Complete Course Of Chemotherapy Research Articles

Assessment of barriers to optimal cancer control in adult cancer treatment centres in Cameroon.

Approximately 20,745 new cases of cancer were registered annually with 13,199 (64%) deaths in 2020 in Cameroon. Despite the increasing cancer burden, there is a paucity of reliable data that can enhance decision-making for cancer control in Cameroon. This assessment was, therefore, designed to generate data that may enable stakeholders, policymakers and funders to make data-driven decisions on cancer control. We conducted a cross-sectional survey in July 2020, which enabled us to collect data on key cancer variables from six adult cancer treatment centres in Cameroon. The key components of the assessment included case detection, service availability, human resource capacity, cost of chemotherapy and radiotherapy, the safety of chemotherapy sessions, data systems, patient education, palliative care, funding for chemotherapy and chemotherapy stock. Data were compiled and analysed using Microsoft Excel 2016. Data from four of the 6 sites show that 1,636 new cases were recorded representing an annual case detection rate of 11.8%. All the six assessed facilities offered chemotherapy services, 5/6 (83.3%) offered surgery for cancers, while just 1 (16.7%) offered radiotherapy services. In addition, none offered nuclear medicine services for cancer care and treatment. Similarly, none of the facilities had the WHO-recommended number of human resources for optimal cancer care. Overall, there were only 6 medical oncologists, 2 surgical oncologists, 3 radiation oncologists and 14 oncology nurses providing services across the 6 cancer treatment centres. Treatment services are expensive for an average national, with a complete course of chemotherapy followed by radiotherapy costing ~XAF 1,240,000 (~$2,480). None of the survey facilities had a recommended safe biosafety cabinet and clean room for the preparation of chemotherapies, rendering the preparation of chemotherapies suboptimal and hazardous. Data collection tools were manual, relatively available and very different across all the surveyed sites and the interval for data collection and transmission was collectively undefined. Optimal cancer care in adult cancer treatment centres is limited by several health systems and socio-economic factors. The identification of these barriers has enabled the formulation of action-oriented interventions, leveraging on the recently adopted national strategy for the prevention and control of cancers in the country.

Exhaled phospholipids as a prognostic factor of pulmonary complications in children with acute lymphoblastic leukemia

Introduction. Pulmonary complications are common in children with acute lymphoblastic leukemia (ALL). The assessment of phospholipids (PL) in the exhaled breath condensate can provide more information about pathological processes in the lungs in children with ALL. Purpose - to assess the level of PL in the exhaled breath condensate (EBC) in children with ALL and its prognostic value. Materials and methods. 40 children with ALL aged 6-17 years were examined. 1st group included newly diagnosed children with ALL (n=18). 2nd group involved ALL survivors, who had completed the total course of chemotherapy (n=22). The control (С) group consisted of 15 healthy children. The levels of PL in the EBC were investigated by spectrophotometric thin-layer chromatography using an SPh 46 spectrophotometer. Results. The frequency of pulmonary complication was 82.5% during chemotherapy protocols and 18.4% in ALL survivals. The statistically significant increase in the level of phospholipids in 1st (150.75 (137.62; 158.45) mmol/l) and 2nd (130.12 (120.59; 138.34) mmol/l) ALL groups compared with the group C (54.80 (48.30; 60.80) mmol/l) has been detected (p1-C=0.0000; p2-C=0.0000). Children of the 1st group had significantly higher levels of PL in the EBC than children of the 2nd group (p1-2=0.002911). PL level in EBC collected during induction phase of chemotherapy >132.15 mmol/l can be prognostic for the development of acute pulmonary complications (Sensitivity 93.75%; Specificity 100%). PL level in EBC collected after a complete course of chemotherapy >133.28 mmol/l can be predictive for persistent pulmonary complications (Sensitivity 100.00%; Specificity 83.33%). Conclusions. PL level in EBC can be prognostic for the development of pulmonary complications, both during chemotherapy and in long-term remission after completed chemotherapy course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Prevalence and Potential Factors Related to Irreversible Chemotherapy-Induced Amenorrhea in Premenopausal Breast Cancer Patients

Objective: To evaluate the prevalence and potential factors related to irreversible chemotherapy-induced amenorrhea (CIA) in premenopausal women with breast cancer. Methods: First diagnosis breast cancer women in Stages I-III who had menstruation within three months before receiving chemotherapy and completed a course of treatment were interviewed about the menstrual cycle after a complete course of chemotherapy and the subsequent menstrual status. Clinical data were retrospectively reviewed. Age at starting chemotherapy was calculated for an optimal cut-off point by using the receiver operating characteristic curve to predict irreversible CIA. The clinicopathological variables were compared using univariate and multivariate analysis to identify the independent factors related to irreversible CIA. Results: One hundred and fifty-four premenopausal breast cancer women who met the inclusion criteria were interviewed. They were treated with chemotherapy between October 1999 and September 2018. The median age at the start of treatment was 43.5 years. One hundred forty-two patients (92.2%) developed CIA and 37 cases subsequently resumed menstruation (RM). Thus, the prevalence of irreversible CIA was 68.2%. The group > 45 years of age, estrogen receptor-positive, progesterone receptor-positive and maintenance treatment with tamoxifen significantly developed irreversible CIA in univariate analysis. However, only the > 45-year-old group was an independent factor for the CIA with an adjusted odds ratio of 23.04. Conclusion: Nearly 70% of premenopausal breast cancer women developed irreversible CIA and the independent factor for this event was being older than 45-years-old when receiving chemotherapy.

The effect of some natural antioxidants against cisplatin-induced neurotoxicity in rats: behavioral testing

BackgroundCisplatin (CP) is a common antineoplastic agent widely used to treat a broad spectrum of cancers. However, its usage for cancer treatment was restricted due to various side effects such as neurotoxicity, nephrotoxicity, hepatotoxicity and ototoxicity. Neurotoxicity in patients who have undergone a complete course of chemotherapy is clinically evident. CP administration caused problems in rats with memory and learning. MethodsThe effect of combination of CP with either thymoquinone (TQ) or geraniol (Ger) on cell viability of human breast cancer cells (MCF-7) was detected by MTT assay. Forty male Wistar albino rats, healthy and adult, were divided into four groups: normal control, CP-treated group, CP + TQ-treated group and CP + Ger-treated group. ResultsOur results demonstrated that prophylactic treatment with either TQ or Ger plus CP enhanced the anticancer effect of CP in MCF-7 cell line. In vivo study showed that CP-treated rats had higher depressives like behavior in open field and Morris water maze test while prophylactic treatment with either TQ or Ger and CP significantly enhanced the performance of depressive-like behavior. Also, histopathological evaluation of brain tissues proved the neurotoxic effect of CP and the possible protective activity of either TQ or Ger. ConclusionThe findings of the present work revealed that TQ or Ger along with CP may enhance the antitumor effect of CP. Also, spontaneous administration of CP with either TQ or Ger as natural antioxidants may prevent CP-induced neurotoxicity in rats through diminishing the memory and learning impairment.

Adding carboplatin to chemotherapy regimens for metastatic castrate-resistant prostate cancer in postsecond generation hormone therapy setting: Impact on treatment response and survival outcomes.

The clinical course in metastatic castrate-resistant prostate cancer (mCRPC) can be complicated when patients have disease progression after prior treatment with second generation hormone therapy (second HT), such as enzalutamide or abiraterone. Currently, limited data exist regarding the optimal choice of chemotherapy for mCRPC after failing second generation hormone therapy. We sought to evaluate three common chemotherapy regimens in this setting. We retrospectively identified 150 mCRPC patients with disease progression on enzalutamide or abiraterone. Of these 150 patients, 92 patients were chemo-naïve while 58 patients had previously received docetaxel chemotherapy before being started on second HT. After failing second HT, 90 patients were assigned for docetaxel-alone (group A), 33 patients received carboplatin plus docetaxel (group B), while 27 patients received cabazitaxel-alone (Group C). A favorable response was defined by more than or equal to 50% reduction in prostate-specific antigen from the baseline level after a complete course of chemotherapy. Survival outcomes were assessed for 30-month overall survival. Patients in group (B) were 2.6 times as likely to have a favorable response compared to patients in group (A) (OR = 2.625, 95%CI: 1.15-5.99) and almost three times compared to patients in group (C) (OR = 2.975, 95%CI: 1.04-8.54) (P = .0442). 30-month overall survival was 70.7%, 38.9% and 30.3% for group (B), (A), and (C), respectively (P = .008). We report a Hazard Ratio of 3.1 (95% CI, 1.31-7.35; P = .0037) between patients in group (A) versus those in group (B) and a Hazard Ratio of 4.18 (95% CI, 1.58-11.06; P = .0037) between patients in group (C) compared to those in group (B) CONCLUSION: This data demonstrates improved response and overall survival in treatment-refractory mCRPC with a chemotherapy regimen of docetaxel plus carboplatin when compared to docetaxel alone or cabazitaxel alone. Further investigations are required.

Ginkgo biloba Alleviates Cisplatin-Mediated Neurotoxicity in Rats via Modulating APP/Aβ/P2X7R/P2Y12R and XIAP/BDNF-Dependent Caspase-3 Apoptotic Pathway

Neurotoxicity is an obvious adverse effect in Patients encountering a complete course of chemotherapy. The present work is conducted to evaluate the neuroprotective effect of Ginkgo biloba (Ginkgo) against the neurotoxicity induced by Cisplatin (Cis) in rats. Forty male Wistar albino rats were arranged into four groups: (1) Control group, rats were given saline; (2) Cis group, rats were injected by Cis 2 mg/kg body weight i.p., twice a week starting on the fifth day for thirty days; (3) Ginkgo group, rats were administered Ginkgo (50 mg/kg orally) daily for thirty days; and (4) Ginkgo+Cis group, rats received Ginkgo (50 mg/kg orally) daily and on the fifth day, rats were injected with Cis (2 mg/Kg body weight i.p.) twice a week for thirty days. Cis significantly increased Gamma glutamyltransferase (GGT) and Acetyl Cholinesterase (CHE) as compared to the control group and also disturbed cerebral oxidative/antioxidant redox. Co-administration of Ginkgo and Cis reversed the adverse effect of Cis on the brain tissue. Moreover, co-administration of Ginkgo and Cis ameliorated Cis induced brain damage by reducing Amyloid precursor protein (APP), amyloid β (Aβ), P2Y12R and P2X7R mRNA expressions and proteins. Furthermore, Ginkgo regulated XIAP/BDNF expressions with a consequent decrease of caspase-3 and DNA fragmentation%. The current results concluded that concurrent treatment with Ginkgo can mitigate neurotoxicity mediated by Cis in experimental animals through exhibiting antioxidant effect by restoring cerebral oxidative/antioxidant redox and anti-apoptotic effect via regulating cerebral APP/Aβ/P2Y12R/P2X7R and XIAP/BDNF signaling pathways.

Addition of carboplatin to chemotherapy regimens for metastatic castrate-resistant prostate cancer in post-second generation hormone therapy setting: Does it improve treatment response and survival outcomes?

e17540 Background: The clinical course in metastatic castrate-resistant prostate cancer (mCRPC) can be complicated when patients have disease progression after treatment with 2nd generation hormone therapy (2nd-HT), such as enzalutamide or abiraterone. Currently, limited data exist regarding the optimal choice of chemotherapy for mCRPC after failing 2nd-HT. We sought to evaluate three common chemotherapy regimens in this setting. Methods: We retrospectively identified 150 patients with mCRPC with disease progression on enzalutamide or abiraterone. 92 patients were chemo-naïve, while 58 patients had previously received docetaxel chemotherapy prior to 2nd-HT. After failing 2nd-HT, 90 patients received docetaxel-alone (group A), 33 patients received carboplatin plus docetaxel (group B), while 27 patients received cabazitaxel-alone (Group C). Favorable response was defined by ≥50% reduction in PSA level from baseline after a complete course of chemotherapy. Survival outcome was assessed for 30-month overall survival. Results: Mean (SD) age was 71.2 (8.28), 69.5(8.38) and 67.2 (8.36) for group (A), (B) and (C), respectively. Mean (SD) pre-chemotherapy PSA was 63.8 (138.18), 58.5 (118.15) and 53.7 (88.15) for group (A), (B) and (C), respectively. Mean (SD) Gleason score was 7.9 (1.1), 8.4 (0.88) and 8.1 (1.06) for group (A), (B) and (C), respectively. Patients in group (B) were 2.6 times more likely to have a favorable response compared to group (A) (OR = 2.625, 95%CI: 1.15 - 5.99) and almost 3 times compared to patients in group (C) (OR = 2.975, 95%CI: 1.04 – 8.54) (p-value = 0.0442). We report a Hazard Ratio (HR) of 3.1 (95% CI 1.31-7.35; p = 0.0037) between patients in group (A) versus group (B), and a HR of 4.18 (95% CI 1.58-11.06; p = 0.0037) between patients in group (C) versus group (B). Thirty-month overall survival was 70.7%, 38.9%, and 30.3% for group (B), (A), and (C) respectively (p-value = 0.008). Conclusions: Our data demonstrate improved response and cancer-specific survival in patients with treatment-refractory mCRPC on docetaxel plus carboplatin compared to docetaxel or cabazitaxel alone. Selection bias is inherent in any retrospective study; however, our finding suggests that clinicians may consider docetaxel plus carboplatin in mCRPC patients who fail 2nd-HT. Further prospective studies are warranted.

Inter-Observer Agreement of Whole-Body Computed Tomography in Staging and Response Assessment in Lymphoma: The Lugano Classification.

SummaryBackgroundTo assess inter-observer agreement of whole-body computed tomography (WBCT) in staging and response assessment in lymphoma according to the Lugano classification.Material/MethodsRetrospective analysis was conducted of 115 consecutive patients with lymphomas (45 females, 70 males; mean age of 46 years). Patients underwent WBCT with a 64 multi-detector CT device for staging and response assessment after a complete course of chemotherapy. Image analysis was performed by 2 reviewers according to the Lugano classification for staging and response assessment.ResultsThe overall inter-observer agreement of WBCT in staging of lymphoma was excellent (k=0.90, percent agreement=94.9%). There was an excellent inter-observer agreement for stage I (k=0.93, percent agreement=96.4%), stage II (k=0.90, percent agreement=94.8%), stage III (k=0.89, percent agreement=94.6%) and stage IV (k=0.88, percent agreement=94%). The overall inter-observer agreement in response assessment after a completer course of treatment was excellent (k=0.91, percent agreement=95.8%). There was an excellent inter-observer agreement in progressive disease (k=0.94, percent agreement=97.1%), stable disease (k=0.90, percent agreement=95%), partial response (k=0.96, percent agreement=98.1%) and complete response (k=0.87, Percent agreement=93.3%).ConclusionsWe concluded that WBCT is a reliable and reproducible imaging modality for staging and treatment assessment in lymphoma according to the Lugano classification.

Composite type A thymoma and diffuse large B-cell lymphoma

The concurrent occurrence of thymoma and diffuse large B-cell lymphoma in the thymus has not been previously reported. We describe a 74-year-old man who presented with general weakness, neck lymphadenopathy, night sweats, and body weight loss. A right anterior mediastinal mass was found on computed tomography of the chest. The immunohistochemical stains AE1/AE3, CD20, CD3, and MUM-1 confirmed the different components of the mediastinal tumor. A heavy-chain gene clonality assay and light-chain gene clonality assay confirmed the B-cell clonality of the mediastinal tumor and neck lymph node. The patient had received a complete course of chemotherapy, and the result of positron emission tomography–computed tomography showed complete remission. The pathologic report of this mass revealed composite type A thymoma and diffuse large B-cell lymphoma. If concurrent or composite thymoma and lymphoma are suspected, a thorough examination of the thymoma with a combination of ancillary studies is recommended to rule out the possibility of concurrent lymphoma.

Primary granulocytic sarcoma: a rare presentation of an ovarian mass

Background: Primary granulocytic sarcoma (GS) only rarely presents with an ovarian mass classified as extramedullary myeloid progenitor tumor cells. Few patients with cases of primary GS survive after systemic chemotherapy. Objective: To present a case of primary GS treated with complete course of chemotherapy. The patient is currently in complete remission. Methods: Retrospective review of medical records and comparison with previous case reports. Results: A 41-year-old woman presented with an ovarian mass of 6 months duration. There was no previous history of hematologic disease or presence of leukemic cells in other organs at the time of diagnosis. Immunohistochemistry confirmed the diagnosis. She received complete course of chemotherapy, after which complete remission was achieved. Conclusion: A case of primary granulocytic sarcoma of the ovary was successfully treated with chemotherapy. This disease needs careful diagnosis and appropriate treatment for a good outcome.

Clinical report. Primary granulocytic sarcoma: a rare presentation of an ovarian mass

Abstract Background: Primary granulocytic sarcoma (GS) only rarely presents with an ovarian mass classified as extramedullary myeloid progenitor tumor cells. Few patients with cases of primary GS survive after systemic chemotherapy. Objective: To present a case of primary GS treated with complete course of chemotherapy. The patient is currently in complete remission. Methods: Retrospective review of medical records and comparison with previous case reports. Results: A 41-year-old woman presented with an ovarian mass of 6 months duration. There was no previous history of hematologic disease or presence of leukemic cells in other organs at the time of diagnosis. Immunohistochemistry confirmed the diagnosis. She received complete course of chemotherapy, after which complete remission was achieved. Conclusion: A case of primary granulocytic sarcoma of the ovary was successfully treated with chemotherapy. This disease needs careful diagnosis and appropriate treatment for a good outcome.

Study of conjunctival changes following treatment of retinoblastoma with radiotherapy and chemotherapy

Purpose The aim of this study was to investigate the effect of chemotherapy and radiotherapy in the treatment of retinoblastoma on the conjunctiva, using the impression cytology technique. Patients and methods The study included three groups comprising 15 eyes each of children aged 1-7 years. Group I comprised patients receiving a complete course of chemotherapy alone since at least 3 months. Group II comprised patients receiving a complete course of chemotherapy and radiotherapy since at least 3 months. Group III was the control group. Impression cytology was used to take samples from the conjunctiva; the samples were fixed with ethyl alcohol 97% and then rehydrated and stained. Microscopic examination was carried out for cohesion power, cell size, nucleus/cytoplasm ratio, distribution of goblet cells, and degree of keratinization. Results As regards age distribution, there were statistically nonsignificant differences between all three groups ( P = 0.73). As regards sex distribution, there were statistically nonsignificant differences between the groups ( P = 0.902). Impression cytology revealed no statistically significant difference between the three groups with respect to the cohesion power, the cell size, nuclear cytoplasm ratio, goblet cell distribution, and the degree of keratinization. Conclusion There is no evident effect of either radiotherapy or systemic chemotherapy used in the treatment of retinoblastoma on the surface of the eyes of the patients, specifically the conjunctival epithelium. Further studies are needed to ascertain the exact effect of modality, or to document the nullity of effect.

Outcome of Patients with Newly Diagnosed Diffuse Large B-Cell Non-Hodgkin Lymphomas (DLBCL) Receiving Initial Therapy in Hospital Compared with An Out-Patient Setting

Abstract 4944 Background:DLBCL is the most common form of aggressive non-Hodgkin lymphoma (NHL). Despite its aggressive nature, the majority of patients are diagnosed and managed in an out-patient setting and only minority of patients require hospital admission, for symptom control or management of associated co-morbid conditions. The outcomes of patients admitted to hospital with newly diagnosed DLBCL, though presumed to be inferior to patients managed in an outpatient setting, due to advanced disease or poorer performance status is presently unknown. The aims of this study were to identify predictors of treatment location (in-patient vs. out-patient), and assess the survival of patients according to treatment location (in-hospital or out-patient). Methods:Retrospective chart review over 5 years (January 2005 to December 2009) of newly diagnosed patients with DLBCL in Winnipeg, Canada. These patients were treated either in a teaching hospital, at Health Sciences Center, or in the out-patient setting, at CancerCare Manitoba. Clinical predictors of treatment setting were analyzed using multivariable logistic regression. Survival at one and three years was assessed with Kaplan-Meier statistics. Results:We included140 patients (46 in-patients and 96 outpatients). The mean age of the in-patient population was 68.3 (SD 14.2); while for the out-patient group it was 65.2 (SD 15.3). The in-patient group was comprised of 47.8% female, with the outpatient having 52.1%. Fifty percent of the in-patient group came from a rural residence, while only 28.1% of the out-patient group was from a rural residence. Of the in-patient group 21.7% had a favorable IPI (0-2), compared with 70.8% of the out-patient population.Of the 46 in-patients, 28 (60.9%) received R-CHOP, compared with 69 (71.9%) from the out-patient group. Four (8.7%) in-patients received an alternate form of chemotherapy (e.g. R-CVP), compared with 18 (18.8%) outpatients. Fourteen (30.4%) in-patients received no chemotherapy, compared with 9 (9.4%) in the out-patient group. Patients with an IPI of 3 or higher at diagnosis were significantly more likely to require hospital admission for initial treatment [Odds ratio (OR) = 8.43; (95% CI 2.55–19.30), p-value <0.01]. Patients living in rural setting were more likely to be hospitalized compared to those who resided in Winnipeg [OR = 2.34; (95% CI 0.86–6.46), p-value = 0.04]. Overall survival at one and three year was 50.0% and 38.8% for the in-patient group, compared with 85.3% and 69.3 for the out-patient group (p<0.01). In a subgroup of patients who received R-CHOP, survival for in-patients compared with out-patients was 71.4%% vs. 89.7%% at one year, and 57.7% vs. 76.8% (p=0.03) at three years respectively. Survival of in-patients with a low IPI (0-2) that completed R-CHOP (six cycles) therapy was 100% at one year, compared with 97.7% in the out-patient group (p=0.10). Survival of in-patients with high IPI (≥3) that completed R-CHOP was 68.2% at one year, compared to 66.7% in the out-patient group (p=0.51). Conclusions:The overall survival of patients with DLBCL that require hospital admission to receive their first cycle of chemotherapy is inferior to patients who can be treated in the out-patient setting. Observed differences in survival may relate to the decreased administration of chemotherapy among in-patients, which may further relate to patient co-morbidity and functional status. Among patients who receive a full course of chemotherapy, the location of treatment initiation does not appear to impact survival. Factors found to be associated with in-patient treatment initiation include high IPI and rural status. Initial in-patient treatment is not a necessarily associated with poor prognosis if a complete course of chemotherapy can be delivered and to better inform prognosis, further studies are needed to predict which patients will ultimately not be able to tolerate a full course of chemotherapy and thus be at high risk for death. Disclosures:Rubinger:Roche Canada: Consultancy.

Completion of Adjuvant Chemotherapy and Use of Health Services for Older Women With Epithelial Ovarian Cancer

This analysis identifies factors associated with completion of adjuvant chemotherapy for patients with ovarian cancer and subsequent use of health services. We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare database to identify 4,617 women age 65 years or older with ovarian cancer diagnosed from 2001 to 2005. By using multivariable analyses with completion of chemotherapy as the outcome of interest, we describe factors associated with completion of treatment, including age, race, marital status, comorbidities, and sociodemographic factors. Use of health services was captured from Medicare claims. Among 4,617 patients with untreated ovarian cancer, 1,329 (28.8%) received no chemotherapy, 1,139 (24.7%) received a partial course of chemotherapy, and 2,149 (46.5%) completed chemotherapy. Women age 75 years or older were at greater risk of incomplete chemotherapy versus women age 65 to 74 years (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.04). Having two or more comorbidities was also significantly associated with incomplete chemotherapy (OR, 1.83; 95% CI, 1.34 to 2.50). Among women who received either a partial or complete course of chemotherapy, we did not find an increase in use of health services (hospitalizations, emergency department visits, or physician visits) for the oldest women (age 80 years or older) compared with younger women. There is considerable room for improvement in helping older patients with ovarian cancer initiate and complete chemotherapy. The oldest women who completed chemotherapy in this study did not use health services more than younger women did. Treatment teams for older patients with ovarian cancer should include expertise in geriatric assessment, should carefully identify medical and psychosocial barriers to completing treatment, and should support patients throughout treatment.

Assessing the initiation and completion of adjuvant chemotherapy in a large nationwide and population-based cohort of elderly patients with stage-III colon cancer

Randomized trials conducted in the 1980s have established the effectiveness of 5-fluorouracil-based adjuvant chemotherapy in treating stage-III colon cancer. However, the initiation of adjuvant chemotherapy is just the first step for survival improvement. Little is known about the actual completion rate of such a therapy in the community. The objectives of this study were to measure the initiation and completion rate of adjuvant chemotherapy and to identify the associated factors. We studied 12,265 patients aged 65+ diagnosed with stage-III colon cancer between 1991 and 2005 who were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. Chemotherapy initiation was defined as at least one claim indicating the use of chemotherapy. The first and last claims were used to measure the length of chemotherapy. A complete course of chemotherapy was defined as 8-13months for 1991-1995 cohort and 5-7months for 1996-2005 cohort according to clinical guideline. Of the 12,265 patients, 64.4% received adjuvant chemotherapy within 3months after tumor resection. Among those who had chemotherapy initiated, 62.2% (or 38.0% of 12,265 patients) received a complete course of chemotherapy. Patient's age at diagnosis, marital status, and comorbidity score were the significant predictors for chemotherapy initiation. These variables remained significant in predicting chemotherapy completion after adjusting for year of diagnosis and other factors. In conclusion, initiation and completion of chemotherapy was largely influenced by patient's age, marital status and comorbidity. Further investigation is needed to explore the cause of these differences in adherence to standard treatment that is essential for better quality of cancer care.

The Case for Selective Use of Pre-Operative Chemotherapy for Hepatic Colorectal Metastases: More Is Not Always Better

The Case for Selective Use of Pre-Operative Chemotherapy for Hepatic Colorectal Metastases: More Is Not Always Better

Capping the dose of paclitaxel in endometrial cancer patients: Does this affect clinical outcome?

e16563 Background: Various protocols recommend capping chemotherapy dosing of paclitaxel at 2m2 while other protocols dose paclitaxel according to actual body weight (ABW). In endometrial cancer where a significant portion of patients are obese this dosing difference may affect clinical outcome. We performed a retrospective review of patients with endometrial cancer who received paclitaxel and carboplatin after surgical staging. We compared patients who received paclitaxel dosed according to ABW with patients whose dose was capped at 2m2 to determine if differences in dosing affected progression free survival (PFS). Methods: Patients with endometrial cancer undergoing adjuvant treatment with paclitaxel and carboplatin from January 2000 to January 2008 were identified. Patient age, endometrial histology, stage, BSA, and paclitaxel treatment dose were collected and progression free survival was determined. Differences in outcome were compared and evaluated using student's t test. Results: 109 women were identified of whom 70 were treated according to their ABW (&lt;2m2) and 39 obese patients received paclitaxel dose capped at 2m2. 95% of all the patients received the complete course of chemotherapy. PFS for both groups were 21.4±2.2 and 23.2±2.2 months with no significant difference in PFS (p = 0.62). When evaluating patients with endometrioid histology alone, no difference between patients receiving dosages according to ABW compared to those whose dosages were capped at 2m2 (25 patients vs. 19 patients, PFS 19.3±3.7 and 27.0±3.7 respectively, p = 0.16). However for patients with serous histology, PFS was significantly greater in those patients treated per their ABW when compared to patients capped at 2m2 (45 patients vs. 20 patients, PFS 30.2±3.2 and 19.6±3.5 months respectively, p = 0.05). Conclusions: There was no difference in PFS for patients with endometrioid cancer who were treated with ABW vs. capped doses of paclitaxel. However patients with serous histology experienced longer PFS when receiving paclitaxel dosed per ABW as compared to patients whose dose was capped at 2m2. This difference may reflect increased sensitivity of serous cancers to chemotherapy or other unknown biologic variables. Capping paclitaxel dosing in patients with serous endometrial cancers may affect their PFS. No significant financial relationships to disclose.

Dissemination of tubercular bacilli by shunt placement

A unique case of tubercular meningitis, developing shunt complication is being reported. We present a pediatric patient with tubercular ulcer formation at abdominal shunt insertion site, marking a grotesque form of tuberculosis. The final outcome of the child was satisfactory after complete course of chemotherapy. doi : 10.5214/ans.0972.7531.2009.160211 Competing interests: None. Source of Funding: None Received Date: 07 April 2009 Revised Date: 29 April 2009 Accepted Date: 09 May 2009

Pericardial effusion – an unusual manifestation of salmonellosis: a case report

BackgroundNontyphoidal salmonellae are important food-borne pathogens that are usually associated with self-limiting gastroenteritis. Occurrence of extra-intestinal non-typhoidal salmonellosis in humans is increasing in many developing countries. The risk of extra-intestinal nontyphoidal salmonellosis is higher in patients with impaired cell mediated immunity, lympho-proliferative disorders and IL-12 deficiencies. Pericardial involvement is one of the rare manifestations accounting for <2% cases but the mortality is very high.Case presentationA 23 year old male was admitted in the medicine ward with complaints of fever, chest pain with non-productive cough, not associated with hemoptysis for past 3 weeks. He was a known case of Hodgkin's lymphoma and was treated with complete course of chemotherapy. Cardiovascular examination, chest X-ray and ECG findings suggested this to be a case of pericardial effusion. The causative agent of this purulent pericardial effusion was identified as Group B Salmonella following isolation from the pericardial fluid.

Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients

This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis in early operable breast cancer outpatients. Sixty-two subjects were randomly allocated to receive yoga (n = 28) or supportive therapy intervention (n = 34) during the course of their chemotherapy. Both groups had similar socio-demographic and medical characteristics. Intervention consisted of both supervised and home practice of yoga sessions lasting for 60 min daily, while the control group received supportive therapy and coping preparation during their hospital visits over a complete course of chemotherapy. The primary outcome measure was the Morrow Assessment of Nausea and Emesis (MANE) assessed after the fourth cycle of chemotherapy. Secondary outcomes included measures for anxiety, depression, quality of life, distressful symptoms and treatment-related toxicity assessed before and during the course of chemotherapy. Following yoga, there was a significant decrease in post-chemotherapy-induced nausea frequency (P = 0.01) and nausea intensity (P = 0.01), and intensity of anticipatory nausea (P = 0.01) and anticipatory vomiting (P = 0.05) as compared with the control group. There was a significant positive correlation between MANE scores and anxiety, depression and distressful symptoms. In conclusion, the results suggest a possible use for stress reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy-related nausea and emesis.