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A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying
BACKGROUND: The Neuberger review made a number of recommendations to improve end of life care, including research into the biology of dying. An important aspect of the biology of dying is the identification of biomarkers as indices of disease processes. Biomarkers have the potential to inform the cu...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383239/ https://www.ncbi.nlm.nih.gov/pubmed/28384249 http://dx.doi.org/10.1371/journal.pone.0175123 |
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author | Reid, Victoria Louise McDonald, Rachael Nwosu, Amara Callistus Mason, Stephen R. Probert, Chris Ellershaw, John E. Coyle, Séamus |
author_facet | Reid, Victoria Louise McDonald, Rachael Nwosu, Amara Callistus Mason, Stephen R. Probert, Chris Ellershaw, John E. Coyle, Séamus |
author_sort | Reid, Victoria Louise |
collection | PubMed |
description | BACKGROUND: The Neuberger review made a number of recommendations to improve end of life care, including research into the biology of dying. An important aspect of the biology of dying is the identification of biomarkers as indices of disease processes. Biomarkers have the potential to inform the current, limited understanding of the dying process and assist clinicians in recognising dying, in particular how to distinguish dying from reversible acute deterioration. OBJECTIVES: To critically appraise the literature on biological factors that may be used as prognostic indicators in advanced cancer patients and to identify candidate biomarkers of the dying process that can be measured serially in cancer patients’ bodily fluids. METHODS: A systematically structured review was conducted using three electronic databases. A hand search of six peer-reviewed journals and conference abstracts was also conducted. Studies reporting prognostic biomarkers in cancer patients with a median survival of ≤90 days and post-mortem studies were included. Final levels of evidence and recommendations were made using the Evidence Based Medicine modified GRADE system. RESULTS: 30 articles were included. Seven prognostic biological factors demonstrated Grade A evidence (lymphocyte count, white blood cell count, serum C-reactive protein, albumin, sodium, urea and alkaline phosphatase). An additional eleven prognostic factors were identified with Grade B evidence (platelet count, international normalised ratio, serum vitamin B12, prealbumin, bilirubin, cholesterol, aspartate aminotransferase, alanine transaminase, lactate dehydrogenase, pseudocholinesterase and urate). A number of biomarkers were specifically identified in the last two weeks of life but limitations exist. No post-mortem studies met the inclusion criteria. CONCLUSION: The biology of dying is an important area for future research, with the evidence focused on signs, symptoms and prognostic factors. This review identifies a number of common themes shared amongst advanced cancer patients and highlights candidate biomarkers which may be indicative of a common biological process to dying. |
format | Online Article Text |
id | pubmed-5383239 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-53832392017-05-03 A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying Reid, Victoria Louise McDonald, Rachael Nwosu, Amara Callistus Mason, Stephen R. Probert, Chris Ellershaw, John E. Coyle, Séamus PLoS One Research Article BACKGROUND: The Neuberger review made a number of recommendations to improve end of life care, including research into the biology of dying. An important aspect of the biology of dying is the identification of biomarkers as indices of disease processes. Biomarkers have the potential to inform the current, limited understanding of the dying process and assist clinicians in recognising dying, in particular how to distinguish dying from reversible acute deterioration. OBJECTIVES: To critically appraise the literature on biological factors that may be used as prognostic indicators in advanced cancer patients and to identify candidate biomarkers of the dying process that can be measured serially in cancer patients’ bodily fluids. METHODS: A systematically structured review was conducted using three electronic databases. A hand search of six peer-reviewed journals and conference abstracts was also conducted. Studies reporting prognostic biomarkers in cancer patients with a median survival of ≤90 days and post-mortem studies were included. Final levels of evidence and recommendations were made using the Evidence Based Medicine modified GRADE system. RESULTS: 30 articles were included. Seven prognostic biological factors demonstrated Grade A evidence (lymphocyte count, white blood cell count, serum C-reactive protein, albumin, sodium, urea and alkaline phosphatase). An additional eleven prognostic factors were identified with Grade B evidence (platelet count, international normalised ratio, serum vitamin B12, prealbumin, bilirubin, cholesterol, aspartate aminotransferase, alanine transaminase, lactate dehydrogenase, pseudocholinesterase and urate). A number of biomarkers were specifically identified in the last two weeks of life but limitations exist. No post-mortem studies met the inclusion criteria. CONCLUSION: The biology of dying is an important area for future research, with the evidence focused on signs, symptoms and prognostic factors. This review identifies a number of common themes shared amongst advanced cancer patients and highlights candidate biomarkers which may be indicative of a common biological process to dying. Public Library of Science 2017-04-06 /pmc/articles/PMC5383239/ /pubmed/28384249 http://dx.doi.org/10.1371/journal.pone.0175123 Text en © 2017 Reid et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Reid, Victoria Louise McDonald, Rachael Nwosu, Amara Callistus Mason, Stephen R. Probert, Chris Ellershaw, John E. Coyle, Séamus A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying |
title | A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying |
title_full | A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying |
title_fullStr | A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying |
title_full_unstemmed | A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying |
title_short | A systematically structured review of biomarkers of dying in cancer patients in the last months of life; An exploration of the biology of dying |
title_sort | systematically structured review of biomarkers of dying in cancer patients in the last months of life; an exploration of the biology of dying |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383239/ https://www.ncbi.nlm.nih.gov/pubmed/28384249 http://dx.doi.org/10.1371/journal.pone.0175123 |
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