fentanyl dose rate and urinary excretion and to incorporate influencing factors. For different patch nominal dose strengths, wide but comparable variability in estimated dose rate and delivery efficiency was observed (coefficients of variation of 15% to 17%). Fentanyl delivery efficiency was 8.5% higher for patches of 25 microg/h as compared to 75 microg/h and, accordingly, 7.5% for patch application on the arm as compared to the leg. Urinary fentanyl and norfentanyl concentrations varied considerably. The general linear model revealed a positive effect of the calculated transdermal dose rate on urinary fentanyl levels, explaining 34% of the variability (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). In addition, gender (P = .04) and type of cancer pathology (P = .03) exerted significant effects on the linear model, explaining 40% and 64% of the variability, respectively. Delivery efficiency of fentanyl patches can vary substantially, possibly leading to either underdosing or overdosing.
Research Interests: Pain, Palliative Care, Clinical Pharmacology, Linear Model, Humans, and 15 moreMixed Effects Models, Chronic Disease, Female, Male, Coefficient of Variation, Dose rate, Aged, Middle Aged, Adult, Neoplasms, General Linear Model, Linear Regression Model, Drug Carriers, Fentanyl, and Pharmacology and pharmaceutical sciences
Purpose: Oligodendroglial tumors are chemotherapy-sensitive tumors, with two thirds of patients responding to combination chemotherapy with procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ), a new alkylating and... more
Purpose: Oligodendroglial tumors are chemotherapy-sensitive tumors, with two thirds of patients responding to combination chemotherapy with procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ), a new alkylating and methylating agent, has demonstrated high response rates in patients with recurrent anaplastic astrocytoma. We investigated TMZ as first-line chemotherapy in recurrent oligodendroglial tumors (OD) and mixed oligoastrocytomas (OA) after surgery and radiation therapy. Patients and Methods: In a prospective, nonrandomized, multicenter, phase II trial, patients were treated with 200 mg/m2 of TMZ on days 1 through 5 in 28-day cycles for 12 cycles. Patients with a recurrence after prior surgery and radiotherapy, and with measurable and enhancing disease on magnetic resonance imaging (MRI) were eligible for this study. Patients with large lesions and mass effect or with new clinical deficits were not eligible. Pathology and the MRI scans of all responding patients w...
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An 18-yr-old boy presented with extreme back pain as the result of multiple vertebral fractures. At age 16 he had developed a tumor of the mesencephalon. A ventriculoperitoneal shunt was established surgically. One year later, he... more
An 18-yr-old boy presented with extreme back pain as the result of multiple vertebral fractures. At age 16 he had developed a tumor of the mesencephalon. A ventriculoperitoneal shunt was established surgically. One year later, he developed progressive neurologic deficits in his upper and lower limbs with an increase in the size of the tumor. He was treated by irradiation and high doses of glucocorticoids. Although the neurologic deficits progressively improved, he developed severe back pain resulting in complete immobilization for 3 mo in spite of neurologic recovery. Multiple vertebral fractures were diagnosed by X-ray. Bone density was extremely low (Z-score of -5.5 in the spine and -3.1 in the femoral neck). The patient was treated with calcium and vitamin D, calcitonin, bisphosphonates, physiotherapy, and progressive mobilization. Glucocorticoids were decreased and could be stopped as the neurologic deficits fully recovered. After 1 yr of treatment with intermittent i.v. pamidronate, bone density had increased by 40% in the spine and by 25% in the femoral neck despite growth arrest. He progressively recovered from back pain and is now, at age 20, fully ambulant, studying mechanical engineering, without neurologic sequelaes and free of glucocorticoids. Magnetic resonance imaging revealed that the tumor had disappeared. This case proves that treatment of symptomatic glucocorticoid-induced osteoporosis during puberty can be rewarding, even when multiple and invalidating vertebral fractures already exist.
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Research Interests: Carbon Dioxide, Cell Division, Humans, Glioma, Female, and 15 moreClinical, Feasibility Studies, Clinical oncology, Laryngeal Cancer, Clinical Sciences, Aged, Great Britain, Carcinoma, Adult, Fractionation, Chi Square Distribution, Laryngectomy, Brain Neoplasms, Combined Modality Therapy, and Disease Free Survival
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Research Interests: Adolescent, Positron Emission Tomography, Humans, Child, Dynamic Analysis, and 15 moreGlioma, PET imaging, Female, Male, Clinical Sciences, Adult, Methionine, Retrospective Studies, Clinical Study, Reproducibility of Results, Radiopharmaceuticals, Retrospective Study, Brain Neoplasms, Brain Tumour, and Neoplasm staging
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Many head and neck cancer (HNC) patients experience painful therapy-related mucositis and dermatitis. This prospective observational study evaluated transdermal buprenorphine use in HNC patients to relieve treatment-related pain. During... more
Many head and neck cancer (HNC) patients experience painful therapy-related mucositis and dermatitis. This prospective observational study evaluated transdermal buprenorphine use in HNC patients to relieve treatment-related pain. During treatment with paracetamol or tramadol, visual analogue scale (VAS)-pain scores &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30/100 occurred in 26/45 patients 4 weeks after starting cancer therapy, persisting for ≥2 weeks after treatment. These patients subsequently received transdermal buprenorphine. Pain therapy should be more accurately up-titrated to the maximum recommended dose (140 μg/hr) where necessary to maintain pain scores ≤30/100 and, for some patients, should be continued for 6 weeks after the last cancer treatment day.
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Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of... more
Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative ...
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Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of... more
Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative ...
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Background: Surgical exploration in mediastinoscopy proven N2 non-small cell lung cancer (NSCLC) is unrewarding. Theoretical concepts suggest a beneficial role for preoperative induction treatment. The solidity of the therapeutic results... more
Background: Surgical exploration in mediastinoscopy proven N2 non-small cell lung cancer (NSCLC) is unrewarding. Theoretical concepts suggest a beneficial role for preoperative induction treatment. The solidity of the therapeutic results with this approach in the currently available data is examined. Methods: Literature on induction therapy followed by surgical exploration, consisting of randomized reports and phase II reports meeting some essential
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BACKGROUND AND PURPOSE: Pseudoprogression is a frequent phenomenon observed since the introduction of postoperative therapy with radiotherapy and temozolomide (RT/TMZ) in glioblastoma multiforme (GBM) patients. However, the criteria... more
BACKGROUND AND PURPOSE: Pseudoprogression is a frequent phenomenon observed since the introduction of postoperative therapy with radiotherapy and temozolomide (RT/TMZ) in glioblastoma multiforme (GBM) patients. However, the criteria defining pseudoprogression, its incidence, the time of occurrence and its impact on therapy and outcome remain poorly defined. METHODS: The objective of this study is to compare two sets of criteria (liberal and stringent), defining pseudoprogression, in a cohort of patients treated before and after the introduction of RT/TMZ in the standard postoperative treatment. This retrospective review includes 136 unselected and consecutively treated patients with pathologically diagnosed GBM. RESULTS: Pseudoprogression was observed in 10 (12%) cases applying the stringent criteria, and in 18 (23%) patients when using the liberal criteria, in the cohort treated with RT/TMZ. Pseudoprogression was observed in only one patient treated with RT alone. The median time t...
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(1) To assess the interobserver variability of brain tumor delineation on computed tomography (CT). (2) To assess the impact of the addition of magnetic resonance imaging (MRI) information. Nine physicians were asked to delineate the... more
(1) To assess the interobserver variability of brain tumor delineation on computed tomography (CT). (2) To assess the impact of the addition of magnetic resonance imaging (MRI) information. Nine physicians were asked to delineate the gross tumor volume (GTV) of five patients with supratentorial inoperable brain tumors on CT scans and 2 weeks (or more) later on MRIs. The delineations were performed on a computer screen. During delineation on MRI, the registered CT images (without delineation) were displayed on the screen (MRI+CT). A high interobserver variability in GTV delineation on CT is found: the ratio of the largest to the smallest defined volumes varies for the five patients by factors of resp. 2.8, 1.8, 1.8, 1.9 and 1.7. The interobserver variability is as large on MRI+CT as on CT alone (ratio largest/smallest volume: 2.4, 1.7, 1.9, 2.7 and 1.5). Volumes delineated on MRI+CT (mean: 69.6 cm(3)) are larger than on CT alone (mean: 59.5 cm(3)). Residual volumes (volume delineated on one image modality but not on the other) are &gt;0 for CT alone and for MRI+CT. A large interobserver variability in GTV delineation of brain tumors is demonstrated. The addition of MRI to CT does not reduce interobserver variability. GTVs delineated on MRI+CT are larger than on CT alone, but some volumes are delineated on CT and not on MRI. Therefore, a combination of the two image modalities is recommended for brain tumor delineation for treatment planning.
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Research Interests: Pain, Depression, Palliative Care, Quality of life, Treatment Outcome, and 18 moreEuthanasia, Fatigue, Comorbidity, Belgium, Humans, Female, Male, Life Expectancy, Risk factors, Empirical Study, Aged, Prevalence, Middle Aged, Longitudinal Studies, Longitudinal Study, Survival Rate, Risk Factors, and Terminal care
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... Claessens, Patricia RN, MSN; Genbrugge, Ellen RN; Vannuffelen, Rita RN; Broeckaert, Bert PhD; Schotsmans, Paul PhD; Menten, Johan MD, PhD. ... Johan Menten, MD, PhD, is the Head of the Palliative Care Unit, University Hospitals... more
... Claessens, Patricia RN, MSN; Genbrugge, Ellen RN; Vannuffelen, Rita RN; Broeckaert, Bert PhD; Schotsmans, Paul PhD; Menten, Johan MD, PhD. ... Johan Menten, MD, PhD, is the Head of the Palliative Care Unit, University Hospitals Leuven, Belgium. ...
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Research Interests: Radiation Therapy, Adolescent, Multivariate Analysis, Prospective studies, Humans, and 18 moreLow Dose, Glioma, Female, Male, Follow-up studies, Randomized Trial, Data Center, Clinical Sciences, Middle Aged, Dose Response Relationship, Adult, Prognosis, Astrocytoma, Prospective Study, Brain Neoplasms, Low Grade Glioma, Progression Free Survival, and Oligodendroglioma
18F-fluorodeoxyglucose (FDG) and 11C-methionine (MET) PET imaging studies allow the investigation of metabolism and amino acid transport in brain tumours. Their (relative) usefulness and prognostic value in suspected recurrence or... more
18F-fluorodeoxyglucose (FDG) and 11C-methionine (MET) PET imaging studies allow the investigation of metabolism and amino acid transport in brain tumours. Their (relative) usefulness and prognostic value in suspected recurrence or progression of primary brain tumours after previous therapy is an issue of debate. The aim of this study was to compare directly both radioligands in this setting. Cerebral uptake of FDG and MET was determined sequentially on the same day in 30 patients (21 males, nine females; age 40.4+/-15.6 years), on average 4.0 years (range 0.1-18) after therapy for a primary brain tumour (23 grade II-IV astrocytomas, four oligodendrogliomas and three mixed oligo-astrocytomas). Images were acquired on a Siemens HR+ dedicated PET camera. Two observers scored FDG and MET scans independently. Semi-quantitative indices defined by the tumour (maximum)-to-background ratio were calculated based on manual ROI delineation and by using MET ROIs for FDG after automated co-registration. Patient follow-up was conducted until the last contact with inconspicuous clinical findings (average 41 months, range 12-62 months after PET) [(n=10)] or until death (n=20). Overall median survival was 15.0 months. MET showed pathologically increased uptake in 28/30 scans, and FDG in 17/30. The inter-observer agreement was 100% for MET and 73% for FDG. Using Kaplan-Meier survival analysis, significant differences were found for both FDG (cut-off 0.8, log-rank p=0.007) and MET (cut-off 2.2, log-rank p=0.014). The combination of FDG and MET information resulted in the highest prognostic accuracy (p=0.003), while MET alone was the best prognostic predictor in the subgroup of patients with primary astrocytoma (n=23). FDG and MET PET studies provide complementary prognostic information in patients with suspected brain tumour recurrence or progression after primary therapy. MET is considered the single agent of choice in the evaluation of these patients because of its sensitivity and clearer delineation of the suspected recurrence.
Research Interests: Survival Analysis, Risk assessment, Adolescent, Positron Emission Tomography, Belgium, and 25 moreHumans, Child, Glioma, PET imaging, Female, Male, Risk factors, Clinical Sciences, European, Aged, Prevalence, Middle Aged, Kaplan-Meier, Observer Variation, Adult, Methionine, Retrospective Studies, Prognosis, Reproducibility of Results, Risk Factors, Risk Assessment, Radiopharmaceuticals, Sensitivity and Specificity, Brain Neoplasms, and Brain Tumour
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Dose-dense temozolomide schedules deplete O6-methylguanine methyltransferase and may overcome chemoresistance. This multicenter cohort study enrolled 19 patients (15 anaplastic astrocytoma, 4 anaplastic oligoastrocytoma) who received... more
Dose-dense temozolomide schedules deplete O6-methylguanine methyltransferase and may overcome chemoresistance. This multicenter cohort study enrolled 19 patients (15 anaplastic astrocytoma, 4 anaplastic oligoastrocytoma) who received temozolomide (100 mg/m2/day for 21 consecutive days every 28-day cycle) at first recurrence, either until disease progression or 12 cycles. Six-month progression-free survival was 56%, comparing favorably with historic controls treated with the standard 5-day temozolomide schedule. Median survival was 12.9 months (95% CI: 3.7, 22 months). Among 15 evaluable patients, 2 had a complete or partial response, and 10 had stable disease. Grade 3 and 4 lymphopenia occurred in 53% and 47% of patients, respectively.
Research Interests: Survival Analysis, Humans, Female, Male, Cohort Study, and 6 moreAged, Middle Aged, Adult, Astrocytoma, Brain Neoplasms, and Cohort Studies
Research Interests: Immunology, Quality of life, Treatment Outcome, Adolescent, Dendritic Cells, and 29 moreCancer Vaccines, Brain Tumor, Neuro-Oncology, Humans, Glioblastoma, Female, Feasibility Studies, Male, DNA methylation, Immunotherapy, Neuro, Young Adult, Dendritic cell, Ischemic Stroke, Aged, Middle Aged, Pilot study, Adult, Survival Rate, Adverse Event, Glioblastoma Multiforme, Chemoradiotherapy, Pilot Projects, Standard of Care, Survival Data Analysis, Overall Survival, Neurosciences, Brain Neoplasms, and Progression Free Survival
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Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS)... more
Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. These aspects are tested in a descriptive, comparative, longitudinal study based on 3 convenience samples. The first consisted of 8 palliative care experts. The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;new-wave&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.