Delays In Cancer Treatment Research Articles

Development and validation of a questionnaire to assess delay in treatment for breast cancer

BackgroundThis study reports the reliability and validity of a questionnaire designed to measure the time from detection of a breast cancer to arrival at a cancer hospital, as well as the factors that are associated with delay.MethodsThe proposed questionnaire measures dates for estimation of the patient, provider and total intervals from detection to treatment, as well as factors that could be related to delays: means of problem identification (self-discovery or screening), the patients’ initial interpretations of symptoms, patients’ perceptions of delay, reasons for delay in initial seeking of medical care, barriers perceived to have caused provider delay, prior utilisation of health services, use of alternative medicine, cancer-screening knowledge and practices, and aspects of the social network of support for medical attention. The questionnaire was assembled with consideration for previous research results from a review of the literature and qualitative interviews of patients with breast cancer symptoms. It was tested for face validity, content validity, reliability, internal consistency, convergent and divergent validity, sensitivity and specificity in a series of 4 tests with 602 patients.ResultsThe instrument showed good face and content validity. It allowed discrimination of patients with different types and degrees of delay, had quite good reliability for the time intervals (with no significant mean differences between the two measurements), and fairly good internal consistency of the item dimensions (with Cronbach’s alpha values for each dimension between 0.42 and 0.85). Finally, sensitivity and specificity were 74.68% and 48.81%, respectively.ConclusionsTo the best of our knowledge, this is the first published report of the development and validation of a questionnaire for estimation of breast cancer delay and its correlated factors. It is a valid, reliable and sensitive instrument.

Surveillance of Healthcare Associated Infection in the Adult Hematology Unit

Abstract 4712 Background:Patients with hematological malignancies are at risk for Healthcare Associated Infection (HAIs) due to malignancy types, antineoplastic chemotherapies, immunosuppressant treatment, and prolonged hospital day. HAIs cause delay in cancer treatment, increase morbidity or mortality and increase costs of treatment affecting successful outcomes of cancer care. We describe the outcome of the surveillance in adult hematology patients in our hospital and identified groups most at risk for HAIs. We describe the outcome of the surveillance study in adult hematology patients in Morocco. Methods: A prospective surveillance study included all patients admitted to the adult hematology unit from March 2011 to August 2011. They excluded patients from the transplant unit and day hospital. The Center for Disease Control and Prevention standard definitions were used to determine if an infection was hospital acquired. We collected data in demographics, risk factors, the presence or absence of HAIs and its type. Results: A total of 180 patients that represented 377 admissions, with 4438 hospitalization-days, were included in the study. They have a mean age of 35 years (18–78 years). The sex-ratio H/F was 1.7. The distribution of the patient’s diagnosis is related in Table1. 63 patients had 110 episodes of HAIs. The incidence rate of HAIs was 24.74/1000 hospitalization-days. The most frequent of infectious episodes were bacteremia (38.18%) and pneumonia (24.54%). The fever of unknown origin represented 35.45%.The distribution of the intrinsic risk factors with regard to episodes of HAIs was the following: 83.48% presented with neutropenia, 59.79% presented with severe neutropenia. With regard to extrinsic risk factors for HAIs, 61.03% of the infectious episodes had central venous catheterization. The mortality rate due to HAIs was 8%. Conclusion: Although the overall HAI rate is in line with published reports in hematology units, our mortality rate is higher. This finding suggests that we must be more aggressive to prevent infections in the patients in these units. Table I: Distribution of patient’s diagnosis and incidence rate of HAIs Infection Incidence rate (/1000 hospital day) N n % Age (years) 18–40 41–60 > 60 Hematologic neoplasia 245 97 35 70 31 9 28,57 31,96 25,71 Acute myeloid leukemia 147 98 89,00 35,27 Acute lymphoblastic leukemia 83 5 4,54 Non Hodgkin’s lymphoma 102 5 4,54 Hodgkin’s disease 36 0 Aplastic anemia 3 2 Others 6 0 Total 377 110 100 Disclosures:No relevant conflicts of interest to declare.

1621 - Fertility Preservation in Young Early Breast Cancer: Strategies and Patient Preferences

ABSTRACT Background In Italy, approximately 1800 women younger than 39 years of age are diagnosed with breast cancer (BC) every year. Chemotherapy (CT)-induced loss of fertility is a major concern for these patients. Different strategies are available to attempt to preserve ovarian function and they should be considered as early as possible during treatment planning. We evaluated feasibility and patient preferences of two different strategies: oocyte cryopreservation (OC) and temporary ovarian suppression with the administration of LHRH analogue (LHRHa) during CT. Materials and methods From March 2010 to April 2012 28 BC patients younger than 41 years (median age: 38 [range 33-41]) candidates for CT, referred to our institution. They were offered the possibility to reduce the gonadotoxic effects of such treatments by two different strategies. The oncologist proposed both the administration of LHRHa before and during CT, and a reproductive counselling performed by the gynecologist, where OC was discussed. Results The majority of patients (25 [89.3%]) accepted to undergo a treatment with LHRHa, started at least 1 week before CT. Nineteen patients (67.9%) refused the reproductive counselling; the reasons for refusal were: previous pregnancies (13 patients [46.4%]) and no desire for children (6 patients [21.4%]). Out of 9 patients (32.1%) that accepted the reproductive counselling, only 3 (10.7%) accepted to undergo OC. The reasons for refusal were: fear of delaying cancer treatment (2 patients [7.1%]), fear of the ovarian stimulation required (1 patients [3.6%]), not eligible for comorbidities (1 patients [3.6%]), low successful rate of the technique (1 patients [3.6%]) and unknown in 1 cases (3.6%). The 3 patients underwent a controlled ovarian stimulation with the use of daily injections of recombinant FSH: median length of stimulation was 9 days (range, 8 to 9 days); peak estradiol levels ranged from 280 to 521 pg/ml. An average of 13.3 ± 5.7 oocytes was retrieved, and 8.3 ± 3.1 oocytes cryopreserved per patient. Conclusions This analysis suggests that the majority of patients (89%) accept the administration of LHRHa during CT and approximately 11% of patients undergoes OC. Disclosure All authors have declared no conflicts of interest.

Treatment of breast cancer during pregnancy: an observational study

Little is known about the treatment of breast cancer during pregnancy. We aimed to determine whether treatment for breast cancer during pregnancy is safe for both mother and child. We recruited patients from seven European countries with a primary diagnosis of breast cancer during pregnancy; data were collected retrospectively if the patient was diagnosed before April, 2003 (when the registry began), or prospectively thereafter, irrespective of the outcome of pregnancy and the type and timing of treatment. The primary endpoint was fetal health for up to 4 weeks after delivery. The registry is ongoing. The study is registered with ClinicalTrials.gov, number NCT00196833. From April, 2003, to December, 2011, 447 patients were registered, 413 of whom had early breast cancer. Median age was 33 years (range 22-51). At the time of diagnosis, median gestational age was 24 weeks (range 5-40). 197 (48%) of 413 women received chemotherapy during pregnancy with a median of four cycles (range one to eight). 178 received an anthracycline, 15 received cyclophosphamide, methotrexate, and fluorouracil, and 14 received a taxane. Birthweight was affected by chemotherapy exposure after adjustment for gestational age (p=0·018), but not by number of chemotherapy cycles (p=0·71). No statistical difference between the two groups was observed for premature deliveries before the 37th week of gestation. 40 (10%) of 386 infants had side-effects, malformations, or new-born complications; these events were more common in infants born before the 37th week of gestation than they were in infants born in the 37th week or later (31 [16%] of 191 infants vs nine [5%] of 195 infants; p=0·0002). In infants for whom maternal treatment was known, adverse events were more common in those who received chemotherapy in utero compared with those who were not exposed (31 [15%] of 203 vs seven [4%] of 170 infants; p=0·00045). Two infants died; both were exposed to chemotherapy and delivered prematurely, but both deaths were thought not to be related to treatment. Median disease-free survival for women with early breast cancer was 70·6 months (95% CI 62·1-105·5) in women starting chemotherapy during pregnancy and 94·4 months (lower 95% CI 64·4; upper 95% CI not yet reached) in women starting chemotherapy after delivery (unadjusted hazard ratio 1·13 [95% CI 0·76-1·69]; p=0·539). Although our data show that infants exposed to chemotherapy in utero had a lower birthweight at gestational age than did those who were unexposed, and had more complications, these differences were not clinically significant and, since none of the infants was exposed to chemotherapy in the first trimester, were most likely related to premature delivery. Delay of cancer treatment did not significantly affect disease-free survival for mothers with early breast cancer. Because preterm birth was strongly associated with adverse events, a full-term delivery seems to be of paramount importance. BANSS Foundation, Biedenkopf, Germany and the Belgian Cancer Plan, Ministry of Health, Belgium.

Identifying Mediators of the Racial/Ethnic Disparity in Breast Cancer Treatment Delay

Identifying Mediators of the Racial/Ethnic Disparity in Breast Cancer Treatment Delay

Cancer, fertility preservation, and future pregnancy: a comprehensive review.

Given the increases in 5-year cancer survival and recent advances in fertility preserving technologies, an increasing number of women with cancer are presenting for discussion of fertility preserving options. This review will summarize the risk of infertility secondary to cancer treatment, available treatment options for fertility preservation, and techniques to reduce future risks for patients. Concerns that will be addressed include the risk of the medications and procedures, the potential delay in cancer treatment, likelihood of pregnancy complications, as well as the impact of future pregnancy on the recurrence risk of cancer. Recent advances in oocyte cryopreservation and ovarian stimulation protocols will be discussed. Healthcare providers need to be informed of available treatment options including the risks, advantages, and disadvantages of fertility preserving options to properly counsel patients.

Determinants of patientʼs and doctorʼs delay in diagnosis and treatment of colorectal cancer

Early detection and treatment is important for the management of colorectal cancer (CRC). To assess patient and doctor delay and their determinants. A retrospective observational study in a primary care setting concerning 197 patients with CRC. The time between initial symptoms and the onset of treatment was categorized into four periods. With multivariable logistic regression analysis, determinants of delay were investigated. The median time from onset of symptoms until the start of treatment was 138 days. Median time for the four periods to: first general practitioner consult, first specialist consult, histological diagnosis, and start treatment were 30, 14, 27, and 18 days, respectively. Rectal blood loss and weight loss were significantly related to patient delay, whereas psychiatric comorbidity was related to delay in referral by the general practitioner. For delay in histological diagnosis and start of definitive treatment no determinants were found. Delay was not associated with more advanced disease stages. There is considerable delay in the management of CRC, especially in time to consultation and time to onset of clinical treatment. Education among the general public about the importance of alarm symptoms and increasing efficiency of the diagnostic process in hospital setting are a key in improving CRC disease management.

Fertility preservation in girls and young women

There is increasing interest and experience in the options available to preserve fertility in those about to undergo potentially gonadotoxic chemotherapy or radiation therapy, usually related to treatment for cancer. Recent years have seen the development of methods for prepubertal girls, female adolescents and adult women, although these remain less established than sperm cryopreservation for men. At present, the options for prepubertal boys remain experimental. Embryo cryopreservation following ovarian stimulation and IVF is a routine procedure technically and its success in the management of infertility is established. However, there are no data on uptake or success rates in the context of fertility preservation in women with cancer. Oocyte cryopreservation is technically challenging and requires ovarian stimulation, thus potentially resulting in a delay in cancer treatment. Oocyte vitrification offers increased success rates in comparison with slow freezing; however, this approach is also limited by the number of oocytes that can be obtained. The third possibility, ovarian tissue cryopreservation, can be performed without significant delay and is the only option for prepubertal girls. Worldwide, a small number of children have been born following reimplantation of frozen/thawed ovarian tissue. It is clear that fertility preservation is important for some girls and young women facing treatments that will compromise their fertility, but the availability of all approaches varies widely. Effective approaches for prepubertal boys are also required.

Health of IVM children

In vitro maturation (IVM) is an emerging type of assisted reproductive technology (ART), in which immature as opposed to mature oocytes are collected from the ovaries and allowed to mature in vitro prior to fertilisation by either standard in vitro fertilisation (IVF) on intracytoplasmic sperm injection (ICSI). Since the first report of a human birth resulting from IVM in 1991 [1], it is estimated that over 1,300 babies have been born following the technique [2] (in contrast to an estimated 3 million babies conceived by standard IVF and ICSI over the last 30 years). IVM offers a number of potential benefits when compared to standard IVF, principally related to the avoidance of high doses of hormonal stimulation with gonadotrophins and GnRH analogues. In patients with polycystic ovary syndrome (PCOS) this avoids the risk of ovarian hyperstimulation syndrome (OHSS). The high costs of hormonal therapy also make IVM cheaper than conventional alternatives. Immature oocyte retrieval, without the need to wait for hormonal stimulation and in vivo maturation, offers the possibility of expedient oocyte cryopreservation for patients diagnosed with cancers without delaying cancer treatment. However, despite recent improvements, pregnancy rates with IVM remain lower than with conventional IVF, and higher miscarriage rates have been reported with IVM [2]. For these reasons IVM has yet to become widely used in the field of ART. Given that IVM is not yet a mainstream ART technique, it is not surprising that there is very limited follow-up data regarding the health of children conceived following its use. This is in contrast to a significant volume of high quality studies that have followed-up children conceived following standard IVF and ICSI. In this article we discuss hypothetical concerns regarding the health of IVM children, and review the few studies published in this area. Health of IVF & ICSI children High multiple pregnancy rates continue to be the single greatest factor adversely impacting upon the outcome of ART pregnancies [3, 4], with resulting increased risk of preterm delivery, low birth weight, and perinatal mortality. However, evidence regarding the health of ART singletons when compared to spontaneously conceived singletons is generally reassuring. The majority of studies investigating the risk of congenital malformations, neurodevelopmental outcome, physical health, growth, and psychosocial well-being in ART children are reassuring [5, 6]. Concerns have been raised that ART children may exhibit higher rates of cancer [7] and rare imprinting disorders [8] (such as Beckwith-Wiedemann Syndrome and Angelman Syndrome), however larger studies are required to confirm these associations. Risks of infertility and cardiovascular disease in later life remain unexplored areas of concern and require follow-up of cohorts of ART children to continue into adulthood.

Treatment outcomes and quality-of-life assessment in a university-based fertility preservation program: Results of a registry of female cancer patients at 2 years

To explore patient goals and quality of life (QOL) via a prospective registry and compare fertility preservation (FP) outcomes before, during, and after cancer therapy. Of 35 patients entering the registry from 3/2008 to 3/2010, 29/35 completed the study survey and agreed to follow-up, and 31/35 completed treatment. Survey results and FP outcomes were analyzed. Most patients rated the impact of cancer treatment on fertility of highest importance at baseline and 1-year follow-up. QOL scores were overall positive at both intervals. Patients naïve to any cancer treatment (n = 12) had more gametes frozen than patients with prior cancer treatment (n = 19) with no difference in age or gonadotropin dosage. For patients awaiting cancer treatment, the median time from consultation to oocyte retrieval was 25 days. Cancer treatment sequalae posed challenges to optimal FP outcomes. Fertility preservation remains a significant issue for cancer patients. With early reproductive endocrinologist referral, cancer treatment delay is minimized and FP outcomes are optimized.

Race and Ethnicity are Associated with Delays in Breast Cancer Treatment (2003–2006)

Access to timely treatment may be one contributing factor to survival differences by race/ethnicity among breast cancer patients. In this study, we examined the relationship between race and treatment delay among breast cancer patients diagnosed between 2003 and 2006 with Stage I-III breast cancer from the National Cancer Database (n=250,007). We evaluated factors associated with receipt of initial treatment more than 30, 60, and 90 days after biopsy using multivariable log binomial models to estimate risk ratios (RR) and 95% confidence intervals (CI). The average time to treatment was 34.30 days (±31.77). Independent of health insurance, stage at diagnosis, and age, Black and Hispanic patients had higher risks of 30, 60, and 90-day treatment delay compared with White patients. Further studies are needed to define the role of structural, health system, physician, clinical and patient factors in treatment delay among Black and Hispanic women and appropriate interventions.

Abstract P4-10-13: Therapeutic Delays, Mode of Diagnosis and Surgical Treatment of Operable Invasive Breast Cancer (BC) in Elderly Versus Non Elderly Patients in the Community

Abstract Background: National mammography screening program covers populations aged 50-74. We wondered whether breast cancer characteristics and treatment delays were influenced by age and screening method in a community-based breast unit. Patients and Methods: We analyzed complete data of prospectively recorded community operable breast cancer cases in a single regional cancer center between Jan 1st, 2005 and Oct 10th, 2007. Pts were eligible if they i. had a final diagnosis of invasive BC ii. were operated as first trt for BC, iii. had no history of other previous malignancy within the past 5 year period. Logistic regression analyses (SAS) were used to determine factors influencing delays between first description of the lesion and first appointment at breast unit. Results: 1044 pts met the inclusion criteria and had full data available. Age did not appear as a predictor of therapeutic delay, with both elderly and non-elderly pts having a median delay of 19 days between first screening/evidence of disease and 1st appointment at the breast unit. 59% of elderly and 65% of non-elderly pts had respectively had their breast cancer diagnosed through mammographic screening. As expected, mammographic screening as mode of discovery of the cancer was highest, among the 688 pts aged 50-74 (73%). Tumors characteristics and surgical treatment did not differ according to age categories elderly/non elderly as described in Table 1. Conservation rates were high in both populations. Conclusion: Despite absence of national mammographic screening program in elderly populations, patterns of screening and care appear efficient in a community-based setting, with absence of therapeutic delays, similar tumor staging and similar accesss to conservative surgery as compared to younger populations. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-13.

The Macrobiotic Diet in Chronic Disease

The macrobiotic diet is a low-fat, high-fiber, high-complex carbohydrate, mainly vegetarian diet. It is associated with a lifestyle system and a spiritual philosophy of life. Unlike many diets, the composition is not fixed and may be altered depending on a person's health status, among other considerations. Studies indicating lower serum lipid levels and blood pressure in people following a macrobiotic diet than in the general population suggest it to be an effective preventive strategy for cardiovascular disease. Many of its components suggest macrobiotics would be a valuable approach to cancer prevention. On the other hand, it has been the subject of controversy, especially with respect to its use in patients suffering from malignancies. Several remarkable anecdotal case reports have supported a therapeutic effect in patients with advanced cancers. However, to date, the few studies attempted have been inadequate to prove effectiveness and further research is warranted. Concerns include potential delay in conventional treatment for cancer, risks associated with nutrition deficiencies, and social limitations related to the complexities of strict adherence to this diet. Many aspects of currently popular dietary recommendations such as eating locally grown, in-season, fresh, organic foods are legacies of the macrobiotic lifestyle and diet.

Improving fertility preservation in cancer: ovarian tissue cryobanking followed by ovarian stimulation can be efficiently combined

This pilot study evaluated whether combination of partial removal of ovarian tissue for cryobanking followed by ovarian stimulation and cryopreservation of oocytes can improve the efficacy of fertility preservation without further delaying cancer treatment. Initial partial removal of ovarian tissue did not substantially affect the average number and quality of retrieved oocytes after ovarian stimulation in this study.

Treatment of pregnancy associated breast cancer

Pregnancy-associated breast cancer (PABC) is defined as cancer of the breast diagnosed during pregnancy and up to 1 year postpartum. The crude incidence is 1/3000 pregnant women. As women delay childbearing the incidence of PABC increases with age. Young patients with PABC do not have worse prognosis compared with those with non-PABC; however, pregnancy can contribute to a delay in breast cancer diagnosis, evaluation, and treatment. Primary care physicians and gynecologists should be careful in the thorough workup of breast symptoms in the pregnant population to expedite diagnosis and allow multidisciplinary treatment as early as possible following the established diagnosis. Authors report a case of a 30-year-old pregnant woman, who detected inflammatory signs of her right breast and a palpable axillary mass at the 21st week of gestation. Her symptoms did not improve with administration of antibiotics. Therefore fine needle aspiration biopsy of the axillary lump was performed, with the result of unequivocal diagnosis of metastatic invasive carcinoma. The patient was referred to the multidisciplinary tumor board of our Department at the 27st week of gestation with the symptoms of inflammatory breast cancer, palpable right axillary and supraclavicular lymph nodes. Core biopsy showed an ER and PR negative, Her-2 positive, grade 3, infiltrating ductal carcinoma of the breast. After multidisciplinary team consultation the patient declined any kind of therapy during her pregnancy. On the 30th week of gestation caesarean section was performed. The premature baby girl was treated in the Neonatal Intensive Care Unit. Imaging modalities revealed no evidence of distant metastases short after the delivery. After 6 cycles of chemotherapy (docetaxel-doxorubicin-cycclophosphamid) the patient underwent right mastectomy and axillary lymph node dissection. Complete pathological response was diagnosed, since no residual tumor was found in the surgical resection specimen. After radiotherapy, trastuzumab medication was initiated. To date, there is no evidence of local recurrence or distant metastases during her 24 months follow-up. The newborn is on close neurohabilitation follow-up due to the evidence of generalized muscle dystonia. Had the patient accepted chemotherapy, the damage of the newborn baby would have been avoidable.

Delays in Head and Neck Cancer Treatment for the Uninsured

OBJECTIVE: Delays from diagnosis to treatment may account in part for poor head and neck cancer outcomes among patients of low socioeconomic status, minority patients, and the uninsured. The purpose of this study is to evaluate factors associated with treatment delay in an urban county hospital system. METHOD: Retrospective review of consecutive head and neck cancer patients treated at a county hospital serving an indigent urban population and uninsured county residents. Multivariate analysis was performed using the Cox regression model. RESULTS: Ninety consecutive patients were evaluated. The average time from diagnosis to initiation of treatment was 49 days. On univariate analysis, age 55 years, oropharyngeal primary tumor site, and primary treatment with chemotherapy and radiation were associated with a statistically significant longer delay to treatment. On multivariate analysis, male gender (HR 2.5, 95% CI 1.3-4.9, p0.008), nonsurgical primary treatment modality (HR 0.8, 95% CI 0.3-0.6, p0.003), and positive nodal status (HR0.4, 95% CI 0.2-0.9, p0.018) were associated with a significantly longer delay in treatment, while an association with oropharyngeal primary tumor site approached statistical significance (HR2.2, 95% CI 1.0-4.8, p0.052). CONCLUSION: Alarming delays in head and neck cancer care exist among indigent patients and the uninsured, with young adult males, patients with positive nodal disease, and those receiving primary chemoradiation at highest risk. Possible reasons for the delay include difficulty navigating multidisciplinary cancer care, poor patient compliance, and a lack of resources. Improved patient outreach and more efficient allocation of treatment resources are needed.

Why so late?!—delay in treatment of colorectal cancer is socially determined

The interval between symptom onset and therapy in patients with colorectal cancer was studied. One hundred twenty three patients with colorectal cancer were included. Demography data, symptoms, consultations, and tumour stage were obtained by standardized questionnaires. Risk factors for delayed treatment were analysed. Eighty six patients suffered from colonic cancer. The total time between the first symptoms and therapy ranged from 13 to 442 days (mean, 148). Delay of surgical therapy was responsible for significantly higher tumour grades. Delayed start of therapy was found to be correlated to the type of cancer, socioeconomic status, marital status, and quality of first consultation (univariate analysis). On multivariate analyses, type of cancer, marital and socioeconomic status remained significantly associated with delayed treatment (all p values ≤ 0.001, r(2) = 0.50). The delay in treatment of colorectal cancer depends on socioeconomic status and family background. Achieving equity in colorectal cancer detection may require consideration of high-risk subgroups.

Reactivation of chronic hepatitis B virus in cancer patients receiving immunosuppression: The case for screening.

9088 Background: Reactivation of hepatitis B virus (HBV) infection following immunosuppressive therapy can cause significant morbidity and mortality. This study aims to estimate the frequency and clinical consequences of reactivation of HBV in a diverse group of cancer patients (pts) receiving immunosuppression. Methods: We retrospectively reviewed all pts at Memorial Sloan-Kettering Cancer Center between 2003 and 2009 who had an HBV DNA PCR>1000 to identify cases of reactivation of HBV. The medical record was used to distinguish between reactivation and de novo infection. Pt demographics, type of malignancy, immunosuppressive agent, and clinical outcome were recorded. Results: Between 2003 and 2009, 241 pts had HBV PCR>1000 copies including 23 with associated abrupt increase in serum ALT. Twenty-two of these pts (median age: 53; 45% Asian descent) had no risk factors for acute HBV, suggesting reactivation. Immunosuppressive therapy began a median of 21 days (range 1-175) prior to reactivation. Varied chemotherapeutic agents were used; 1 pt received high dose steroids only. Seven (32%) patients had lymphoma, and 15 (68%) had other tumors: hepatocellular carcinoma (2), glioblastoma (2), leukemia (2), multiple myeloma (1), esophageal ca (1), sarcoma (1), breast ca (1), lung ca (1), jejunal ca (1), pancreatic ca (1), ovarian ca (1), and neuroendocrine tumor (1). Four (21%) pts died from liver failure; 19 (86%) required hospitalization (median LOS 5 days (range 2-33)). Four pts had clinically significant delays in cancer treatment due to HBV reactivation. Three pts were transferred for liver transplant evaluation; 1 pt underwent transplant. Conclusions: Reactivation of HBV during chemotherapy-induced immunosuppression is a completely preventable disease with substantial morbidity and mortality. Our 3 cases per year of clinically significant HBV reactivation occurred in patients of various nationalities without association with a particular malignancy or medication. Because of these findings, we now screen all patients initiating immunosuppressive therapy for HBV; subsequent use of antiviral prophylaxis is based on planned treatment and HBV risk group. No significant financial relationships to disclose.

Public Awareness of Testis Cancer and the Prevalence of Testicular Self-examination—Changing Patterns Over 20 Years

Delay in treatment of testis cancer (TC) has a proven negative impact on disease stage, treatment outcome, and mortality. Poor public awareness of the disease and lack of testis self-examination (TSE) may account for late presentation. The aim of this study was to examine the knowledge of TC and performance of TSE in a group of men over 2 time periods 20 years apart. In the current study, 677 men from a banking institution were surveyed on their knowledge of TC and their performance of TSE. Comparisons were made from the current data and those from the original study in 1986. This study demonstrates an increase in public awareness and modest concomitant increase in TSE since first studied in this country in 1986. There was no difference in knowledge across age groups in this study. Furthermore, men who demonstrate a superior degree of knowledge were more likely to perform TSE. Limitations included possible selection bias in the 2 studies conducted in a banking institution. Increased testicular cancer knowledge combined with TSE may have a role in improving detection of significant testicular pathology.

Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up