scholarly journals Immunometabolic Status of COVID-19 Cancer Patients

2020 ◽  
Vol 100 (4) ◽  
pp. 1839-1850
Author(s):  
A. Sica ◽  
M. P. Colombo ◽  
A. Trama ◽  
L. Horn ◽  
M. C. Garassino ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Progression ◽  
Macrophage Activation ◽  
Viral Infections ◽  
Immune Cell ◽  
Case Series ◽  
The United States ◽  
Alternative Activation ◽  
Nad Metabolism ◽  
Increased Risk

Cancer patients appear to be more likely to be diagnosed with coronavirus disease 2019 (COVID-19). This is supported by the understanding of immunometabolic pathways that intersect patients with infection and cancer. However, data derived by case series and retrospective studies do not offer a coherent interpretation, since data from China suggest an increased risk of COVID-19, while data from the United States and Italy show a prevalence of COVID-19 in cancer patients comparable with the general population. Noteworthy, cancer and COVID-19 exploit distinct patterns of macrophage activation that promote disease progression in the most severe forms. In particular, the alternative activation of M2-polarized macrophages plays a crucial role in cancer progression. In contrast, the macrophage-activation syndrome appears as the source of M1-related cytokine storm in severe COVID-19 disease, thus indicating macrophages as a source of distinct inflammatory states in the two diseases, nonetheless as a common therapeutic target. New evidence indicates that NAMPT/NAD metabolism can direct both innate immune cell effector functions and the homeostatic robustness, in both cancer and infection. Moreover, a bidirectional relationship exists between the metabolism of NAD and the protective role that angiotensin converting enzyme 2, the COVID-19 receptor, can play against hyperinflammation. Within this immunometabolic framework, the review considers possible interference mechanisms that viral infections and tumors elicit on therapies and provides an overview for the management of patients with cancer affected by COVID-19, particularly for the balance of risk and benefit when planning normally routine cancer treatments and follow-up appointments.

scholarly journals Multiple Myeloma and SARS-CoV-2 Infection: Clinical Characteristics and Prognostic Factors of Inpatient Mortality

2020 ◽  
Author(s):  
Joaquín Martínez-López ◽  
María-Victoria Mateos ◽  
Cristina Encinas ◽  
Anna Sureda ◽  
José Ángel Hernández-Rivas ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factors ◽  
Renal Disease ◽  
Cancer Patients ◽  
Case Series ◽  
Clinical Severity ◽  
Collaborative Group ◽  
List Type ◽  
Inpatient Mortality ◽  
Increased Risk

ABSTRACTThere is limited information on the characteristics, pre-admission prognostic factors, and outcomes of patients with multiple myeloma (MM) hospitalized with coronavirus disease 2019 (COVID-19). This retrospective case series investigated characteristics and outcomes of 167 MM patients hospitalized with COVID-19 reported from 73 hospitals within the Spanish Myeloma Collaborative Group network in Spain between March 1 and April 30, 2020. Outcomes were compared with a randomly selected contemporary cohort of 167 age-/sex-matched non-cancer patients with COVID-19 admitted at 6 participating hospitals. Common demographic, clinical, laboratory, treatment, and outcome variables were collected; specific disease status and treatment data were collected for MM patients. Among the MM and non-cancer patients, median age was 71 years and 57% of patients were male in each series, and 75% and 77% of patients, respectively, had at least one comorbidity. COVID-19 clinical severity was moderate-severe in 77% and 89% of patients and critical in 8% and 4%, respectively. Supplemental oxygen was required by 47% and 55% of MM and non-cancer patients, respectively, and 21%/9% vs 8%/6% required non-invasive/invasive ventilation. Inpatient mortality was 34% and 23% in MM and non-cancer patients, respectively. Among MM patients, inpatient mortality was 41% in males, 42% in patients aged >65 years, 49% in patients with active/progressive MM at hospitalization, and 59% in patients with comorbid renal disease at hospitalization, which were independent prognostic factors of inpatient mortality on adjusted multivariate analysis. This case series demonstrates the increased risk and identifies predictors of inpatient mortality among MM patients hospitalized with COVID-19.Key PointsThere is an increased risk of inpatient mortality (34% vs 23%) in MM vs age-/sex-matched non-cancer patients hospitalized with COVID-19.Adverse prognostic factors at admission for inpatient mortality in MM patients include age >65 y, male sex, renal disease, and active MM.

Propping up the parents: An environmental scan of childcare programs available to cancer patients in North America.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18805-e18805
Author(s):  
Katherine Preston ◽  
Mackenzie MacDonald ◽  
Meredith Elana Giuliani ◽  
Barbara L. Melosky ◽  
Bonnie Leung ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Current Knowledge ◽  
Grey Literature ◽  
The United States ◽  
Care Needs ◽  
Cancer Treatments ◽  
Environmental Scan ◽  
Pediatric Hospitals ◽  
Current State ◽  
Increased Risk

e18805 Background: Approximately 20% of newly diagnosed cancer patients are between the ages of 20 and 54, and many of these patients are also the primary caregivers of children. Qualitative studies focusing on this demographic indicate that patients who are parents struggle to balance their own care needs with those of their children. Further, a lack of childcare support during cancer treatments can negatively impact compliance and increase existing psychological stress for patients. In the efforts to establish a child-minding program at a major Canadian cancer centre, we carried out an environmental scan to evaluate the current state of childcare support for cancer patients. Methods: Firstly, a literature scan was conducted in order to assess current knowledge about childcare and cancer patients, which included the use of search engines, directed internet searches, a review of oncology conference proceedings and websites of oncology associations. Literature was selected based on pre-determined criteria. Secondly, 12 representatives from major Canadian cancer centres (CCC) completed a questionnaire assessing current childcare strategies at their respective institutions. Finally, a broad scan of the grey literature was conducted by investigating 161 Canadian and American hospitals for on-site childcare services, using lay-accessible searching techniques (hand-searching hospital websites, phone and email correspondences). Results: The literature scan identified seventeen primary articles, which focused largely on exploring the role strain faced by patients who are also parents. A single study explored the instrumental challenges of being a parent with cancer, and formally assessed the childcare needs of these patients. The questionnaire results indicated that only two of the twelve investigated CCCs had established an approach to child-minding for patients. The grey literature scan identified twenty-six on-site, patient-accessible child-minding centres at hospitals in Canada and the US based on pre-determined inclusion criteria. Of these, 76.9% of centres were associated with pediatric hospitals, and 69.2% were located in the United States. Most centres (76.9%) were open for over 30 hours per week, and 88.5% of centres were free of charge to users. Conclusions: These findings generally indicate that a minority of Canadian and American hospitals and cancer centres have formal childcare services in place to support patients who are also parents. As cancer patients are at increased risk for financial toxicity, they may be particularly in need of this kind of instrumental support. This highlights the importance of carrying out a targeted needs assessment in order to fully elucidate the need for patient-accessible childcare services at CCCs.

The Combined Percentage of Gleason Patterns 4 and 5 Is the Best Predictor of Cancer Progression After Radical Prostatectomy

2005 ◽  
Vol 23 (13) ◽  
pp. 2911-2917 ◽  
Author(s):  
Liang Cheng ◽  
Michael O. Koch ◽  
Beth E. Juliar ◽  
Joanne K. Daggy ◽  
Richard S. Foster ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Cancer Patients ◽  
Gleason Score ◽  
Cancer Progression ◽  
Tumor Volume ◽  
High Grade ◽  
Cox Regression Analysis ◽  
Total Tumor Volume ◽  
Increased Risk

Purpose Clinical outcome is variable in prostate cancer patients treated with radical prostatectomy. The Gleason histologic grade of prostatic adenocarcinoma is one of the strongest predictors of biologic aggressiveness of prostate cancer. We evaluated the significance of the relative proportion of high-grade cancer (Gleason patterns 4 and/or 5) in predicting cancer progression in prostate cancer patients treated with radical prostatectomy. Patients and Methods Radical prostatectomy specimens from 364 consecutive prostate cancer patients were totally embedded and whole mounted. Various clinical and pathologic characteristics were analyzed. All pathologic data, including Gleason grading variables, were collected prospectively. Results A multiple-factor analysis was performed that included the combined percentage of Gleason patterns 4 and 5, Gleason score, tumor stage, surgical margin status, preoperative prostate-specific antigen (PSA), extraprostatic extension, and total tumor volume. Using Cox regression analysis with bootstrap resampling for predictor selection, we identified the combined percentage of Gleason patterns 4 and 5 (P < .0001) and total tumor volume (P = .009) as significant predictors of PSA recurrence. Conclusion The combined percentage of Gleason patterns 4 and 5 is one of the most powerful predictors of patient outcome, and appears superior to conventional Gleason score in identifying patients at increased risk of disease progression. On the basis of our results, we recommend that the combined percentage of Gleason patterns 4 and 5 be evaluated in radical prostatectomy specimens. The amount of high-grade cancer in a prostatectomy specimen should be taken into account in therapeutic decision making and assessment of patient prognosis.

scholarly journals Microparticles as Biomarkers of Blood Coagulation in Cancer

2015 ◽  
Vol 7 ◽  
pp. BIC.S30347 ◽  
Author(s):  
Shosaku Nomura ◽  
Maiko Niki ◽  
Tohru Nisizawa ◽  
Takeshi Tamaki ◽  
Michiomi Shimizu
Keyword(s):  
Cancer Cells ◽  
Cancer Patients ◽  
Cancer Progression ◽  
Vascular Complications ◽  
Membrane Vesicles ◽  
Cell Types ◽  
Target Cells ◽  
Breast Cancer Patients ◽  
Patient Morbidity ◽  
Increased Risk

Cancer is associated with hypercoagulopathy and increased risk of thrombosis. This negatively influences patient morbidity and mortality. Cancer is also frequently complicated by the development of venous thromboembolism (VTE). Tumor-derived tissue factor (TF)-bearing microparticles (MPs) are associated with VTE events in malignancy. MPs are small membrane vesicles released from many different cell types by exocytic budding of the plasma membrane in response to cellular activation or apoptosis. MPs may also be involved in clinical diseases through expression of procoagulative phospholipids. The detection of TF-expressing MPs in cancer patients may be clinically useful. In lung and breast cancer patients, MPs induce metastasis and angiogenesis and may be indicators of vascular complications. Additionally, MPs in patients with various types of cancer possess adhesion proteins and bind target cells to promoting cancer progression or metastasis. Overexpression of TF by cancer cells is closely associated with tumor progression, and shedding of TF-expressing MPs by cancer cells correlates with the genetic status of cancer. Consequently, TF-expressing MPs represent important markers to consider in the prevention of and therapy for VTE complications in cancer patients.

scholarly journals Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series

2020 ◽  
Author(s):  
Michael C. Spaeder ◽  
Claire Stewart ◽  
Matthew P. Sharron ◽  
Julia R. Noether ◽  
Natalia Martinez-Schlurman ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Medical Condition ◽  
Case Series ◽  
The United States ◽  
Chronic Medical Condition ◽  
Icu Admission ◽  
Increased Risk ◽  
Immunocompromised State ◽  
To Receive ◽  
Viral Respiratory

AbstractViral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States. There were 107 mortality cases included in our study, 73% of which had a chronic medical condition. The most common chronic medical condition was immunocompromised state in 37 cases (35%). The incidences of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were profound. Immunocompetent cases were more likely to receive mechanical ventilation within the first hour of ICU admission (60 vs. 14%, p < 0.001) and extracorporeal membrane oxygenation (27 vs. 5%, p = 0.009), and less likely to receive continuous renal replacement therapy (20 vs. 49%, p = 0.002) or have renal dysfunction (54 vs. 78%, p = 0.014) as compared with immunocompromised cases. Immunocompromised cases were more likely to have bacteremia (57 vs. 16%, p < 0.001) and adenoviremia (51 vs. 17%, p < 0.001) and be treated with antiviral medications (81 vs. 26%, p < 0.001). We observed a high burden of nonrespiratory organ system dysfunction in a cohort of pediatric case fatalities with adenoviral respiratory infection. The majority of cases had a chronic medical condition associated with an increased risk of complications from viral respiratory illness, most notably immunocompromised state. Important treatment differences were noted between immunocompromised and immunocompetent cases.

scholarly journals COVID-19 hospitalizations in five California hospitals: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miriam Nuño ◽  
Yury García ◽  
Ganesh Rajasekar ◽  
Diego Pinheiro ◽  
Alec J. Schmidt
Keyword(s):  
Mortality Rate ◽  
Hospital Admissions ◽  
Large Population ◽  
Case Series ◽  
The United States ◽  
Composite Outcome ◽  
Retrospective Case ◽  
Hospital System ◽  
Icu Admission ◽  
Increased Risk

Abstract Background The novel coronavirus pandemic has had a differential impact on communities of color across the US. The University of California hospital system serves a large population of people who are often underrepresented elsewhere. Data from hospital stays can provide much-needed localized information on risk factors for severe cases and/or death. Methods Patient-level retrospective case series of laboratory-confirmed COVID-19 hospital admissions at five UC hospitals (N = 4730). Odds ratios of ICU admission, death, and a composite of both outcomes were calculated with univariate and multivariate logistic regression based on patient characteristics, including sex, race/ethnicity, and select comorbidities. Associations between comorbidities were quantified and visualized with a correlation network. Results Overall mortality rate was 7.0% (329/4,730). ICU mortality rate was 18.8% (225/1,194). The rate of the composite outcome (ICU admission and/or death) was 27.4% (1298/4730). Comorbidity-controlled odds of a composite outcome were increased for age 75–84 (OR 1.47, 95% CI 1.11–1.93) and 85–59 (OR 1.39, 95% CI 1.04–1.87) compared to 18–34 year-olds, males (OR 1.39, 95% CI 1.21–1.59) vs. females, and patients identifying as Hispanic/Latino (OR 1.35, 95% CI 1.14–1.61) or Asian (OR 1.43, 95% CI 1.23–1.82) compared to White. Patients with 5 or more comorbidities were exceedingly likely to experience a composite outcome (OR 2.74, 95% CI 2.32–3.25). Conclusions Males, older patients, those with multiple pre-existing comorbidities, and those identifying as Hispanic/Latino or Asian experienced an increased risk of ICU admission and/or death. These results are consistent with reported risks among the Hispanic/Latino population elsewhere in the United States, and confirm multiple concerns about heightened risk among the Asian population in California.

Outcomes With Severe Blastomycosis and Respiratory Failure in the United States

2020 ◽  
Author(s):  
Barret Rush ◽  
Sylvain Lother ◽  
Bojan Paunovic ◽  
Owen Mooney ◽  
Anand Kumar
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Ventilatory Support ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Female Gender ◽  
The United States ◽  
Teaching Hospitals ◽  
Historical Case ◽  
Increased Risk

Abstract Background Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50–90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis. Methods We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006–2014. Patients aged &gt;18 years with a diagnosis of blastomycosis who received MV were included. Results There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P &lt; .01). The median (IQR) time to death for patients requiring MV was 12 (8–16) days. The median length of hospital stay for survivors of MV was 22 (14–37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06–3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33–2.02; P &lt; .01). Conclusions In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.

scholarly journals Are All Patients with Cancer at Heightened Risk for Severe Coronavirus Disease 2019 (COVID-19)?

2020 ◽  
Author(s):  
Georgios Chamilos ◽  
Michail S Lionakis ◽  
Dimitrios P Kontoyiannis
Keyword(s):  
Cancer Patients ◽  
Viral Infections ◽  
Case Series ◽  
Mortality Rates ◽  
Heterogeneous Population ◽  
Patients With Cancer ◽  
Underlying Malignancy ◽  
Epidemiological Surveys ◽  
Early Case ◽  
Per Se

Abstract Cancer patients are traditionally considered at high risk for complicated respiratory viral infections, due to their underlying immunosuppression. In line with this notion, early case series reported high mortality rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with malignancy. However, subsequent large, prospective, epidemiological surveys indicate that the risk for severe coronavirus disease 2019 (COVID-19) may be largely attributed to the multiple confounders operating in this highly heterogeneous population of patients, rather than the cancer or its treatment per se. We critically discuss the conundrums of SARS-CoV-2 infection in cancer patients and underscore mechanistic insights on the outcome of COVID-19 as it relates to cancer therapy and the type and status of the underlying malignancy. Not all cancer patients are similarly at risk for a complicated COVID-19 course. A roadmap is needed for translational and clinical research on COVID-19 in this challenging group of patients.

Risk factors for opioid abuse/dependence in hospitalized cancer patients in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11589-11589
Author(s):  
Veli Bakalov ◽  
Amy Tang ◽  
Amulya Yellala ◽  
Laila Babar ◽  
Rupin Shah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Cancer ◽  
Cancer Patients ◽  
Mental Disease ◽  
The United States ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Inhospital Mortality ◽  
Cancer Type ◽  
Increased Risk

11589 Background: Opioid medications are the mainstay for treating cancer pain. Goal of this study was to identify risk factors for opioid abuse/dependence in patients hospitalized with cancer, explore whether risk of opioid abuse/dependence varies by cancer type and to assess whether opioid abuse/dependence in cancer patients effects the outcomes of hospitalization. Methods: The Nationwide Inpatient Sample for the years of 2011-2015 was queried for the analysis. We used ICD-9-CM codes of solid tumors as a primary diagnosis for hospitalization, and opioid abuse/dependence as a secondary diagnosis of the hospitalization. We performed univariate and multivariate logistic regression analyses to examine the association between risk factors and opioid abuse/dependence. Data were analyzed using SAS v9.4 (SAS Institute, Cary, NC). Results: Total of 524,624 patients were included in our cohort. Rate of opioid abuse/dependence was highest in patients with liver cancer (1.77%). Opioid abuse/dependence was less associated with age (>65 years old: OR 0.29, 95% CI 0.21-0.39). Patients with Medicaid insurance associated with increased risk of opioid abuse/dependence comparing to other insurances (OR 5.29, 95% CI 4.78-5.86). Strongest association with opioid abuse/dependence were in patients with liver cancer (OR 6.07, 95% CI 5.11-7.20) followed by head and neck cancer (OR 3.20, 95% CI 2.67-3.84). Substance abuse (OR 9.9, 95% CI 9.04-10.84), mental disease (OR-2.87, 95% CI 2.64-3.13) and nutrition deficiency (OR-2.09, 95% CI 1.90-2.31) were highly associated with opioid abuse dependence. Inhospital mortality rate, total cost of hospitalization, and length of stay were significantly higher in patients with opioid abuse/dependence (Table). Conclusions: We identified risk factors for opioid abuse/dependence in hospitalized patients with cancer and demonstrated that risk of opioid abuse varies by cancer type, and opioid abuse/dependence affects the outcomes of hospitalization. Findings of our study can be used for development of the screening tools with higher sensitivity and specificity for predicting the risk of opioid abuse/dependence in cancer patients.[Table: see text]

Controlling MRSA in Surgical Head&Neck Patients: What Works?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P35-P36
Author(s):  
Mrinal Supriya ◽  
Louise Santangeli ◽  
Muhammad Shakeel ◽  
Kim Ah-See
Keyword(s):  
Risk Factors ◽  
Head And Neck Cancer ◽  
Hospital Stay ◽  
Head And Neck ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Neck Cancer ◽  
Case Series ◽  
Surveillance Cultures ◽  
Increased Risk

Objective Can we control MRSA incidence in head and neck cancer patients by 1) Active surveillance cultures of patients fulfilling Society for Healthcare Epidemiology of America (SHEA) & Scottish Infection Standards and Strategy (SISS) guideline? 2) Cohorting these patients? 3) Restricted Health Care Workers (HCW) access? Methods Prospective case series: July 2007–January 2008. 26 preoperative head and neck cancer patients had a questionnaire filled in to identify known predictors for MRSA as suggested by SISS Group. Intervention: Preoperative nasal swabs, cohorting away from other cases, restricted access. MRSA incidence compared to that over the preceding year(Jan 2006-Jan 2007). Results 26 eligible patients. None of them had known risk factors for MRSA. 17 patients had swabs taken pre-admission. All screened patients were non-carriers of MRSA in their nose and none of them developed MRSA infection during hospital stay. Of remaining 9 patients swabbed after admission, 3 developed MRSA during hospital stay. The incidence of MRSA was 11.5% (3/26) during study period, compared to 28.5% (24/84) the year before implementing these interventions. Conclusions Head and neck cancer patients do not have increased risk factors for MRSA colonization and their active surveillance cultures are unlikely to influence MRSA incidence. Cohorting these patients with restricted HCW access decreased the MRSA rate at our centre.

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