Catherine Weber

Malignant Irreversible Intestinal Obstruction: The Powerful Association of Octreotide to Corticosteroids, Antiemetics, and Analgesics

In the case of malignant intestinal obstruction, surgery often carries important mortality and morbidity risks, and feasibility is neither realistic nor reasonable. A total of 4 clinical cases of intestinal obstruction caused by advanced gastrointestinal cancers in their terminal phase are described. The association of analgesics, corticosteroids, antiemetics, and octreotide was effective to relieve symptoms of intestinal obstruction for the remaining lifetime. The insertion of a nasogastric tube was avoided in 3 of 4 cases. Death occurred 51, 56, and 64 days after clinical and radiological diagnosis of irreversible intestinal obstruction. This combination of drugs appears very powerful and well tolerated. The relatively long survival that was observed should encourage future studies of longer half-life somatostatin analogues with no need of continuous infusion or multiple daily injections.

Anatomopathological Causes of Death in Patients with Advanced Cancer: Association with the Use of Anticoagulation and Antibiotics at the End of Life

BACKGROUND Anatomopathological studies that described the immediate causes of death of patients with advanced cancer were first published approximately 20 years ago. OBJECTIVE Our objective was to analyze if causes of death changed with a wider use of broad spectrum antibiotics and prophylactic anticoagulation. METHODS We conducted a retrospective study of all patients with an advanced cancer hospitalized in the Division of Palliative Medicine at the University Hospital Geneva from 2004 to 2010 who had an autopsy. RESULTS Two hundred forty patients were included (130 men, mean age: 74±13). Main causes of death discovered at the autopsy were pulmonary infection (n=131; 55%), advanced cancer (n=39; 16%), pulmonary infection together with pulmonary embolism (PE) (n=27; 12%), PE alone (n=22; 9%), cardiac complications (n=19; 5%) and others (n=2; 1%). In a logistic regression model, with adjusting for age, gender, main diagnosis, comorbidities, blood count, corticosteroids, and antibiotics, there were no independent factors associated with pulmonary infection at autopsy. In a similar model, with adjusting for age, gender, main diagnosis, comorbidities, and anticoagulation, the only independent factor associated with PE at autopsy was the history of thrombo-embolic disease and therapeutic anticoagulation. CONCLUSION The results of this retrospective study demonstrate that causes of death did not change with the modification of our practice. The high rate of pulmonary infection and embolism in this population, including in patients who received broad spectrum and prophylactic anticoagulation should encourage us to pursue other prospective studies to actually demonstrate the benefit of these treatments in this population.

Is chemotherapy underutilized in the elderly

Is chemotherapy underutilized in the elderly? Yes, most probably. Back in 1990, a group of pioneers in the field of geriatric oncology published a provocative editorial entitled ‘Why are elderly cancer patients badly treated?’ [1]. Eminent members of the same group recently concluded their scientific review on the treatment of cancer in older patients by writing: “Although we are on the right track, there is still a long way to go” [2]. Answers have thus been provided in the interval between these two communications but many questions still remain. There have been remarkable societal changes in the 20th century and the unexpected lengthening of life-expectancy has been one of the most crucial. Previously, the third and the fourth age were the privilege of few lucky individuals, capable of escaping from misery, epidemics and catastrophes. Today, the vast majority of us may expect to get old and to live these years in very good health. However, parallel to the aging of the population, cancer disorders have increased in number and over half are now diagnosed in the eight, ninth and tenth decades of life. If the incidence of cancer is 207/100,000 below 65 years of age, it rises to 2261/100,000 above that age, that is, 11-fold higher [3]. In other words, cancer has now become a disease of the elderly. It is predicted that 15 million new cases of cancer will be diagnosed worldwide in the year 2020 in comparison with 10 million 20 years before [4]. And the evidence is that the majority will concern people over the age of 70 years, the senior adults. These numbers demand serious analysis. What we have learned over the past years should be used to prepare for the future in the full respect of the ethics of our societies. To find the balance between autonomy, beneficence and justice is a major challenge. Despite scientific advances in the