The aim of this study was to identify the decision-making process of anti-cancer treatment in elderly patients with advanced lung cancer. Semi-structured interviews were conducted with 17 patients aged 70 and above to...The aim of this study was to identify the decision-making process of anti-cancer treatment in elderly patients with advanced lung cancer. Semi-structured interviews were conducted with 17 patients aged 70 and above to collect data on their feelings and thoughts from the time of diagnosis till they made treatment decisions. The data was analyzed using the Modified Grounded Theory Approach that was modified by Prof. Yasuhito Kinoshita. We found the process to be composed of six categories. The results showed that elderly patients with advanced lung cancer were panicked over unavoidable death when informed of stage IV lung cancer and offered suggestions about anti-cancer treatment. However, trying to accept the situation where death is imminent, patients reconsidered having cancer in older age and recognized a desire to survive even in older age. This process diverged into two paths: one group of patients changed their ideas from radical to life-prolonging treatment by recognizing a desire to survive even in older age and then made anti-cancer treatment decisions by carefully choosing treatment that would allow to carry on their usual way of life;the other group of patients made treatment decisions by carefully choosing physicians to whom they could entrust their life in older age. These findings suggest that it is important for nurses to: 1) encourage patients to talk in order to have them think about what they have valued and want to value in the rest of their life;2) assess if patients prefer to decide on their own by carefully choosing treatment or entrust treatment decisions to physicians;and 3) offer support according to patients’ preferences.展开更多
Background: The purpose of this study is to evaluate the clinical efficacy and safety of abraxane-based chemotherapy with/without nedaplatin in elderly patients with non-small-cell lung cancer (NSCLC). Materials an...Background: The purpose of this study is to evaluate the clinical efficacy and safety of abraxane-based chemotherapy with/without nedaplatin in elderly patients with non-small-cell lung cancer (NSCLC). Materials and methods: From October 2009 to January 2013, 48 elderly patients (≥65 years) with NSCLC were investigated in this clinical trial. The patients were randomized and equally allocated into arms A and AP- (A) abraxane (130 mg/m2, days 1, 8); (B) abraxane + nedaplatin (20 mg/m2 days 1-3, q3w). The parameters of objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and side effects were evaluated between two arms. Results: Over 80% of the patients completed four cycles of chemotherapy. The total ORR was 21.3 %, DCR was 55.3%, PFS 4.5 months and OS 12.6 months. No significant difference was found between arms A and AP in terms of ORR (16.7% vs. 26.1%, P=0.665) or DCR (55.3% vs. 56.5%, P=0.871). The median PFS in arm A was 3.3 months [25-75% confidence interval (CI): 3.1-7.2] and 5.5 months (25-75% CI: 3.2-7.0) in arm AP with no statistical significance (P=0.640). The median OS in arm A was 12.6 months (25-75% CI: 5.7-26.2) and 15.1 months (25-75% CI: 6.4-35.3) in arm AP with no statistical significance (P=0.770). The side effects were mainly grade 1-2. The incidence of grade 3-4 toxicities was 29.1% in arm A and 62.5% in arm AP with a statistical significance (P=0.020). Conclusions: Compared with combined therapy, abraxane alone chemotherapy was beneficial for elderly NSCLC patients with better tolerability and less adverse events, whereas did not significantly differ in terms of ORR, DCR, PFS or OS.展开更多
Objective:The purpose of this study was to evaluate the efficacy and safety of gemcitabine(GEM) and carboplatin(CBP) used as induction regimen in the treatment of elderly patients with locally advanced unresectable no...Objective:The purpose of this study was to evaluate the efficacy and safety of gemcitabine(GEM) and carboplatin(CBP) used as induction regimen in the treatment of elderly patients with locally advanced unresectable non-small cell lung cancer(NSCLC).Methods:Seventy-eight cases of elderly patients have been cytologically and pathologically confirmed with locally advanced unresectable NSCLC,the age of the patients ranged from 65 to 75 years.The patients were treated with the combined regimen of gemcitabine and cisplatin.GEM 1000 mg/m2 intravenously injected by drip on the 1st,8th day and the dosage of CBP was AUC 4 that was used on the 1st day,21 days apart to each cycle,most patients received 2 cycles.Treatment response was evaluated according to the criteria of RECIST(Response Evaluation Criteria in Solid Tumor),the side effect of the regimen was judged based on WHO criteria.Results:Seventy-eight patients were evaluated and received a total of 156 cycles chemotherapy.There were no complete regression that could be observed,but 32 cases had partial regression(PR),37 cases with no change(NC) and 9 cases with progression disease(PD).The overall response rate was 41.0%.The main side effects were hematological toxicity.Conclusion:The GC regimen could be used as induction treatment for elderly patients with locally advanced unresectable NSCLC,and the regimen could be well tolerated and is safe in terms of side effects.展开更多
Objective: To evaluate the significance of adjuvant chemotherapy and radiotherapy (Gamma-knife) in the elderly patients with retreated advance lung cancer. Methods 83 patients (age 50 to 81 years) with retreating adva...Objective: To evaluate the significance of adjuvant chemotherapy and radiotherapy (Gamma-knife) in the elderly patients with retreated advance lung cancer. Methods 83 patients (age 50 to 81 years) with retreating advanced (III/IV stage) lung cancer were divided into three groups according to patients received treating by different methods. The cases were treated by synchronous chemo-radiotherapy (A group), sequentially chemo-radiotherapy (B group) and continuous systematized chemotherapy alone (C group). The systemic 3-dimensional orientation apparatus was used in radiotherapy. The chemotherapy regimen in combined radiotherapy was given by common first line regimen on lung cancer. The regimen of chemotherapy combated with whole body hyperthermia by using micro-wave on abodeman about 2 or 3 line was used in C group only. Results: The overall responses rates (RR) of A, B and C groups were 17.1%, 11.5% and 31.8%, but it was non-significance difference (P > 0.05). Overall responses rates (RR) of III and IV stage groups were 18.2% and 20.0%. The average overall survival time (OS) and median survival time (MST) of the patients treated by chemotherapy (C group) were highest about 14.2 and 9.3 months (respectively at A group 6.7 and 6.0 months. P < 0.01), in which B group was longer than A group (P < 0.05), and 95.5% CI value was not overlap. The total survival time of postoperative patients was longer in the various groups by different treated than that in non-operations. Conclusion: The rates (RR) of III and IV stage groups were non-significance difference. The higher of ORR, OS and MST in a few patients of re-treated advanced lung cancer was presented in case with treated by continuous system chemotherapy. There were survival superiority in initial postoperative patients groups by different treated. It is a profitable and effect treatment that the pure reasonable systemic chemotherapy was used for elderly case with advanced retreated lung cancer.展开更多
Purpose: In Japan, many elderly cancer patients are receiving chemotherapy using oral molecularly targeted drugs. They receive treatment in outpatient setting and have a need to self-manage at home. The purpose of thi...Purpose: In Japan, many elderly cancer patients are receiving chemotherapy using oral molecularly targeted drugs. They receive treatment in outpatient setting and have a need to self-manage at home. The purpose of this study was to clarify how elderly patients with lung cancer who are undergoing treatment with molecularly targeted drugs in outpatient setting establish self-management. Methods: The study used Kinoshita’s Modified Grounded Theory. Semi-structured interviews were conducted with 17 patients (eight males and nine females). Results: This study identified six categories: Accepting life with cancer, Maintaining activities of daily living without feeling shackled by cancer, Reconsidering how to continue being themselves in daily life until life comes to an end, Using trial and error to integrate treatment and daily living, Formulating their criteria for continuing treatment, and Obtaining help from caregivers. Conclusion: The self-management process in elderly patients consisted of maintaining treatment and integrating treatment with daily living. And they are exploring the effects of treatment and side effects in order to live their own life. Implications for Nursing: In many elderly patients with lung cancer the purpose of treatment is curative extension of survival and improved quality of life. Our findings suggest that is important we help patients to identify how patients want to live, identify ways to improve their quality of life, and share the goals of treatment between the patient and the caregiver.展开更多
Objective:The aim of our study was to evaluate the clinical efficacy and side effects of docetaxel as single chemotherapy for elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: Forty-two elder...Objective:The aim of our study was to evaluate the clinical efficacy and side effects of docetaxel as single chemotherapy for elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: Forty-two elderly patients with advanced NSCLC who were chemotherapy-naive were enrolled in this study. Docetaxel at the doses of 70 mg/m2 was administrated intravenously every 21 days as a cycle, each patient received 2-4 cycles. All patients were followed up until disease progressed or patients died. Results: Among 42 patients, 40 could be evaluated, 1 complete response (CR), 9 partial response (PR), 13 stable disease (SD), 17 progress disease (PD). The overall response rate (CR+PR) was 35% and disease control rate (CR+PR+SD) was 57.5%. The median time to progress (TTP) was 4.2 months, median survival time was 6.1 months and 1-year survival rate was 35.8%. The main toxicity was myelosuppression and decreasing platelet. Conclusion: Single agent docetaxel for elderly patients with advanced NSCLC is an efficient and well-tolerated chemotherapeutic approach with a low toxicity level.展开更多
Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pair...Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a “tentative” decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were “conducting a comprehensive review of the place of death” and “embracing the wishes for a way of life without difficulty”. Involving the family in making a “tentative” decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were “examining the place of death from different aspects” and “respecting the patient’s intention as far as possible”. Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.展开更多
Objective: To observe the effect of Astragalus injection (AI) combined with chemotherapy on quality of life (QOF) in patients with advanced non-small cell lung caner (NSCLC). Methods: Sixty NSCLC patients were randoml...Objective: To observe the effect of Astragalus injection (AI) combined with chemotherapy on quality of life (QOF) in patients with advanced non-small cell lung caner (NSCLC). Methods: Sixty NSCLC patients were randomly divided into the treated group (n=30,treated with AI combined with chemotherapy) and the control group (n=30, treated with chemotherapy alone). Chemotherapy of MVP protocol was applied to both groups. AI was supplemented to the treated group by intravenous dripping 60 ml per day. Treatment of 21-28 days consisted one treatment cycle, and 2-3 cycles were applied. WResults: The effective rate in the treated group was 40.0% and in the control group was 36.7%, the mean remission rate in them being 5.4 month s and 3.3 months, the median survival period 11 month and 7 month and the 1-year survival rate 46.75% and 30.0%, respectively, the difference of these indexes between the two groups were all significant (P<0 05). Moreover, the clinical improving rate and QOF elevation rate in the treated group was 80.4% and 43.3%, as compared with those in the control group (50.0% and 23.3% respectively), the different was also significant (P<0 01). Conclusion: AI combined with chemotherapy can significantly improve the QOF in NSCLC patients of advanced stage.展开更多
More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general...More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general consensus on how to treat elderly patients is still far from being achieved. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients and radiochemotherapy. We discuss the existing evidence related to radio-chemotherapy in the elderly, focusing primarily on the lung cancer (NSCLC and SCLC) most commonly seen in older patients, and making general treatment recommendations.展开更多
Objective:To investigate the effect of Kanglaite injection combined with docetaxel in advanced esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients.Method:A total of 130 patients wi...Objective:To investigate the effect of Kanglaite injection combined with docetaxel in advanced esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients.Method:A total of 130 patients with advanced esophageal cancer admitted in our hospital from October 2014 to July 2017were selected and divided into two groups according to the time of admission, 65 cases in each group, set as observation group and control group, all patients were treated with conventional radiotherapy (cisplatin combined with 5-fluorouracil), the observation group was given Kanglaite injection combined with docetaxel on the basis of this, while the control group only was given docetaxel treatment, the treatment period was 6 weeks, tumor markers, VEGF and immune function of both group after treatment were compared.Result: After treatment, the levels of carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9) and carcino-embryonic antigen (CEA) in the observation group were lower than those in the control group, the difference was statistically significant;VEGF level in the observation group after treatment was lower than the control group, the difference was statistically significant;After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group, while the levels of CD8+ in the observation group was lower than those in the control group, the difference was statistically significant.Conclusion: Kanglaite injection combined with docetaxel in the treatment of elderly patients with advanced esophageal cancer is better, effectively reducing the level of tumor markers and vascular endothelial growth factor, improve immune function, it isworthy of clinical application.展开更多
Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the ...Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the incidence of related complications and shorten hospital stays, but also has been proved to be effective and safe in the perioperative application of gastric cancer. This article reviews the clinical application and research progress of enhanced recovery after surgery in the perioperative period of advanced gastric cancer in the elderly.展开更多
Lung cancer is the leading cause of cancerrelated mortality in China.(1'2) Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.
Bevacizumab,an anti-VEGF monoclonal antibody,has significantly improved the clinical outcomes of patients with advanced non-squamous NSCLC(ns-NSCLC).However,the safety and efficacy of bevacizumab for elderly patients ...Bevacizumab,an anti-VEGF monoclonal antibody,has significantly improved the clinical outcomes of patients with advanced non-squamous NSCLC(ns-NSCLC).However,the safety and efficacy of bevacizumab for elderly patients with advanced NSCLC require further investigation.Thus,59 patients were included in the present retrospective study,22 patients in the bevacizumab plus pemetrexed and platinum(B+PP)group,and 37 patients in the pemetrexed and platinum(PP)group.For the entire cohort of patients,the median OS was 33.3 months,and the 1-year and 2-year overall survival rates were 88.5%and 67.8%,respectively.The median OS and 1-year and 2-year OS rates were 20.5 months,70.3%and 0%,respectively,in the B+PP group and 33.4 months,97.0%and 89.4%,respectively,in the PP group(P<0.001).The incidence of grade≥3 adverse events was higher in the B+PP group than in the PP group(27.3%vs.10.8%,respectively;P=0.204).Univariate and multivariate analyses suggested that the receipt of≥5 cycles of first-line chemotherapy was an independent favorable prognostic factor for OS,whereas the addition of bevacizumab was an unfavorable prognostic factor.With increased toxicities,the addition of bevacizumab to PP does not improve the overall survival of elderly patients with advanced ns-NSCLC.展开更多
Laparoscopy-assisted distal gastrectomy(LDG)combined with D2 lymphadenectomy may be safely performed in patients with advanced gastric cancer(AGC)by experienced surgeons at specialized high-volume institutions as show...Laparoscopy-assisted distal gastrectomy(LDG)combined with D2 lymphadenectomy may be safely performed in patients with advanced gastric cancer(AGC)by experienced surgeons at specialized high-volume institutions as shown in the Chinese Laparoscopic Gastrointestinal Surgery Study(CLASS)-01.However,studies focusing on the use of LDG in patients with gastric cancer older than 65 years are rare.This study was designed to investigate the morbidity and mortality of elderly patients with gastric cancer who underwent laparoscopic-assisted or open distal gastrectomy(ODG).In this prospective,randomized,open,parallel controlled trial,patients older than 65 years with tumor located at the middle or lower part of the stomach will be enrolled in this study.Patients will be randomly divided into a laparoscopic group and an open surgery group.The early post-operative complications,intra-operative complications and post-operative recovery will be compared between the two groups.This trial will provide valuable clinical evidence for the objective assessment of the feasibility,short-term safety,and potential benefits of LDG compared with ODG for gastric cancer in the elderly patients.This trial has been registered on ClinicalTrials.gov.(Identifier:NCT02246153.)in September 22,2014.展开更多
Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the industrialized world. Despite significant progress in early stage of the disease, the overall survival rates for advanced disease remain...Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the industrialized world. Despite significant progress in early stage of the disease, the overall survival rates for advanced disease remain low. Herein we present a case of NSCLC who was treated with Chinese medicine and chemotherapy with a longer overall survival.展开更多
目的探讨清肺化痰汤治疗痰热郁肺证老年晚期非小细胞肺癌患者的临床疗效及对其生活质量、血清癌胚抗原(Carcinoembryonic antigen,CEA)、神经元特异性烯醇化酶(Neuron specific enolase,NSE)、细胞角质素片段抗原(Cytokeratin 19 fragme...目的探讨清肺化痰汤治疗痰热郁肺证老年晚期非小细胞肺癌患者的临床疗效及对其生活质量、血清癌胚抗原(Carcinoembryonic antigen,CEA)、神经元特异性烯醇化酶(Neuron specific enolase,NSE)、细胞角质素片段抗原(Cytokeratin 19 fragment antigen21-1,CYRAF21-1)水平的影响。方法选取2019年7月—2020年10月期间在东南大学医学院附属南京同仁医院接受治疗的非小细胞肺癌患者80例,采用随机数字表法分为对照组和观察组,每组各40例。对照组采用DP化疗方案治疗,观察组在对照组基础上联合清肺化痰汤治疗,每个疗程为21 d,连续治疗4个疗程。观察比较两组患者临床疗效、不良反应情况,治疗前后痰热郁肺证证候积分(咳嗽,咳痰、咯痰黄稠,气喘或气急,喉中痰鸣,发热,口渴)、血清肿瘤标记物(CEA、NSE、CYRAF21-1)、生命质量量表(QOL-38)评分改善情况。结果治疗后观察组总缓解率62.5%(25/40)、临床获益率85.0%(34/40)均明显高于对照组总缓解率40.0%(16/40)、临床获益率65.0%(26/40),差异有统计学意义(P<0.05)。治疗后两组患者咳嗽、咳痰、咯痰黄稠、气喘或气急、喉中痰鸣、发热、口渴评分均较治疗前降低,差异有统计学意义(P<0.01);且观察组痰热郁肺证证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清CEA、NSE及CYRAF21-1水平均较治疗前明显降低,差异有统计学意义(P<0.01);且观察组血清CEA、NSE及CYRAF21-1水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者身体状况、情绪状况、功能状况、肺癌相关症状、社会/家庭状况评分均较治疗前明显降低,总体健康状况评分较治疗前明显升高,差异有统计学意义(P<0.01);且观察组QOL-38评分改善情况明显优于对照组,差异有统计学意义(P<0.05)。治疗期间,观察组不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论清肺化痰汤治疗痰热郁肺证老年晚期非小细胞肺癌疗效显著,能够有效降低血清CEA、NSE及CYRAF21-1水平,缓解临床症状,减轻化疗药物不良反应,提高患者生活质量。展开更多
We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1(ros-1)rearrangement adenocarcinoma and breast cancer.After about 14 months of a reduced dose of crizotinib treatment,she had a...We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1(ros-1)rearrangement adenocarcinoma and breast cancer.After about 14 months of a reduced dose of crizotinib treatment,she had a stable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1(RECIST 1.1).This patient’s case demonstrates that ros-1 rearrangements are not limited to patients of young age.In addition,this case indicates that crizotinib,as second-line,or even first-line,treatment may be effective and manageable in elderly patients.Furthermore,for elderly patients carrying a ros1 fusion,a reduced dose of crizotinib may be efficacious rather than a resistance factor.Based on our findings,we recommend that elderly patients with advanced lung adenocarcinoma should be considered for inclusion in molecular screening for ros-1 translocation,especially for never-smokers negative for epidermal growth factor receptor(egfr)mutation and the fusion between echinoderm microtubule associated protein-like 4(EML4)and anaplastic lymphoma kinase(ALK).This deserves attention because the population is aging,with increasing incidence and morbidity of multiple primary malignant tumors.Neglect of breast nodules at the onset is one of the limitations of our case,as combination of primary lung cancer with breast cancer is common.Above all,use of antiestrogens before and after the diagnosis of non-small-cell lung cancer is related to a reduced risk of lung cancer mortality.Therefore,careful attention should always be paid to these cases.展开更多
文摘The aim of this study was to identify the decision-making process of anti-cancer treatment in elderly patients with advanced lung cancer. Semi-structured interviews were conducted with 17 patients aged 70 and above to collect data on their feelings and thoughts from the time of diagnosis till they made treatment decisions. The data was analyzed using the Modified Grounded Theory Approach that was modified by Prof. Yasuhito Kinoshita. We found the process to be composed of six categories. The results showed that elderly patients with advanced lung cancer were panicked over unavoidable death when informed of stage IV lung cancer and offered suggestions about anti-cancer treatment. However, trying to accept the situation where death is imminent, patients reconsidered having cancer in older age and recognized a desire to survive even in older age. This process diverged into two paths: one group of patients changed their ideas from radical to life-prolonging treatment by recognizing a desire to survive even in older age and then made anti-cancer treatment decisions by carefully choosing treatment that would allow to carry on their usual way of life;the other group of patients made treatment decisions by carefully choosing physicians to whom they could entrust their life in older age. These findings suggest that it is important for nurses to: 1) encourage patients to talk in order to have them think about what they have valued and want to value in the rest of their life;2) assess if patients prefer to decide on their own by carefully choosing treatment or entrust treatment decisions to physicians;and 3) offer support according to patients’ preferences.
文摘Background: The purpose of this study is to evaluate the clinical efficacy and safety of abraxane-based chemotherapy with/without nedaplatin in elderly patients with non-small-cell lung cancer (NSCLC). Materials and methods: From October 2009 to January 2013, 48 elderly patients (≥65 years) with NSCLC were investigated in this clinical trial. The patients were randomized and equally allocated into arms A and AP- (A) abraxane (130 mg/m2, days 1, 8); (B) abraxane + nedaplatin (20 mg/m2 days 1-3, q3w). The parameters of objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and side effects were evaluated between two arms. Results: Over 80% of the patients completed four cycles of chemotherapy. The total ORR was 21.3 %, DCR was 55.3%, PFS 4.5 months and OS 12.6 months. No significant difference was found between arms A and AP in terms of ORR (16.7% vs. 26.1%, P=0.665) or DCR (55.3% vs. 56.5%, P=0.871). The median PFS in arm A was 3.3 months [25-75% confidence interval (CI): 3.1-7.2] and 5.5 months (25-75% CI: 3.2-7.0) in arm AP with no statistical significance (P=0.640). The median OS in arm A was 12.6 months (25-75% CI: 5.7-26.2) and 15.1 months (25-75% CI: 6.4-35.3) in arm AP with no statistical significance (P=0.770). The side effects were mainly grade 1-2. The incidence of grade 3-4 toxicities was 29.1% in arm A and 62.5% in arm AP with a statistical significance (P=0.020). Conclusions: Compared with combined therapy, abraxane alone chemotherapy was beneficial for elderly NSCLC patients with better tolerability and less adverse events, whereas did not significantly differ in terms of ORR, DCR, PFS or OS.
文摘Objective:The purpose of this study was to evaluate the efficacy and safety of gemcitabine(GEM) and carboplatin(CBP) used as induction regimen in the treatment of elderly patients with locally advanced unresectable non-small cell lung cancer(NSCLC).Methods:Seventy-eight cases of elderly patients have been cytologically and pathologically confirmed with locally advanced unresectable NSCLC,the age of the patients ranged from 65 to 75 years.The patients were treated with the combined regimen of gemcitabine and cisplatin.GEM 1000 mg/m2 intravenously injected by drip on the 1st,8th day and the dosage of CBP was AUC 4 that was used on the 1st day,21 days apart to each cycle,most patients received 2 cycles.Treatment response was evaluated according to the criteria of RECIST(Response Evaluation Criteria in Solid Tumor),the side effect of the regimen was judged based on WHO criteria.Results:Seventy-eight patients were evaluated and received a total of 156 cycles chemotherapy.There were no complete regression that could be observed,but 32 cases had partial regression(PR),37 cases with no change(NC) and 9 cases with progression disease(PD).The overall response rate was 41.0%.The main side effects were hematological toxicity.Conclusion:The GC regimen could be used as induction treatment for elderly patients with locally advanced unresectable NSCLC,and the regimen could be well tolerated and is safe in terms of side effects.
文摘Objective: To evaluate the significance of adjuvant chemotherapy and radiotherapy (Gamma-knife) in the elderly patients with retreated advance lung cancer. Methods 83 patients (age 50 to 81 years) with retreating advanced (III/IV stage) lung cancer were divided into three groups according to patients received treating by different methods. The cases were treated by synchronous chemo-radiotherapy (A group), sequentially chemo-radiotherapy (B group) and continuous systematized chemotherapy alone (C group). The systemic 3-dimensional orientation apparatus was used in radiotherapy. The chemotherapy regimen in combined radiotherapy was given by common first line regimen on lung cancer. The regimen of chemotherapy combated with whole body hyperthermia by using micro-wave on abodeman about 2 or 3 line was used in C group only. Results: The overall responses rates (RR) of A, B and C groups were 17.1%, 11.5% and 31.8%, but it was non-significance difference (P > 0.05). Overall responses rates (RR) of III and IV stage groups were 18.2% and 20.0%. The average overall survival time (OS) and median survival time (MST) of the patients treated by chemotherapy (C group) were highest about 14.2 and 9.3 months (respectively at A group 6.7 and 6.0 months. P < 0.01), in which B group was longer than A group (P < 0.05), and 95.5% CI value was not overlap. The total survival time of postoperative patients was longer in the various groups by different treated than that in non-operations. Conclusion: The rates (RR) of III and IV stage groups were non-significance difference. The higher of ORR, OS and MST in a few patients of re-treated advanced lung cancer was presented in case with treated by continuous system chemotherapy. There were survival superiority in initial postoperative patients groups by different treated. It is a profitable and effect treatment that the pure reasonable systemic chemotherapy was used for elderly case with advanced retreated lung cancer.
文摘Purpose: In Japan, many elderly cancer patients are receiving chemotherapy using oral molecularly targeted drugs. They receive treatment in outpatient setting and have a need to self-manage at home. The purpose of this study was to clarify how elderly patients with lung cancer who are undergoing treatment with molecularly targeted drugs in outpatient setting establish self-management. Methods: The study used Kinoshita’s Modified Grounded Theory. Semi-structured interviews were conducted with 17 patients (eight males and nine females). Results: This study identified six categories: Accepting life with cancer, Maintaining activities of daily living without feeling shackled by cancer, Reconsidering how to continue being themselves in daily life until life comes to an end, Using trial and error to integrate treatment and daily living, Formulating their criteria for continuing treatment, and Obtaining help from caregivers. Conclusion: The self-management process in elderly patients consisted of maintaining treatment and integrating treatment with daily living. And they are exploring the effects of treatment and side effects in order to live their own life. Implications for Nursing: In many elderly patients with lung cancer the purpose of treatment is curative extension of survival and improved quality of life. Our findings suggest that is important we help patients to identify how patients want to live, identify ways to improve their quality of life, and share the goals of treatment between the patient and the caregiver.
文摘Objective:The aim of our study was to evaluate the clinical efficacy and side effects of docetaxel as single chemotherapy for elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: Forty-two elderly patients with advanced NSCLC who were chemotherapy-naive were enrolled in this study. Docetaxel at the doses of 70 mg/m2 was administrated intravenously every 21 days as a cycle, each patient received 2-4 cycles. All patients were followed up until disease progressed or patients died. Results: Among 42 patients, 40 could be evaluated, 1 complete response (CR), 9 partial response (PR), 13 stable disease (SD), 17 progress disease (PD). The overall response rate (CR+PR) was 35% and disease control rate (CR+PR+SD) was 57.5%. The median time to progress (TTP) was 4.2 months, median survival time was 6.1 months and 1-year survival rate was 35.8%. The main toxicity was myelosuppression and decreasing platelet. Conclusion: Single agent docetaxel for elderly patients with advanced NSCLC is an efficient and well-tolerated chemotherapeutic approach with a low toxicity level.
文摘Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a “tentative” decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were “conducting a comprehensive review of the place of death” and “embracing the wishes for a way of life without difficulty”. Involving the family in making a “tentative” decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were “examining the place of death from different aspects” and “respecting the patient’s intention as far as possible”. Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.
文摘Objective: To observe the effect of Astragalus injection (AI) combined with chemotherapy on quality of life (QOF) in patients with advanced non-small cell lung caner (NSCLC). Methods: Sixty NSCLC patients were randomly divided into the treated group (n=30,treated with AI combined with chemotherapy) and the control group (n=30, treated with chemotherapy alone). Chemotherapy of MVP protocol was applied to both groups. AI was supplemented to the treated group by intravenous dripping 60 ml per day. Treatment of 21-28 days consisted one treatment cycle, and 2-3 cycles were applied. WResults: The effective rate in the treated group was 40.0% and in the control group was 36.7%, the mean remission rate in them being 5.4 month s and 3.3 months, the median survival period 11 month and 7 month and the 1-year survival rate 46.75% and 30.0%, respectively, the difference of these indexes between the two groups were all significant (P<0 05). Moreover, the clinical improving rate and QOF elevation rate in the treated group was 80.4% and 43.3%, as compared with those in the control group (50.0% and 23.3% respectively), the different was also significant (P<0 01). Conclusion: AI combined with chemotherapy can significantly improve the QOF in NSCLC patients of advanced stage.
文摘More than 60% of lung cancer patients in Europe and the USA are older than 65 years at the time of diagnosis. Despite this, elderly patients are generally under-represented in clinical trials. That being so, a general consensus on how to treat elderly patients is still far from being achieved. In this review, we address some of the issues and challenges surrounding the treatment of older cancer patients and radiochemotherapy. We discuss the existing evidence related to radio-chemotherapy in the elderly, focusing primarily on the lung cancer (NSCLC and SCLC) most commonly seen in older patients, and making general treatment recommendations.
文摘Objective:To investigate the effect of Kanglaite injection combined with docetaxel in advanced esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients.Method:A total of 130 patients with advanced esophageal cancer admitted in our hospital from October 2014 to July 2017were selected and divided into two groups according to the time of admission, 65 cases in each group, set as observation group and control group, all patients were treated with conventional radiotherapy (cisplatin combined with 5-fluorouracil), the observation group was given Kanglaite injection combined with docetaxel on the basis of this, while the control group only was given docetaxel treatment, the treatment period was 6 weeks, tumor markers, VEGF and immune function of both group after treatment were compared.Result: After treatment, the levels of carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9) and carcino-embryonic antigen (CEA) in the observation group were lower than those in the control group, the difference was statistically significant;VEGF level in the observation group after treatment was lower than the control group, the difference was statistically significant;After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group, while the levels of CD8+ in the observation group was lower than those in the control group, the difference was statistically significant.Conclusion: Kanglaite injection combined with docetaxel in the treatment of elderly patients with advanced esophageal cancer is better, effectively reducing the level of tumor markers and vascular endothelial growth factor, improve immune function, it isworthy of clinical application.
文摘Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the incidence of related complications and shorten hospital stays, but also has been proved to be effective and safe in the perioperative application of gastric cancer. This article reviews the clinical application and research progress of enhanced recovery after surgery in the perioperative period of advanced gastric cancer in the elderly.
基金Supported by the National Natural Science Foundation of China(No.81273718 and No.81102719)
文摘Lung cancer is the leading cause of cancerrelated mortality in China.(1'2) Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.
基金supported by the National Key R&D Program of China(No.2018YFC1313201)the Innovation Project of Shandong Academy of Medical Sciences(No.2019-04)the Academic Promotion Program of Shandong First Medical University(No.2019ZL002).
文摘Bevacizumab,an anti-VEGF monoclonal antibody,has significantly improved the clinical outcomes of patients with advanced non-squamous NSCLC(ns-NSCLC).However,the safety and efficacy of bevacizumab for elderly patients with advanced NSCLC require further investigation.Thus,59 patients were included in the present retrospective study,22 patients in the bevacizumab plus pemetrexed and platinum(B+PP)group,and 37 patients in the pemetrexed and platinum(PP)group.For the entire cohort of patients,the median OS was 33.3 months,and the 1-year and 2-year overall survival rates were 88.5%and 67.8%,respectively.The median OS and 1-year and 2-year OS rates were 20.5 months,70.3%and 0%,respectively,in the B+PP group and 33.4 months,97.0%and 89.4%,respectively,in the PP group(P<0.001).The incidence of grade≥3 adverse events was higher in the B+PP group than in the PP group(27.3%vs.10.8%,respectively;P=0.204).Univariate and multivariate analyses suggested that the receipt of≥5 cycles of first-line chemotherapy was an independent favorable prognostic factor for OS,whereas the addition of bevacizumab was an unfavorable prognostic factor.With increased toxicities,the addition of bevacizumab to PP does not improve the overall survival of elderly patients with advanced ns-NSCLC.
基金supported by the Research Fund of Public Welfare in Health Industry,National Health and Family Planning Commission of China(No.201402015).
文摘Laparoscopy-assisted distal gastrectomy(LDG)combined with D2 lymphadenectomy may be safely performed in patients with advanced gastric cancer(AGC)by experienced surgeons at specialized high-volume institutions as shown in the Chinese Laparoscopic Gastrointestinal Surgery Study(CLASS)-01.However,studies focusing on the use of LDG in patients with gastric cancer older than 65 years are rare.This study was designed to investigate the morbidity and mortality of elderly patients with gastric cancer who underwent laparoscopic-assisted or open distal gastrectomy(ODG).In this prospective,randomized,open,parallel controlled trial,patients older than 65 years with tumor located at the middle or lower part of the stomach will be enrolled in this study.Patients will be randomly divided into a laparoscopic group and an open surgery group.The early post-operative complications,intra-operative complications and post-operative recovery will be compared between the two groups.This trial will provide valuable clinical evidence for the objective assessment of the feasibility,short-term safety,and potential benefits of LDG compared with ODG for gastric cancer in the elderly patients.This trial has been registered on ClinicalTrials.gov.(Identifier:NCT02246153.)in September 22,2014.
文摘Non-small cell lung cancer (NSCLC) is the leading cause of cancer death in the industrialized world. Despite significant progress in early stage of the disease, the overall survival rates for advanced disease remain low. Herein we present a case of NSCLC who was treated with Chinese medicine and chemotherapy with a longer overall survival.
文摘目的探讨清肺化痰汤治疗痰热郁肺证老年晚期非小细胞肺癌患者的临床疗效及对其生活质量、血清癌胚抗原(Carcinoembryonic antigen,CEA)、神经元特异性烯醇化酶(Neuron specific enolase,NSE)、细胞角质素片段抗原(Cytokeratin 19 fragment antigen21-1,CYRAF21-1)水平的影响。方法选取2019年7月—2020年10月期间在东南大学医学院附属南京同仁医院接受治疗的非小细胞肺癌患者80例,采用随机数字表法分为对照组和观察组,每组各40例。对照组采用DP化疗方案治疗,观察组在对照组基础上联合清肺化痰汤治疗,每个疗程为21 d,连续治疗4个疗程。观察比较两组患者临床疗效、不良反应情况,治疗前后痰热郁肺证证候积分(咳嗽,咳痰、咯痰黄稠,气喘或气急,喉中痰鸣,发热,口渴)、血清肿瘤标记物(CEA、NSE、CYRAF21-1)、生命质量量表(QOL-38)评分改善情况。结果治疗后观察组总缓解率62.5%(25/40)、临床获益率85.0%(34/40)均明显高于对照组总缓解率40.0%(16/40)、临床获益率65.0%(26/40),差异有统计学意义(P<0.05)。治疗后两组患者咳嗽、咳痰、咯痰黄稠、气喘或气急、喉中痰鸣、发热、口渴评分均较治疗前降低,差异有统计学意义(P<0.01);且观察组痰热郁肺证证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清CEA、NSE及CYRAF21-1水平均较治疗前明显降低,差异有统计学意义(P<0.01);且观察组血清CEA、NSE及CYRAF21-1水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者身体状况、情绪状况、功能状况、肺癌相关症状、社会/家庭状况评分均较治疗前明显降低,总体健康状况评分较治疗前明显升高,差异有统计学意义(P<0.01);且观察组QOL-38评分改善情况明显优于对照组,差异有统计学意义(P<0.05)。治疗期间,观察组不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论清肺化痰汤治疗痰热郁肺证老年晚期非小细胞肺癌疗效显著,能够有效降低血清CEA、NSE及CYRAF21-1水平,缓解临床症状,减轻化疗药物不良反应,提高患者生活质量。
基金This work was supported by the National Science and Technology Major Project(Grant No.2017ZX09304023).
文摘We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1(ros-1)rearrangement adenocarcinoma and breast cancer.After about 14 months of a reduced dose of crizotinib treatment,she had a stable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1(RECIST 1.1).This patient’s case demonstrates that ros-1 rearrangements are not limited to patients of young age.In addition,this case indicates that crizotinib,as second-line,or even first-line,treatment may be effective and manageable in elderly patients.Furthermore,for elderly patients carrying a ros1 fusion,a reduced dose of crizotinib may be efficacious rather than a resistance factor.Based on our findings,we recommend that elderly patients with advanced lung adenocarcinoma should be considered for inclusion in molecular screening for ros-1 translocation,especially for never-smokers negative for epidermal growth factor receptor(egfr)mutation and the fusion between echinoderm microtubule associated protein-like 4(EML4)and anaplastic lymphoma kinase(ALK).This deserves attention because the population is aging,with increasing incidence and morbidity of multiple primary malignant tumors.Neglect of breast nodules at the onset is one of the limitations of our case,as combination of primary lung cancer with breast cancer is common.Above all,use of antiestrogens before and after the diagnosis of non-small-cell lung cancer is related to a reduced risk of lung cancer mortality.Therefore,careful attention should always be paid to these cases.