Defaulters among lung cancer patients in a suburban district in a developing country

Real-world multicenter study of the safety and efficacy of netupitant plus palonosetron fixed-dose combination to prevent chemotherapy-induced nausea and vomiting among Malaysian patients receiving moderately or highly emetogenic chemotherapy

AIM

A large proportion of cancer patients are at high risk for chemotherapy-induced nausea and vomiting (CINV), but the choice of anti-emetics for CINV in Malaysia is limited.

METHODS

This was a real-world study of a fixed-dose combination of netupitant and palonosetron (NEPA) to inhibit CINV in adult patients receiving moderately (MEC) or highly emetogenic chemotherapy (HEC) for solid/hematological malignancies at eight Malaysian centers. Each HEC/MEC cycle received one dose of NEPA + dexamethasone for CINV prevention. Complete response (no emesis, no rescue medication) (CR), no more than mild nausea (severity score ≤ 2.5), and complete control (CR) (no more than mild nausea) during the acute (0-24 h), delayed (25-120 h), and overall (0-120 h) phases post-chemotherapy were measured. Treatment-related adverse events (AEs) were recorded.

RESULTS

During March 2016-April 2018 (NMRR-17-3286-38282), NEPA + dexamethasone was administered to 54 patients (77.8% solid, 22.2% hematological malignancies). Note that 59.3% received HEC, while 40.7% received MEC regimen. During the overall phase of the first cycle, the majority had CR (77.8%), no more than mild nausea (74.1%), and complete control (61.1%). Seventeen patients received two consecutive cycles at any point of chemotherapy cycles. During the overall phases across two consecutive cycles, all patients achieved CR, and the majority reported no more than mild nausea and complete control. No grades 3-4 AEs were reported.

CONCLUSIONS

NEPA had sustained efficacy and tolerability at first administration and across two cycles of MEC/HEC for CINV prevention.

Reasons for missed chemotherapy appointments in retinoblastoma patients undergoing chemotherapy: A report from a Tertiary Care Hospital from India

Background

Delays in chemotherapy due to missed‐appointments can lead to sub‐optimal outcomes in any cancer. Missed appointments or delayed follow up are an important concern in the treatment of pediatric cancers as it compromises the patient's health and overall outcomes.

Aim

This study was conducted to understand the reasons responsible for missed‐appointments in Retinoblastoma (RB) patients scheduled for daycare based chemotherapy.

Methods

We prospectively recorded the causes for missed‐appointments in RB patients from February 2018 to September 2018. A delay of more than 48‐hours from the pre‐scheduled date of chemotherapy was categorized as a “missed‐appointment.”

Results

Out of 870 scheduled visits of patients with RB for chemotherapy to our center, there were 122 (14%) instances of missed‐appointments during the study period. There were 40 instances (4.6%) where the patient had missed‐appointments (possibly avoidable reasons). These 40 instances occurred in 33 patients who had a median age of 29 months (IQR 22.5‐51.5 m) with 22 males. Six patients lived within 100 km of the treating center, 12 lived between 100 and 500 km, and 15 patients lived beyond 500 km. The median length of delay was 13.75 days (IQR‐7‐20.75 days). Twenty‐seven patients used a train as a means of transport, and 10 used the state‐bus. The main cause of delay was the illness of other family members (52.5%) followed by financial issues (27.5%), transport‐related problems (10%), and absence of an adult to accompany (10%).

Conclusion

Causes for missed‐appointments for chemotherapy in RB patients were multifactorial and included the illness of other family members, financial issues, distance/transport‐related problems, and no caregiver to accompany. The future study with a large sample size with a multicenter design is needed to confirm the results of the current study and to know the deficiency in the improvement of the follow‐up RB patients.

Feasibility of Patient Navigation to Improve Breast Cancer Care in Malaysia

PURPOSE

Late stage at presentation and poor adherence to treatment remain major contributors to poor survival in low- and middle-income countries (LMICs). Patient navigation (PN) programs in the United States have led to improvement in diagnostic or treatment timeliness, particularly for women in lower socioeconomic classes or minority groups. To date, studies of PN in Asia have been limited. We aimed to assess the feasibility of PN in a state-run hospital in an LMIC and to report the impact on diagnostic and treatment timeliness for patients in its first year of implementation.

METHODS

We established PN in a dedicated breast clinic of a Malaysian state-run hospital. We compared diagnostic and treatment timeliness between navigated patients (n = 135) and patients diagnosed in the prior year (n = 148), and described factors associated with timeliness.

RESULTS

Women with PN received timely mammography compared with patients in the prior year (96.4% v 74.4%; P < .001), biopsy (92.5% v 76.1%; P = .003), and communication of news (80.0% v 58.5%; P < .001). PN reduced treatment default rates (4.4% v 11.5%; P = .048). Among navigated patients, late stage at presentation was independently associated with having emotional and language barriers ( P = .01). Finally, the main reason reported for delay, default, or refusal of treatment was the preference for alternative therapy.

CONCLUSION

PN is feasible for addressing barriers to cancer care when integrated with a state-run breast clinic of an LMIC. Its implementation resulted in improved diagnostic timeliness and reduced treatment default. Wider adoption of PN could be a key element of cancer control in LMICs.

Prevalence and characteristics associated with default of treatment and follow-up in patients with cancer

Defaulting is an important issue across all medical specialties, but much more so in cancer as delayed or incomplete treatment has been shown to result in worse clinical outcomes such as treatment resistance, disease progression as well as lower survival. Our objective was to identify psychosocial variables and characteristics associated with default among cancer patients. A total of 467 consecutive adult cancer patients attending the oncology clinic at a single academic medical centre completed the Hospital Anxiety and Depression Scale and reported their preference for psychological support at baseline, 4-6 weeks and 12-18 months follow-up. Default was defined as refusal, delay or discontinuation of treatment or visit, despite the ability to do so. A total of 159 of 467 (34.0%) cancer patients were defaulters. Of these 159 defaulters, 89 (56.0%) desired psychological support, compared to only 13 (4.2%) of 308 non-defaulters. Using a logistic regression, patients who were defaulters had 52 times higher odds (P = 0.001; 95% confidence interval 20.61-134.47) of desiring psychological support than non-defaulters after adjusting for covariates. These findings suggest that defaulters should be offered psychological support which may increase cancer treatment acceptance rates and improve survival.

Survival of lung cancer patients in a resource-limited country

AIM

Data on lung cancer survival are lacking in developing countries. Our objectives were to describe the survival of our lung cancer patients and to determine independent prognostic factors affecting survival.

METHOD

All patients diagnosed with lung cancer from August 2007 to August 2010 were recruited from a single referral hospital of the state of Pahang, Malaysia. Detailed demographic data, ECOG (Eastern Cooperation Oncology Group) performance status, stage of disease and treatment were recorded. The date of histology or cytology confirmation was used as the date of entry. Survival time was calculated from the date of entry to the date of death.

RESULTS

One hundred forty-nine patients were included for survival analysis. The median age was 62 years and patients were predominantly males (78%) and smokers (78%). The majority had non-small cell lung cancer (NSCLC) (94%); only six patients (4%) had small cell lung cancer. All patients presented with stage 3 or stage 4 disease. Overall median survival was 18 weeks. "No definitive treatment" and "ECOG 3-4" were the significant independent predictors of death, with the hazard ratios of 2.1 (95% confidence interval [CI] 1.4, 3.0) and 1.6 (95% CI 1.1, 2.3) times, respectively. Among NSCLC patients on treatment, 1- and 2-year survival rates were 27% and 15%, respectively.

CONCLUSION

The majority of lung cancer patients in Pahang presented with advanced disease. No definitive treatment and ECOG 3-4 were independent poor prognostic factors.

Does hydatid disease have protective effects against lung cancer?

We hypothesized that solid tumors rarely occur in patients with hydatid disease. We obtained the serum of 14 patients diagnosed with hydatid disease, the serum of 10 patients who did not have a history of hydatid disease, and the hydatid cyst fluid from six patients. These sera and fluid samples were added at different concentrations to NCI-H209/An1 human lung small cell carcinoma cells and L929 mouse fibroblasts as a control group. Sera of patients with hydatid diseases had cytotoxic effects on NCI-H209/An1 cells, but they did not have cytotoxic effects on fibroblast cells. Sera from healthy subjects did not have a cytotoxic effect on the tumor cell line or control fibroblasts. Cyst fluid, also, did not have toxic effects on the NCI-H209/An1 cell line, but was toxic to fibroblasts up to a 1:32 dilution. Sera from patients with hydatid disease had cytotoxic effects on human small cell lung cancer cells in vitro.