Course Of Cancer Treatment Research Articles

Motor Performance in Children Diagnosed with Cancer: A Longitudinal Observational Study.

Children with cancer are dealing with different side and long-term effects caused by cancer and its treatments, like vinca-alkaloids, which may have negative effects on motor performance. However, the affected areas of motor performance (aiming and catching, balance, manual dexterity) and the differences in these areas between boys and girls and diagnoses are not frequently reported in a longitudinal design. Therefore, the aim of this study was to investigate how motor performance changes over the course of cancer treatment. The study was conducted with 3-to 16-year-old children with cancer (N = 36) in 2013–2017. The five assessment points were 0, 2, 6, 12 and 30 months from diagnosis. Movement-ABC2 was used to assess motor performance. We found that aiming and catching skills decreased significantly during the follow-up (p < 0.05). Balance was affected at the 2-month measurement point (p < 0.05) and more in children with acute lymphoblastic leukemia than in children with other cancer diagnoses (p < 0.05). Girls performed better than boys in manual dexterity at 6, 12 and 30 months (p < 0.05, p < 0.05, p < 0.05, respectively). Individual monitoring of motor performance with standardized tests and physical activity/exercise programs during and after treatment are needed.

The Role of Exosomal microRNA in Cancer Drug Resistance.

Exosomes affect the initiation and progression of cancers. In the tumor microenvironment, not only cancer cells, but also fibroblasts and immunocytes secrete exosomes. Exosomes act as a communicator between cells by transferring different cargos and microRNAs (miRNAs). Drug resistance is one of the critical factors affecting therapeutic effect in the course of cancer treatment. The currently known mechanisms of drug resistance include drug efflux, alterations in drug metabolism, DNA damage repair, alterations of energy programming, cancer stem cells and epigenetic changes. Many studies have shown that miRNA carried by exosomes is closely associated with the development of drug resistance mediated by the above-mentioned mechanisms. This review article will discuss how exosomal miRNAs regulate the drug resistance.

The body's dangerous defenders.

Neutrophils fiercely attack infections, but can also trigger disease. Researchers are trying to tame them.

Barriers to Quality of Care for Cancer Patients in Rural Areas: A Study from the Faroe Islands.

IntroductionResearch has indicated that cancer patients living in rural areas receive poorer quality of treatment and care than their urban counterparts. With a population of approximately 51,000, the Faroe Islands may be characterized as a small-scale, rural society. Due to the geographical location and size of the Faroe Islands, patients who live there often receive part of their treatment abroad. Although a shift in the focus of cancer care from a disease-focused approach to a person-centered approach has been successfully implemented elsewhere, legal and structural conditions unique to the Faroe Islands might prohibit the realization of this paradigmatic shift in the Faroe Islands. The aim of this qualitative study was to examine how Faroese cancer patients have experienced their disease, treatment, and care and provide additional knowledge on cancer patients living in small-scale and rural societies.MethodsFive men and three women who had been through a cancer treatment course with a good prognosis volunteered to be interviewed. Their ages varied from 40 to 80 years. “Active interviewing”, a constructionist approach to qualitative interviewing and latent thematic analysis, was applied.ResultsThree overlapping themes were identified from the categories: sense of coherence, resources and challenges in everyday life, and trust in the system. The analysis uncovered multiple factors related to legal and structural conditions that were barriers to ensuring the quality of cancer care for patients, for instance, shifting consultants, a lack of coherence in treatment, information loss and insufficient contact with cancer nurse specialists.DiscussionThis study is based on a limited number of participants. However, the findings from this study provide insight into the special conditions of cancer patients living in a small-scale, rural society and help explain disparities in the quality of cancer treatment and care between urban and rural areas.

Short Communication: Differences in 5-Year Survival After Cancer Diagnosis Between HIV Clinic Enrollees and the General U.S. Population.

A total of 236 people with HIV (PWH) with cancer diagnosed between 1997 and 2014 in the Johns Hopkins HIV Clinical Cohort (JHHCC) were compared with a sample from NCI's Surveillance, Epidemiology, and End Results (SEER) Program, presumed to be HIV negative. Using G-computation with random survival forest methods, we estimated 5-year restricted mean survival time (RMST) differences by HIV status. Sensitivity analyses were performed among non-AIDS defining cancers, males, females, and stratifying PWH by CD4 ≤ 200 or >200 cells/mm3 at cancer diagnosis. PWH with CD4 ≤ 200 cells/mm3 had decreased survival compared with those in SEER (-7 months; 95% CI = -13 to -2). Women with HIV and CD4 ≤ 200 cells/mm3 at cancer diagnosis had lower survival than SEER women (-10 months; 95% CI = -18 to -2). In the total population, there was no significant difference in 5-year RMST; however, women with HIV and low CD4 had higher mortality despite accounting for stage at diagnosis and first course of cancer treatment.

Identification of urinary candidate biomarkers of cisplatin-induced nephrotoxicity in patients with carcinoma

Nephrotoxicity limits the use of cisplatin (CP) in cancer therapy; however, current clinical measures of renal health do not reflect low degrees of kidney injury. Therefore, discovering new biomarkers for CP-induced acute kidney injury (AKI) is essential for monitoring kidney health during therapy. To identify novel candidate biomarkers in urine for reduced renal function due to CP therapy, we conducted a pilot study on cancer patients eligible for CP treatment. Urine from 30 patients was collected before (baseline) and after 3d of intravenous CP infusion. Urine samples were subjected to Isobaric Tag for Relative Absolute Quantitation (iTRAQ) analysis. Biological roles and pathways for the proteins with altered urine concentrations were identified using bioinformatic tools ITRAQ analysis detected 1411 proteins, 12 of which showed significantly altered levels. Growth differentiation factor-15 (GDF15), leucine-rich alpha-2-glycoprotein 1 (LRG1), and secreted phosphoprotein 1 (SPP1/ osteopontin, OPN) were identified as potential candidate markers by proteomic analysis and were validated by ELISA in another 30 patients and in a CP-induced AKI mouse model. Therefore, GDF15, LRG1, and SPP1 may be applied as novel candidate urinary markers of kidney injury after cisplatin treatment. These findings may facilitate the development of new methods to monitor kidney function, particularly in CP-based chemotherapy. SignificanceCisplatin is pivotal for cancer treatment; however, nephrotoxicity limits its use. Clinical measures for renal health are not reflective of early signs of acute kidney injury. Thus, new indicators of the state of renal health following cisplatin treatment will have to be discovered. This study reports the use of proteomics to mine for candidate markers of kidney injury in the urine of patients undergoing treatment with cisplatin. Results were experimentally validated using patient urine and a mouse model of cisplatin-induced acute kidney injury. The novel candidate biomarkers reported in this study may be used for the non-invasive monitoring of renal health and in mitigating the side-effects of cisplatin during the course of cancer treatment.

Audiological Management of Pediatric Oncology Patients

Audiological Management of Pediatric Oncology Patients

VIST - a Variant-Information Search Tool for precision oncology

BackgroundDiagnosis and treatment decisions in cancer increasingly depend on a detailed analysis of the mutational status of a patient’s genome. This analysis relies on previously published information regarding the association of variations to disease progression and possible interventions. Clinicians to a large degree use biomedical search engines to obtain such information; however, the vast majority of scientific publications focus on basic science and have no direct clinical impact. We develop the Variant-Information Search Tool (VIST), a search engine designed for the targeted search of clinically relevant publications given an oncological mutation profile.ResultsVIST indexes all PubMed abstracts and content from ClinicalTrials.gov. It applies advanced text mining to identify mentions of genes, variants and drugs and uses machine learning based scoring to judge the clinical relevance of indexed abstracts. Its functionality is available through a fast and intuitive web interface. We perform several evaluations, showing that VIST’s ranking is superior to that of PubMed or a pure vector space model with regard to the clinical relevance of a document’s content.ConclusionDifferent user groups search repositories of scientific publications with different intentions. This diversity is not adequately reflected in the standard search engines, often leading to poor performance in specialized settings. We develop a search engine for the specific case of finding documents that are clinically relevant in the course of cancer treatment. We believe that the architecture of our engine, heavily relying on machine learning algorithms, can also act as a blueprint for search engines in other, equally specific domains. VIST is freely available at https://vist.informatik.hu-berlin.de/

Yi-qi-yang-yin-tian-sui-fang enhances cisplatin-induced tumor eradication and inhibits interleukin-7 reduction in non-small cell lung cancer.

Traditional Chinese Medicine (TCM) has been recognized to be conducive to enhancing the efficiency and reducing the side effects in the whole course of cancer treatment. The mechanisms of TCM/chemotherapy combination involved with interleukin-7 (IL-7) potentially enhance immune responses against tumor. In the present study, we emphasized on a herbal formulation Yi-qi-yang-yin-tian-sui-fang or TCM for short, and investigated its roles in chemotherapy in non-small cell lung cancer (NSCLC). The mice bared with tumor were treated with cisplatin (DDP) and simultaneously administrated with/without low, medium and high doses of TCMs (effective content: 0.5, 2.0 and 8.0 g/per mice) via oral gavage. The results indicated that combination of TCM further elevated the therapy efficiency of DDP in a dose-dependent manner. The growth of tumor cells was estimated by Ki-67 stain and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assay. The addition of TCM to the DDP treatment could significantly decrease the expression of Ki-67 and promote the apoptosis of tumor cells. In addition, the serum IL-7 level was down-regulated by DDP but restored by the treatment of TCM. The expression of IL-7 and its receptor IL-7R in tumor tissues was also recovered by TCM. Furthermore, the side effect from bone marrow suppression (myelosuppression) induced by DDP were assessed. TCM could abrogate DDP-induced apoptosis of bone marrow and also remarkably induced the expressions of IL-7 and hematopoietic growth factors including G-CSF, GM-CSF, SCF, and SDF-1 in bone marrow. These data indicated that this TCM combined with DDP showed superior anti-tumor effects with reduced myelosuppression via up-regulating IL-7.

Longitudinal strain analysis allows the identification of subclinical deterioration of right ventricular function in patients with cancer therapy-related left ventricular dysfunction

Background: This study was designed to assess right ventricular systolic function in cancer patients. Methods and Results: 68 consecutive patients receiving potentially cardiotoxic agents were followed for 6 months in a single-center, observational, cohort-study. Left ventricle and free-wall right ventricular longitudinal strain were analyzed prior and after 6 months of treatment, using a vendor-independent software, together with left ventricle ejection fraction, tricuspid annulus plane systolic excursion and right ventricular fractional area change. Cancer therapy-related cardiac dysfunction was defined as a left ventricle ejection fraction drop of >10% to <53%. Both left ventricle ejection fraction (59±7% vs. 55±8%, p<0.0001) and left ventricle longitudinal strain (−19.7±2.5% vs. −17.1±2.6%, p<0.0001) were reduced at follow up, along with free-wall right ventricular longitudinal strain (−24.9±4.5% vs. −21.6±4.9%, p<0.0001). Cancer therapy-related cardiac dysfunction was detected in 20 patients (29%). In 15 out of these 20 patients (75%), a concomitant relative reduction in free-wall right ventricular longitudinal strain magnitude by 17±7% was detected. Moreover, there was a significant correlation between left ventricle and free-wall right ventricular longitudinal strain at follow-up examinations (r=0.323, p<0.0001). A relative drop of right ventricular longitudinal strain >17% had a sensitivity of 55% and a specificity of 70% (AUC=0.75, 0.7-0.8, 95% CI) to identify patients with cancer treatment related cardiac dysfunction. Neither tricuspid annulus plane systolic excursion (24±5 vs. 23±4 mm, p=0.07), nor right ventricular fractional area change (45±8% vs. 44±7%, p=0.6) showed any significant change between examinations.Conclusions: Longitudinal strain analysis allows the identification of subclinical right ventricular dysfunction appearing in the course of cancer treatment when conventional indices of right ventricular dysfunction function are unaffected.

Targeting Pancreatic Cancer Cells with Peptide-Functionalized Polymeric Magnetic Nanoparticles.

Pancreatic cancer is a concealed and highly malignant tumor, and its early diagnosis plays an increasingly weighty role during the course of cancer treatment. In this study, we developed a polymeric magnetic resonance imaging (MRI) nanoplatform for MRI contrast agents. To improve tumor-targeting delivery of MRI contrast agents, we employed a pancreatic cancer targeting CKAAKN peptide to prepare a peptide-functionalized amphiphilic hyaluronic acid–vitamin E succinate polymer (CKAAKN–HA–VES) for delivering ultra-small superparamagnetic iron oxide (USPIO), namely, CKAAKN–HA–VES@USPIO. With the modification of the CKAAKN peptide, CKAAKN–HA–VES@USPIO could specifically internalize into CKAAKN-positive BxPC-3 cells. The CKAAKN–HA–VES@USPIO nanoparticles presented a more specific accumulation into pancreatic cancer cells than normal pancreatic cells, and an obvious decrease in signal intensity was observed in CKAAKN-positive BxPC-3 cells, compared with CKAAKN-negative HPDE6-C7 cells and non-targeting HA–VES@USPIO nanoparticles. The results demonstrated that our polymeric MRI nanoplatform could selectively internalize into CKAAKN-positive pancreatic cancer cells by the specific binding of CKAAKN peptide with pancreatic cancer cell membrane receptors, which provided a novel polymeric MRI contrast agent with high specificity for pancreatic cancer diagnosis, and makes it a very promising candidate for magnetic resonance imaging contrast enhancement.

암보험 약관의 개선 방안에 관한 연구

It appears that the coverage of cancer claims is ultimately the need for hospitalization for the treatment of cancer, and that it is concluded whether by the hospitalization in the course of cancer treatment or after the treatment is closed, and the gravity of the patient’s condition, as shown in the Accepted and rejected cases. In conclusion, there seems to be no inherent difference between the phrase “for the purpose of treating cancer” and the phrase “for the direct purpose of treating cancer,” which eventually modifies the hospitalization.BR The need for hospitalization should be considered as a risk requirement for cancer treatment and as a requirement for cancer treatment. The treatment of cancer is treated through administration of anti-cancer drugs, radiation treatment, surgery, etc. In addition, the treatment of side effects associated with the treatment of cancer, or adverse events occurring in the cancer itself, can be considered to be included in direct cancer treatment.BR Hospitalization means that a patient enters and stays in a hospital for a certain period of time to cure a disease, and the need for hospitalization is considered as a separate requirement in the sense of hospitalization for the direct purpose of treating cancer.BR The need for hospitalization is required to be considered as a separate requirement in the sense of direct purpose hospitalization. However, when determining the requirements for hospitalization, it is necessary to broadly recognize the requirements for hospitalization by considering symptoms, difficulties in treatment or patient condition, depending on the broad-ranging criteria. If hospitalization is interpreted as essential to receive anti-cancer medication, there is room to unfairly reduce the scope of hospital admission.

The course of cancer-related insomnia: don't expect it to disappear after cancer treatment

ObjectiveThe study aimed to examine the 12-month course of cancer-related insomnia (CRI) and to identify possible predictors for the prevalence and persistence of CRI. MethodsThis longitudinal multicenter study included N = 405 patients with cancer (56% females, mean age: 58.6 years). CRI was measured by the Insomnia Severity Index (ISI). Socio-demographic and clinical data, as well as psychological parameters (Distress Thermometer, PHQ-9, GAD-7, and EORTC-Fatigue), were assessed at baseline (T1) and 12 months later (T2). ResultsIn our sample, a high prevalence of relevant insomnia symptoms (49.4%, ISI > 7) was found, while a clinical insomnia diagnosis was verified in 12.8% (ISI > 14). When insomnia was present at T1, this problem was persistent after one year in 64%. At T2, however, significantly more women suffered from insomnia symptoms (53.3% women vs. 39.3% men; p = 0.003). Insomnia was associated with many clinical and psychological parameters, especially with fatigue (r = 0.5). Multiple regression analysis revealed that, in women, only insomnia at T1 was a significant predictor for insomnia at T2 (R2 = 0.40; F(5) = 12.5; p < 0.001), whereas in men insomnia, depressive symptoms and the use of psychotropic drugs at T1 predicted the extent of insomnia at T2 (R2 = 0.28; F(7) = 9.5; p < 0.001). In all participants, levels of distress, depression, and anxiety decreased from T1 to T2 (p's < 0.016). ConclusionInsomnia is a common disorder in cancer patients. Although medical and psychological parameters improved during the 12-month course of cancer treatment, our results show that insomnia is highly persistent, especially in women. This indicates that adequate support for those affected is needed.Clinical Trial Registration Number: DRKS00004860.

Intricate role of mitochondrial lipid in mitophagy and mitochondrial apoptosis: its implication in cancer therapeutics.

The efficacy of chemotherapy is mostly restricted by the drug resistance developed during the course of cancer treatment. Mitophagy, as a pro-survival mechanism, crucially maintains mitochondrial homeostasis and it is one of the mechanisms that cancer cells adopt for their progression. On the other hand, mitochondrial apoptosis, a precisely regulated form of cell death, acts as a tumor-suppressive mechanism by targeting cancer cells. Mitochondrial lipids, such as cardiolipin, ceramide, and sphingosine-1-phosphate, act as a mitophageal signal for the clearance of damaged mitochondria by interacting with mitophagic machinery as well as activate mitochondrial apoptosis via the release of cytochrome c into the cytoplasm. In the recent time, the lipid-mediated lethal mitophagy has also been used as an alternative approach to abolish the survival role of lipid in cancer. Therefore, by targeting mitochondrial lipids in cancer cells, the detailed mechanism linked to drug resistance can be unraveled. In this review, we precisely discuss the current knowledge about the multifaceted role of mitochondrial lipid in regulating mitophagy and mitochondrial apoptosis and its application in effective cancer therapy.

Influence of Prior Psychiatric Disorders on the Treatment Course of Gynaecological Cancer – A Nationwide Cohort Study

AimsTo examine the influence of pre-existing psychiatric disorder on the choice of treatment in patients with gynaecological cancer. Materials and methodsThe analyses were based on all patients who underwent surgical treatment for endometrial, ovarian or cervical cancer who were registered in the Danish Gynecological Cancer Database in the years 2007–2014 (3059 patients with ovarian cancer, 5100 patients with endometrial cancer and 1150 with cervical cancer). Logistic regression model and Cox regression model, adjusted for relevant confounders, were used to estimate the effect of pre-existing psychiatric disorder on the course of cancer treatment. Our outcomes were (i) presurgical oncological treatment, (ii) macroradical surgery for patients with ovarian cancer, (iii) radiation/chemotherapy within 30 days and 100 days after surgery and (iv) time from surgery to first oncological treatment. ResultsIn the group of patients with ovarian cancer, more patients with a psychiatric disorder received macroradical surgery versus patients without a psychiatric disorder, corresponding to an adjusted odds ratio of 1.24 (95% confidence interval 0.62–2.41) and the chance for having oncological treatment within 100 days was odds ratio = 1.26 (95% confidence interval 0.77–2.10). As for patients with endometrial cancer, all outcome estimates were close to unity. The adjusted odds ratio for oncological treatment within 30 days after surgery in patients with cervical cancer with a history of psychiatric disorder was 0.20 (95% confidence interval 0.03–1.54). ConclusionsWe did not find any significant differences in the treatment of ovarian and endometrial cancer in patients with pre-existing psychiatric diagnoses. When it comes to oncological treatment, we suggest that increased attention should be paid to patients with cervical cancer having a pre-existing psychiatric diagnosis.

PCN25 - Evaluating Availability, Prices and Affordability: Case Study of Selected Oncology and Innovator Medicines in Malaysia

High-priced medicines such as patented innovators and oncology items are great burden to healthcare budgets and barriers to treatment access worldwide. This study investigates availability, medicine price and affordability of selected oncology and on-patent medicines (medicines that still have patent protection) in Malaysia’s public and private sectors. This cross sectional study adapted the validated methodology developed by the World Health Organization/Health Action International. Procurement and patient prices were collected from public and private facilities nationwide for a case study of four oncology and four on-patent medicines. Availability was reported as the percentage of medicine outlets with the medicine. For international comparison, median prices were compared against International Reference Price (IRP). Mark-up was calculated as the percentage of patient price to procurement price. Affordability was determined by the number of days’ wages required for selected treatment courses. The average availability of the selected basket of oncology and on-patent medicines were 53.9% and 51.0%, respectively. There were wide variations between public and private procurement prices of the medicines studied. Compared to international benchmarks, oncology drugs were procured at 0.2 to 3.2 times the IRP. Median retail mark-ups of originator and generic oncology medicines were 20.7% and 130.2%, respectively. High mark-ups of 41.4% were observed for on-patent medicines. Although generics were affordable, originators were unaffordable. To illustrate, low-income patients need to work for about three days to afford on-patent medicines and up to a year to afford one course of cancer treatment. Since there are no generic alternatives, patients that are not able to afford the needed treatment may not have other treatment alternatives. Sustainable financing for expensive medicines is needed to safeguard medicines access and prevent catastrophic outcomes. Policies to reward innovation should be balanced with affordability, as people from different socio-economic groups deserve the same treatment.

Abstract B33: Coexpression and frequency of immune checkpoint proteins in the tumor microenvironment analyzed via multiplex immunohistochemistry

Abstract Antibody blockade of the PD-1/PD-L1 axis is approved for clinical use in multiple tumor types in an effort to block tumor immune evasion. The high number of emerging cancer immunotherapy agents indicates that there is an increased importance in assessing and understanding the immunosuppressive tumor microenvironment. In this study, we applied a 7-color multiplex immunohistochemistry panel to a lung tumor tissue microarray consisting of FFPE adenocarcinoma and squamous cell carcinoma cores. The panel was composed of immune checkpoint receptors PD-1 and TIM-3; PD-L1, a PD-1 ligand; CD68 and CD8, macrophage and cytotoxic T cell markers, respectively; as well as cytokeratin as the tumor mask and DAPI as the nuclear counterstain. The array included three cores per patient, and the concordance between fields was analyzed. Additionally, the frequency and co-localization of these markers and checkpoint proteins in the tumor and tumor microenvironment were quantified. TIM-3 expression was found not only on CD8+ T cells, but also on CD68+ macrophages, where it is thought to have a distinct function involved in phagocytosis of tumor cells. Furthermore, the significant role that macrophages play in tumor progression via promoting angiogenesis and inhibiting antitumor immunity makes these data increasingly relevant. These data demonstrate how antibody-based multiplex analysis in tissue can provide insight into the various cell types involved in tumor-mediated immune evasion. Multiplex IHC with highly specific antibodies will serve to improve our understanding of how immunotherapies can be used to affect the innate and adaptive branches of the immune system in the course of cancer treatment. Citation Format: Jennifer Ziello, Sarah Klein, Katherine Crosby. Coexpression and frequency of immune checkpoint proteins in the tumor microenvironment analyzed via multiplex immunohistochemistry [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2017 Oct 1-4; Boston, MA. Philadelphia (PA): AACR; Cancer Immunol Res 2018;6(9 Suppl):Abstract nr B33.

Radiotherapy Utilization and Fractionation Patterns During the First Course of Cancer Treatment in the United States From 2004 to 2014

BackgroundThe changing use of radiation as a first-line cancer therapy in the United States is poorly characterized. This study aims to report radiotherapy utilization and fractionation patterns during the first course of cancer treatment. MethodsWe extracted all solid tumor cases from 2004 to 2014 in the National Cancer Data Base, which captures only the first course of treatment. Patients were subcategorized by disease site: breast, central nervous system (CNS), gastrointestinal, genitourinary, gynecologic, head and neck (HN), musculoskeletal, skin, or thoracic. Receipt of therapy was identified (systemic, surgical, or radiation therapy). Radiotherapy was subcategorized as external beam radiation therapy (EBRT) (conventional and stereotactic), brachytherapy, and radio-isotopes. Radiotherapy was also characterized by intent (palliative or definitive). The percent of patients receiving therapy and in those receiving radiotherapy, the mean number of radiation treatments, or fractions, delivered over time were reported. ResultsThe utilization of radiotherapy among all cases declined from 33.9% to 31.2% (P < .001), and systemic therapy and surgical therapy use went from 37.3% to 44.1% (P < .001) and 67.7% to 67.5% (P = .79), respectively. Radiotherapy utilization decreased most in genitourinary, HN, and CNS cases with relative declines of −42.5% (−12.4% absolute decrease, P < .001), −10.3% (−6.1%, P < .001), and −9.6% (−3.2%, P = .001), respectively. Radiotherapy utilization increased in gastrointestinal (+0.6% absolute increase, P < .001), musculoskeletal (+1.0%, P = .002), skin (+0.7%, P = .002), and thoracic (+0.1%, P = .46) malignancies. In patients receiving EBRT, the mean number of fractions delivered per patient declined from 28.7 to 25.2 (P < .001); declines were evident in all disease sites but CNS. ConclusionWe found a steady decrease in the percent of patients receiving radiotherapy in their first course of treatment, and a global decline in the mean number of fractions delivered per patient receiving EBRT, compared with an increase in systemic therapy and stable surgery utilization. These results illustrate the changing use of radiotherapy and fractionation during first-line therapy in contemporary US cancer care.

Oncology Section EDGE Task Force on Cancer: A Systematic Review of Clinical Measures for Pain

Background: Pain is one of the most common complaints in individuals with cancer and can occur at any point during the course of cancer treatment. Purpose: To identify outcome measures for assessing pain and to evaluate their psychometric properties and relevance to adults with a diagnosis of cancer. Methods: Three electronic databases (CINAHL, MEDLINE, and PsycINFO) were reviewed using specific search terms to locate articles that identify outcome measures assessing pain in adults with a diagnosis of cancer. From the 1164 articles identified, 494 articles were reviewed and 22 outcome measures were selected for analysis. Each outcome measure was independently reviewed and rated by 2 reviewers using the updated Cancer EDGE Task Force Outcome Measure Rating Form. Any discrepancies between reviewers were discussed, and an overall recommendation for each measure was made using the 4-point Cancer EDGE Task Force Rating Scale. Results: On the basis of the psychometric properties, clinical utility, and relevance to adults with a diagnosis of cancer, the following 3 measures are highly recommended: McGill Pain Questionnaire–Short Form, Numeric Rating Scale, and Visual Analog Scale. Four measures are recommended: Brief Pain Inventory, Brief Pain Inventory–Short Form, McGill Pain Questionnaire, and Pain Disability Index. Eleven measures are recommended as reasonable to use, and 3 are not recommended. Conclusions: Seven of the 22 pain measures demonstrated satisfactory psychometric properties and clinical utility and are thereby recommended for clinical and research use in adults with a diagnosis of cancer.

Is quality of registry treatment data related to registrar experience and workload? A study of Taiwan cancer registry data

Although cancer treatment information has been collected through the Cancer Registry system in Taiwan for more than 10 years, the accuracy of such data has never been evaluated. This study examined the accuracy rate between registrar experience and on-site chart review for the first course of cancer treatment. In this retrospective chart review study, 392 randomly selected medical records from 14 hospitals were re-abstracted by experienced abstractors. The kappa coefficients of accuracy for the abstracting data were calculated against the gold standard. Correlations between registrar background and workload were then identified through regression analysis. Regarding surgery type, low accuracy rates were noted for gastric cancer (84.0%), oral cavity cancer (84.6%), and bladder cancer (88.9%). For chemotherapy, low accuracy rates were observed for hematopoietic diseases (81.3%) and esophageal cancer (88.0%). For radiotherapy, low accuracy rates were noted for esophageal cancer (80.0%), cervical cancer (81.8%), and lymphoma (85.7%). When stratifying by surgery type after adjustment for hospital caseload, a high accuracy rate was found for cancer registrars who had progressed from basic to advanced licenses within 5 years of graduating. The accuracy rate for the first course of cancer treatment was affected by the cancer type and the experience of cancer registrars, but it was not affected by the workload of cancer registrars. We recommend that cancer registrars with basic licenses upgrade to advanced licenses as soon as possible. Medical record collaboration should establish documentation for checklist of radiotherapy and surgical operation records.