Care Cancer Center Research Articles

A Study On Clinical Response And Toxicity In Locally Advanced Head And Neck Cancers

Background: Treatment of locally advanced head and neck cancer is a clinical challenge and requires aggressive and concerted measures. Radiotherapy with concurrent chemotherapy is the standard curative treatment strategy for the locally advanced head and neck cancer. The ultimate aim of radiation therapy is the maximum local control of the tumour with minimal toxicity. Objectives: To assess the clinical response of treatment using Response Evaluation Criteria In Solid Tumors (RECIST) (version1.1) criteria. To assess the toxicities among the study population during chemo-radiation. Methodology: Hospital based observational prospective study was conducted at Department of Radiation oncology, in a Tertiary cancer care centre among Head and neck Cancer patients. Results: Most common site of head and neck cancer in the study was oral cavity followed by oropharynx and hypo pharynx. At the end of 4th week 58.33% had grade1 and 33.33% grade 2 mucositis. Response to treatment was found to be statistically significant. Conclusion: Mucositis was significant toxicities during treatment followed by dysphagia and radiation dermatitis. Complete response is seen in 50% of the patients clinically and radiologically. No patient died during treatment or at follow up.

Optimising Initial Pain Management and its Influence on Compliance and Treatment Abandonment in Newly Diagnosed Head-and-Neck Cancer Patients: A Real-world Experience

Objectives: Improper pain management is a significant contributing factor and a potential correctable factor for low cure rates of head-and-neck cancer (HNC) patients. This study aims to assess the significance of the Quantitative Improvement Programme (QIP) in evaluating pain levels and its correlation with treatment compliance in recently diagnosed HNC patients undergoing curative treatment at a surgical oncology outpatient department (OPD). The study was conducted from January 2022 to August 2023 at a tertiary cancer care centre in Northeast India. Materials and Methods: This cohort study used secondary data. We implemented the QIP in December 2022. There were 204 patients in the non-implemented group (NIG) (January 2022 to December 2022), and 110 patients were in the implemented group (IG) (January 2023 to August 2023). Results: The study included 314 HNC patients. The mean age was 57 years, and the male-to-female ratio was 3:1. More than two-thirds (70%) of patients presented with pain. Pain assessment was carried out in 63% (120) of patients in the NIG and 86% (95) patients in the IG and was found to differ significantly (P < 0.0001) between the groups. Treatment abandonment (default before starting treatment) was reported amongst 23% in the NIG, compared to 16% in the IG. 41% (85) of patients in the NIG and 39% (43) in the IG reported non-compliance with treatment (breaks after commencing treatment). There were only 7% of patients from the NIG and 4% of patients from the IG who experienced unfavourable events (relapse, death and treatment failure). Of the various factors analysed, we found age as the single most significant predictor of compliance to treatment (age 18–39 years: Risk ratio [RR] = 2.482, 95% confidence interval [CI]: 0.88, 6.99 [P < 0.08]; age group 40–64 years: RR = 0.54, 95% CI: 0.33, 0.90 [P < 0.01]). Conclusion: QIP for pain management resulted in efficient pain assessment, enhanced patient compliance and reduced rates of treatment abandonment. The study findings mandate QIP for effective pain management of HNC patients in all cancer centres.

Radiation Myelitis Risk After Hypofractionated Spine Stereotactic Body Radiation Therapy

Stereotactic body radiation therapy (SBRT) for spinal metastases improves symptomatic outcomes and local control compared to conventional radiotherapy. Treatment failure most often occurs within the epidural space, where dose is constrained by the risk of radiation myelitis (RM). Current constraints designed to prevent RM after spine SBRT are derived from limited data. To characterize the risk of RM after spine SBRT and to update the dosimetric constraints for preventing it. This cohort study was conducted in a single tertiary cancer care center with patients treated for spinal metastases from 2014 to 2023. All included participants had undergone spine SBRT, had a minimum of 1-month follow-up with magnetic resonance imaging (MRI), a maximal cord dose to a voxel (Dmax) greater than 0 Gy, and no overlapping prior radiotherapy. In all, 2051 patients received SBRT to 2835 spinal metastases (levels C1-L2) during the study period. Three-fraction spine SBRT to a prescription dose of 27 to 36 Gy. RM defined as radiographic evidence of spinal cord injury in the treatment field, classified as grade (G) 1 to G4 or G3 to G4 per the Common Terminology Criteria for Adverse Events, version 5.0. Multiple dosimetric parameters of the true spinal cord structure were assessed for an association with risk of RM to determine the important covariates associated with this toxicity. The analysis included 1423 patients (mean [SD] age, 61.6 [12.9] years; 695 [48.8%] females and 728 [51.1%] males) who received SBRT for 1904 spinal metastases. Among them, 30 cases of RM were identified, 19 of which were classified as G3 to G4. Two years after SBRT, the rate of G1 to G4 RM was 1.8% (95% CI, 1.2%-2.5%) and the rate of G3 to G4 RM was 1.1% (95% CI, 0.7%-1.7%). The minimum dose to the 0.1 cm3 of spinal cord receiving the greatest dose (D0.1cc) was the most important covariate on univariable cause-specific hazards regression for RM (for G3 to G4: hazard ratio, 2.14; 95% CI, 1.68-2.72; P < .001). A true cord D0.1cc of 19.1 Gy and Dmax of 20.8 Gy estimated a 1.0% risk (95% CI, 0.3%-1.6% and 0.4%-1.6%, respectively) of G3 to G4 RM 2 years after SBRT. The findings of this cohort study indicate that a cord (myelogram or MRI-derived) D0.1cc constraint of 19.1 Gy and a Dmax constraint of 20.8 Gy correspond with a 1.0% risk of G3 to G4 RM at 2 years.

Assessment of Symptom Burden and Quality of Life in Patients With Primary Brain Tumours Attending Palliative Care in a Tertiary Cancer Care Centre.

Background: Patients with primary brain tumors navigate a distinct illness trajectory, characterized by an uncertain prognosis, a rapid decline in physical functioning, and a significant deterioration in the quality of life. These unique challenges underscore the importance of our research in understanding and addressing the needs of these patients. Methods: The EORTC QLQ C30 & EORTC BN 20 questionnaires assessed the quality of life and symptom burden in patients with primary brain tumors. The scores were analyzed using SPSS statistical software. Results: 100 patients - 61 males and 39 females-were included with radiological or histopathological diagnoses of primary brain tumours. Seizures (38%) was the most common presenting symptom, followed by headache (18%), loss of consciousness (13%), focal neurological deficit (9%), and blurring of vision (8%). The mean quality of life at baseline was 78.29, with a standard deviation of 9.67 on a scale of 0 to 100, and the brain tumor-specific symptom burden score was 46.9, with a standard deviation of 17.95 on a scale of 0 to 100. There was a significant difference in the global health status score between the first and third visits at 3months (P value = .03). Conclusion: Despite the aggressive and often incurable nature of primary brain tumors, there is hope in the form of palliative care. By addressing unmet symptoms, uncertainties about the future, and social functioning, palliative care can significantly improve the quality of life of these patients.

The Impact of a Breast Cancer Diagnosis on the Social Interaction Patterns of Young Omani Women: A Qualitative Study Approach.

Young women diagnosed with breast cancer (BC) face considerable psychological and emotional distress, impacting their interactions with themselves, their families, and the wider community. This study sought to explore the interaction patterns of young Omani BC survivors following their diagnosis and during treatment. Semi-structured individual interviews were conducted with 11 Omani women diagnosed with BC, recruited from the Sultan Qaboos Comprehensive Cancer Care and Research Centre in Muscat, Oman. Participants were selected using purposive sampling to target Omani BC survivors aged under 45 years, with one to five years of survivorship post-diagnosis. Framework analysis was employed to analyse the qualitative data. Six key types of interactions with various groups were identified: self, children, spouses, family, friends, and society. While many BC survivors demonstrated resilience through their strong faith, viewing the illness as part of a divine plan, others experienced diminished confidence and social withdrawal due to body image issues. Interactions with children centred on maintaining normalcy, while spouses typically provided emotional support despite challenges with intimacy. Family and friends offered crucial support, although concerns regarding societal stigma led some women to conceal their diagnosis. Participants in this study demonstrated a strong sense of acceptance of their cancer diagnosis as a result of their faith, viewing it as part of a divine plan. Their belief in divine guidance, paired with optimism about the available treatments, fostered resilience, allowing them to maintain a calm and hopeful outlook during their journey of treatment and recovery. However, some participants experienced a decline in self-confidence, particularly after treatment. This affected their willingness to socialise and interact with others, leading to introversion and a marked withdrawal from social interactions, often related to changed self-perception or fear of judgment following changes in appearance.

Specialty-specific hand hygiene compliance: 5-year study from a large public sector teaching hospital, South India

: Hand hygiene (HH) is essential for preventing healthcare-associated infections (HAIs), especially in ICUs and cancer care centers. These settings often involve immunocompromised patients and invasive devices, making HH critical for patient safety. Despite its recognized importance, consistent adherence to HH practices by healthcare workers (HCWs) remains a significant challenge. This study aimed to evaluate HH compliance in a tertiary care hospital in South India using a customized Android application aligned with WHO guidelines. : This observational study was conducted across high-risk areas of a tertiary care hospital from June 2019 to May 2024. The hospital's high-risk units, under medical, surgical, and pediatric alliances, were included. An Android application based on the Ibhar platform and WHO hand hygiene audit guidelines was used for data collection. The study recorded HH opportunities, Complete HH Adherence (HHCAR), Partial HH Adherence (HHPAR), and Total HH Adherence (HHTAR). The data were analyzed for location-specific, profession-specific, and moment-specific compliance rates. : A total of 196,252 HH opportunities were recorded, with the surgical alliance accounting for the highest number. Pediatric units had the highest compliance, with an HHTAR of 89% and an HHCAR of 66%. Nurses demonstrated the highest compliance among professions, with an HHTAR of 82.8%. Compliance was higher after patient care moments compared to before. Statistically significant differences were noted across different specialties and moments. : This large-scale study highlights the variation in HH compliance across different specialties and the need for targeted training sessions. Given the resource constraints in many tertiary care centers, focusing audits on high-risk areas is practical. The use of software-based applications like Ibhar enhances data collection and analysis, making the audit process more efficient. Regular HH audits and behavioral changes are essential to improve and sustain high standards of HH compliance, ultimately contributing to better infection control practices.

The creation of competence centers (using the example of the organization of outpatient cancer care centers) in the public health system: The experience of Moscow

The large-scale transformation of the capital’s healthcare system included the creation of competence centers to provide citizens with affordable and high-quality medical care in the most popular fields, including oncology. To provide medical care to patients with neoplasms in a full cycle, outpatient cancer care centers were included in the structure of cancer centers. Aim. To analyze Moscow’s experience in launching competence centers using the example of creating outpatient cancer care centers. Materials and methods. In the course of the research, a content analysis of literary data and regulatory legal acts of the Moscow Healthcare Department was used. The analysis of indicators of primary morbidity of the entire population (A00-T98) and by class of neoplasm (C00-D48) in Russia as a whole, the Central Federal District according to Rosstat and Moscow. A sociological method was used in the form of a survey and questionnaire of patients. Results. The number of all registered diseases in the medical organizations of the Moscow Healthcare Department in 2022 amounted to 752.4 cases per 1000 population, which is lower than in Russia and the Central Federal District. The number of registered malignant neoplasms in 2022 was 12.0 cases per 1000 population, which is higher than the average for Russia and the Central Federal District. In Moscow, in 2022, for the first time, 65 % of patients with malignant neoplasms detected at stages I and II were registered at the dispensary. The proportion of patients registered for 5 years or more in 2022 was 58.7 %. Conclusion. At the moment, the system of organization of oncological care is a set of structures that combine all stages of care: from diagnosis to follow-up. Monitoring of diagnostic and treatment results at the level of the patient and the entire organization as a whole is carried out continuously and is the basis for evaluating the achievement of performance indicators.

Differences in survival of patients with multiple myeloma in rural versus metropolitan regions: Analysis of population data of an Australian local health district.

The objective of this study is to determine if there are differences in outcome for patients diagnosed with multiple myeloma in a rural setting compared to a metropolitan setting and which factors influence these outcomes. Retrospective cohort study. Illawarra Shoalhaven Local Health District. A total of 391 patients diagnosed with multiple myeloma between 2000 and 2022. Treatment and survival outcomes of these patients. Patients being treated in a rural cancer care centre had lower overall survival compared to those treated at a metropolitan cancer care centre (median OS = 44.4 months vs. 80.2 months, p = 0.002), despite access to similar treatments by the same group of haematologists. There was a significantly higher rate of upfront autologous transplantation (38% vs. 20%, p = 0.001) and higher rate of inclusion in clinical trials (16% vs. 7%, p = 0.021) in patients treated at a metropolitan cancer care centre compared to the rural cancer care centre. Multiple myeloma patients treated at a rural centre had shorter survival compared to patients treated at a metropolitan centre, and this may be related to lower rates of autologous transplantation and inclusion in clinical trials.

Striving for textbook outcomes in esophagectomy – an experience of first 100 patients from a tertiary cancer care center in Southern India.

Striving for textbook outcomes in esophagectomy – an experience of first 100 patients from a tertiary cancer care center in Southern India.

Acute myeloid leukemia in the next-generation sequencing era : Real-world data from an Austrian tertiary cancer care center.

Next-generation sequencing (NGS) has recently entered routine acute myeloid leukemia (AML) diagnostics. It is paramount for AML risk stratification and identification of molecular therapeutic targets. Most NGS feasibility and results data are derived from controlled clinical intervention trials (CCIT). We aimed to validate these data in areal-world setting. This study retrospectively analyzed 447 AML patients treated at an Austrian tertiary cancer care center. A total of 284 out of the 447 cases were treated between 2013-2023 when NGS was locally available for the clinical routine. The NGS was successfully performed from bone marrow biopsies and aspirates, with processing times decreasing from 22days in 2013/2014 to 10days in 2022. Molecular therapeutic target(s) were identified by NGS in 107/284 (38%) cases and enabled risk stratification in 10 cases where conventional karyotyping failed. Concerning molecular landscape, TET2 (27%), FLT3 (25%), DNMT3A (23%), and NPM1 (23%) were most frequently mutated. Comparing older and younger patients (cut-off 70years) showed enrichment in older people for mutations affecting DNA methylation (72% vs.45%; P < 0.001) and the spliceosome (28% vs. 11%; P = 0.006) and more cellular signaling mutations in younger patients (61% vs. 46%; P = 0.022). Treatment outcomes corroborated asignificant survival benefit in the recent NGS era and patients treated with novel/molecularly targeted drugs. Ultimately, biospecimens of these patients are stored within aleukemia biobank, generating avaluable tool for translational science. Our study validates data from CCIT and supports their relevance for treatment decisions in areal-world setting. Moreover, they demonstrate the feasibility and benefits of NGS within aroutine clinical setting.

Socioeconomic Factors' Impact on Survivorship in Patients with Cervical Cancer: A Study from the Tertiary Cancer Center in Muzaffarpur, North Bihar, India

ObjectiveTo ascertain the survivorship among cervical cancer patients and the factors responsible for early death. In India, cervical cancer ranks second among cancer-related deaths among women. Estimating the survivability rate of patients with cervical cancer who come to our tertiary cancer care center was imperative, as was figuring out.What was causing the greater death rate.MethodThe present study is a retrospective audit of cervical cancer registered at our hospital-based cancer registry from 2021 till date.ResultThe three-year survival rate among women with late-stage cervical cancer was 45%, while 100% of women with early-stage care were alive at the end of three years. The survival rate was also poor among women belonging to middle and low socioeconomic status and illiterate women.ConclusionAmong women who have cervical cancer, those with early-stage cancer, who are literate and those who belong to above middle socioeconomic status have higher survivorship than their counterparts.

Self protective health care in childhood cancer survivors from the perspective of survivors, parents, and professionals: a qualitative study

IntroductionChildhood cancer survivors experience many health problems that they must protect themselves from their destructive physical and psychological effects. Understanding experiences of children about self-protective care will help health care providers manage long-term care plans. Therefore, this study was conducted with the aim of exploring self-protection care in childhood cancer survivors.MethodsThis is a phenomenological study that was conducted in the clinics and cancer care centers of Urmia and Khoy in Iran. 27 participants were selected by purposive sampling until data saturation. The data was collected using a semi-structured and in-depth face to face interview. Content analysis approach used for data analysis and MAXQUDA 10 software used for data management.ResultsData analysis led to the emergence of “self-protection health care” as a main category, two categories “maintaining physical health” and “keeping a strong mindset” and 9 sub-categories including “abstain activities that may cause harm”, “refusing contact with others for possible infection”, “monitoring symptoms and side-effects of cancer coming back”, “avoiding unhealthy diet”, “knowing about cancer from similar others”, “keep away negative thoughts and emotions”, “drawing on spiritual resources”, “creating a bridge to life again” and “being healthy for the sake of one’s family”.ConclusionAccording to the results of this study, self-protection is one of the most important cares for childhood cancer survivors. Over time, the influence of the clinical team and parents on children’s health care diminishes. Therefore, they should promote their health and well-being behaviors and use a variety of protective approaches to self-care.

Breast cancer survivorship care: a narrative review of challenges and future directions.

Breast cancer (BC) is the most prevalent cancer among women worldwide. With a growing number of BC survivors (BCSs), the number of survivors who require high-quality survivorship care is increasing. Various recommendations have been proposed for survivorship care plans (SCPs). However, globally, limited progress has been made to implement these recommendations consistently in cancer care centers. This review explores the gaps and challenges that exist in BC survivorship care (BCSC) and proposes future directions for improving survivorship care for patients and the healthcare system. Current literature on BCSC was searched using PubMed and Google Scholar. The search strategy utilized a combination of keywords related to BCSC, gaps in survivorship care, and health promotion. Retrievable and English articles from January 2000 to March 2024 were included in the review. Despite the large number of guidelines and recommendations on best BCSC practices, only a small number of these have been translated into clinical practices that help streamline patient care. There are many gaps to the provision of high-quality survivorship care, all of which negatively affect patient outcomes. Some of these gaps include but are not limited to: the limited role of primary care providers (PCPs), lack of coordination of care, lack of evidence-based research, insufficient data on health promotion, and challenges implementing comprehensive care. These findings indicate the need for a holistic and personalized approach to BCSC. The importance of implementing a multi-disciplinary and coordinated approach to survivorship care has been emphasized. This includes further involvement of PCPs, through increased training for PCPs in survivorship care. Despite available models of survivorship care, further research is needed to determine optimal BCSC that improves patient outcomes while decreasing the strain on the healthcare system. Additionally, technology can play a beneficial role in survivorship care, especially through telehealth and artificial intelligence (AI). Nonetheless, further research is needed on BCSC.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Mesothelioma: Outcomes From a Tertiary Cancer Care Center in India.

Malignant peritoneal mesothelioma (MPM) is a rare and aggressive form of cancer arising from the peritoneum. The prognosis for MPM has historically been poor, and treatment options are limited. This study evaluated the impact of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) as a treatment modality for MPM. This retrospective analysis included 15 patients diagnosed with MPM between 2012 and 2023 at a tertiary referral cancer care center in North India. Patients underwent CRS followed by HIPEC. The study assessed outcomes based on overall survival (OS) and postoperative morbidity rates. Demographic analysis revealed a female preponderance (n = 9, 60%) and a majority of younger patients, 80% (n = 12) of whom were younger than the age of 50. The mean peritoneal cancer index (PCI) was 14.0, with 60% (n = 9) of patients having a PCI above the mean. The completeness of cytoreduction (CC) varied, with 40% (n = 6) achieving CC0, 33.33% (n = 5) CC1, and 26.67% (n = 4) CC2. Adjuvant chemotherapy was administered to 60%(n = 9) of the patients. The median follow-up period was 25 months, revealing an overall median survival of 27.0 months, with one- and three-year survival rates of 86.7% and 33.3%, respectively. CRS combined with HIPEC is a viable and effective treatment option for patients with MPM and offers improved survival rates and an acceptable safety profile. These findings support the integration of this treatment modality into the management plan for select patients with MPM, although optimal management is still evolving.

A retrospective audit of audiology encounters in patients undergoing Cisplatin treatment at a large Australian tertiary cancer care centre.

To identify the number and timing of audiology encounters for adult oncology patients in a tertiary care setting in Australia. A retrospective case review was completed for 149 patients who received Cisplatin chemotherapy (CT) at a large, publicly funded tertiary hospital in Brisbane, Queensland, Australia between 1st January and 31st December 2019. Patient data was extracted from the Queensland Oncology Repository (QOR) provided by Cancer Alliance Queensland (CAQ). The number of audiology encounters was low overall with a median of 0 and interquartile range (IQR) of 0-1. Of the entire patient cohort, there was a mean of 1.2 encounters with 56% of patients not engaging with audiology. Where audiology did occur, encounters were most likely before or early in the CT treatment period. This study has demonstrated engagement with audiology services for patients undergoing CT treatment was limited with the few audiology engagements occurring before or early in the CT treatment period. Further research is needed to identify the barriers and facilitators to accessing audiological ototoxic monitoring (OtoM) during chemotherapy treatment in hospitals in Australia. Early identification of ototoxic hearing loss offers the opportunity to minimise further exposure to the ototoxic agent, minimise functional and communication impacts for the patient and provide early opportunity for discussion, education and counselling with patients, carers and their treating team. This, in turn, is expected to improve health related quality of life.

Integrating Biomarker Testing into EHR Systems: Implications for the Laboratory Based on Findings from a Multistakeholder Summit

Abstract Introduction/Objective Guideline-driven tumor biomarker testing remains standard of care for precision oncology due to the increasing number of treatment decisions that can be made based on tumor-specific alterations. However, most electronic health record (EHR) systems lack bidirectional interfaces with labs that enable computerized order entry and tumor biomarker testing results. Without these integrations, cancer centers may experience delays in test ordering and resulting, manual data entry errors, and operational inefficiencies that impact patient care and survival outcomes. Methods/Case Report To explore how cancer centers, hospitals, oncology practices, and labs integrate EHRs to streamline cancer biomarker testing processes, the Association of Cancer Care Centers (ACCC), in partnership with LUNGevity, convened a multistakeholder summit on Oct. 4, 2023. The summit brought together clinicians, pathologists, genetic counselors, and administrators to discuss practical solutions to issues surrounding interoperability, clinical workflows, and access to clinical data. Results (if a Case Study enter NA) Key findings from the summit include: -EHR-integrated orders and results save time, reduce errors, and streamline clinical workflow. These electronic interfaces enable clear communication between multidisciplinary teams system-wide and ensure that required patient information is readily available at the time of therapy planning. -Standardized workflows that define test ordering, tracking, and resulting protocols for in-house and send-out testing offer important downstream benefits. Staff should clearly understand how specimens are handled for in-house and send-out testing. -Integrations should be planned and built based on the EHR/laboratory information systems (LIS) in place can incorporate solutions to integrate with reference labs using HL7 standards and/or add-on modules to enable discrete genomic data elements. Conclusion Clinicians, pathologists, and administrators should prioritize EHR/LIS integrations to enable more effective cancer biomarker test ordering and resulting. These pre/post-analytic processes have significant implications for patient care. Findings from this summit can enable cancer programs and labs to evaluate current processes, work collaboratively to build integrations, and streamline biomarker testing workflows to enhance the quality and efficiency of delivering precision oncology.

Short-Course TNT Improves Rectal Tumor Downstaging in a Retrospective Study of the US Rectal Cancer Consortium.

The RAPIDO trial showed promising rates of pathologic complete response (pCR) after neoadjuvant short-course radiation with consolidation chemotherapy (total neoadjuvant therapy [SC TNT]) for rectal cancer. Only single-center reviews comparing tumor downstaging between SC TNT and long-course chemoradiation (LCRT) have been published in the United States. We reviewed our multi-institutional experience with both. The US Rectal Cancer Consortium database (2007-2018) including data from six high-volume rectal cancer care centers was reviewed. Patients with nonmetastatic, rectal adenocarcinoma who had neoadjuvant LCRT alone or SC TNT before excision or definitive nonoperative management were included. The primary outcome was the rate of complete response (CR), including pCR or durable (12 month) clinical complete response. Of 857 included patients, 175 (20%) received SC TNT and 682 (80%) received LCRT. The LCRT group had more low tumors (51.8% vs. 37.1%, p < 0.0001) and more clinically node-negative disease (31.8% vs. 22.3%, p < 0.0001). The CR rate was higher after SC TNT (34.1% vs. 20.3%, p = 0.0001). SC TNT was a predictor of CR (OR: 2.52, CI: 1.68-3.78). SC TNT patients completing 5-6 months of consolidation chemotherapy had a CR rate of 42.9%. There was no difference in 3-year PFS. SC TNT increases CR rate when compared to LCRT. For patients seeking nonoperative options or fewer radiation treatments, SC TRT should be preferred over LCRT alone.

Dose-adjusted direct oral anticoagulants (DOACs) in patients with acute leukemia: experience of a tertiary cancer care center.

Dose-adjusted direct oral anticoagulants (DOACs) in patients with acute leukemia: experience of a tertiary cancer care center.

PDOC-12 PEDIATRIC BRAIN TUMOR INCIDENCE, AND TREATMENT MODALITY AT KILIMANJARO CHRISTIAN MEDICAL CENTER

Abstract INTRODUCTION Pediatric brain tumors (PBT) a significant health concern, they are the primary cause of cancer-related deaths among children. PBTs in Low- and Middle-Income Countries are diagnosed late due to insufficient resources. This abstract describes Pediatric Brain tumor incidence and treatment modalities at Kilimanjaro Christian Medical Center (KCMC) Cancer Care Center (CCC), Moshi, Tanzania from December 2016 to March 2024. METHOD Data on pediatric patients treated at the CCC between Dec. 2016 and March 2024, were analyzed. Inclusion criteria were a primary brain tumor and patients aged 0-19 at the time of diagnosis. All patients were previously diagnosed by computer tomography/ magnetic resonance imaging. Variables retrospectively collected from patient’s medical records were: demographic characteristics (age, gender, Place of residence, and insurance status), previous history of malignant diseases, incidence date, and treatment modality. RESULTS Total of 748 cases of pedeatric cancer were diagnosed at CCC. Of all the pediatric cancers diagnosed, brain cancer accounted for 22(2.9%). Out of these cases of brain cancer, 63.6% were males and 36.4% were females.Majority of them came within the Kilimanjaro region. 41% were palliated while 59% had a curative intent at the time of diagnosis, 22.7% died between December 2016 to March 2024.Embryonal tumors were (40.9%) with a breakdown that includes 6 Medulloblastoma and 3 cases of Craniopharyngioma (teratoid/rhabdoid), gliomas (36.4%) with sub-types such as Ependymoma, Anaplastic Astrocytoma, Pilocytic Astrocytoma, Pineocytoma, Stem glioma, and Tectal glioma, unspecified cases (13.6%), and Pineoblastoma were (9.1%). Surgery was used in 40.9% of cases, radiotherapy in 31.8%, and chemotherapy in 72.7%. Chemoradiotherapy was used in 31.8% of cases. 13.6% of cases utilized a combined approach, including chemotherapy, radiotherapy, and surgery. CONCLUSION PBT incidence at KCMC is 2.9%, improving access to screening, accurate diagnosis and treatment modalities are essential in identifying and managing PBT in our setting.

COVID-19 pandemic impact on gynecologic cancer treatment pathways in a Finnish tertiary center.

COVID-19 and new guidelines during the pandemic affected the gynecologic cancer treatment pathways, resulting in recorded delays and modifications in the treatment protocols. The aim of this study was to determine the impact of the COVID-19 pandemic in one of the major gynecologic cancer care centers in Finland, Tampere University Hospital. Our retrospective register study included 909 patients that were new gynecologic cancer cases (uterine, cervical, vulvar, vaginal, or ovarian) referred to the Tampere University Hospital Gynecologic Oncology Outpatient Clinic between March 17th, 2018, and March 15th, 2022. The patients were divided into two separate groups depending on their time of referral: time before COVID (March 17th, 2018, to March 15th, 2020), and during COVID (March 16th, 2020, to March 15th, 2022). These groups were compared in terms of patient characteristics, different cancer types and stages, symptoms, and treatment methods. During the COVID-19 pandemic, patients generally suffered from cancer symptoms longer (p < 0.003) and were more likely to be overweight (p = 0.035). The improved multidisciplinary team meeting gave the patients a faster route to their first intervention during COVID (p < 0.05). An insignificant shift toward nonsurgical first interventions and non-curative intent was seen during COVID, but the multidisciplinary team treatment plans were mostly implemented accordingly on both eras. No decrease was seen in the number of new gynecologic cancer cases, and the one-year overall survival remained the same in both groups. Overall, the COVID-19 pandemic did not significantly alter treatment pathways in gynecologic cancer care at Tampere University Hospital. The number of new patients and given treatments remained relatively stable. During COVID, access from referral to cancer treatment was significantly accelerated, which is likely confounded by changes to the multidisciplinary team protocol made in early 2021.