bluuebunny/crossref_metadata_2025 huggingface dataset:
Are we meeting the standards for cancer survivor care?
Authors: Crabbe Wendy W. , Karnad Anand B. , Kaklamani Virginia
Published: February 2017

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Background: The Institute of Medicine (IOM), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (r) (NCCN (r)) have issued standards of care for cancer survivors including development of a cancer treatment summary and coordination with the patient’s primary care provider (PCP) and other providers for follow up care. The author’s NCI-designated cancer center recently developed a survivor program for women with breast cancer and the plan is to expand the program to all cancers. Methods: To find out what physicians or providers are doing at baseline with cancer survivor care, a short 9 question survey was developed with questions based on the NCCN guidelines (r) and standards for survivorship care. These questions were sent to providers in all the disease specific clinics. The survey was sent to a total of 51 providers via email using SurveyMonkey.com and given 2.5 weeks to complete the survey. Results: A total of 51 providers were sent the survey by email and 21 responded (41%). Ten different disease subspecialties within oncology were represented with an average of 15 years of experience with providers seeing an average of 42 survivors per month. Seventy-one percent felt prepared to discuss survivorship care. Greater than 66% discussed prevention and all the providers who responded screened for recurrence or development of second cancers (100%). Greater than 47% screened for late physical and psychosocial effects of treatment. Most of the providers (61%) had interventions for physical but not psychosocial late effects of treatment. The majority of respondents felt that communication was poor between the oncology specialty provider and the patient’s PCP regarding survivorship care. Conclusions: Based on the responses to the survey based on NCCN standards for survivor care, at our institution most of the providers feel capable of discussing survivor care and 100% of those that responded screen for recurrence or second cancers. Providers need more help with interventions for late effects of treatment especially for psychosocial issues. The area that needs the most improvement is communication between specialty provider and PCP about survivorship care.
Patient-reported outcomes in patients enrolled at Pain Control Center Hospice of Solofra (Italy): A management model.
Authors: Genua Geppino , Fasano Mela , Rizzo Luisa M , Genua Lucia , Landolfi Vincenzo , Strollo AnnaMaria , De Vinco Elena , Fina P. Lino , Canzanella Sergio , Ferrante Mario Nicola Vittorio , Servillo Giuseppe
Published: February 2017

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Background: The Pain Control Center of Solofra (Italy) is managed with a mixed public / private using the funds provided by Law 39/1999 of the Italian Republic for the establishment of the hospice. The daily rate for each resident is € 281.09 and is paid entirely by the national health system. We have evaluated the treatment procedures and the clinical outcome on 282 consecutive patients enrolled from December 2012 to May 2015 at “Pain Control Center” of the Hospice. Methods: The following characteristics have been evaluated: patient gender, mean hospitalization time, differentiation between patients (pts) with and without cancer , tumor type, medical weapon use, venous access type, parenteral feeding, transfer in intensive care units, pain killer use. Results: 282/164 pt males 282/118 females, mean age 72.04 yr (range 18-92 yr, mean hospitalization time 38 days), 205/282 pt (72.69%) had tumor diseases and 77/282 pt (27.31%) non cancer diseases. % Types of cancer: lung 20, colorectal 13.6, breast 7.7, ovarian 3.1, bladder 4, gastric 6.8, prostate 4.5, hepatocellular and biliary tract 7.7, pancreas 2, head and neck 8.6, kidney 2.7, other tumors 19. The central venous accesses were already present at the time of hospitalization in 77/282 pt (27.30%); the central venous access were made on 65/282 (29.44%). 131/282 pt received either parenteral feeding while 39/282 pt enteral feeding. 11/282 pt were transferred to ICU and 189/273 pt (69.23%) deceased at hospice. Analgesic therapy with opiates was administered at 216/282 pt (76.59%). The most intensively treated pt were those with tracheostomy(4.96%) and followed by uretero and colostomy(11.34%). About 30% of pt required central venous access procedures. Conclusions: The present study shows the underestimation of the parenteral feeding and analgesic requirements by pts with chronic diseases. The results lead us to continue the experience of public / private collaboration to achieve greater effectiveness of care and improve the overall management of patients so peculiar.
Colorectal cancer survivorship statistics: A Veterans Affairs Central Cancer Registry analysis.
Authors: Zullig Leah L. , Smith Valerie , Danus Susanne , Schnell Merritt , Lindquist Jennifer , Provenzale Dawn T. , Jackson George L. , Weinberger Morris , Kelley Michael J. , Bosworth Hayden B
Published: February 2017

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Background: Our objective was to evaluate VA CRC incidence and survival and compare with the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) data. Methods: Data were obtained from VACCR for veterans diagnosed/treated in VA for incident CRC during fiscal years (FY) 2009-2012. Using VHA Support Service Center information about the distribution of VA healthcare system enrollees for corresponding years, we adjusted incidence rates for age and gender to the underlying VA population. Survival data were available through January 2015; thus, patients in the analysis had 3-6 years of follow-up data and were censored accordingly. CRC incidence and survival among VA patients was compared to projected national 2014 CRC-specific SEER and supporting data sources. Results: From FY 2009-2012, 12,551 patients (2.6% women; 97.4% men) were in the analytic cohort. Among VACCR patients, the most common tumor location was proximal colon (38%), followed by rectum (31%), distal colon (26%), and other colon (5%). This is comparable to SEER, in which proximal colon and rectum are most common. Among patients in the VACCR, SEER summary stage distribution was: 44% local, 36% regional, 17% distant and 4% unknown. This also aligns with SEER, in which approximately 40% of CRC cases are diagnosed locally. Mirroring SEER, overall VA CRC incidence rate decreased from 0.22 to 0.16 cases per 1,000 veterans in FYs 2009 and 2012. Evaluating survival, median follow-up time was 3.3 years among veterans. The 3-year survival rate for VA patients was 65.9%. Overall 3-year survival is slightly higher for rectal (66.4%) than for colon (65.6%). This is comparable to 5-year SEER survival rates (66.5% and 64.2% for rectal and colon, respectively). Also consistent with SEER, VA CRC patients < 65 have higher rates of 3-year survival than patients > 65 years (74.6% vs. 58.5%, respectively). Conclusions: VACCR data indicate that CRC incidence and survival in FY 2009-2012 approximated SEER projections during a similar timeframe. This suggests that, although VA patients are more complex than the general population, they are diagnosed with comparable CRC locations and stages.
Cognitive impairment and dementia in older cancer patients.
Authors: Edwards Beatrice Jara-Almonte , Khalil Peter , Holmes Holly Michelle , Sun Ming , Song Juhee , Valladarez Heather
Published: February 2017

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Background: Chemotherapy effect on cognitive function has also been described in women with breast cancer. Our objective was to define the prevalence of cognitive impairment and dementia in older patients with cancer. Methods: This is a retrospective study at the Program for Healthy Aging at MD Anderson Cancer Center between January 1, 2013 and March 31, 2015. Patients with cancer, 65 years of age and older underwent functional and cognitive testing through personal interview, using IADLs, ADLs, and the Montreal cognitive assessment (MOCA). Screening for depression used PHQ-9. Risk factors for dementia assessed, included depression, concussions, alcohol abuse, and family history of dementia. Level of education was determined. Cognitive impairment was diagnosed with an abnormal MOCA ( < 26) without functional impairment, dementia was diagnosed with an abnormal MOCA with functional impairment. Imaging and assessment for reversible factors of memory loss was conducted. SAS 9.4 (SAS Institute INC, Cary, NC) was used for data analysis. Results: 192 patients were evaluated, male gender (n = 93, 48.4%), female (n = 99, 51.6%), mean age 78 years old (SD, 7) range 65 to 94 years. Sixty-two patients (32.3%) with a hematological malignancy; 26 (13.5%) with breast cancer; 22 (11.5%) with GI cancer; 19 (9.9%) with prostate malignancy; 16 (8.3%) with lung cancer; 14 (7.3%) with bladder cancer; and 33 (17.2%) with other malignancies. Cognitive impairment and/or dementia was identified in 118 (61.5%) patients. Mild cognitive impairment was evidenced in 27 cases (18.2%). Types of dementia included Alzheimer’s disease (n = 11, 7.4%), vascular dementia (n = 21, 14.2%), and mixed dementia (n = 59, 39.9%). The majority of cases of dementia were early stage dementia (n = 45, 56.3%), moderate stage dementia (n = 29, 36.3%), and advanced or severe dementia (n = 6, 7.5%). No significant thyroid abnormalities, B12 deficiency or other reversible causes were identified. Conclusions: Cognitive impairment and/or dementia are commonly seen in patients with cancer in a comprehensive cancer center. Further research in this area is necessary.
Perioperative evaluation of medical comorbidities at a comprehensive cancer center.
Authors: Sahai Sunil Kumar , Nekkalapudi Divya K. , Foreman Jessica T. , Lin Heather Y. , Voss Rachel , Andrabi Tayab A. , Aloia Thomas A. , Hwang Jessica
Published: February 2017

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Background: The Internal Medicine Perioperative Assessment Center (IMPAC), the first and only dedicated perioperative cancer medicine service at a comprehensive cancer center, provides medical risk assessment and optimization of patients undergoing surgery at The University of Texas MD Anderson Cancer Center. We examined the demographic and clinical characteristics of patients seen in the IMPAC program over the last decade. Methods: Retrospective cohort study of patients who were referred to the IMPAC program from November 2004 through January 2015. We identified patient demographics as well as type of cancer at presentation and frequency of comorbidities. Our analysis was based on review of billing data using institutional administrative and clinical databases. Comorbidities were determined based on ICD-9 billing diagnosis at time of initial consultation in the IMPAC program. Results: During the study period, 29,732 patients between the ages of 9 to 105 years old were evaluated for perioperative risk assessment, and 50% were female. The patients were referred to IMPAC program from a primary cancer center. The top referring centers were Head & Neck (7353 patients), Gastrointestinal (4939), Genitourinary (4759), Breast (3565), Gynecology (3175), Melanoma/Skin (1355), Leukemia/Lymphoma (1056), Sarcoma (975), Endocrine (913), Thoracic (779), and Brain and Spine (714). The most frequent comorbidities among all patients seen in the IMPAC program were hypertension (57%), dyslipidemia (35%), diabetes (22%), and coronary artery disease and heart failure (16%). Conclusions: Cardiovascular diseases and diabetes were common comorbidities among patients with cancer awaiting surgery. The identification and optimization of comorbid medical conditions such as diabetes and cardiovascular disease are important because they are known to predict clinical outcomes. Future work should focus on optimal perioperative management strategies to reduce risk of complications in patient with cancer and comorbidities.
Cancer survivorship: Is there a role for cancer survivor clinics?
Authors: Tirelli Umberto , Zanet Ernesto , Spina Michele , Michieli Mariagrazia
Published: February 2017

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Background: The population of survivors of cancer is increasing worldwide. In Italy, 2,243,953 patients (4% of the Italian population) survived after a cancer diagnosis in 2006. The drafting of survivorship care plans (SCPs), consisting of a written treatment summary and a follow-up care plan, is regarded by both the Institute of Medicine and the American Society of Clinical Oncology as an essential step in the care of survivors of cancer. However, Salz et al. in 2013 reported in Cancer that although oncology providers have positive feelings regarding SCPs, only 52% of them ever provided any component of an SCP to their patients. Ultimately, the lack of integration of SCPs into clinical practice is due to the absence of definite guidance regarding what constitutes standards of care for survivors of cancer. Methods: We propose the establishment of cancer survivor clinics (CSCs), which consist of health professionals (i.e., medical oncologists; radiation therapists; psychologists; nurses; and other physicians such as cardiologists, gynecologists, and urologists) dedicated to the care of survivors of cancer who we have previously defined as disease and treatment free for at least 5 years and that is established within our Institution since 2013. Results: The number of these CSCs should be planned in relation to the estimated number of survivors of cancer in each country and designed within the medical oncology departments. Conclusions: CSCs should assess: 1) the occurrence of any known side effects from cancer or its treatment (i.e., neurocognitive problems, premature menopause, infertility, cardiorespiratory system dysfunctions, and chronic fatigue); 2) the concomitant presence of comorbidities and their influence on the patient’s general health status; 3) psychological disturbances (i.e., fear of cancer recurrence, anxiety, depression, and body image perception disorders); and 4) problems regarding social and employment reintegration. Moreover, CSCs should provide screening guidelines for cancer recurrence and second primary tumors, design proper clinical follow-up pathways, promote behavioral changes (i.e., smoking cessation and alcohol intake reduction), and improve screening and prevention programs for the relatives of cancer survivors.
Is survivorship care plan discussion important to patients?
Authors: Leatherwood Amy Eiko , Thomas Charles R.
Published: February 2017

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Background: The 2015 Commission on Cancer standard requires that cancer survivors receive a personalized survivorship care plan (SCP). There are variations on how this plan is delivered, depending on time and available staff. These can include mailing the SCP, delivering the SCP at the conclusion of a visit, and fully discussing the SCP at a survivorship visit. There is a need to evaluate the growth in patient satisfaction with not only receipt of SCP, but also personalized care and education regarding the SCP and follow up. Methods: A simple, anonymous questionnaire was routinely given, for quality assurance purposes, to cancer patients who had completed treatment in a radiation oncology setting. Patients were given the questionnaire at the conclusion of a survivorship visit, during which they had received an SCP with full discussion and explanation by the nurse practitioner. The questionnaire asks two questions: 1) Did you find the survivorship visit helpful and/or educational? 2) Was it more helpful to have the survivorship summary explained to you in person? These questions could be answered with a “yes” or “no” answer. Results: This data collection is at a preliminary stage. We received 19 completed questionnaires from patients. Of these 19 questionnaires, 18/19 or 95% of responses were “yes” for question 1. For question 2, 18/19 or 95% of responses were “yes.” Conclusions: This information on patient-perceived value of survivorship visits and SCPs is at an early stage, and more responses will be needed to confirm its validity in the future; however, preliminary data show that the majority of patients are finding survivorship summaries to be helpful and educational to them. Patients are also indicating that visits “in person,” with face-to-face explanation of survivorship summaries, are more helpful than receiving a summary without verbal involvement or explanation.
Health care providers’ perspective on communication of cancer diagnosis and treatment plan to geriatric patients.
Authors: Lanka Himabindu , Zirker William , Dorokhine Igor
Published: February 2017

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Background: Physician communication with patients is vital to deliver a proper diagnosis. In addition, it is important to appropriately answer questions to improve the quality of care especially with geriatric patients with cancer. However, patients feel their questions are not being answered in a timely manner. Multiple international studies involving oncologists have identified communication barriers such as cultural differences, paternalistic views and family dynamics. Furthermore, barriers to communication in geriatric patients are cognitive impairment and hearing loss. The aim of this study is to assess health care providers’ perspective on communicating cancer diagnosis and treatment plan in geriatric population. Methods: A ten-question survey was created and was emailed to health care providers using Survey Monkey. Data analysis consisted of distribution frequency and Chi-squared test/Fischer test. Results: 69 health care providers’ participated in the survey. 13 of the 69 (18.8%) did not see any geriatric patients with cancer and were excluded from the study. Amongst the communication parameters assessed, 85% of them said they had a particular approach to diagnosis. 76.9% of them included side effects of chemotherapy, risks and benefits of treatment and an option of no treatment in their initial treatment plan. Also, 67.3% of them included advance directives, hospice and prognosis in their initial plan. (Table 1) An adequate comparison was not possible due to the small sample size. Conclusions: In communicating cancer diagnosis and treatment plan, health care providers’ feel that they adequately answer questions and address needs of their geriatric patients. [Table: see text]
The Life Raft Group and establishment of the Virtual GIST Tumor Board in partnership with NIH.
Authors: Rothschild Sara , Menos Mildred , Scherzer Norman J. , Durborow Michelle
Published: February 2017

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Background: In 2008, the National Institutes of Health (NIH) launched an in-person clinic for the Pediatric and Wild-type GIST community allowing clinicians and researchers from across the world to collaborate with each other and meet patients and their families firsthand. This led to several important breakthroughs, including investigating germline mutations in the succinate dehydrogenase complex (SDH), which helps physicians understand how wild-type GISTs are formed, and that Pediatric GIST can be diagnosed after age 18 and should thus be titled “SDH-deficient GIST.” Yet, decreases in government funding have reduced the number of in-person meetings to one per year. To supplement this loss of an in-person clinic, The Life Raft Group partnered with the NIH to launch the Virtual GIST Tumor Board. Methods: The process is an augmentation of how virtual tumor review boards work. If selected, doctors of GIST patients log on and review their de-identified patient case with a panel of experts using the internet, secure servers, and state-of-the-art video conferencing software. The LRG uses cutting-edge technology to connect the local treating physicians and their team with key opinion leaders in the field of Pediatric (SDH-deficient) GIST. Participants virtually access radiology films such as CT scans and other necessary medical reports to help review particular cases and provide advice. Results: The Virtual GIST Tumor Board has met twice, and reviewed cases from patients as far away as Latin America and the Ukraine. The physicians of these patients have elevated the level of care they provide due to the interaction with experts the Board makes possible. Conclusions: The purpose of the Pediatric GIST Virtual Tumor Board is to bring together leading experts to discuss pediatric/wild-type (SDH-deficient) GIST cases, and be an educational resource for physicians. It is transformative, because it provides valuable access for patients and doctors who would not be able to attend an in-person clinic due to resources or distance; educates doctors on the most up to date treatment options, trials, and studies; serves as a triage to bring patients to the in-person clinic; and encourages collaborative efforts of leading GIST experts around the world.
Late events audit of sequential studies of seminoma after carboplatin.
Authors: Oliver Tim R. D.
Published: February 2017

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Background: Seminoma is the least malignant subtype of testicular germ cell cancer and has the least risk of metastasis at presentation. Less established compared with its radio-sensitivity, is the fact that it is more chemo-sensitive than non-seminoma. Despite reporting single agent Platinum data in 1982 which supported this concept, most standards of care do not treat seminoma differently from non-seminoma. This abstract reviews personal series some with more than 30 years follow up primarily using email follow up with access to clinical support as required to support this concept. Methods: A total of 97 metastatic seminoma (20 cisplatin, 77 Carboplatin) treated 1980-2006, 167 Stage 1 cases receiving either 1 or two courses of adjuvant therapy treated 1985-2006 and 54 cases receiving chemotherapy as part of testis conservation (12 single agent Platinum and 42 BEP therapy) treated between 1978 and 2006. Prior to 1996 participation was through verbal informed consent and since this time ethical committee approval has been obtained for the ongoing studies. Results: A total of 11 relapses have occurred in patients in 5 studies of carboplatin monotherapy in 264 patients with various stages of seminoma. All have been salvaged by BEP as have 16 relapses after I course carboplatin in the MRC TE19 randomised trial No relapses have occurred after 24 months despite median of 96 months follow-up, 51(19%) > 20 years. Though late malignant and non-malignant events have occurred, the frequency in the cohort followed between 10 and 15 years (n = 93) is not in excess of age matched controls. Conclusions: While in primum non noce does not trump the Sword of Damocles, the lack of any problems to date provide justification for further prospective evaluation of this less toxic option in patient preference studies.
A novel risk score for prediction of hypersensitivity reactions in cancer patients receiving carboplatin: Retrospective observational analysis.
Authors: Suppramote Orawan , Pongpunpisand Prapatsara , Ladkam Kanlaya , Rujirawat Somkiat
Published: February 2017

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Background: Hypersentitivity reactions (HSRs) from carboplatin are high incidence and most severity in Chulabhorn hospital. These reactions are associated with several causes including patient factors and experience in drug used. A reliable and valid tool for evaluated risk of HSRs before started carboplatin infusion should lead to prevent or decrease severity of the reactions. We innovated risk score to screen patient at high risk of HSRs. Methods: From October 2013 to September 2014, all cancer patients who received carboplatin in Chulabhorn hospital were included. A retrospective study design to developed risk scoring system for prediction of patients at high risk of carboplatin hypersensitivity called “Hypersensitivity risk score”. The hypersensitivity risk score was calculated for all patients receiving carboplatin and data for carboplatin hypersensitivity were obtained from medical records. Expected and observed HSRs were analyzed by using receiver operating characteristic (ROC) curve. Results: Seventy-three cancer patients received carboplatin and five (7%) patients had HSRs. Our scoring algorithm based on cancer type, number of carboplatin retreatment, duration between each retreatment, and number of carboplatin infusions prior to first reaction. All significant predictors were weighted into points and categorized to risk group which ranged from 0 to 8 . The ROC analysis for hypersensitivity risk score indicated good predictive accuracy with an area under the curve of 0.96 (95 %CI: 0.91-1.00). Data showed high sensitivity (80%) and specificity (94.85%) for a risk score cut-off of 4. The hypersensitivity risk score clearly differentiated the low (0-1), intermediate (2-3) and intermediate-high (4-5) and high (6-8) risk patients. Conclusions: The hypersensitivity risk score is a simple scoring system with high predictive value and differentiates low versus high risk patients. This score should be used for screen high risk of hypersensitivity reactions in patients receiving carboplatin.
An international, population-level initiative to promote healthy lifestyle practices among prostate cancer survivors.
Authors: Chan June M. , Newton Robert Usher , Culos-Reed S. Nicole , Faithfull Sarah , Lambert Sylvie , Kenfield Stacey A. , Van Blarigan Erin , Lyons Karen S , Ramsdill Justin , Zahavich Ashley , Duncan Lindsay , Hart Nicolas , Dew Mike , Moe Esther L , Dixon Cyril , Winters-Stone Kerri M
Published: February 2017

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Background: Growing evidence suggests that specific lifestyle practices (e.g., diet and exercise) may delay cancer progression among prostate cancer survivors (PCS) and restore post-treatment quality of life. However, there are limited efforts to translate this knowledge to sustainable behavior change among PCS at a population level. Methods: TrueNTH is an international partnership to develop innovative evidence-based interventions and care models to improve the physical and mental wellbeing of PCS. Within TrueNTH, four countries (U.S.A., Australia, Canada, U.K.) are developing solutions to improve lifestyle practices among PCS. Australia is implementing face-to-face and telehealth delivery of exercise and dietary programs facilitated by a web-based portal. Canada is implementing group-based exercise and yoga programs combined with a web-based portal to deliver exercise, nutrition and stress-reduction resources for PCS and caregivers. The U.K. is implementing a healthy living pharmacy approach to deliver tailored diet and exercise advice and support to men. The U.S. will implement a scalable web-based portal that reaches PCS, providers and partners and provides personalized exercise prescriptions and dietary advice, interactive guidance, and behavioral support via social media, tele-exercise, and face-to-face communities. Results: TrueNTH initiatives are in various phases of a three-year project. Australia has enrolled 30 of 80 men across 2 sites and via telehealth, and demonstrated acceptance of the portal. Canada has enrolled 30+ men in exercise programs and will soon add 4 sites and launch their portal. The UK has evaluated assessment protocols in 2 sites and will soon add a 3rd site and implement the pharmacy-based program. The U.S. is building the portal and supportive tools and will begin a trial in Fall 2016. Conclusions: Each TrueNTH program shares common goals to improve lifestyle practices among PCS. Common metrics across initiatives will allow for a global comparison of implementation approaches and assessment of impact at a population level. TrueNTH will utilize this initiative to create a lifestyle survivorship program that improves the lives of PCS worldwide.
Underserved community-based walking program for breast cancer survivors.
Authors: Tjoe Judy Angela , Piacentine Linda B. , Robinson Karen M. , Ng Alexander V. , Waltke Leslie J. , Sinner Angela A.
Published: February 2017

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Background: Advancements in early detection and new treatment options have improved outcomes for breast cancer survivors (BCS). With increased survivorship, improving quality of life (QOL) may be a challenge for some women. Exercise improves QOL for BCS and decreases recurrence, but, despite this many women do not routinely exercise. Underserved areas are at particular risk. Few studies have examined factors influencing exercise initiation and maintenance in underserved areas among minority overweight women. The purpose of this mixed methods study was to examine physiological outcomes and motivational factors in a community-based goal oriented walking program for BCS. Methods: A convenience sample of female BCS was recruited from an inner-city community center 12-week walking program. Women participated in physiological testing and focus groups before and after the program. Data was collected regarding strength, fitness, quality of life, and motivation of the women. Quantitative data was analyzed with paired t-tests. Two researchers independently analyzed focus groups’ transcriptions and like statements and phrases were coded. Themes emerged after discussions between the researchers. Results: The 13 participants [overweight BMI (n = 2), and obese BMI (n = 11)] had a mean survivorship of 5.4 years (range .25-14.5) years. Only 7 participants completed both pre and post physiological testing. Functional endurance significantly improved as indicated by the 6 Minute Walk Test (pre = 503(56), post = 570 (63) meters, mean(sd)), p = 0.02). While overall QOL did not improve, functional well-being showed significant improvement. Two focus group sessions were held at the beginning (n = 13) and end (n = 11) of the program. Themes emerged identifying 1) Treatment Weight Gain, 2) Familial Support, 3) Not Wanting to Go it Alone, 4) The Team Made the Difference Conclusions: Female BCS spoke of interpersonal and environmental factors involved in the decision to engage and maintain exercise with the walking program. Further research is needed to examine exercise motivation in underserved, overweight and obese breast cancer survivors.
Nimotuzumab in combination with preoperative concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma: A prospective trial.
Authors: Wu Xiaoyuan , Chen Yongshun , Yang Yuanyuan , Hao Daxuan , Li Xue , He Chunyu , Liu Jinsong , Wang Jianhua
Published: February 2017

101

Background: Preoperative chemoradiotherapy is an accepted standard treatment for patients with locally advanced esophageal cancer. Nimotuzumab is a monoclonal antihuman EGFR IgG1 antibody that has demonstrated synergistic activity with both radiotherapy and platinum-based chemotherapy in some solid tumors. The aim of this study is to investigate the safety and efficacy of nimotuzumab in combination with preoperative concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma (ESCC). Methods: Previously untreated patients with stage II-III ESCC received nimotuzumab (200mg per week in weeks1-5), paclitaxel(45 mg/m2 per week in weeks 2-5), cisplatin(20 mg/m2 per week in weeks 2-5) and radiotherapy at a total dose of 40 Gy (2.0Gy/d,5 days per week in weeks 2-5). Esophagectomy was performed 4 weeks after the completion of preoperative strategies. Results: Eighteen eligible patients were enrolled. All patients completed the preoperative regimen, and seventeen patients underwent surgery. The clinical response rate was 94.4% (17/18). The most frequent Grade 1/2 toxicities were esophagitis(12/17), leukocytopenia(14/17), nausea/vomiting(8/17) and fatigue(4/17). Grade 3 leukocytopenia was observed in 11.8 % of patients (3/17). The rate of radical resection was 100%, and the pathological complete response rate was 41.2%(7/17). Downstaging occurred in 15/17 (88.2 %) patients by T stage and 8/17 (47.1%) by N stage. The incidences of postoperative anastomotic leak, pulmonary infection, hoarseness and arrhythmia were 11.8%, 11.8%, 5.9%, and 5.9%, respectively. No perioperative deaths occurred in the study. Conclusions: The regimen of nimotuzumab in combination with preoperative concurrent chemoradiotherapy is safe for locally advanced ESCC. The preoperative strategy is able to achieve substantially high clinical response rate and pathological complete response rate.
Is there a role for neoadjuvant radiation dose escalation in esophageal cancer? A meta-analysis.
Authors: Lobo Laila , Yakoub Danny , Ripat Caroline , Sharma Rishika , Yechieli Raphael
Published: February 2017

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Background: In treating esophageal cancer chemo-radiation is used in the definitive as well as neo-adjuvant setting. Optimal dosage of radiation for best outcome has been debated. The aim of this study is to evaluate clinical outcomes of lower radiation dosage compared to higher. Methods: Online search for studies comparing radiation dose from 1990 to present was performed. Primary outcome was overall-survival rates for up to 5 years. Secondary outcomes included post-treatment complications and treatment response. A cut point of 51 Gy and less was considered as lower dose and greater than 51 Gy was considered higher dose. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 142 studies, 12 met our selection criteria and included 1876 patients receiving radiation for resectable esophageal carcinoma. Of these patients, 1057 received lower and 819 were treated with greater than 51 Gy. Median age was 63 and 64 years for lower and higher radiation dose respectively. Meta-analysis showed no statistically significant difference in survival and toxicities between the two groups. 1 year overall survival (RR = 0.97, 95% CI 0.84-1.13, p = 0.69), 2 year overall survival (RR = 1.29, 95% CI 0.76-2.19, p = 0.34), 3 year overall survival (RR = 1.18, 95% CI 0.83-1.68, p = 0.37), 4 year overall survival (RR = 1.37, 95% CI 0.64-2.94, p = 0.41), 5 year overall survival (RR = 1.11, 95% CI 0.72-1.69, p = 0.64), Esophagitis (RR = 0.76, 95% CI 0.39-1.50, p = 0.43), Dermatitis (RR = 0.98, 95% CI 0.12-7.94, p = 0.99), Fistula formation (RR = 0.72, 95% CI 0.32-1.60, p = 0.42), Hematologic complications (RR = 1.10, 95% CI 0.20-6.02, p = 0.91), Stricture formation (RR = 1.39, 95% CI 0.54-3.58, p = 0.5). Conclusions: Lower radiation dose appears to be as effective as higher dose in esophageal carcinoma with similar toxicity profile and survival rates. Larger prospective randomized trials, focusing on patient-reported quality-of-life are required to consolidate these results.
Role of nutritional status as predictor of survival in oesophageal cancer treated with definitive chemoradiation (dCRT): outcome from SCOPE1, a phase II/III randomised trial of dCRT +/- cetuximab.
Authors: Cox Samantha , Powell Ceri , Carter Ben , Hurt Chris , Mukherjee Somnath , Crosby Tom David Lewis
Published: February 2017

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Background: Malnutrition is common in oesophageal cancer and may be related to the disease or treatment. We aimed to identify nutritional prognostic factors and the outcome of nutritional intervention in patients recruited to the SCOPE1 trial. Methods: 258 patients were randomly allocated to dCRT with or without the addition of cetuximab. Data was collected prior to induction chemotherapy (iCT) and before commencing concurrent CRT. Nutritional Risk Index (NRI) was calculated and categorised; ≥ 100 (no risk of malnutrition), 97.5-100 (mild risk), and < 97.5 (moderate to severe risk). The maximal nutritional intervention (MNI) received was classified as: none, dietary advice, oral supplementation or major intervention (enteral feeding/tube placement). Univariate and multivariate analyses using Cox proportional hazard modelling were conducted to identify predictive factors and important interactions involving MNI. Results: An NRI score < 100 at baseline strongly predicted reduced median overall survival (OS) in multivariate analysis (HR = 12.45, 95% CI 5.24 – 29.57; p = < 0.001). Furthermore, OS was improved in this group if they received dietary advice (HR = 0.12, p = 0.004), oral supplementation (HR = 0.13, p = < 0.001) or major intervention (HR = 0.13, p = 0.003) prior to commencement of iCT, but there was no benefit if intervention occurred after commencement of iCT. Patients on cetuximab arm undergoing major intervention had worse outcomes compared to control (13 months vs 28 months, p = 0.003). Conclusions: Assessment and correction of poor nutritional state at baseline may improve survival outcomes in oesophageal cancer patients treated with dCRT. The benefit of intervention is no longer observed once treatment has commenced, highlighting the need for early nutritional assessment and intervention. Reason for poor OS in patients on cetuximab requiring major intervention is unclear. Clinical trial information: 47718479.
Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.
Authors: Park Hyungchul , Kim Do Hoon , Gong Eun Jeong , Na Hee Kyong , Ahn Ji Yong , Lee Jeong Hoon , Jung Kee Wook , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong , Kim Jin-Ho
Published: February 2017

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Background: Endoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN. Methods: Patients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated. Results: ESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range: 44–86 years), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range: 5–85 mm) and median procedure time was 45 minutes (range: 9–160 minutes). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range: 18–62 months), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively. Conclusions: ESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.
Phase I study of intraperitoneal paclitaxel combined with S-1 plus cisplatin for gastric cancer with peritoneal metastasis.
Authors: Kobayashi Daisuke , Ishigami Hironori , Kanda Mitsuro , Tanaka Chie , Yamaguchi Hironori , Kitayama Joji , Kodera Yasuhiro
Published: February 2017

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Background: Intraperitoneal (IP) chemotherapy is a promising treatment option for gastric cancer (GC) with peritoneal metastasis (PM). Efficacy of IP paclitaxel (PTX) combined with S-1 and intravenous PTX was reported in a phase II study. Attempts to combine IP PTX with other systemic therapies with higher efficacy are warranted. We designed a new regimen combining IP PTX with S-1/cisplatin (SP) which is regarded as the standard first-line treatment of metastatic GC in Japan. We subsequently carried out a dose-escalation study to determine the maximum-tolerated dose (MTD) and recommended dose (RD). Methods: The combination was a five-week regimen. IP PTX was to be administered on days 1, 8 and 22 with an initial dose of 15 mg/m2 at level 1 and 20 mg/m2 at level 2. S-1 was to be administered orally at a fixed dose of 80 mg/m2 bid for 21 days followed by a 14-day rest. Cisplatin was to be administered intravenously at a dose of 60 mg/m2 on day 8, and was to be decreased to 50 mg/m2 (level 0) if necessary. Since the dosage of S-1 at the fixed dose and cisplatin at level 1 were identical to SP regimen, no further dose-escalation was planned. Dose-limiting toxicities (DLTs) were defined as Grade 4 (G4) leukopenia, G3 febrile neutropenia, G3 thrombocytopenia, and G3 non-hematological toxicity. The MTD was defined as the dose level at which ≥2 of 3 or 6 patients developed DLTs during the first course of treatment. The RD was defined as one level below the MTD. Results: A total of 9 patients with macroscopic PM were enrolled. No DLTs were observed among the 3 patients at level 1 and 6 patients at level 2. Furthermore, no G3 toxicities were observed in any of the patients enrolled. Anemia in 1 patient at level 2 was the only G2 toxicity observed. No adverse events or technical problems associated with the IP administration were observed. Consequently, the MTD was not reached, and the RD of IP PTX was determined as 20 mg/m2 (level 2). As for the efficacy, peritoneal lavage cytology turned negative after the first course in 4 of 7 patients who had positive cytology before treatment. Conclusions: Addition of IP PTX at 20 mg/m2 to the SP regimen at an established dose/schedule was safe and promising, and further evaluation in a phase II trial is underway. Clinical trial information: UMIN000013528.
T-shaped linear-stapled intrathoracic esophagogastric anastomosis for minimally invasive Ivor Lewis esophagectomy.
Authors: Dong YiNan
Published: February 2017

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Background: Linear stapler is increasingly used for the gastroesophageal anastomosis in minimally invasive esophageal cancer surgeries; however, it is more commonly used in cervical delta anastomosis, less in totally thoracoscopic Ivor Lewis esophagectomy for esophageal cancer. A standardized rapid linear stapler based gastroesophageal anastomotic technique remains to be developed. Methods: Here we report a new technique for the endoscopic gastroesophageal anastomosis that is completed just with a linear stapler (Ethicon Flex 60). In this technique, a linear stapler is first fired upward to establish the side to side anastomosis of the esophagus and stomach. This creates the anterior and posterior wall of the anastomotic site. The linear stapler is then fired along the extension line of the gastric conduit, to complete the anastomosis and at the same time resect the lesser curvature of the stomach and the esophageal cancer. Upon completion, the anastomotic plane is axial, and contains a superior edge, inferior edge, and anterior edge. Results: By the middle of September 2015, we have performed the minimally invasive Ivor Lewis esophagectomy with this anastomosis for 26 esophageal cancer patients. We are following these patients, and the longest follow up time is about 18 month and the shortest is 12 month. None of these patients has had any anastomotic bleeding, leak, or stenosis. Conclusions: This new technique is less restricted by the limited space during minimally invasive Ivor Lewis procedure. The anastomotic technique is easy to perform and appears to be reliable, safe and effective judging from our limited clinical experience up to this date.
Radiofrequency ablation for pulmonary metastases from esophageal squamous cell carcinoma.
Authors: Shigaki Hironobu , Kosumi Keisuke , Tokunaga Ryuma , Harada Kazuto , Kurashige Junji , Iwatsuki Masaaki , Baba Yoshifumi , Sakamoto Yasuo , Miyamoto Yuji , Yoshida Naoya , Baba Hideo
Published: February 2017

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Background: Radiofrequency ablation (RFA) is increasingly being used for the treatment of intrathoracic malignancies. Although RFA has been found to be promising in the treatment of lung metastases from some types of neoplasms, little is known concerning its clinical significance in the treatment of pulmonary metastasis from esophageal squamous cell carcinoma (ESCC). This retrospective study evaluated the feasibility, safety, and effectiveness of computed tomography-guided RFA for pulmonary metastasis from ESCC. Methods: Of 322 patients with ESCC underwent esophagectomy at Kumamoto University Hospital between January 2007 and May 2015, 23 cases had pulmonary recurrence. Selection criteria for CT-guided RFA for pulmonary metastasis were as follows: (i) there were no distant metastases except for pulmonary lesions, when there were extrapulmonary recurrences that had to be controlled by additional therapies; (ii) there were up to three pulmonary tumors; (iii) the number of pulmonary tumors did not increase over a certain period while receiving pre-RFA chemotherapy; (iv) the metastatic lesions were not adjacent to major pulmonary vessels, major bronchi, or the heart. 17 patients who underwent CT-guided RFA for metachronous pulmonary metastasis from ESCC were included in this study. Results: Correct placement of the ablation device into the target tumor proved to be feasible in all tumors (100%). The mean visual analog scale score, with values that ranged from 0 (no pain) to 10 (worst pain possible), was 1. This suggested that this procedure was well tolerated. No procedure-related deaths occurred. A pneumothorax needing drainage was a major complication in two patients. 6 patients died of recurrent disease. The predicted 1- and 2-year overall survival rates after lung RFA were 78.8% and 46.7%, respectively. Conclusions: Percutaneous computed tomography-guided RFA yielded relatively high levels of local control in patients with pulmonary metastases from ESCC and was associated with an acceptable level of complications. It was concluded that a prospective study will be necessary to evaluate the effectiveness of a combination of systemic therapy and RFA for ESCC lung metastases.
Prognostic factors for survival in patients with advanced gastric cancer treated with chemotherapy.
Authors: Mangas Montserrat , Carmona Bayonas Alberto , Sanchez Lorenzo Maria Luisa , Ramchandani Avinash , Garcia Teresa , Custodio Ana B. , Lorenzo Barreto Jose Enrique , Echavarria Diaz Guardamino Isabel , Diaz Serrano Asuncion , Cano Juana Maria , Azkarate Aitor , Longo Federico , Mugica Maitane , Sanchez Rodrigo , Serrano Raquel , Alvarez Manceñido Felipe Jose , Alsina Maria , Jiménez-Fonseca Paula , Garrido Marcelo , Gallego Plazas Javier
Published: February 2017

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Background: A prognostic model in advanced gastric cancer that integrates the Her2 status,histopathological classifications and other patient’s or treatment-dependent parameters is lacking. The aim is to identify clinicopathological factors for overall survival in a cohort of patients with advanced gastric cancer. Methods: 526 consecutive patients with advanced adenocarcinoma of the distal esophagus, gastroesophageal junction or stomach were analyzed. All patients were treated with poly-chemotherapy ( ≥ 2 drugs) at 19 Spanish and one Chilean centers between 2012 and 2015. Characteristics of patients, tumors, therapies and pathological factors, were analyzed by a Cox proportional hazards model. Results: The median overall survival was 10.3 months [95% confidence interval (CI), 9.5-11.1], and the time to progression was 6.7 months (95% CI, 6.1-7.2). Independent prognostic factors associated with overall survival were: distal non-diffuse histopathological subtype (hazard ratio, (HR) 0.73), Her2 positive 3+ (HR 0.54), Her2 positive 2+ with FISH + (HR 0.68), surgery of metastases (HR 0.34), Eastern Cooperative Group performance status (ECOG PS) 2 (HR 2.5), ECOG PS 3 (HR 7.37), and only distant lymph node metastases (HR 0.63) (Table 1). Conclusions: We have identified clinicopathological prognostic factors that could be important to stratify advanced gastric cancer, with potential implications in research and treatment. [Table: see text]