Peter Sørensen

The occurrence of hyponatremia in SCLC and the influence on prognosis: A retrospective study of 453 patients treated in a single institution in a 10-year period

Hyponatremia is often seen in SCLC, and is thought to be caused by the paraneoplastic syndrome SIADH. Variable results of the prognostic significance of low P-sodium (P-Na) have been reported. This study was performed to investigate the prognostic value of hyponatremia in SCLC. Data was obtained from files from 453 patients diagnosed with SCLC and treated at Odense University Hospital from 1995 to 2005 in which data on P-sodium was available. The standard chemotherapy was six cycles of carboplatin-etoposide. P-Na was <125 mEq/L in 47 patients (11%) and 126-135 mEq/L in 151 (33%), and 255 patients (56%) showed normal values. The median survival was 11.2 months in patients with normal P-Na, and 7.1 months in patients with subnormal values (p=0.0001). In a Cox multivariate analysis of the 402 patients treated with carboplatin-etoposide, hyponatremia was associated with poorer prognosis. Other independent prognostic factors included LDH, gender, age, performance status, stage, and low value of albumin. Treatment prior to year 2000 was of border line significance, while in-significant factors included hemoglobin level, WBC and alkaline phosphatase. In 61 patients with P-Na <130 mEq/L receiving two or more cycles of chemotherapy, only 15 of the 61 patients (25%) normalized the value of P-Na to 136 mEq/L or above at the time of the second cycle of chemotherapy. The patients who did not fully regain normal values of P-Na, had poorer survival compared with the patients who did in a univariate analysis (p=0.027), and in a Cox multivariate analysis. In conclusion, hyponatremia was a significant prognostic factor associated with poor prognosis and so was failure to normalize P-Na within the first two cycles of chemotherapy.

Long-term Continuous 5-Fluorouracil Infusion in Patients with Advanced Head and Neck Cancer

Forty-two patients with advanced head and neck cancer entered this phase II trial of long-term continuous 5-fluorouracil (5-FU) infusion at a dose of 300 mg/m2/day for a maximum of 16 weeks. Objective response rate was 15% in 41 evaluable patients. Median time to progression was 2.9 months, and median survival 4 months. Toxicity was generally mild. Reversible stomatic and hand-foot syndrome WHO grade III-IV was observed in 5 and 3 patients, respectively. Haematologic toxicity and emesis were less pronounced with no grade III-IV toxicity. One patient had to discontinue treatment because of ataxia. No catheter-related toxicity and no treatment-related mortality were observed. In the present study long-term continuous infusion of 5-FU has only modest activity in terms of response rate, but the activity is comparable with other single-agent regimens. The treatment is well tolerated, with minimal toxicity making it usable in a palliative situation.

Low incidence of nosocomial infections in an oncologyward

Background: Oral mucositis (OM) is a common debiliating adverse effect following high dose chemotherapy prior to bone marrow transplantation. OM often interferes with food intake and lead to malnutrition, weight loss and impaired quality of life. These adverse effects may require intravenous morphine for pain alleviation, Although uncomfortable to the patient, oral cryotherapy with ice chips has been shown to reduce the grade and extent of OM. Purpose: The purpose of the present study is to evaluate whether an intraoral cooling device has the same effectiveness as ice chips when it comes to cooling the oral mucosa. Method: Five healthy volunteers (mean age 36.2 years) chewed ice under surveillance for 30 minutes. Before the start of and immediately after the termination of the ice chewing, the intraoral mucosal temperature was measured using a modified thermometer. The same protocol was used to asses the cooling efficacy obtained by the newly developed intraoral device. Results: No statistical significant differences in cooling of teh oral mucosa (p=0.12) were obtained. The mean surface temperature following cooling was 25.7 degrees Celcius with ice chips and 24.7 degrees Celcius with the cooling device. Conclucion: The cooling device is as effective as ice chips in terms of cooling the oral mucosa. The next step in this research is to use the cooling devise to establish the highest surface temperature of the oral mucosa, during infusion of chemotherapy, that will still result in prevention of oral mucositis.Introduction Lifestyle interventions might be useful in the management of adverse effects of androgen deprivation therapy (ADT) in men with prostate cancer. Objectives To examine the effects of dietary and exercise interventions on quality of life (QoL), metabolic risk factors and androgen deficiency symptoms in men with prostate cancer undergoing ADT. Methods CINAHL, Cochrane library, Medline and PsychINFO were searched to identify randomised controlled trials published from January, 2004 to October, 2014. Data extraction and methodological quality assessment was independently conducted by two reviewers. Meta-analysis was conducted using RevMan® 5.3.5. Results Of 2183 articles retrieved, 11 studies met the inclusion criteria and had low risk of bias.Nine studies evaluated exercise (resistance and/or aerobic and/or counselling) and three evaluated dietary supplementation. Median sample size =79 (33–121) and median intervention duration was 12 weeks (12–24). Exercise improved QoL measures (SMD 0.26, 95%CI −0.01 to 0.53) but not body composition, metabolic risk or vasomotor symptoms. Qualitative analysis indicated soy (or isoflavone) supplementation did not improve vasomotor symptoms; however, may improve QoL. Conclusions Few studies have evaluated the efficacy of lifestyle interventions in the management of adverse effects of ADT. We found inconclusive results for exercise in improving QoL and negative results for other outcomes. For soy-based products, we found negative results for modifying vasomotor symptoms and inconclusive results for improving QoL. Future work should investigate the best mode of exercise for improving QoL and other interventions such as dietary counselling should be investigated for their potential to modify these outcomes.