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L'Hospitalet de Llobregat, Spain

Centeno C.,University of Navarra | Sanz A.,Hospital Universitario Del Rio Hortega | Cuervo M.A.,Palliative Care Team | Ramos D.,Palliative Care Team | And 7 more authors.
BMJ Supportive and Palliative Care | Year: 2012

Introduction: Methylphenidate is a psychostimulant that has been used to relieve depressive symptoms in advanced cancer patients. No studies compare its efficacy against placebo in this group of patients. Objective: To explore the efficacy of methylphenidate compared with placebo in the relief of depressive symptoms in advanced cancer patients. Material and methods: A multicentre, doubleblind, randomised placebo-controlled clinical trial was undertaken comparing the efficacy of methylphenidate and placebo in depressive symptoms. Advanced stage cancer patients were eligible if they scored at least two points on the Two Question Screening Survey for depression. A reduction of at least two points on the Edmonton Symptom Assessment Scale for depression (0-10) was considered as a response. Results: Sixty-nine patients were included (methylphenidate: n=31, placebo: n=38); median daily dose of methylphenidate was 25 mg. Fifty-eight patients (84%) who completed the first week of treatment were considered suitable for evaluation. In the intention to treat analysis, there were 14/31 (45%) responses with methylphenidate and 10/38 (26%) responses with placebo (difference: 19%; 95% CI: 4% to 39%; p=0.10). With the Hospital Anxiety and Depression Scale, 11/19 (58%) patients with methylphenidate and 10/24 (42%) with placebo improved from a score compatible with depression in the first 7 days (difference 16%; 95% CI 13% to 42%; p=0.29). The proportion of patients indicating adverse effects was similar for both cohorts (p=0.99). Conclusion: Compared with the placebo, methylphenidate demonstrated a positive trend in the incidence of response for depressive symptoms in advanced cancer patients.

Garzon-Rodriguez C.,Institute Catala Oncologia | Porta-Sales J.,Institute Catala Oncologia | Manas-Izquierdo V.,Institute Catala Oncologia | Llorens-Torrome S.,Institute Catala Oncologia
Medicina Paliativa | Year: 2015

Background Venous thromboembolic (VTD) disease in advanced cancer patients is a serious, not always well documented, complication. Primary aim: to determine the frequency of VTD in advanced cancer patients admitted to an Acute Palliative Care Unit. Secondary aim: to assess the thromboprophylaxis (TP) used during hospitalisation, the associated complications, and patient acceptance of TP. Methods The following variables were recorded in this descriptive prospective study of advanced cancer patients: socio-demographic data, risk factors of VTD, occurrence of VTD on/during hospitalisation and at 15 days post-discharge from hospital, and complications associated with the use of low molecular weight heparin (LMWH). Patient awareness and satisfaction with primary TP was evaluated using an ordinal scale questionnaire. Results Between March and June 2010, 140 consecutive patients were enrolled. VTD was noted in 10 patients (7.1%); in 4 (2.9%) it was the reason for admission, and in 6 (4.3%) it occurred during admission or 15 days after discharge. Pulmonary thromboembolism was more frequent than deep vein thrombosis. Complications associated with TP were minor (6% bleeding and no thrombocytopenia). A higher mean stay (17.6 vs. 11.4 days; P <.05) was observed in the VTD group. The aims of TP were well known to 30% of patients. The majority of patients (92%) noted that subcutaneous LMWH administration did not cause discomfort. Conclusions The frequency of VTD in advanced cancer patients admitted to a Palliative Care Unit is low, but associated to a longer stay and complications. Adverse effects related to the use of heparin were few, and mild. There was very good patient acceptance (92%) of subcutaneous LMWH use, despite the low awareness of TP (30%). Further randomised studies are necessary to avoid confounding factors and to draw a definitive conclusion. © 2012 Sociedad Española de Cuidados Paliativos.

Montal R.,Institute Catala Oncologia | Oliva M.,Institute Catala Oncologia | Taberna M.,Institute Catala Oncologia | Taberna M.,University of Barcelona | And 13 more authors.
Clinical and Translational Oncology | Year: 2016

Purpose: Management of residual neck disease (RND) is one of the unsolved points after bio-radiotherapy (BRT) in loco-regional advanced squamous-cell carcinoma of the head and neck (SCCHN). The aims of the study were to characterize the radiological pattern of response by computed tomography (CT) and to assess the role of positron-emission tomography (PET)/CT in this setting for a better decision-making in the indication of neck dissection (ND). Methods: We retrospectively reviewed 202 patients consecutively diagnosed with node-positive SCCHN (N1: 24; N2: 152; N3: 26) who had been treated with concomitant radiotherapy and cetuximab with or without previous induction chemotherapy between 2006 and 2013. Radiological evaluation after treatment was assessed by standard criteria using CT and in addition by PET/CT when RND was suspected in cases from 2010. Results: There were 42 (21 %) patients who achieved complete response of the primary tumor persisting RND by CT. From this group, 24 patients were managed without PET/CT, leading to the performance of ND in 22 (92 %). On the other hand, 18 patients underwent PET/CT and ND was performed in only 6 (33 %). The overall survival was not different between both groups (p = 0.32). After histological examination and follow-up, PET/CT obtained a positive predictive value of 56 % and a negative predictive value of 89 %. Conclusions: Radiological response after BRT is similar to that after treatment with chemo-radiotherapy, thereby validating in this scenario the accepted CT criteria to define complete response of the neck. However, when RND is suspected by CT, PET/CT is useful to prevent unnecessary ND. © 2016 Federación de Sociedades Españolas de Oncología (FESEO)

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