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Hasselt, Belgium

Baitar A.,Ziekenhuisnetwerk Antwerpen Middelheim | Van Fraeyenhove F.,Ziekenhuisnetwerk Antwerpen Middelheim | Vandebroek A.,Ziekenhuisnetwerk Antwerpen Middelheim | De Droogh E.,Ziekenhuisnetwerk Antwerpen Middelheim | And 3 more authors.
Journal of Geriatric Oncology

Objective: In this study, we evaluated the Groningen Frailty Indicator (GFI) and the G8 questionnaire as screening tools for a Comprehensive Geriatric Assessment (CGA) in older patients with cancer. Patients and Methods: Eligible patients with various types and stages of cancer were evaluated for frailty before treatment. Patients were categorized as patients with a normal CGA and abnormal CGA (≥2 impaired tests). The diagnostic performance of the screening tools was evaluated against the CGA with Receiver Operating Characteristic analysis. Results: In total, 170 patients (79 women) with median age 77. years old (range 66-97. years) were included. Sixty-four percent of patients had an abnormal CGA while according to the GFI (GFI. ≥4) and G8 questionnaire (G8≤14) 47% and 76% of patients had an abnormal screening test, respectively. Overall, there was no significant difference (p=0.97) in diagnostic performance between the two screening tools. The Area Under the Curve was 0.87 for both tools. For the GFI and G8 questionnaire the sensitivity was respectively 66% (95% CI: 56-75%), 92% (95% CI: 85-96%); the negative predictive value (NPV): 59% (95 CI%: 49-69%), 78% (95% CI: 63-88%); and the specificity: 87% (95% CI: 76-94%), 52% (95% CI: 39-65%). Conclusion: In this study, we showed that overall both the GFI and the G8 questionnaire were able to separate older patients with cancer with a normal and abnormal CGA. For the G8 questionnaire, an adequate sensitivity and NPV were demonstrated, however at the expense of the specificity. For the GFI, we suggest to lower the threshold with one point to GFI ≥3 to screen patients for a CGA. © 2012 Elsevier Inc. Source

De Meester J.,AZ Nikolaas | Maes B.,Heilig Hart Ziekenhuis | De Vriese A.,Az St. Jan | De Moor B.,Jessa Ziekenhuis | And 4 more authors.
Acta Clinica Belgica

In March 2008 and June 2009, an ad hoc Working Group of nephrologists discussed the status of anaemia therapy with erythropoiesis-stimulating agents [ESA] in patients on chronic haemodialysis, the phenomenon of fluctuations of haemoglobinaemia, and the need for individualisation of ESA treatment. The Working Group put together the following statements: 1. ESAs increase the haemoglobin concentration and adaptations of the ESA dose adjust the response according to a negative-feedback loop. The long lag time between an ESA dose change and its effect on erythropoiesis is cumbersome. The optimal haemoglobin target concentration is different for every haemodialysis patient; the lowest haemoglobin concentration upon which one could consistently demonstrate a positive subjective and objective clinical benefit in chronic dialysis is 11 g/dL, in contrast to the lowest haemoglobin concentration of 10 g/dL recommended in the current EMEA label for ESAs. 2. Intra-individual fluctuation of haemoglobinaemia over time is unavoidable, not only due to the ESA dose/haemoglobin response interaction, but also, and more importantly, due to the occurrence of acute illnesses and exacerbations of co-morbid conditions. Many different methodologies to characterise haemoglobin variability have been described but there is currently no universally applied definition of the phenomenon. 3. An impact of the haemoglobin level and the amplitude of the haemoglobin fluctuations on patient outcome has been observed. Without disclosing any causal relationship, worse outcomes were associated with haemoglobin fluctuations around the lower target level, but later on, more simply linked to the relative time spent below the haemoglobin concentration of 11 g/dL and to the administration of inappropriately high ESA doses in order to achieve the recommended haemoglobin target range. A plausible mechanism might be that acute illnesses blunt the patients' basal ESA sensitivity; this leads to subnormal and/or varying haemoglobin levels, currently initiating an ESA dose increase. The longer it takes the patient to recover from the acute illness, the more the prolongation of the clinically poor condition is to some extent maintained by the persistence of low haemoglobinaemia and/or by the administration of high ESA doses, and, as such, on their turn possibly contributing to an ultimate poor outcome. In the absence of clinical trials, recommendations should be offered how to proceed with the administration of ESAs as optimal as possible in periods of clinical instability. Source

Peirsman E.J.,University of Antwerp | Carvelli T.J.,Center Hospitalier Peltzer la Tourelle | Hage P.Y.,Universitair Kinderziekenhuis Koningin Fabiola | Hanssens L.S.,Universitair Kinderziekenhuis Koningin Fabiola | And 5 more authors.
Pediatric Pulmonology

Objective We investigated the potential yield of incorporating fractional exhaled nitric oxide (FeNO) measurements in childhood allergic asthma management. Methods Ninety-nine children with persistent allergic asthma were included in this multicentre, single-blind, randomized controlled trial. Treatment was based on the Global Initiative for Asthma (GINA) guidelines. In the FeNO group, asthma management was also guided by FeNO measurements. Health outcomes were evaluated over a 52-week timeframe. Results Fewer asthma exacerbations were registered in the FeNO group. 24% of the children in the FeNO group experienced one or more exacerbations per year, compared with 48% in the clinical group (P-=-0.017). The proportion of symptom-free days did not differ between groups. In the FeNO group, more months of leukotriene receptor antagonist use (median (interquartile range)) were observed: 12 (9-12) months, compared with 9 (3-12) months in the clinical group (P-=-0.019). Next, the evolution of inhaled corticosteroid doses between visits 1 and 5 (median change (interquartile range)) showed a significant increase of +100-μg (0, +400) in the FeNO group and a change of 0-μg (-200, +80) in the clinical group (P-=-0.016). Conclusions FeNO measurements in childhood asthma management did not improve the proportion of symptom-free days, but did result in fewer asthma exacerbations associated with an increased leukotriene receptor antagonist use and an augmentation of the inhaled corticosteroid doses. © 2013 Wiley Periodicals, Inc. Source

De Droogh E.,Ziekenhuisnetwerk Antwerpen Middelheim | Galdermans D.,Ziekenhuisnetwerk Antwerpen Middelheim | Mebis J.,Jessa Ziekenhuis
Journal of Geriatric Oncology

Background: Screening tools are used in geriatric oncology to determine who should receive a Comprehensive Geriatric Assessment (CGA). However, in this prospective study, we evaluated the association between geriatric screening results, measured with the G8 and Groningen Frailty Indicator (GFI), and severe treatment toxicity. Methods: Patients over 65. years with various types and stages of cancer were screened with the G8 and the GFI prior to the start of treatment. The association between geriatric screening results and Serious Adverse Events (SAE) after the first cycle of (radio)chemotherapy were studied with bivariate analysis (normal versus abnormal screening test) and logistic regression analysis. Results: From 170 screened patients, 85 patients were eligible for this study. The median age was 76. years (range: 66-88. years). The treatment intent was curative in 46% and palliative in 54%. A SAE occurred in 15 patients (18%) of which three resulted in death. There was no significant association between the G8, as a dichotomous predictor (p = 0.376) or as a continuous predictor (p = 0.298), and risk of a SAE. We also found no significant association for the GFI analysed as a dichotomous predictor (cut-off ≥ 4: p = 0.384; cut-off ≥ 3: p = 0.773), nor as a continuous predictor (p = 0.734). All associations remained insignificant when adjusted for treatment type and comorbidity. Conclusion: The G8 and the GFI can be used to select patients for CGA, but they do not seem to be predictive for short-term severe treatment toxicity. © 2014 Elsevier Inc. Source

Duerinck J.,UZ Brussel | Clement P.M.,UZ Leuven | Bouttens F.,AZ Sint Lucas | Andre C.,CHU Sart Tilman | And 11 more authors.
Journal of Neurology

Bevacizumab (BEV) has demonstrated anti-tumor activity in patients with recurrent glioblastoma (rGB). Given the unmet need for active therapeutic options in rGB patients, a medical need program was initiated by the Belgian competent authorities. Between November 2010 and February 2013, a total of 313 patients with rGB initiated treatment with BEV administered at a dose of 10 mg/kg every 2 weeks. All patients had failed prior treatment with at least radiation therapy and temozolomide and the majority of patients (70 %) were treated with corticosteroids at baseline. Patients received a median of 6 BEV administrations (range 1–53). Overall, BEV was well tolerated. During BEV treatment the WHO-Performance Score (WHO-PS) improved in 59 patients (19 %) and stabilized for at least 6 weeks in an additional 139 (44 %) patients. Corticosteroid treatment could be stopped in 16 % or reduced in dose in 32 % of patients. The best objective tumor response rate using RANO criteria (investigator’s assessment) was 3.5 % CR, 22 % PR, 38 % SD and 37 % PD. The median and 6-month PFS were 13 weeks (95 % CI 12.7–14) and 27.3 % (95 % CI 22.3–32.5), median and 6-month OS rates were 26 weeks (23–29) and 52 % (46.4–58.6), respectively. WHO-PS (0–1 vs. 2–3) and baseline steroid use were significantly correlated with PFS and OS. Our observations support the use of BEV as a monotherapy for patients with rGB who have no alternative treatment options. Optimal benefit from BEV treatment is likely to be obtained when treatment is initiated before the performance status deteriorates to two or less. © 2015, Springer-Verlag Berlin Heidelberg. Source

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