Consensus statement and clinical pathway for the management of colon cancer with peritoneal metastases in the state of Delaware

BACKGROUND

Increasing data suggests that the combination of modern systemic therapies and Cytoreductive surgery with or without Hyperthermic Intraperitoneal Chemotherapy (HIPEC) may improve the outcome of patients with colon cancer with peritoneal metastases. Patient selection and sequence of treatments remains ill-defined.

MATERIALS AND METHODS

A working group, the State of Delaware Peritoneal Surface Malignancies Task Force (DE-PSM-TF), was created including representatives from medical and surgical oncology from the acute care hospitals in Delaware. An extensive review of all available literature was carried out. Virtual meetings were held, and interpretation and discussion of the data was conducted.

RESULTS

A clinical pathway that includes a multidisciplinary evaluation at the time of diagnosis of colon cancer with peritoneal metastases and reflects a consensus from the Task Force on 7 key points that suggest the management of these patients based on the severity of their peritoneal metastases and incorporates all currently available therapies was created. The sequence of therapies of this multimodality treatment was determined by the Peritoneal Surface Disease Severity Score (PSDSS) (Fig. 1).

CONCLUSION

The current pathway represents a comprehensive, team effort that should improve the outcome of patients with Colon Cancer with peritoneal metastases in the state of Delaware by having multidisciplinary discussions at the time of diagnosis, selecting the best order of sequence of currently available therapies in order to maximize benefits and minimize morbidity.

Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres

INTRODUCTION

The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic.

METHODS

Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded.

RESULTS

At the start of 'lockdown', 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases ('new event'). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds.

CONCLUSIONS

These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a 'hybrid follow-up approach' that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.

A-09 The Relationship Between Subjective Cognitive Complaints, Depression, and Executive Functioning in mTBI Veterans

Objective

Among individuals with mild traumatic brain injury (mTBI), those with depression report greater subjective cognitive complaints than those without depression. In mTBI patients with general cognitive complaints, depression may account for poor performance on objective neuropsychological measures. This study seeks to expand this research by examining depression, subjective executive functioning (EF) complaints, and objective EF performance in Veterans with mTBI.

Method

Fifty-seven Veterans with deployment-related mTBI (12% female; age M = 42.0, SD = 13.6; years education M = 15.0, SD = 1.8) with (n = 29) or without (n = 28) a chart diagnosis of depression. Participants were administered the Behavioral Rating Inventory of Executive Functioning (BRIEF) and objective neuropsychological measures of working memory (i.e., Weschler Adult Intelligence Scale-IV Working Memory Index) and aspects of EF (i.e., Trail Making Test B and Delis-Kaplan Executive Functioning System (D-KEFS) subtests).

Results

Principal component analysis identified similar domains of EF to the BRIEF, including: task monitoring (Trail Making Test B, D-KEFS Letter Fluency, and D-KEFS Tower Test, eigenvalue = 1.93) and shifting (D-KEFS: Color-Word Interference Conditions 3 and 4, and Category Switching, eigenvalue = 1.24). Individuals with depression had greater subjective EF complaints in each BRIEF domain than non-depressed individuals (p’s ≤ .01). However, subjective complaints in these domains were not related to objective performance (r’s = −0.17,-0.19, p’s > .05). Moreover, depressed and non-depressed individuals performed similarly on all EF measures (p’s > .05).

Conclusions

mTBI Veterans with depression report more subjective EF complaints than those without depression. The lack of association between subjective complaints and objective EF performance suggests it is important to treat depression in mTBI patients to remedy perceived cognitive deficits.

Our experience of a nurse-led oral and maxillofacial surgical clinic in a tertiary centre: two years on

We describe our two-year experience of a nurse led clinic (NLC) in a tertiary centre oral and maxillofacial surgical (OMFS) department. The clinic is run by a specialist nurse, in parallel with a consultant's clinic and focuses on the management and review of non-malignant lesions. Increased clinical flexibility, reduced waiting times, and tailored educational resources have contributed to an improved experience for the patients.

Early experience of a nurse-led clinic in a tertiary centre

A busy head and neck or oral and maxillofacial (OMFS) National Health Service (NHS) clinic treats patients with many different conditions. A large proportion will have cancer of the head and neck, and they will be at different stages of their treatment. Their clinical needs may be different from a larger group of patients who have been referred through the "two-week wait" referral pathway, and who are present in the same clinic for their biopsy results. We present our early experience of "fast-track" referrals and their potential effect on the overall volume of work. They are only a small number of the patients who are typically seen in a nurse-led clinic.

Timeliness of Breast Cancer Treatment in Delaware

Studies have shown timely screening, diagnosis, and treatment of breast cancer reduces mortality rates. The objective of this study was to evaluate the overall timeliness of breast cancer diagnosis and treatment for Delawarean women using the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program (NBCCEDP)'s recommendations of 60 days maximum for screening to diagnosis and 60 days maximum for diagnosis to treatment. This study analyzed Delaware Cancer Registry data for female Delawarean breast cancer patients diagnosed in 2010 who had valid screening, diagnosis, and treatment dates. Calculations of 3 time intervals were performed: screening to diagnosis (time interval A), diagnosis to treatment (time interval B), and screening to treatment (time interval C). The mean and median for time intervals A (21.2 days, 17.0 days), B (27.8 days, 25.0 days), and C (49.0 days, 42.0 days) met CDC recommendations. Our results show most Delawarean women who had valid screening, diagnosis, and treatment dates received a diagnosis within 60 days of screening and first course of treatment occurred within 60 days of diagnosis and therefore met the NBCCEDP recommendations.

Consensus guidelines from The American Society of Peritoneal Surface Malignancies on standardizing the delivery of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer patients in the United States

BACKGROUND

The American Society of Peritoneal Surface Malignancies (ASPSM) is a consortium of cancer centers performing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). This is a position paper from the ASPSM on the standardization of the delivery of HIPEC.

METHODS

A survey was conducted of all cancer centers performing HIPEC in the United States. We attempted to obtain consensus by the modified method of Delphi on seven key HIPEC parameters: (1) method, (2) inflow temperature, (3) perfusate volume, (4) drug, (5) dosage, (6) timing of drug delivery, and (7) total perfusion time. Statistical analysis was performed using nonparametric tests.

RESULTS

Response rates for ASPSM members (n = 45) and non-ASPSM members (n = 24) were 89 and 33 %, respectively. Of the responders from ASPSM members, 95 % agreed with implementing the proposal. Majority of the surgical oncologists favored the closed method of delivery with a standardized dual dose of mitomycin for a 90-min chemoperfusion for patients undergoing cytoreductive surgery for peritoneal carcinomatosis of colorectal origin.

CONCLUSIONS

This recommendation on a standardized delivery of HIPEC in patients with colorectal cancer represents an important first step in enhancing research in this field. Studies directed at maximizing the efficacy of each of the seven key elements will need to follow.

Feasibility of using central registry data to assess timeliness of breast cancer care in Delaware

Studies have shown that timely screening, diagnosis, and treatment of breast cancer reduces mortality rates. The objective of this study was to determine if data collected by the Delaware Cancer Registry (DCR) could be used to access the timeliness of diagnosis and treatment for breast cancer patients, using the Centers for Disease Control and Prevention (CDC) recommendations of 60 days maximum for screening to diagnosis and 60 days maximum for diagnosis to treatment. This study analyzed DCR data for female Delawarean breast cancer patients diagnosed in 2004; data were included that had a valid screening, diagnosis, and treatment date. Calculations of 3 time intervals were performed: screening to diagnosis (time interval A), diagnosis to treatment (time interval B), and screening to treatment (time interval C). Results of this study show that, while not captured as an independent variable, screening dates could be extracted from text fields to calculate appropriate time intervals. The mean and median for time intervals A (23.2 days, 20.0 days), B (2.1 days, 0.0 days), and C (40.1 days, 37.0 days) met CDC recommendations. This study shows that it is possible to utilize DCR data to conduct a timeliness of breast cancer treatment providing the ability to benchmark Delaware breast cancer treatment timelines to national recommendations.

A comparison of the effects of olopatadine and ketotifen on model membranes

Olopatadine is a human conjunctival mast cell stabilizer with antihistaminic activity. Ketotifen is an older molecule that possesses antihistaminic activity and is reported to have additional pharmacological properties. The interactions of these two compounds with model membranes (i.e., monolayers of 1-stearoyl-2-oleoyl-sn-glycerophosphocholine at the argon-buffer interface), and natural (i.e., erythrocyte) membranes were compared in an effort to understand the differences in their biological activities. Drug-lipid interaction with monolayers was determined by monitoring the surface pressure as a function of the drug concentration in the aqueous phase supporting the monolayer. Drug interaction with erythrocyte membranes was determined by monitoring changes in the permeability of the membranes to hemoglobin and 6-carboxyfluorescein as a function of drug concentration in the medium. Olopatadine and ketotifen are both intrinsically surface active and both interact with phospholipid monolayers. However, in both the presence and absence of lipid monolayers, the changes in surface pressure induced by olopatadine are lower than those caused by ketotifen. The effects of these two drugs on cell membranes were dramatically different. Exposure of bovine erythrocytes to increasing concentrations of ketotifen (1-10 mM) resulted in complete hemolysis of the cells, whereas olopatadine (1-10 mM) caused only minimal hemolysis (< 8%). Consistent results were obtained in experiments measuring the leakage of 6-carboxyfluorescein from erythrocyte ghosts as a more sensitive marker of membrane perturbation. Olopatadine treatment (0.1-10 mM) minimally perturbed the cell membrane while ketotifen (1-10 mM) caused a concentration dependent release of the fluorescent marker. These data demonstrate fundamental differences between the two drugs in their effects on cell membranes. Moreover, the differences are consistent with the surface activities of the two compounds measured in monolayers and with reported differences in their pharmacological activities. These findings offer an explanation for the biphasic non-specific cytotoxic effect of ketotifen on histamine release from mast cells and may account for the nonlytic mast cell stabilizing activity of olopatadine.

Head and neck mucosal melanoma: a 32-year review

Because mucosal melanoma of the head or neck is uncommon, retrospective data are of value in defining its natural history, response to treatment, and patterns of recurrence. We analyzed the medical records of 28 patients who had been treated for a mucosal melanoma of the head or neck between 1961 and 1993. We found that their cumulative 5-year survival rate was 20%. Patients who had primary tumors of the nasal cavity had significantly better 5-year survival than other patients. Early stage at presentation was another predictor of a more favorable outcome. Only 2 of the 17 patients (12%) who underwent surgery died with local disease. However, 13 of these 17 surgical patients (76%) eventually died of distant metastases. There were 3 long-term (> 5 yr) survivors: 2 who were treated by surgery alone, and 1 who was treated with surgery and radiation therapy. We found that aggressive resection of the primary tumor and of any local recurrence can achieve local control in most patients with mucosal melanoma of the head or neck. Distant metastasis is the limiting factor for long-term survival.

Head and Neck Mucosal Melanoma: A 32-year Review

Because mucosal melanoma of the head or neck is uncommon, retrospective data are of value in defining its natural history, response to treatment, and patterns of recurrence. We analyzed the medical records of 28 patients who had been treated for a mucosal melanoma of the head or neck between 1961 and 1993. We found that their cumulative 5-year survival rate was 20%. Patients who had primary tumors of the nasal cavity had significantly better 5-year survival than other patients. Early stage at presentation was another predictor of a more favorable outcome.

Only 2 of the 17 patients (12%) who underwent surgery died with local disease. However, 13 of these 17 surgical patients (76%) eventually died of distant metastases. There were 3 long-term (>5 yr) survivors: 2 who were treated by surgery alone, and 1 who was treated with surgery and radiation therapy.

We found that aggressive resection of the primary tumor and of any local recurrence can achieve local control in most patients with mucosal melanoma of the head or neck. Distant metastasis is the limiting factor for long-term survival