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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..

Curr. Oncol., Volume 21, Issue 4 (August 2014) – 21 articles

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Case Report
Successful Management of a Childhood Osteosarcoma with Epiphysiolysis and Distraction Osteogenesis
Curr. Oncol. 2014, 21(4), 658-662; https://doi.org/10.3747/co.21.1956 - 01 Aug 2014
Cited by 8 | Viewed by 116
Abstract
In an 11-year-old boy with osteosarcoma in the proximal tibia (type iii), 2 cycles of dia chemotherapy (cisplatin, ifosfamide, doxorubicin) were administered preoperatively while epiphysiolysis was performed. Clinical response was determined to be complete by radiography and histopathology. Marginal excision was then [...] Read more.
In an 11-year-old boy with osteosarcoma in the proximal tibia (type iii), 2 cycles of dia chemotherapy (cisplatin, ifosfamide, doxorubicin) were administered preoperatively while epiphysiolysis was performed. Clinical response was determined to be complete by radiography and histopathology. Marginal excision was then performed with preservation of the proximal tibial epiphysis. Metaphyseal reconstruction was performed using distraction osteogenesis. Six cycles of dia chemotherapy were administered postoperatively. Twenty months later, the patient had developed no complications and experienced full bone healing, with no limb discrepancy. In selected adolescent patients with osteosarcoma, in whom the tumour is in full contact with the epiphysis, epiphyseal preservation by epiphysiolysis and reconstruction by distraction osteogenesis can provide an excellent outcome, resulting in a stable reconstruction that functionally restores the native limb. Full article
Article
Role of Neoadjuvant Therapy in the Management of Pancreatic Cancer: Is the Era of Biomarker-Directed Therapy Here?
Curr. Oncol. 2014, 21(4), 650-657; https://doi.org/10.3747/co.21.2006 - 01 Aug 2014
Cited by 7 | Viewed by 289
Abstract
Pancreatic cancer is the 4th leading cause of cancerrelated death. Complete surgical resection (CR0) is considered the only curative treatment. Most patients present with unresectable or borderline resectable disease. Many small phase i/ii trials have tried to address the role of neoadjuvant treatment [...] Read more.
Pancreatic cancer is the 4th leading cause of cancerrelated death. Complete surgical resection (CR0) is considered the only curative treatment. Most patients present with unresectable or borderline resectable disease. Many small phase i/ii trials have tried to address the role of neoadjuvant treatment using chemotherapy with or without chemoradiation in the management of locally advanced disease. However, many of them looked at the rate of CR0 resection and the feasibility of such treatment. A trend for improved overall survival has been observed in the group of patients with borderline resectable disease who completed neoadjuvant treatment. A large proportion of patients progress while on treatment, sparing them from unnecessary surgery. We searched the PubMed database (using the key words “pancreatic cancer,” or “pancreatic neoplasm,” or “pancreatic adenocarcinoma,” and “neoadjuvant treatment,” or “neoadjuvant chemotherapy,” or “neoadjuvant radiation therapy,” or “neoadjuvant chemoradiation,” or “adjuvant therapy” [all fields] and “clinical trial” or “study”) and abstracts presented at the American Society of Clinical Oncology meetings on gastrointestinal cancers. Here, we review the most recent papers that present results on neoadjuvant therapy in pancreatic cancer. All but one report used overall survival as an endpoint. Unfortunately, there are no valid biomarkers predicting tumour progression or recurrence, and response to treatment than can help to guide therapeutic choices. Our recommendation is to consider neoadjuvant treatment in cases of borderline resectable disease. In patients with primary resectable tumours, surgery followed by adjuvant treatment and enrollment on adjuvant treatment studies would be appropriate. Full article
Article
Treatment and Follow-Up Strategies in Desmoid Tumours: A Practice Guideline
Curr. Oncol. 2014, 21(4), 642-649; https://doi.org/10.3747/co.21.2112 - 01 Aug 2014
Cited by 13 | Viewed by 134
Abstract
Objectives: We set out to determine the optimal treatment options—surgery, radiation therapy (RT), systemic therapy, or any combinations thereof—for patients with desmoid tumours once the decision to undergo active treatment has been made (that is, monitoring and observation have been determined [...] Read more.
Objectives: We set out to determine the optimal treatment options—surgery, radiation therapy (RT), systemic therapy, or any combinations thereof—for patients with desmoid tumours once the decision to undergo active treatment has been made (that is, monitoring and observation have been determined to be inadequate); provide clinical-expert consensus opinions on follow-up strategies in patients with desmoid tumours after primary interventional management. Methods: This guideline was developed by Cancer Care Ontario’s Program in Evidence-Based Care and the Sarcoma Disease Site Group. The MEDLINE, EMBASE, and Cochrane Library databases, main guideline Web sites, and abstracts of relevant annual meetings (1990 to September 2012) were searched. Internal and external reviews were conducted, with final approval by the Program in Evidence-Based Care and the Sarcoma Disease Site Group. Recommendations: Treatments: Surgery with or without RT can be a reasonable treatment option for patients with desmoid tumours whose surgical morbidity is deemed to be low; The decision about whether RT should be offered in conjunction with surgery should be made by clinicians and patients after weighing the potential benefit of improved local control against the potential harms and toxicity associated with RT; Depending on individual patient preferences, systemic therapy alone or RT alone might also be reasonable treatment options, regardless of whether the desmoid tumours are deemed to be resectable. Follow-Up Strategies: Undergo evaluation for rehabilitation (occupational therapy or physical therapy, or both); Continue with rehabilitation until maximal function is achieved; Undergo history and physical examinations with appropriate imaging every 3–6 months for 2–3 years, and then annually. Full article
Guidelines
Management of Hypersensitivity to Platinum- and Taxane-Based Chemotherapy: cepo Review and Clinical Recommendations
Curr. Oncol. 2014, 21(4), 630-641; https://doi.org/10.3747/co.21.1966 - 01 Aug 2014
Cited by 42 | Viewed by 343
Abstract
(1) Background: Although antineoplastic agents are critical in the treatment of cancer, they can potentially cause hypersensitivity reactions that can have serious consequences. When such a reaction occurs, clinicians can either continue the treatment, at the risk of causing a severe or [...] Read more.
(1) Background: Although antineoplastic agents are critical in the treatment of cancer, they can potentially cause hypersensitivity reactions that can have serious consequences. When such a reaction occurs, clinicians can either continue the treatment, at the risk of causing a severe or a potentially fatal anaphylactic reaction, or stop the treatment, although it might be the only one available. The objective of the present work was to evaluate the effectiveness of methods used to prevent and treat hypersensitivity reactions to platinum- or taxane-based chemotherapy and to develop evidence-based recommendations. (2) Methods: The scientific literature published to December 2013, inclusive, was reviewed. (3) Results: Premedication with antihistamines, H2 blockers, and corticosteroids is not effective in preventing hypersensitivity reactions to platinum salts. However, premedication significantly reduces the incidence of hypersensitivity to taxanes. A skin test can generally be performed to screen for patients at risk of developing a severe reaction to platinum salts in the presence of grade 1 or 2 reactions, but skin testing does not appear to be useful for taxanes. A desensitization protocol allows for re-administration of either platinum- or taxane-based chemotherapy to some patients without causing severe hypersensitivity reactions. (4) Conclusions: Several strategies such as premedication, skin testing, and desensitization protocols are available to potentially allow for administration of platinum- or taxane-based chemotherapy to patients who have had a hypersensitivity reaction and for whom no other treatment options are available. Considering the available evidence, the Comité de l’évolution des pratiques en oncologie made recommendations for clinical practice in Quebec. Full article
Review
A Systematic Review of Active Treatment Options in Patients with Desmoid Tumours
Curr. Oncol. 2014, 21(4), 613-629; https://doi.org/10.3747/co.21.1995 - 01 Aug 2014
Cited by 24 | Viewed by 128
Abstract
Introduction: We conducted a systematic review to determine the optimal treatment options in patients with desmoid tumours who have declined observational management. Methods: A search was conducted of the medline and embase databases (1990 to September 2012), the Cochrane Library, and [...] Read more.
Introduction: We conducted a systematic review to determine the optimal treatment options in patients with desmoid tumours who have declined observational management. Methods: A search was conducted of the medline and embase databases (1990 to September 2012), the Cochrane Library, and relevant guideline Web sites and conference materials. Results: One systematic review and forty-six studies met the preplanned study selection criteria; data from twenty-eight articles were extracted and analyzed. For local control, three studies reported a statistically significant difference in favour of surgery plus radiotherapy (rt) compared with surgery alone, and one study did not; two studies reported the lack of a statistical difference between surgery plus rt and rt alone in maintaining local control. Multivariate risk factors for local recurrence included positive surgical margins and young patient age. Single-agent imatinib led to a progression-free survival rate of 55% at 2 years and 58% at 3 years. Methotrexate plus vinblastine led to a progression-free survival rate of 67% at 10 years. Significant toxicities were reported for all treatment modalities, including surgical morbidity, and rt- and chemotherapy-related toxicities. Conclusions: In patients who have declined observational management, the local control rate was higher with surgery plus rt than with surgery alone. However, the additional rt-related complications should be considered in treatment decision-making. Surgery, rt, and systemic therapy are all reasonable treatment options for patients with desmoid tumours. Full article
Review
Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use
Curr. Oncol. 2014, 21(4), 604-612; https://doi.org/10.3747/co.21.1990 - 01 Aug 2014
Cited by 20 | Viewed by 137
Abstract
Background: Chemotherapy is an effective treatment in the fight against many cancers. Medication errors in oncology can be particularly serious given the narrow therapeutic window of antineoplastic drugs and their high toxicities. Computerized prescriber order entry (cpoe) has consistently been [...] Read more.
Background: Chemotherapy is an effective treatment in the fight against many cancers. Medication errors in oncology can be particularly serious given the narrow therapeutic window of antineoplastic drugs and their high toxicities. Computerized prescriber order entry (cpoe) has consistently been shown to reduce medication errors and adverse drug events in various settings, but its use in the oncology setting has not been well established. To gain a better understanding of the meaningful use of cpoe systems in the outpatient chemotherapy setting, we undertook a systematic review of systemic therapy cpoe. Methods: A province-wide expert panel consisting of clinical experts, health information professionals, and specialists in human factors design provided guidance in the development of the research questions, search terms, databases, and inclusion criteria. The systematic review was undertaken by a core team consisting of a medical oncologist, nurse, pharmacist, and methodologist. The medline, embase, cinahl, and compendex databases were searched for relevant evidence. Results: The database searches resulted in 5642 hits, of which 9 met the inclusion criteria and were retained. In the oncology setting, cpoe systems generally reduce chemotherapy medication errors; however, specific types of errors increase with the use of cpoe. These systems affect practice both positively and negatively with respect to time, workload, and productivity. Conclusions: Despite the paucity of oncology-specific research, cpoe should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors. Adoption by clinicians will be enhanced by. Full article
Review
Bortezomib in Multiple Myeloma: Systematic Review and Clinical Considerations
Curr. Oncol. 2014, 21(4), 573-603; https://doi.org/10.3747/co.21.1798 - 01 Aug 2014
Cited by 70 | Viewed by 311
Abstract
We conducted a systematic review to determine the appropriate use of bortezomib alone or in combination with other agents in patients with multiple myeloma (MM). We searched MEDLINE, EMBASE, the Cochrane Library, conference proceedings, and the reference lists of [...] Read more.
We conducted a systematic review to determine the appropriate use of bortezomib alone or in combination with other agents in patients with multiple myeloma (MM). We searched MEDLINE, EMBASE, the Cochrane Library, conference proceedings, and the reference lists of included studies. We analyzed randomized controlled trials and systematic reviews if they involved adult MM patients treated with bortezomib and if they reported on survival, disease control, response, quality of life, or adverse effects. Twenty-six unique studies met the inclusion criteria. For patients with previously untreated MM and for candidates for transplantation, we found a statistically significant benefit in time to progression [hazard ratio (HR): 0.48, p < 0.001; and HR: 0.63, p = 0.006, respectively] and a better response with a bortezomib than with a non-bortezomib regimen (p < 0.001). Progression-free survival was longer with bortezomib and thalidomide than with thalidomide alone (p = 0.01). In non-candidates for transplantation, a significant benefit in overall survival was observed with a bortezomib regimen (HR compared with a non-bortezomib regimen: 0.61; p = 0.008), and in transplantation candidates receiving bortezomib, the response rate was improved after induction (p = 0.004) and after a first transplant (p = 0.016). In relapsed or refractory MM, overall survival (p = 0.03), time to progression (HR: 1.82; p = 0.000004), and progression-free survival (HR: 1.69; p = 0.000026) were significantly improved with bortezomib and pegylated liposomal doxorubicin (compared with bortezomib alone), and bortezomib monotherapy was better than dexamethasone alone (HR: 0.77; p = 0.027). Bortezomib combined with thalidomide and dexamethasone was better than either bortezomib monotherapy or thalidomide with dexamethasone (p < 0.001). In previously untreated or in relapsed or refractory MM patients, bortezomib-based therapy has Full article
Article
Factors Associated with Publication of Randomized Phase iii Cancer Trials in Journals with a High Impact Factor
Curr. Oncol. 2014, 21(4), 564-572; https://doi.org/10.3747/co.21.1937 - 01 Aug 2014
Cited by 10 | Viewed by 130
Abstract
(1) Background: Impact factor (if) is often used as a measure of journal quality. The purpose of the present study was to determine whether trials with positive outcomes are more likely to be published in journals with higher ifs. [...] Read more.
(1) Background: Impact factor (if) is often used as a measure of journal quality. The purpose of the present study was to determine whether trials with positive outcomes are more likely to be published in journals with higher ifs. (2) Methods: We reviewed 476 randomized phase iii cancer trials published in 13 journals between 1995 and 2005. Multivariate logistic regression models were used to investigate predictors of publication in journals with high ifs (compared with low and medium ifs). (3) Results: A positive outcome had the strongest association with publication in high-if journals [odds ratio (or): 4.13; 95% confidence interval (ci): 2.67 to 6.37; p < 0.001]. Other associated factors were a larger sample size (or: 1.06; 95% ci: 1.02 to 1.10; p = 0.001), intention-to-treat analysis (or: 2.53; 95% ci: 1.56 to 4.10; p < 0.001), North American authors (or for European authors: 0.36; 95% ci: 0.23 to 0.58; or for international authors: 0.41; 95% ci: 0.20 to 0.82; p < 0.001), adjuvant therapy trial (or: 2.58; 95% ci: 1.61 to 4.15; p < 0.001), shorter time to publication (or: 0.84; 95% ci: 0.77 to 0.92; p < 0.001), uncommon tumour type (or: 1.39; 95% ci: 0.90 to 2.13; p = 0.012), and hematologic malignancy (or: 3.15; 95% ci: 1.41 to 7.03; p = 0.012). (4) Conclusions: Cancer trials with positive outcomes are more likely to be published in journals with high ifs. Readers of medical literature should be aware of this “impact factor bias,” and investigators should be encouraged to submit reports of trials of high methodologic quality to journals with high ifs regardless of study outcomes. Full article
Article
Use of Chemotherapy and Radiofrequency Ablation to Treat Colorectal Cancer Metastases: A Retrospective Review of the Ottawa Hospital Cancer Centre over 7 Years
Curr. Oncol. 2014, 21(4), 557-563; https://doi.org/10.3747/co.21.1929 - 01 Aug 2014
Cited by 13 | Viewed by 109
Abstract
(1) Background: Almost 40% of people diagnosed with colorectal cancer will die from their disease, most with metastatic spread. When feasible, hepatic resection offers the greatest probability of cure for isolated liver metastases, but there are barriers to curative resection. Those barriers [...] Read more.
(1) Background: Almost 40% of people diagnosed with colorectal cancer will die from their disease, most with metastatic spread. When feasible, hepatic resection offers the greatest probability of cure for isolated liver metastases, but there are barriers to curative resection. Those barriers include the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age. Chemotherapy is often administered before or after resection with the intention of improving disease-free and overall survival. The timing of chemotherapy (adjuvant vs. neoadjuvant vs. perioperative) for patients undergoing potentially curative hepatic resection of metastasis of colorectal cancer origin is controversial. (2) Methods: Colorectal cancer patients with liver metastases resected at The Ottawa Hospital between January 1, 2003, and December 31, 2009, were identified, and their clinical records were retrospectively reviewed. Patients receiving intraoperative radiofrequency ablation (rfa) as part of their management were included. Factors associated with overall and disease-free survival were evaluated. (3) Results: The 168 identified patients (57% men, 43% women) had a median age of 63 years (range: 31–84 years). After hepatectomy, 10% had positive resection margins. Intraoperative rfa was used in 25 patients (15%). Chemotherapy was administered in the neoadjuvant (19%), adjuvant (31%), or “perioperative” (both neoadjuvant and adjuvant, 50%) setting. Use or omission of intraoperative rfa was not associated with a difference in overall survival (hazard ratio: 0.99; 95% confidence interval: 0.53 to 1.84; p = 0.97). (4) Conclusions: Compared with patients who did not receive chemotherapy, those who received chemotherapy, regardless of timing, experienced improved overall survival and disease-free survival. Use of rfa where required as an adjunct to hepatic resection appears to be effective and is not associated with worse overall survival. Full article
Article
18F-Fluorodeoxyglucose Positron-Emission Tomography Could Have a Prognostic Role in Patients with Advanced Hepatocellular Carcinoma
Curr. Oncol. 2014, 21(4), 551-556; https://doi.org/10.3747/co.21.1959 - 01 Aug 2014
Cited by 6 | Viewed by 116
Abstract
(1) Introduction: We set out to evaluate the prognostic value of 18F-fluorodeoxyglucose positron-emission tomography (pet) in patients with advanced (non-transplant-eligible) hepatocellular carcinoma (hcc) and to evaluate the correlation between standardized uptake values (suvs) and survival outcomes. [...] Read more.
(1) Introduction: We set out to evaluate the prognostic value of 18F-fluorodeoxyglucose positron-emission tomography (pet) in patients with advanced (non-transplant-eligible) hepatocellular carcinoma (hcc) and to evaluate the correlation between standardized uptake values (suvs) and survival outcomes. (2) Methods: We identified patients with hcc who, from 2005 to 2013, underwent pet imaging before any treatment. This retrospective study from our hcc database obtained complete follow-up data for the 63 identified patients. (3)Results: Of the 63 patients, 10 underwent surgical resection, and 59 underwent locoregional therapy. In this cohort, 28 patients were pet-positive (defined as any lesion with a suv ≥ 4.0) before any therapy was given, and 35 patients were pet negative (all lesions with a suv < 4.0). On survival analysis, median survival was greater for the pet-negative than for the pet-positive patients: 29 months (range: 16.3–41.1 months) versus 12 months (range: 4.0–22.1 months) respectively, p = 0.0241. The pet-positive patients more often had large tumours (≥5 cm), poor differentiation, and extrahepatic disease, reflecting more aggressive tumours. On multivariate analysis, only pet positivity was associated with poor survival (p = 0.049). (4) Conclusions: Compared with pet-positive patients, pet-negative patients with hcc experienced longer survival. Imaging by pet can be of value in early prognostication for patients with hcc, especially patients receiving locoregional therapy for whom pathologic tumour differentiation is rarely available. This potential role for pet requires further validation in a prospective study. Full article
Article
Cost-Effectiveness of First-Line Treatments for Patients with Kras Wild-Type Metastatic Colorectal Cancer
Curr. Oncol. 2014, 21(4), 541-550; https://doi.org/10.3747/co.21.1837 - 01 Aug 2014
Cited by 19 | Viewed by 134
Abstract
Background: Combinations of chemotherapy regimens and monoclonal antibodies have been demonstrated to improve clinical outcomes in patients with metastatic colorectal cancer (MCRC). Although these combination treatment strategies are safe and effective in first-line treatment for MCRC, little is known about [...] Read more.
Background: Combinations of chemotherapy regimens and monoclonal antibodies have been demonstrated to improve clinical outcomes in patients with metastatic colorectal cancer (MCRC). Although these combination treatment strategies are safe and effective in first-line treatment for MCRC, little is known about their economic consequences and resource allocation implications. In the present study, we evaluated the cost-effectiveness of bevacizumab plus FOLFIRI, cetuximab plus FOLFIRI, and panitumumab plus folfiri for patients with KRAS wild-type MCRC. Methods: A Markov model simulated the lifetime patient outcomes and costs of each first-line treatment strategy and subsequent lines of treatment from the perspective of the health care payer in Ontario. The model was parameterized using data from the Ontario Cancer Registry, Ontario health administrative databases, and published randomized control trials. Patient outcomes were measured in quality-adjusted life years (QALYS), and costs were measured in monetary terms. Costs and outcomes were both discounted at 5% and expressed in 2012 Canadian dollars. Results: For MCRC patients with KRAS wild-type disease, the treatment strategy of bevacizumab plus FOLFIRI was found to dominate the other two first-line treatment strategies. Sensitivity analyses revealed that the incremental cost-effectiveness ratio values were sensitive to the effectiveness of treatment, the costs of bevacizumab and cetuximab, and health utility values. Conclusions: Evidence from Ontario showed that bevacizumab plus FOLFIRI is the cost-effective first-line treatment strategy for patients with KRAS wild-type MCRC. The panitumumab plus FOLFIRI and cetuximab plus FOLFIRI options were both dominated, but the cetuximab plus FOLFIRI strategy must be further investigated given that, in the sensitivity analyses, the cost-effectiveness of that strategy was found to be superior to that of bevacizumab plus FOLFIRI under certain ranges of parameter values. Full article
Article
Protective Skin Care Behaviors in Cancer Survivors
Curr. Oncol. 2014, 21(4), 531-540; https://doi.org/10.3747/co.21.1893 - 01 Aug 2014
Cited by 8 | Viewed by 120
Abstract
(1) Purpose: Research suggests that physicians neglect preventive care for cancer survivors. A survivor’s self-motivation with respect to preventive care is unknown. Using protective skin care as a proxy, our aims were to characterize preventive care in cancer survivors and to identify [...] Read more.
(1) Purpose: Research suggests that physicians neglect preventive care for cancer survivors. A survivor’s self-motivation with respect to preventive care is unknown. Using protective skin care as a proxy, our aims were to characterize preventive care in cancer survivors and to identify factors associated with appropriate prevention. (2) Methods: Using data from the 2009 U.S. Health Information National Trends Survey, we compared preventive skin care patterns in cancer survivors and non-cancer patients. Primary endpoints were the use of sunscreens, long-sleeved shirts, hats, and shade. (3) Results: We identified 179 early cancer survivors (10 years), and 5951 non-cancer patients. The use of sunscreens (60%), long-sleeved shirts (88%), hats (58%), and shade (68%) was suboptimal. Overall, cancer survivors were not more likely to adhere to preventive care (p = 0.89). A composite score showed a significant difference between the cancer survivor groups (p < 0.01) whereby intermediate survivors reported the best preventive practices. (4) Conclusions: A prior diagnosis of cancer does not appear to increase personal compliance with cancer prevention. Reasons for this poor engagement are not clear. Targeted strategies to increase self-motivation might improve preventive practices in cancer survivors. Full article
Commentary
Thoughts on Jim Flaherty. When Should Physicians Retire?
Curr. Oncol. 2014, 21(4), 528-530; https://doi.org/10.3747/co.21.2142 - 01 Aug 2014
Cited by 1 | Viewed by 93
Abstract
As I reflect on my almost two decades in politics, I am proud of the accomplishments of the governments I was part of....[...] Full article
Article
Adjuvant and Neoadjuvant Treatment for Rectal Cancer, Colon Cancer, and Non-Small-Cell Lung Cancer in Older Patients
Curr. Oncol. 2014, 21(4), 193-195; https://doi.org/10.3747/co.21.2109 - 01 Aug 2014
Cited by 1 | Viewed by 109
Abstract
Evidence-based treatment guidelines exist to improve quality of care for patients and are based on randomized trials that show evidence of benefit.[...] Full article
Article
The Role of Palliative Chemotherapy in Hospitalized Patients
Curr. Oncol. 2014, 21(4), 187-192; https://doi.org/10.3747/co.21.1989 - 01 Aug 2014
Cited by 15 | Viewed by 123
Abstract
Background: Hospitalized patients with advanced cancer often have a poor performance status, which is considered a relative contraindication to cytotoxic chemotherapy. We investigated outcomes in hospitalized solid tumour oncology patients who received palliative chemotherapy (pct). Methods: With ethics approval, [...] Read more.
Background: Hospitalized patients with advanced cancer often have a poor performance status, which is considered a relative contraindication to cytotoxic chemotherapy. We investigated outcomes in hospitalized solid tumour oncology patients who received palliative chemotherapy (pct). Methods: With ethics approval, we performed a single-institution chart review of all patients hospitalized on our oncology unit who received pct between April 2008 and January 2010. Patient demographics, reasons for admission, cancer type, prior therapy, and administered chemotherapy were recorded. The primary endpoint was median survival from date of inpatient chemotherapy until death or last known follow up. We also investigated place of discharge and whether patients received additional therapy. Results: During the study period, 199 inpatients received pct. Median age was 61 years; 59% of the patients were women. Most had been admitted with dyspnea (31%) or pain (29%) as the dominant symptom. Common cancers represented were breast (23%), small-cell lung cancer (sclc, 22%), non-small-cell lung cancer (nsclc, 16%), and colorectal cancer (9%). Most patients (67%) were receiving first-line chemotherapy. Median overall survival duration was 4.5 months, and the 6-month survival rate was 41%. The longest and shortest survivals were seen in the sclc and nsclc groups (7.3 and 2.5 months respectively). Factors significantly associated with shorter survival were baseline hypoalbuminemia and therapy beyond the first line. In this cohort, 77% of patients were discharged home, and 72% received further chemotherapy. Conclusions: Despite a short median survival, many patients are well enough to be discharged home and to receive further chemotherapy. The development of risk models to predict a higher chance of efficacy will have practical clinical utility. Full article
Article
Factors Associated with Delayed Time to Adjuvant Chemotherapy in Stage iii Colon Cancer
Curr. Oncol. 2014, 21(4), 181-186; https://doi.org/10.3747/co.21.1963 - 01 Aug 2014
Cited by 13 | Viewed by 133
Abstract
(1) Background: Adjuvant chemotherapy started more than 56 days after colon cancer resection has been associated with lesser overall survival among patients with stage iii colon cancer. The objective of the present population-based study was to determine, in referred patients with resected [...] Read more.
(1) Background: Adjuvant chemotherapy started more than 56 days after colon cancer resection has been associated with lesser overall survival among patients with stage iii colon cancer. The objective of the present population-based study was to determine, in referred patients with resected stage iii colon cancer, factors associated with delayed time to adjuvant chemotherapy (ttac), defined as more than 56 days from the date of surgery. (2) Methods: Eligible patients had been diagnosed with stage iii colon cancer and had received at least 1 cycle of adjuvant chemotherapy at one of the four regional cancer treatment sites during 2008–2009. Prognostic and treatment information was prospectively collected through the BC Cancer Agency’s GI Cancers Outcomes Unit, and Charlson comorbidity score was retrospectively determined by chart review. Chi-square and Wilcoxon rank-sum tests were used to measure associations between the timing of adjuvant chemotherapy and select prognostic and treatment variables. (3) Results: Median ttac from surgery for the 395 included patients was 58 days, with 54% of the patients receiving adjuvant chemotherapy beyond the recommended 56 days. On multivariate analysis, only treatment at the highest-volume site was independently associated with delayed ttac. Comorbidity index, age, performance status, T stage, tumour location, and oral chemotherapy (compared with intravenous) were not independently associated with delayed ttac. Delays were observed during each interval associated with the patient’s transition from surgery to first cycle of adjuvant chemotherapy. (4) Conclusions: More than half the patients failed to receive adjuvant chemotherapy within the recommended ttac of 56 days. Delayed ttac was associated with process-related delays rather than with patient- or disease-related factors. Efforts to improve timely referral, triage of consultations, and chemotherapy wait lists are required. Full article
Article
The Influence of Chemotherapy-Induced Neurotoxicity on Psychological Distress and Sleep Sisturbance in Cancer Patients
Curr. Oncol. 2014, 21(4), 174-180; https://doi.org/10.3747/co.21.1984 - 01 Aug 2014
Cited by 46 | Viewed by 259
Abstract
(1) Purpose: In the present study, we aimed to investigate the effects of chemotherapy-induced peripheral neurotoxicity (cipn) on psychological distress and sleep quality in cancer patients. (2) Methods: A total of 706 cancer patients were interviewed for the study. [...] Read more.
(1) Purpose: In the present study, we aimed to investigate the effects of chemotherapy-induced peripheral neurotoxicity (cipn) on psychological distress and sleep quality in cancer patients. (2) Methods: A total of 706 cancer patients were interviewed for the study. In the 4th week of treatment, patient cipn was measured using the Patient Neurotoxicity Questionnaire (pnq). The sleep quality and psychological distress of patients were measured using the Pittsburgh Sleep Quality Index (psqi), the Distress Thermometer (dt), and the Hospital Anxiety and Depression Scale (hads). Multiple logistic regression was applied to determine the independent effects of cipn on psychological distress and sleep disturbance in the patients. (3) Results: These correlation coefficients were obtained: 0.387 (p < 0.0001) between the pnq total score and the dt score, 0.386 (p < 0.0001) between the pnq total score and the hads Depression score, 0.379 (p < 0.0001) between the pnq total score and the hads Anxiety score, and 0.399 (p < 0.0001) between the pnq total score and the psqi global score. The prevalence rates of distress, depression, anxiety, and poor sleep quality in the five pnq grades were statistically significantly different (p < 0.0001). After controlling for age, sex, education level, social supports, fatigue, disease stage, and tumour site, the pnq grades were found to be associated with depression (p < 0.0001), anxiety (p < 0.0001), and poor sleep quality (p < 0.0001). (4) Conclusions: Chemotherapy-induced peripheral neurotoxicity negatively affects psychological distress and sleep quality in cancer patients treated with chemotherapy. High pnq grades were significantly associated with poor psychological status and sleep quality. Our results emphasize the importance of assessing peripheral neuropathies during chemotherapy and of adjusting treatment plans based on assessment results. Full article
Article
Information Needs and Sources of Information for Patients during Cancer Follow-Up
Curr. Oncol. 2014, 21(4), 165-173; https://doi.org/10.3747/co.21.1932 - 01 Aug 2014
Cited by 95 | Viewed by 616
Abstract
(1) Background: Now more than ever, cancer patients want health information. Little has been published to characterize the information needs and preferred sources of that information for patients who have completed cancer treatment. (2) Methods: We used a nationally validated instrument [...] Read more.
(1) Background: Now more than ever, cancer patients want health information. Little has been published to characterize the information needs and preferred sources of that information for patients who have completed cancer treatment. (2) Methods: We used a nationally validated instrument to prospectively survey patients attending a cancer clinic for a post-treatment follow-up visit. All patients who came to the designated clinics between December 2011 and June 2012 were approached (N = 648), and information was collected only from those who agreed to proceed. (3) Results: The 411 patients who completed the instrument included individuals with a wide range of primary malignancies. Their doctor or health professional was overwhelmingly the most trusted source of cancer information, followed by the Internet, family, and friends. The least trusted sources of information included radio, newspaper, and television. Patients most preferred to receive personalized written information from their health care provider. (4) Conclusions: Cancer survivors are keenly interested in receiving information about cancer, despite having undergone or finished active therapy. The data indicate that, for patients, their health care provider is the most trusted source of cancer information. Cancer providers should ask patients about the information they want and should direct them to trusted sources. Full article
Editorial
Venous Thromboembolism in Cancer Patients: A Call for More Awareness
Curr. Oncol. 2014, 21(4), 163-164; https://doi.org/10.3747/co.21.2175 - 01 Aug 2014
Cited by 1 | Viewed by 98
Abstract
As elegantly reported by Drs. Shea–Budgell, Donnellan, and colleagues in the last issue of Current Oncology, venous thromboembolism (VTE) is a frequent clinical problem in cancer patients1,2.[...] Full article
Editorial
Biologic, Psychological, and Social Health Needs in Cancer Care: How Far Have We Come?
Curr. Oncol. 2014, 21(4), 161-162; https://doi.org/10.3747/co.21.2156 - 01 Aug 2014
Cited by 2 | Viewed by 101
Abstract
In 2007, the U.S. Institute of Medicine delivered a report titled Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs1, in which gaps in the provision of psychosocial care for cancer patients were identified.[...] Full article
Editorial
Reflecting on Inpatient Palliative Chemotherapy—Is There Ever a “Right Place” at the “Right Time”?
Curr. Oncol. 2014, 21(4), 158-160; https://doi.org/10.3747/co.21.2126 - 01 Aug 2014
Viewed by 86
Abstract
Early in clinical training, medical oncologists are taught that the goals of any palliative oncologic therapy include symptom control, quality-of-life improvement through disease stabilization, and prolongation of progression-free survival.[...] Full article
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