217 results on '"Florian Strasser"'
Search Results
2. Lenalidomide in cancer cachexia: a randomized trial of an anticancer drug applied for anti‐cachexia
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David Blum, Caroline Hertler, Rolf Oberholzer, Susanne deWolf‐Linder, Markus Joerger, Christoph Driessen, and Florian Strasser
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Neoplasms ,Cachexia ,Randomized controlled trial ,Lenalidomide ,Internal medicine ,RC31-1245 - Abstract
Abstract Background Cancer cachexia (CC) impacts quality of life, physical function, anticancer treatment response, and survival. Inflammation is a prominent pathomechanism of CC. This small‐scale study sets out to investigate the immunomodulatory drug lenalidomide in inflammatory CC in a randomized, double‐blind, placebo‐controlled trial. Methods Patients with advanced solid malignancies, documented weight loss, no or unchanged anticancer treatment, and C‐reactive protein > 30 mg/L were included. In a 2:2:1 randomization, patients received either lenalidomide 25 mg once daily or C‐reactive protein‐guided dose, starting with 5 mg lenalidomide once daily or placebo once a day for 8 weeks. Dose adaption and safety were assessed twice a week. Treatment response was defined as an increase of lean body mass of more than 2% in a lower lumbar computed tomography and an increase in dynamometer‐assessed handgrip strength of 4 kg. Secondary endpoints included adverse events, C‐reactive protein response, nutritional intake, and symptoms. Results Of 24 eligible patients, 16 were included (25% female). At baseline, the mean age was 67 (range 51–88) years, and mean body weight was 64.7 kg (range 39.8–87.2 kg). Five were diagnosed with mesothelioma, two with non‐small‐cell lung cancer, two with renal cell carcinoma, two with neuroendocrine tumours, and five with other malignancies. Mean survival was 43 days. Eleven adverse events (four of which were severe) were recorded with a probable link to study participation. Nine patients completed the study. No participant showed a treatment response. C‐reactive protein‐guided dosing did not result in lower doses of lenalidomide. Lean body mass decreased less in the treatment groups. For the lenalidomide and placebo groups respectively, handgrip strength decreased by 2.3 vs. 5.5 kg, nutritional intake decreased by 249 vs. 32 kcal/day, and C‐reactive protein increased by 35 mg/dL vs. decreased by 17 mg/dL. The study was closed prematurely due to slow accrual and the need for concurrent anticancer treatments. Conclusions No treatment response on muscle mass and muscle strength was observed with lenalidomide. Because of several limiting factors, including low recruitment caused in part by an ambitious study design and concomitant anticancer treatment, this study did not generate adequate data to draw reliable conclusions.
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- 2022
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3. Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi‐cohort analysis
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Lisa Martin, Maurizio Muscaritoli, Isabelle Bourdel‐Marchasson, Catherine Kubrak, Barry Laird, Bruno Gagnon, Martin Chasen, Ioannis Gioulbasanis, Ola Wallengren, Anne C. Voss, Francois Goldwasser, R. Thomas Jagoe, Chris Deans, Federico Bozzetti, Florian Strasser, Lene Thoresen, Sean Kazemi, Vickie Baracos, and Pierre Senesse
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Cancer ,Cachexia ,Malnutrition ,Reduced food intake ,Inflammation ,Weight loss ,Diseases of the musculoskeletal system ,RC925-935 ,Human anatomy ,QM1-695 - Abstract
Abstract Background Cancer‐associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C‐reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer‐associated WL (primary endpoint) and overall survival (OS, secondary endpoint). Methods The data set included a total of 12,253 patients at risk for cancer‐associated WL. Patient‐reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively. Results Patients had a mean weight change of −7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5–5.9% (19.7%), 6.0–10.0% (23.2%), 11.0–14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P 100 mg/L: OR 2.30 (95% CI 1.62–3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5–10.3), with median follow‐up of 39.7 months (95% CI 38.8–40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P
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- 2021
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4. Natural ghrelin in advanced cancer patients with cachexia, a case series
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David Blum, Susanne deWolf‐Linder, Rolf Oberholzer, Michael Brändle, Thomas Hundsberger, and Florian Strasser
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Ghrelin ,Cancer cachexia ,Appetite ,Muscle mass ,Diseases of the musculoskeletal system ,RC925-935 ,Human anatomy ,QM1-695 - Abstract
Abstract Background Natural ghrelin, a peptide growth hormone secretagogue, has a therapeutic potential in cachexia. We designed a dose‐finding trial of subcutaneous natural ghrelin to improve nutritional intake (NI) in advanced cancer patients. Methods Advanced cancer patients with cachexia management (symptom management, physiotherapy, nutritional, and psychosocial support) started with ghrelin at 32 μg/kg body weight, followed by 50% dose increases. Patients self‐injected ghrelin twice daily for 4 days followed by a wash‐out period. After reaching the primary endpoint, maximal NI (minimal dose for maximal NI), a maintenance period followed during which patients injected 10 doses of ghrelin per week. Safety parameters, NI, and cachexia outcomes (symptoms, narratives, muscle mass, and strength) were measured over 6 weeks. Results Ten patients with metastatic solid tumours were included, and six (100% male, mean age 61.8 ± 8.5 SD) received ghrelin. Minimal dose for maximal NI was reached in four patients. Three patients reached the end‐of study visit. Ghrelin was well tolerated with variable results on appetite and eating‐related symptoms but a positive effect in the narratives. Mean Functional Assessment of Appetite & Cachexia Therapy score was 6.8 points lower at final measurement compared with baseline, t(5) = 5.98, P
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- 2021
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5. Sarcopenia: A Time for Action. An SCWD Position Paper
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Juergen Bauer, John E. Morley, Annemie M.W.J. Schols, Luigi Ferrucci, Alfonso J. Cruz‐Jentoft, Elsa Dent, Vickie E. Baracos, Jeffrey A. Crawford, Wolfram Doehner, Steven B. Heymsfield, Aminah Jatoi, Kamyar Kalantar‐Zadeh, Mitja Lainscak, Francesco Landi, Alessandro Laviano, Michelangelo Mancuso, Maurizio Muscaritoli, Carla M. Prado, Florian Strasser, Stephan vonHaehling, Andrew J.S. Coats, and Stefan D. Anker
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Sarcopenia ,Cachexia ,Geriatric assessment ,Muscle ,Skeletal ,Muscle strength ,Diseases of the musculoskeletal system ,RC925-935 ,Human anatomy ,QM1-695 - Abstract
Abstract The term sarcopenia was introduced in 1988. The original definition was a “muscle loss” of the appendicular muscle mass in the older people as measured by dual energy x‐ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC‐F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease‐related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age‐related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age‐related and disease‐related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life‐long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.
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- 2019
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6. A prospective study examining cachexia predictors in patients with incurable cancer
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Ola Magne Vagnildhaug, Cinzia Brunelli, Marianne J. Hjermstad, Florian Strasser, Vickie Baracos, Andrew Wilcock, Maria Nabal, Stein Kaasa, Barry Laird, and Tora S. Solheim
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Cachexia ,Pre-cachexia ,Weight loss ,Cancer ,Palliative care ,Special situations and conditions ,RC952-1245 - Abstract
Abstract Background Early intervention against cachexia necessitates a predictive model. The aims of this study were to identify predictors of cachexia development and to create and evaluate accuracy of a predictive model based on these predictors. Methods A secondary analysis of a prospective, observational, multicentre study was conducted. Patients, who attended a palliative care programme, had incurable cancer and did not have cachexia at baseline, were amenable to the analysis. Cachexia was defined as weight loss (WL) > 5% (6 months) or WL > 2% and body mass index
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- 2019
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7. Orphan disease status of cancer cachexia in the USA and in the European Union: a systematic review
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Markus S. Anker, Richard Holcomb, Maurizio Muscaritoli, Stephan vonHaehling, Wilhelm Haverkamp, Aminah Jatoi, John E. Morley, Florian Strasser, Ulf Landmesser, Andrew J.S. Coats, and Stefan D. Anker
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Cachexia ,Orphan disease ,Prevalence ,Epidemiology ,European Union ,USA ,Diseases of the musculoskeletal system ,RC925-935 ,Human anatomy ,QM1-695 - Abstract
Abstract Background Cachexia has significant impact on the patients' quality of life and prognosis. It is frequently observed in patients with cancer, especially in advanced stages, but prevalence data for the overall population are lacking. Good quality estimates of cancer cachexia in general and for each of the major cancer types would be highly relevant for potential treatment development efforts in this field. Both the USA and European Union (EU) have implemented special clinical development rules for such rare disorders what are called ‘orphan diseases’. The cut‐off level for a disease to be considered an orphan disease in the USA is 200 000 people (0.06% of the population) and EU is 5 per 10 000 people (0.05% of the population). Methods For this systematic review, we searched at PubMed (from inception to 31 January 2018) to identify clinical studies that assessed the prevalence of cachexia in cancer patients at risk. Studies reporting the prevalence of either cancer cachexia or wasting disease in the top‐10 cancer types and 4 other selected cancer types known to be particularly commonly complicated by cachexia were included in this analysis (i.e. prostate cancer, breast cancer, colorectal cancer, melanoma, endometrial cancer, thyroid cancer, urinary bladder cancer, non‐hodgkin lymphoma, lung cancer, kidney and renal pelvis cancer, head and neck cancer, gastric cancer, liver cancer, and pancreatic cancer). We calculated the current burden of cancer cachexia, disease by disease, in the USA and in the EU and compared them to the current guidelines for the definition of orphan disease status. Results We estimate that in 2014 in the USA, a total of 527 100 patients (16.5 subjects per 10 000 people of the total population), and in 2013 in the EU, a total of 800 300 patients (15.8 subjects per 10 000 people of the total population) suffered from cancer cachexia (of any kind). In the 14 separately analysed cancer types, the prevalence of cancer cachexia in the USA ranged between 11 300 (0.4/10 000, gastric cancer) and 92 000 patients (2.9/10 000, lung cancer) and in the EU between 14 300 (0.3/10 000, melanoma of the skin) and 150 100 (3.0/10 000, colorectal cancer). Conclusions The absolute number of patients affected by cancer cachexia in each cancer group is lower than the defined thresholds for orphan diseases in the USA and EU. Cancer cachexia in each subgroup separately should be considered an orphan disease.
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- 2019
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8. Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non‐small‐cell lung cancer
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Tateaki Naito, Shuichi Mitsunaga, Satoru Miura, Noriatsu Tatematsu, Toshimi Inano, Takako Mouri, Tetsuya Tsuji, Takashi Higashiguchi, Akio Inui, Taro Okayama, Teiko Yamaguchi, Ayumu Morikawa, Naoharu Mori, Toshiaki Takahashi, Florian Strasser, Katsuhiro Omae, Keita Mori, and Koichi Takayama
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Non‐small‐cell lung cancer ,Pancreatic cancer ,Elderly ,Cancer cachexia ,Multimodal intervention ,Physical activity ,Diseases of the musculoskeletal system ,RC925-935 ,Human anatomy ,QM1-695 - Abstract
Abstract Background Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. Methods This was a multicentre prospective single‐arm study. We recruited 30 of 46 screened patients aged ≥70 years scheduled to receive first‐line chemotherapy for newly diagnosed, advanced pancreatic, or non‐small‐cell lung cancer. Physical activity was measured using pedometers/accelerometer (Lifecorder®, Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home‐based low‐intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched‐chain amino acids (Inner Power®, Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥4 of six sessions. Secondary endpoints included compliance and safety. Results The median patient age was 75 years (range, 70–84). Twelve patients (40%) were cachectic at baseline. Twenty‐nine patients attended ≥4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). Conclusions The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non‐small‐cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.
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- 2019
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9. Cancer cachexia associates with a systemic autophagy-inducing activity mimicked by cancer cell-derived IL-6 trans-signaling
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Kristine Pettersen, Sonja Andersen, Simone Degen, Valentina Tadini, Joël Grosjean, Shinji Hatakeyama, Almaz N. Tesfahun, Siver Moestue, Jana Kim, Unni Nonstad, Pål R. Romundstad, Frank Skorpen, Sveinung Sørhaug, Tore Amundsen, Bjørn H. Grønberg, Florian Strasser, Nathan Stephens, Dag Hoem, Anders Molven, Stein Kaasa, Kenneth Fearon, Carsten Jacobi, and Geir Bjørkøy
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Medicine ,Science - Abstract
Abstract The majority of cancer patients with advanced disease experience weight loss, including loss of lean body mass. Severe weight loss is characteristic for cancer cachexia, a condition that significantly impairs functional status and survival. The underlying causes of cachexia are incompletely understood, and currently no therapeutic approach can completely reverse the condition. Autophagy coordinates lysosomal destruction of cytosolic constituents and is systemically induced by starvation. We hypothesized that starvation-mimicking signaling compounds secreted from tumor cells may cause a systemic acceleration of autophagy during cachexia. We found that IL-6 secreted by tumor cells accelerates autophagy in myotubes when complexed with soluble IL-6 receptor (trans-signaling). In lung cancer patients, were cachexia is prevalent, there was a significant correlation between elevated IL-6 expression in the tumor and poor prognosis of the patients. We found evidence for an autophagy-inducing bioactivity in serum from cancer patients and that this is clearly associated with weight loss. Importantly, the autophagy-inducing bioactivity was reduced by interference with IL-6 trans-signaling. Together, our findings suggest that IL-6 trans-signaling may be targeted in cancer cachexia.
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- 2017
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10. ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology Edition 2016
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Enriqueta Felip, Josep Tabernero, Maria De Santis, Emile Voest, Mark Robson, Fatima Cardoso, Elisabeth G E de Vries, Fedro Alessandro Peccatori, Svetlana Jezdic, Giannis Mountzios, Smita Bhatia, Alexandru Eniu, Luzia Travado, Ulrich Keilholz, Jonas Bergh, Jan Buckner, Friedrich Stiefel, Ahmad Awada, Cristiana Sessa, Olivier Michielin, Marc Ernstoff, Ben Markman, Lisa Licitra, Rossana Berardi, Jill Gilbert, Lidia Schapira, Eva Schernhammer, Jeffrey S Weber, Heinz-Josef Lenz, Piotr Rutkowski, Jennifer Duff, Axel Grothey, Yuichiro Ohe, Saskia Litiere, Hans Wildiers, Christian Dittrich, Michael Kosty, Doug Pyle, Nagi El-Saghir, Jean-Pierre Lotz, Pia Österlund, Nicholas Pavlidis, Gunta Purkalne, Susana Banerjee, Jan Bogaerts, Paolo Casali, Edward Chu, Julia Lee Close, Bertrand Coiffier, Roisin Connolly, Sarah Coupland, Luigi De Petris, Don S Dizon, Linda R Duska, Martin F Fey, Nicolas Girard, Andor W J M Glaudemans, Priya K Gopalan, Stephen M Hahn, Diana Hanna, Christian Herold, Jørn Herrstedt, Krisztian Homicsko, Dennie V Jones, Lorenz Jost, Saad Khan, Alexander Kiss, Claus-Henning Köhne, Rainer Kunstfeld, Stuart Lichtman, Thomas Lion, Lifang Liu, Patrick J Loehrer, Merry Jennifer Markham, Marius Mayerhoefer, Johannes G Meran, Elizabeth Charlotte Moser, Timothy Moynihan, Torsten Nielsen, Kjell Öberg, Antonio Palumbo, Michael Pfeilstöcker, Chandrajit Raut, Scot C Remick, Roberto Salgado, Martin Schlumberger, Hans-Joachim Schmoll, Lowell Schnipper, Charles L Shapiro, Julie Steele, Cora N Sternberg, Florian Strasser, Roger Stupp, Richard Sullivan, Marcel Verheij, Everett Vokes, Jamie Von Roenn, and Yosef Yarden
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
The European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) are publishing a new edition of the ESMO/ASCO Global Curriculum (GC) thanks to contribution of 64 ESMO-appointed and 32 ASCO-appointed authors. First published in 2004 and updated in 2010, the GC edition 2016 answers to the need for updated recommendations for the training of physicians in medical oncology by defining the standard to be fulfilled to qualify as medical oncologists. At times of internationalisation of healthcare and increased mobility of patients and physicians, the GC aims to provide state-of-the-art cancer care to all patients wherever they live. Recent progress in the field of cancer research has indeed resulted in diagnostic and therapeutic innovations such as targeted therapies as a standard therapeutic approach or personalised cancer medicine apart from the revival of immunotherapy, requiring specialised training for medical oncology trainees. Thus, several new chapters on technical contents such as molecular pathology, translational research or molecular imaging and on conceptual attitudes towards human principles like genetic counselling or survivorship have been integrated in the GC. The GC edition 2016 consists of 12 sections with 17 subsections, 44 chapters and 35 subchapters, respectively. Besides renewal in its contents, the GC underwent a principal formal change taking into consideration modern didactic principles. It is presented in a template-based format that subcategorises the detailed outcome requirements into learning objectives, awareness, knowledge and skills. Consecutive steps will be those of harmonising and implementing teaching and assessment strategies.
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- 2016
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11. Electromagnetic Characterization and Simulation of a Carbonate Buffer System on a Microwave Biosensor
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Lisa-Marie Wagner, Florian Strasser, Eva Melnik, and Martin Brandl
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microwave biosensor ,split-ring resonator ,electromagnetic characterization ,high-frequency simulation ,General Works - Abstract
In order to develop a fast, sensitive and easy-to-produce biosensor, a high-quality microwave split-ring resonator is going to be developed. In the final sensing device, a blood sample will be placed as a droplet on the sensitive area of the sensor. In case of specific target biomolecules binding a shift in resonance frequency will be induced due to the effective permittivity change. This shift in resonance frequency depends on the concentration of biomolecules and is therefore quantitative. The aim of this work is to find a position for the bio-functionalization that providesa measurable frequency shift when the analyte is added. Different areas are tested experimentally and via simulations. Two buffer solutions are used which have to be characterized in terms of its electromagnetic properties in advance. This preliminary study should pave the way for the measurements in real human samples such as serum or plasma.
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- 2017
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12. Constricting Gaps: Protocol development, implementation challenges and lessons learned for the reality map of unmet needs for Palliative Care Interventions in advanced cancer patients study in Romania and Switzerland
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Natalie, Kalbermatten, Razvan, Curca, Alexandru, Grigorescu, Daniela, Mosoiu, Florina, Pop, Vladimir, Poroch, Ariana, Rosiu, Patriciu, Achimas-Cadariu, and Florian, Strasser
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- 2024
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13. Diffusion-based Generative Prior for Low-Complexity MIMO Channel Estimation.
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Benedikt Fesl, Michael Baur, Florian Strasser, Michael Joham, and Wolfgang Utschick
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- 2024
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14. On the Asymptotic Mean Square Error Optimality of Diffusion Probabilistic Models.
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Benedikt Fesl, Benedikt Böck, Florian Strasser, Michael Baur, Michael Joham, and Wolfgang Utschick
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- 2024
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15. Spiking Neural Network Linear Equalization: Experimental Demonstration of 2km 100Gb/s IM/DD PAM4 Optical Transmission.
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Georg Böcherer, Florian Strasser, Elias Arnold, Youxi Lin, Johannes Schemmel, Stefano Calabrò, and Maxim Kuschnerov
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- 2023
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16. Uplink Downlink Duality for Multi-Cell Massive MISO FDD Systems with per Base Station Power Constraints.
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Donia Ben Amor, Florian Strasser, Michael Joham, and Wolfgang Utschick
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- 2021
17. Algorithmic Resource Allocation for Spacecraft Operations
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Florian Strasser, Martin Favin–Lévêque, Till Assmann, and Florian Schummer
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- 2023
18. Spiking Neural Network Nonlinear Demapping on Neuromorphic Hardware for IM/DD Optical Communication
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Elias Arnold, Georg Bocherer, Florian Strasser, Eric Muller, Philipp Spilger, Sebastian Billaudelle, Johannes Weis, Johannes Schemmel, Stefano Calabro, and Maxim Kuschnerov
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Signal Processing (eess.SP) ,FOS: Electrical engineering, electronic engineering, information engineering ,Electrical Engineering and Systems Science - Signal Processing ,Atomic and Molecular Physics, and Optics - Abstract
Neuromorphic computing implementing spiking neural networks (SNN) is a promising technology for reducing the footprint of optical transceivers, as required by the fast-paced growth of data center traffic. In this work, an SNN nonlinear demapper is designed and evaluated on a simulated intensity-modulation direct-detection link with chromatic dispersion. The SNN demapper is implemented in software and on the analog neuromorphic hardware system BrainScaleS-2 (BSS-2). For comparison, linear equalization (LE), Volterra nonlinear equalization (VNLE), and nonlinear demapping by an artificial neural network (ANN) implemented in software are considered. At a pre-forward error correction bit error rate of 2e-3, the software SNN outperforms LE by 1.5 dB, VNLE by 0.3 dB and the ANN by 0.5 dB. The hardware penalty of the SNN on BSS-2 is only 0.2 dB, i.e., also on hardware, the SNN performs better than all software implementations of the reference approaches. Hence, this work demonstrates that SNN demappers implemented on electrical analog hardware can realize powerful and accurate signal processing fulfilling the strict requirements of optical communications., Comment: 9 pages, 5 figures, accepted for publication by the IEEE/Optica Publishing Group Journal of Lightwave Technology
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- 2023
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19. A Conceptual Framework For Cautious Escalation Of Anticancer Treatment: How To Optimize Overall Benefit And Obviate The Need For De-Escalation Trials
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Ivan Pourmir, Hendrik Van Halteren, Reza Elaidi, Dario Trapani, Florian Strasser, Gerard Vreugdenhil, and Mike Clarke
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History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2023
20. MOVE-III: A CubeSat for the detection of sub-millimetre space debris and meteoroids in Low Earth Orbit
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Xanthi Oikonomidou, Eleftherios Karagiannis, Dominik Still, Florian Strasser, Felix S. Firmbach, Jonathan Hettwer, Allan G. Schweinfurth, Paul Pucknus, Deniz Menekay, Tianyi You, Maximilian Vovk, Selina Weber, and Zeyu Zhu
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Space Technologies ,space debris ,impact detection ,CubeSat ,MOVE-III ,DEDRA ,space debris modelling ,ddc - Abstract
The Munich Orbital Verification Experiment (MOVE) is a CubeSat student project housed at the Scientific Workgroup for Rocketry and Spaceflight at the Technical University of Munich. MOVE-III is the fourth CubeSat under development, and the first 6U mission of the MOVE project that will carry a dedicated scientific payload in orbit. The mission aims at acquiring in-situ observations of sub-millimetre space debris and meteoroids in Low Earth Orbit, with the objective of compiling a dataset of flux, as well as object mass and velocity measurements that can be used for the validation of the small object estimates of space debris models and support further studies related to the characterisation of the space environment. The MOVE-III CubeSat employs the MOVE-BEYOND platform and is planned to carry three Debris Density Retrieval and Analysis (DEDRA) plasma ionization sensors. The Preliminary Design Review has been completed in early 2022, with the next milestone being the Critical Design Review, planned for 2023. The paper elaborates on the scientific objectives of the mission and the expected data products, provides an overview of the detector operation principle and presents the overall system architecture, the platform configuration and the subsystem interaction. Considerations on the debris mitigation aspects of the mission are additionally discussed.
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- 2022
21. Overcoming barriers to timely recognition and treatment of cancer cachexia: Sharing Progress in Cancer Care Task Force Position Paper and Call to Action
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Jann Arends, Maurizio Muscaritoli, Stefan Anker, Riccardo Audisio, Rocco Barazzoni, Snezana Bosnjak, Paolo Bossi, Jacqueline Bowman, Stefan Gijssels, Željko Krznarić, Florian Strasser, and Matti Aapro
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Oncology ,Hematology - Published
- 2023
22. ESPEN practical guideline: Clinical Nutrition in cancer
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Maurizio Muscaritoli, Jann Arends, Patrick Bachmann, Vickie Baracos, Nicole Barthelemy, Hartmut Bertz, Federico Bozzetti, Elisabeth Hütterer, Elizabeth Isenring, Stein Kaasa, Zeljko Krznaric, Barry Laird, Maria Larsson, Alessandro Laviano, Stefan Mühlebach, Line Oldervoll, Paula Ravasco, Tora S. Solheim, Florian Strasser, Marian de van der Schueren, Jean-Charles Preiser, Stephan C. Bischoff, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, and Amsterdam Gastroenterology Endocrinology Metabolism
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0301 basic medicine ,Societies, Scientific ,Cachexia ,Nutritional Status ,030209 endocrinology & metabolism ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Chemotherapy ,Humans ,Cancer ,Global Nutrition ,Wereldvoeding ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Radiotherapy ,Nutritional Support ,Malnutrition ,Scientific ,Anorexia ,Europe ,anorexia ,cachexia ,cancer ,chemotherapy ,malnutrition ,radiotherapy ,Societies - Abstract
Background: This practical guideline is based on the current scientific ESPEN guidelines on nutrition in cancer patients. Methods: ESPEN guidelines have been shortened and transformed into flow charts for easier use in clinical practice. The practical guideline is dedicated to all professionals including physicians, dieticians, nutritionists and nurses working with patients with cancer. Results: A total of 43 recommendations are presented with short commentaries for the nutritional and metabolic management of patients with neoplastic diseases. The disease-related recommendations are preceded by general recommendations on the diagnostics of nutritional status in cancer patients. Conclusion: This practical guideline gives guidance to health care providers involved in the management of cancer patients to offer optimal nutritional care. (c) 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
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- 2021
23. Correction to: Enteral and parenteral nutrition in cancer patients, a comparison of complication rates: an updated systematic review and (cumulative) meta-analysis
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Tian Yi Tang, Monica Krishnan, Michael Lock, Egidio Del Fabbro, Alex Molassiotis, Elisabeth Isenring, Leonard Chiu, Ronald Chow, Nicholas Chiu, Henry Lam, Florian Strasser, Carlo DeAngelis, Eduardo Bruera, Jann Arends, Declan Walsh, and Stephanie Chan
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medicine.medical_specialty ,Parenteral nutrition ,Oncology ,business.industry ,Meta-analysis ,Medicine ,Cancer ,business ,Intensive care medicine ,medicine.disease ,Complication ,Enteral administration - Published
- 2019
24. Onkologische Rehabilitation integriert in die Behandlungspfade der modernen Onkologie
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Florian Strasser
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Oncology ,medicine.medical_specialty ,Rehabilitation ,030504 nursing ,business.industry ,medicine.medical_treatment ,Prehabilitation ,Psychological intervention ,Psycho-oncology ,General Medicine ,Disease ,Competence (law) ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,030212 general & internal medicine ,0305 other medical science ,business ,Goal setting ,Reimbursement - Abstract
Cancer Rehabilitation: integrated in the care pathways of modern oncology Abstract. People suffering from cancer are affected both by the cancer disease and from side-effects of multimodal anticancer interventions such as surgical, radiooncological and drug therapies. These effects can lead to physical, emotional, social, intellectual or existential functional deficits, which presence and impact are often underrecgonized by oncology professionals. Oncological rehabilitation targets such deficits by multimodal, transprofessionally delivered, goal steered and human centered coordinated interventions. Indications for oncological rehabilitation exist in situations before, during, between and after cancer therapies in both curative and non-curative intention. This includes for example prehabilitation, rehabilitation of myeloma patients between transplantions, of patients suffering from cancer-treatment related fatigue or from advanced cancer undergoing anticancer treatment: basically, every patient in modern oncology who suffers from substantial functional deficits. Oncological rehabilitation defines concrete goals in order to achieve the functions in comparison to before the deficits occurred, the overlaying aims to achieve an optimal self-determination and independence. A profound understanding of the oncological situation by both the patient and professionals is necessary to define realistic goals. Based on - and steered by - these goals, oncological rehabilitation employs specific rehabilitation interventions, supported by a transprofessionally coordinated team of exercise specialists, physiotherapy, ergotherapy, speech, art and music therapists, nutritional, socialwork and psycho-oncological counsellors, as well as activating and therapy-accompanying nurses and physicians. Competence in both cancer disease and anticancer treatment side effects as well as rehabilitation procedures is relevant in goal setting and rehabilitative treatment guidance as well as administration of systemic cancer therapies during oncological rehabilitation. It is a reality in modern oncology that many cancer patients require both oncological rehabilitation and ongoing anticancer treatments. The integration of oncological rehabilitation in the treatment pathways of modern oncology demands new models - including new forms of reimbursement - making allowance for the realities and needs of modern oncology.
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- 2019
25. Systemische Krebstherapien während der onkologischen Rehabilitation
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Florian Strasser and Oliver Rick
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,business - Abstract
In vielen Rehabilitationskliniken werden keine Chemo- oder Immuntherapien wahrend der Rehabilitation durchgefuhrt. Onkologie-spezifische Rehabilitationsbehandlungen mussen in die Behandlungspfade der modernen Onkologie integriert werden, dazu konnen systemische Krebstherapien wahrend einer stationaren Rehabilitation gehoren.
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- 2019
26. Parenteral nutrition
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Jann Arends and Florian Strasser
- Abstract
Parenteral nutrition (PN) is an invasive approach that aims to supply energy and nutrients when food intake in patients with an advanced disease is inadequate to the degree that it impairs quality of life, reduces mobility, enhances fragility, and shortens survival. The use of PN is complicated by serious risks and substantial logistic burdens for the patient and their care providers. Since maintaining body resources and performance is of major importance early in the trajectory but much less so as the patient approaches the end of life, decision-making must take into account the evolution of the underlying illness as well as the prevailing circumstances, prognosis, and goals of care. These decisions require balancing the possible benefits and risks and communicating these considerations with the patient and their caregivers and within the therapeutic team. It is of critical importance to differentiate pure starvation, due to an inability to take in, digest, or absorb nutrients, from cachexia, that is, anorexia and catabolism produced by cancer-associated systemic inflammation. PN is the technique of choice when intestinal failure develops in a patient with an otherwise stable condition, motivated and able to be physically active, and with an expected survival of at least several weeks or months. Supplying PN to patients with a working gut has not been shown reliably to be beneficial and other options for feeding should generally be pursued. In all circumstances, the patient’s consent to nutritional interventions is required. In situations when both tube feeding and PN are options, frequently, patients prefer the intravenous route. Composition, application, and follow-up of PN should follow rigorous procedures. Accepting the inevitability of disease progression, artificial nutrition should always be seen as one tool among others, which may support the patient during some episodes but will lose relevance during the final stages of an incurable disease.
- Published
- 2021
27. Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines☆
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Paula Ravasco, Jann Arends, Florian Strasser, M. Chasen, C.I. Ripamonti, C. Madeddu, S. Gonella, Tora Skeidsvoll Solheim, Christine Baldwin, L. Buonaccorso, M. A. E. de van der Schueren, Veritati - Repositório Institucional da Universidade Católica Portuguesa, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, and Amsterdam Gastroenterology Endocrinology Metabolism
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Cancer Research ,medicine.medical_specialty ,assessment ,cachexia ,Cachexia ,Special Article ,Multidisciplinary approach ,medicine ,cancer ,Intensive care medicine ,Global Nutrition ,Wereldvoeding ,Adult patients ,treatment ,business.industry ,digestive, oral, and skin physiology ,Cancer cachexia ,Cancer ,Guideline ,musculoskeletal system ,medicine.disease ,Clinical Practice ,nutrition ,Oncology ,Expert opinion ,Clinical Practice Guidelines ,business - Abstract
Submitted by Agostinho Macau (arm@ucp.pt) on 2021-07-06T10:44:13Z No. of bitstreams: 1 1_s2.0_S2059702921000491_main.pdf: 724032 bytes, checksum: a340b86fa3273196e1fe7a9f47af4b1a (MD5) Made available in DSpace on 2021-07-06T10:44:14Z (GMT). No. of bitstreams: 1 1_s2.0_S2059702921000491_main.pdf: 724032 bytes, checksum: a340b86fa3273196e1fe7a9f47af4b1a (MD5) Previous issue date: 2021-06-01 info:eu-repo/semantics/publishedVersion
- Published
- 2021
28. Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis
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Florian Strasser, François Goldwasser, Vickie E. Baracos, Ioannis Gioulbasanis, Isabelle Bourdel-Marchasson, R. Thomas Jagoe, Maurizio Muscaritoli, Martin Chasen, Ola Wallengren, Bruno Gagnon, Barry Laird, Lene Thoresen, Federico Bozzetti, Pierre Senesse, Anne C. Voss, Chris Deans, Catherine Kubrak, Lisa Martin, Sean Kazemi, University of Alberta, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome] (UNIROMA), Université de Bordeaux (UB), University of Edinburgh, Université Laval [Québec] (ULaval), University of Toronto, Larissa University Hospital, Sahlgrenska University Hospital [Gothenburg], Abbott Nutrition R&D, Prévention et traitement de la perte protéique musculaire en situation de résistance à l'anabolisme (PRETRRAM (URP_4466)), Université Paris Cité (UPCité), Jewish General Hospital, Università degli Studi di Milano = University of Milan (UNIMI), Fribourg Cantonal Hospital, St. Olavs Hospital HF (St. Olav's University Hospital), Institut du Cancer de Montpellier (ICM), Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and KARLI, Mélanie
- Subjects
medicine.medical_specialty ,reduced food intake ,Canada ,Cachexia ,[SDV]Life Sciences [q-bio] ,Diseases of the musculoskeletal system ,malnutrition ,Gastroenterology ,cachexia ,Cancer ,Inflammation ,Malnutrition ,Reduced food intake ,Weight loss ,Cohort Studies ,Eating ,Humans ,Weight Loss ,Neoplasms ,Physiology (medical) ,Internal medicine ,medicine ,Clinical endpoint ,cancer ,Orthopedics and Sports Medicine ,Performance status ,Proportional hazards model ,business.industry ,Weight change ,QM1-695 ,Original Articles ,medicine.disease ,[SDV] Life Sciences [q-bio] ,RC925-935 ,inflammation ,Human anatomy ,Original Article ,medicine.symptom ,weight loss ,business ,Cohort study - Abstract
International audience; Background: Cancer-associated weight loss (WL) associates with increased mortality. International consensus suggests that WL is driven by a variable combination of reduced food intake and/or altered metabolism, the latter often represented by the inflammatory biomarker C-reactive protein (CRP). We aggregated data from Canadian and European research studies to evaluate the associations of reduced food intake and CRP with cancer-associated WL (primary endpoint) and overall survival (OS, secondary endpoint).Methods: The data set included a total of 12,253 patients at risk for cancer-associated WL. Patient-reported WL history (% in 6 months) and food intake (normal, moderately, or severely reduced) were measured in all patients; CRP (mg/L) and OS were measured in N = 4960 and N = 9952 patients, respectively. All measures were from a baseline assessment. Clinical variables potentially associated with WL and overall survival (OS) including age, sex, cancer diagnosis, disease stage, and performance status were evaluated using multinomial logistic regression MLR and Cox proportional hazards models, respectively.Results: Patients had a mean weight change of -7.3% (±7.1), which was categorized as: ±2.4% (stable weight; 30.4%), 2.5-5.9% (19.7%), 6.0-10.0% (23.2%), 11.0-14.9% (12.0%), ≥15.0% (14.6%). Normal food intake, moderately, and severely reduced food intake occurred in 37.9%, 42.8%, and 19.4%, respectively. In MLR, severe WL (≥15%) (vs. stable weight) was more likely (P < 0.0001) if food intake was moderately [OR 6.28, 95% confidence interval (CI 5.28-7.47)] or severely reduced [OR 18.98 (95% CI 15.30-23.56)]. In subset analysis, adjusted for food intake, CRP was independently associated (P < 0.0001) with ≥15% WL [CRP 10-100 mg/L: OR 2.00, (95% CI 1.58-2.53)] and [CRP > 100 mg/L: OR 2.30 (95% CI 1.62-3.26)]. Diagnosis, stage, and performance status, but not age or sex, were significantly associated with WL. Median OS was 9.9 months (95% CI 9.5-10.3), with median follow-up of 39.7 months (95% CI 38.8-40.6). Moderately and severely reduced food intake and CRP independently predicted OS (P < 0.0001).Conclusions: Modelling WL as the dependent variable is an approach that can help to identify clinical features and biomarkers associated with WL. Here, we identify criterion values for food intake impairment and CRP that may improve the diagnosis and classification of cancer-associated cachexia.
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- 2021
29. Natural ghrelin in advanced cancer patients with cachexia, a case series
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Florian Strasser, David Blum, Thomas Hundsberger, Susanne de Wolf-Linder, Michael Brändle, Rolf Oberholzer, University of Zurich, and Blum, David
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Male ,0301 basic medicine ,medicine.medical_specialty ,Cachexia ,media_common.quotation_subject ,Appetite ,610 Medicine & health ,Diseases of the musculoskeletal system ,Gastroenterology ,616: Innere Medizin und Krankheiten ,Eating ,03 medical and health sciences ,0302 clinical medicine ,2732 Orthopedics and Sports Medicine ,2737 Physiology (medical) ,Growth hormone secretagogue ,Neoplasms ,Physiology (medical) ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,media_common ,business.industry ,QM1-695 ,digestive, oral, and skin physiology ,Cancer cachexia ,Muscle mass ,Original Articles ,Middle Aged ,medicine.disease ,Advanced cancer ,10044 Clinic for Radiation Oncology ,Ghrelin ,030104 developmental biology ,RC925-935 ,Tolerability ,030220 oncology & carcinogenesis ,Human anatomy ,Toxicity ,Original Article ,Corrigendum ,business - Abstract
BACKGROUND Natural ghrelin, a peptide growth hormone secretagogue, has a therapeutic potential in cachexia. We designed a dose-finding trial of subcutaneous natural ghrelin to improve nutritional intake (NI) in advanced cancer patients. METHODS Advanced cancer patients with cachexia management (symptom management, physiotherapy, nutritional, and psychosocial support) started with ghrelin at 32 μg/kg body weight, followed by 50% dose increases. Patients self-injected ghrelin twice daily for 4 days followed by a wash-out period. After reaching the primary endpoint, maximal NI (minimal dose for maximal NI), a maintenance period followed during which patients injected 10 doses of ghrelin per week. Safety parameters, NI, and cachexia outcomes (symptoms, narratives, muscle mass, and strength) were measured over 6 weeks. RESULTS Ten patients with metastatic solid tumours were included, and six (100% male, mean age 61.8 ± 8.5 SD) received ghrelin. Minimal dose for maximal NI was reached in four patients. Three patients reached the end-of study visit. Ghrelin was well tolerated with variable results on appetite and eating-related symptoms but a positive effect in the narratives. Mean Functional Assessment of Appetite & Cachexia Therapy score was 6.8 points lower at final measurement compared with baseline, t(5) = 5.98, P
- Published
- 2021
30. Sarcopenia: A Time for Action. An SCWD Position Paper
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Annemie M. W. J. Schols, Steven B. Heymsfield, Florian Strasser, Vickie E. Baracos, Wolfram Doehner, Carla M. Prado, Luigi Ferrucci, Andrew J.S. Coats, Elsa Dent, Michelangelo Mancuso, Maurizio Muscaritoli, Alfonso J. Cruz-Jentoft, Stephan von Haehling, Kamyar Kalantar-Zadeh, Francesco Landi, John E. Morley, Aminah Jatoi, Stefan D. Anker, Juergen M. Bauer, Alessandro Laviano, Mitja Lainscak, Jeffrey Crawford, Pulmonologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health
- Subjects
0301 basic medicine ,Sarcopenia ,lcsh:Diseases of the musculoskeletal system ,Cachexia ,Disease ,Geriatric assessment ,Muscle ,Skeletal ,Muscle strength ,DOUBLE-BLIND ,Grip strength ,0302 clinical medicine ,Orthopedics and Sports Medicine ,VITAMIN-D ,Wasting ,ULTRASOUND ,PHYSICAL FUNCTION ,COPD ,education.field_of_study ,Disease Management ,lcsh:Human anatomy ,musculoskeletal system ,CANCER ,3. Good health ,030220 oncology & carcinogenesis ,Practice Guidelines as Topic ,Position Paper ,Disease Susceptibility ,medicine.symptom ,medicine.medical_specialty ,Population ,CACHEXIA SYNDROME ,lcsh:QM1-695 ,SKELETAL-MUSCLE MASS ,03 medical and health sciences ,Physical medicine and rehabilitation ,Physiology (medical) ,medicine ,Vitamin D and neurology ,Humans ,OLDER-ADULTS ,education ,business.industry ,Settore MED/09 - MEDICINA INTERNA ,medicine.disease ,body regions ,INTERNATIONAL-CONFERENCE ,030104 developmental biology ,CLINICAL-PRACTICE ,lcsh:RC925-935 ,business ,human activities - Abstract
The term sarcopenia was introduced in 1988. The original definition was a “muscle loss” of the appendicular muscle mass in the older people as measured by dual energy x‐ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC‐F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease‐related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age‐related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age‐related and disease‐related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life‐long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.
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- 2019
31. Orphan disease status of cancer cachexia in the USA and in the European Union: a systematic review
- Author
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Maurizio Muscaritoli, Stephan von Haehling, Ulf Landmesser, Stefan D. Anker, Florian Strasser, Andrew J. S. Coats, Wilhelm Haverkamp, John E. Morley, Markus S. Anker, Aminah Jatoi, and Richard Holcomb
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Cachexia ,Colorectal cancer ,Epidemiology ,lcsh:QM1-695 ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Breast cancer ,Physiology (medical) ,Internal medicine ,Pancreatic cancer ,medicine ,Prevalence ,media_common.cataloged_instance ,Orthopedics and Sports Medicine ,European Union ,European union ,Thyroid cancer ,USA ,media_common ,business.industry ,Cancer ,lcsh:Human anatomy ,Original Articles ,medicine.disease ,3. Good health ,030104 developmental biology ,Orphan disease ,030220 oncology & carcinogenesis ,Original Article ,lcsh:RC925-935 ,business - Abstract
Background Cachexia has significant impact on the patients' quality of life and prognosis. It is frequently observed in patients with cancer, especially in advanced stages, but prevalence data for the overall population are lacking. Good quality estimates of cancer cachexia in general and for each of the major cancer types would be highly relevant for potential treatment development efforts in this field. Both the USA and European Union (EU) have implemented special clinical development rules for such rare disorders what are called ‘orphan diseases’. The cut‐off level for a disease to be considered an orphan disease in the USA is 200 000 people (0.06% of the population) and EU is 5 per 10 000 people (0.05% of the population). Methods For this systematic review, we searched at PubMed (from inception to 31 January 2018) to identify clinical studies that assessed the prevalence of cachexia in cancer patients at risk. Studies reporting the prevalence of either cancer cachexia or wasting disease in the top‐10 cancer types and 4 other selected cancer types known to be particularly commonly complicated by cachexia were included in this analysis (i.e. prostate cancer, breast cancer, colorectal cancer, melanoma, endometrial cancer, thyroid cancer, urinary bladder cancer, non‐hodgkin lymphoma, lung cancer, kidney and renal pelvis cancer, head and neck cancer, gastric cancer, liver cancer, and pancreatic cancer). We calculated the current burden of cancer cachexia, disease by disease, in the USA and in the EU and compared them to the current guidelines for the definition of orphan disease status. Results We estimate that in 2014 in the USA, a total of 527 100 patients (16.5 subjects per 10 000 people of the total population), and in 2013 in the EU, a total of 800 300 patients (15.8 subjects per 10 000 people of the total population) suffered from cancer cachexia (of any kind). In the 14 separately analysed cancer types, the prevalence of cancer cachexia in the USA ranged between 11 300 (0.4/10 000, gastric cancer) and 92 000 patients (2.9/10 000, lung cancer) and in the EU between 14 300 (0.3/10 000, melanoma of the skin) and 150 100 (3.0/10 000, colorectal cancer). Conclusions The absolute number of patients affected by cancer cachexia in each cancer group is lower than the defined thresholds for orphan diseases in the USA and EU. Cancer cachexia in each subgroup separately should be considered an orphan disease.
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- 2019
32. Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non‐small‐cell lung cancer
- Author
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Teiko Yamaguchi, Taro Okayama, Ayumu Morikawa, Koichi Takayama, Tetsuya Tsuji, Satoru Miura, Takashi Higashiguchi, Tateaki Naito, Katsuhiro Omae, Shuichi Mitsunaga, Akio Inui, Naoharu Mori, Florian Strasser, Toshimi Inano, Noriatsu Tatematsu, Keita Mori, Toshiaki Takahashi, and Takako Mouri
- Subjects
0301 basic medicine ,Male ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Lung Neoplasms ,Psychological intervention ,Phases of clinical research ,lcsh:QM1-695 ,03 medical and health sciences ,0302 clinical medicine ,Elderly ,Physiology (medical) ,Pancreatic cancer ,Internal medicine ,Carcinoma, Non-Small-Cell Lung ,medicine ,Clinical endpoint ,Humans ,Orthopedics and Sports Medicine ,Adverse effect ,Lung cancer ,Muscle, Skeletal ,Aged ,Aged, 80 and over ,business.industry ,Physical activity ,Cancer ,Non‐small‐cell lung cancer ,Cancer cachexia ,lcsh:Human anatomy ,Original Articles ,medicine.disease ,Confidence interval ,Exercise Therapy ,Pancreatic Neoplasms ,030104 developmental biology ,Nutrition Assessment ,Physical Fitness ,030220 oncology & carcinogenesis ,Multimodal intervention ,Feasibility Studies ,Original Article ,Female ,Nutrition Therapy ,lcsh:RC925-935 ,business - Abstract
Background Combinations of exercise and nutritional interventions might improve the functional prognosis for cachectic cancer patients. However, high attrition and poor compliance with interventions limit their efficacy. We aimed to test the feasibility of the early induction of new multimodal interventions specific for elderly patients with advanced cancer Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC) programme. Methods This was a multicentre prospective single‐arm study. We recruited 30 of 46 screened patients aged ≥70 years scheduled to receive first‐line chemotherapy for newly diagnosed, advanced pancreatic, or non‐small‐cell lung cancer. Physical activity was measured using pedometers/accelerometer (Lifecorder®, Suzuken Co., Ltd., Japan). An 8 week educational intervention comprised three exercise and three nutritional sessions. The exercise interventions combined home‐based low‐intensity resistance training and counselling to promote physical activity. Nutritional interventions included standard nutritional counselling and instruction on how to manage symptoms that interfere with patient's appetite and oral intake. Supplements rich in branched‐chain amino acids (Inner Power®, Otsuka Pharmaceutical Co., Ltd., Japan) were provided. The primary endpoint of the study was feasibility, which was defined as the proportion of patients attending ≥4 of six sessions. Secondary endpoints included compliance and safety. Results The median patient age was 75 years (range, 70–84). Twelve patients (40%) were cachectic at baseline. Twenty‐nine patients attended ≥4 of the six planned sessions (96.7%, 95% confidence interval, 83.3 to 99.4). One patient dropped out due to deteriorating health status. The median proportion of days of compliance with supplement consumption and exercise performance were 99% and 91%, respectively. Adverse events possibly related to the NEXTAC programme were observed in five patients and included muscle pain (Grade 1 in two patients), arthralgia (Grade 1 in one patient), dyspnoea on exertion (Grade 1 in one patient), and plantar aponeurositis (Grade 1 in one patient). Conclusions The early induction of multimodal interventions showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non‐small‐cell lung cancer receiving concurrent chemotherapy. We are now conducting a randomized phase II study to measure the impact of these interventions on functional prognosis.
- Published
- 2018
33. Management of Cancer-Related Fatigue
- Author
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Florian Strasser
- Subjects
medicine.medical_specialty ,Massage ,medicine.diagnostic_test ,Strength training ,business.industry ,Psychological intervention ,Physical exercise ,Acupressure ,Neuropsychological test ,medicine ,Physical therapy ,medicine.symptom ,business ,Cancer-related fatigue ,Depression (differential diagnoses) - Abstract
Fatigue is the leading symptom of cancer survivors with a substantial risk of disability. Patients shall be screened in routine care by simple assessment tools for fatigue (e.g., ESAS), then assessed for impact of fatigue (e.g., Brief Fatigue Inventory) and of fatigue domains (e.g., Single-Item-Fatigue), and finally a list of possible reversible causes for fatigue shall be checked and treated (e.g., dehydration, hypercalcemia, hypothyroidism, anemia, depression). Then a diagnosis of cancer-related fatigue (CRF) shall be made, using the DICRFS (Diagnostic Interview for Cancer Related Fatigue), and a neuropsychological test considered. For the management of CRF and the appraisal to evidence, it is crucial to separate cancer-treatment related fatigue (CtrF) and cancer-disease related fatigue (cancer [pre-] cachexia). Management of CRF shall be multimodal delivered by transprofessional working team members and include (a) physical exercise (endurance- and strength training), (b) nutrition with protein-rich diet and secondary preventive, (c) psychological and creative therapies to cope with disability, trauma, and (unconscious) emotions, (d) physical therapies (e.g., massage, acupressure), (e) MBSR-based and Mind-Body interventions (e.g., yoga, mindfulness meditation, body scan, PMR, conscious breathing), (f) energy conservation and self-management enhancing psychoeducative and cognitive-behavioral interventions, (g) social work support, and (h) considering pharmacological treatment in few selected indications. The evidence for such a full multimodal intervention is still scarce since such complex trials are missing. The probably most effective CRF interventions are physical exercise and psychological interventions.
- Published
- 2021
34. Definition of Survivorship Care
- Author
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Florian Strasser
- Subjects
Cancer survivorship ,Cancer survivor ,medicine.medical_specialty ,Palliative care ,business.industry ,Cancer ,Institute of medicine ,medicine.disease ,humanities ,Anticancer treatment ,Survivorship curve ,medicine ,Incurable cancer ,Intensive care medicine ,business ,human activities - Abstract
The evolution of the term cancer survivor moved from a mainly prognosis- and catastrophe-(Hiroshima) based term to a more patient-needs-based term, driven by a physician experiencing cancer, who cofounded the National Coalition for Cancer Survivorship 1986. The Institute of Medicine report 2006 boosted cancer survivorship research and clinical projects. Unfortunately, the evidence that the promoted cancer survivorship plans are efficient is still lacking. In the last years, awareness is rising that patients confronted with metastatic cancer may also experience survivors needs; however, metastatic survivorship overlaps largely with early integrated palliative care. The ESMO/ECPC definition of a cancer survivor does not include the acute anticancer treatment period(s) nor the advanced, symptomatic, and terminal phase, this in contrast to non-European definitions. The ESMO/ECPC definition includes a) survivors cured without anticancer treatment, b) survivors with anticancer (adjuvant) treatment in curative intent, and c) survivors with well-controlled incurable cancer with or without anticancer treatment. This definition may guide effective cancer survivorship care tackling survivors’ needs effectively.
- Published
- 2021
35. Tools for guiding interventions to address patient-perceived multidimensional unmet healthcare needs in palliative care: systematic literature review
- Author
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Florian Strasser, David Blum, Ellie B Schmidt, Mathias Schlögl, Franzisca Domeisen Benedetti, University of Zurich, and Schmidt, Ellie B
- Subjects
Palliative care ,11221 Clinic for Geriatric Medicine ,Psychological intervention ,Medicine (miscellaneous) ,Context (language use) ,610 Medicine & health ,616: Innere Medizin und Krankheiten ,Unmet needs ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Intervention (counseling) ,Health care ,Medicine ,030212 general & internal medicine ,Oncology (nursing) ,business.industry ,2701 Medicine (miscellaneous) ,General Medicine ,10044 Clinic for Radiation Oncology ,610.73: Pflege ,Medical–Surgical Nursing ,Systematic review ,030220 oncology & carcinogenesis ,business ,2917 Oncology (nursing) ,Inclusion (education) ,2914 Medical and Surgical Nursing - Abstract
ContextThe unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs.ObjectiveIdentify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease.MethodsWe conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool’s relationship to delivering defined palliative interventions, and the number of palliative care domains covered.ResultsThe majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research.ConclusionA new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.
- Published
- 2020
36. [Cancer Rehabilitation: integrated in the care pathways of modern oncology]
- Author
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Florian, Strasser
- Subjects
Neoplasms ,Physicians ,Psycho-Oncology ,Humans ,Medical Oncology - Abstract
Cancer Rehabilitation: integrated in the care pathways of modern oncology
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- 2020
37. Meaning in life and quality of life: palliative care patients versus the general population
- Author
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Claudia Gamondi, Gian Domenico Borasio, Mathieu Bernard, André Berchtold, and Florian Strasser
- Subjects
Gerontology ,education.field_of_study ,Palliative care ,Oncology (nursing) ,Visual analogue scale ,business.industry ,Population ,Medicine (miscellaneous) ,General Medicine ,Telephone survey ,03 medical and health sciences ,Medical–Surgical Nursing ,0302 clinical medicine ,Quality of life (healthcare) ,Life evaluation ,030220 oncology & carcinogenesis ,Medicine ,030212 general & internal medicine ,Meaning (existential) ,Spiritual care ,education ,business - Abstract
Background and objectivesMeaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL).MethodsA cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a single-item visual analogue scale (0–10). Sociodemographic variables were controlled for in the analyses.Results206 patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both populations even if the difference was significant (patients 81.9 vs general population 87, pConclusionsOur data emphasise the importance of MIL as a contributor to QOL in both populations. It highlights the importance of the life areas contributing to MIL, especially social interactions for both populations, and spirituality and areas related to growth in palliative care patients.
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- 2020
38. Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide
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Tristan Cudennec, E Carola, Fabio Gomes, Florian Scotté, P Dielenseger, S Knox, Florian Strasser, and P Bossi
- Subjects
Gerontology ,medicine.medical_specialty ,Consensus ,Advisory Committees ,MEDLINE ,Survivorship ,Medical Oncology ,Quality-of-life (QoL) ,03 medical and health sciences ,Elderly ,0302 clinical medicine ,Cancer Survivors ,Older patients ,Quality of life ,Medical ,Neoplasms ,Survivorship curve ,80 and over ,medicine ,Humans ,Cancer ,Older ,Oncology ,Age Factors ,Aged ,Aged, 80 and over ,Geriatric Assessment ,Geriatrics ,Societies, Medical ,Quality of Life ,030212 general & internal medicine ,Set (psychology) ,business.industry ,Hematology ,medicine.disease ,humanities ,Geriatric oncology ,030220 oncology & carcinogenesis ,Societies ,business - Abstract
Around 60% of people living with cancer are aged 65 years or older. Older cancer patients face a unique set of age-associated changes, comorbidities and circumstances that impact on their quality of life (QoL) in ways that are different from those affecting younger patients. A Task Force of the International Society of Geriatric Oncology recommends and encourages all healthcare professionals involved in cancer care to place greater focus on the QoL of older people living with cancer. This paper summarizes current thinking on the key issues of importance to addressing QoL needs of older cancer patients and makes a series of recommendations, together with practical guidance.
- Published
- 2018
39. ESPEN expert group recommendations for action against cancer-related malnutrition
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Arved Weimann, Peter Vaupel, Donald C. McMillan, Alessandro Laviano, Matthias Pirlich, Jann Arends, Hartmut Bertz, Federico Bozzetti, Philip C. Calder, M.A.E. de van der Schueren, Johann Ockenga, N. Erickson, Dileep N. Lobo, Maurizio Muscaritoli, Florian Strasser, Vickie E. Baracos, Nicolaas E. P. Deutz, Michael P. Lisanti, and A. Van Gossum
- Subjects
0301 basic medicine ,Sarcopenia ,medicine.medical_specialty ,Cachexia ,Nutritional Status ,Anorexia ,Clinical nutrition ,Disease ,Critical Care and Intensive Care Medicine ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Terminology as Topic ,Prevalence ,medicine ,Humans ,Resting energy expenditure ,Intensive care medicine ,Exercise ,Cancer ,Nutritional intervention ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Malnutrition ,Nutritional Support ,business.industry ,Nutritional Requirements ,Health Care Costs ,medicine.disease ,Diet ,Nutrition Assessment ,030220 oncology & carcinogenesis ,Body Composition ,Position paper ,medicine.symptom ,business ,Body mass index - Abstract
Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
- Published
- 2017
40. Patterns of integrating palliative care into standard oncology in an early ESMO designated center: a 10-year experience
- Author
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David Blum, E. Schmidt, Matea Pavic, Annina Seiler, Florian Strasser, University of Zurich, and Blum, D
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Oncology ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Specialty ,integration ,610 Medicine & health ,Medical Oncology ,Cohort Studies ,Neoplasms ,Internal medicine ,medicine ,Humans ,1306 Cancer Research ,In patient ,Original Research ,Accreditation ,Patterns of care ,business.industry ,Palliative Care ,10044 Clinic for Radiation Oncology ,Integrated care ,designated center ,Hospice and Palliative Care Nursing ,Cohort ,2730 Oncology ,Active treatment ,Corrigendum ,business - Abstract
Background Integration of specialist palliative care (PC) into standard oncology care is recommended. This study investigated how integration at the Cantonal Hospital St. Gallen (KSSG) was manifested 10 years after initial accreditation as a European Society for Medical Oncology (ESMO) Designated Center (ESMO-DC) of Integrated Oncology and Palliative Care. Methods A chart review covering the years 2006-2009 and 2016 was carried out in patients with an incurable malignancy receiving PC. Visual graphic analysis was utilized to identify patterns of integration of PC into oncology based on the number and nature of medical consultations recorded for both specialties. A follow-up cohort collected 10 years later was analyzed and changes in patterns of integrating specialist PC into oncology were compared. Results Three hundred and forty-five patients from 2006 to 2009 and 64 patients from 2016 were included into analyses. Four distinct patterns were identified using visual graphic analysis. The ‘specialist PC-led pattern’ (44.9%) and the ‘oncology-led pattern’ (20.3%) represent disciplines that took primary responsibility for managing patients, with occasional and limited involvement from other disciplines. Patients in the ‘concurrent integrated care pattern’ (18.3%) had medical consultations that frequently bounced between specialist PC and oncology. In the ‘segmented integrated care pattern’ (16.5%), patients had sequences of continuous consultations provided by one discipline before alternating to a stretch of consultations provided by the other specialty. In the 2016 follow-up, while the ‘oncology-led pattern’ occurred significantly less frequently relative to the ‘specialist PC-led pattern’ and the ‘segmented integrated care pattern’, the ‘concurrent integrated care pattern’ emerged more frequently when compared with the 2006-2009 follow-up. Conclusion The ‘specialist PC-led pattern’ was the most prominent pattern in this data. The 2016 follow-up showed that a growing number of patients received a collaborative pattern of care, indicating that integration of specialist PC into standard oncology can manifest as either segmented or concurrent care pathways. Our data suggest a closer, more dynamic and flexible collaboration between oncology and specialist PC early in the disease course of patients with advanced cancer and concurrent with active treatment., Highlights • Specialist palliative care into oncology was evaluated in an ESMO Designated Center 10 years following accreditation. • In the 2016 follow-up, there was a significant increase of integrative procedures implemented in clinical practice. • Notwithstanding, 20% of patients with incurable cancer did not receive specialist palliative care with concurrent treatment of cancer. • There is a persisting need to overcome barriers to early palliative care in medical oncology.
- Published
- 2021
41. The ‘critical mass’ survey of palliative care programme at ESMO designated centres of integrated oncology and palliative care
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Nicola Jane Latino, Nathan I. Cherny, David Hui, and Florian Strasser
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Oncology ,medicine.medical_specialty ,Internationality ,Palliative care ,Oncology clinic ,Cancer Care Facilities ,Medical Oncology ,Tertiary care ,Special Article ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Surveys and Questionnaires ,Internal medicine ,Acute care ,medicine ,Humans ,030212 general & internal medicine ,Accreditation ,Response rate (survey) ,Delivery of Health Care, Integrated ,business.industry ,Palliative Care ,Hematology ,Advanced cancer ,030220 oncology & carcinogenesis ,Family medicine ,Emergency medicine ,Workforce ,business ,Program Evaluation - Abstract
Background The ESMO Designated Centres (ESMO-DCs) of Integrated Oncology and Palliative Care (PC) Incentive Programme has grown steadily. We aimed to characterise the level of PC clinical services, education and research at ESMO-DCs. Methods We sent all 184 ESMO-DCs an electronic survey consisting of 78 questions examining the DC characteristics, palliative care clinical programme (structure, processes, and outcomes), primary PC delivery by oncologists, education, research and attitudes and beliefs towards the ESMO-DC programme. Results The response rate was 83% (152/184). 115 (76%) ESMO-DCs were from Europe, 87 (57%) were tertiary care centres. 136 (90%) had inpatient consultation teams, 135 (89%) had outpatient PC clinics, 107 (71%) had dedicated acute care beds, and 75 (50%) offered community-based PC. An estimated 70% (interquartile range [IQR] 28–80%) of patients with advanced cancer had a PC consultation before death, occurring 90 days before death (median, IQR 40–150 days) for outpatients and 21 days (IQR 14–45 days) for inpatients. 59 (39%) offered PC fellowship programme; 47 (32%) had mandatory PC rotations for oncology fellows. Ninety-nine (65%) had double-boarded palliative oncologists. 118 (78%) of the ESMO-DCs reported that routine symptom screening was offered in the oncology clinic and 30% of patients had documented end-of-life discussions by their oncologists. Most centres (>80%) perceived the ESMO-DC programme to increase their status. Conclusions The ESMO-DCs had a high level of PC infrastructure and provided access to a large proportion of patients with advanced cancer. The survey supports that the 13 criteria required for ESMO designation set a robust framework for integration, stimulated investment of resources into some palliative care programmes prior to accreditation, and raised the interest about palliative care among clinicians, trainees and patients.
- Published
- 2017
42. Fear, Pain, Denial, and Spiritual Experiences in Dying Processes
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M. Schuett Mao, B. Traichel, O. Reichmuth, Malte Renz, Florian Strasser, D. Bueche, and Thomas Cerny
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Adult ,Male ,Attitude to Death ,Psychotherapist ,media_common.quotation_subject ,Pain ,03 medical and health sciences ,0302 clinical medicine ,Denial ,existential suffering ,Spirituality ,near-death experiences ,Humans ,030212 general & internal medicine ,end-of-life care ,Aged ,media_common ,Aged, 80 and over ,Patient Care Team ,Dying processes ,deathbed phenomena ,Terminal Care ,states of consciousness ,Palliative Care ,Original Articles ,Fear ,General Medicine ,Middle Aged ,spirituality ,spiritual care ,030220 oncology & carcinogenesis ,fears of death and dying ,Female ,Spiritual care ,Consciousness ,Psychology ,End-of-life care ,Switzerland ,Clinical psychology - Abstract
Purpose: Approaching death seems to be associated with physiological/spiritual changes. Trajectories including the physical–psychological–social–spiritual dimension have indicated a terminal drop. Existential suffering or deathbed visions describe complex phenomena. However, interrelationships between different constituent factors (e.g., fear and pain, spiritual experiences and altered consciousness) are largely unknown. We lack deeper understanding of patients’ inner processes to which care should respond. In this study, we hypothesized that fear/pain/denial would happen simultaneously and be associated with a transformation of perception from ego-based (pre-transition) to ego-distant perception/consciousness (post-transition) and that spiritual (transcendental) experiences would primarily occur in periods of calmness and post-transition. Parameters for observing transformation of perception (pre-transition, transition itself, and post-transition) were patients’ altered awareness of time/space/body and patients’ altered social connectedness. Method: Two interdisciplinary teams observed 80 dying patients with cancer in palliative units at 2 Swiss cantonal hospitals. We applied participant observation based on semistructured observation protocols, supplemented by the list of analgesic and psychotropic medication. Descriptive statistical analysis and Interpretative Phenomenological Analysis (IPA) were combined. International interdisciplinary experts supported the analysis. Results: Most patients showed at least fear and pain once. Many seemed to have spiritual experiences and to undergo a transformation of perception only partly depending on medication. Line graphs representatively illustrate associations between fear/pain/denial/spiritual experiences and a transformation of perception. No trajectory displayed uninterrupted distress. Many patients seemed to die in peace. Previous near-death or spiritual/mystical experiences may facilitate the dying process. Conclusion: Approaching death seems not only characterized by periods of distress but even more by states beyond fear/pain/denial.
- Published
- 2017
43. Automatic referral to standardize palliative care access: an international Delphi survey
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Florian Strasser, Tiina Saarto, Nathan I. Cherny, Masanori Mori, Sharon Watanabe, Eduardo Bruera, Yee Choon Meng, Augusto Caraceni, Stein Kaasa, Paul Glare, David Hui, Clinicum, Department of Oncology, University of Helsinki, and HUS Comprehensive Cancer Center
- Subjects
Male ,Standards ,medicine.medical_specialty ,Consensus ,Quality management ,Palliative care ,Delphi Technique ,Referral ,3122 Cancers ,Delphi method ,Health Services Accessibility ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Neoplasms ,Surveys and Questionnaires ,Outpatients ,medicine ,Humans ,030212 general & internal medicine ,Referral and Consultation ,computer.programming_language ,Response rate (survey) ,business.industry ,Nursing research ,Palliative Care ,RANDOMIZED CONTROLLED-TRIAL ,Quality Improvement ,3. Good health ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,ADVANCED CANCER ,Female ,business ,Critical pathways ,INTEGRATION ,computer ,Delphi - Abstract
Palliative care referral is primarily based on clinician judgment, contributing to highly variable access. Standardized criteria to trigger automatic referral have been proposed, but it remains unclear how best to apply them in practice. We conducted a Delphi study of international experts to identify a consensus for the use of standardized criteria to trigger automatic referral. Sixty international experts stated their level of agreement for 14 statements regarding the use of clinician-based referral and automatic referral over two Delphi rounds. A consensus was defined as an agreement of ae70% a priori. The response rate was 59/60 (98%) for the first round and 56/60 (93%) for the second round. Twenty-six (43%), 19 (32%), and 11 (18%) respondents were from North America, Asia/Australia, and Europe, respectively. The panel reached consensus that outpatient palliative care referral should be based on both automatic referral and clinician-based referral (agreement = 86%). Only 18% felt that referral should be clinician-based alone, and only 7% agreed that referral should be based on automatic referral only. There was consensus that automatic referral criteria may increase the number of referrals (agreement = 98%), facilitate earlier palliative care access, and help administrators to set benchmarks for quality improvement (agreement = 86%). Our panelists favored the combination of automatic referral to augment clinician-based referral. This integrated referral framework may inform policy and program development.
- Published
- 2017
44. The applicability of a weight loss grading system in cancer cachexia: a longitudinal analysis
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Ola Magne Vagnildhaug, Peter Fayers, David Blum, Florian Strasser, Barry Laird, Andrew Wilcock, Vickie E. Baracos, Stein Kaasa, Marianne Jensen Hjermstad, and Tora Skeidsvoll Solheim
- Subjects
0301 basic medicine ,Oncology ,medicine.medical_specialty ,business.industry ,Proportional hazards model ,Cancer ,Cancer cachexia ,Anorexia ,medicine.disease ,Cachexia ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Weight loss ,030220 oncology & carcinogenesis ,Physiology (medical) ,Internal medicine ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,medicine.symptom ,Stage (cooking) ,business ,Body mass index - Abstract
Background A body mass index (BMI) adjusted weight loss grading system (WLGS) is related to survival in patients with cancer. The aim of this study was to examine the applicability of the WLGS by confirming its prognostic validity, evaluating its relationship to cachexia domains, and exploring its ability to predict cachexia progression. Methods An international, prospective observational study of patients with incurable cancer was conducted. For each patient, weight loss grade was scored 0–4. Weight loss grade 0 represents a high BMI with limited weight loss, progressing through to weight loss grade 4 representing low BMI and a high degree of weight loss. Survival analyses were used to confirm prognostic validity. Analyses of variance were used to evaluate the relationship between the WLGS and cachexia domains [anorexia, dietary intake, Karnofsky performance status (KPS), and physical and emotional functioning]. Cox regression was used to evaluate if the addition of cachexia domains to the WLGS improved prognostic accuracy. Predictive ability of cachexia progression was assessed by estimating proportion of patients progressing to a more advanced weight loss grade. Results One thousand four hundred six patients were analysed (median age 66 years; 50% female, 63% KPS ≤ 70). The overall effect of the WLGS on survival was significant as expressed by change in −2 log likelihood (P < 0.001) and persisted after adjustment for age, sex, and cancer type and stage (P < 0.001). Median survival decreased across the weight loss grades ranging from 407 days (95% CI 312–502)—weight loss grade 0 to 119 days (95% CI 93–145)—weight loss grade 4. All cachexia domains significantly deteriorated with increasing weight loss grade, and deterioration was greatest for dietary intake, with a difference corresponding to 0.87 standard deviations between weight loss grades 0 and 4. The addition of KPS, anorexia, and physical and emotional functioning improved the prognostic accuracy of the WLGS. Likelihood of cachexia progression was greater in patients with weight loss grade 2 (39%) than that with weight loss grade 0 (19%) or 1 (22%). Conclusions The WLGS is related to survival, cachexia domains, and the likelihood of progression. Adding certain cachexia domains to the WLGS improves prognostic accuracy.
- Published
- 2017
45. Referral criteria for outpatient specialty palliative cancer care: an international consensus
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Florian Strasser, Nathan I. Cherny, Eduardo Bruera, Sharon Watanabe, Augusto Caraceni, Stein Kaasa, Masanori Mori, David Hui, Tiina Saarto, and Paul Glare
- Subjects
medicine.medical_specialty ,Consensus ,Palliative care ,Delphi Technique ,Referral ,Specialty ,MEDLINE ,Delphi method ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Neoplasms ,Outpatients ,medicine ,Humans ,030212 general & internal medicine ,Referral and Consultation ,business.industry ,Palliative Care ,3. Good health ,Distress ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Medicine ,Delirium ,medicine.symptom ,business - Abstract
Summary Although outpatient specialty palliative-care clinics improve outcomes, there is no consensus on who should be referred or the optimal timing for referral. In response to this issue, we did a Delphi study to develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care. 60 international experts (26 from North America, 19 from Asia and Australia, and 11 from Europe) on palliative cancer care rated 39 needs-based criteria and 22 time-based criteria in three iterative rounds. Nearly all experts responded in each round. Consensus was defined by an a-priori agreement of 70% or more. Panellists reached consensus on 11 major criteria for referral: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor criteria for specialist palliative-care referral. These criteria, if validated, could provide guidance for identification of patients suitable for outpatient specialty palliative care.
- Published
- 2016
46. Meaning in life and quality of life: comparison between palliative care patients and a representative sample of the Swiss population
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Mathieu Bernard, André Berchtold, Florian Strasser, Claudia Gamondi, and Gian Domenico Borasio
- Abstract
Background and objectives Existential areas, and in particular the concept of meaning in life, represent a key topic in palliative care. The aims of this study are to explore (i) the differences in perceived meaning in life (MIL) and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (ii) to what extent MIL can be considered as a significant predictor of quality of life (QOL) in the two populations. Methods A cross sectional study was conducted separately for the patients (face-to-face interviews) and the representative sample of the Swiss population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a with a single item visual analogue scale (0-10). Socio-demographic variables were controlled for in the analyses. Results 206 palliative care patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both population even if the difference was significant (patients 81.9 vs general population 87, p
- Published
- 2019
47. Refractory Cancer Cachexia
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Florian Strasser and David Blum
- Subjects
medicine.medical_specialty ,business.industry ,digestive, oral, and skin physiology ,Psychological intervention ,Physical function ,musculoskeletal system ,Refractory cancer ,medicine.disease ,Cachexia ,Discontinuation ,Refractory ,Weight loss ,Medicine ,medicine.symptom ,business ,Intensive care medicine ,Psychosocial ,hormones, hormone substitutes, and hormone antagonists - Abstract
Cachexia is a common cause of involuntary weight loss in advanced cancer. It is defined by muscle loss and leads to declined physical function. A classification of three stages (precachexia, cachexia and refractory cachexia) is proposed. Manifest cachexia requires both standard management and pharmacologic and nutritional interventions. Cachexia becomes refractory if the underlying disease is far advanced, rapidly progressive, and unresponsive to treatment, and catabolism so increased that weight loss management is not possible or indicated. Refractory cachexia can often only be diagnosed after a defined treatment attempt. The emotional and existential burden of the patients and their carers is often underestimated and can be overwhelming. In refractory cachexia therapeutic interventions focus on alleviating symptoms and avoiding complications. This often includes discontinuation of nutritional treatment attempts. Psychosocial counseling at this stage becomes essential.
- Published
- 2019
48. Enteral and parenteral nutrition in cancer patients, a comparison of complication rates: an updated systematic review and (cumulative) meta-analysis
- Author
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Carlo DeAngelis, Elisabeth Isenring, Ronald Chow, Henry Lam, Tian Yi Tang, Jann Arends, Egidio Del Fabbro, Leonard Chiu, Nicholas Chiu, Monica Krishnan, Michael Lock, Alex Molassiotis, Florian Strasser, Declan Walsh, Eduardo Bruera, and Stephanie Chan
- Subjects
Pediatrics ,medicine.medical_specialty ,Funnel plot ,Parenteral Nutrition ,Nutritional Status ,Clinical nutrition ,Infections ,Enteral administration ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Enteral Nutrition ,Randomized controlled trial ,Weight loss ,law ,Neoplasms ,Weight Loss ,medicine ,Humans ,030212 general & internal medicine ,Randomized Controlled Trials as Topic ,business.industry ,Publication bias ,Parenteral nutrition ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,medicine.symptom ,business - Abstract
Weight loss in cancer patients is a worrisome constitutional change predicting disease progression and shortened survival time. A logical approach to counter some of the weight loss is to provide nutritional support, administered through enteral nutrition (EN) or parenteral nutrition (PN). The aim of this paper was to update the original systematic review and meta-analysis previously published by Chow et al., while also assessing publication quality and effect of randomized controlled trials (RCTs) on the meta-conclusion over time. A literature search was carried out; screening was conducted for RCTs published in January 2015 up until December 2018. The primary endpoints were the percentage of patients achieving no infection and no nutrition support complications. Secondary endpoints included proportion of patients achieving no major complications and no mortality. Review Manager (RevMan 5.3) by Cochrane IMS and Comprehensive Meta-Analysis (version 3) by Biostat were used for meta-analyses of endpoints and assessment of publication quality. An additional seven studies were identified since our prior publication, leading to 43 papers included in our review. The results echo those previously published; EN and PN are equivalent in all endpoints except for infection. Subgroup analyses of studies only containing adults indicate identical risks across all endpoints. Cumulative meta-analysis suggests that meta-conclusions have remained the same since the beginning of publication time for all endpoints except for the endpoint of infection, which changed from not favoring to favoring EN after studies published in 1997. There was low risk of bias, as determined by assessment tool and visual inspection of funnel plots. The results support the current European Society of Clinical Nutrition and Metabolism guidelines recommending enteral over parenteral nutrition, when oral nutrition is inadequate, in adult patients. Further studies comparing EN and PN for these critical endpoints appear unnecessary, given the lack of change in meta-conclusion and low publication bias over the past decades.
- Published
- 2019
49. Impact of Theoretical Palliative Care Training for Oncology Residents in Romania
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Florian Strasser, Daniel Hishaw, Oana Predoiu, Laura Iosub, and Daniela Mosoiu
- Published
- 2019
50. Prognostic impact of polypharmacy and drug interactions in patients with advanced cancer
- Author
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Manuel Haschke, Christoph Driessen, Florian Strasser, Thomas Wälti, Beat Thürlimann, Markus Joerger, Alexander von Kameke, Holger Barth, Alexander Hoemme, Claudia Lehner, Stephan Krähenbühl, and Martin Früh
- Subjects
0301 basic medicine ,Drug ,Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Palliative care ,Lung Neoplasms ,media_common.quotation_subject ,Breast Neoplasms ,610 Medicine & health ,Toxicology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Internal medicine ,Carcinoma, Non-Small-Cell Lung ,Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Pharmacology (medical) ,Drug Interactions ,Lung cancer ,media_common ,Aged ,Retrospective Studies ,Pharmacology ,Polypharmacy ,Aged, 80 and over ,business.industry ,Palliative Care ,Cancer ,Drug interaction ,Middle Aged ,medicine.disease ,Prognosis ,Survival Rate ,030104 developmental biology ,030220 oncology & carcinogenesis ,Cohort ,Female ,business - Abstract
The risk of potential drug-drug interactions (PDI) is poorly studied in oncology. We included 105 patients with advanced non-small-cell lung cancer (NSCLC), 100 patients with advanced breast cancer (BC) and 100 patients of the palliative care unit (PCU) receiving systemic palliative treatment between 2010 and 2015. All patients suffered from advanced incurable cancer and received basic palliative care. PDI were assessed using the hospINDEX of all drugs approved in Switzerland in combination with a specific drug interaction software. Primary study objective was to assess the prognostic impact of PDI per patient cohort using Kaplan-Meier statistics. The median number of comedications was 5 (range 0-15). Major-risk PDI were detected in 74 patients (24.3%). The number of comedications was significantly associated with PDI (p 11 comedications. Median overall survival (OS) was 8.6 months in NSCLC, 33 months in BC and 1.2 months in PCU patients. PDI were significantly associated with inferior OS in BC (HR = 1.32, 95% CI 1.01-1.74, p = 0.049), but not in NSCLC (HR = 1.11, 95% CI 0.84-1.47, p = 0.45) or PCU (HR = 1.12, 95% CI 0.86-1.45, p = 0.41). PDI remained significantly associated with OS in BC (HR = 1.32, p = 0.049) in the adjusted model. In conclusion, PDI are frequent in patients with advanced cancer and increased caution with polypharmacy is warranted when treating such patients.
- Published
- 2019
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