Search Results (87)

Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. While most diagnoses occur in outpatient settings, a subset of cases are incidentally identified during emergency department (ED) visits. The clinical characteristics and treatment decisions of these patients, particularly in relation to social background factors such as living situation and access to primary care, remain poorly understood. Methods: We conducted a retrospective study of patients diagnosed with malignancies in the ED of a single institution between April 2018 and December 2021. Patients diagnosed with lung cancer within 60 days of an ED visit were included. Data on demographics, disease status, treatment decisions, and background factors—including whether patients lived alone or had a primary care physician (PCP)—were extracted and analyzed. Results: Among 32,108 patients who visited the ED, 148 were diagnosed with malignancy within 60 days; 23 had lung cancer. Of these, 69.6% had metastatic disease at diagnosis, and 60.9% received active treatment (surgery or chemotherapy). No significant associations were observed between the extent of disease and either living arrangement or PCP status. However, the presence of a PCP was significantly associated with the selection of best supportive care (p = 0.023). No significant difference in treatment decisions was observed based on age (cutoff: 75 years). Conclusions: Although social background factors such as living alone were not significantly associated with cancer stage or treatment choice, the presence of a primary care physician was associated with a higher likelihood of best supportive care being selected. This may indicate that patients with an established PCP have more clearly defined care goals at the end of life. These findings suggest that primary care access may play a role in shaping end-of-life care preferences, highlighting the importance of personalized approaches in acute oncology care. Full article

Background and Objectives: A commonly observed phenomenon in outpatient oncological patients is the appearance of hypotension not attributable to other causes in hypertensive patients undergoing oncological treatment. Once antihypertensive treatment is discontinued, patients remain normotensive after the oncological treatment ends. The objective of this research is to analyze our experience with this phenomenon and try to provide an explanation. Materials and Methods: A retrospective case-control study was conducted with a total sample of 302 hypertensive oncological patients, with cases presenting symptomatic hypotension and controls not. Descriptive and inferential statistics were performed, with the latter focusing on studies by Odds Ratio, Chi-square, Z test for comparison of two proportions, and multivariate regression. Results: Regarding the results obtained, it is noteworthy that in both the univariate and multivariate models, treatment with cisplatin showed statistical significance (Univariate, OR 3.06 (CI 1.82–5.11). Z 4.45, p < 0.0001; multivariate, p < 0.001, Nagelkerke R2 74.8%). Cisplatin treatment and the study phenomenon were correlated with magnesium levels (Chi-square 8.2, p = 0.017), relating hypotension to hypertensive patients with low magnesium levels. Conclusions: CDDP treatment is associated with hypotension or normotension in previously hypertensive cancer patients. This may be related to peripheral vascular fragility induced by oncological drugs, leading to reduced vascular resistance. Although magnesium deficiency is generally linked to hypertension, chemotherapy-related shifts in magnesium levels due to impaired renal handling may play a role. These findings may help improve the understanding of blood pressure regulation in oncology patients. Full article

Background and Objectives: The COVID-19 pandemic disrupted cancer care, prompting adaptations to reduce patient exposure while preserving treatment efficacy. This retrospective observational study compared a weekly cisplatin and 5-fluorouracil (5-FU) regimen to the standard monthly regimen for neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma. Materials and Methods: This single-center retrospective study included 91 patients, divided into two cohorts: weekly chemotherapy (n = 30) and standard chemotherapy (n = 61). Treatment assignment was based on hospital policy changes during the pandemic, with weekly outpatient chemotherapy implemented after November 2022 to conserve inpatient resources. All patients received radiotherapy at 50 Gy in 25 fractions. The weekly regimen consisted of cisplatin 20 mg/m² and 5-FU 800 mg/m², administered over 1–2 h weekly, while the standard regimen administered the same doses over four consecutive days on weeks 1 and 5. Primary endpoints were pathologic complete response (pCR), progression-free survival (PFS), and overall survival (OS). Results: The response rates were similar between groups (weekly: 86.7% vs. standard: 90.2%; p = 0.724). The weekly regimen group showed a higher pCR (40.0% vs. 26.2%; p = 0.181) and significantly lower recurrence (26.7% vs. 52.5%; p = 0.020). Mortality was also reduced in the weekly group (6.7% vs. 34.4%; p = 0.004), though the follow-up duration was shorter (10.6 vs. 22.8 months; p < 0.001). Conclusions: In this retrospective observational study, weekly cisplatin and 5-FU demonstrated comparable efficacy to the standard regimen, with potential advantages in reducing recurrence and mortality. This modified approach may be a viable alternative for maintaining oncologic outcomes while minimizing the burden on healthcare systems during pandemic conditions, although prospective validation is needed. Full article

Background/Objectives: The main objective of the study is to assess the clinical utility of microbial cell-free DNA (mcfDNA) in neutropenic patients diagnosed with acute myeloid leukemia (AML) undergoing chemotherapy in the outpatient setting. Neutropenia is a common complication in this patient cohort and enhances the risk of fatal opportunistic bacterial and fungal infections. Accurate and timely diagnosis of these infections in outpatient asymptomatic individuals is critical. Methods: Fourteen patients were studied in this prospective observational case series. Traditional blood cultures (BCs) were obtained when clinically indicated and blood samples were collected for plasma mcfDNA metagenomic sequencing up to two times a week at outpatient oncology appointments. Results were compared in identifying potential infectious agents. Results: BCs identified pathogens in only two patients, despite several cases where infection was suspected. In contrast, mcfDNA testing detected pathogens in 11 of the 14 patients, including bacteria, such as Staphylococcus aureus, and invasive fungi, such as Candida and Aspergillus species, and Pneumocystis jirovecii. Conclusions: In the outpatient setting, mcfDNA surveillance offers a more reliable method for detecting pathogens. This approach identified actionable microbiologic results in immunocompromised individuals who did not meet standard clinical criteria for suspicion of infection. Further research is required to confirm the potential of mcfDNA surveillance in an outpatient setting to guide more accurate treatment decisions, reduce extensive clinical investigations, and improve neutropenic patient outcomes. Full article

This retrospective cohort study evaluated characteristics, treatment patterns, and clinical outcomes in adults with locally advanced/metastatic urothelial carcinoma (la/mUC) receiving first-line (1L) systemic treatment with or without avelumab 1L maintenance (1LM) between January 2020 and July 2023. The index date was the first date with a claim for 1L systemic therapy after a la/mUC diagnosis. Patients with continuous health plan enrollment for ≥6 months before and ≥1 month after the index date were identified from Carelon Research’s Healthcare Integrated Research Database. Of 2820 patients receiving 1L treatment, 37.0% received platinum-based chemotherapy (PBC); 39.0%, immuno-oncology (IO) monotherapy; and 24.0%, other therapies. Renal disease and other comorbidities influenced 1L regimen choice. Healthcare resource utilization (HCRU) and costs were reported for patients receiving second-line (2L) treatment. HCRU was high in 32.8% of patients (926 of 2820) who received 2L treatment. Median all-cause direct medical costs per patient per month were USD 15,859, USD 19,781, USD 11,346, and USD 9516 for 1L PBC, 1L PBC + avelumab 1LM, 1L IO monotherapy, and 1L other therapies, respectively. Most direct healthcare costs were attributed to all-cause outpatient visits. Full article

Background/Objectives: This prospective study investigated the impact of high-dose chemotherapy and autologous stem cell transplantation (ASCT) on anti-COVID-19 antibody levels in previously vaccinated multiple myeloma (MM) patients with confirmed antibody response (AR). Methods: All patients underwent at least a two-dose regimen mRNA vaccination and later received a high-dose melphalan conditioning regimen and ASCT. Results: Fourteen MM patients with confirmed AR underwent a total of nineteen ASCT reinfusions; their median age was 55 (34–67). The study found a significant and progressive decrease in antibody levels after ASCT, from 311 BAU/mL at baseline to 276 BAU/mL and 188 BAU/mL after one and three months, respectively, with a median anti-COVID-19 antibody level reduction of 39% (range 16–66%) that was statistically significant (p = 0.014) using the Friedman test. However, the third “booster” vaccination post-ASCT improved the humoral response at six months in nine patients (50% response rate) and corrected, at least in part, the negative impact of high-dose chemotherapy (p = 0.597). Despite the antibody decline, three patients who contracted COVID-19 after ASCT experienced mild, outpatient-managed infections, suggesting sufficient immune response. Furthermore, booster doses increased the proportion of high-responders (AR > 500 BAU/mL) post-ASCT from 22% to 55% (5/9 patients) at three and six months, respectively. Conclusions: The study concludes that ASCT negatively affects the humoral response, but booster vaccination can improve it, and residual antibodies may prevent severe COVID-19 in these vulnerable patients. Full article

Breast cancer is the most common cancer in women worldwide. Anthracyclines (doxorubicin, epirubicin, daunorubicin, idarubicin) are among the most used drugs for the treatment of breast cancer. Unfortunately, anthracyclines cause cardiotoxicity, which is a limiting factor for its use, and the lifetime cumulative dose of anthracyclines is the major risk factor for cardiotoxicity. In our study, we focused on acute and subacute heart damage. One of the main factors is a genetic predisposition, which determines individual susceptibility to anthracycline cardiotoxicity. The main idea of this study was, for the first time, to evaluate drug metabolism-related genes as a risk factor for developing cardiovascular toxicity in breast cancer patients. The main objective of our study was to identify the impact of drug metabolism-related gene SNPs on the development of subclinical heart damage during and/or after doxorubicin-based chemotherapy in breast cancer patients. The data of 81 women with breast cancer treated with doxorubicin-based chemotherapy in an outpatient clinic were analyzed, and SNP RT-PCR tests were performed. The drug metabolism-related gene variants SULT2B1 rs10426377, UGT1A6 rs17863783, CBR1 rs9024, CBR3 rs1056892, NCF4 rs1883112, and CYBA rs1049255 did not reach a statistically important impact on ABCC in multivariate logistic regression analysis. However, we identified that NCF4 rs1883112 had a risk reduction tendency for ABCC (OR = 0.49, 95% CI 0.27–0.87, p = 0.015). Our findings suggest that some SNPs, such as NCF4 rs1883112, may be associated with a reduced risk of cardiotoxicity, while no variants in this study showed a statistically significant increased risk. Even though, NCF4 rs1883112 showed a risk reduction tendency, suggesting the potential for personalized risk stratification. We can conclude that multiple genes are involved in ABCC, with different impacts, and it is unlikely that there is a single driver gene in ABCC pathogenesis. Full article

Background/Objectives: Sparse data exist identifying racial/ethnic outcome disparities among patients with lung cancer, specifically regarding healthcare utilization patterns, such as emergency department visits and outpatient follow-ups. We aimed to utilize our large, multicenter, and ethnically diverse integrated health system to assess for such disparities among patients undergoing pulmonary resections for lung cancer. Methods: The cohort comprised all patients undergoing pulmonary resections for lung cancer at our integrated health system from 1 January 2016 to 31 December 2020. Outcomes including the length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day overall mortality were compared by race/ethnicity. Multivariable logistic and linear models adjusted for age, sex, body mass index (BMI), Charlson Comorbidity Index scores, procedure approach, neighborhood deprivation index (NDI), cancer stage, receipt of adjuvant chemotherapy, and insurance. Results: Of the 645 included patients, non-Hispanic White patients tended to be older and live in the least deprived neighborhoods. Among each race/ethnicity, the percentage of patients insured by Medicaid was highest among Asian patients. On bivariate analysis, only the outcome of surgical outpatient appointments within 30 days had differing distributions by race/ethnicity with no other significant associations between race/ethnicity and other outcomes; however, multivariable analysis showed Asian patients having lower odds of 30d-ED (adjusted odds ratio 0.51; 95% CI 0.27–0.98) while those with Medicaid insurance had higher odds of 30d-ED (adjusted odds ratio 3.29; 95% CI 1.26–8.59). Conclusions: Despite parity across clinical outcomes, some patient encounter-related differences still exist within our system. To better understand racial/ethnic disparities in care, systems must track such disparities in addition to clinical outcomes. Full article

Peritoneal carcinomatosis is a common presentation found in advanced-stage gastrointestinal (GI) and gynecological cancers. Combined cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant survival benefits for select patients. CRS/HIPEC is not currently provided in Newfoundland and Labrador (NL). The Canadian HIPEC Collaborative Group recommends that centres complete a minimum of one case monthly to maintain competency and achieve good outcomes. Thus, we aimed to demonstrate that the annual patient volume in NL justifies the feasibility of implementing a combined surgical and gynecological oncology CRS/HIPEC program. Methods: A retrospective chart review of the NL Cancer Care Registry identified patients with stage IV colorectal, appendiceal, or gastric cancer and stage III to IV epithelial ovarian cancer over a 1-year period (1 January 2020–31 December 2020) to identify the number of patients meeting the criteria for CRS/HIPEC and/or those referred out of province to receive the treatment. The results are presented as proportions and percentages. Results: Thirty-one patients were eligible to receive CRS/HIPEC during the study period (11 GI, 20 gynecological). Of the GI patients, 63% were referred out of province for the procedure. Gynecological patients underwent CRS and systemic therapy +/− outpatient intraperitoneal chemotherapy in NL. Conclusions: Allowing patients to receive this standard of care treatment near home reduces financial, social, and emotional stressors. Our results confirm a sufficient patient volume to support a combined CRS/HIPEC program in NL. The implementation of this program will require multidisciplinary collaboration, specialized training, equipment, and protocol development. Full article

Background: Peripherally Inserted Central Catheters (PICCs) and midline catheters are crucial for chemotherapy and supportive care in cancer patients. Their use requires ongoing monitoring to prevent late complications such as infections, dislodgements, and replacements. The COVID-19 pandemic challenged healthcare systems, potentially increasing these complications due to reduced outpatient services and limited specialized personnel. Objectives: This study compared the incidence of late complications associated with PICCs and midline catheters in cancer patients during and after the COVID-19 pandemic. Methods: A retrospective observational study was conducted at a Cancer Center in Italy from March 2020 to April 2024. Catheter-related complications were divided into two cohorts: during the pandemic (March 2020–March 2022) and post-pandemic (April 2022–April 2024). The primary outcome was the incidence of late complications requiring device removal, categorized as infections, dislodgements, and replacements. Statistical analyses included the Chi-squared test for categorical variables and the Kruskal–Wallis test for continuous variables. Results: Of 4104 PICC and midline catheter placements, 2291 removals were recorded, with 550 (24%) due to late complications—404 during the pandemic and 146 post-pandemic (p < 0.001). Suspected infections were the most frequent complication, significantly higher during the pandemic (p < 0.001). Dislodgements and replacements also decreased markedly post-pandemic. Limited outpatient services and disrupted healthcare workflows likely contributed to higher complication rates during the pandemic. Conclusions: The COVID-19 pandemic negatively impacted catheter management in cancer patients, increasing late complications. The post-pandemic decline highlights the importance of consistent care, infection prevention, remote monitoring, and stronger healthcare resilience to reduce risks in future crises. Full article

Background: Chemotherapy-induced peripheral neuropathy (CIPN) affects 20–85% of individuals exposed to neurotoxic chemotherapeutic agents. Perineural electrical dry needling (PEDN) and neural mobilization (NM) interventions may be beneficial in the management of chronic neurogenic pain; however, there is a paucity of research on the efficacy of both interventions for CIPN. Methods: Three patients were referred to an outpatient physical therapy clinic with chronic neuropathic pain associated with CIPN. Each underwent PEDN and NM twice weekly until goals were met or progress stalled. The primary outcome measure was the Numeric Pain Rating Scale (NPRS). Secondary outcomes included the Global Rating of Change (GROC) and the Lower Extremity Functional Scale (LEFS). All outcome measures were assessed at evaluation and discharge. Results: At discharge, patients A and B exceeded the minimum clinically important difference (MCID) for the primary and secondary outcome measures, indicating decreased neuropathic pain and improved lower extremity function. Patient C improved in all outcome measures but only experienced clinically meaningful changes in the NPRS and LEFS, not the GROC. Conclusions: Following 4–8 sessions of PEDN and NM, three patients with CIPN demonstrated clinically meaningful improvements in chronic lower extremity neuropathic pain and function. PEDN and NM may be beneficial in the management of patients presenting with chronic neuropathic pain secondary to CIPN. Full article

Background and clinical significance: Large-cell neuroendocrine carcinoma (LCNEC) of the cervix is considered a rare type of cancer: it represents <1% of invasive cervical cancers. The optimal treatment protocol is not fully established because of its rarity and diagnostic challenges. Case Presentation: A 72-year-old Asian female presented to our outpatient clinic with postmenopausal vaginal spotting for 1 month. Vaginal sonography revealed a cervical tumor of 2.7 cm in diameter with hypervascularity. Tumor markers such as CA 125, CA 19-9, carcinoembryonic antigen, and squamous cell carcinoma antigen all showed no abnormality. Due to high suspicion of cervical cancer, a pap smear and endocervical curettage were performed and confirmed the diagnosis of LCNEC. A positron emission tomography–computed tomography scan demonstrated a glucose hypermetabolic lesion in the mid-pelvic region, localized to the uterus, consistent with LCNEC. Surgery with radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection was performed. The patient was finally diagnosed with pT1b2N1mi, FIGO IIIC1. Immunohistochemical stain shows that the neoplastic cells were CK (+), p63 (−), p16 (−), CEA (−), vimentin (−), ER (−), WT-1 (−), p53 (−), and CD56 (+), with a high Ki67 index (75%). Concurrent chemotherapy with cisplatin and radiotherapy was performed. Four cycles of etoposide and cisplatin were planned. A 3-month follow-up of this patient revealed stable tumor marker levels. Conclusions: This case highlights the diagnostic challenges and aggressive nature of LCNEC of the cervix, emphasizing the need for a standardized treatment approach to improve patient outcomes. Full article

Background: Negative Pressure Wound Therapy (NPWT) has proven to be an effective intervention in preventing postoperative complications across a range of surgical specialties, including orthopedics, vascular, and abdominal surgery. This study aimed to assess the prophylactic use of NPWT dressing compared to the Standard of Care (SOC) in high-risk patients undergoing oncoplastic and reconstructive breast surgery. Materials and Methods: This preliminary case-control study included 23 high-risk patients, enrolled between September 2023 and February 2024, at San Martino Polyclinic Hospital, Genoa. High-risk patients were defined as those with one or more of the following risk factors: obesity, prior radiotherapy, neoadjuvant chemotherapy, smoking history, diabetes, or corticosteroid use. The surgical procedures evaluated in this study included mastectomy with immediate implant-based breast reconstruction, reduction mammoplasty, and oncoplastic breast surgery following local excision or quadrantectomy. NPWT dressing was applied immediately after skin closure in the operating room, replaced after 2–3 days, and removed 7 days post-procedure. Surgical outcomes assessed included skin flap necrosis, wound dehiscence, infection, implant loss, and delays in adjuvant therapy. Results: A total of 23 patients, aged 45 to 57 years, were enrolled. Eleven patients received NPWT dressing, while twelve were treated with SOC. No complications occurred in the NPWT dressing group, whereas four complications were observed in the SOC group. Of the control group, three patients developed infections, which were treated with oral antibiotics for two, while one required implant replacement surgery. The remaining patient in the control group experienced wound dehiscence, which was successfully managed conservatively on an outpatient basis. Discussion and Conclusions: Our findings suggest that prophylactic NPWT dressing in oncoplastic and reconstructive breast surgery results in a significantly lower rate of wound-related complications. Although this is a preliminary study, it provides a foundation for further research in a larger cohort. These results also prompt a discussion of the cost-effectiveness of NPWT dressing relative to the SOC, given its higher cost. Full article

This study characterizes real-world treatment patterns and economic and healthcare resource utilization (HCRU) burden associated with first-line (1L) treatment of metastatic non-small cell lung cancer (NSCLC) without actionable alterations in the United States. This retrospective observational study used Optum Clinformatics^® data. A total of 15,659 patients with metastatic NSCLC who started 1L treatment between January 2020 and March 2023 were included (52% male; mean age at the start of 1L treatment 71.7 years; 86% Medicare Advantage). The most frequent 1L regimens were immune checkpoint inhibitor (ICI) + platinum-based chemotherapy (PBCT) (47%), PBCT only (26%), and ICI only (20%). The median 1L treatment duration was 4.2 months (range 2.7–6.5) and was shorter with chemotherapy-only regimens. Outpatient visits accounted for the majority of HCRU (mean 6.6 visits per patient per month [PPPM]). Outpatient, inpatient, and emergency department visits were highest for chemotherapy-only regimens. Mean total (all-cause) healthcare costs were $32,215 PPPM and were highest for ICI + chemotherapy ($34,741–38,454 PPPM). Inpatient costs PPPM were highest for PBCT ($4725) and ICI + non-PBCT ($4648). First-line treatment of metastatic NSCLC without actionable alterations imposes a notable HCRU and cost burden, underscoring the need for better treatment options to improve outcomes and reduce economic impact. Full article

Febrile neutropenia (FN) is a serious complication of chemotherapy that often leads to hospitalization in cancer patients. It is now well-established that carefully selected patients can be safely treated on an outpatient basis. The objective of this study was to assess the number and proportion of patients hospitalized for FN in a university hospital setting who would have met the low-risk criteria for FN, and whether these patients experienced favorable outcomes during hospitalization. We conducted a retrospective study of all patients admitted for FN at three hospitals in Quebec City between 1 January 2018 and 31 December 2019. Patients with leukemia and those who had undergone stem cell transplants were excluded. A retrospective chart review was performed to establish the Multinational Association for Supportive Care in Cancer (MASCC) score for each patient. Based on predefined criteria, we also determined whether the clinical course was favorable or unfavorable. A total of 177 hospitalizations met our inclusion criteria. We found that 101/177 (57.1%) of the hospitalized patients met the low-risk FN criteria according to their MASCC score. Among these, 74/177 (41.8%) met all the criteria for outpatient treatment. The majority of these patients had a favorable outcome (70/74, 94.6%). In contrast, among patients who did not meet the eligibility criteria for outpatient treatment, 44.7% (46/103) experienced favorable outcomes during their hospitalization. These data highlight the importance of patient selection for outpatient care. Full article