Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

BACKGROUND The benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear. OBJECTIVES To analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS. DESIGN A randomised, double-blinded, single-centre clinical trial. SETTING A tertiary university hospital between March 2010 and April 2014. PATIENTS Ninety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study. INTERVENTION To receive thoracic paravertebral analgesia with either 2 mg ml−1 ropivacaine and 0.25 μg ml−1 sufentanil (ropivacaine + sufentanil group) or 2 mg ml−1 ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg−1 h−1 in both groups. MAIN OUTCOME MEASURES The primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively. RESULTS The mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either in pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay. CONCLUSION Adding 0.25 μg ml−1 sufentanil to 2 mg ml−1 ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed. TRIAL REGISTRATION Clinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744. Correspondence to Christian Bauer, MD, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Anesthésie-Réanimation, 103 grande rue de la Croix-Rousse, 69004 Lyon, France Tel: +33 426732660; e-mail: christian.bauer@chu-lyon.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Comparison of double intravenous vasopressor automated system using nexfin versus manual vasopressor bolus administration for maintenance of haemodynamic stability during spinal anaesthesia for caesarean delivery: A randomised double-blind controlled trial

BACKGROUND Hypotension is a common side effect of spinal anaesthesia during caesarean delivery and is associated with maternal and foetal adverse effects. We developed an updated double intravenous vasopressor automated (DIVA) system that administers phenylephrine or ephedrine based on continuous noninvasive haemodynamic monitoring using the Nexfin device. OBJECTIVE The aim of our present study is to compare the performance and reliability of the DIVA system against Manual Vasopressor Bolus administration. DESIGN A randomised, double-blind controlled trial. SETTING Single-centre, KK Women's and Children's Hospital, Singapore. PATIENTS Two hundred and thirty-six healthy women undergoing elective caesarean delivery under spinal anaesthesia. MAIN OUTCOME MEASURES The primary outcome was the incidence of maternal hypotension. The secondary outcome measures were reactive hypertension, total vasopressor requirement and maternal and neonatal outcomes. RESULTS The DIVA group had a significantly lower incidence of maternal hypotension, with 39.3% (46 of 117) patients having any SBP reading less than 80% of baseline compared with 57.5% (65 of 113) in the manual vasopressor bolus group (P = 0.008). The DIVA group also had fewer hypotensive episodes than the manual vasopressor bolus group (4.67 versus 7.77%; P 

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Colorectal Cancer:

Publication date: Available online 20 January 2018
Source:Surgical Oncology Clinics of North America
Author(s): Nathan C. Hall, Alexander T. Ruutiainen

Teaser

Progressive technological advancements in imaging have significantly improved the preoperative sensitivity for the detection of very small foci of regionally- or hematogenously-metastatic colorectal cancer. Unfortunately, this information has not translated to continued linear gains in patient survival, and might even result in the false-positive upstaging of some cases: these are two conundrums in the imaging of colorectal cancer. Both conundrums might be resolved by the widespread use of real-time imaging guidance during operative procedures. This might open the way for the widespread use of fluorodeoxyglucose PET/CT for the initial staging of patients with colorectal cancer.


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Computed tomography and magnetic resonance imaging evaluation of pelvic lymph node metastasis in bladder cancer

Abstract

Background

Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.

Methods

We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cystectomy. The data regarding size, shape, density, and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal–Wallis test and χ² test. The optimal cutoff value for the size of metastatic node was determined using the receiver operating characteristic (ROC) curve analysis.

Results

A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes. Among 82 imaging-detectable lymph nodes, 51 were confirmed to be positive for metastasis. The detection rate of metastatic nodes increased along with more advanced tumor stage (P < 0.001). Once the ratio of short- to long-axis diameter ≤ 0.4 or fatty hilum was observed in lymph nodes on imaging, it indicated non-metastases. Besides, lymph nodes with spiculate or obscure margin or necrosis indicated metastases. Furthermore, the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node, with the area under ROC curve of 0.815.

Conclusions

The probability of metastatic nodes significantly increased with more advanced T stages. Once lymph nodes are detected on imaging, the characteristic signs should be paid attention to. The short diameter > 6.8 mm may indicate metastatic lymph nodes in BCa.

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Computed tomography and magnetic resonance imaging evaluation of pelvic lymph node metastasis in bladder cancer

Abstract

Background

Accurate evaluation of lymph node metastasis in bladder cancer (BCa) is important for disease staging, treatment selection, and prognosis prediction. In this study, we aimed to evaluate the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for metastatic lymph nodes in BCa and establish criteria of imaging diagnosis.

Methods

We retrospectively assessed the imaging characteristics of 191 BCa patients who underwent radical cystectomy. The data regarding size, shape, density, and diffusion of the lymph nodes on CT and/or MRI were obtained and analyzed using Kruskal–Wallis test and χ² test. The optimal cutoff value for the size of metastatic node was determined using the receiver operating characteristic (ROC) curve analysis.

Results

A total of 184 out of 3317 resected lymph nodes were diagnosed as metastatic lymph nodes. Among 82 imaging-detectable lymph nodes, 51 were confirmed to be positive for metastasis. The detection rate of metastatic nodes increased along with more advanced tumor stage (P < 0.001). Once the ratio of short- to long-axis diameter ≤ 0.4 or fatty hilum was observed in lymph nodes on imaging, it indicated non-metastases. Besides, lymph nodes with spiculate or obscure margin or necrosis indicated metastases. Furthermore, the short diameter of 6.8 mm was the optimal threshold to diagnose metastatic lymph node, with the area under ROC curve of 0.815.

Conclusions

The probability of metastatic nodes significantly increased with more advanced T stages. Once lymph nodes are detected on imaging, the characteristic signs should be paid attention to. The short diameter > 6.8 mm may indicate metastatic lymph nodes in BCa.

http://ift.tt/2rJ5BC5

Immune gene expression and response to chemotherapy in advanced breast cancer

Immune gene expression and response to chemotherapy in advanced breast cancer

Immune gene expression and response to chemotherapy in advanced breast cancer, Published online: 25 January 2018; doi:10.1038/bjc.2017.446

Immune gene expression and response to chemotherapy in advanced breast cancer

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Immune gene expression and response to chemotherapy in advanced breast cancer

Immune gene expression and response to chemotherapy in advanced breast cancer

Immune gene expression and response to chemotherapy in advanced breast cancer, Published online: 25 January 2018; doi:10.1038/bjc.2017.446

Immune gene expression and response to chemotherapy in advanced breast cancer

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STINGing Antitumor Immunity into Action [News in Depth]

Efforts to modulate STING signaling for therapeutic purposes are rapidly gaining steam.

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Immune gene expression and response to chemotherapy in advanced breast cancer

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Immune gene expression and response to chemotherapy in advanced breast cancer

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Health Related Quality of Life and Care Satisfaction Outcomes: Informing Psychosocial Oncology Care among Latina and African-American Young Breast Cancer Survivors

Abstract

Objective

When breast cancer occurs in young women, the medical, physical, psychosocial, and overall impacts can be more severe warranting targeted medical and psychosocial oncology care. Yet, despite their risk for poorer survival and survivorship outcomes, little research has focused on this group with critical gaps concerning ethnic minorities who are particularly medically vulnerable. Therefore, this preliminary study examined demographic characteristics and patient centered outcomes i.e., health related quality of life, quality care satisfaction to inform targeted psychosocial oncology care among African-American and Latinas young breast cancer survivors (YBCS).

Methods

116 African-American and Latina YBCS aged ≥21-50 years were recruited from cancer registries and community agencies. Based on prior research and the literature, Latinas were categorized into English language proficient (ELP) and Spanish language proficient (SLP) based on their choice of language to conduct the study including completion of the measures.

Results

SLP Latinas reported lower educational attainment and income (p<0.001); and were more likely to report having a mastectomy (p<0.01) but less likely to report breast reconstruction (p<0.05). Satisfaction with care was correlated with patient-provider communication and overall HRQOL (p<0.01) and physical, social/family, emotional and functional wellbeing (p<0.01). SLP Latinas had lower emotional wellbeing than African-American YBCS (p<0.01) and lower functional wellbeing than ELP Latina YBCS (p<0.05). SLP Latina YBCS were less satisfied with their care compared to African-American and ELP Latina YBCS (p<0.01). Financial toxicity seem to directly influence both access to care and quality care and survivorship outcomes.

Conclusions

Investigating demographic characteristics and medical outcomes including HRQOL outcomes and satisfaction with care among ethnic minority YBCS are needed to advance the science as well as assist health professionals with precision care delivery. Greater translational and patient-centered research must focus on at-risk population such as YBCS to inform precision psychosocial oncology care and reduce health disparities.

http://ift.tt/2DKEU4z

Healthcare professionals’ perspective on return to work in cancer survivors

Abstract

Objective

Healthcare professionals play a significant role in cancer survivors' decisions regarding return to work. While there is ample research about cancer survivors' views on return to work, little is known about the views of the professionals who accompany them from diagnosis to recovery. The study explores professionals' perceptions of cancer survivors in the return to work context, as well as their views about their own role in the process.

Methods

In-depth interviews (N=26) with professionals specializing in physical or mental health working with working-age cancer survivors: occupational physicians, oncologists, oncology nurses, social workers and psychologists specializing in oncology.

Results

An analysis of the interviews revealed two prominent perceptual dimensions among professionals: the cancer survivor's motivation to return to work and understanding illness-related implications upon returning to work. The two dimensions imply the following four groups of cancer survivors in the RTW context, as viewed by health professionals: the "realist"; the "enthusiast"; the "switcher"; and the "worrier". The results also indicate that social workers and psychologists view their role in terms of jointly discussing options and implications with the cancer survivor, while physicians and nurses view their role more in terms of providing information and suggestions.

Conclusions

The training of professionals should increase awareness of the assumptions they make about cancer survivors in regard to RTW. Additionally, training might elaborate professionals' view of their role in the interaction with cancer survivors regarding return to work.

http://ift.tt/2FdRFlp

Health Related Quality of Life and Care Satisfaction Outcomes: Informing Psychosocial Oncology Care among Latina and African-American Young Breast Cancer Survivors

Abstract

Objective

When breast cancer occurs in young women, the medical, physical, psychosocial, and overall impacts can be more severe warranting targeted medical and psychosocial oncology care. Yet, despite their risk for poorer survival and survivorship outcomes, little research has focused on this group with critical gaps concerning ethnic minorities who are particularly medically vulnerable. Therefore, this preliminary study examined demographic characteristics and patient centered outcomes i.e., health related quality of life, quality care satisfaction to inform targeted psychosocial oncology care among African-American and Latinas young breast cancer survivors (YBCS).

Methods

116 African-American and Latina YBCS aged ≥21-50 years were recruited from cancer registries and community agencies. Based on prior research and the literature, Latinas were categorized into English language proficient (ELP) and Spanish language proficient (SLP) based on their choice of language to conduct the study including completion of the measures.

Results

SLP Latinas reported lower educational attainment and income (p<0.001); and were more likely to report having a mastectomy (p<0.01) but less likely to report breast reconstruction (p<0.05). Satisfaction with care was correlated with patient-provider communication and overall HRQOL (p<0.01) and physical, social/family, emotional and functional wellbeing (p<0.01). SLP Latinas had lower emotional wellbeing than African-American YBCS (p<0.01) and lower functional wellbeing than ELP Latina YBCS (p<0.05). SLP Latina YBCS were less satisfied with their care compared to African-American and ELP Latina YBCS (p<0.01). Financial toxicity seem to directly influence both access to care and quality care and survivorship outcomes.

Conclusions

Investigating demographic characteristics and medical outcomes including HRQOL outcomes and satisfaction with care among ethnic minority YBCS are needed to advance the science as well as assist health professionals with precision care delivery. Greater translational and patient-centered research must focus on at-risk population such as YBCS to inform precision psychosocial oncology care and reduce health disparities.

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Healthcare professionals’ perspective on return to work in cancer survivors

Abstract

Objective

Healthcare professionals play a significant role in cancer survivors' decisions regarding return to work. While there is ample research about cancer survivors' views on return to work, little is known about the views of the professionals who accompany them from diagnosis to recovery. The study explores professionals' perceptions of cancer survivors in the return to work context, as well as their views about their own role in the process.

Methods

In-depth interviews (N=26) with professionals specializing in physical or mental health working with working-age cancer survivors: occupational physicians, oncologists, oncology nurses, social workers and psychologists specializing in oncology.

Results

An analysis of the interviews revealed two prominent perceptual dimensions among professionals: the cancer survivor's motivation to return to work and understanding illness-related implications upon returning to work. The two dimensions imply the following four groups of cancer survivors in the RTW context, as viewed by health professionals: the "realist"; the "enthusiast"; the "switcher"; and the "worrier". The results also indicate that social workers and psychologists view their role in terms of jointly discussing options and implications with the cancer survivor, while physicians and nurses view their role more in terms of providing information and suggestions.

Conclusions

The training of professionals should increase awareness of the assumptions they make about cancer survivors in regard to RTW. Additionally, training might elaborate professionals' view of their role in the interaction with cancer survivors regarding return to work.

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SEOM clinical guidelines for the treatment of head and neck cancer (2017)

Abstract

Head and neck cancer (HNC) is defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2013 publication, Spanish Society of Medical Oncology (SEOM) presents an update of HNC diagnosis and treatment guideline. The eighth edition of TNM classification, published in January 2017, introduces important changes for p16-positive oropharyngeal tumours, for lip and oral cavity cancer and for N3 category. In addition, there are new data about induction chemotherapy and the role of immunotherapy in HNC.

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Stridor as the First Presentation of Metastatic Breast Cancer that Was Managed with Chemotherapy: a Case Report

Abstract

Supraclavicular nodal metastases of breast cancer are rare and occur in about 8% of newly diagnosed cases. It is rarely discussed in the literature that breast cancer was metastasizing to higher levels of the cervical nodes. We report a case of metastatic breast cancer to the deep cervical lymph nodes that caused stridor due to compression of the recurrent laryngeal nerve which was diagnosed by indirect laryngoscopy. After full investigations, urgent chemotherapy was started and it showed a dramatic response with disappearance of the lymph node after two cycles with resolution of the stridor. This report also highlights the association of other metastatic sites with this higher level of neck nodal metastases of breast cancer.

http://ift.tt/2rF93h0

Stridor as the First Presentation of Metastatic Breast Cancer that Was Managed with Chemotherapy: a Case Report

Abstract

Supraclavicular nodal metastases of breast cancer are rare and occur in about 8% of newly diagnosed cases. It is rarely discussed in the literature that breast cancer was metastasizing to higher levels of the cervical nodes. We report a case of metastatic breast cancer to the deep cervical lymph nodes that caused stridor due to compression of the recurrent laryngeal nerve which was diagnosed by indirect laryngoscopy. After full investigations, urgent chemotherapy was started and it showed a dramatic response with disappearance of the lymph node after two cycles with resolution of the stridor. This report also highlights the association of other metastatic sites with this higher level of neck nodal metastases of breast cancer.

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Fertility preservation options in pediatric and adolescent patients with cancer

Abstract

The incidence of childhood cancer has steadily increased since the 1950s, with approximately 16,000 children diagnosed each year. However, with the advent of more effective multimodal therapies, childhood cancer survival rates have continued to improve over the past 40 years, with >80% of patients now surviving into adulthood. Fertility preservation (FP) has become an important quality-of-life issue for many survivors of childhood cancer. As a result, the therapeutic options have become less gonadotoxic over time and more patients are being offered FP options. This review examines the indications for consultation, male and female FP options both in the prepubertal patient and adolescent patient, and the unique ethical issues surrounding FP in this vulnerable population. Cancer 2018. © 2018 American Cancer Society.

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Survival by Hispanic ethnicity among patients with cancer participating in SWOG clinical trials

BACKGROUND

Racial disparities in cancer outcomes have been described. To the authors' knowledge, it remains unclear whether patients of Hispanic ethnicity have better or worse survival outcomes. In the current study, the authors evaluated whether Hispanic participants in SWOG clinical trials had different survival outcomes compared with non-Hispanics.

METHODS

Adult patients registered in SWOG phase 2/3 clinical trials between 1986 and 2012 were analyzed. Studies of similar histology and stage of disease were combined. Within each analysis, Kaplan-Meier survival curves were generated to examine differences in outcome by ethnicity. Multivariate Cox regression was used to estimate the association between ethnicity and survival outcomes, controlling for major disease-specific prognostic factors and demographic variables plus area-level income and education to account for socioeconomic status.

RESULTS

A total of 29,338 patients registered to 38 trials were included; 5% of these patients were Hispanic. Hispanic patients were more likely to be younger and from areas of lower income and education (all P<.05). No differences in survival were observed across tumor types except in the patients with advanced stage prostate cancer, in whom the authors observed an association between Hispanic ethnicity and worse overall survival (hazard ratio [HR], 1.40; P = .006), progression-free survival (HR, 1.36; P = .007), and cancer-specific survival (HR, 1.42; P = .013). After adjusting for multiple comparisons, no differences in outcomes were noted.

CONCLUSIONS

Hispanic patients participating in SWOG trials who received uniform treatment and follow-up were found to have similar survival outcomes compared with non-Hispanic patients, with the single exception of those patients with advanced stage prostate cancer. The results of the current study demonstrate that Hispanic patients receiving uniform treatment and follow-up have similar outcomes compared with non-Hispanics. Cancer 2018. © 2018 American Cancer Society.

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Temporal trends in the risk of second primary cancers among survivors of adult-onset cancers, 1980 through 2013: An Australian population-based study

BACKGROUND

The authors' systematic review indicated an increasing trend in the risk of second primary cancers (SPCs) from the 1980s to 2000 when considering studies from the United States and Australia. It is uncertain whether this trend has continued to increase since 2000.

METHODS

The current study was a population-based study of 51,802 individuals with adult-onset cancers identified in the Tasmanian Cancer Registry. Patients with a first cancer diagnosis made between 1980 and 2009 were followed up to December 2013. SPC risks were quantified using standardized incidence ratios (SIRs) and absolute excess risks (AERs). Trends in SPC risk were assessed using multivariable Poisson models.

RESULTS

With a median follow-up of 4.8 years (mean, 6.9 years), a total of 5339 SPCs were observed. The SIRs for any SPC increased from 0.98 (95% confidence interval, 0.90-1.07) after a first cancer diagnosis in 1980 through 1984 to 1.12 (95% confidence interval, 1.05-1.20) in 2005 through 2009. In multivariable Poisson models accounting for patient sex, age at the time of the first cancer diagnosis, follow-up interval, and first cancer type, the trend in SIRs increased significantly from 1980 through 2009 for all SPCs (P for trend <.001) and for specific SPCs of the head and neck, lung, digestive tract, and prostate (all P for trend <.05). From 2000 onward, the AER for specific SPCs after specific first cancers was highest for prostate cancer after first cancers of the urinary tract (AER, 54.3 per 10,000 person-years).

CONCLUSIONS

In Tasmania, the risk of SPCs among survivors of adult-onset cancers has increased with periods of first cancer diagnosis from 1980 through 2009. Increased cancer screening and improved medical imaging may have contributed to the greater risk in recent years. Cancer 2018. © 2018 American Cancer Society.

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Dasatinib dose management for the treatment of chronic myeloid leukemia

Chronic myeloid leukemia (CML) has evolved into a chronic disease that is managed with tyrosine kinase inhibitor therapy. Now that long-term survival has been achieved in patients with CML, the focus of treatment has shifted to dose optimization, with the goal of maintaining response while improving quality of life. In this review, the authors discuss optimizing the dose of the second-generation tyrosine kinase inhibitor dasatinib. Once-daily dosing regimens for dasatinib in the first and later lines of treatment were established through long-term (5-year and 7-year) trials. Recently published data have indicated that further dose optimization may maintain efficacy while minimizing adverse events. Results obtained from dose optimization and discontinuation trials currently in progress will help practitioners determine the best dose and duration of dasatinib for patients with CML, because treatment decisions will be made through continued discussions between physicians and patients. Cancer 2018. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Racial disparities in prostate cancer survival in a screened population: Reality versus artifact

BACKGROUND

Racial disparities in prostate cancer survival (PCS) narrowed during the prostate-specific antigen (PSA) era, suggesting that screening may induce more equitable outcomes. However, the effects of lead time and overdiagnosis can inflate survival even without real screening benefit.

METHODS

A simulation model of PCS in the early PSA era (1991-2000) was created. The modeled survival started with baseline survival in the pre-PSA era (1975-1990) and added lead times and overdiagnosis using estimates from published studies. The authors quantified 1) discrepancies between modeled and observed PCS in the PSA era and 2) residual period effects on PCS given specified values for screening benefit.

RESULTS

Lead time and overdiagnosis explained more of the improvement in PCS for older ages at diagnosis (46% [95% confidence interval (CI), 44%-50%] for blacks and 51% [95% CI, 50%-52%] for all races ages 50-54 years vs 98% [95% CI, 97%-99%] for blacks and 100% for all races ages 75-79 years). They also explained more of the narrowing in PCS disparities for older ages (33% [95% CI, 31%-43%] for men ages 50-54 years vs 74% [95% CI, 71%-81%] for men ages 75-79 years). The period effects amounted to reductions of 27% to 40% among blacks and 26% to 38% among all races in the risk of prostate cancer death, depending on the screening benefit.

CONCLUSIONS

Real improvements in survival disparities in the PSA era are smaller than those observed and reflect similar reductions in the risk of prostate cancer death among blacks and all races. Understanding screening artifacts is necessary for valid interpretation of observed survival trends. Cancer 2018. © 2018 American Cancer Society.

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Imaging-based biomarkers: Changes in the tumor interface of pancreatic ductal adenocarcinoma on computed tomography scans indicate response to cytotoxic therapy

BACKGROUND

The assessment of pancreatic ductal adenocarcinoma (PDAC) response to therapy remains challenging. The objective of this study was to investigate whether changes in the tumor/parenchyma interface are associated with response.

METHODS

Computed tomography (CT) scans before and after therapy were reviewed in 4 cohorts: cohort 1 (99 patients with stage I/II PDAC who received neoadjuvant chemoradiation and surgery); cohort 2 (86 patients with stage IV PDAC who received chemotherapy), cohort 3 (94 patients with stage I/II PDAC who received protocol-based neoadjuvant gemcitabine chemoradiation), and cohort 4 (47 patients with stage I/II PDAC who received neoadjuvant chemoradiation and were prospectively followed in a registry). The tumor/parenchyma interface was visually classified as either a type I response (the interface remained or became well defined) or a type II response (the interface became poorly defined) after therapy. Consensus (cohorts 1-3) and individual (cohort 4) visual scoring was performed. Changes in enhancement at the interface were quantified using a proprietary platform.

RESULTS

In cohort 1, type I responders had a greater probability of achieving a complete or near-complete pathologic response (21% vs 0%; P = .01). For cohorts 1, 2, and 3, type I responders had significantly longer disease-free and overall survival, independent of traditional covariates of outcomes and of baseline and normalized cancer antigen 19-9 levels. In cohort 4, 2 senior radiologists achieved a κ value of 0.8, and the interface score was associated with overall survival. The quantitative method revealed high specificity and sensitivity in classifying patients as type I or type II responders (with an area under the receiver operating curve of 0.92 in cohort 1, 0.96 in cohort 2, and 0.89 in cohort 3).

CONCLUSIONS

Changes at the PDAC/parenchyma interface may serve as an early predictor of response to therapy. Cancer 2018. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Fertility preservation options in pediatric and adolescent patients with cancer

Abstract

The incidence of childhood cancer has steadily increased since the 1950s, with approximately 16,000 children diagnosed each year. However, with the advent of more effective multimodal therapies, childhood cancer survival rates have continued to improve over the past 40 years, with >80% of patients now surviving into adulthood. Fertility preservation (FP) has become an important quality-of-life issue for many survivors of childhood cancer. As a result, the therapeutic options have become less gonadotoxic over time and more patients are being offered FP options. This review examines the indications for consultation, male and female FP options both in the prepubertal patient and adolescent patient, and the unique ethical issues surrounding FP in this vulnerable population. Cancer 2018. © 2018 American Cancer Society.

http://ift.tt/2DEF9ii

Survival by Hispanic ethnicity among patients with cancer participating in SWOG clinical trials

BACKGROUND

Racial disparities in cancer outcomes have been described. To the authors' knowledge, it remains unclear whether patients of Hispanic ethnicity have better or worse survival outcomes. In the current study, the authors evaluated whether Hispanic participants in SWOG clinical trials had different survival outcomes compared with non-Hispanics.

METHODS

Adult patients registered in SWOG phase 2/3 clinical trials between 1986 and 2012 were analyzed. Studies of similar histology and stage of disease were combined. Within each analysis, Kaplan-Meier survival curves were generated to examine differences in outcome by ethnicity. Multivariate Cox regression was used to estimate the association between ethnicity and survival outcomes, controlling for major disease-specific prognostic factors and demographic variables plus area-level income and education to account for socioeconomic status.

RESULTS

A total of 29,338 patients registered to 38 trials were included; 5% of these patients were Hispanic. Hispanic patients were more likely to be younger and from areas of lower income and education (all P<.05). No differences in survival were observed across tumor types except in the patients with advanced stage prostate cancer, in whom the authors observed an association between Hispanic ethnicity and worse overall survival (hazard ratio [HR], 1.40; P = .006), progression-free survival (HR, 1.36; P = .007), and cancer-specific survival (HR, 1.42; P = .013). After adjusting for multiple comparisons, no differences in outcomes were noted.

CONCLUSIONS

Hispanic patients participating in SWOG trials who received uniform treatment and follow-up were found to have similar survival outcomes compared with non-Hispanic patients, with the single exception of those patients with advanced stage prostate cancer. The results of the current study demonstrate that Hispanic patients receiving uniform treatment and follow-up have similar outcomes compared with non-Hispanics. Cancer 2018. © 2018 American Cancer Society.

http://ift.tt/2n8lNXU

Temporal trends in the risk of second primary cancers among survivors of adult-onset cancers, 1980 through 2013: An Australian population-based study

BACKGROUND

The authors' systematic review indicated an increasing trend in the risk of second primary cancers (SPCs) from the 1980s to 2000 when considering studies from the United States and Australia. It is uncertain whether this trend has continued to increase since 2000.

METHODS

The current study was a population-based study of 51,802 individuals with adult-onset cancers identified in the Tasmanian Cancer Registry. Patients with a first cancer diagnosis made between 1980 and 2009 were followed up to December 2013. SPC risks were quantified using standardized incidence ratios (SIRs) and absolute excess risks (AERs). Trends in SPC risk were assessed using multivariable Poisson models.

RESULTS

With a median follow-up of 4.8 years (mean, 6.9 years), a total of 5339 SPCs were observed. The SIRs for any SPC increased from 0.98 (95% confidence interval, 0.90-1.07) after a first cancer diagnosis in 1980 through 1984 to 1.12 (95% confidence interval, 1.05-1.20) in 2005 through 2009. In multivariable Poisson models accounting for patient sex, age at the time of the first cancer diagnosis, follow-up interval, and first cancer type, the trend in SIRs increased significantly from 1980 through 2009 for all SPCs (P for trend <.001) and for specific SPCs of the head and neck, lung, digestive tract, and prostate (all P for trend <.05). From 2000 onward, the AER for specific SPCs after specific first cancers was highest for prostate cancer after first cancers of the urinary tract (AER, 54.3 per 10,000 person-years).

CONCLUSIONS

In Tasmania, the risk of SPCs among survivors of adult-onset cancers has increased with periods of first cancer diagnosis from 1980 through 2009. Increased cancer screening and improved medical imaging may have contributed to the greater risk in recent years. Cancer 2018. © 2018 American Cancer Society.

http://ift.tt/2nfQBGr

Imaging-based biomarkers: Changes in the tumor interface of pancreatic ductal adenocarcinoma on computed tomography scans indicate response to cytotoxic therapy

BACKGROUND

The assessment of pancreatic ductal adenocarcinoma (PDAC) response to therapy remains challenging. The objective of this study was to investigate whether changes in the tumor/parenchyma interface are associated with response.

METHODS

Computed tomography (CT) scans before and after therapy were reviewed in 4 cohorts: cohort 1 (99 patients with stage I/II PDAC who received neoadjuvant chemoradiation and surgery); cohort 2 (86 patients with stage IV PDAC who received chemotherapy), cohort 3 (94 patients with stage I/II PDAC who received protocol-based neoadjuvant gemcitabine chemoradiation), and cohort 4 (47 patients with stage I/II PDAC who received neoadjuvant chemoradiation and were prospectively followed in a registry). The tumor/parenchyma interface was visually classified as either a type I response (the interface remained or became well defined) or a type II response (the interface became poorly defined) after therapy. Consensus (cohorts 1-3) and individual (cohort 4) visual scoring was performed. Changes in enhancement at the interface were quantified using a proprietary platform.

RESULTS

In cohort 1, type I responders had a greater probability of achieving a complete or near-complete pathologic response (21% vs 0%; P = .01). For cohorts 1, 2, and 3, type I responders had significantly longer disease-free and overall survival, independent of traditional covariates of outcomes and of baseline and normalized cancer antigen 19-9 levels. In cohort 4, 2 senior radiologists achieved a κ value of 0.8, and the interface score was associated with overall survival. The quantitative method revealed high specificity and sensitivity in classifying patients as type I or type II responders (with an area under the receiver operating curve of 0.92 in cohort 1, 0.96 in cohort 2, and 0.89 in cohort 3).

CONCLUSIONS

Changes at the PDAC/parenchyma interface may serve as an early predictor of response to therapy. Cancer 2018. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Dasatinib dose management for the treatment of chronic myeloid leukemia

Chronic myeloid leukemia (CML) has evolved into a chronic disease that is managed with tyrosine kinase inhibitor therapy. Now that long-term survival has been achieved in patients with CML, the focus of treatment has shifted to dose optimization, with the goal of maintaining response while improving quality of life. In this review, the authors discuss optimizing the dose of the second-generation tyrosine kinase inhibitor dasatinib. Once-daily dosing regimens for dasatinib in the first and later lines of treatment were established through long-term (5-year and 7-year) trials. Recently published data have indicated that further dose optimization may maintain efficacy while minimizing adverse events. Results obtained from dose optimization and discontinuation trials currently in progress will help practitioners determine the best dose and duration of dasatinib for patients with CML, because treatment decisions will be made through continued discussions between physicians and patients. Cancer 2018. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Racial disparities in prostate cancer survival in a screened population: Reality versus artifact

BACKGROUND

Racial disparities in prostate cancer survival (PCS) narrowed during the prostate-specific antigen (PSA) era, suggesting that screening may induce more equitable outcomes. However, the effects of lead time and overdiagnosis can inflate survival even without real screening benefit.

METHODS

A simulation model of PCS in the early PSA era (1991-2000) was created. The modeled survival started with baseline survival in the pre-PSA era (1975-1990) and added lead times and overdiagnosis using estimates from published studies. The authors quantified 1) discrepancies between modeled and observed PCS in the PSA era and 2) residual period effects on PCS given specified values for screening benefit.

RESULTS

Lead time and overdiagnosis explained more of the improvement in PCS for older ages at diagnosis (46% [95% confidence interval (CI), 44%-50%] for blacks and 51% [95% CI, 50%-52%] for all races ages 50-54 years vs 98% [95% CI, 97%-99%] for blacks and 100% for all races ages 75-79 years). They also explained more of the narrowing in PCS disparities for older ages (33% [95% CI, 31%-43%] for men ages 50-54 years vs 74% [95% CI, 71%-81%] for men ages 75-79 years). The period effects amounted to reductions of 27% to 40% among blacks and 26% to 38% among all races in the risk of prostate cancer death, depending on the screening benefit.

CONCLUSIONS

Real improvements in survival disparities in the PSA era are smaller than those observed and reflect similar reductions in the risk of prostate cancer death among blacks and all races. Understanding screening artifacts is necessary for valid interpretation of observed survival trends. Cancer 2018. © 2018 American Cancer Society.

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SEOM clinical guidelines for the treatment of head and neck cancer (2017)

Abstract

Head and neck cancer (HNC) is defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2013 publication, Spanish Society of Medical Oncology (SEOM) presents an update of HNC diagnosis and treatment guideline. The eighth edition of TNM classification, published in January 2017, introduces important changes for p16-positive oropharyngeal tumours, for lip and oral cavity cancer and for N3 category. In addition, there are new data about induction chemotherapy and the role of immunotherapy in HNC.

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SEOM clinical guidelines for the treatment of head and neck cancer (2017)

Abstract

Head and neck cancer (HNC) is defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2013 publication, Spanish Society of Medical Oncology (SEOM) presents an update of HNC diagnosis and treatment guideline. The eighth edition of TNM classification, published in January 2017, introduces important changes for p16-positive oropharyngeal tumours, for lip and oral cavity cancer and for N3 category. In addition, there are new data about induction chemotherapy and the role of immunotherapy in HNC.

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The clinicopathological features and prognosis of tumor MSI in East Asian colorectal cancer patients using NCI panel

Future Oncology, Ahead of Print.


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The clinicopathological features and prognosis of tumor MSI in East Asian colorectal cancer patients using NCI panel

Future Oncology, Ahead of Print.


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Patient positioning in head and neck cancer

Abstract

Objective

To evaluate the interfractional variations of patient positioning during intensity-modulated radiotherapy (IMRT) with helical tomotherapy in head and neck cancer and to calculate the required safety margins (sm) for bony landmarks resulting from the necessary table adjustments.

Materials and methods

In all, 15 patients with head and neck cancer were irradiated using the Hi-Art II tomotherapy system between April and September 2016. Before therapy sessions, patient position was frequently checked by megavolt computed tomography (MV-CT). Necessary table adjustments (ta) in the right-left (rl), superior-inferior (si) and anterior-posterior (ap) directions were recorded for four anatomical points: second, fourth and sixth cervical vertebral body (CVB), anterior nasal spine (ANS). Based upon these data sm were calculated for non-image-guided radiotherapy, image-guided radiotherapy (IGRT) and image guidance limited to a shortened area (CVB 2).

Results

Based upon planning CT the actual treatment required ta from –0.05 ± 1.31 mm for CVB 2 (ap) up to 2.63 ± 2.39 mm for ANS (rl). Considering the performed ta resulting from image control (MV-CT) we detected remaining ta from –0.10 ± 1.09 mm for CVB 4 (rl) up to 1.97 ± 1.64 mm for ANS (si). After theoretical adjustment of patients position to CVB 2 the resulting ta ranged from –0.11 ± 2.44 mm for CVB6 (ap) to 2.37 ± 2.17 mm for ANS (si). These data imply safety margins: uncorrected patient position: 3.63–9.95 mm, corrected positioning based upon the whole target volume (IGRT): 1.85–6.63 mm, corrected positioning based upon CVB 2 (IGRT): 3.13–6.66 mm.

Conclusions

The calculated safety margins differ between anatomic regions. Repetitive and frequent image control of patient positioning is necessary that, however, possibly may be focussed on a limited region.

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Retrospective inconsistent analysis cannot validate safety of a treatment strategy

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Einfluss der prophylaktischen Ganzhirnbestrahlung auf das Gesamtüberleben beim fortgeschrittenen kleinzelligen Bronchialkarzinom

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Pathogen-Reduced Platelets for the Prevention of Bleeding

This Clinical Evidence Synopsis summarizes 12 randomized clinical trials to compare whether pathogen-reduced platelets are as effective as standard platelets for the prevention of bleeding in platelet transfusions.

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Metronomic Therapy for Progressive Pediatric Solid Malignant Tumors—Reply

In Reply We thank Fang et al for their interest in our study. Just eyeballing the progression-free and overall survival Kaplan-Meier curves, it is evident that survival experiences in both arms of the study are essentially similar without any meaningful difference. The restricted mean survival (event-free) time (RMST) up to a specific time point is an attractive new but seldom-used alternative approach to evaluate differences in the Kaplan-Meier curves, if the curves show apparent differences and the proportional hazards assumption is not plausible. When Kaplan-Meier curves overlap with no apparent differences, the proportional hazards assumption is redundant. Furthermore, the RMST approach needs a prespecification of time point because it varies with the time point at which we truncate our graphs for assessing clinically meaningful outcomes.

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Patient Portal Use in Oncology Practice

This study examines the association of accessing electronic oncology patient portal data with patient characteristics and type of portal content.

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Metronomic Therapy for Progressive Pediatric Solid Malignant Tumors

To the Editor First of all, we congratulate Pramanik et al for carrying out the first randomized clinical trial in the field of metronomic chemotherapy. However, we would like to raise some pertinent issues.

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Metronomic Therapy for Progressive Pediatric Solid Malignant Tumors

To the Editor In the trial conducted by Pramanik and colleagues for treating progressive pediatric solid malignant tumors, the primary end point was progression-free survival (PFS). The hazard ratio (HR) for metronomic chemotherapy vs best supportive care (BSC) was 0.69 (95% CI, 0.47-1.03; P = .07). Numerically, this HR value is impressive, but it is not statistically significant. Therefore, the authors concluded that metronomic chemotherapy would not improve PFS, compared with placebo, among pediatric patients with extracranial progressive solid malignant tumors. The profile of the difference of the 2 Kaplan-Meier PFS curves in Figure 2 of the article for metronomic chemotherapy and BSC suggests that the proportional hazards model assumption is not plausible. That is, the HR is not constant over the entire study follow-up time. This implies that the observed HR is difficult to interpret clinically and, furthermore, it is likely that the test based on HR might not have enough statistical power to detect a real metronomic treatment effect. The authors also reported that the median PFS times between the 2 arms were similar. On the other hand, visually the Kaplan-Meier curves suggested that metronomic chemotherapy appeared to prolong the patients' PFS after 2 months of follow-up. For this situation, the median is not sensitive enough to capture the relatively long-term survival profile from metronomic chemotherapy. It is also known that generally the estimate of the median survival time is notoriously unstable and results in an inconclusive claim about the treatment difference.

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Residual Risk–Based Eligibility in Breast Cancer Adjuvant Trials

This modeling study calculates individualized residual risk estimates for patients with early-stage breast cancer and assesses whether defining eligibility based on a minimum residual risk threshold could increase the reliability of clinical trial power calculations.

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Comparison Between Adjuvant and Early-Salvage Postprostatectomy Radiotherapy for Prostate Cancer

This multi-institutional cohort study compares adjuvant radiotherapy with early-salvage radiotherapy used to manage postoperative patients with prostate cancer who have adverse pathological features.

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Concurrent renal cell carcinoma and urothelial carcinoma: long-term follow-up study of 27 cases

Abstract

Background

To investigate the clinical manifestation, diagnosis, treatment, and outcome of simultaneous occurrence of renal cell carcinoma (RCC) and urothelial carcinoma.

Methods

Twenty-seven consecutive patients with synchronous renal cell carcinoma and urothelial carcinoma treated in two tertiary medical centers from March 2005 to December 2015 were retrospectively reviewed. Their clinical, pathological, and prognostic features were evaluated. Kaplan-Meier curves were used to estimate overall survival.

Results

The median age was 69 years (range, 37–79 years). Seventeen patients presented with macroscopic hematuria, and 10 patients were asymptomatic. B-ultrasound, computed tomography (CT), and cystoscopy initially indicated RCC concurrent with ipsilateral upper tract urothelial carcinoma (UTUC) in 5 cases, RCC concurrent with contralateral UTUC in 1 case, RCC concurrent with bladder tumor in 17 cases, RCC concurrent with both ipsilateral UTUC and bladder tumor in 1 case, RCC in 2 cases and ureter carcinoma in 1 case. Different treatments were performed. The median follow-up time after surgery was 23 months. For patients with synchronous RCC and bladder tumor, there was no significant survival difference between patients treated with partial nephrectomy and radical nephrectomy. During follow up, four patients died of RCC, three patients died of non-oncological disease, one patient died of ureter carcinoma. The 3-year overall survival rate was 80.8%.

Conclusions

Concurrence of RCC and urothelial carcinoma is clinically rare. Treatments should be individualized. The prognosis for a patient with synchronous RCC and urothelial carcinoma is possibly associated with the more aggressive one.

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Concurrent renal cell carcinoma and urothelial carcinoma: long-term follow-up study of 27 cases

Abstract

Background

To investigate the clinical manifestation, diagnosis, treatment, and outcome of simultaneous occurrence of renal cell carcinoma (RCC) and urothelial carcinoma.

Methods

Twenty-seven consecutive patients with synchronous renal cell carcinoma and urothelial carcinoma treated in two tertiary medical centers from March 2005 to December 2015 were retrospectively reviewed. Their clinical, pathological, and prognostic features were evaluated. Kaplan-Meier curves were used to estimate overall survival.

Results

The median age was 69 years (range, 37–79 years). Seventeen patients presented with macroscopic hematuria, and 10 patients were asymptomatic. B-ultrasound, computed tomography (CT), and cystoscopy initially indicated RCC concurrent with ipsilateral upper tract urothelial carcinoma (UTUC) in 5 cases, RCC concurrent with contralateral UTUC in 1 case, RCC concurrent with bladder tumor in 17 cases, RCC concurrent with both ipsilateral UTUC and bladder tumor in 1 case, RCC in 2 cases and ureter carcinoma in 1 case. Different treatments were performed. The median follow-up time after surgery was 23 months. For patients with synchronous RCC and bladder tumor, there was no significant survival difference between patients treated with partial nephrectomy and radical nephrectomy. During follow up, four patients died of RCC, three patients died of non-oncological disease, one patient died of ureter carcinoma. The 3-year overall survival rate was 80.8%.

Conclusions

Concurrence of RCC and urothelial carcinoma is clinically rare. Treatments should be individualized. The prognosis for a patient with synchronous RCC and urothelial carcinoma is possibly associated with the more aggressive one.

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Utilization of agents to prevent skeletal-related events among patients with multiple myeloma: analysis of real-world data

Abstract

Purpose

This study examined real-world utilization patterns of bone-targeted agents (BTA) in patients with multiple myeloma (MM).

Methods

In this retrospective cohort study, adults with an MM diagnosis recorded in 2012–2014 were identified from electronic health records in the Oncology Services Comprehensive Electronic Records (OSCER) database. Patients received zoledronic acid (ZA) or pamidronate (PA) on/after first MM diagnosis recorded in the study period, had no BTA use in prior 6 months, and were followed through earliest of May 31, 2015 or last clinic visit. Patients with any solid tumor diagnosis were excluded. Time to BTA initiation, compliance (≥ 12 administrations in a year), switching, and non-persistence (switch or ≥ 90-day gap in therapy) were described by agent and follow-up period.

Results

Among 9,617 patients with MM, 3,735 (38.8%) received a BTA. Most patients (90.9%) received ZA, with first BTA use generally seen within 3 months of first observed MM diagnosis (ZA 76.1%, PA 75.1%). A minority of ZA (27.4%) and PA (23.0%) patients were compliant in Year 1, with lower compliance in Year 2 (19.8% and 15.6%, respectively). The median time to non-persistence was 16.2 (95% confidence interval [CI] 15.4–17.4) months for ZA and 13.8 (95% CI 11.5–15.4) months for PA. Persistence was 86% at 6 months and 34% at 24 months for ZA, and 77% and 30% for PA, respectively.

Conclusions

These results highlight the possibility of suboptimal prevention of skeletal-related events due to non-compliant dosing and non-persistence after patients initiate BTA therapy.

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Impact of body composition on outcome in patients with early breast cancer

Abstract

Purpose

We investigated the impact of body composition on outcomes of patients with early breast cancer. Skeletal muscle mass, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and muscle fat infiltration or inter-muscular adipose tissue areas (IMAT), obtained by computed tomography (CT), were assessed.

Methods

A total of 119 female patients who had breast cancer were included in this retrospective study. The total skeletal muscle and fat tissue areas were evaluated in two adjacent axial slices obtained at the third lumbar vertebra by CT used for disease staging. The women were assigned to either a sarcopenia or non-sarcopenia group based on their skeletal muscle index (cut-off 41.0 cm²/m²). They also were classified into high and low VAT/SAT ratio groups and assigned to either the high or low IMAT index group. The association of the body composition parameters and prognosis was statistically analyzed.

Results

Among the 119 evaluable patients, 58 were sarcopenic (48.8%), 55 (46.2%) had a high VAT/SAT ratio, and 62 (52.1%) had a high IMAT index. Median follow-up was 52.4 months. Multivariate analysis revealed sarcopenia and IMAT index as independent prognostic factors for disease-free survival (p = 0.02 and p = 0.04, respectively) and overall survival (p = 0.05 and p = 0.02, respectively). BMI was not significantly associated with disease-free survival, but a trend was observed (p = 0.09).

Conclusions

Sarcopenia and IMAT index are independent prognostic factors in early breast cancer; therefore, assessing body composition could be a simple and useful approach to integrate into patient management.

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Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients

Abstract

Purpose

Family caregivers play a significant role in the care of cancer patients, especially in their end of life. Identifying and meeting the needs of these caregivers is essential to improving their quality of patient care. This study was conducted to identify the unmet needs of the caregivers of end-of-life cancer patients.

Methods

A total of 18 semi-structured interviews were held with the family caregivers of end-of-life cancer patients using purposive sampling. The interviews were recorded, transcribed, and analyzed using qualitative content analysis.

Results

The analysis of the data led to the formation of three main categories, including social needs, cognitive needs, and psychological needs. The social needs category comprised of the subcategories of support for care, effective communication and financial support. The cognitive needs category comprised of educational support and support in decision-making. The psychological needs category comprised of support for psychological trauma, preparation to confront the reality of the death of a loved one, and support for mourning.

Conclusions

The family caregivers of end-of-life cancer patients take on the responsibility of many aspects of care for their patient, but many of their own needs remain unmet. The findings of this study can be used for healthcare policy planning and the development of palliative interventions, particularly for the family caregivers of end-of-life cancer patients.

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Relationship between phase I study duration and symptom burden

Abstract

Purpose

Phase I clinical trials are critical to development of cancer therapeutics. Adverse events (AEs) and symptom burden contribute to early treatment withdrawal, and it is often difficult to ascertain whether these events are disease- or treatment-related. Regardless, early withdrawal may delay determination of the effectiveness of potential new therapies. We sought to characterize the reasons for early treatment termination to identify potential modifiable events.

Methods

A retrospective chart review was conducted on solid tumor patients enrolled in institutional phase I clinical trials from 2003 to 2013 through the Case Comprehensive Cancer Center.

Results

Two hundred fifty-five patients were included in the analysis. The mean duration on study was 78.4 days (SD 63.4 days), and 23% of the patients were on study ≤ 30 days. Patients experienced an average of 25.1 AEs, of which 46.9% were non-laboratory. Constitutional symptoms (29.3%), gastrointestinal symptoms (24%), and pain (12.8%) were the most common non-laboratory AEs. Disease progression (57.6%) was the most common reason for study discontinuation, followed by adverse events (16.5%). Approximately 13% of the patients discontinued treatment for other reasons, of which 41.7% were identified as related to symptom burden on further review. Increased rates of AEs negatively correlated with duration on study (r = − 0.331; p < 0.01).

Conclusions

AEs may lead to early termination of trial participation and confound clinical assessment of investigational treatments. Designing interventions to reduce AE burden may extend duration on trial, affect the recommended phase II dose, and benefit the quality of life of participants on phase I trials.

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Employer’s management of employees affected by cancer

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Efficacy and safety of 153 Sm-EDTMP as treatment of painful bone metastasis: a large single-center study

Abstract

Purpose

The purpose of this study is to assess the efficacy of ¹⁵³Sm-EDTMP (Quadramet®) in a clinical setting.

Methods

We have conducted a retrospective study of all consecutive patients (pts) treated with ¹⁵³Sm-EDTMP for painful bone metastases. At each visit (before and after treatment), four parameters were collected: (i) pain assessment according to the 10-step visual analogue scale (VAS), (ii) sleep disturbance related to pain, (iii) dose of analgesic medication, and (iv) answer to the following closed question "Do you think you obtained a benefit from treatment?" Success of treatment was defined by the combination of these four parameters.

Results

Three hundred seventy consecutive ¹⁵³Sm-EDTMP treatments for painful bone metastases were given. Patients had the following primary tumors: breast carcinoma (153), prostate carcinoma (155), lung carcinoma (27), or other cancers (35). Fifty-eight percent of the patients had received previous external osseous radiotherapy. Ninety-seven percent of the patients were treated with concomitant analgesics and 61% were treated with diphosphonates. A clinical benefit was described in 55.0% of cases at D30. Treatment was more effective in cases of breast and prostate cancers compared with other types of primary cancers. Patients described a benefit at D30 in 62, 58, 6, and 38% of cases of breast, prostate, lung, and other cancers. The subjective efficacy was accompanied by a decrease in analgesic intake in 35.0% of cases.

Conclusion

¹⁵³Sm-EDTMP therapy is an effective supportive treatment in patients who suffer from bone metastases, especially in patients with breast or prostate cancer.

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Influence of cancer and acute inflammatory disease on taste perception: a clinical pilot study

Abstract

Purpose

Cancer patients are at high risk of malnutrition and tumor cachexia further increasing morbidity and mortality. Reasons for cachexia are not clear yet, but inflammatory processes as well as the occurrence of taste disorders reducing nutrient uptake are discussed to play key roles. The purpose of this study was to gain insight into causative factors of taste disturbance in cancer patients. Does the cancer itself, inflammatory processes or cancer therapy influence taste disorders?

Methods

To capture an underlying taste disorder patients with cancer (n = 42), acutely hospitalized inflammatory disease patients (n = 57) and healthy controls (n = 39) were examined. To assess the influence of chemotherapy, patients with and without chemotherapy were compared. Taste tests were performed according to DIN ISO 3972:2011. Inflammation was recorded using laboratory parameters. Statistical evaluation was conducted using the Software R.

Results

Cancer patients showed significantly increased taste thresholds for sweet, salty, and umami compared to healthy controls. There were no significant differences in taste detection and recognition between patients with former, current, or without chemotherapeutical treatment. Patients with an acute inflammatory disease showed an increased taste threshold for umami compared to healthy controls.

Conclusions

It could be shown that cancer patients suffer from taste disorders irrespective of an existing chemotherapeutical treatment. Cancer-related inflammation appears to have a greater impact on taste perception than an acute inflammatory process. Therefore, an adapted dietary adjustment should be carried out at an early stage for cancer patients in order to avoid nutritional disorders caused by a taste disorder.

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Defibrotide for the treatment of sinusoidal obstruction syndrome: evaluation of response to therapy and patient outcomes

Abstract

Purpose

Defibrotide is an agent used to treat sinusoidal obstruction syndrome (SOS/VOD) in patients undergoing haemopoietic stem cell transplantation. The aim of this study was to evaluate the effectiveness of defibrotide used within institutional guidelines for the treatment of SOS/VOD in patients undergoing haemopoietic stem cell transplantation (HSCT).

Methods

Data for 23 patients was retrospectively reviewed to evaluate the effectiveness of defibrotide and the utility of response criteria to direct therapy as specified within institution guidelines. Patients met institutional criteria for a diagnosis of SOS/VOD based on predominantly Baltimore criteria and received defibrotide. Stabilisation or improvement in symptoms and biochemical markers was required for continuation of therapy with defibrotide.

Results

Overall, 14 patients responded to therapy. Survival at day 100 post HSCT was 70%. Median serum (total) bilirubin concentrations in all evaluable patients had decreased at days 5 and 10 (p < 0.001). There was a proportional reduction in median weight of 4% by day 5 and 6.6% by day 10 (p < 0.001). On cessation of defibrotide, there was a decrease in the proportion of patients exhibiting hepatomegaly (p = 0.02), ascites (p < 0.01) and requiring oxygen supplementation (p < 0.01), with 70% survival at day 100 post HSCT.

Conclusion

Defibrotide to treat SOS/VOD and continued based on attainment of early response was effective management of this condition. Defibrotide should be considered in any consensus protocol providing guidance on the management of SOS/VOD, with future studies considered to assess appropriate time points for response to therapy during treatment.

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Evaluation of an advance care planning web-based resource: applicability for cancer treatment patients

Abstract

Purpose

The purpose of this study was to explore the acceptability, applicability, and understandability of a promising advance care planning (ACP) web-based resource for use with oncology patients, and determine whether revisions to the website would be necessary before implementation into oncology care. The resource is called PREPARE (www.prepareforyourcare.org) and it had not been tested for use within oncology, but had previously been shown to influence the readiness of older, community-dwelling adults to engage in ACP behaviors.

Methods

This qualitative descriptive study included participants receiving cancer medications and one participant on watchful waiting post-chemotherapy (n = 21). Data were collected via cognitive interviewing, followed by a brief semi-structured interview to gather a meaningful account of the participants' experience with PREPARE. Content analysis resulted in a comprehensive summary of what participants liked and did not like about the resource, as well as suggestions for change.

Results

Overall, participants agreed PREPARE was acceptable, applicable, and understandable for cancer patients. A small number of participants had difficulty with the life-limiting language found within the website and this requires follow-up to determine whether the language causes distress or disengagement from ACP. These findings extend our understanding of barriers to engagement in ACP that appear unique to cancer patients receiving active treatment.

Conclusions

Results indicated that PREPARE is a reflective, capacity-building ACP resource that was acceptable, applicable, and understandable for use in oncology. These findings offer direction for both research and practice.

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Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care

Abstract

Aim

The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care.

Methods

A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1 week after palliative care (T7).

Results

Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD = 6.69); the mean PaP score at admission was 6.9 (SD = 3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4 days (SD = 48, range 2–220). The mean MDAS values at admission and after 1 week of palliative care were 6.9 (SD = 6.71) and 8.8 (SD = 8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥ 7 at admission and after 1 week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS > 7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7.

Conclusion

Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This information is relevant for decision-making when delirium does not change despite a traditional intervention. Continuous assessment of delirium should be performed in these settings to detect deterioration of cognitive function. Further studies should elucidate whether an earlier approach to palliative care would decrease the prevalence of delirium at a late stage of disease.

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Oncologists’ responses to patient and caregiver negative emotions and patient perception of quality of communication: results from a multi-ethnic Asian setting

Abstract

Purpose

Patients with advanced cancer and their caregivers experience many negative emotions. Empathic responses from oncologists can help alleviate their distress. We aimed to assess expressions of negative emotions among patients with advanced cancer and their caregivers and oncologists' empathic responses during consultations in an Asian setting. We also assessed the association between oncologists' expression of empathy and patients' and caregivers' perception of communication quality.

Methods

We surveyed 100 patients with advanced cancer and their caregivers and audio recorded consultations with their oncologists. We coded expressions of negative emotions by patients and caregivers and oncologists' empathic responses. We also surveyed participating oncologists (n = 30) about their confidence in expressing empathy and perceived communication behavior outcomes.

Results

About 52% of patients and 49% of caregivers expressed at least one negative emotion during the consultation, though 59% of patients and 48% of caregivers reported not wanting to discuss negative emotions. Oncologists responded empathically to 12% of patients' negative emotions and 9% of caregivers' negative emotions, despite 92% of them reporting confidence in expressing empathy. Oncologists' expression of empathy did not vary significantly by patient, caregiver, or their own demographic characteristics. It also did not differ based on their confidence in expressing empathy and positive outcome expectations. When oncologists responded empathically just one time, patients perceived communication more favorably.

Conclusions

In this Asian setting, patients and caregivers commonly expressed negative emotions. Oncologists' expressed empathy infrequently, although when they were empathic, it was related to improved patient perception of communication quality.

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Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre

Abstract

Background

Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period.

Methods

Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons.

Results

Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported.

Conclusion

Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.

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Randomized control trial of benzydamine HCl versus sodium bicarbonate for prophylaxis of concurrent chemoradiation-induced oral mucositis

Abstract

Purpose

The purpose of the study is to compare the efficacy of benzydamine HCl with sodium bicarbonate in the prevention of concurrent chemoradiation-induced oral mucositis in head and neck cancer patients.

Methods

Sixty locally advanced head and neck cancer patients treated with high-dose radiotherapy concurrently with platinum-based chemotherapy were randomly assigned to receive either benzydamine HCl or sodium bicarbonate from the first day of treatment to 2 weeks after the completion of treatment. The total score for mucositis, based on the Oral Mucositis Assessment Scale (OMAS), was used for the assessment, conducted weekly during the treatment period and at the fourth week of the follow-up. Pain score, all prescribed medications, and tube feeding needs were also recorded and compared.

Results

The median of total OMAS score was statistically significant lower in patients who received benzydamine HCl during concurrent chemo-radiotherapy (CCRT) than in those who received sodium bicarbonate, (p value < 0.001). There was no difference in median pain score, (p value = 0.52). Nineteen percent of patients in sodium bicarbonate arm needed oral antifungal agents whereas none in the benzydamine HCl arm required such medications, (p value = 0.06). Tube feeding needs and the compliance of CCRT were not different between the two study arms.

Conclusions

For patients undergoing high-dose radiotherapy concurrently with platinum-based chemotherapy, using benzydamine HCl mouthwash as a preventive approach was superior to basic oral care using sodium bicarbonate mouthwash in terms of reducing the severity of oral mucositis and encouraging trend for the less need of oral antifungal drugs.

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Assessing the utility of a distress screening tool at capturing sexual concerns in a gyne-oncology follow-up clinic

Abstract

Purpose

Communication and assessment of sexual health within cancer care is poor despite high rates of sexual dysfunction in cancer survivors. Screening for distress programs have been implemented, as a standardized part of cancer care across Canada, with the aim of increasing identification and improving access to support. Alberta Health Services uses a general distress screening form, containing the Canadian Problem Checklist, which includes a list of possible problems, one of which is "intimacy/sexuality." Theoretically, the discreet nature of the screening for distress form may reduce patient discomfort in disclosing sexual concerns verbally, and therefore help health care providers identify patients requiring intervention. This study aims to determine the adequacy of this distress screening tool in identifying gynecological cancer patients who have an intimacy/sexuality concern.

Methods

A chart review was conducted on all follow-up visits in a gyne-oncology clinic over 1 year. Each patient's chart was reviewed to determine the prevalence of the distress screening form completion, prevalence of the "intimacy/sexuality" item being checked, and documentation of actions taken to address any reported intimacy/sexuality problems.

Results

Seven hundred thirty patient visits were recorded during this period with completed distress screening forms found on 79.0% (n = 577) of charts. Only 6% of the patients indicated an intimacy/sexuality concern on this form. Of those, only one third had documentation that their problem was addressed.

Conclusions

These results call into question the utility of the intimacy/sexuality item on the Canadian Problem Checklist to identify gynecological cancer patients who have sexual concerns. Furthermore, even among those patients who indicated concerns, there is evidence that their problems are rarely addressed. Providers need to directly inquire with patients about their sexual health.

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A single-center, retrospective analysis to compare the efficacy and safety of filgrastim-sndz to filgrastim for prophylaxis of chemotherapy-induced neutropenia and for neutrophil recovery following autologous stem cell transplantation

Abstract

Filgrastim-sndz (Zarxio®) was approved by the FDA in March 2015 as a biosimilar product of its reference product, filgrastim (Neupogen®) for all five indications. The NCCN Clinical Practice Guidelines has incorporated filgrastim-sndz into its recommendations as a category 1 recommendation for use in settings of febrile neutropenia, myelosuppressive chemotherapy administration, and post-hematopoietic stem cell transplant (HSCT). As a cost-saving initiative, our institution switched from filgrastim to filgrastim-sndz for all indications starting in March 2016. The purpose of this study was to assess for any difference in clinical or safety outcomes between filgrastim and filgrastim-sndz. This is an IRB-approved, single institution, 1-year retrospective chart review (September 2015 to August 2016) conducted in hospitalized adults who received either filgrastim or filgrastim-sndz either for prophylaxis of chemotherapy-induced myelosuppression or for neutrophil recovery after autologous HSCT. Our data showed no differences in duration of G-CSF therapy (7.96 vs. 8.5 days, P = 0.36), white blood count (WBC) (8.99 vs. 8.04, P = 0.28), absolute neutrophil count (ANC) (7.62 vs. 6.91 × 10⁹/L, P = 0.36) at the time of granulocyte-colony stimulating factor (G-CSF) discontinuation, or safety of filgrastim and filgrastim-sndz. The efficacy and safety of filgrastim and filgrastim-sndz were similar for prophylaxis of chemotherapy-induced neutropenia and neutrophil recovery post-autologous HSCT.

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Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi

Abstract

Purpose

Lymphoma is the commonest pediatric cancer in sub-Saharan Africa (SSA). Frequent treatment abandonment contributes to suboptimal outcomes. We examined risk factors and reasons for treatment abandonment for this population in Malawi.

Methods

We conducted a mixed methods study among children < 18 years old with newly diagnosed lymphoma, prospectively enrolled during 2013–2016. All children received standardized diagnosis and treatment, and were followed for up to 2 years. Treatment abandonment was defined as failure to attend prescribed chemotherapy within 4 weeks, or post-treatment visit within 3 months. Child, guardian, and household characteristics associated with treatment abandonment were assessed. Semi-structured interviews were conducted with primary caregivers of children experiencing treatment abandonment.

Results

Of 121 children with newly diagnosed lymphoma, 72 (60%) had complete information regarding child, guardian, and household characteristics. Of these, 56 (78%) had Burkitt's and 16 (22%) Hodgkin's lymphoma. Forty-nine (68%) were male, median age was 10.6 years (interquartile range [IQR] 7.9–13.0), and 26 (36%) experienced treatment abandonment. Lack of guardian education and travel time ≥ 4 h to clinic were independently associated with treatment abandonment, with adjusted hazard ratio (aHR) 3.8 [95% confidence interval (CI) 1.5–8.9, p = 0.005] and aHR 2.9 (95% CI 1.2–6.9, p = 0.019), respectively. Commonest reasons for treatment abandonment endorsed by 15 guardians were community influence, suboptimal clinic environment, logistical challenges, transport costs, treatment toxicities, loss of hope, alternative healers, and beliefs about cure.

Conclusions

These findings highlight families at risk for treatment abandonment, underlying reasons, and opportunities to improve retention in care for pediatric cancer patients in SSA.

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Enhancing an oncologist’s recommendation to exercise to manage fatigue levels in breast cancer patients: a randomized controlled trial

Abstract

Purpose

Fatigue is a troublesome symptom for breast cancer patients, which might be mitigated with exercise. Cancer patients often prefer their oncologist recommend an exercise program, yet a recommendation alone may not be enough to change behavior. Our study determined whether adding an exercise DVD to an oncologist's recommendation to exercise led to better outcomes than a recommendation alone.

Methods

Ninety breast cancer patients, at varying phases of treatment and stages of disease, were randomized to receive the following: an oncologist verbal recommendation to exercise (REC; n = 43) or REC plus a cancer-specific yoga DVD (REC + DVD; n = 47). Fatigue, vigor, and depression subscales of the Profile of Mood States, and physical activity levels (MET-min/week), exercise readiness, and self-efficacy were assessed at baseline, 4, and 8 weeks. Analyses controlled for age, time since diagnosis, and metastatic disease.

Results

Over 8 weeks, women in REC + DVD used the DVD an average of twice per week. The REC + DVD group had greater reductions in fatigue (− 1.9 ± 5.0 vs. − 1.0 ± 3.5, p = 0.02), maintained exercise readiness (− 0.1 ± 1.1 vs. − 0.3 ± 1.3; p = 0.03), and reported less of a decrease in physical activity (− 420 ± 3075 vs. − 427 ± 5060 MET-min/week, p = 0.06) compared to REC only.

Conclusions

A low-cost, easily distributed, and scalable yoga-based DVD could be a simple booster to an oncologist's advice that motivates breast cancer patients, even those with advanced disease and/or in treatment, to engage in self-care, e.g., exercise, to manage fatigue.

Trial registration

ClinicalTrials.gov Identifier: NCT03120819

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Palliative care content on cancer center websites

Abstract

Purpose

Professional guidelines recommend that palliative care begin early in advanced cancer management, yet integration of palliative and cancer care remains suboptimal. Cancer centers may miss opportunities to provide palliative care information online. In this study, we described the palliative care content on cancer center websites.

Methods

We conducted a systematic content analysis of 62 National Cancer Institute- (NCI) designated cancer center websites. We assessed the content of center homepages and analyzed search results using the terms palliative care, supportive care, and hospice. For palliative and supportive care webpages, we assessed services offered and language used to describe care. Two researchers analyzed all websites using a standardized coding manual. Kappa values ranged from 0.78 to 1.

Results

NCI-designated cancer center homepages presented information about cancer-directed therapy (61%) more frequently than palliative care (5%). Ten percent of cancer centers had no webpage with palliative care information for patients. Among centers with information for patients, the majority (96%) defined palliative or supportive care, but 30% did not discuss delivery of palliative care alongside curative treatment, and 14% did not mention provision of care early in the disease process.

Conclusions

Cancer center homepages rarely mention palliative care services. While the majority of centers have webpages with palliative care content, they sometimes omit information about early use of care. Improving accessibility of palliative care information and increasing emphasis on early provision of services may improve integration of palliative and cancer care.

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Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study

Abstract

Purpose

Limited research has focused on women with lung cancer (LC) although they are recognized as the most vulnerable to psychological distress. This study explored in-depth the psychological distress experienced by women with incurable LC and analyzed the coping strategies with which they manage that distress.

Methods

A qualitative methodology with in-depth interviews was employed for 34 women with advanced or recurrent LC. An inductive data-driven thematic analysis was applied to analyze transcripts.

Results

Psychological distress was an iterative process for the women. Four themes were identified: shock regarding the diagnosis, distress regarding cancer treatment and its side effects, the facing of a recurrent or progressive disease, and persistent struggle with the life-limiting disease. Various coping strategies applied by the women to manage psychological distress were grouped into four themes: relying upon social support, focusing on positive thoughts, avoidance-based strategies, and religious faith and acceptance.

Conclusions

Women with incurable LC experienced substantial iterative psychological distress throughout the illness, regardless of length of illness at time of interview. They applied multiple forms of coping. The findings enrich the limited existing literature on this understudied population and provide direction for the future development of interventions to improve their psychological well-being.

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Short-term follow-up of the nutritional status of children with Fanconi anemia undergoing hematopoietic stem cell transplant

Abstract

Objective

The objective of this study was to evaluate the nutritional status of children diagnosed with Fanconi anemia (FA) during hematopoietic stem cell transplant (HSCT), comparing it with healthy children and children with other hematologic diseases.

Methods

Observational retrospective study was conducted with patients submitted to HSCT in a period of 5 years. We assessed anthropometric and biochemical data, food intake, and gastrointestinal complications in 49 FA patients. We compared the anthropometric information with those of transplanted patients with other diagnoses (n = 54) in three periods (pre-transplant, 15 and 30 days after the HSCT), and with a group of healthy children (n = 24).

Results

Throughout the post-HSCT period, there was a significant decline in the nutritional status of FA patients: 83.3% presented weight loss equal to or greater than 5%. A progressive decrease in food intake after the transplantation was observed, with weekly deficits reaching 7841.3 kcal and 347.6 g of protein (both p < 0.05). When comparing FA with other diagnoses patients, the former displayed a poorer nutritional status prior to HSCT (p < 0.01 for BMI/age z-score), and that difference was maintained during the transplant (p < 0.01 for the same parameter), with similar weight loss values for both groups (8.99 vs 7.91%, respectively; p > 0.05). When compared to the control group of healthy children, FA patients prior HSCT showed substantially lower z-scores for Ht./age (p < 0.01) and BMI/age (p < 0.05).

Conclusion

Although FA patients demonstrated poorer nutritional status as compared to other diagnosis and healthy children, the decline of anthropometric measures along the treatment is similar to other transplanted patients, imposing a greater risk to FA patients.

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Bias in matched case–control studies: DAGs are not enough

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Dietary non enzymatic antioxidant capacity and the risk of myocardial infarction in the Swedish women’s lifestyle and health cohort

Abstract

Foods rich in antioxidants have been associated with a reduced risk of myocardial infarction. However, findings from randomized clinical trials on the role of antioxidant supplementation remain controversial. It has been suggested that antioxidants interact with each other to promote cardiovascular health. We therefore investigated the association between dietary Non Enzymatic Antioxidant Capacity (NEAC), measuring the total antioxidant potential of the whole diet, and the risk of myocardial infarction. We followed 45,882 women aged 30–49 years and free from cardiovascular diseases through record linkages from 1991 until 2012. Dietary NEAC was assessed by a validated food frequency questionnaire collected at baseline. Total dietary NEAC was categorized into quintiles and multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HR) with 95% confidence intervals (CI). During a mean follow-up time of 20.3 years we detected 657 incident cases of myocardial infarction. After adjusting for potential confounders, we found a significant 28% lower risk of myocardial infarction among women in the fourth (HR: 0.72; 95% CI 0.55–0.95) and a 40% lower risk among women in the fifth quintile (HR: 0.60, 95% CI 0.45–0.81) of dietary NEAC compared to women in the first quintile, with a significant trend (p-value < 0.001). Higher dietary NEAC is associated with a lower risk of myocardial infarction in young to middle-aged women. These findings support the hypothesis that dietary antioxidants protect from myocardial infarction and that this effect might be exerted through interactions between antioxidants.

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Bias in matched case–control studies: DAGs are not enough

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Dietary non enzymatic antioxidant capacity and the risk of myocardial infarction in the Swedish women’s lifestyle and health cohort

Abstract

Foods rich in antioxidants have been associated with a reduced risk of myocardial infarction. However, findings from randomized clinical trials on the role of antioxidant supplementation remain controversial. It has been suggested that antioxidants interact with each other to promote cardiovascular health. We therefore investigated the association between dietary Non Enzymatic Antioxidant Capacity (NEAC), measuring the total antioxidant potential of the whole diet, and the risk of myocardial infarction. We followed 45,882 women aged 30–49 years and free from cardiovascular diseases through record linkages from 1991 until 2012. Dietary NEAC was assessed by a validated food frequency questionnaire collected at baseline. Total dietary NEAC was categorized into quintiles and multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HR) with 95% confidence intervals (CI). During a mean follow-up time of 20.3 years we detected 657 incident cases of myocardial infarction. After adjusting for potential confounders, we found a significant 28% lower risk of myocardial infarction among women in the fourth (HR: 0.72; 95% CI 0.55–0.95) and a 40% lower risk among women in the fifth quintile (HR: 0.60, 95% CI 0.45–0.81) of dietary NEAC compared to women in the first quintile, with a significant trend (p-value < 0.001). Higher dietary NEAC is associated with a lower risk of myocardial infarction in young to middle-aged women. These findings support the hypothesis that dietary antioxidants protect from myocardial infarction and that this effect might be exerted through interactions between antioxidants.

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Usability and acceptance evaluation of ACESO: a Web-based breast cancer survivorship tool

Abstract

Purpose

The specific objective of this research is to design and develop a personalized Web application to support breast cancer survivors after treatment, as they deal with post-treatment challenges, such as comorbidities and side effects of treatment.

Methodology

A mixed-methods approach, utilizing a combination of think-aloud analysis, personal interviews, and surveys, was adopted for user acceptance and usability testing among a group of breast cancer survivors. User feedback was gathered on their perceived value of the application, and any user-interface issues that may hinder the overall usability were identified.

Results

The application's portability and capability of organizing their entire breast cancer-related medical history as well as tracking various quality of life indicators were perceived to be valuable features. The application had an overall high usability; however, certain sections of the application were not as intuitive to locate. Visual elements of the website were appreciated; however, overall experience would benefit from incorporating more sociable elements that exhibit positive re-enforcement within the end user and provide a friendlier experience.

Conclusion

The results of the study showcase the need for more personalized tools and resources to support survivors in self-management. It also demonstrates the ability to integrate breast cancer survivorship care plans from diverse providers and paves the way to add further value-added features in consumer health applications, such as personal decision support.

Implications for Cancer Survivors

Using a personal decision support-based tool can serve as a training tool and resource, providing these patients with pertinent information about the various aspects of their long-term health, while educating them about any related side effects and symptoms. It is hoped that making such tools more accessible could help in engaging survivors to play an active role in managing their health and encourage shared decision-making with their providers.

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