Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance statusBACKGROUND: The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. METHODS: We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3-4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. RESULTS: Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1-507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. CONCLUSIONS: Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.
Longitudinal analysis of cancer symptom clusters and inflammatory biomarkers: Insights into quality of life in Brazilian breast cancer patients undergoing chemotherapy.e24045 Background: Chronic inflammation and cancer share a complex relationship. Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), and C-reactive protein (CRP) are reliable biomarkers linked to inflammation and cancer prognosis. Elevated levels correlate with poorer quality of life (QoL). Research on cancer symptom clusters (CSC) may elucidate mechanisms and improve symptom management, particularly regarding QoL. This study assessed associations between inflammatory biomarkers, CSCs, and QoL in Brazilian breast cancer (BC) patients under chemotherapy (CT). Methods: A longitudinal study at a southeastern Brazil cancer center (2022-2024) included newly diagnosed women (≥18 years) with stage I-III BC under outpatient CT. Exclusion criteria: palliative care and >1 primary tumor. Data collection occurred before CT-infusion including: blood samples for inflammatory biomarker analysis, CSC data (MSAS), and QoL scores (EQ-5D-3L) were collected across six 21-day CT-cycles. Descriptive, bivariate, and multivariate analyses were held. Results: Fifty BC patients (mean age: 53.3±11.4) were followed. Diagnoses included invasive ductal carcinoma (IDC) (50%) and non-IDC (50%), with stages I (16%), II (62%), and III (22%). Adjuvant therapy regimens for breast cancer included anthracycline in 42% of patients, while 58% received nonanthracycline therapy . Effect sizes (Glass' delta) were large for NLR (0.83 [0.03-1.62]) and PLR (0.92 [0.25-1.57] and moderate for MLR (0.59 [0.22-0.96]). NLR (p=0.013), PLR (p<0.001), and MLR (p=0.001) increased significantly during CT1-CT6 cycles, indicating inflammation and poor prognosis. Differences emerged between IDC and non-IDC for PLR at CT3 (p=0.042) and CT4 (p=0.042), and NLR at CT5 (p=0.05). QoL averaged was 79.36 (p=0.219). MLR impacted D5-Anxiety/Depression at CT3 (p=0.028) and D3-Usual Activities at CT6 (p=0.019). Predominant CSCs during CT1-CT5 included: Cluster-1 (emotional): concentration issues-nervousness-insomnia-sadness-worry-irritability; and Cluster-2 (somatic): pain-fatigue-dry mouth. At CT6, Cluster-2 persisted, joined by Cluster-4 (gastrointestinal): nausea-appetite loss-taste changes-bloating-weight loss-diarrhea. Cluster-1 impacted D2 (p<0.001), D3 (p<0.001), and D5 (p<0.001). Cluster-2 affected D4 (p<0.001) and D5 (p<0.001). Clusters-2 and 4 worsened all QoL domains at CT6 (p<0.001). Conclusions: Emotional, somatic, and gastrointestinal CSCs significantly impaired QoL during CT. Inflammatory biomarkers progressively increased, reflecting poor prognosis and QoL impact. CSC and biomarker research may provide insights into the complex biological networks underpinning cancer symptoms, supporting personalized care, enabling early interventions to manage CT side effects.