Background: Although Hospice has been associated with improved symptom management, quality of life, lower costs and length of survival in terminally ill patients, it is underutilized. The primary outcome of this study was to examine the relationship between hospice enrollment status and hospital readmissions in elderly patients with solid tumors. Secondary outcomes were length of [...]

Background: Aggressive EOL treatments in advanced cancer patients are associated with low-value care and frequently lead to unnecessary hospitalizations. Since 2012, the National Quality Forum (NQF), American Society of Clinical Oncology (ASCO), and Centers for Medicare and Medicaid Services (CMS) have adopted EOL quality measures to reduce aggressive care. Using these measures, we conducted a [...]

Background: Subcutaneous (SC) methylnaltrexone (MNTX) is approved for opioid-induced constipation (OIC) in adults with chronic noncancer pain and OIC in adults with advanced illness or with active cancer who require opioid dosage escalation for palliative care. This post hoc analysis evaluated data pooled from 3 randomized studies of patients with advanced illness and OIC. Methods: [...]

Case Presentation: A 69 year-old woman with recently diagnosed endometrial cancer presented with two weeks of dysphagia and progressive upper extremity weakness. On exam she was dysarthric with oral mucous retention and poor dentition; she had left supraclavicular lymphadenopathy. Neurologically, cranial nerves were intact except shoulder shrug, and shoulder girdle strength was 3+/5 bilaterally with [...]

Case Presentation: A 68 year-old-woman with right upper lobe non-small cell lung cancer on chemotherapy presented with shortness of breath. A CT scan of the chest prior to admission revealed a right hilar mass encasing and narrowing the distal superior vena cava (SVC). Her exam was notable for distended neck veins and diminished breath sounds [...]

Case Presentation: An 84 year old male with past medical history of prostate cancer with metastasis to bone presented with thrombocytopenia. His original diagnosis of prostate cancer was made with a PSA and a transrectal ultrasound-guided needle biopsy of the prostate. The biopsy showed extensive adenocarcinoma in all core samples taken. Bone scan at that [...]

Case Presentation: A 54 year-old female presented to the ED with five days of fatigue, nausea, vomiting, and abdominal pain, increasing confusion, and somnolence after a recent viral illness. On physical exam, she was noted to have large, fixed masses in her breasts with bulky axillary lymphadenopathy. Upon further questioning, the patient revealed that she [...]

Case Presentation: The patient is a 35-year-old female who presented to the emergency department with a chief complaint of abdominal swelling and 10-pound weight gain over the last month. She also reported diffuse abdominal pain, nausea, and vomiting during this time. She had a past medical history of fibromyalgia. She had no relevant social or [...]

Case Presentation: A 61-year-old Indian man with past medical history of type 2 diabetes mellitus and dyslipidemia presented with a 3-month history of intermittent dry cough associated with fevers, chills, night sweats, and generalized weakness. He worked in California as an engineer doing home remodeling, never smoked, and had no sick contact, or animal exposure. [...]

Case Presentation: A 51-year-old female presented with a three month history of migratory rash and weakness. Initially, she developed periorbital swelling, eyelid discoloration, and a migrating pruritic erythematous rash. The rash originated on her upper arms and thighs progressing to her chest, back, and face. She reported muscle weakness, most notably an inability to lift [...]