Shortcuts August 2013
Support Care Cancer. 2013 Sep;21(9):2599-607
Del Fabbro E, Garcia JM, Dev R, Hui D, Williams J, Engineer D, Palmer JL, Schover L, Bruera E.
In this randomized, double-blinded placebo-controlled trial the effect of testosterone replacement on fatigue in hypogonadal male outpatients with advanced cancer was evaluated. Although 43 patients were randomised, 29 completed the study. Testosterone or sesame seed oil placebo (all 2 mL) were administered intra-muscularly and titrated every 14 days, up to day 57, to achieve bioavailable testosterone levels between 70-270 ng/dL. Symptoms and quality-of-life were evaluated by the Functional Assessment of Chronic Illness Therapy-Fatigue subscale, functional Assessment of Anorexia/Cachexia Therapy subscale, Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression and Sexual Desire Inventory-2 at day 29 and 72. There were some baseline racial differences, with the testosterone group having more Hispanic and less black patients, this group also tended to be younger. No difference was found for fatigue scores between arms after 29 days, but Sexual Desire Inventory score and performance status improved in the testosterone group. Fatigue subscale scores were better in those treated with testosterone by day 72. There was a trend towards benefit in quality of life from testosterone replacement in hypogonadal men with cancer which might be clinically significant. The authors state that the study is underpowered to detect a statistical difference and larger studies of longer duration are needed.
doi: 10.1007/s00520-013-1832-5
Palliat Med. 2013. [Epub ahead of print]
Hussain JA, Mooney A, Russon L.
This retrospective observational study compared survival, hospital admissions and palliative care input of patients aged over 70 years with stage 5 chronic kidney disease between renal replacement therapy (RRT) and conservative management (CM). RRT was chosen by 269 patients and CM by 172 patients. Patients took an average of 53 days (range = 0–824 days) to make their treatment decision. 178 patients died during the follow-up. Although the RRT group survived a median of 2.4 years longer, when factors influencing survival were stratified, there was no difference in survival in patients over 80 years old or with a World Health Organization performance score of 3 or more. Furthermore, a high Charlson’s Comorbidity Index score reduced the effect of RRT on survival. There was an increase in acute hospital admissions in patients on RRT compared with CM (relative risk 1.6), with 69% of RRT patients and 47% of CM patients dying in hospital. A consultant in palliative medicine reviewed 85% of CM patients and 4% of patients on RRT. Community specialist palliative care and/or hospice day care support was given to 76% of the CM group, whereas none of the patients on RRT had input, despite 20% dying before starting dialysis.
doi: 10.1177/0269216313484380
by Jason Boland