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Zhang D, Dorman K, Westphalen CB, Haas M, Ormanns S, Neumann J, Seidensticker M, Ricke J, De Toni EN, Klauschen F, Algül H, Reisländer T, Boeck S, Heinemann V. Unresectable biliary tract cancer: Current and future systemic therapy. Eur J Cancer 2024; 203:114046. [PMID: 38626513 DOI: 10.1016/j.ejca.2024.114046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/18/2024]
Abstract
For decades, treatment of advanced biliary tract cancer (BTC) was confined to the use of chemotherapy. In recent years however, the number of therapeutic options available for patients with unresectable BTC have drastically increased, with immunotherapy and targeted treatment gradually joining the ranks of guideline-recommended treatment regimens. The aim of the present review is to summarise the current knowledge on unresectable BTC focusing on epidemiology, anatomical distribution and current strategies for systemic treatment. We further outline ongoing clinical trials and provide an outlook on future therapeutic interventions. In the realm of gastrointestinal malignancies, the increasing number of systemic treatment options for BTC is finally delivering on the longstanding commitment to personalised oncology. This emphasises the need for considering a comprehensive genomic-based pathology assessment right from the initial diagnosis to fully leverage the expanding array of therapeutic options that have recently become accessible.
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Affiliation(s)
- Danmei Zhang
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Klara Dorman
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - C Benedikt Westphalen
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Michael Haas
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center Munich, Marchioninistr. 15, 81377 Munich, Germany; Department of Hematology and Oncology, München Klinik Neuperlach, Munich, Germany
| | - Steffen Ormanns
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany; Innpath GmbH, Tirolkliniken, Innsbruck, Austria
| | - Jens Neumann
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany
| | - Max Seidensticker
- Department of Radiology, LMU University Hospital, LMU Munich, Germany
| | - Jens Ricke
- Department of Radiology, LMU University Hospital, LMU Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, LMU University Hospital, LMU Munich, Germany; Boehringer Ingelheim, Clinical Program Lead, Bingerstrasse 137, Ingelheim am Rhein 55218, Germany
| | | | - Hana Algül
- Comprehensive Cancer Center Munich TUM, Institute for Tumor Metabolism, Technical University of Munich, Munich, Germany
| | - Timo Reisländer
- SERVIER Deutschland GmbH, Medical Affairs, Elsenheimerstr. 53, 80687 Munich, Germany
| | - Stefan Boeck
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center Munich, Marchioninistr. 15, 81377 Munich, Germany; Department of Hematology and Oncology, München Klinik Neuperlach, Munich, Germany
| | - Volker Heinemann
- Department of Medicine III, LMU University Hospital, LMU Munich and Comprehensive Cancer Center Munich, Marchioninistr. 15, 81377 Munich, Germany.
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2
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Brun SS, Hansen TF, Wen SWC, Nyhus CH, Bertelsen L, Jakobsen A, Hansen TS, Nederby L. Soluble programmed death ligand 1 as prognostic biomarker in non-small cell lung cancer patients receiving nivolumab, pembrolizumab or atezolizumab therapy. Sci Rep 2024; 14:8993. [PMID: 38637655 PMCID: PMC11026506 DOI: 10.1038/s41598-024-59791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
Many studies have focused on the prognostic role of soluble programmed death ligand 1 (sPD-L1) in non-small cell lung cancer (NSCLC), but outcomes are ambiguous and further investigations are needed. We addressed the matter by studying sPD-L1 in baseline samples and in longitudinal samples taken prior to three subsequent cycles of anti-PD-1/anti-PD-L1 treatments. Eighty patients with NSCLC were enrolled. Median sPD-L1 level at baseline was 52 pg/mL [95% confidence interval (CI) 49-57]. In patients treated with pembrolizumab and nivolumab, the concentration of sPD-L1 remained rather stable throughout treatment. In contrast, sPD-L1 rose by 50-fold following the first cycle of atezolizumab therapy. We found the baseline level of sPD-L1 to be related to overall survival (OS) after two years of follow-up in simple Cox analysis (p = 0.006) and multiple Cox Regression, hazard ratio 1.02 (95% CI 1.00-1.03) (p = 0.033). There was no association between sPD-L1 and tissue PD-L1 expression, overall response rate, or progression free survival. In conclusion, sPD-L1 measured in baseline serum samples may be associated with OS in NSCLC patients receiving anti-PD1/anti-PD-L1 treatment. Importantly, the results signify that further research is warranted to explore the clinical utility of sPD-L1 in patients treated with anti-PD-L1.
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Affiliation(s)
- Sinne Søberg Brun
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslowsvej 19, 3, 5000 Odense, Denmark
| | - Sara Witting Christensen Wen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslowsvej 19, 3, 5000 Odense, Denmark
| | - Christa Haugaard Nyhus
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lisbeth Bertelsen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Anders Jakobsen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J. B. Winslowsvej 19, 3, 5000 Odense, Denmark
| | - Torben Schjødt Hansen
- Department of Oncology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - Line Nederby
- Department of Biochemistry and Immunology, Vejle Hospital-University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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3
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Singh Z, Holt SK, Gore JL, Nyame YA, Wright JL, Schade GR. Chronic Glucocorticoid Use and Risk for Advanced Prostate Cancer at Presentation: A SEER-Medicare Cohort Study. Clin Genitourin Cancer 2024; 22:68-73.e2. [PMID: 37806926 DOI: 10.1016/j.clgc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Examine the relationship between exposure to systemic glucocorticoids (steroids) and advanced prostate cancer (PCa) at presentation. Prior work suggested that steroid use may be associated with increased PCa risk. MATERIALS AND METHODS We queried the linked SEER-Medicare database (2004-2015) to identify PSA screened patients diagnosed with PCa. Criteria for screening included a PSA lab test or DRE exam in both the 12 month and 13 to 36 month periods prior to diagnosis of PCa. Steroid exposure was determined using Medicare Part D and groups were divided based on duration of use in the 3 years prior to diagnosis: controls with no exposure, <30 days, 30 days - 1 year, 1 to 2 years, and >2+ years. Advanced PCa was defined as systemic metastases or regional lymph node metastasis at presentation. Risk estimates for advanced PCa at presentation for steroid exposure groups vs. controls were assessed with univariable and multivariable logistic regression models. RESULTS We identified 22,920 PSA screened patients diagnosed with PCa of which 29% used glucocorticoids in the exposure period. The mean (SD) duration for glucocorticoid use (in days) among all steroid users was 76.7 days (192.1). On univariable and multivariable analyses, > 2 years of steroid exposure was associated with significantly increased risk for advanced PCa (OR 2.06, 95% CI 1.35-3.14 and OR 1.74, 95% CI 1.12-2.69, respectively). CONCLUSION In this population-based PSA-screened cohort, prolonged steroid use was associated with increased risk of advanced PCa at diagnosis. With the widespread use of glucocorticoids, it is important to consider the role steroids may play in PCa pathogenesis.
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Affiliation(s)
- Zorawar Singh
- Department of Urology, University of Washington Medical Center, Seattle, WA; Smith Institute for Urology at Northwell Health of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Sarah K Holt
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Yaw A Nyame
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Jonathan L Wright
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington Medical Center, Seattle, WA.
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4
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Jahan N, Cathcart-Rake E, Vierkant RA, Larson N, Loprinzi C, O'Sullivan CC, Faubion S, Kuhle C, Vencill JA, Couch F, Olson JE, Ruddy KJ. Sexual Dysfunction in Patients With Metastatic Breast Cancer. Clin Breast Cancer 2024; 24:72-78.e4. [PMID: 37867114 DOI: 10.1016/j.clbc.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Sexual well-being is a key determinant of quality of life. Sexual dysfunction in patients with metastatic breast cancer (MBC) is understudied. PATIENTS AND METHODS Patients were eligible for this study if they participated in the Mayo Clinic Breast Disease Registry (MCBDR), had a diagnosis of de novo MBC, and responded to a question about sexual dysfunction at the baseline MCBDR survey. Participants reported their sexual dysfunction on a scale of 0 (no dysfunction) to 10 (severe dysfunction) at baseline and then annually for 4 years. Participants answered additional sexual symptom questions in years 2 and 4. Associations between patient attributes and the presence and severity of sexual dysfunction, changes in sexual dysfunction from baseline to subsequent surveys, and associations between specific sexual symptoms and severity of sexual dysfunction were assessed. RESULTS One hundred three patients with de novo MBC answered the sexual dysfunction question at baseline. The prevalence of any sexual dysfunction (score of 1-10) was 56.3% at baseline (n = 103), 57.1 % at year 1 (n = 77), 80.4% at year 2 (n = 46), 65.8% at year 3 (n = 38), and 85% at year 4 (n = 20). Vaginal dryness was reported by approximately 49% and 39% of patients in years 2 and 4 respectively. Vaginal dryness was associated with higher severity of sexual dysfunction. CONCLUSIONS Self-reported sexual dysfunction is frequent in women with de novo MBC. Vaginal dryness is a frequently reported treatable symptom associated with higher severity of sexual dysfunction. Clinicians should assess patients with MBC for sexual dysfunction and discuss potential treatment strategies.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology and Oncology, University Alabama at Birmingham, Birmingham, AL
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nicole Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Carol Kuhle
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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5
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Estephan F, Lap CJ, Banagan J, Antonio M, Liu S, Diao G, Rozalen AZ, Rajendran R, Krasnow S, Subrahmanyam R, Nava VE, Jain M. The prevalence and clinical significance of HER2 expression in prostate adenocarcinoma. Ann Diagn Pathol 2023; 67:152219. [PMID: 38622987 DOI: 10.1016/j.anndiagpath.2023.152219] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 04/17/2024]
Abstract
AIMS Abnormalities in HER2 are well-established oncogenic drivers and are approved therapeutic targets in various malignancies. Prior studies evaluating HER2 expression in prostate cancer (PCa) have yielded variable results. Most of these studies used immunohistochemistry scoring systems based on breast cancer data. The goal of this study was to determine the prevalence and clinical significance of HER2 expression using a scoring system that better reflects the HER2 staining pattern observed in PCa. METHODS We randomly selected similar numbers of localized low risk (AJCC stage I), locally advanced (AJCC stages II & III), and metastatic (AJCC stage IV) PCa patients treated at the DC VA Medical Center between 2000 and 2022. Among them, we included patients who had sufficient PCa tissue samples and clinical information required for this analysis. Two experienced pathologists independently scored HER2 expression (Ventana Pathway anti-HER2) according to a modified gastric cancer HER2 scoring system. RESULTS Out of the 231 patients included, 85 % self-identified as Black. 58.9 % of patients expressed HER2 (1+: 35.5 %; 2+: 18.2 %; 3+: 5.2 %). Validity of the results was confirmed using the HercepTest antibody. Higher HER2 expression was associated with a higher Gleason Score/Grade Group and advanced disease. CONCLUSIONS Our findings support the adverse prognostic impact on HER2 in PCa. We propose the use of a modified scoring system to evaluate HER2 expression in PCa. The observed high prevalence of HER2 expression supports the consideration of novel HER2-targeted therapies addressing even low levels of HER2 expression in future PCa trials.
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Affiliation(s)
- Fayez Estephan
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA
| | - Coen J Lap
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA
| | - Jeff Banagan
- Institute for Clinical Research, Washington, DC, USA
| | | | - Shanshan Liu
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, Washington, DC, USA
| | - Guoqing Diao
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, Washington, DC, USA
| | - Alexandra Zara Rozalen
- The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA
| | | | - Steven Krasnow
- The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA
| | - Ramesh Subrahmanyam
- The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA
| | - Victor E Nava
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA
| | - Maneesh Jain
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA; The Edward P. Evans Precision Oncology Center of Excellence, Washington DC VA Medical Center, Washington, DC, USA.
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Bautista-Perez IJ, Luna-Peteuil Z, Pacheco-Molina C, Garcia-Ortega DY, Villavicencio-Valencia V, Luna-Ortiz K. Acrometastasis: The Tip of the Iceberg of Metastatic Disease from Thyroid Cancer. Two Cases Report. Indian J Otolaryngol Head Neck Surg 2023; 75:2263-2266. [PMID: 37636720 PMCID: PMC10447663 DOI: 10.1007/s12070-023-03555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
Acrometastasis, especially in the hands and fingers, is a rare clinical condition resulting from primary cancers such as lung, breast, kidney, and, rarely, thyroid cancer. Acrometastasis tends to be the tip of the iceberg in patients with extensive systemic disease, which could be regional, pulmonary, skeletal, neurological, or all of them combined. Even though these tumors are clearly visible and symptomatic, the diagnosis is usually misleading because such distal metastatic disease is not thought of at first. In general, systemic treatments should be given to any patient presenting digital acrometastasis. We describe two cases of papillary thyroid carcinoma and digital acrometastasis as a sign of advanced disease.
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Affiliation(s)
- Irvint Joel Bautista-Perez
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, 14080 Mexico City, Tlalpan Mexico
| | | | - Carlos Pacheco-Molina
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, 14080 Mexico City, Tlalpan Mexico
| | | | | | - Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Av San Fernando #22 Col. Sección XVI, 14080 Mexico City, Tlalpan Mexico
- Department of General Surgery (Head and Neck Surgery), Hospital General “Manuel Gea Gonzalez” (Mexico), Mexico City, Tlalpan México
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Clarke G, Crooks J, Bennett MI, Mirza Z, Obe RB, Nazar W, Mughal R, Ahmed S. Experiences of pain and pain management in advanced disease and serious illness for people from South Asian communities in Leeds and Bradford: a qualitative interview study. BMC Palliat Care 2023; 22:90. [PMID: 37464365 DOI: 10.1186/s12904-023-01208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/22/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Pain is a significant problem for many people with advanced disease or a serious illness. Culture and ethnicity can affect the experience and management of pain. However, there is limited research in South Asian communities in the UK on their experiences of pain. The aim of this study is to explore the experiences and attitudes of patients and family carers from South Asian communities about pain and its management within advanced disease or serious illness. METHODS Qualitative thematic analysis based on descriptive phenomenology (Sundler et al. 2019). Qualitative semi-structured interviews with patients or family carers from South Asian communities (N = 15). Interviews were recorded, transcribed and analysed using an inductive approach. Public and Patient Involvement representatives from British South Asian communities were consulted for guidance. RESULTS There were five key themes from the interviews: The importance of communication about pain with healthcare professionals; Concerns about taking pain medication; Personal resilience, privacy and self-management; Gender, culture and pain; Home pain management as struggle and frustration. CONCLUSION To improve pain management for people from South Asian communities with advanced disease or a serious illness, there are a number of important issues for healthcare professionals from palliative and primary care services to address. These include: greater awareness around people's fears and concerns about pain medication; their potential use of alternative pain management strategies; and cultural issues such as resilience, privacy, dignity and gender roles. Effective communication between doctors, patients and family members could be improved by using a 'cultural humility' model; providing clear and accessible pain medication information; understanding and taking account of people with both low, and medium levels, of English language proficiency; and improving patient trust. Additionally, improvements to out of hours services could improve pain management for all patients managing their pain at home.
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Affiliation(s)
- Gemma Clarke
- St Gemma's Academic Unit of Palliative Care, Division of Primary Care Palliative Care and Public Health, Leeds Institute of Health Sciences, University of Leeds, Level 10, Worsley Building, Leeds, LS2 9NL, UK.
| | - Jodie Crooks
- Policy and Research Team, Marie Curie, London, UK
| | - Michael I Bennett
- St Gemma's Academic Unit of Palliative Care, Division of Primary Care Palliative Care and Public Health, University of Leeds, Leeds, UK
| | - Zarina Mirza
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ruby Bhatti Obe
- Independent Patient and Public Involvement (PPI) Representative, Bradford, UK
| | - Wali Nazar
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rahila Mughal
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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8
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Crooks J, Trotter S, Clarke G. How does ethnicity affect presence of advance care planning in care records for individuals with advanced disease? A mixed-methods systematic review. BMC Palliat Care 2023; 22:43. [PMID: 37062841 PMCID: PMC10106323 DOI: 10.1186/s12904-023-01168-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) is the process supporting individuals with life-limiting illness to make informed decisions about their future healthcare. Ethnic disparities in ACP have been widely highlighted, but interpretation is challenging due to methodological heterogeneity. This review aims to examine differences in the presence of documented ACP in individuals' care records for people with advanced disease by ethnic group, and identify patient and clinician related factors contributing to this. METHODS Mixed-methods systematic review. Keyword searches on six electronic databases were conducted (01/2000-04/2022). The primary outcome measure was statistically significant differences in the presence of ACP in patients' care records by ethnicity: quantitative data was summarised and tabulated. The secondary outcome measures were patient and clinician-based factors affecting ACP. Data was analysed qualitatively through thematic analysis; themes were developed and presented in a narrative synthesis. Feedback on themes was gained from Patient and Public Involvement (PPI) representatives. Study quality was assessed through Joanna Briggs Institute Critical Appraisal tools and Gough's Weight of Evidence. RESULTS N=35 papers were included in total; all had Medium/High Weight of Evidence. Fifteen papers (comparing two or more ethnic groups) addressed the primary outcome measure. Twelve of the fifteen papers reported White patients had statistically higher rates of formally documented ACP in their care records than patients from other ethnic groups. There were no significant differences in the presence of informal ACP between ethnic groups. Nineteen papers addressed the secondary outcome measure; thirteen discussed patient-based factors impacting ACP presence with four key themes: poor awareness and understanding of ACP; financial constraints; faith and religion; and family involvement. Eight papers discussed clinician-based factors with three key themes: poor clinician confidence around cultural values and ideals; exacerbation of institutional constraints; and pre-conceived ideas of patients' wishes. CONCLUSIONS This review found differences in the presence of legal ACP across ethnic groups despite similar presence of informal end of life conversations. Factors including low clinician confidence to deliver culturally sensitive, individualised conversations around ACP, and patients reasons for not wishing to engage in ACP (including, faith, religion or family preferences) may begin to explain some documented differences. TRIAL REGISTRATION PROSPERO-CRD42022315252.
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Affiliation(s)
| | - Sophie Trotter
- Academic Unit of Palliative Care, University of Leeds, Leeds, UK
| | - Gemma Clarke
- Academic Unit of Palliative Care, University of Leeds, Leeds, UK
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Schmid S, Cheng S, Chotai S, Garcia M, Zhan L, Hueniken K, Balaratnam K, Khan K, Patel D, Grant B, Raptis R, Brown MC, Xu W, Moriarty P, Shepherd FA, Sacher AG, Leighl NB, Bradbury PA, Liu G. Real-World Treatment Sequencing, Toxicities, Health Utilities, and Survival Outcomes in Patients with Advanced ALK-Rearranged Non-Small-Cell Lung Cancer. Clin Lung Cancer 2023; 24:40-50. [PMID: 36270866 DOI: 10.1016/j.cllc.2022.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This real-world analysis describes treatment patterns, sequencing and clinical effectiveness, toxicities, and health utility outcomes in advanced-stage, incurable ALK-positive NSCLC patients across five different ALK-TKIs. MATERIALS AND METHODS Clinicodemographic, treatment, and toxicity data were collected retrospectively in patients with advanced-stage ALK-positive NSCLC at Princess Margaret Cancer Centre. Patient-reported symptoms, toxicities, and health utilities were collected prospectively. RESULTS Of 148 ALK-positive NSCLC patients seen July 2009-May 2021, median age was 58.9 years; 84 (57%) were female; 112 (76%) never-smokers; 54 (47%) Asian and 40 (35%) white; 139 (94%) received at least one ALK-TKI: crizotinib (n = 74; 54%) and alectinib (n = 61; 44%) were administered mainly as first-line ALK-TKI, ceritinib, brigatinib and lorlatinib were administered primarily after previous ALK-TKI failure. Median overall survival (OS) was 54.0 months; 31 (21%) patients died within two years of advanced-stage diagnosis. Treatment modifications were observed in 35 (47%) patients with crizotinib, 19 (61%) with ceritinib, 41 (39%) with alectinib, 9 (41%) with brigatinib and 8 (30%) with lorlatinib. Prevalence of dose modifications and self-reported toxicities were higher with early versus later generation ALK-TKIs (P<.05). The presence of early treatment modification was not negatively associated with progression-free survival (PFS) and OS analyses. CONCLUSION Serial ALK-TKI sequencing approaches are viable therapeutic options that can extend quality of life and quantity-of-life, though a fifth of patients died within two years. No best single sequencing approach could be determined. Clinically relevant toxicities occurred across all ALK-TKIs. Treatment modifications due to toxicity may not necessarily compromise outcomes, allowing multiple approaches to deal with ALK-TKI toxicities.
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Affiliation(s)
- Sabine Schmid
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada; Inselspital Berne, University of Berne, Switzerland
| | - Sierra Cheng
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Simren Chotai
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Miguel Garcia
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Luna Zhan
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Katrina Hueniken
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Karmugi Balaratnam
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Khaleeq Khan
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Devalben Patel
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Benjamin Grant
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Roula Raptis
- Applied Health Research Centre, Unity Health, Toronto, Canada
| | - M Catherine Brown
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Wei Xu
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Frances A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Adrian G Sacher
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Natasha B Leighl
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Geoffrey Liu
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada.
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Gong T, Jaratlerdsiri W, Jiang J, Willet C, Chew T, Patrick SM, Lyons RJ, Haynes AM, Pasqualim G, Brum IS, Stricker PD, Mutambirwa SBA, Sadsad R, Papenfuss AT, Bornman RMS, Chan EKF, Hayes VM. Genome-wide interrogation of structural variation reveals novel African-specific prostate cancer oncogenic drivers. Genome Med 2022; 14:100. [PMID: 36045381 PMCID: PMC9434886 DOI: 10.1186/s13073-022-01096-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND African ancestry is a significant risk factor for advanced prostate cancer (PCa). Mortality rates in sub-Saharan Africa are 2.5-fold greater than global averages. However, the region has largely been excluded from the benefits of whole genome interrogation studies. Additionally, while structural variation (SV) is highly prevalent, PCa genomic studies are still biased towards small variant interrogation. METHODS Using whole genome sequencing and best practice workflows, we performed a comprehensive analysis of SVs for 180 (predominantly Gleason score ≥ 8) prostate tumours derived from 115 African, 61 European and four ancestrally admixed patients. We investigated the landscape and relationship of somatic SVs in driving ethnic disparity (African versus European), with a focus on African men from southern Africa. RESULTS Duplication events showed the greatest ethnic disparity, with a 1.6- (relative frequency) to 2.5-fold (count) increase in African-derived tumours. Furthermore, we found duplication events to be associated with CDK12 inactivation and MYC copy number gain, and deletion events associated with SPOP mutation. Overall, African-derived tumours were 2-fold more likely to present with a hyper-SV subtype. In addition to hyper-duplication and deletion subtypes, we describe a new hyper-translocation subtype. While we confirm a lower TMPRSS2-ERG fusion-positive rate in tumours from African cases (10% versus 33%), novel African-specific PCa ETS family member and TMPRSS2 fusion partners were identified, including LINC01525, FBXO7, GTF3C2, NTNG1 and YPEL5. Notably, we found 74 somatic SV hotspots impacting 18 new candidate driver genes, with CADM2, LSAMP, PTPRD, PDE4D and PACRG having therapeutic implications for African patients. CONCLUSIONS In this first African-inclusive SV study for high-risk PCa, we demonstrate the power of SV interrogation for the identification of novel subtypes, oncogenic drivers and therapeutic targets. Identifying a novel spectrum of SVs in tumours derived from African patients provides a mechanism that may contribute, at least in part, to the observed ethnic disparity in advanced PCa presentation in men of African ancestry.
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Affiliation(s)
- Tingting Gong
- grid.1013.30000 0004 1936 834XAncestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia ,grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia ,grid.8547.e0000 0001 0125 2443Human Phenome Institute, Fudan University, Shanghai, China
| | - Weerachai Jaratlerdsiri
- grid.1013.30000 0004 1936 834XAncestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia ,grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia
| | - Jue Jiang
- grid.1013.30000 0004 1936 834XAncestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia ,grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia
| | - Cali Willet
- grid.1013.30000 0004 1936 834XSydney Informatics Hub, University of Sydney, Sydney, NSW Australia
| | - Tracy Chew
- grid.1013.30000 0004 1936 834XSydney Informatics Hub, University of Sydney, Sydney, NSW Australia
| | - Sean M. Patrick
- grid.49697.350000 0001 2107 2298School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Ruth J. Lyons
- grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia
| | - Anne-Maree Haynes
- grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia
| | - Gabriela Pasqualim
- grid.8532.c0000 0001 2200 7498Endocrine and Tumor Molecular Biology Laboratory, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ,grid.411598.00000 0000 8540 6536Laboratory of Genetics, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande, Rio Grande, Brazil
| | - Ilma Simoni Brum
- grid.8532.c0000 0001 2200 7498Endocrine and Tumor Molecular Biology Laboratory, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Phillip D. Stricker
- grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia ,grid.437825.f0000 0000 9119 2677Department of Urology, St. Vincent’s Hospital, Darlinghurst, NSW Australia
| | - Shingai B. A. Mutambirwa
- grid.461049.eDepartment of Urology, Sefako Makgatho Health Science University, Dr George Mukhari Academic Hospital, Medunsa, Ga-Rankuwa, South Africa
| | - Rosemarie Sadsad
- grid.1013.30000 0004 1936 834XSydney Informatics Hub, University of Sydney, Sydney, NSW Australia
| | - Anthony T. Papenfuss
- grid.1042.70000 0004 0432 4889Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria Australia ,grid.1008.90000 0001 2179 088XDepartment of Medical Biology, University of Melbourne, Melbourne, Victoria Australia
| | - Riana M. S. Bornman
- grid.49697.350000 0001 2107 2298School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Eva K. F. Chan
- grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia ,grid.416088.30000 0001 0753 1056NSW Health Pathology, Sydney, Australia
| | - Vanessa M. Hayes
- grid.1013.30000 0004 1936 834XAncestry and Health Genomics Laboratory, Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia ,grid.415306.50000 0000 9983 6924Genomics and Epigenetics Theme, Garvan Institute of Medical Research, Darlinghurst, NSW Australia ,grid.49697.350000 0001 2107 2298School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa ,grid.411732.20000 0001 2105 2799Faculty of Health Sciences, University of Limpopo, Turfloop Campus, Mankweng, South Africa
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11
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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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12
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Kelleher SA, Fisher HM, Winger JG, Miller SN, Amaden GH, Somers TJ, Colloca L, Uronis HE, Keefe FJ. Virtual reality for improving pain and pain-related symptoms in patients with advanced stage colorectal cancer: A pilot trial to test feasibility and acceptability. Palliat Support Care 2022;:1-11. [PMID: 35078545 DOI: 10.1017/S1478951521002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Virtual reality (VR) has the potential to improve pain and pain-related symptoms. We examined the feasibility, acceptability, safety, and impact of a 30-min virtual underwater/sea environment (VR Blue) for reducing pain and pain-related symptoms in advanced colorectal cancer patients. A qualitative exit interview was conducted to understand preferences, thoughts, and feelings about the VR session. METHOD Participants (N = 20) had stage IV colorectal cancer and moderate-to-severe pain. Participants completed a 30-min VR Blue session that visually and aurally immersed them in virtual ocean scenarios. Feasibility was assessed by accrual (N = 20), protocol adherence (≥80% completing VR Blue), and completed data (≥80% assessment completion). Acceptability was determined by patients reporting ≥80% intervention satisfaction. Safety was determined by ≥80% of patients completing the session without self-reported side effects. Measures of pain, tension, relaxation, stress, anxiety, and mood were collected before, during, and after the VR Blue session. A semi-structured qualitative interview was conducted after VR Blue to assess participants' VR experiences. RESULTS All participants (100%) completed the VR Blue session. There was 100% data collection at the pre- and post-assessments. Satisfaction with VR Blue was high M = 3.3 (SD = 0.4) (83%). No significant side effects were reported. Pain decreased by 59% (Pre-M = 3 [1]; Post-M = 1 [1]). Tension decreased by 74% (Pre-M = 30 [24]; Post-M = 8 [13]). Relaxation improved by 38% (Pre-M = 62 [21]); Post-M = 86 [17]). Stress decreased by 68% (Pre-M = 24 [24]; Post-M = 8 [14]). Anxiety decreased by 65% (Pre-M = 20 [23]; Post-M = 7 [13]). Mood improved by 70% (Pre-M = 13 [16]; Post-M = 4 [11]). Qualitative data suggested a positive response to the VR Blue protocol. SIGNIFICANCE OF RESULTS This work supports the feasibility, acceptability, and safety of VR Blue for advanced colorectal cancer patients. Participants showed significant pre-post improvement in pain and pain-related symptoms hinting to the potential feasibility of VR interventions in this population. Larger, randomized trials with a control condition are needed to examine the efficacy of VR-based interventions for patients with advanced colorectal cancer and pain.
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Rimmer B, Crowe L, Todd A, Sharp L. Assessing unmet needs in advanced cancer patients: a systematic review of the development, content, and quality of available instruments. J Cancer Surviv 2021. [PMID: 34363187 DOI: 10.1007/s11764-021-01088-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Advances in treatment, including biological and precision therapies, mean that more people are living with advanced cancer. Supportive care needs likely change across the cancer journey. We systematically identified instruments available to assess unmet needs of advanced cancer patients and evaluated their development, content, and quality. METHODS Systematic searches of MEDLINE, CINAHL, Embase, PubMed, and PsycINFO were performed from inception to 11 January 2021. Independent reviewers screened for eligibility. Data was abstracted on instrument characteristics, development, and content. Quality appraisal included methodological and quality assessment, GRADE, feasibility, and interpretability, following consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines. RESULTS Thirty studies reporting 24 instruments were identified. These were developed for general palliative patients (n = 2 instruments), advanced cancer (n = 8), and cancer irrespective of stage (n = 14). None focused on patients using biological or precision therapies. The most common item generation and reduction techniques were amending an existing instrument (n = 11 instruments) and factor analysis (n = 8), respectively. All instruments mapped to ≥ 5 of 11 unmet need dimensions, with Problems and Needs in Palliative Care (PNPC) and Psychosocial Needs Inventory (PNI) covering all 11. No instrument reported all of the COSMIN measurement properties, and methodological quality was variable. CONCLUSIONS Many instruments are available to assess unmet needs in advanced cancer. There is extensive heterogeneity in their development, content, and quality. IMPLICATIONS FOR CANCER SURVIVORS Given the growth of precision and biological therapies, research needs to explore how these instruments perform in capturing the needs of people using such therapies.
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14
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Redondo A, Oaknin A, Rubio MJ, Barretina-Ginesta MP, de Juan A, Manso L, Romero I, Martin-Lorente C, Poveda A, Gonzalez-Martin A. Management of advanced ovarian cancer in Spain: an expert Delphi consensus. J Ovarian Res 2021; 14:72. [PMID: 34039386 PMCID: PMC8157411 DOI: 10.1186/s13048-021-00816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To determine the state of current practice and to reach a consensus on recommendations for the management of advanced ovarian cancer using a Delphi survey with a group of Spanish gynecologists and medical oncologists specially dedicated to gynecological tumors. METHODS The questionnaire was developed by the byline authors. All questions but one were answered using a 9-item Likert-like scale with three types of answers: frequency, relevance and agreement. We performed two rounds between December 2018 and July 2019. A consensus was considered reached when at least 75% of the answers were located within three consecutive points of the Likert scale. RESULTS In the first round, 32 oncologists and gynecologists were invited to participate, and 31 (96.9%) completed the online questionnaire. In the second round, 27 (87.1%) completed the online questionnaire. The results for the questions on first-line management of advanced disease, treatment of patients with recurrent disease for whom platinum might be the best option, and treatment of patients with recurrent disease for whom platinum might not be the best option are presented. CONCLUSIONS This survey shows a snapshot of current recommendations by this selected group of physicians. Although the majority of the agreements and recommendations are aligned with the recently published ESMO-ESGO consensus, there are some discrepancies that can be explained by differences in the interpretation of certain clinical trials, reimbursement or accessibility issues.
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Affiliation(s)
- Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - Ana Oaknin
- Medical Oncology Department, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Maria Jesus Rubio
- Medical Oncology Department, Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), Córdoba, Spain
| | - Maria-Pilar Barretina-Ginesta
- Medical Oncology Department, Girona Biomedical Research Institute (IdIBGi) and Department of Medical Sciences, Catalan Institute of Oncology (ICO), Medical School University of Girona, Girona, Spain
| | - Ana de Juan
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Luis Manso
- Medical Oncology Department, Hospital Universitario 12 de Octubre-i+12, Madrid, Spain
| | - Ignacio Romero
- Medical Oncology Department, Instituto Valenciano Oncologia, Valencia, Spain
| | - Cristina Martin-Lorente
- Medical Oncology Department, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Andres Poveda
- Oncogynecologic Department, Initia Oncology, Hospital Quironsalud, Valencia, Spain
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15
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McNamara MG, Bridgewater J, Palmer DH, Faluyi O, Wasan H, Patel A, Ryder WD, Barber S, Gnanaranjan C, Ghazaly E, Evans TJ, Valle JW. A Phase Ib Study of NUC-1031 in Combination with Cisplatin for the First-Line Treatment of Patients with Advanced Biliary Tract Cancer (ABC-08). Oncologist 2021; 26:e669-e678. [PMID: 33210382 PMCID: PMC8018303 DOI: 10.1002/onco.13598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cisplatin/gemcitabine is standard first-line treatment for patients with advanced biliary tract cancer (ABC). NUC-1031 (phosphoramidate transformation of gemcitabine) is designed to enhance efficacy by maximizing intratumoral active metabolites. METHODS Patients with untreated ABC, Eastern Cooperative Oncology Group performance status 0-1 received NUC-1031 (625 or 725 mg/m2 ) and cisplatin (25 mg/m2 ) on days 1 and 8, every 21 days. Primary objectives were safety and maximum tolerated dose; secondary objectives were objective response rate (ORR), pharmacokinetics, progression-free survival (PFS), and overall survival (OS). RESULTS Twenty-one patients (median age 61 years, n = 13 male; 17 cholangiocarcinoma, 2 ampullary, and 2 gallbladder cancer) received NUC-1031 625 mg/m2 (n = 8 and expansion n = 7; median six cycles) or 725 mg/m2 (n = 6; median 7.5 cycles). Treatment was well tolerated; most common treatment-emergent grade 3-4 adverse events occurring in more than one patient with 625 mg/m2 NUC-1031 were increased gamma-glutamyl transferase (GGT), 40%; alanine aminotransferase, 20%; bilirubin, 13%; neutropenia, 27%; decreased white cell count, 20%; thrombocytopenia, 13%; nausea, 13%; diarrhea, 13%; fatigue, 13%; and thrombus, 20% and with 725 mg/m2 , increased GGT, 67%, and fatigue, 33%. NUC-1031 725 mg/m2 was selected as the recommended dose with cisplatin in ABC. ORR was 33% (one complete response, six partial responses), DCR was 76%, median PFS was 7.2 months (95% confidence interval [CI], 4.3-10.1), and median OS was 9.6 months (95% CI, 6.7-13.1). The median estimates of area under the plasma concentration-time curve from time 0 to last measurable time and maximum concentration were highest for NUC-1031 (218-324 μg•h/mL and 309-889 μg/mL, respectively) and lowest for di-fluoro-deoxycytidine (0.47-1.56 μg•h/mL and 0.284-0.522 μg/mL, respectively). CONCLUSION This is the first study reporting on the combination of NUC-1031 with cisplatin in ABC and demonstrated a favorable safety profile; 725 mg/m2 NUC-1031 in combination with cisplatin is undergoing phase III trial evaluation in ABC. (ClinicalTrials.gov ID: NCT02351765; EudraCT ID: 2015-000100-26). IMPLICATIONS FOR PRACTICE The prognosis for patients with advanced biliary tract cancer (ABC) is approximately 1 year, and new treatment options are required. The cisplatin/gemcitabine combination is standard first-line treatment for patients with ABC. NUC-1031 is a phosphoramidate transformation of gemcitabine and is designed to enhance efficacy by maximizing intratumoral active metabolites. This phase Ib study (ABC-08) demonstrated a favorable safety profile of NUC-1031 in combination with cisplatin for the first-line treatment of patients with ABC, and 725 mg/m2 NUC-1031 was recommended in combination with cisplatin for phase III trial evaluation; the NuTide:121 global randomized study is currently enrolling.
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Affiliation(s)
- Mairéad G. McNamara
- Division of Cancer Sciences, University of ManchesterManchesterUnited Kingdom
- Department of Medical Oncology, The Christie NHS Foundation TrustManchesterUnited Kingdom
| | | | - Daniel H. Palmer
- Clatterbridge Cancer Centre and Liverpool Experimental Cancer Medicine CentreLiverpoolUnited Kingdom
| | - Olusola Faluyi
- Clatterbridge Cancer Centre and Liverpool Experimental Cancer Medicine CentreLiverpoolUnited Kingdom
| | | | - Alkesh Patel
- Department of Pharmacy, The Christie NHS Foundation TrustManchesterUnited Kingdom
| | - William D. Ryder
- Manchester Clinical Trials Unit, University of ManchesterManchesterUnited Kingdom
| | - Safia Barber
- Manchester Clinical Trials Unit, University of ManchesterManchesterUnited Kingdom
| | | | - Essam Ghazaly
- Barts Cancer Institute, Queen Mary University of LondonLondonUnited Kingdom
- Beatson West of Scotland Cancer Centre, University of GlasgowUnited Kingdom
| | - T.R. Jeff Evans
- Beatson West of Scotland Cancer Centre, University of GlasgowUnited Kingdom
| | - Juan W. Valle
- Division of Cancer Sciences, University of ManchesterManchesterUnited Kingdom
- Department of Medical Oncology, The Christie NHS Foundation TrustManchesterUnited Kingdom
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16
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Steele EM, Robertson SE, Holmes JA. The effect of distance from cancer facility on advanced clinical stage at diagnosis in patients with cervical cancer. Cancer Treat Res Commun 2020; 25:100226. [PMID: 33120317 DOI: 10.1016/j.ctarc.2020.100226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE/OBJECTIVES In the United States, cervical cancer remains a significant cause of morbidity and mortality. The effect of distance has a complicated relationship with disease characteristics and outcomes in other cancers. The purpose of this study is to investigate the relationship between distance from cancer facility on clinical stage at diagnosis in women with cervical cancer. MATERIALS/METHODS Data were obtained from the National Cancer Database which include patient demographics, disease characteristics, and treatment details. Persons diagnosed with cervical cancer from 2004 to 2015 were included. Subjects were excluded if they had missing information, variant histology, or lived >1,000 miles from their facility resulting in 51,413 persons. Disease was classified as localized (stage 1a-2a) or advanced (stage 2b-4b). Univariate comparisons were performed using analysis of variance and chi-square test. Multivariable logistic regression was used to investigate the effect of distance quartiles on advanced stage while adjusting for other significant variables. RESULTS Mean age was 51.0 years, 16.9% of women were black, 14.7% were Hispanic, 45.0% had private insurance, and 10.7% were uninsured. Overall, 50.9% of women presented with advanced disease. In multivariable analysis, greater distance demonstrated a stepwise risk reduction of advanced disease where those in the farthest quartile had odds ratio of 0.73 (p<0.001) relative to the closest. Additionally, age, race, income, and insurance status significantly affected risk of advanced disease. CONCLUSIONS Distance from cancer facility resulted in lower risk of advanced stage disease at diagnosis. Additional research could elucidate the nuanced relationship between distance, disease characteristics and outcomes in cervical cancer.
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Affiliation(s)
- Ethan M Steele
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sharon E Robertson
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Gynecologic Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, United States
| | - Jordan A Holmes
- Indiana University School of Medicine, Indianapolis, IN, United States; Department of Radiation Oncology, Indiana University Simon Cancer Center, Indianapolis, IN, United States.
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Boilève A, Grignano E, Bouscary D, Fourquet A, Deau-Fischer B, Kirova Y. Relapsed, Refractory, or Advanced Hodgkin Lymphoma: A Single-Center Experience. Clin Lymphoma Myeloma Leuk 2020; 21:e27-e31. [PMID: 32933880 DOI: 10.1016/j.clml.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/17/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the treatment and outcomes of patients with relapsed, refractory, or advanced Hodgkin lymphoma treated with consolidation or salvage radiotherapy. PATIENTS AND METHODS We studied all patients diagnosed with this profile treated by radiotherapy in our center between 2006 and 2019. RESULTS A total of 33 patients who received external-beam radiotherapy for advanced (21%), relapsed (52%), or refractory (24%) Hodgkin lymphoma were studied. Median [interquartile range] age was 25 [22-38] years, with 11 women (33%). The follow-up after first-line treatment was 28 [10-53] months. Number of chemotherapy lines received before radiotherapy was 3 [1-4]. Fourteen patients (42%) had undergone autologous stem-cell transplantation before radiotherapy, and 2 patients were treated by radiotherapy alone. Nine patients (27%) were treated by involved-field radiotherapy, 17 (52%) by involved-site radiotherapy, 5 (17%) by involved-node radiotherapy, and 2 by other volumes. The acute toxicity profile was favorable, with grade 1 radiodermatitis (33%) or dysphagia (30%). Overall, 21 patients (64%) experienced prolonged complete response and 12 experienced relapse (36%) after radiotherapy. Median disease-free survival was 68.8 months. CONCLUSIONS External-beam radiotherapy should be considered an effective treatment modality for advanced, relapsed, or refractory Hodgkin lymphoma as part of a multimodal approach.
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Affiliation(s)
- Alice Boilève
- Département de radiothérapie, Institut Curie, Paris, France.
| | - Eric Grignano
- Département d'hématologie Clinique, Hôpital Cochin, Paris, France
| | - Didier Bouscary
- Département d'hématologie Clinique, Hôpital Cochin, Paris, France
| | - Alain Fourquet
- Département de radiothérapie, Institut Curie, Paris, France
| | | | - Youlia Kirova
- Département de radiothérapie, Institut Curie, Paris, France
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18
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Teixeira MJC, Abreu W, Costa N, Maddocks M. Understanding family caregivers' needs to support relatives with advanced progressive disease at home: an ethnographic study in rural Portugal. BMC Palliat Care 2020; 19:73. [PMID: 32450848 PMCID: PMC7249372 DOI: 10.1186/s12904-020-00583-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers’ experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time. Methods An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014 and 16 using serial participant observations (n = 33) and in-depth interviews (n = 11). Thematic content analysis was used to analyse the data. Results Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers’ physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time. Conclusions These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.
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Affiliation(s)
- Maria João Cardoso Teixeira
- Royal National Orthopaedic Hospital NHS Foundation Trust & National Institute for Health Research (NIHR), Brockley Hill Road, Stanmore, Middlesex, HA7 4LP, UK.
| | - Wilson Abreu
- School of Nursing & Research Centre "Centre for Health Technology and Services Research / ESEP -CINTESIS", Porto, Portugal
| | - Nilza Costa
- University of Aveiro - Research Centre "Didactic and Technology in the Education of Educators/CIDTFF", Aveiro, Portugal
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College of London, London, UK
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Palacios-Baena ZR, Martín-Ortega M, Ríos-Villegas MJ. Profile of new HIV diagnoses and risk factors associated with late diagnosis in a specialized outpatient clinic during the 2014-2018 period. Med Clin (Barc) 2020; 155:482-487. [PMID: 32418627 DOI: 10.1016/j.medcli.2020.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/21/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Late diagnosis (LD) of HIV infection is associated with an increase in morbidity and mortality and transmissibility. The aim of this study was to define the clinical characteristics of new diagnoses and clarify the risk factors (RF) associated with LD with or without advanced disease (AD) between 2014 and 2018. METHODS Patients with a new diagnosis of HIV infection treated in a specialised outpatient clinic of a third level hospital were included. LD with or without AD was defined as aCD4 count < 350 cel/mm3 or CD4 < 200 cel/mm3 respectively and/or the presence of any AIDS condition on diagnosis. An analysis was performed using binary logistic regression to analyse the RF associated with LD and the AD. RESULTS Of the 205 new diagnoses, 102 (50%) were LD. Age ≥ 32 years [(OR, 95% CI); 2.92 (1.52-5.59)], transmission different than in men who have sex with men [3.39 (1.56-7.34)] and hospitalisation on diagnosis [9.68 (2.63-35.68)] were RF associated with LD. On the other hand, having a concomitant sexually transmitted disease (STD) [.37 (.17-.77)] was associated with an early diagnosis. The results were similar when analysing the LD with AD except for the STD. CONCLUSION Knowledge of the clinical and epidemiological characteristics of new diagnoses of HIV infection and of the RF for LD with or without AD provides an opportunity for early diagnosis and to reduce transmissibility.
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Affiliation(s)
- Zaira R Palacios-Baena
- Unidad de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España.
| | - Miguel Martín-Ortega
- Unidad de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España
| | - M José Ríos-Villegas
- Unidad de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva. Hospital Universitario Virgen Macarena. Instituto de Biomedicina de Sevilla (IBIS), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España
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Park H. Survival Outcomes After Initial Treatment for Anal Adenocarcinoma: A Population-Based Cohort Study. Clin Colorectal Cancer 2020; 19:e75-e82. [PMID: 32389595 DOI: 10.1016/j.clcc.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anal adenocarcinoma (AA) is reported to represent 5% to 10% of all anal cancer. Currently there is no evidence-based treatment of AA. We investigated clinical outcomes after treatment regimens in patients with AA and used the Surveillance, Epidemiology, and End Results (SEER) registry to examine the outcome. PATIENTS AND METHODS We searched for patients diagnosed with histologically confirmed adenocarcinoma of the anal canal with stage I to III disease between 2010 and 2016 using SEER∗Stat software. RESULTS A total of 393 patients treated from 2010 to 2016 for AA were identified. Patients were divided into 5 groups according to treatment: 68 patients (17.3%) receiving radiotherapy (RT) and chemotherapy (CTx), 16 patients (4.1%) receiving RT or CTx, 108 patients (27.5%) receiving surgery alone, 137 patients (34.8%) receiving preoperative RT or CTx with surgery, and 64 patients (16.3%) receiving postoperative RT or CTx with surgery. The 3-year cause-specific survival (CSS) rates were 63.9% in the RT and CTx group, 35.7% in the RT or CTx group, 77.7% in the surgery-alone group, 80.3% in the preoperative RT or CTx group, and 65.8% in the postoperative group (P < .001). Preoperative RT or CTx was associated with improved CSS on multivariate analysis (P = .024). The 3-year CSS rates for those who received surgery and those who did not receive surgery were 81.5% and 87.5% for stage I disease, and 74.4% and 57.3% for stage II/III disease. CONCLUSION Preoperative treatment with surgical resection may maximize the survival outcome. Although chemoradiotherapy alone may be sufficient for early stages of disease, patients with advanced disease should be treated with a combination of surgical resection and chemoradiotherapy. Future studies are required to determine the appropriate treatment strategies in AA.
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Affiliation(s)
- Hyojung Park
- Department of Radiation Oncology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea.
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Chung MP, Park MS, Oh IJ, Lee HB, Kim YW, Park JS, Uh ST, Kim YS, Jegal Y, Song JW. Safety and Efficacy of Pirfenidone in Advanced Idiopathic Pulmonary Fibrosis: A Nationwide Post-Marketing Surveillance Study in Korean Patients. Adv Ther 2020; 37:2303-16. [PMID: 32297284 DOI: 10.1007/s12325-020-01328-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Indexed: 12/12/2022]
Abstract
Aim The efficacy and safety of pirfenidone have been previously demonstrated in patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF). However, the effect of pirfenidone in patients with advanced IPF remains unclear. Here, we investigated the effects of pirfenidone against advanced IPF in a real-world setting. Methods A prospective nationwide post-marketing study was conducted on 258 patients from 10 Korean institutions. Patients with a predicted forced vital capacity (FVC) less than 50% or a diffusing capacity of the lung for carbon monoxide (DLco) less than 35% at baseline were classified as the advanced IPF group. Results Of 219 patients included in the analysis, the majority were male (76.3%); the mean age was 67.3 years, and the advanced group accounted for 17.8% of the patients. The median treatment duration was 298 days. Among the subjects, 86.3% experienced adverse events (AEs), of which a decreased appetite (32.4%) and a photosensitivity reaction (13.7%) were the most frequent. The incidence of AEs was similar between the advanced and non-advanced groups (92.3% vs. 85.0%, respectively; p = 0.229). Although the overall discontinuation rate was higher in the advanced group than in the non-advanced group (74.4% vs. 50.0%, respectively; p = 0.006), the percentages of the patients who discontinued treatment as a result of AEs were similar in both groups (20.5% vs. 23.3%, respectively; p = 0.704). In all patients, the rates of decline in the predicted FVC and DLco over 48 weeks were − 4.3 ± 1.3% and − 4.4 ± 1.7%, respectively. There was no between-group difference in the rate of lung function decline. Conclusions Pirfenidone used for the treatment of patients with IPF in a real-world setting was well tolerated, with an acceptable safety profile and a consistent therapeutic effect, regardless of the disease severity. Trial Registration ClinicalTrials.gov NCT03761082; the trial was retrospectively registered on December 3, 2018. Electronic supplementary material The online version of this article (10.1007/s12325-020-01328-8) contains supplementary material, which is available to authorized users.
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Yao S, Wang R, Qian K, Zhang Y. Real world study for the concordance between IBM Watson for Oncology and clinical practice in advanced non-small cell lung cancer patients at a lung cancer center in China. Thorac Cancer 2020; 11:1265-1270. [PMID: 32191394 PMCID: PMC7180560 DOI: 10.1111/1759-7714.13391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 01/15/2023] Open
Abstract
Background IBM Watson for Oncology (WFO) provides physicians with evidence‐based treatment options. This study was designed to explore the concordance of the suggested therapeutic regimen for advanced non‐small cell lung (NSCLC) cancer patients between the updated version of WFO and physicians in our department, in order to reflect the differences of cancer treatment between China and the United States. Methods Retrospective data from 165 patients with advanced NSCLC from September 2014 to March 2018 were entered manually into WFO. WFO recommendations were provided in three categories: recommended, for consideration, and not recommended. Concordance was analyzed by comparing the treatment decisions proposed by WFO with the real treatment. Potential influenced factors were also analyzed. Results Overall, the treatment recommendations were concordant in 73.3% (121/165) of cases. When two alternative drugs such as icotinib and nedaplatin were included as “for consideration,” the total consistency could be elevated from 73.3% to 90.3%(149/165). The logistic regression analysis showed that gender (P = 0.096), ECOG (P = 0.0.502), smoking (P = 0.455), and pathology (P = 0.633) had no effect on consistency, but stages (P = 0.019), including stage ≤III (77.8%, 21/27) and stage IV (93.5%, 129/138) had significant effects on consistency. Conclusions In China, most of the treatment recommendations of WFO are consistent with the real world treatment. Factors such as patient preferences, prices, drug approval and medical insurance are also taken into consideration, and they ultimately affect the inconsistency. To be comprehensively and rapidly applied in China, localization needs to be accelerated by WFO.
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Affiliation(s)
- Shuyang Yao
- Department of thoracic surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ruotian Wang
- Department of thoracic surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kun Qian
- Department of thoracic surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of thoracic surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Fleming M, Craigs CL, Bennett MI. Palliative care assessment of dry mouth: what matters most to patients with advanced disease? Support Care Cancer 2020; 28:1121-1129. [PMID: 31201546 PMCID: PMC6989644 DOI: 10.1007/s00520-019-04908-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/31/2019] [Indexed: 12/02/2022]
Abstract
PURPOSE Dry mouth is a highly prevalent and significant symptom in patients with advanced progressive diseases. It is a poorly understood area of research, and currently, there is no standardised outcome measure or assessment tool for dry mouth. METHODS To assess responses to self-reported dry mouth questions, the impact of dry mouth, methods used to reduce symptoms and relevance of the questionnaire. A cross-sectional multisite study of 135 patients with advanced progressive disease experiencing dry mouth. Participants were located in the inpatient, day care, outpatient or community setting. RESULTS The majority (84.4%) of patients rated their dry mouth as moderate or severe using the verbal rating scale (VRS). Seventy-five percent (74.7%) had a numeric rating scale (NRS) score of 6 or more for dry mouth severity. Patients reported that dry mouth interfered most with talking and was the most important function to assess (median score 6 out of 10) followed by eating (median 5) and taste (median 5). Taking sips of drink was the most common and most effective self-management strategy. Over half of patients (54.6%) also reported impact on swallow and sleep and associated dryness of lips, throat and nasal passages. CONCLUSIONS This study highlights the severity of dry mouth in advanced disease. Important factors when assessing patients with dry mouth should include the functional impact on day-to-day activities including talking, dysphagia and sleep. Simple considerations for patients include provision of drinks and reviewing medications. This study could be used to develop a standardised assessment tool for dry mouth to use in clinical practice.
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Affiliation(s)
- Michelle Fleming
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.
| | - Cheryl L Craigs
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
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Panda S, Nayak BB, Manjunath NML, Panda K, Pathi PC. Epidemiological Features and Management of Oral Cancer Patients: Experience from a Single Private Comprehensive Cancer Care Center in the State of Odisha. Indian J Otolaryngol Head Neck Surg 2019; 71:358-62. [PMID: 31741986 DOI: 10.1007/s12070-018-1309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 03/17/2018] [Indexed: 10/17/2022] Open
Abstract
Oral cancer is the most common cancer in India. Challenges in the management of oral cancer patients in India include, delay in the presentation with high volume of advanced disease to be handled, affordability of patients and lack economical support especially in the non-governmental institutions and lack of awareness among patients and their relatives. Present study, a retrospective analysis of a prospectively maintained data, portrays the epidemiological features and management of patients with oral cancer presented to a private comprehensive cancer care hospital in the state of Odisha, India. A total of 1049 patients were considered for the analyses, managed between January 2014 and December 2016. Among 1049 patients, 20% (n, 215) were females and 80% (n, 834) were males. Mean age among the present cohort of patients was 50 years with age group 40-55 years being most common. All the patients underwent resection with curative intent and a 1 cm gross resection margins with or without bone and skin. Margin negative resection could be achieved in 82% of patients. Nodal involvement was seen in 36% of patients in the final histopathological assessment. Management of oral cancer patients is a major oncological and reconstructive challenge in India due to the advanced nature of disease at presentation. Inspite of socioeconomic constraints, these patients can be managed even in a private cancer centers with optimum outcomes. This is possible through coordinated team efforts.
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Auvray M, Tougeron D, Auclin E, Moulin V, Artru P, Hautefeuille V, Hammel P, Lecomte T, Locher C, Sickersen G, Coriat R, Lecaille C, Vernerey D, Taieb J, Pernot S. Efficacy and Safety of Aflibercept in Combination With Chemotherapy Beyond Second-Line Therapy in Metastatic Colorectal Carcinoma Patients: An AGEO Multicenter Study. Clin Colorectal Cancer 2019; 19:39-47.e5. [PMID: 31648924 DOI: 10.1016/j.clcc.2019.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/10/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although no data have been reported beyond second-line therapy, aflibercept is approved in this setting in many countries. We conducted a multicenter study to analyze the efficacy and safety of a aflibercept-chemotherapy regimen beyond second-line therapy in patients with metastatic colorectal cancer. PATIENTS AND METHODS Metastatic colorectal cancer patients treated with aflibercept beyond second-line therapy were included. Objective response rate, overall survival (OS), and progression-free survival (PFS) were assessed. RESULTS A total of 130 patients were included. Median OS and PFS were 7.6 months (95% confidence interval, 6.2-9.3) and 3.3 months (95% confidence interval, 2.7-3.8), respectively. The best response rates were partial response 6.9%, stable disease 38.5%, progressive disease 42.5%, and not evaluable 12%. According to whether patients received previous FOLFIRI (leucovorin, 5-fluorouracil, irinotecan, and oxaliplatin)-bevacizumab or not, OS was 7.7 and 8.1 months (P = .31), and PFS was 2.9 and 3.9 months (P = .02), respectively. Interestingly, PFS and OS were both significantly improved by 4% and 5% per month, respectively, without antiangiogenic treatment before the initiation of the aflibercept regimen. The negative effect of prior FOLFIRI-bevacizumab or shorter time since last bevacizumab was maintained in multivariate analysis for both OS and PFS. CONCLUSION The aflibercept-chemotherapy regimen is a therapeutic option in patients with chemorefractory disease beyond second-line therapy, in particular in patients with an antiangiogenic-free interval.
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Affiliation(s)
- Marie Auvray
- Department of Digestive Oncology, European Georges Pompidou Hospital, René Descartes University, Paris, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, Center Hospitalo-Universitaire de Poitiers, Poitiers, France
| | - Edouard Auclin
- Methodology and quality of life unit in oncology, University hospital of Besançon, Besançon, France; University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Valérie Moulin
- Department of Digestive Oncology Center Hospitalier de La Rochelle, La Rochelle, France
| | - Pascal Artru
- Department of Hepato-Gastroenterology, Jean Mermoz Hospital, Lyon, France
| | | | - Pascal Hammel
- Department of Digestive Oncology, Beaujon University Hospital, AP-HP and University Paris 7, Denis Diderot, Clichy, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU de Tours, Hôpital Trousseau, Tours, France
| | - Christophe Locher
- Department of Hepato-Gastroenterology, Center Hospitalier de Meaux, Meaux, France
| | - Gaëlle Sickersen
- Department of Hepato-Gastroenterology, CHU Saint-Louis, Paris, France
| | - Romain Coriat
- Department of Hepato-Gastroenterology and Digestive Oncology, CHU Cochin, Paris, France
| | - Cédric Lecaille
- Department of Gastroenterology and Digestive Oncology, Polyclinique de Bordeaux Nord, Bordeaux, France
| | - Dewi Vernerey
- Methodology and quality of life unit in oncology, University hospital of Besançon, Besançon, France
| | - Julien Taieb
- Department of Digestive Oncology, European Georges Pompidou Hospital, René Descartes University, Paris, France
| | - Simon Pernot
- Department of Digestive Oncology, European Georges Pompidou Hospital, René Descartes University, Paris, France.
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Kupeli N, Chatzitheodorou G, Troop NA, McInnerney D, Stone P, Candy B. Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review. BMC Palliat Care 2019; 18:65. [PMID: 31375118 PMCID: PMC6676535 DOI: 10.1186/s12904-019-0449-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). Results Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. Conclusion Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. Trial registration The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193). Electronic supplementary material The online version of this article (10.1186/s12904-019-0449-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | | | - N A Troop
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hertfordshire, UK
| | - D McInnerney
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - P Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - B Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Benzekri NA, Sambou JF, Ndong S, Tamba IT, Faye D, Diallo MB, Diatta JP, Faye K, Sall I, Sall F, Manga NM, Malomar JJ, Ndour CT, Hawes SE, Seydi M, Gottlieb GS. Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa. BMC Infect Dis 2019; 19:261. [PMID: 30876400 PMCID: PMC6420737 DOI: 10.1186/s12879-019-3826-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive therapy (IPT), fluconazole pre-emptive therapy, and adherence support. The goals of this study were to determine the prevalence of advanced HIV disease among individuals initiating ART in Senegal, to identify predictors of advanced disease, and to evaluate adherence to the WHO guidelines. METHODS This study was conducted among HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal. Clinical evaluations, laboratory analyses, questionnaires and chart review were conducted. Logistic regression was used to identify predictors of advanced disease. RESULTS A total of 198 subjects were enrolled; 70% were female. The majority of subjects (71%) had advanced HIV disease, defined by the WHO as a CD4 count < 200 cells/mm3 or clinical stage 3 or 4. The median CD4 count was 185 cells/mm3. The strongest predictors of advanced disease were age ≥ 35 (OR 5.80, 95%CI 2.35-14.30) and having sought care from a traditional healer (OR 3.86, 95%CI 1.17-12.78). Approximately one third of subjects initiated ART within 7 days of diagnosis. Co-trimoxazole prophylaxis was provided to 65% of subjects with CD4 counts ≤350 cells/mm3 or stage 3 or 4 disease. TB symptom screening was available for 166 subjects; 54% reported TB symptoms. Among those with TB symptoms, 39% underwent diagnostic evaluation. Among those eligible for IPT, one subject received isoniazid. No subjects underwent CrAg screening or received fluconazole to prevent cryptococcal meningitis. CONCLUSIONS This is the first study to report an association between seeking care from a traditional healer and presentation with WHO defined advanced disease in sub-Saharan Africa. Given the widespread use of traditional healers in sub-Saharan Africa, future studies to further explore this finding are indicated. Although the majority of individuals in this study presented with advanced disease and warranted management according to WHO guidelines, there were numerous missed opportunities to prevent HIV-associated morbidity and mortality. Programmatic evaluation is needed to identify barriers to implementation of the WHO guidelines and enhanced funding for operational research is indicated.
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Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Box 358061, 750 Republican St, Seattle, WA, 98109-4725, USA.
| | | | - Sanou Ndong
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | | | - Mouhamadou Baïla Diallo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | - Khadim Faye
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | | | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Sénégal
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Box 358061, 750 Republican St, Seattle, WA, 98109-4725, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Costabel U, Albera C, Glassberg MK, Lancaster LH, Wuyts WA, Petzinger U, Gilberg F, Kirchgaessler KU, Noble PW. Effect of pirfenidone in patients with more advanced idiopathic pulmonary fibrosis. Respir Res 2019; 20:55. [PMID: 30866942 DOI: 10.1186/s12931-019-1021-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
Data from controlled clinical studies in patients with more advanced idiopathic pulmonary fibrosis (IPF) could inform clinical practice, but they are limited, since this sub-population is usually excluded from clinical trials. These exploratory post-hoc analyses of the open-label, long-term extension study RECAP (NCT00662038) aimed to assess the efficacy and safety of pirfenidone in patients with more advanced IPF. Patients were categorised according to the extent of lung function impairment at baseline: more advanced (percent predicted FVC <50% and/or DLco <35%) and less advanced (percent predicted FVC ≥50% and DLco ≥35%).Overall, 596 patients with baseline FVC and/or DLco values available were included in the analyses; 187 patients had more advanced disease, and 409 patients had less advanced disease. Mean percent predicted FVC declined throughout 180 weeks of treatment in both more and less advanced disease subgroups. Both subgroups exhibited a similar pattern of adverse events; however, adverse events related to IPF progression were experienced by a higher proportion of patients with more advanced versus less advanced disease. Discontinuation rates due to any reason, adverse events related to IPF progression, or deaths were each higher in the more advanced versus the less advanced disease subgroup.These analyses found that longer-term pirfenidone treatment resulted in a similar rate of lung function decline and safety profile in patients with more advanced versus less advanced IPF, and the data suggest that pirfenidone is efficacious, well tolerated, and a feasible treatment option in patients with more advanced IPF.
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Abstract
Mastocytosis is a group of rare disorders characterized by abnormal accumulation of mast cells in one or several organs. Mastocytosis can be seen at any age; but, in adults, the disease is usually systemic and chronic. Patients with indolent systemic mastocytosis (SM) are usually treated symptomatically, but cytoreductive treatments are needed in more advanced SM. In most patients with SM, an activating KIT D816V mutation is found. Thus, patients with advanced SM benefit from treatment with KIT-targeting tyrosine kinase inhibitors. However, none of these drugs are curative; new targeted drugs or combinations are still needed to improve patients' outcome.
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Affiliation(s)
- Siham Bibi
- Cellular and Molecular Oncology, LBPA CNRS UMR8113, Ecole Normale Supérieure de Paris Saclay, 61, Avenue du Président Wilson, Cachan Cedex 94235, France
| | - Michel Arock
- Cellular and Molecular Oncology, LBPA CNRS UMR8113, Ecole Normale Supérieure de Paris Saclay, 61, Avenue du Président Wilson, Cachan Cedex 94235, France; Laboratory of Hematology, Pitié-Salpêtrière Hospital, 83, Boulevard de l'Hôpital, Paris 75013, France.
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Brighton LJ, Tunnard I, Farquhar M, Booth S, Miller S, Yi D, Gao W, Bajwah S, Man WDC, Reilly CC, Ogden M, Bailey S, Ewart C, Higginson IJ, Maddocks M. Recommendations for services for people living with chronic breathlessness in advanced disease: Results of a transparent expert consultation. Chron Respir Dis 2019; 16:1479973118816448. [PMID: 30789022 PMCID: PMC6313262 DOI: 10.1177/1479973118816448] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/06/2018] [Indexed: 11/19/2022] Open
Abstract
Chronic breathlessness is highly distressing for people with advanced disease and their informal carers, yet health services for this group remain highly heterogeneous. We aimed to generate evidence-based stakeholder-endorsed recommendations for practice, policy and research concerning services for people with advanced disease and chronic breathlessness. We used transparent expert consultation, comprising modified nominal group technique during a stakeholder workshop, and an online consensus survey. Stakeholders, representing multiple specialities and professions, and patient/carers were invited to participate. Thirty-seven participants attended the stakeholder workshop and generated 34 separate recommendations, rated by 74 online survey respondents. Seven recommendations had strong agreement and high levels of consensus. Stakeholders agreed services should be person-centred and flexible, should cut across multiple disciplines and providers and should prioritize breathlessness management in its own right. They advocated for wide geographical coverage and access to expert care, supported through skills-sharing among professionals. They also recommended recognition of informal carers and their role by clinicians and policymakers. Overall, stakeholders' recommendations reflect the need for improved access to person-centred, multi-professional care and support for carers to provide or access breathlessness management interventions. Future research should test the optimal models of care and educational strategies to meet these recommendations.
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Affiliation(s)
- Lisa Jane Brighton
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - India Tunnard
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich,
UK
| | - Sara Booth
- Department of Oncology, University of Cambridge, Cambridge
Biomedical Campus, Cambridge, UK
| | - Sophie Miller
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - William DC Man
- National Heart and Lung Institute, Imperial College, London,
UK
- Harefield Pulmonary Rehabilitation and Muscle Research Laboratory,
Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Charles C Reilly
- Department of Physiotherapy, King’s College Hospital NHS Foundation
Trust, London, UK
| | - Margaret Ogden
- Cicely Saunders Institute Patient and Public Involvement Group,
King’s College London, London, UK
| | - Sylvia Bailey
- Cicely Saunders Institute Patient and Public Involvement Group,
King’s College London, London, UK
| | - Colleen Ewart
- Cicely Saunders Institute Patient and Public Involvement Group,
King’s College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and
Rehabilitation, King’s College London, London, UK
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Abstract
Objective: This study was undertaken to explore the perspectives regarding spirituality and spiritual care held by individuals with advanced disease. The aim was to gain a deeper understanding about their viewpoints surrounding spiritual care and the role of health-care professionals in providing such care. Methods: Sixteen individuals with advanced disease and a prognosis of <12 months underwent an in-depth interview. Transcripts were subjected to a qualitative descriptive analysis to identify salient content and themes. Results: Four overall themes were identified: Spirituality is personal, spiritual distress is about separation, spiritual care is about connecting, and conversations about spirituality must align with the patient's beliefs. Subthemes emphasized the individuality of spiritual expression, the potential for illness impacting spiritual beliefs, and the value of connections to one's spiritual community. Participants thought healthcare providers needed to be able to identify individuals who were experiencing a spiritual struggle, acknowledge the reality of that struggle, and connect the individual with the appropriate resource or person. Conclusions: Patients with advanced disease are likely to express their spirituality in unique ways. Being able to talk about their spiritual beliefs and doubts during illness without judgment was seen as a benefit to them. Healthcare providers ought to be able to identify those patients who require assistance in connecting to appropriate spiritual care resources.
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Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Ruth Bartlett
- Wycliffe College, University of Toronto, Ontario, Canada
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Nacher M, Huber F, Adriouch L, Djossou F, Adenis A, Couppié P. Temporal trend of the proportion of patients presenting with advanced HIV in French Guiana: stuck on the asymptote? BMC Res Notes 2018; 11:831. [PMID: 30477588 DOI: 10.1186/s13104-018-3944-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
Objective In French Guiana, the French territory with the most preoccupying HIV epidemic, there have been great efforts to intensify and diversify HIV testing strategies. The aim of the present study was to review the temporal trends of patients diagnosed with advanced HIV disease in French Guiana. Data trends from the HIV cohort of French Guiana between 1996 and 2016 were thus analyzed. Results The proportion of patients diagnosed with advanced disease did not decline over time. Males had lower CD4 counts at the time of diagnosis and there was a plateau for both males (around 40%) and females (around 25%) with no apparent reduction of the proportion of advanced disease. Older age groups and migrants presented more often with advanced disease. By contrast, the proportion of patients diagnosed with stage B and C disease declined over time and the CD4 count at antiretroviral initiation and the CD4 nadir increased over time. Despite some progress, the group of patients with advanced disease reached a plateau around 30% suggesting this particular group still has epidemiological importance in driving the epidemic and in fueling morbidity and mortality, and thus remains a challenge for testing strategies. Electronic supplementary material The online version of this article (10.1186/s13104-018-3944-y) contains supplementary material, which is available to authorized users.
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Reimers MA, Shango MM, Daignault-Newton S, Dedinsky R, Karsies D, Kraft S, Riddle L, Felton JA, Wen B, Gersch C, Rae JM, Redman BG, Alva AS. Pazopanib with low fat meal (PALM) in advanced renal cell carcinoma. Invest New Drugs 2018; 37:323-330. [PMID: 30393825 DOI: 10.1007/s10637-018-0692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
Background Pazopanib is approved for metastatic renal cell carcinoma (RCC). We assessed the safety and efficacy of pazopanib with a low fat meal (LFM): <400 cal and < 20% fat or 10 g per meal. Methods A single arm study of pazopanib with a LFM in 16 adult patients with metastatic RCC with a clear cell component, RECIST 1.1 measurable disease, ECOG PS ≤ 2, and ≤ 3 prior therapies. Pazopanib at 400 mg daily given with LFM for 12 weeks. Incremental dose increases up to 800 mg, or irreversible decreases to 200 mg, allowed every 2 weeks. Primary study endpoint was safety; adverse events (AE) measured per CTCAE version 4.0. Secondary endpoints of RECIST 1.1 response with assessment as 12 weeks; pharmacokinetic (PK) analysis at nine time points, and CYP3A4 polymorphism evaluation. Results Pazopanib with a LFM was well tolerated; 13 of 16 subjects completed all 12 weeks. Three patients withdrew due to adverse events (AEs), with five occurrences of grade 3 AEs. Conclusions Pazopanib with a LFM has acceptable safety and comparable efficacy to fasting administration. Total median pazopanib dose per subject for the study duration was 63.5% of maximum possible conventional dose. A larger study is warranted. Clinical Trial Registration Number: NCT02729194.
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Affiliation(s)
- Melissa A Reimers
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
| | - Maryann M Shango
- Swedish Medical Center, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Rachel Dedinsky
- College of Literature, Arts and Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Danielle Karsies
- Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI, USA
| | - Shawna Kraft
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Liam Riddle
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy A Felton
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Bo Wen
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Christina Gersch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Bruce G Redman
- Department of Internal Medicine, Division of Hematology/Oncology, Ann Arbor, MI, USA
| | - Ajjai S Alva
- Department of Internal Medicine, Division of Hematology/Oncology, Ann Arbor, MI, USA
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Bisht S, Feldmann G. Novel Targets in Pancreatic Cancer Therapy - Current Status and Ongoing Translational Efforts. Oncol Res Treat 2018; 41:596-602. [PMID: 30269126 DOI: 10.1159/000493437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/03/2018] [Indexed: 12/11/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC, pancreatic cancer) carries one of the poorest overall prognoses of all human malignancies known to date. Despite the introduction of novel therapeutic regimens, the outcome has not markedly improved over the past decades, the incidence rates are almost identical to the mortality rates, and PDAC is projected to soon become the second most common cause of cancer-related mortality in Western countries. Despite this clear medical need to develop novel therapeutic strategies against this dire malady, this need has so far not been addressed with sufficient institutional attention and support in terms of research funding and strategical programs. Given the still growing life expectancy and projected demographic changes with a growing proportion of senior citizens in many European societies, this discrepancy is likely to become even more pressing in the future. This article provides a brief overview of ongoing preclinical efforts to identify novel targets and, based on this, to develop novel strategies to treat advanced pancreatic cancer and improve survival and the quality of life of patients suffering from this malignancy.
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Turkdogan S, Forest VI, Hier MP, Tamilia M, Florea A, Payne RJ. Carcinoembryonic antigen levels correlated with advanced disease in medullary thyroid cancer. J Otolaryngol Head Neck Surg 2018; 47:55. [PMID: 30223887 PMCID: PMC6142324 DOI: 10.1186/s40463-018-0303-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022] Open
Abstract
Background Medullary thyroid cancer (MTC) cells are capable of secreting various tumor markers including calcitonin and carcinoembyronic antigen (CEA). The purpose of this study is to determine whether abnormal CEA levels may be used as a tumor marker to predict the severity of disease in MTC. Methods A retrospective analysis was completed for 33 patients with MTC who had preoperative serum CEA levels. Univariate and multivariate analyses were used to quantify the relationship between serum CEA levels and tumor stage and prognosis. Results On multivariate analysis, elevated preoperative CEA levels were significantly associated with the size and stage of tumor, distant metastasis, decreased biochemical cure, and mortality. There was a significant association between tumor size greater than 37 mm and elevated CEA levels (> 271 ng/ml). There was also a positive correlation with increased cancer stage (> 377 ng/ml), distant metastasis (> 405 ng/ml), and contralateral compartment location of lymph node metastasis (> 162 ng/ml). When pre-operative CEA levels are > 500 ng/ml, patient mortality was 67%. Conclusion In this study, both pre-operative calcitonin and CEA levels were significantly correlated with the extent of disease in MTC. While calcitonin has a linear relationship with disease progression, abnormal CEA levels were a better indicator of advanced disease. CEA levels > 271 ng/ml are significant for advanced tumor size and staging, metastasis to the central compartment, and decreased chance of biochemical cure. CEA levels greater than 500 ng/ml are associated with significant patient mortality.
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Affiliation(s)
| | - Véronique-Isabelle Forest
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada
| | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada
| | - Michael Tamilia
- Department of Endocrinology and Metabolism, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada
| | - Anca Florea
- Department of Pathology, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada. .,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, Montreal, Canada.
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Lafitte C, Etienne-Mastroianni B, Fournel C, Natoli L, Foucaut AM, Girard N. Implementation of optimized supportive care and hospital needs along the management of patients with advanced lung cancer. Lung Cancer 2018; 124:143-147. [PMID: 30268453 DOI: 10.1016/j.lungcan.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Supportive care in cancer (SCC) have been recommended to be integrated in the management of patients with lung cancer all along the course of the disease. We took advantage of a pilot program of early implementation of optimized SCC, to report the feasibility such program in patients with advanced lung cancer, and correlate patient characteristics and outcomes with the actual use of optimized SCC. METHODS This study is a retrospective analysis of all consecutive patients with lung cancer treated at our center between 2012 and 2016. Optimized SCC included the intervention of a nurse for the home-hospital network coordination, as well as socio-aesthetics, psychomotricity, art-therapy, adapted physical activity, and also establishment of at-home hospitalization. RESULTS 309 patients were included. Median overall survival was 11.2 months. Unplanned hospitalizations occurred for 276 (89%) patients. The median duration of hospital stay was 19 days. Unplanned hospitalizations more frequently occurred within the first 3 months after the diagnosis of advanced cancer, and in the last 3 months before death. A short - less than 3 months - delay between diagnosis and unplanned hospitalization was associated with poor outcome. 272 (88%) patients received optimized SCC, within a median delay of 8 weeks after diagnosis. Intervention of the nurse for in- and out-patient network coordination was done for 143 (46%) patients, and at-home hospitalization was organized for 78 (25%) patients. The outcome of patients who received optimized SCC was numerically, but not significantly better (median overall survival of 11.8 vs. 6.9 months, p = 0.270). CONCLUSION Our study provides landmark data to support an early integration of optimized SCC for patients with advanced lung cancer, that includes multimodal supportive care interventions along the course of the disease. This highlights the role of multidisciplinary teams to optimize the management of patients with advanced lung cancer.
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Affiliation(s)
- Claire Lafitte
- Respiratory Medicine Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Lyon, France
| | | | | | - Louise Natoli
- Respiratory Medicine Department, Hospices Civils de Lyon, Lyon, France
| | | | - Nicolas Girard
- Respiratory Medicine Department, Hospices Civils de Lyon, Lyon, France; Claude Bernard University Lyon 1, Lyon, France.
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Arend RC, Jones BA, Martinez A, Goodfellow P. Endometrial cancer: Molecular markers and management of advanced stage disease. Gynecol Oncol 2018; 150:569-580. [PMID: 29843906 DOI: 10.1016/j.ygyno.2018.05.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022]
Abstract
Endometrial cancer is the most prevalent gynecologic cancer in the United States. Over the last 10 years, death rates from endometrial cancer have been rising about 1.4% per year. Traditionally endometrial cancer treatment has been driven by stage and histology. Recent studies have, however, shown that cancers of the same stage and histology have very distinct molecular and genomic profiles. Translational research is progressing rapidly and endometrial cancer-specific precision medicine is evolving. The first tissue agnostic therapy based on the molecular profile of the tumor was approved by the FDA this year. The approval of immune checkpoint inhibitor, pembrolizumab (anti-PD-1), for all solid tumors with defective DNA mismatch repair, could benefit 20-30% of patients with advanced endometrial cancer. Other genomic changes and molecular markers in endometrial cancer, such as hormone receptor status, could lead to more tailored therapy in the future. Pre-clinical and clinical investigations of targeted therapies suggest efficacy for some agents. Single agent targeted therapies, however, have modest activity. Identifying biomarkers that effectively determine response to targeted therapy remains a challenge. The next generation of clinical trials will focus on novel combinations and how to best utilize the advances that have been made in sequencing technology and bioinformatics. Although there is currently an immense body of data and many options for obtaining genomic characteristics of endometrial cancer, how to interpret and utilize this data is still being explored. This review will summarize the important trials that have led to the treatment options we have for advanced and/or recurrent endometrial cancer and discuss the important studies that have led to a better understanding of the distinctive molecular and genomic profiles within endometrial cancer. We will review the current status of biomarker-driven targeted therapy in endometrial cancer and the rationale behind ongoing clinical trials that are utilizing novel targeted agents.
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Affiliation(s)
- Rebecca C Arend
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Bayley A Jones
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Alba Martinez
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
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Stecklein SR, Frumovitz M, Klopp AH, Gunther JR, Eifel PJ. Effectiveness of definitive radiotherapy for squamous cell carcinoma of the vulva with gross inguinal lymphadenopathy. Gynecol Oncol 2018; 148:474-479. [PMID: 29336837 DOI: 10.1016/j.ygyno.2018.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and long-term side effects of definitive groin radiotherapy for vulvar cancer with grossly involved inguinal lymph nodes. METHODS The records of 407 women with vulvar squamous cell carcinoma treated with radiotherapy at one institution during 1992-2014 were reviewed to identify patients who had radiographic or histologic evidence of grossly involved inguinal lymph nodes. Patients with lymphadenectomy before radiotherapy and patients treated for recurrent disease were excluded. Actuarial incidences of vulvar, inguinal, and distant recurrences, the relationship between vulvar recurrence and inguinal recurrence, and overall survival were analyzed using the Kaplan-Meier method. RESULTS Thirty-three patients were identified. The median age at diagnosis was 64 years. The median long-axis radiographic diameter of the largest inguinal lymph node or lymph node mass was 2.5 cm (range, 1.4-8.7). Sixteen patients (48%) also had evidence of pelvic lymph node metastasis. The median radiation dose delivered to grossly involved nodes was 66.0 Gy (range, 60.0-70.0). The 3-year actuarial incidences of vulvar, groin, and distant recurrences were 24.2%, 17.7%, and 30.3%, respectively. With a median follow-up time of 28 months (range, 2-196), four patients (12%) had groin recurrence, of whom three also had vulvar recurrence. There were few major late adverse effects of regional radiotherapy. The 3-year overall survival rate was 51%. CONCLUSIONS High-dose volume-directed radiotherapy achieves a high rate of local control with low risk of serious long-term toxic effects in patients with vulvar squamous cell carcinoma and grossly involved inguinal lymph nodes.
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Affiliation(s)
- Shane R Stecklein
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Godoy-Ortiz A, Plata Y, Alcaide J, Galeote A, Pajares B, Saez E, Alba E, Sánchez-Muñoz A. Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients. Clin Transl Oncol 2017; 20:922-927. [PMID: 29222647 DOI: 10.1007/s12094-017-1808-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.
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Affiliation(s)
- A Godoy-Ortiz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.
| | - Y Plata
- Department of Oncology, Complejo Hospitalario de Jaén, Jaén, Spain
| | - J Alcaide
- Medical Oncology Service, Hospital Costa del Sol, Málaga, Marbella, Spain
| | - A Galeote
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - B Pajares
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - E Saez
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain
| | - E Alba
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain.,Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Madrid, Spain
| | - A Sánchez-Muñoz
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria, Av. Carlos Haya s/n, 29010, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
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Payne S, Eastham R, Hughes S, Varey S, Hasselaar J, Preston N. Enhancing integrated palliative care: what models are appropriate? A cross-case analysis. BMC Palliat Care 2017; 16:64. [PMID: 29179710 PMCID: PMC5704425 DOI: 10.1186/s12904-017-0250-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Effective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced. Methods Longitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources. Results The study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities. Conclusion UK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK.
| | - Rachael Eastham
- Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Sandra Varey
- Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
| | - Jeroen Hasselaar
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, LA1 4YG, UK
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Hughes D, Giugliani R, Guffon N, Jones SA, Mengel KE, Parini R, Matousek R, Hawley SM, Quartel A. Clinical outcomes in a subpopulation of adults with Morquio A syndrome: results from a long-term extension study of elosulfase alfa. Orphanet J Rare Dis 2017; 12:98. [PMID: 28535791 DOI: 10.1186/s13023-017-0634-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background This post hoc subanalysis examined outcomes in adult patients with Morquio A (mucopolysaccharidosis IVA) who received enzyme replacement therapy (ERT) with elosulfase alfa over a 120-weeks period. Patients ≥18 years of age evaluated in an open-label, long-term extension study of elosulfase alfa (modified per protocol [MPP], n = 32; intent-to-treat [ITT], n = 37; MOR-005; NCT01415427) were compared with the ≥18-year-old untreated population with 2-years follow-up from a Morquio A natural history study (n = 10; MorCAP; NCT00787995). The MOR-005 MPP population excluded patients who underwent orthopedic surgical procedures or were noncompliant with study protocol (defined as missing ≥20% of ERT infusions). No MorCAP patients underwent orthopedic surgical procedures during the relevant time period. Endurance was assessed by the 6-min walk test (6MWT) and 3-min stair climb test (3MSCT). Activities of daily living (ADLs) were assessed by the MPS Health Assessment Questionnaire (MPS HAQ). Results Least squares (LS) mean (SE) 6MWT distances increased by 34.9 (11.7) m (MPP) and 30.5 (10.8) m (ITT) by week 120; LS mean (SE) change in 3MSCT at week 120 was 6.7 (1.8) stairs/min (MPP) and 5.9 (1.7) stairs/min (ITT). MorCAP patients showed no improvement in 6MWT distance or 3MSCT over a similar period of time. Pulmonary function measures remained unchanged in both MOR-005 and MorCAP adults. All MPS HAQ domain scores improved in MOR-005 adults, whereas MorCAP adults had unchanged caregiver assistance and mobility outcomes and worsened self-care outcomes. Conclusions Long-term ERT in adult patients with Morquio A was associated with increased endurance and improvement in performance of ADLs. Trial registration Trial Registration NCT01415427. Name of registry: Long-Term Efficacy and Safety Extension Study of BMN 110 in Patients With Mucopolysaccharidosis IVA (Morquio A Syndrome). Registered 8 August 2011, retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s13023-017-0634-0) contains supplementary material, which is available to authorized users.
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Tampellini M, Di Maio M, Baratelli C, Anania L, Brizzi MP, Sonetto C, La Salvia A, Scagliotti GV. Treatment of Patients With Metastatic Colorectal Cancer in a Real-World Scenario: Probability of Receiving Second and Further Lines of Therapy and Description of Clinical Benefit. Clin Colorectal Cancer 2017; 16:372-376. [PMID: 28465170 DOI: 10.1016/j.clcc.2017.03.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/16/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal therapeutic strategy for metastatic colorectal cancer patients is still a matter of debate. There are no prognostic variables indicating how many lines individual patients ought to receive, and whether later lines could be effective even when earlier ones were not. PATIENTS AND METHODS We retrospectively collected data from 420 consecutive patients with metastatic colorectal cancer at our institution, describing the proportion of patients who received second or later lines of therapy and the chance of a line of treatment being active when the previous line was not. For each line of treatment, we defined clinical benefit as the probability of not having had evidence of disease progression 6 months after the start of chemotherapy. RESULTS Of the 373 patients with disease progression after first-line chemotherapy (1L), 277 received a second line (2L) (probability of being submitted to a 2L (P(2L)) = 74.3%): 143 (63.3%) of 226 received a 3L (P(3L)), and 56 (45.9%) of 122 were submitted to a 4L (P(4L)). Joint probabilities were: 2L 74.3%, 3L 47.0%, and 4L 21.6%. A total of 298 (71.5%) of 417 patients had a clinical benefit with 1L; 134 (48.6%) of 276 with 2L; 50 (35.2%) of 142 with 3L; and 12 (25.0%) of 48 with 4L. Taking all these data together, 31% of the patients who experienced early progression at 1L had the chance to have a clinical benefit with any further lines. CONCLUSION Our study demonstrated that of 4 patients submitted to a 1L, about 3 will receive a 2L, about 2 a 3L, and nearly 1 a 4L. Later lines could be beneficial even though earlier ones were not.
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Affiliation(s)
- Marco Tampellini
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy.
| | | | | | - Lorenzo Anania
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
| | - Maria Pia Brizzi
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
| | - Cristina Sonetto
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
| | - Anna La Salvia
- Department of Oncology, University of Torino, AOU San Luigi di Orbassano, Orbassano, Italy
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Merchant SJ, Kim J, Choi AH, Sun V, Chao J, Nelson R. A rising trend in the incidence of advanced gastric cancer in young Hispanic men. Gastric Cancer 2017; 20:226-234. [PMID: 26924751 PMCID: PMC5630456 DOI: 10.1007/s10120-016-0603-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the incidence of gastric cancer has been decreasing, recent reports suggest an increased rate in select populations. We sought to evaluate trends in gastric cancer incidence to identify high-risk populations. METHODS Gastric cancer incidence rates from 1992 to 2011 were computed with use of the Surveillance, Epidemiology, and End Results (SEER) registry. We evaluated trends in incidence rates by calculating the annual percent change (APC) across three age groups (20-49 years, 50-64 years, and 65 years or older) and four racial/ethnic groups (Hispanics, non-Hispanic whites, blacks, and Asian/Pacific Islanders). RESULTS We identified 41,428 patients with gastric cancer. For the entire cohort during the study period, the APC was decreased. When patients were grouped according to sex, the APC was flat or decreased in women regardless of age or race/ethnicity. The APC was also flat or decreased for all men except young Hispanic men (20-49 years), who had an increased APC of nearly 1.6 % (1.55 %, 95 % confidence interval 0.26-2.86 %). Furthermore, young Hispanic men were the only group to have increased incidence of stage IV disease (APC 4.34 %, 95 % confidence interval 2.76-5.94 %) and poorly differentiated tumors (APC 2.08 %, 95 % confidence interval 0.48-3.70 %). CONCLUSIONS The APC of the incidence of gastric cancer in young Hispanic men places it among the top cancers with rising incidence in the USA. This is concomitant with increased incidence of advanced disease at presentation. This major public health concern warrants additional research to determine the cause of the increasing incidence in this group.
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Affiliation(s)
| | - Joseph Kim
- Division of Surgical Oncology, Stony Brook Medicine, Stony Brook, NY, United States
| | - Audrey H. Choi
- Divisions of Surgical Oncology, City of Hope, Duarte, CA, United States
| | - Virginia Sun
- Nursing Research and Education, City of Hope, Duarte, CA, United States
| | - Joseph Chao
- Medical Oncology, City of Hope, Duarte, CA, United States
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Pasini F, Fraccon AP, Modena Y, Bencivenga M, Giacopuzzi S, La Russa F, Gusella M, de Manzoni G. Targeted therapies for advanced and metastatic adenocarcinoma of the gastroesophageal junction: is there something new? Gastric Cancer 2017; 20:31-42. [PMID: 27568322 DOI: 10.1007/s10120-016-0626-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 08/02/2016] [Indexed: 02/07/2023]
Abstract
Despite improvements in systemic chemotherapy (CT), the prognosis of metastatic adenocarcinoma of the gastroesophageal junction remains poor. Over the years, new targeting agents have become available and were tested, with or without CT, in first or subsequent lines of therapy. The epidermal growth factor receptor family was targeted with monoclonal antibodies (MoAbs) (trastuzumab, cetuximab, panitumumab) and tyrosin kinase inhibitors (TKIs) (lapatinib, erlotinib, gefitinib). Only trastuzumab, in combination with cisplatin and fluoropyrimidines, significantly improved overall survival (OS) in first-line therapy (13.8 vs. 11.1 months). Angiogenesis also was targeted with MoAbs (bevacizumab and ramucirumab); ramucirumab, a vascular endothelial growth factor-receptor 2 antagonist, enhanced OS in two phase III studies in the first (9.6 vs. 7.4 months) and subsequent lines of treatment (5.2 vs. 3.8 months), while the bevacizumab study was negative. TKIs (sunitinib, sorafenib, regorafenib, apatinib) were tested in this setting in phase II studies in the second/third line, only showing modest antitumor activity. The hepatocyte growth factor receptor (MET) was targeted in untreated patients in a phase III trial with MoAb rilotumumab, with or without CT, but the study was stopped because of mortality excess in the rilotumumab arm. Mammalian target of rapamycin (MTOR) pathway inhibition with everolimus was tested in pretreated patients in a placebo-controlled phase III trial who failed to improve OS (5.4 vs. 4.3 months). In conclusion, considering the modest survival gain obtained overall, the high cost of these therapies and the quality of life issue must be primarily considered in treating these patients.
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Affiliation(s)
- Felice Pasini
- Department of Medical Oncology, Ospedale S. Maria della Misericordia, Viale Tre Martiri, 140-45100, Rovigo, Italy.
| | - Anna Paola Fraccon
- Medical Oncology Unit, Casa di Cura Pederzoli, Peschiera del Garda, Verona, Italy
| | - Yasmina Modena
- Department of Medical Oncology, Ospedale S. Maria della Misericordia, Viale Tre Martiri, 140-45100, Rovigo, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - Francesca La Russa
- Department of Medical Oncology, Ospedale S. Maria della Misericordia, Viale Tre Martiri, 140-45100, Rovigo, Italy
| | - Milena Gusella
- Department of Medical Oncology, Ospedale S. Maria della Misericordia, Viale Tre Martiri, 140-45100, Rovigo, Italy
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Abstract
CONTEXT While the patient-carer dyad has been broadly described, there is little exploration of patient-carer models in use. AIM To explore types of patient-carer models in use for those with advanced and progressive disease. METHODS Qualitative interviews were undertaken with patients at risk of dying in the next year and their carers across three sites (residential care home, medical assessment unit, general medical unit). Thematic analysis was undertaken. RESULTS Four patient-carer models were identified. In these, the provision of care and of coordination of care services were important areas and organised differently across the patient, the carer, and alternative sources of support. CONCLUSION A 'one size fits all' patient-carer model is outdated and a new understanding of different types of patient-carer models are required to fully inform care delivered at end of life.
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Affiliation(s)
- Roses Parker
- Research Assistant, Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kay deVries
- Deputy Head, School of Health Sciences, University of Brighton, Brighton, UK
| | - Maureen A Coombs
- Professor of Clinical Nursing (Critical Care), Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Capital and Coast District Health Board, Wellington
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Schuler MK, Gerdes S, West A, Richter S, Busemann C, Hentschel L, Lenz F, Kopp HG, Ehninger G, Reichardt P, Pink D. Efficacy and safety of Dexrazoxane (DRZ) in sarcoma patients receiving high cumulative doses of anthracycline therapy - a retrospective study including 32 patients. BMC Cancer 2016; 16:619. [PMID: 27507014 PMCID: PMC4977890 DOI: 10.1186/s12885-016-2654-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/29/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anthracyclines, as the most effective therapy, are the cornerstone of advanced stage sarcoma treatment. However, anthracyclines can also contribute to myocardial dysfunction and congestive heart failure, ultimately limiting the therapeutic potential of the drug. Coadministration of Dexrazoxane has been shown to effectively reduce cardiotoxicity, however primarily in patients suffering in diseases other than sarcoma. METHODS The aim of this retrospective analysis was to evaluate safety and efficacy of chemotherapy with high cumulative doses of anthracyclines in combination with Dexrazoxane. The medical charts of 32 patients treated in four institutions were analyzed. Reasons for coadministration were rechallenge, reaching the cumulative anthracycline dose and preexisting heart failure. RESULTS The median age was 54 years [18-68 years]. The median cumulative anthracycline dose before adding DRZ was 450 mg/m(2) and after administration of last anthracycline containing therapy 750 mg/m(2). Either during treatment or follow up, 2/27 patients (7 %) without preexisting major cardiac findings developed anthracycline-induced cardiotoxicity. The median overall survival (OS) from start of the first anthracycline containing chemotherapy was 46 months and 17 months from the initial coadministration of DRZ. At rechallenge, the median progression free survival (PFS) with DRZ was 7 months. In continuous therapy, the median PFS was 13 months from beginning of chemotherapy and 9 months from the addition of DRZ. CONCLUSION Chemotherapy with high cumulative doses of anthracyclines in addition with DRZ demonstrated a remarkable OS in these advanced disease patients. Cardiac side-effects due to high cumulative doses of anthracyclines requiring discontinuation of anthracycline treatment were rare. A PFS of 9 months from the beginning of the coadministration of DRZ indicates that continuing anthracycline therapy beyond established cumulative doses is a promising therapeutic option.
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Affiliation(s)
- Markus K Schuler
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany. .,Department of Internal Medicine II, HELIOS Clinic Emil von Behring, Walterhöferstr. 11, 14165, Berlin, Germany.
| | - Sebastian Gerdes
- Institute of Medical Informatics and Biometry, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Antje West
- Department of Hematology and Oncology, HELIOS Clinic Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Germany
| | - Stephan Richter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christoph Busemann
- Department of Internal Medicine C, University Hospital Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Leopold Hentschel
- University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Felicitas Lenz
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Hans-Georg Kopp
- Department of Internal Medicine II, University Hospital Tübingen, Eberhard Karls University Tübingen, Geissweg 3, 72076, Tübingen, Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,University Cancer Center, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Peter Reichardt
- Department of Interdisciplinary Oncology, HELIOS Clinic Berlin-Buch, Berlin, Germany
| | - Daniel Pink
- Department of Hematology and Oncology, HELIOS Clinic Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Germany.,Department of Internal Medicine C, University Hospital Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
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Farquhar MC, Prevost AT, McCrone P, Brafman-Price B, Bentley A, Higginson IJ, Todd CJ, Booth S. The clinical and cost effectiveness of a Breathlessness Intervention Service for patients with advanced non-malignant disease and their informal carers: mixed findings of a mixed method randomised controlled trial. Trials 2016; 17:185. [PMID: 27044249 PMCID: PMC4820876 DOI: 10.1186/s13063-016-1304-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 03/18/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Breathlessness is the most common and intrusive symptom of advanced non-malignant respiratory and cardiac conditions. The Breathlessness Intervention Service (BIS) is a multi-disciplinary complex intervention, theoretically underpinned by a palliative care approach, utilising evidence-based non-pharmacological and pharmacological interventions to support patients with advanced disease in managing their breathlessness. Having published the effectiveness and cost effectiveness of BIS for patients with advanced cancer and their carers, we sought to establish its effectiveness, and cost effectiveness, in advanced non-malignant conditions. METHODS This was a single-centre Phase III fast-track single-blind mixed method RCT of BIS versus standard care for breathless patients with non-malignant conditions and their carers. Randomisation was to one of two groups (randomly permuted blocks). Eighty-seven patients referred to BIS were randomised (intervention arm n = 44; control arm n = 43 received BIS after four-week wait); 79 (91 %) completed to key outcome measurement. The primary outcome measure was 0-10 numeric rating scale for patient distress due to breathlessness at four weeks. Secondary outcome measures were Chronic Respiratory Questionnaire, Hospital Anxiety and Depression Scale, Client Service Receipt Inventory, EQ-5D and topic-guided interviews. RESULTS Qualitative analyses showed the positive impact of BIS on patients with non-malignant conditions and their carers; quantitative analyses showed a non-significant greater reduction in the primary outcome ('distress due to breathlessness'), when compared to standard care, of -0.24 (95 % CI: -1.30, 0.82). BIS resulted in extra mean costs of £799, reducing to £100 when outliers were excluded; neither difference was statistically significant. The quantitative findings contrasted with those previously reported for patients with cancer and their carers, which showed BIS to be both clinically and cost effective. For patients with non-malignant conditions there was a notable trend of improvement over both trial arms to the key measurement point; participants may have experienced a therapeutic effect from the research interviews, diluting the intervention's impact. CONCLUSIONS BIS had a statistically non-significant effect for patients with non-malignant conditions, and slightly increased service costs, but had a qualitatively positive impact consistent with findings for advanced cancer. Trials of palliative care interventions should consider multiple, mixed method, primary outcomes and ensure that protocols limit potential contaminating therapeutic effects in study designs. TRIAL REGISTRATION Current Controlled Trials ISRCTN04119516 (December 2008); ClinicalTrials.gov NCT00678405 (May 2008).
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Affiliation(s)
- Morag C. Farquhar
- />Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Robinson Way, Cambridge, CB2 0SR UK
| | - A. Toby Prevost
- />Imperial Clinical Trials Unit, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH UK
| | - Paul McCrone
- />Institute of Psychiatry, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Barbara Brafman-Price
- />Formerly of Palliative Care Service, Cambridge University Hospitals’ NHS Foundation Trust, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ UK
| | - Allison Bentley
- />Formerly of Palliative Care Service, Cambridge University Hospitals’ NHS Foundation Trust, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ UK
| | - Irene J. Higginson
- />Department of Palliative Care, Policy & Rehabilitation, King’s College London, Cicely Saunders Institute, Denmark Hill, London, SE5 9PJ UK
| | - Chris J. Todd
- />School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Rd, Manchester, M13 9PL UK
| | - Sara Booth
- />Formerly of Palliative Care Service, Cambridge University Hospitals’ NHS Foundation Trust, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ UK
- />Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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Musa J, Nankat J, Achenbach CJ, Shambe IH, Taiwo BO, Mandong B, Daru PH, Murphy RL, Sagay AS. Cervical cancer survival in a resource-limited setting-North Central Nigeria. Infect Agent Cancer 2016; 11:15. [PMID: 27014366 PMCID: PMC4806480 DOI: 10.1186/s13027-016-0062-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organized cervical cancer screening services are presently lacking in Nigeria contributing to late presentation and diagnosis of invasive cervical cancer cases (ICCs) at advanced stages in most gynecologic units in Nigeria. We evaluated outcomes of ICCs diagnosed at Jos University Teaching Hospital (JUTH) to better understand factors associated with cervical cancer survival in similar resource limited settings. METHODS We performed a retrospective cohort study with a prospective follow up data to estimate time from diagnosis to mortality among women diagnosed with ICCs at JUTH. Women who were diagnosed with ICCs between January 2011 and May 2013 were followed up after initial evaluation at JUTH and subsequent referral for specialized treatment in one of the national oncology treatment centers in Nigeria. The main outcome measured was all-cause mortality rate and overall survival (OS) after diagnosis of ICC. The follow up data were updated and observations were censored March 31, 2015. The overall death rate was estimated using the total number of death events and the cumulative follow-up time from diagnosis to death. We conducted Cox proportional hazard regression to assess factors associated with death. RESULTS A total of 65 histologically confirmed ICCs were followed up. The median age of the cohort was 50 years with a median parity of 7. The HIV prevalence in the cohort was 8.2 % and the majority (72.3 %) were diagnosed at advanced stages (AD) of ICC. Simple total abdominal hysterectomy (TAH) was performed in 38.9 % of patients who were diagnosed at early stage disease (ED). After a cumulative follow up of 526.17 months, 35 deaths occurred with an overall death rate of 79.8 per 100 women-years. We also found a significantly higher hazard of death in women with AD (HR = 3.3) and baseline anemia (HR = 3.0). In the subgroup of women with ED, the OS was significantly higher for those who had TAH compared to those who did not (26.5 versus 11.6 months respectively). CONCLUSION Advanced stage disease and baseline anemia were independently associated with higher death rate. Cervical cancer patients diagnosed at early stages by non-oncologic specialist in settings lacking the standard of care may benefit from improve survival with simple hysterectomy.
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Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Joseph Nankat
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Chad J Achenbach
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Babafemi O Taiwo
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Barnabas Mandong
- Department of Pathology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
| | - Robert L Murphy
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos/Jos University Teaching Hospital, Jos, Plateau State Nigeria
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Vlenterie M, Litière S, Rizzo E, Marréaud S, Judson I, Gelderblom H, Le Cesne A, Wardelmann E, Messiou C, Gronchi A, van der Graaf WT. Outcome of chemotherapy in advanced synovial sarcoma patients: Review of 15 clinical trials from the European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group; setting a new landmark for studies in this entity. Eur J Cancer 2016; 58:62-72. [PMID: 26968015 DOI: 10.1016/j.ejca.2016.02.002] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/01/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Previous studies in metastatic soft tissue sarcomas (STS) showed that synovial sarcomas tend to have better survival rates and a higher chemosensitivity than other STS subtypes. However, data are derived from relatively small subgroups and statistical significance of these observations is lacking. Larger cohorts are necessary to define and confirm the specific characteristics of this subtype. PATIENTS AND METHODS Patient data were retrieved from 15 European Organisation for Research and Treatment of Cancer advanced first-line STS trials. Patient characteristics, survival and treatment response of synovial sarcoma patients were compared to other STS patients. Univariable and multivariable analyses were performed to evaluate prognostic factors. RESULTS In total, 3330 advanced STS patients were retrieved, of whom 313 had a synovial sarcoma. Synovial sarcoma patients were significantly younger (median 40 versus 52 years), more often had extremity primary tumours and had a better performance status (PS 0: 50.2 versus 43.4%) compared to other STS patients. Additionally, synovial sarcoma patients had a significantly better response to chemotherapy (responders: 27.8 versus 18.8%) and better survival rates (progression free survival [PFS]: 6.3 versus 3.7 months; Overall survival [OS]: 15.0 versus 11.7 months). Age, PS, and presence of metastatic disease were defined as prognostic factors for PFS and OS in the univariable analysis. The last two factors were confirmed in the multivariable analysis for OS. DISCUSSION Advanced synovial sarcomas are a distinct subgroup of STS, with a better response to systemic chemotherapy and longer PFS and OS. These results should be taken into account in the design of future synovial sarcoma specific studies.
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Affiliation(s)
- Myrella Vlenterie
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Saskia Litière
- European Organization for Research and Treatment of Cancer (EORTC) Head Quarters, Brussels, Belgium
| | - Elisa Rizzo
- European Organization for Research and Treatment of Cancer (EORTC) Head Quarters, Brussels, Belgium
| | - Sandrine Marréaud
- European Organization for Research and Treatment of Cancer (EORTC) Head Quarters, Brussels, Belgium
| | - Ian Judson
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Eva Wardelmann
- Gerhard Domagk Institute for Pathology, University Hospital Muenster, Muenster, Germany
| | - Christina Messiou
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
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Mücke M, Mochamat, Cuhls H, Peuckmann-Post V, Minton O, Stone P, Radbruch L. Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review. J Cachexia Sarcopenia Muscle 2016; 7:23-7. [PMID: 27066315 PMCID: PMC4799864 DOI: 10.1002/jcsm.12101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In palliative care patients, fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of life. Further complicating issues are the multidimensionality, subjective nature and lack of a consensus definition of fatigue. The review aimed to evaluate the efficacy of pharmacological treatments for fatigue in palliative care, with a focus on patients at an advanced stage of disease, including patients with cancer and other chronic diseases. METHODS We considered randomized controlled trials concerning adult palliative care with a focus on pharmacological treatment of fatigue compared with placebo, application of two drugs, usual care or a non-pharmacological intervention. The primary outcome had to be non-specific fatigue (or related terms such as asthenia). We searched the CENTRAL, MEDLINE, PsycINFO and EMBASE, and a selection of cancer journals up to 28 April 2014. Two review authors independently assessed trial quality and extracted the data. RESULTS We screened 1645 publications of which 45 met the inclusion criteria. In total, we analysed data from 18 drugs and 4696 participants. There was a very high degree of statistical and clinical heterogeneity in the trials. Meta-analysis of data was possible for modafinil, pemoline, and methylphenidate. CONCLUSIONS Due to the limited evidence, we cannot recommend a specific drug for the treatment of fatigue in palliative care patients. Some drugs, which may be beneficial for the treatment of fatigue associated with palliative care such as amantadine, methylphenidate, and modafinil, should be further researched.
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Affiliation(s)
- Martin Mücke
- Department of Palliative Medicine University Hospital Bonn Bonn Germany; Department of General Practice and Family Medicine University Hospital Bonn Bonn Germany; Center for Rare Diseases Bonn (ZSEB) University Hospital of Bonn Bonn Germany
| | - Mochamat
- Department of Palliative Medicine University Hospital Bonn Bonn Germany; Department of Anesthesiology and Intensive Therapy University of Diponegoro/Kariadi Hospital Jawa Tengah Indonesia
| | - Henning Cuhls
- Department of Palliative Medicine University Hospital Bonn Bonn Germany
| | | | - Ollie Minton
- Division of Mental Health St George's University of London London UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department UCL Division of Psychiatry London UK
| | - Lukas Radbruch
- Department of Palliative Medicine University Hospital Bonn Bonn Germany; Centre for Palliative Care Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg Bonn Germany
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