The aim of this study was to assess the prognostic importance of lymph node ratio (LNR) in stage III melanoma after complete lymph nodal dissections. From European Organization for Research and Treatment of Cancer randomized trials 18871, 18952, and 18991, 2358 patients had full information on positive and examined lymph nodes (LNs) and were included. Cox proportional hazards models stratified by trial were used to assess the prognostic impact of LNR adjusted for confounders on melanoma-specific survival. Optimal cutoff values for LNR were calculated for each LN dissection site (axillary, inguinal, and neck). LNR (≥ vs.
http://ift.tt/2nYPcUU
Cancer Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Κυριακή 11 Φεβρουαρίου 2018
Targeting of glutamine transporter ASCT2 and glutamine synthetase suppresses gastric cancer cell growth
Abstract
Purpose
Glutamine (Gln) is essential for the proliferation of most cancer cells, making it an appealing target for cancer therapy. However, the role of Gln in gastric cancer (GC) metabolism is unknown and Gln-targeted therapy against GC remains scarce. The aim of this study was to investigate the relevance of Gln in GC growth and targeting.
Methods
Expression of Gln transporter ASCT2 and glutamine synthetase (GS) in the parental and molecularly engineered GC cells or in human GC specimens was determined by RT-PCR and western blot analysis or immunohistochemistry. Cell proliferation and survival was assessed by CCK-8 assay and colony formation assay. Intracellular Gln content was measured by a HPLC system. Effects of ASCT2 and/or GS inhibitor on tumor growth were investigated in xenograft models.
Results
A significant heterogeneity of GC cells was observed with respect to their response to the treatment of ASCT2 inhibitor benzylserine (BenSer). Gln deprivation did not affect the BenSer-resistant cell growth due to endogenous GS expression, whose inhibition remarkably reduced cell proliferation. The differential in vitro sensitivity correlated with overall intracellular Gln content. Combined therapy with both ASCT2 and GS inhibitors produced a greater therapeutic efficacy than the treatment of either inhibitor alone. Furthermore, 77% human GC tissues were found to express moderate and high levels of ASCT2, 12% of which also co-expressed relatively high levels of GS.
Conclusion
Gln mediates GC growth and the therapeutic efficacy of Gln-targeted treatment relies on distinct ASCT2 and GS expression pattern in specific gastric cancer groups.
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Targeting of glutamine transporter ASCT2 and glutamine synthetase suppresses gastric cancer cell growth
Abstract
Purpose
Glutamine (Gln) is essential for the proliferation of most cancer cells, making it an appealing target for cancer therapy. However, the role of Gln in gastric cancer (GC) metabolism is unknown and Gln-targeted therapy against GC remains scarce. The aim of this study was to investigate the relevance of Gln in GC growth and targeting.
Methods
Expression of Gln transporter ASCT2 and glutamine synthetase (GS) in the parental and molecularly engineered GC cells or in human GC specimens was determined by RT-PCR and western blot analysis or immunohistochemistry. Cell proliferation and survival was assessed by CCK-8 assay and colony formation assay. Intracellular Gln content was measured by a HPLC system. Effects of ASCT2 and/or GS inhibitor on tumor growth were investigated in xenograft models.
Results
A significant heterogeneity of GC cells was observed with respect to their response to the treatment of ASCT2 inhibitor benzylserine (BenSer). Gln deprivation did not affect the BenSer-resistant cell growth due to endogenous GS expression, whose inhibition remarkably reduced cell proliferation. The differential in vitro sensitivity correlated with overall intracellular Gln content. Combined therapy with both ASCT2 and GS inhibitors produced a greater therapeutic efficacy than the treatment of either inhibitor alone. Furthermore, 77% human GC tissues were found to express moderate and high levels of ASCT2, 12% of which also co-expressed relatively high levels of GS.
Conclusion
Gln mediates GC growth and the therapeutic efficacy of Gln-targeted treatment relies on distinct ASCT2 and GS expression pattern in specific gastric cancer groups.
http://ift.tt/2EAavpW
Dynamic changes and molecular analysis of cell death in the spinal cord of SJL mice infected with the BeAn strain of Theiler’s murine encephalomyelitis virus
Abstract
Theiler's murine encephalomyelitis (TME) is caused by the TME virus (TMEV) and represents an important animal model for multiple sclerosis (MS). Oligodendroglial apoptosis and reduced apoptotic elimination of encephalitogenic leukocytes seem to participate in autoimmune demyelination in MS. The present study quantified apoptotic cells in BeAn–TMEV-induced spinal cord white matter lesions at 14, 42, 98, and 196 days post infection (dpi) using immunostaining. Apoptotic cells were identified by transmission electron microscopy and double-immunofluorescence. The mRNA expression of apoptosis-related genes was investigated using microarray analysis. Oligodendroglial apoptosis was already detected in the predemyelinating phase at 14 dpi. Apoptotic cell numbers peaked at 42 dpi and decreased until 196 dpi partly due to reduced T cell apoptosis. In addition to genes involved in the classical pathways of apoptosis induction, microarray analysis detected the expression of genes related to alternative mechanisms of cell death such as pyroptosis, necroptosis, and endoplasmic reticulum stress. Consequently, oligodendroglial apoptosis is involved in the initiation of the TME demyelination process, whereas the development of apoptosis resistance of T cells potentially favors the maintenance of inflammation and myelin loss.
http://ift.tt/2G3AYt6
Plagioneurin B, a potent isolated compound induces apoptotic signalling pathways and cell cycle arrest in ovarian cancer cells
Abstract
Plagioneurin B belongs to acetogenin group has well-established class of compounds. Acetogenin group has attracted worldwide attention in the past few years due their biological abilities as inhibitors for several types of tumour cells. Plagioneurin B was isolated via conventional chromatography and tested for thorough mechanistic apoptosis activity on human ovarian cancer cells (CAOV-3). Its structure was also docked at several possible targets using Autodock tools software. Our findings showed that plagioneurin B successfully inhibits the growth of CAOV-3 cells at IC50 of 0.62 µM. The existence of apoptotic bodies, cell membrane blebbing and chromatin condensation indicated the hallmark of apoptosis. Increase of Annexin V-FITC bound to phosphatidylserine confirmed the apoptosis induction in the cells. The apoptosis event was triggered through the extrinsic and intrinsic pathways via activation of caspases 8 and 9, respectively. Stimulation of caspase 3 and the presence of DNA ladder suggested downstream apoptotic signalling were initiated. Further confirmation of apoptosis was conducted at the molecular levels where up-regulation in Bax, as well as down-regulation of Bcl-2, Hsp-70 and survivin were observed. Plagioneurin B was also seen to arrest CAOV-3 cells cycle at the G2/M phase. Docking simulation of plagioneurin B with CD95 demonstrated that the high binding affinity and hydrogen bonds formation may explain the capability of plagioneurin B to trigger apoptosis. This study is therefore importance in finding the effective compound that may offer an alternative drug for ovarian cancer treatment.
http://ift.tt/2H5ybku
Phase IIa study of the CD19 antibody MOR208 in patients with relapsed or refractory B-cell non-Hodgkin’s lymphoma
Abstract
Background
This two-stage, phase IIa study (ClinicalTrials.gov: NCT01685008) investigated the antitumor activity and safety of MOR208, an Fc-engineered, humanized, CD19 antibody, in patients with relapsed or refractory (R-R) B-cell non-Hodgkin's lymphoma (NHL). CD19 is broadly expressed across the B-lymphocyte lineage, including in B-cell malignancies, but not by hematological stem cells. Patients and methods
Patients aged ≥18 years, with R-R NHL progressing after ≥1 prior rituximab containing regimen were enrolled into subtype-specific cohorts: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), other indolent (i)NHL and mantle cell lymphoma (MCL). Treatment was MOR208, 12 mg/kg intravenously, weekly, for 8 weeks. Patients with at least stable disease could continue treatment for an additional 4 weeks. Those with a partial or complete response after 12 weeks could receive extended MOR208 treatment (12 mg/kg, either monthly or every second week) until progression. The primary endpoint was overall response rate. Results
Ninety-two patients were enrolled: DLBCL (n=35), FL (n=34), other iNHL (n=11) and MCL (n=12). Responses were observed in DLBCL, FL and other iNHL cohorts (26%, 29% and 27%, respectively). They lasted ≥12 months in 5/9 responding patients with DLBCL, 4/9 with FL and 2/3 with other iNHL. Responses in nine patients are ongoing (>26 months in five instances). Patients with rituximab refractory disease showed a similar response rate and progression-free survival time to patients with non-refractory disease. The most common adverse events (any grade) were infusion-related reactions (IRRs; 12%) and neutropenia (12%). One patient experienced a grade 4 IRR and eight patients (9%) grade 3/4 neutropenia. No treatment-related deaths were reported. Conclusions
MOR208 monotherapy demonstrated promising clinical activity in patients with R-R DLBCL and R-R FL, including in patients with rituximab refractory tumors. These efficacy data and the favorable safety profile support further investigation of MOR208 in phase II/III combination therapy trials in R-R DLBCL. ClinicalTrials.gov number
NCT01685008http://ift.tt/2H47vk9
Factors associated with romantic relationship formation difficulties in women with breast cancer
Abstract
Objective
Many un-partnered women report difficulty in forming romantic relationships after breast cancer, characterized by high dating-related anxiety and low perceived interpersonal competence. This study examined the relationship between poor body image (appearance investment and body dissatisfaction) and self-compassion, and women's ability to form romantic relationships post-breast cancer.
Methods
Women (N=152) diagnosed with breast cancer, who were either un-partnered and expressed interest in romantic dating, or who had commenced a relationship post-diagnosis, completed an online survey. Assessments included the Interpersonal Competence Questionnaire, Dating Anxiety Scale, Self-compassion Scale, Appearance Schemas Inventory-Revised, Body Image Scale, and Experiences in Close Relationships Scale. Multiple regression analyses assessed the relationships between these variables.
Results
Partnered and un-partnered women differed in levels of dating anxiety, interpersonal competence, anxious attachment and the self-evaluative salience facet of appearance investment. Analyses revealed a significant model for dating anxiety, with high self-evaluative salience, body image dissatisfaction, and attachment avoidance independently associated with this outcome. The model for interpersonal competence was also significant, with low attachment avoidance and high self-compassion independently associated with this outcome.
Conclusions
Un-partnered women who place high importance on appearance for their self-worth, and who report poor body image and low self-compassion are at risk of experiencing difficulties in forming new romantic relationships after breast cancer. Future interventions should target these variables to facilitate romantic dating during cancer survivorship.
http://ift.tt/2BmlEJc
Sexual function, psychosocial adjustment to illness and quality of life among Chinese gynaecological cancer survivors
Abstract
Background
Disrupted sexual function is a prevalent and sustained side effect of gynaecological cancer and its related treatment. This problem may pose challenges to the survivors in the process of illness adjustment, leading to elevated psychological distress and impaired quality of life. However, care and interventions in this area have been neglected in most countries.
Objectives
To investigate sexual function, psychosocial adjustment to illness and quality of life among Chinese gynaecological cancer survivors in Hong Kong, and to explore their associations.
Methods
A cross-sectional design was adopted. Gynaecological cancer survivors were recruited from a gynaecological oncology out-patient clinic at a regional hospital in Hong Kong.
Results
A total of 225 Chinese gynaecological cancer survivors were recruited. Their sexual function was found to be impaired. They had satisfactory performance in psychosocial adjustment to illness, but the worst domain was sexual relationships. Their quality of life was fair, with physical and social functioning performing best. Path analysis demonstrated that psychosocial adjustment to illness played a significant mediating role in the relationship between sexual function and quality of life among those who were married or had a regular sex partner.
Conclusions
Impaired sexual function was prevalent among Chinese gynaecological cancer survivors and psychosocial adjustment to illness mediates the relationship between sexual function and quality of life. In Chinese clinical settings without routine sexuality assessments, early sexual function and psychosocial adjustment assessment should be integrated into routine nursing practice. In addition, a culturally appropriate practice model should be developed to guide sexuality care delivery.
http://ift.tt/2BTKKjI
Expecting the worst? The relationship between retrospective and prospective appraisals of illness on quality of life in prostate cancer survivors
Abstract
Objective
Despite a generally good prognosis many prostate cancer survivors have poor quality of life (QOL). A greater understanding of how psychological appraisals influence QOL is merited given their potentially modifiable nature. In this study we considered how elements of survivors' retrospective and prospective appraisals relate to QOL.
Methods
1,229 prostate cancer survivors between 2-5 years post-diagnosis, identified from a population-based National Cancer Registry, were asked questions on their socio-demographics, health, treatment received and adverse-effects using a cross-sectional design. QOL was assessed using the EORTC QLQ-C30. Retrospective appraisals were assessed by asking survivors to reflect on their experience of treatment-related adverse-effects compared to their prior expectations. A Fear of Recurrence (FOR) scale assessed prospective appraisals of future disease course. A multiple regression model explored the impact of psychological appraisals on QOL, after controlling for socio-demographic, treatment and health-related factors.
Results
The model was significant explaining 37% of variance in QOL. The strongest associate with QOL was FOR (β=-.29; p<.001). Survivors who experienced side-effects that were worse than expected had significantly lower QOL (β=-.10; p=.002). Other significant correlates of lower QOL were: presence of comorbidities, having undergone a less invasive treatment, and having more advanced disease. Working at diagnosis and having a higher level of education were significantly associated with higher QOL.
Conclusions
Results suggest both retrospective and prospective appraisals are independently related to QOL in prostate cancer. Providing survivors with more information about possible adverse-effects of treatment, as well as providing appropriate information regarding future disease progression, may improve QOL.
http://ift.tt/2BodqQK
Phase IIa study of the CD19 antibody MOR208 in patients with relapsed or refractory B-cell non-Hodgkin’s lymphoma
Abstract
Background
This two-stage, phase IIa study (ClinicalTrials.gov: NCT01685008) investigated the antitumor activity and safety of MOR208, an Fc-engineered, humanized, CD19 antibody, in patients with relapsed or refractory (R-R) B-cell non-Hodgkin's lymphoma (NHL). CD19 is broadly expressed across the B-lymphocyte lineage, including in B-cell malignancies, but not by hematological stem cells. Patients and methods
Patients aged ≥18 years, with R-R NHL progressing after ≥1 prior rituximab containing regimen were enrolled into subtype-specific cohorts: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), other indolent (i)NHL and mantle cell lymphoma (MCL). Treatment was MOR208, 12 mg/kg intravenously, weekly, for 8 weeks. Patients with at least stable disease could continue treatment for an additional 4 weeks. Those with a partial or complete response after 12 weeks could receive extended MOR208 treatment (12 mg/kg, either monthly or every second week) until progression. The primary endpoint was overall response rate. Results
Ninety-two patients were enrolled: DLBCL (n=35), FL (n=34), other iNHL (n=11) and MCL (n=12). Responses were observed in DLBCL, FL and other iNHL cohorts (26%, 29% and 27%, respectively). They lasted ≥12 months in 5/9 responding patients with DLBCL, 4/9 with FL and 2/3 with other iNHL. Responses in nine patients are ongoing (>26 months in five instances). Patients with rituximab refractory disease showed a similar response rate and progression-free survival time to patients with non-refractory disease. The most common adverse events (any grade) were infusion-related reactions (IRRs; 12%) and neutropenia (12%). One patient experienced a grade 4 IRR and eight patients (9%) grade 3/4 neutropenia. No treatment-related deaths were reported. Conclusions
MOR208 monotherapy demonstrated promising clinical activity in patients with R-R DLBCL and R-R FL, including in patients with rituximab refractory tumors. These efficacy data and the favorable safety profile support further investigation of MOR208 in phase II/III combination therapy trials in R-R DLBCL. ClinicalTrials.gov number
NCT01685008from Cancer via ola Kala on Inoreader http://ift.tt/2H47vk9
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Factors associated with romantic relationship formation difficulties in women with breast cancer
Abstract
Objective
Many un-partnered women report difficulty in forming romantic relationships after breast cancer, characterized by high dating-related anxiety and low perceived interpersonal competence. This study examined the relationship between poor body image (appearance investment and body dissatisfaction) and self-compassion, and women's ability to form romantic relationships post-breast cancer.
Methods
Women (N=152) diagnosed with breast cancer, who were either un-partnered and expressed interest in romantic dating, or who had commenced a relationship post-diagnosis, completed an online survey. Assessments included the Interpersonal Competence Questionnaire, Dating Anxiety Scale, Self-compassion Scale, Appearance Schemas Inventory-Revised, Body Image Scale, and Experiences in Close Relationships Scale. Multiple regression analyses assessed the relationships between these variables.
Results
Partnered and un-partnered women differed in levels of dating anxiety, interpersonal competence, anxious attachment and the self-evaluative salience facet of appearance investment. Analyses revealed a significant model for dating anxiety, with high self-evaluative salience, body image dissatisfaction, and attachment avoidance independently associated with this outcome. The model for interpersonal competence was also significant, with low attachment avoidance and high self-compassion independently associated with this outcome.
Conclusions
Un-partnered women who place high importance on appearance for their self-worth, and who report poor body image and low self-compassion are at risk of experiencing difficulties in forming new romantic relationships after breast cancer. Future interventions should target these variables to facilitate romantic dating during cancer survivorship.
from Cancer via ola Kala on Inoreader http://ift.tt/2BmlEJc
via IFTTT
Sexual function, psychosocial adjustment to illness and quality of life among Chinese gynaecological cancer survivors
Abstract
Background
Disrupted sexual function is a prevalent and sustained side effect of gynaecological cancer and its related treatment. This problem may pose challenges to the survivors in the process of illness adjustment, leading to elevated psychological distress and impaired quality of life. However, care and interventions in this area have been neglected in most countries.
Objectives
To investigate sexual function, psychosocial adjustment to illness and quality of life among Chinese gynaecological cancer survivors in Hong Kong, and to explore their associations.
Methods
A cross-sectional design was adopted. Gynaecological cancer survivors were recruited from a gynaecological oncology out-patient clinic at a regional hospital in Hong Kong.
Results
A total of 225 Chinese gynaecological cancer survivors were recruited. Their sexual function was found to be impaired. They had satisfactory performance in psychosocial adjustment to illness, but the worst domain was sexual relationships. Their quality of life was fair, with physical and social functioning performing best. Path analysis demonstrated that psychosocial adjustment to illness played a significant mediating role in the relationship between sexual function and quality of life among those who were married or had a regular sex partner.
Conclusions
Impaired sexual function was prevalent among Chinese gynaecological cancer survivors and psychosocial adjustment to illness mediates the relationship between sexual function and quality of life. In Chinese clinical settings without routine sexuality assessments, early sexual function and psychosocial adjustment assessment should be integrated into routine nursing practice. In addition, a culturally appropriate practice model should be developed to guide sexuality care delivery.
from Cancer via ola Kala on Inoreader http://ift.tt/2BTKKjI
via IFTTT
Expecting the worst? The relationship between retrospective and prospective appraisals of illness on quality of life in prostate cancer survivors
Abstract
Objective
Despite a generally good prognosis many prostate cancer survivors have poor quality of life (QOL). A greater understanding of how psychological appraisals influence QOL is merited given their potentially modifiable nature. In this study we considered how elements of survivors' retrospective and prospective appraisals relate to QOL.
Methods
1,229 prostate cancer survivors between 2-5 years post-diagnosis, identified from a population-based National Cancer Registry, were asked questions on their socio-demographics, health, treatment received and adverse-effects using a cross-sectional design. QOL was assessed using the EORTC QLQ-C30. Retrospective appraisals were assessed by asking survivors to reflect on their experience of treatment-related adverse-effects compared to their prior expectations. A Fear of Recurrence (FOR) scale assessed prospective appraisals of future disease course. A multiple regression model explored the impact of psychological appraisals on QOL, after controlling for socio-demographic, treatment and health-related factors.
Results
The model was significant explaining 37% of variance in QOL. The strongest associate with QOL was FOR (β=-.29; p<.001). Survivors who experienced side-effects that were worse than expected had significantly lower QOL (β=-.10; p=.002). Other significant correlates of lower QOL were: presence of comorbidities, having undergone a less invasive treatment, and having more advanced disease. Working at diagnosis and having a higher level of education were significantly associated with higher QOL.
Conclusions
Results suggest both retrospective and prospective appraisals are independently related to QOL in prostate cancer. Providing survivors with more information about possible adverse-effects of treatment, as well as providing appropriate information regarding future disease progression, may improve QOL.
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Trajectories of income and social benefits for mothers and fathers of children with cancer: A national cohort study in Sweden
BACKGROUND
The contribution of different income sources from work and social benefits to trajectories of income for the parents of children with cancer has not been empirically investigated.
METHODS
Using Swedish registers, parents of children with an incidence cancer diagnosis between 2004 and 2009 were identified and matched with parents of children without cancer (reference parents). A total of 20,091 families were followed from the year before the diagnosis to a maximum of 8 years. Generalized linear models estimated the ratios of mean incomes from work and social benefits and of its total.
RESULTS
Around the time of the child's cancer diagnosis, the total income was on average up to 6% higher among the mothers of children with cancer compared with reference mothers, but no differences were noted among fathers. Income from work dropped to the lowest level around the time of a cancer diagnosis, with swift recovery noted for fathers but not for mothers. Sickness and childcare-related benefits were up to 6 times larger for the parents of children with cancer than reference parents. As social benefits diminished after approximately 3 years, the total income of mothers of children with cancer became lower than that of reference mothers, and the gap widened over time.
CONCLUSIONS
Social benefits appeared to ease the financial burden during the years around a cancer diagnosis. However, mothers experienced persistently lower income after benefits diminished. Experiences differed by single-parent versus dual-parent households, the survival of the child with cancer, and other relevant characteristics. Further investigation is needed for potential long-term consequences for mothers, including their career and future pension in retirement. Cancer 2018. © 2018 American Cancer Society.
http://ift.tt/2BpQKjf
Trajectories of income and social benefits for mothers and fathers of children with cancer: A national cohort study in Sweden
BACKGROUND
The contribution of different income sources from work and social benefits to trajectories of income for the parents of children with cancer has not been empirically investigated.
METHODS
Using Swedish registers, parents of children with an incidence cancer diagnosis between 2004 and 2009 were identified and matched with parents of children without cancer (reference parents). A total of 20,091 families were followed from the year before the diagnosis to a maximum of 8 years. Generalized linear models estimated the ratios of mean incomes from work and social benefits and of its total.
RESULTS
Around the time of the child's cancer diagnosis, the total income was on average up to 6% higher among the mothers of children with cancer compared with reference mothers, but no differences were noted among fathers. Income from work dropped to the lowest level around the time of a cancer diagnosis, with swift recovery noted for fathers but not for mothers. Sickness and childcare-related benefits were up to 6 times larger for the parents of children with cancer than reference parents. As social benefits diminished after approximately 3 years, the total income of mothers of children with cancer became lower than that of reference mothers, and the gap widened over time.
CONCLUSIONS
Social benefits appeared to ease the financial burden during the years around a cancer diagnosis. However, mothers experienced persistently lower income after benefits diminished. Experiences differed by single-parent versus dual-parent households, the survival of the child with cancer, and other relevant characteristics. Further investigation is needed for potential long-term consequences for mothers, including their career and future pension in retirement. Cancer 2018. © 2018 American Cancer Society.
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Mentoring, Training, and Scholarly Productivity Experiences of Cancer-Related Health Disparities Research Trainees: Do Outcomes Differ for Underrepresented Scientists?
Abstract
The study aims to explore variation in scholarly productivity outcomes by underrepresented status among a diverse sample of researchers in a community-engaged training program. We identified 141 trainees from a web-based survey of researchers in the National Cancer Institute-funded, Community Networks Program Centers (CNPCs) (2011–2016). We conducted a series of multiple logistic regression models to estimate the effect of National Institutes of Health (NIH)-defined underrepresented status on four, self-reported, scholarly productivity outcomes in the previous 5 years: number of publications (first-authored and total) and funded grants (NIH and any agency). Sixty-five percent (n = 92) indicated NIH underrepresented status. In final adjusted models, non-NIH underrepresented (vs. underrepresented) trainees reported an increased odds of having more than the median number of total publications (> 9) (OR = 3.14, 95% CI 1.21–8.65) and any grant funding (OR = 5.10, 95% CI 1.77–14.65). Reporting ≥ 1 mentors (vs. none) was also positively associated (p < 0.05) with these outcomes. The CNPC underrepresented trainees had similar success in first-authored publications and NIH funding as non-underrepresented trainees, but not total publications and grants. Examining trainees' mentoring experiences over time in relation to scholarly productivity outcomes is needed.
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Mentoring, Training, and Scholarly Productivity Experiences of Cancer-Related Health Disparities Research Trainees: Do Outcomes Differ for Underrepresented Scientists?
Abstract
The study aims to explore variation in scholarly productivity outcomes by underrepresented status among a diverse sample of researchers in a community-engaged training program. We identified 141 trainees from a web-based survey of researchers in the National Cancer Institute-funded, Community Networks Program Centers (CNPCs) (2011–2016). We conducted a series of multiple logistic regression models to estimate the effect of National Institutes of Health (NIH)-defined underrepresented status on four, self-reported, scholarly productivity outcomes in the previous 5 years: number of publications (first-authored and total) and funded grants (NIH and any agency). Sixty-five percent (n = 92) indicated NIH underrepresented status. In final adjusted models, non-NIH underrepresented (vs. underrepresented) trainees reported an increased odds of having more than the median number of total publications (> 9) (OR = 3.14, 95% CI 1.21–8.65) and any grant funding (OR = 5.10, 95% CI 1.77–14.65). Reporting ≥ 1 mentors (vs. none) was also positively associated (p < 0.05) with these outcomes. The CNPC underrepresented trainees had similar success in first-authored publications and NIH funding as non-underrepresented trainees, but not total publications and grants. Examining trainees' mentoring experiences over time in relation to scholarly productivity outcomes is needed.
http://ift.tt/2G5affP
Is spinal anaesthesia in young infants really safer and better than general anaesthesia?
Purpose of review Concerns regarding the potential neurotoxic effects of general anaesthesia have seen resurgence in awake spinal anaesthesia in neonates and infants. This review includes recently published data from a large prospective randomized controlled trial with view to determining if spinal anaesthesia is safer and better than general anaesthesia in this population. Recent findings Compared with general anaesthesia, spinal anaesthesia results in less haemodynamic instability and fewer early (
http://ift.tt/2Ewhe4v
http://ift.tt/2Ewhe4v
Acute pain management in children: challenges and recent improvements
Purpose of review The evidence regarding the efficacy of analgesics available to guide postoperative pain treatment in pediatric patients is limited. Opioid medications are very often an important component of pediatric postoperative pain treatment but have been associated with perioperative complications. We will focus on initiatives aiming to provide effective treatment minimizing the use of opioids and preventing the long-term consequences of pain. Recent findings Interpatient variability in postoperative pain is currently managed by applying protocols or by trial and error, thus often leading to patients being either undertreated or overtreated. Few evidence-based reports are available to guide the use of opioid medications in children, including the prescription of opioids after hospital discharge. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids, thus decreasing the risk of toxicity and dose-related side effects. There is a lack of adequate research in this field, and more specifically on identifying which patient is at higher risk of poor postoperative pain management. Summary Treatment options have evolved in recent years, including the combinations of multimodal regimens and regional anesthetic techniques. Using combinations of nonopioid analgesics in a multimodal approach may limit the need for opioids. Correspondence to Pablo M. Ingelmo, MD, Department of Anesthesia, Montreal Children's Hospital, B.04.2427, 1001 Boulevard Decarie, Montreal, QC, Canada H4A3J1. Tel: +1 514 412 4448; e-mail: pablo.ingelmo@mcgill.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2sru278
http://ift.tt/2sru278
Long-term neurocognitive outcomes following surgery and anaesthesia in early life
Purpose of review Repeated controversial and alarming statements of the potential dangers of anaesthetic agents on neurological outcomes in children continue to be issued based primarily on preclinical studies. This review assesses the current evidence of laboratory and clinical data and identifies areas of concerns. Recent findings Published animal and laboratory data consistently indicate that prolonged and excessive use of anaesthetic agents can lead to morphological changes and neurocognitive impairment in animals without a clear cut-off age or a superiority of one technique over another. Retrospective human studies and prospective clinical trials indicate that short exposures to anaesthesia and surgery are safe and have no effect on long-term neurological outcomes. Small and consistent continuing improvements in the perioperative period (aggregation of marginal gains) will impact on long-term neurological morbidity in humans. Summary It is biologically plausible that anaesthetic agents may induce structural changes during mammalian brain development and beyond. However, in the absence of alternatives the impact of the choice of anaesthetic drugs on long-term neurocognitive outcomes is almost certainly to be of limited relevance in humans. The underlying disease processes, surgical intervention, and trauma as well as other known perioperative factors more significantly affect these outcomes. Correspondence to Tom G. Hansen, MD, PhD, Department of Anaesthesia & Intensive Care – Paediatric Section, Odense University Hospital, 5000 Odense C, Denmark. Tel: +45 6541 3812; fax: +45 6611 3415; e-mail: tomghansen@dadlnet.dk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2Ew76J5
http://ift.tt/2Ew76J5
Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia: Efficacy and foetal outcome a randomised double-blinded trial
BACKGROUND During general anaesthesia, endotracheal intubation of patients with pre-eclampsia causes stimulation of the sympathetic nervous system and catecholamine release, which may lead to maternal and neonatal complications. OBJECTIVE To attenuate both the stress response and the haemodynamic response to tracheal intubation in patients with pre-eclampsia. DESIGN A randomised, double-blind, controlled study. SETTING Single University Hospital. PATIENTS Sixty patients aged 18 to 45 years with pre-eclampsia receiving general anaesthesia for caesarean section. INTERVENTIONS The patients were randomly allocated to three groups. Groups D1and D2 received an infusion of dexmedetomidine 1 μg kg−1 over the 10 min before induction of general anaesthesia, then 0.4 and 0.6 μg kg−1 h−1 dexmedetomidine, respectively. Group C received equivalent volumes of 0.9% saline. MAIN OUTCOME MEASURES The primary outcome was the effect of dexmedetomidine on mean arterial blood pressure measured before induction of general anaesthesia at 1 and 5 min after intubation, and then every 5 min until 10 min after extubation. The secondary outcomes were blood glucose and serum cortisol (measured before induction of general anaesthesia, and at 1 and 5 min after intubation), postoperative visual analogue pain scores, time to first request for analgesia, the total consumption of analgesia, Ramsay sedation score, maternal and placental vein blood serum levels of dexmedetomidine and neonatal Apgar score at 1 and 5 min. RESULTS At all assessment times, the mean arterial pressures were significantly lower in the dexmedetomidine groups than in the control group. Compared with group C, the heart rate was significantly lower in both groups D1 and D2. In group D2, the heart rate was lower than in group D1. Serum glucose and cortisol were significantly higher in the controls than in either group D1 or D2. Group D2 patients were significantly more sedated on arrival in the recovery room followed by D1. Time to first analgesia was significantly longer in groups D2 and D1 than in group C, and the visual analogue pain scores were significantly lower in groups D1 and D2 than in group C at 1, 2, 3 and 5 h. Total morphine consumption was significantly lower in groups D1 and D2 than in the control group. There was no difference in Apgar scores across the three groups despite significantly higher dexmedetomidine concentrations in group D2 (both maternal and placental vein) than in group D1. CONCLUSION Administration of dexmedetomidine in doses 0.4 and 0.6 μg kg−1 h−1 was associated with haemodynamic and hormonal stability, without causing significant adverse neonatal outcome. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR201706002303170), (www.pactr.org). Correspondence to Ashraf M. Eskandr, MD, Department of Anesthesia, ICU and Pain Therapy, Faculty of Medicine, Menoufiya University, 3 Yassin Abd-Elghafar Street, Shibin El-koom, Egypt E-mail: ameskandr@yahoo.com © 2018 European Society of Anaesthesiology
http://ift.tt/2EjETBM
http://ift.tt/2EjETBM
Low anaesthetic waste gas concentrations in postanaesthesia care unit: A prospective observational study
BACKGROUND Volatile anaesthetics are a potential hazard during occupational exposure, pregnancy or in individuals with existing disposition to malignant hyperthermia. Anaesthetic waste gas concentration in postanaesthesia care units (PACU) has rarely been investigated. OBJECTIVE(S) The current study aims to assess concentrations of volatile anaesthetics in relation to room size, number of patients and ventilator settings in different PACUs. DESIGN A prospective observational study. SETTING Two different PACUs of the Hannover Medical School (Hannover, Germany) were evaluated in this study. The rooms differed in dimensions, patient numbers and room ventilation settings. PATIENTS During the observation period, sevoflurane anaesthesia was performed in 65 of 140 patients monitored in postanaesthesia unit one and in 42 of 70 patients monitored in postanaesthesia unit two. MAIN OUTCOME MEASURES Absolute trace gas room concentrations of sevoflurane measured with a compact, closed gas loop high-resolution ion mobility spectrometer. RESULTS Traces of sevoflurane could be detected in 805 out of 970 samples. Maximum concentrations were 0.96 ± 0.20 ppm in postanaesthesia unit one, 0.82 ± 0.07 ppm in postanaesthesia unit two. Median concentration was 0.12 (0.34) ppm in postanaesthesia unit one and 0.11 (0.28) ppm in postanaesthesia unit two. CONCLUSION Low trace amounts of sevoflurane were detected in both PACUs equipped with controlled air exchange systems. Occupational exposure limits were not exceeded. Correspondence to Dr. Sebastian Heiderich, MD, Clinic of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany E-mail: heiderich.sebastian@mh-hannover.de © 2018 European Society of Anaesthesiology
http://ift.tt/2EY3yx2
http://ift.tt/2EY3yx2
Low perfusion pressure is associated with renal tubular injury in infants undergoing cardiac surgery with cardiopulmonary bypass: A secondary analysis of an observational study
BACKGROUND Earlier work on adults undergoing surgery with cardiopulmonary bypass suggests that there is a close relationship between the lower limit of the cerebral and renal autoregulation pressures. Although cerebral autoregulation during bypass in infants has been extensively investigated, the impact of bypass on kidney function is not well known. It is, nevertheless, acknowledged that the main pathophysiological process involved in cardiac surgery-related kidney damage is tubular injury, and that urine neutrophil gelatinase-associated lipocaline (uNGAL) is a reliable biomarker of injury. OBJECTIVE To identify the most predictive bypass variable for the measurement of renal injury, its threshold value and the most predictive time below that threshold. DESIGN Observational study linking electronically recorded bypass perfusion pressure and oxygen delivery rate with intra-operative uNGAL excretion. Variations in bypass variables were accounted for by their excursions below several thresholds. SETTING French tertiary referral paediatric cardiac centre. PATIENTS A total of 72 infants in whom uNGAL was measured within 1 h of bypass. INTERVENTIONS None. MAIN OUTCOME MEASURE Renal injury, identified by a high creatinine normalised uNGAL concentration (>21.2 μg mmol−1). RESULTS At the end of bypass, 43.75% of infants had high uNGAL. A more than 40% pressure drop below the normal age-standardised mean arterial pressure was associated with high uNGAL. Receiver operating curve [interquartile range] areas were 0.626 [0.501 to 0.752] for a more than 40% drop, and 0.679 [0.555 to 0.804] for a more than 50% drop. A more than 40% pressure drop for 19.5 min provided a 0.65 negative predictive value for high uNGAL, and a more than 50% pressure drop for 5.4 min provided a 0.67 negative predictive value. The link between uNGAL and oxygen delivery rate was negligible. CONCLUSION Maintaining the perfusion pressure above 60% of the normal age-standardised mean arterial pressure may provide an effective renal protective strategy. TRIAL REGISTRATION Registered on October 11, 2010, ClinicalTrials.gov Identifier: NCT01219998. Correspondence to Mirela Bojan, MD, PhD, Department of Anaesthesiology and Critical Care, Necker-Enfants Malades University Hospital, Assistance Publique – Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France Tel: +33 171396663; e-mail: mirela.bojan@nck.aphp.fr © 2018 European Society of Anaesthesiology
http://ift.tt/2Ejad3I
http://ift.tt/2Ejad3I
Radiation Pneumonitis in Pediatric Hodgkin Lymphoma Patients receiving Radiotherapy to the Chest
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Gary D. Lewis, Jennifer E. Agrusa, Bin S. Teh, Maria M. Gramatges, Viral Kothari, Carl E. Allen, Arnold C. Paulino
PurposeThe purpose of this study is to determine the incidence of radiation pneumonitis (RP) in children receiving radiotherapy (RT) for Hodgkin lymphoma (HL).Patients/MethodsA retrospective chart review was conducted of pediatric HL patients who received multiagent chemotherapy followed by RT to any part of the chest. The National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 was used to determine the RP grade. Parameters analyzed included gender, age, bleomycin dose, and RT dosimetric variables such as mean lung dose (MLD), mean individual (right versus left) lung dose or iMLD, V5 to V25 and individual (i) lung V5 to V25.ResultsFrom 2008-2016, 54 children with HL received RT to the chest and had follow-up and dosimetry information. All patients received induction chemotherapy; the most common regimen was ABVE-PC based chemotherapy (n = 48). All received a prescribed dose of 21 Gy in 14 fractions. Median follow-up from completion of RT was 39.5 months. Three of 54 patients (5.6%) or 3 of 108 (2.8%) lungs developed RP; two lungs had Grade 1 while one had Grade 2 RP. RP was seen only in patients with MLD > 12.4 Gy (p = 0.009), V5 > 66% (p = 0.033), V10 >55% (p = 0.015), V15 >45% (p = 0.005) and V20 > 32% (p = 0.007). Likewise, RP was only seen in lungs with iMLD > 13.8 Gy, iV5 > 75% (p =0.02), iV10 > 64% (p = 0.02), iV15 > 47% (< 0.005), and iV20 >34% (p = 0.003).ConclusionsRP in pediatric HL patients is an uncommon complication. MLD, iMLD, V5-V20 and iV5-iV20 correlated with RP.
http://ift.tt/2nPHw8k
Design and Evaluation of a Safety-Centered User Interface for Radiation Therapy
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Ashleigh P. Shier, Plinio P. Morita, Colleen Dickie, Mohammad Islam, Catherine Burns, Joseph A Cafazzo
PurposeAs radiotherapy treatment grows more complex over time, treatment delivery has become more susceptible to adverse events and patient safety risks due to use error. The radiotherapy monitoring and treatment delivery user interface explored in this study was redesigned using ecological interface design, a human factors engineering method, and evaluated to improve treatment safety.Methods and MaterialsAn initial design concept was created based on previously completed analysis, and informally evaluated in focus groups with radiation therapists. Sixteen newly graduated radiation therapists used both the redesigned and current system in a usability test to determine if the redesigned system better supported detection of errors.ResultsThe redesigned system successfully improved the error detection rate of two errors, wrong treatment volume and wrong treatment site (p < 0.03 and p < 0.01, respectively). It also improved Level 2 and Level 3 situation awareness, i.e. comprehension of the meaning of the information and the projection of the behavior of the technology (p < 0.01 and p < 0.01 respectively), and achieved a higher user satisfaction.ConclusionsThe ecological interface design approach was found to be effective in redesigning a radiotherapy treatment delivery interface. Radiation therapists were able to deliver simulated radiation therapy with a higher rate of error detection, improved higher-level situation awareness, and participants preferred the redesigned interface to the current interface. Overall, the redesigned interface improved the radiation therapists' system understanding and ability to detect errors that affect patient safety.
http://ift.tt/2o32hN8
Impact of timing of radiotherapy on outcomes in atypical meningioma: a clinical audit
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Sidharth Pant, Raees Tonse, Sadhana Kannan, Aliasgar Moiyadi, Prakash Shetty, Sridhar Epari, Ayushi Sahay, Goda Jayant Sastri, Rakesh Jalali, Tejpal Gupta
BackgroundRole of early adjuvant radiotherapy (RT) in patients with atypical meningioma remains controversial.PurposeTo report the impact of timing of RT on outcomes in atypical meningioma.MethodsPatients of atypical meningioma were identified through electronic search of institutional database. Following surgery, RT was delivered either in upfront adjuvant setting (early adjuvant RT) or after recurrence/progression (salvage RT).ResultsThere were 51 patients in early adjuvant RT group and 30 patients in salvage RT group. Six of 51 (12%) patients in early adjuvant RT group recurred/progressed compared to 34 of 35 (97%) patients kept on observation after initial surgery. Thirty of these 34 patients received salvage RT, mostly after re-excision. Twelve of 30 (40%) patients recurred/progressed after salvage RT, compared to 6 of 51 (12%) patients after early adjuvant RT (p=0.003). Post-RT 5-year progression-free survival was significantly better for early adjuvant RT compared to salvage RT (69% vs 28%, log-rank p<0.001).ConclusionsWithin the limitations of any retrospective analysis, upfront early adjuvant RT can significantly reduce the risk of local recurrence/progression in atypical meningiomas compared to initial observation. A sizeable proportion of patients who are observed initially recur/progress over time necessitating salvage therapy. However, re-excision followed by salvage RT may not be as effective as early adjuvant RT.
http://ift.tt/2nXt3Y3
Management of Paranasal Sinus Metastasis by Percutaneous CT guided Permanent Seed Brachytherapy: Technical Report
Publication date: Available online 1 February 2018
Source:Practical Radiation Oncology
Author(s): Stephen Doggett, Shigeru Chino, Todd Lempert, Kunal Sidhar
http://ift.tt/2o03zs7
Pre-Operative Contralateral Radiation Lung Dose is Associated with Post-Operative Pulmonary Toxicity in Patients with Locally-Advanced Non-Small Cell Lung Cancer Treated with Trimodality Therapy
Publication date: Available online 31 January 2018
Source:Practical Radiation Oncology
Author(s): Wenji Guo, Xuan Hui, Salem Alfaifi, Lori Anderson, Scott Robertson, Russell Hales, Chen Hu, Todd McNutt, Stephen Broderick, Jarushka Naidoo, Richard Battafarano, Stephen Yang, K. Ranh Voong
PurposeIn patients with non-small cell lung cancer (NSCLC) who undergo trimodality therapy (chemoradiation followed by surgical resection), it is unknown whether limiting pre-operative radiation dose to the uninvolved lung reduces post-surgical morbidity. This study evaluated whether radiation fall-off dose parameters to the contralateral lung, that is unaffected by NSCLC, are associated with post-operative complications in NSCLC patients treated with trimodality therapy.Methods and materialsWe retrospectively reviewed NSCLC patients who underwent trimodality therapy between March 2008-October 2016, with available restored digital radiation plans. Fischer's exact test was used to assess associations between patient and treatment characteristics and the development of treatment-related toxicity. Spearman's rank correlation was used to measure the strength of association between dosimetric parameters.ResultsForty-six patients were identified who received trimodality therapy with intensity modulated radiation (median 59.4 Gy, range 45-70) and concurrent platinum doublet chemotherapy, followed by surgical resection. The median age was 64.9 years (range 45.6-81.6 years). The median follow-up time was 1.9 years (range 0.3-8.4 years). Twenty-four (52.2%) patients developed any grade pulmonary toxicity and 14 (30.4%) patients developed grade 2+ pulmonary toxicity. There was an increased incidence of any grade pulmonary toxicity in patients with contralateral lung V20≥7% compared to <7% (90%, n=9 versus 41.7%, n=15; p=0.01). Similarly, contralateral lung V10≥20% was associated with an increased rate of any grade pulmonary toxicity compared to V10<20% (80%, n=12 versus 38.7%, n=12; p=0.01). Pneumonectomy/bilobectomy was associated with grade 2+ pulmonary toxicity (p=0.04).ConclusionsPatients who received a higher radiation fall-off dose volume parameter (V20≥7% and V10≥20%) to the contralateral uninvolved lung had a higher incidence of any grade post-operative pulmonary toxicity. Limiting radiation fall-off dose to the uninvolved lung may be an important modifiable radiation parameter in limiting post-operative toxicity in trimodality patients.
http://ift.tt/2nSdVLo
NRG Oncology Medical Physicists’ Manpower Survey Quantifying Support Demands for Multi-Institutional Clinical Trials
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): James I Monroe, Karan Boparai, Ying Xiao, David Followill, James M Galvin, Eric E Klein, Daniel Low, Jean M Moran, Haoyu Zhong, Jason W Sohn
PurposeA survey was created by XXXX to assess a medical physicists' percent Full Time Equivalent (FTE) contribution to multi-institutional clinical trials. A 2012 ASTRO report, 'Safety Is No Accident', quantified medical physics staffing contributions in FTE Factors for clinical departments. No quantification of FTE effort associated with clinical trials was included.MethodsTo address this lack of information, the XXXX Medical Physics Subcommittee decided to obtain manpower data from the medical physics community to quantify the amount of time medical physicists spent supporting clinical trials. A survey, consisting of sixteen questions, was designed to obtain information regarding physicists' time spent supporting clinical trials. The survey was distributed to medical physicists at 1996 radiotherapy institutions included on the membership rosters of the five NCTN clinical trial groups.ResultsOf the 451 institutions who responded; fifty percent (226) of the respondents reported currently participating in radiotherapy trials. On average, the designated physicist at each institution spent 2.4 hours (SD: 5.5 hours) per week supervising or interacting with clinical trial staff. On average, 1.2 hours (SD: 3.1 hours), 1.8 hours (SD: 3.9 hours), and 0.6 hours (SD: 1.1 hours) per week were spent on trial patient simulations, treatment plan reviews, and maintaining a DICOM server, respectively. For all trial credentialing activities, physicists spent an average of 32 hours (SD: 57.2 hours) yearly. Reading protocols and supporting dosimetrists, clinicians, and therapists took an average of 2.1 hours (SD: 3.4 hours) per week. Physicists also attended clinical trial meetings, on average, 1.2 hours (SD: 1.9 hours) per month.ConclusionOn average, physicist spent a non-trivial total of 9 hours per week (0.21 FTE) supporting an average of 10 active clinical trials. This time commitment indicates the complexity of radiotherapy clinical trials and should be taken into account when staffing radiotherapy institutions.
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Utilizing 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) to define suspected non-enhancing tumor for radiotherapy planning of glioblastoma
Publication date: Available online 31 January 2018
Source:Practical Radiation Oncology
Author(s): Aimee R Hayes, Dasantha Jayamanne, Edward Hsiao, Geoffrey P Schembri, Dale L Bailey, Paul J Roach, Mustafa Khasraw, Allison Newey, Helen R Wheeler, Michael Back
AimTo evaluate the impact of 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) on radiotherapy planning for patients diagnosed with glioblastoma (GBM) and presence of suspected non-enhancing tumors compared with standard magnetic resonance imaging (MRI).MethodsPatients with GBM and contrast-enhancing MRI showing regions suspicious of non-enhancing tumor underwent post-operative FET-PET prior to commencing radiotherapy. Two Clinical Target Volumes (CTVs) were created using pre- and post-operative MRI; MRI-FLAIR sequences (CTVFLAIR) and MRI contrast sequences with an expansion on the surgical cavity (CTVSx). FET-PET was used to create Biological Tumor Volumes (BTVs) by encompassing FET avid regions, forming a BTVFLAIR and BTVSx. Volumetric analyses were conducted between CTVs and respective BTVs using Wilcoxon signed-rank tests. The volume increase with addition of FET was analyzed with respect to BTVFLAIR and BTVSx. Presence of focal gadolinium contrast enhancement within previously non-enhancing tumor or within the FET avid region was noted on MRI at one and three months after radiotherapy.ResultsTwenty-six patients were identified retrospectively from our database, of which 24 had demonstrable FET uptake. The median CTVFLAIR, CTVSx, BTVFLAIR and BTVSx was 57.1 cc (range 1.1-217.4), 83.6 cc (range 27.2-275.8), 62.8 cc (range 1.1-307.3) and 94.7 cc (range 27.2-285.5) respectively. When FET-PET was utilized, there was a mean increase in volume from CTVFLAIR to BTVFLAIR by 26.8% and CTVSx to BTVSx by 20.6%. A statistically significant difference was noted on Wilcoxon signed-rank test when assessing volumetric change between CTVFLAIR and BTVFLAIR (P<0.0001) and CTVSx and BTVSx (p<0.0001). Six out of 24 patients (25%), with FET avidity prior to radiotherapy, showed focal gadolinium enhancement within the radiotherapy portal.ConclusionFET-PET may help improve delineation of GBM in cases with a suspected non-enhancing component. This may result in improved radiotherapy target delineation and reduce the risk of potential geographical miss.SummaryWe investigated the impact of 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) on radiotherapy planning for patients diagnosed with glioblastoma (GBM) and a suspected non-enhancing tumor compared with standard magnetic resonance imaging (MRI). We performed volumetric analyses between clinical target volumes and respective biological target volumes using Wilcoxon signed-rank tests. In conclusion, FET-PET may help improve delineation of GBM in cases with a suspected non-enhancing component and reduce the risk of potential geographical miss.
http://ift.tt/2nSxd3a
Development of a Virtual Radiation Oncology Clinic for training and simulation of errors in the radiation oncology workflow
Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): TR Willoughby, SL Meeks, P Kelly, T Dvorak, K. Muller, T. Dana, F Bova
http://ift.tt/2nZ0tok
An interactive contouring module improves engagement and interest in radiation oncology among pre-clinical medical students: Results of a randomized trial
Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): Pushpa Neppala, Michael Sherer, Grant Larson, Alex Bryant, Neil Panjwani, James D. Murphy, Erin F Gillespie
PurposeStudies have shown significant gaps in knowledge of radiation therapy among medical students and primary care providers. The goal of this study was to evaluate the impact of an interactive contouring module on knowledge and interest in radiation oncology among pre-clinical medical students.Methods and MaterialsSecond year medical students at *** were randomized to participate in an interactive contouring exercise or watch a traditional didactic lecture on radiation oncology. Participants completed knowledge tests and surveys at baseline, immediately following the exercise, and 3 months later. Statistical analysis included Wilcoxon signed-rank test for pre- and post-test comparisons and Wilcoxon rank sum test for comparison between groups.ResultsForty-three medical students participated in the trial (21 in the didactic group and 22 in the contouring group). Students completing the contouring module demonstrated similar overall knowledge improvement compared to the traditional didactic group (+8.6% vs. +6.6%, NS) but endorsed greater engagement on a 5-point Likert-type scale (3.10 vs 3.76, p=0.02). At 3-month follow-up, there was a non-significant trend toward improved overall knowledge in the contouring group (43% vs. 51%, p=0.10), with a significance difference in a subset of questions on knowledge of the process of radiation therapy as well as side effects (51% vs. 75%, p=0.002). Students in the contouring group demonstrated more interest in pursuing a clinical radiation oncology rotation (2.52 vs 3.27, p=0.01).ConclusionsUse of an interactive contouring module was an effective method to teach pre-clinical medical students about radiation oncology, with no significant difference in knowledge gained compared to a traditional didactic lecture. However, higher engagement among students completing the contouring module led to improved retention of knowledge of radiation side effects and greater interest in radiation oncology. These data suggest a potential benefit of integrating an interactive radiation oncology module into the pre-clinical medical school curriculum.
http://ift.tt/2nSx9jW
Stereotactic body radiotherapy for high-risk prostate cancer: Not ready
Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): Trevor J. Royce, Ronald C. Chen
http://ift.tt/2nZAKMx
Radiation Pneumonitis in Pediatric Hodgkin Lymphoma Patients receiving Radiotherapy to the Chest
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Gary D. Lewis, Jennifer E. Agrusa, Bin S. Teh, Maria M. Gramatges, Viral Kothari, Carl E. Allen, Arnold C. Paulino
PurposeThe purpose of this study is to determine the incidence of radiation pneumonitis (RP) in children receiving radiotherapy (RT) for Hodgkin lymphoma (HL).Patients/MethodsA retrospective chart review was conducted of pediatric HL patients who received multiagent chemotherapy followed by RT to any part of the chest. The National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 was used to determine the RP grade. Parameters analyzed included gender, age, bleomycin dose, and RT dosimetric variables such as mean lung dose (MLD), mean individual (right versus left) lung dose or iMLD, V5 to V25 and individual (i) lung V5 to V25.ResultsFrom 2008-2016, 54 children with HL received RT to the chest and had follow-up and dosimetry information. All patients received induction chemotherapy; the most common regimen was ABVE-PC based chemotherapy (n = 48). All received a prescribed dose of 21 Gy in 14 fractions. Median follow-up from completion of RT was 39.5 months. Three of 54 patients (5.6%) or 3 of 108 (2.8%) lungs developed RP; two lungs had Grade 1 while one had Grade 2 RP. RP was seen only in patients with MLD > 12.4 Gy (p = 0.009), V5 > 66% (p = 0.033), V10 >55% (p = 0.015), V15 >45% (p = 0.005) and V20 > 32% (p = 0.007). Likewise, RP was only seen in lungs with iMLD > 13.8 Gy, iV5 > 75% (p =0.02), iV10 > 64% (p = 0.02), iV15 > 47% (< 0.005), and iV20 >34% (p = 0.003).ConclusionsRP in pediatric HL patients is an uncommon complication. MLD, iMLD, V5-V20 and iV5-iV20 correlated with RP.
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Design and Evaluation of a Safety-Centered User Interface for Radiation Therapy
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Ashleigh P. Shier, Plinio P. Morita, Colleen Dickie, Mohammad Islam, Catherine Burns, Joseph A Cafazzo
PurposeAs radiotherapy treatment grows more complex over time, treatment delivery has become more susceptible to adverse events and patient safety risks due to use error. The radiotherapy monitoring and treatment delivery user interface explored in this study was redesigned using ecological interface design, a human factors engineering method, and evaluated to improve treatment safety.Methods and MaterialsAn initial design concept was created based on previously completed analysis, and informally evaluated in focus groups with radiation therapists. Sixteen newly graduated radiation therapists used both the redesigned and current system in a usability test to determine if the redesigned system better supported detection of errors.ResultsThe redesigned system successfully improved the error detection rate of two errors, wrong treatment volume and wrong treatment site (p < 0.03 and p < 0.01, respectively). It also improved Level 2 and Level 3 situation awareness, i.e. comprehension of the meaning of the information and the projection of the behavior of the technology (p < 0.01 and p < 0.01 respectively), and achieved a higher user satisfaction.ConclusionsThe ecological interface design approach was found to be effective in redesigning a radiotherapy treatment delivery interface. Radiation therapists were able to deliver simulated radiation therapy with a higher rate of error detection, improved higher-level situation awareness, and participants preferred the redesigned interface to the current interface. Overall, the redesigned interface improved the radiation therapists' system understanding and ability to detect errors that affect patient safety.
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Impact of timing of radiotherapy on outcomes in atypical meningioma: a clinical audit
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Sidharth Pant, Raees Tonse, Sadhana Kannan, Aliasgar Moiyadi, Prakash Shetty, Sridhar Epari, Ayushi Sahay, Goda Jayant Sastri, Rakesh Jalali, Tejpal Gupta
BackgroundRole of early adjuvant radiotherapy (RT) in patients with atypical meningioma remains controversial.PurposeTo report the impact of timing of RT on outcomes in atypical meningioma.MethodsPatients of atypical meningioma were identified through electronic search of institutional database. Following surgery, RT was delivered either in upfront adjuvant setting (early adjuvant RT) or after recurrence/progression (salvage RT).ResultsThere were 51 patients in early adjuvant RT group and 30 patients in salvage RT group. Six of 51 (12%) patients in early adjuvant RT group recurred/progressed compared to 34 of 35 (97%) patients kept on observation after initial surgery. Thirty of these 34 patients received salvage RT, mostly after re-excision. Twelve of 30 (40%) patients recurred/progressed after salvage RT, compared to 6 of 51 (12%) patients after early adjuvant RT (p=0.003). Post-RT 5-year progression-free survival was significantly better for early adjuvant RT compared to salvage RT (69% vs 28%, log-rank p<0.001).ConclusionsWithin the limitations of any retrospective analysis, upfront early adjuvant RT can significantly reduce the risk of local recurrence/progression in atypical meningiomas compared to initial observation. A sizeable proportion of patients who are observed initially recur/progress over time necessitating salvage therapy. However, re-excision followed by salvage RT may not be as effective as early adjuvant RT.
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Management of Paranasal Sinus Metastasis by Percutaneous CT guided Permanent Seed Brachytherapy: Technical Report
Publication date: Available online 1 February 2018
Source:Practical Radiation Oncology
Author(s): Stephen Doggett, Shigeru Chino, Todd Lempert, Kunal Sidhar
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Pre-Operative Contralateral Radiation Lung Dose is Associated with Post-Operative Pulmonary Toxicity in Patients with Locally-Advanced Non-Small Cell Lung Cancer Treated with Trimodality Therapy
Publication date: Available online 31 January 2018
Source:Practical Radiation Oncology
Author(s): Wenji Guo, Xuan Hui, Salem Alfaifi, Lori Anderson, Scott Robertson, Russell Hales, Chen Hu, Todd McNutt, Stephen Broderick, Jarushka Naidoo, Richard Battafarano, Stephen Yang, K. Ranh Voong
PurposeIn patients with non-small cell lung cancer (NSCLC) who undergo trimodality therapy (chemoradiation followed by surgical resection), it is unknown whether limiting pre-operative radiation dose to the uninvolved lung reduces post-surgical morbidity. This study evaluated whether radiation fall-off dose parameters to the contralateral lung, that is unaffected by NSCLC, are associated with post-operative complications in NSCLC patients treated with trimodality therapy.Methods and materialsWe retrospectively reviewed NSCLC patients who underwent trimodality therapy between March 2008-October 2016, with available restored digital radiation plans. Fischer's exact test was used to assess associations between patient and treatment characteristics and the development of treatment-related toxicity. Spearman's rank correlation was used to measure the strength of association between dosimetric parameters.ResultsForty-six patients were identified who received trimodality therapy with intensity modulated radiation (median 59.4 Gy, range 45-70) and concurrent platinum doublet chemotherapy, followed by surgical resection. The median age was 64.9 years (range 45.6-81.6 years). The median follow-up time was 1.9 years (range 0.3-8.4 years). Twenty-four (52.2%) patients developed any grade pulmonary toxicity and 14 (30.4%) patients developed grade 2+ pulmonary toxicity. There was an increased incidence of any grade pulmonary toxicity in patients with contralateral lung V20≥7% compared to <7% (90%, n=9 versus 41.7%, n=15; p=0.01). Similarly, contralateral lung V10≥20% was associated with an increased rate of any grade pulmonary toxicity compared to V10<20% (80%, n=12 versus 38.7%, n=12; p=0.01). Pneumonectomy/bilobectomy was associated with grade 2+ pulmonary toxicity (p=0.04).ConclusionsPatients who received a higher radiation fall-off dose volume parameter (V20≥7% and V10≥20%) to the contralateral uninvolved lung had a higher incidence of any grade post-operative pulmonary toxicity. Limiting radiation fall-off dose to the uninvolved lung may be an important modifiable radiation parameter in limiting post-operative toxicity in trimodality patients.
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NRG Oncology Medical Physicists’ Manpower Survey Quantifying Support Demands for Multi-Institutional Clinical Trials
Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): James I Monroe, Karan Boparai, Ying Xiao, David Followill, James M Galvin, Eric E Klein, Daniel Low, Jean M Moran, Haoyu Zhong, Jason W Sohn
PurposeA survey was created by XXXX to assess a medical physicists' percent Full Time Equivalent (FTE) contribution to multi-institutional clinical trials. A 2012 ASTRO report, 'Safety Is No Accident', quantified medical physics staffing contributions in FTE Factors for clinical departments. No quantification of FTE effort associated with clinical trials was included.MethodsTo address this lack of information, the XXXX Medical Physics Subcommittee decided to obtain manpower data from the medical physics community to quantify the amount of time medical physicists spent supporting clinical trials. A survey, consisting of sixteen questions, was designed to obtain information regarding physicists' time spent supporting clinical trials. The survey was distributed to medical physicists at 1996 radiotherapy institutions included on the membership rosters of the five NCTN clinical trial groups.ResultsOf the 451 institutions who responded; fifty percent (226) of the respondents reported currently participating in radiotherapy trials. On average, the designated physicist at each institution spent 2.4 hours (SD: 5.5 hours) per week supervising or interacting with clinical trial staff. On average, 1.2 hours (SD: 3.1 hours), 1.8 hours (SD: 3.9 hours), and 0.6 hours (SD: 1.1 hours) per week were spent on trial patient simulations, treatment plan reviews, and maintaining a DICOM server, respectively. For all trial credentialing activities, physicists spent an average of 32 hours (SD: 57.2 hours) yearly. Reading protocols and supporting dosimetrists, clinicians, and therapists took an average of 2.1 hours (SD: 3.4 hours) per week. Physicists also attended clinical trial meetings, on average, 1.2 hours (SD: 1.9 hours) per month.ConclusionOn average, physicist spent a non-trivial total of 9 hours per week (0.21 FTE) supporting an average of 10 active clinical trials. This time commitment indicates the complexity of radiotherapy clinical trials and should be taken into account when staffing radiotherapy institutions.
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Utilizing 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) to define suspected non-enhancing tumor for radiotherapy planning of glioblastoma
Publication date: Available online 31 January 2018
Source:Practical Radiation Oncology
Author(s): Aimee R Hayes, Dasantha Jayamanne, Edward Hsiao, Geoffrey P Schembri, Dale L Bailey, Paul J Roach, Mustafa Khasraw, Allison Newey, Helen R Wheeler, Michael Back
AimTo evaluate the impact of 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) on radiotherapy planning for patients diagnosed with glioblastoma (GBM) and presence of suspected non-enhancing tumors compared with standard magnetic resonance imaging (MRI).MethodsPatients with GBM and contrast-enhancing MRI showing regions suspicious of non-enhancing tumor underwent post-operative FET-PET prior to commencing radiotherapy. Two Clinical Target Volumes (CTVs) were created using pre- and post-operative MRI; MRI-FLAIR sequences (CTVFLAIR) and MRI contrast sequences with an expansion on the surgical cavity (CTVSx). FET-PET was used to create Biological Tumor Volumes (BTVs) by encompassing FET avid regions, forming a BTVFLAIR and BTVSx. Volumetric analyses were conducted between CTVs and respective BTVs using Wilcoxon signed-rank tests. The volume increase with addition of FET was analyzed with respect to BTVFLAIR and BTVSx. Presence of focal gadolinium contrast enhancement within previously non-enhancing tumor or within the FET avid region was noted on MRI at one and three months after radiotherapy.ResultsTwenty-six patients were identified retrospectively from our database, of which 24 had demonstrable FET uptake. The median CTVFLAIR, CTVSx, BTVFLAIR and BTVSx was 57.1 cc (range 1.1-217.4), 83.6 cc (range 27.2-275.8), 62.8 cc (range 1.1-307.3) and 94.7 cc (range 27.2-285.5) respectively. When FET-PET was utilized, there was a mean increase in volume from CTVFLAIR to BTVFLAIR by 26.8% and CTVSx to BTVSx by 20.6%. A statistically significant difference was noted on Wilcoxon signed-rank test when assessing volumetric change between CTVFLAIR and BTVFLAIR (P<0.0001) and CTVSx and BTVSx (p<0.0001). Six out of 24 patients (25%), with FET avidity prior to radiotherapy, showed focal gadolinium enhancement within the radiotherapy portal.ConclusionFET-PET may help improve delineation of GBM in cases with a suspected non-enhancing component. This may result in improved radiotherapy target delineation and reduce the risk of potential geographical miss.SummaryWe investigated the impact of 18F-fluoroethyltyrosine (FET) positron emission tomography (PET) on radiotherapy planning for patients diagnosed with glioblastoma (GBM) and a suspected non-enhancing tumor compared with standard magnetic resonance imaging (MRI). We performed volumetric analyses between clinical target volumes and respective biological target volumes using Wilcoxon signed-rank tests. In conclusion, FET-PET may help improve delineation of GBM in cases with a suspected non-enhancing component and reduce the risk of potential geographical miss.
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Development of a Virtual Radiation Oncology Clinic for training and simulation of errors in the radiation oncology workflow
Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): TR Willoughby, SL Meeks, P Kelly, T Dvorak, K. Muller, T. Dana, F Bova
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An interactive contouring module improves engagement and interest in radiation oncology among pre-clinical medical students: Results of a randomized trial
Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): Pushpa Neppala, Michael Sherer, Grant Larson, Alex Bryant, Neil Panjwani, James D. Murphy, Erin F Gillespie
PurposeStudies have shown significant gaps in knowledge of radiation therapy among medical students and primary care providers. The goal of this study was to evaluate the impact of an interactive contouring module on knowledge and interest in radiation oncology among pre-clinical medical students.Methods and MaterialsSecond year medical students at *** were randomized to participate in an interactive contouring exercise or watch a traditional didactic lecture on radiation oncology. Participants completed knowledge tests and surveys at baseline, immediately following the exercise, and 3 months later. Statistical analysis included Wilcoxon signed-rank test for pre- and post-test comparisons and Wilcoxon rank sum test for comparison between groups.ResultsForty-three medical students participated in the trial (21 in the didactic group and 22 in the contouring group). Students completing the contouring module demonstrated similar overall knowledge improvement compared to the traditional didactic group (+8.6% vs. +6.6%, NS) but endorsed greater engagement on a 5-point Likert-type scale (3.10 vs 3.76, p=0.02). At 3-month follow-up, there was a non-significant trend toward improved overall knowledge in the contouring group (43% vs. 51%, p=0.10), with a significance difference in a subset of questions on knowledge of the process of radiation therapy as well as side effects (51% vs. 75%, p=0.002). Students in the contouring group demonstrated more interest in pursuing a clinical radiation oncology rotation (2.52 vs 3.27, p=0.01).ConclusionsUse of an interactive contouring module was an effective method to teach pre-clinical medical students about radiation oncology, with no significant difference in knowledge gained compared to a traditional didactic lecture. However, higher engagement among students completing the contouring module led to improved retention of knowledge of radiation side effects and greater interest in radiation oncology. These data suggest a potential benefit of integrating an interactive radiation oncology module into the pre-clinical medical school curriculum.
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Stereotactic body radiotherapy for high-risk prostate cancer: Not ready
Publication date: Available online 12 January 2018
Source:Practical Radiation Oncology
Author(s): Trevor J. Royce, Ronald C. Chen
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Cancers, Vol. 10, Pages 49: Beyond Brooding on Oncometabolic Havoc in IDH-Mutant Gliomas and AML: Current and Future Therapeutic Strategies
Cancers, Vol. 10, Pages 49: Beyond Brooding on Oncometabolic Havoc in IDH-Mutant Gliomas and AML: Current and Future Therapeutic Strategies
Cancers doi: 10.3390/cancers10020049
Authors: Hanumantha Madala Surendra Punganuru Viswanath Arutla Subhasis Misra T. Thomas Kalkunte Srivenugopal
Isocitrate dehydrogenases 1 and 2 (IDH1,2), the key Krebs cycle enzymes that generate NADPH reducing equivalents, undergo heterozygous mutations in >70% of low- to mid-grade gliomas and ~20% of acute myeloid leukemias (AMLs) and gain an unusual new activity of reducing the α-ketoglutarate (α-KG) to D-2 hydroxyglutarate (D-2HG) in a NADPH-consuming reaction. The oncometabolite D-2HG, which accumulates >35 mM, is widely accepted to drive a progressive oncogenesis besides exacerbating the already increased oxidative stress in these cancers. More importantly, D-2HG competes with α-KG and inhibits a large number of α-KG-dependent dioxygenases such as TET (Ten-eleven translocation), JmjC domain-containing KDMs (histone lysine demethylases), and the ALKBH DNA repair proteins that ultimately lead to hypermethylation of the CpG islands in the genome. The resulting CpG Island Methylator Phenotype (CIMP) accounts for major gene expression changes including the silencing of the MGMT (O6-methylguanine DNA methyltransferase) repair protein in gliomas. Glioma patients with IDH1 mutations also show better therapeutic responses and longer survival, the reasons for which are yet unclear. There has been a great surge in drug discovery for curtailing the mutant IDH activities, and arresting tumor proliferation; however, given the unique and chronic metabolic effects of D-2HG, the promise of these compounds for glioma treatment is uncertain. This comprehensive review discusses the biology, current drug design and opportunities for improved therapies through exploitable synthetic lethality pathways, and an intriguing oncometabolite-inspired strategy for primary glioblastoma.
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Cancers, Vol. 10, Pages 49: Beyond Brooding on Oncometabolic Havoc in IDH-Mutant Gliomas and AML: Current and Future Therapeutic Strategies
Cancers, Vol. 10, Pages 49: Beyond Brooding on Oncometabolic Havoc in IDH-Mutant Gliomas and AML: Current and Future Therapeutic Strategies
Cancers doi: 10.3390/cancers10020049
Authors: Hanumantha Madala Surendra Punganuru Viswanath Arutla Subhasis Misra T. Thomas Kalkunte Srivenugopal
Isocitrate dehydrogenases 1 and 2 (IDH1,2), the key Krebs cycle enzymes that generate NADPH reducing equivalents, undergo heterozygous mutations in >70% of low- to mid-grade gliomas and ~20% of acute myeloid leukemias (AMLs) and gain an unusual new activity of reducing the α-ketoglutarate (α-KG) to D-2 hydroxyglutarate (D-2HG) in a NADPH-consuming reaction. The oncometabolite D-2HG, which accumulates >35 mM, is widely accepted to drive a progressive oncogenesis besides exacerbating the already increased oxidative stress in these cancers. More importantly, D-2HG competes with α-KG and inhibits a large number of α-KG-dependent dioxygenases such as TET (Ten-eleven translocation), JmjC domain-containing KDMs (histone lysine demethylases), and the ALKBH DNA repair proteins that ultimately lead to hypermethylation of the CpG islands in the genome. The resulting CpG Island Methylator Phenotype (CIMP) accounts for major gene expression changes including the silencing of the MGMT (O6-methylguanine DNA methyltransferase) repair protein in gliomas. Glioma patients with IDH1 mutations also show better therapeutic responses and longer survival, the reasons for which are yet unclear. There has been a great surge in drug discovery for curtailing the mutant IDH activities, and arresting tumor proliferation; however, given the unique and chronic metabolic effects of D-2HG, the promise of these compounds for glioma treatment is uncertain. This comprehensive review discusses the biology, current drug design and opportunities for improved therapies through exploitable synthetic lethality pathways, and an intriguing oncometabolite-inspired strategy for primary glioblastoma.
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[Evaluation of the feasibility of a program of adapted physical activity in day hospital of digestive oncology: From the point of view of patients].
[Evaluation of the feasibility of a program of adapted physical activity in day hospital of digestive oncology: From the point of view of patients].
Bull Cancer. 2018 Feb 06;:
Authors: Crespel C, Brami C, de Boissieu P, Mazza C, Chauvet K, Lemoine A, Gavlak B, Léandri C, Brasseur M, Bertin E, Bouché O
Abstract
INTRODUCTION: Adapted physical activity (APA) is recognized as an effective supportive care for asthenia and quality of life in oncology. Before an APA program was organized, the feasibility of such a program was evaluated among the patients.
METHODS: Descriptive, prospective, semi-qualitative, single-center study over a 3-month period in patients treated with ambulatory chemotherapy for digestive cancer. A self-questionnaire was offered to all patients to evaluate their practice and knowledge about APA. In ten patients, fatigue, anxiety and depression were assessed, before and after 9 weeks of hospital-based APA. The scores were compared by matched Student test.
RESULTS: Of the 123 patients treated, 80 questionnaires (65%) were exploitable. Before the diagnosis of cancer, 40 patients (50%) were physically active, 20% after (n=16). The reasons for not practicing were: lack of interest/not the idea (42%), lack of time (34%), do not believe in profit (9%), too expensive (8%). Fifty-three patients (66%) were interested in the program. In 10 patients, the APA program significantly reduced the depression score (P=0.024) and a non-significant improvement in anxiety and fatigue.
DISCUSSION: This study shows that patients treated with chemotherapy are unaware of the usefulness of APA and that medical information can improve adherence to such a program. The establishment of an intra-hospital APA program proved to be possible and relevant.
PMID: 29426740 [PubMed - as supplied by publisher]
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Apple, condom, and cocaine – body stuffing in prison: a case report
Drug dealers and drug users resort to body stuffing to hastily conceal illicit drugs by ingesting their drug packets. This practice represents a medical challenge because rupture of the often insecure packagin...
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Cancers, Vol. 10, Pages 48: Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer
Cancers, Vol. 10, Pages 48: Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer
Cancers doi: 10.3390/cancers10020048
Authors: Masataka Kikuyama Terumi Kamisawa Sawako Kuruma Kazuro Chiba Shinya Kawaguchi Shuzo Terada Tatsunori Satoh
Pancreatic cancer (PC) has a poor prognosis due to delayed diagnosis. Early diagnosis is the most important factor for improving prognosis. For early diagnosis of PC, patients with clinical manifestations suggestive of PC and high risk for developing PC need to be selected for examinations for PC. Signs suggestive of PC (e.g., symptoms, diabetes mellitus, acute pancreatitis, or abnormal results of blood examinations) should not be missed, and the details of risks for PC (e.g., familial history of PC, intraductal mucin producing neoplasm, chronic pancreatitis, hereditary pancreatitis, or life habit) should be understood. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can be performed for diagnosing PC, but the diagnostic ability of these examinations for PC is limited. Endoscopic diagnostic procedures, such as endoscopic ultrasonography, including fine-needle aspiration, and endoscopic retrograde pancreatocholangiography, including Serial Pancreatic-juice Aspiration Cytologic Examination (SPACE), could be recommended for a detailed examination to diagnose pancreatic carcinoma earlier.
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Cancers, Vol. 10, Pages 48: Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer
Cancers, Vol. 10, Pages 48: Early Diagnosis to Improve the Poor Prognosis of Pancreatic Cancer
Cancers doi: 10.3390/cancers10020048
Authors: Masataka Kikuyama Terumi Kamisawa Sawako Kuruma Kazuro Chiba Shinya Kawaguchi Shuzo Terada Tatsunori Satoh
Pancreatic cancer (PC) has a poor prognosis due to delayed diagnosis. Early diagnosis is the most important factor for improving prognosis. For early diagnosis of PC, patients with clinical manifestations suggestive of PC and high risk for developing PC need to be selected for examinations for PC. Signs suggestive of PC (e.g., symptoms, diabetes mellitus, acute pancreatitis, or abnormal results of blood examinations) should not be missed, and the details of risks for PC (e.g., familial history of PC, intraductal mucin producing neoplasm, chronic pancreatitis, hereditary pancreatitis, or life habit) should be understood. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) can be performed for diagnosing PC, but the diagnostic ability of these examinations for PC is limited. Endoscopic diagnostic procedures, such as endoscopic ultrasonography, including fine-needle aspiration, and endoscopic retrograde pancreatocholangiography, including Serial Pancreatic-juice Aspiration Cytologic Examination (SPACE), could be recommended for a detailed examination to diagnose pancreatic carcinoma earlier.
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