Metastatic cancer patients hospitalized at initial diagnosis: when does rescue systemic therapy make sense?

Colin Vercueil,Romain Varnier, Romain Seban, Lisa Ciaptacz, Julien Pavillet, Cléa Fraisse, Tiffany Darbas, Safa Abdallahoui, David Cox,Sophie Martin,Philippe Trensz,Jean-Emmanuel Kurtz,Justine Gantzer, Shanti Amé,Carole Bouleuc,Gisèle Chvetzoff, Lauriane Eberst

crossref(2024)

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摘要
Abstract Purpose Therapeutic management of metastatic cancer patients who are hospitalized at the time of initial diagnosis because of impaired performance status and/or severe symptoms is challenging for clinicians. This study describes their outcome and the effect of systemic anti-neoplastic treatment (SANT) initiation on survival.Methods In this prospective multicentric study, we included all adult, inpatients with newly diagnosed metastatic solid tumors. Our primary objective was to describe overall survival (OS). Secondary objectives included assessing SANT effectiveness, identifying factors influencing initiation of SANT, and assessing usual prognostic tools and factors associated with response.Results 107 patients were included over a six-month period. Seventy-four (69%) initiated a SANT. Among them, 39 patients were alive at 3 months. Median overall survival was 1.7 months for the entire cohort. Thirty-seven patients (55%) died in the unit where they were first admitted. Patients with chemo-sensitive tumors or targeted therapy for specific molecular alterations showed better outcomes. Factors associated with the initiation of a SANT were young age (OR = 0,94 [0,90; 0,98]), low Charlson Comorbidity Index (OR = 0,56 [0,42; 0,73]), and patient’s or caregiver’s request for treatment (OR = 0,07 [0,02; 0,17] and 0,17 [0,06; 0,42], respectively).Conclusion Metastatic cancer patients hospitalized at the time of diagnosis share a similar poor survival. With the notable exception of chemosensitive tumors and specific molecular alterations, initiation of SANT seems to have a limited impact on their outcomes. Best supportive care can be reasonably considered for these patients. The benefit of SANT in this altered population should be assessed in larger prospective studies.
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