Histological Diagnosis Of Cancer Research Articles

The expanding role of artificial intelligence in the histopathological diagnosis in urological oncology: a literature review.

The ongoing growth of artificial intelligence (AI) involves virtually every aspect of oncologic care in medicine. Although AI is in its infancy, it has shown great promise in the diagnosis of oncologic urological conditions. This paper aims to explore the expanding role of artificial intelligence in the histopathological diagnosis in urological oncology. We conducted a focused review of the literature on AI in urological oncology, searching PubMed and Google Scholar for recent advancements in histopathological diagnosis using AI. Various keyword combinations were used to find relevant sources published before April 2nd, 2024. We approached this article by focusing on the impact of AI on common urological malignancies by incorporating the use of different AI algorithms. We targeted the capabilities of AI's potential in aiding urologists and pathologists in histological cancer diagnosis. Promising results suggest AI can enhance diagnosis and personalized patient care, yet further refinements are needed before widespread hospital adoption. AI is transforming urological oncology by improving histopathological diagnosis and patient care. This review highlights AI's advancements in diagnosing prostate, renal cell, and bladder cancer. It is anticipated that as AI becomes more integrated into clinical practice, it will have a greater influence on diagnosis and improve patient outcomes.

Evolution in the management of thyroid surgery over a period of 15 years in a Belgian center

BackgroundGuidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze the change made in operative thyroid management and the impact on thyroid cancer diagnosis.BackgroundGuidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease overdiagnosis of low risk thyroid cancer. Our goal was to study the evolution, over a long period, of pre- and postoperative management and the influence on histological cancer diagnosis and, more particularly, microcancer.MethodsIn this retrospective cohort study, we included 891 consecutive patients who underwent thyroid surgery between 2007 and 2020.ResultsRespectively 305, 290 and 266 patients underwent surgery over the 3 periods of 2007–2010, 2011–2015 and 2016–2020. In all three periods, women represented approximately 70% of the population, and the mean age was 54 years old (range: 67). Most surgeries (90%) involved total thyroidectomies. Over the study period, the proportion of preoperative fine needle aspiration (FNA) increased from 13 to 55%, p < 0,01. Cancer was found in a total of 116 patients: 35 (11%) patients between 2007 and 2010, 50 (17%) between 2011 and 2015 and 32 (12%) between 2016 and 2020 (p = 0.08). For all 3 periods, papillary thyroid cancer (PTC) was the most prevalent, at approximately 80%. The proportion of thyroid cancer > T1a increased significantly from 37% (2011–2015 period) to 81% (2016–2020 period), p = 0.001. Patients treated with radioiodine remained relatively stable (approximately 60%) but were more frequently treated with a low dose of radioiodine (p < 0.01) and recombinant human TSH (p < 0.01). Operative thyroid weight decreased over time in all but the low-risk T1a PTC cases.ConclusionsOver a period of 15 years and according to the evolution of recommendations, the care of patients who underwent thyroid surgery changed with the increased use of preoperative FNA. This change came with a decrease in low-risk T1a PTC.

Cyanoacrylate in Colorectal Surgery: Is It Safe?

Anastomotic leakage (AL) of a gastrointestinal (GI) anastomosis continues to be an important complication in GI surgery. Since its introduction more than 60 years ago, Cyanoacrylate (CA) has gained popularity in colorectal surgery to provide "prophylaxis" against AL. However, although in surgical practice it is increasingly used, evidence on humans is still lacking. The aim of this study is to analyze in humans the safety of CA to seal colorectal anastomosis. All consecutive patients from Jannuary 2022 through December 2022 who underwent minimally invasive colorectal surgery were retrospectively analyzed from a prospectively maintained database. Inclusion criteria were a histological diagnosis of cancer, a totally minimally invasive procedure, and the absence of intraoperative complications. 103 patients were included in the study; N-butyl cyanoacrylate with metacryloxisulfolane (Glubran 2®) was used to seal colorectal anastomosis, no adverse reactions to CA or postoperative complications related to inflammation and adhesions occurred; and only one case of AL (0.9%) was recorded. We can consider this study an important proof of concept on the safety of CA to seal colorectal anastomosis. It opens the possibility of starting prospective and comparative studies in humans to evaluate the effectiveness of CA in preventing colorectal AL.

Pharmacokinetic Exposures Associated With Oral Administration of Sorafenib in Dogs With Spontaneous Tumors.

Sorafenib is a multi-kinase small molecule inhibitor that targets serine/threonine and tyrosine kinases including the RAF kinase family, VEGFR-2, and PDGFR. The aim of this study was to evaluate the systemic pharmacokinetics of a previously defined tolerable oral dose of sorafenib in tumor-bearing dogs. Six client-owned dogs with a cytologic or histologic diagnosis of cancer were enrolled in this open-label, tolerability study. Dogs were administered sorafenib at an intended dose of 3 mg/kg and serum samples were obtained for analysis of sorafenib serum concentrations at 0, 1, 2, 6, 12, 24, 48, 72, 96, and 168 h post-drug administration. Median time to peak serum sorafenib concentration occurred at 4 h (range 2–12 h) resulting in an average serum concentration of 54.9 ± 33.5 ng/mL (118.2 ± 72.1 nM). Mean sorafenib levels declined by over 70% relative to peak serum concentrations by 24 h in all dogs, suggesting the value of at least twice daily administration. Doses of 3 mg/kg were well-tolerated and no patients in the study experienced adverse events that were attributable to sorafenib. Future trials in dogs with cancer are recommended at this dosing schedule to assess the effect of sorafenib administration on anti-tumor efficacy signals and relevant pharmacodynamic target modulation in vivo.

A prospective, randomized, placebo-controlled, double-blinded clinical trial comparing the incidence and severity of gastrointestinal adverse events in dogs with cancer treated with piroxicam alone or in combination with omeprazole or famotidine

To assess the impact of prophylactic omeprazole and famotidine on the incidence and severity of gastrointestinal (GI) adverse events (AEs) in dogs with cancer treated with single agent piroxicam. 39 dogs with a cytologic or histologic diagnosis of cancer with no history of GI disease and received piroxicam. A prospective, randomized, placebo-controlled, double-blinded clinical trial was performed. All dogs received piroxicam (0.3 mg/kg [0.14 mg/lb], PO, q 24 h) and either omeprazole (1 mg/kg [0.45 mg/lb], PO, q 12 h), famotidine (1 mg/kg, PO, q 12 h), or placebo (lactose; PO, q 12 h). Monthly assessments of GI AEs were performed and scored by using the Veterinary Comparative Oncology Group's Common Terminology Criteria for Adverse Events (version 1.1). Compared with dogs in the placebo group, more dogs in the omeprazole group (84.6% vs 36.4%) and famotidine group (80.0% vs 36.4%) experienced GI AEs by day 56. The severity of GI AEs was higher in the omeprazole group, compared with the placebo group. Omeprazole was not helpful in reducing the frequency or severity of GI AEs and was associated with more frequent and severer GI AEs in dogs with cancer treated with single agent piroxicam. Proton-pump inhibitors and H2-receptor antagonists should not be prescribed as prophylaxis with NSAIDs for dogs with cancer.

BREAST CANCER AND PREGNANCY: HOW TO PROCEED?

Breast cancer is one of the most frequent solid tumors associated with pregnancy. The prevalence is constantly increasing with a high character and a greater frequency of advanced forms involving the maternal and fetal prognosis. Clinical, ultrasound, cytological and histological diagnosis of cancer, although slightly more difficult, is possible during pregnancy. The histological types encountered correspond to breast cancers encountered outside the pregnancy period. The prognosis of breast cancer does not appear to be affected by pregnancy, provided that it does not interfere with or delay the initiation of diagnostic and treatment procedures. Decisions should be made in a multidisciplinary meeting to ensure that the patient and her partner are as fully informed as possible about the consequences of the cancer and the possible impact of treatment on the future of their child. Breastfeeding should not be prohibited when the cancer is in complete remission. It is important to mention though that it is usually recommended that a woman who has breast cancer wait two years after completing treatment before allowing a subsequent pregnancy.

Telepathology Practice in Cancer Diagnosis in Saint Jean de Dieu Hospital - Tanguieta, Benin

Both the incidence of cancer and cancer-related mortality rates are high in sub-Saharan Africa, while resources for diagnosis and management are inadequate. In Benin, there is an extreme shortage of pathology services. Because of this shortage we built a histopathology laboratory equipped with an automated immunohistochemistry and a whole-slide imaging and telepathology system. To report our experience of telepathology practice in the improvement of cancer diagnosis. The study was performed in our histopathology laboratory from January 1, 2016, to December 31, 2018. Resident laboratory technicians were trained in the preparation of microscopic and virtual slides by European pathologists. Virtual slides were stored on a Web-accessible server area for reading by 21 telepathologists in Benin and Europe. All patients with a histologic diagnosis of cancer were included in this study. Demographic data of patients, anatomic site of cancer, its histologic type, and its histologic grade were recorded. We registered 399 patients diagnosed with cancer of 1593 patients whose surgical specimens had been analyzed. There were 349 adults including 160 males and 189 females, and 50 children (both sexes) with a mean age of 53.40 years, 46.92 years, and 9.72 years, respectively. Eighty-three of 211 females (39.34%) had infiltrating breast carcinoma, and 34 of 188 males (18.09%) had prostatic carcinoma. Infiltrating carcinoma of no special type represented 51 (91.07%) of all infiltrating breast carcinomas. Prostatic carcinoma and infiltrating breast carcinoma were of high grade in 13 of 23 males (56.52%) and 34 of 56 females (60.71%), respectively. Telepathology is enabling a great improvement in cancer diagnosis in our hospital.

Diagnostic impact of ascites cytology in 941 patients: malignancy rates and time of detection in ovarian cancer relative to other tumor types.

Cytological analysis of ascitic fluid is an important tool for diagnosis, staging, and prognostic assessment in patients with cancer, but more detailed information is needed regarding malignancy rates and the time sequence in which ascites develops for different sites of cancer origin. Especially, an increased early tumor diagnosis may improve the acceptance for cytological examinations for the tumor patients in oncological practice. Ascites specimens from patients who were treated at Bayreuth Hospital from 2006 to 2015 were reevaluated retrospectively and correlated with clinical reports. 580 of all 941 ascitis specimens (61.6%) were from patients with malignancies with predominant appearance of gastrointestinal and gynecological tumors in 516/580 (89%) patients. Histologically, 549 (94.6%) were carcinomas, 23 (4%) hematological malignancies, 5 (0.9%) mesotheliomas and 3 (0.5%) were melanomas. Malignant ascitic fluid was noted in 298 of the 580 (51.4%) patients with cancer, thus the overall malignancy rate in the ascites specimens examined was 298/941 (31.7%). The most frequent malignancy rate for gynecological tumors we obtained in ovarian cancer with 85.7% and in the upper gastrointestinal tract with 77.8% for Barrett's carcinoma and 61,4% for gastric carcinoma. Regarding time of detection, malignant ascitic fluid was noted as a separate finding, prior or simultaneous to the histological diagnosis of cancer in 225/298 patients (75.5%). An outstanding earliest occurrence was found in ovarian carcinoma in 94.9% and in the gastrointestinal tract in pancreatic carcinoma in 66.7%. Tumor staging was the main important clinical question in our single center study of ascitic fluid, especially for patients with gastrointestinal and gynecological malignomas. The highest malignancy rate and earliest time of tumor detection caused the leading importance for ovarian tumors in malignant ascitic fluid. Moreover, the application of immunostains in our study allowed in 75.5% of all tumor patients a correct initial diagnosis, which is important for further clinical therapy.

Development and Prospective Validation of a Rapid Financial Toxicity Screening Instrument for Radiation Oncology Patients

Cancer is among the most costly medical conditions to treat due in part to the escalating price of therapies coupled with the prevalence of out-of-pocket expenses associated with fee-for-service reimbursement. The growing burden of financial toxicity on patients has increasingly been recognized as a side effect, which can contribute to distress. Despite this, the implementation of screening instruments for financial toxicity has been relatively limited. The aim of this study was to evaluate the performance of a rapid screening tool, which could potentially be adopted for routine and practical use. We hypothesize the rapid screening tool will be reliable within the radiation oncology clinic. After approval from the Institutional Review Board, a customized rapid screening tool for financial toxicity was prospectively administered to patients with a histological diagnosis of cancer at a tertiary care-based radiation oncology clinic. The “RAPID-FT” screening tool was developed using previously validated measures and explored five domains related to monetary debt, assistance from caregivers, changes in employment for the patient and caregivers, and overall financial distress. The possible scores for the “RAPID-FT” ranged from 0 (no burden) to 20 (most burden). Findings were correlated to answers from the concurrently administered Comprehensive Score of Financial Toxicity (COST), a screening instrument (scored from 0 to 44) which had been previously validated in the medical oncology setting. Patients were informed that all results would be reviewed anonymously and would not affect subsequent medical care. Goodness of fit models were constructed for statistical analysis with a p-value of 0.05 set for significance. A total of 33 patients (45% male; 55% female) completed the “RAPID-FT” and the COST questionnaires. The median age was 61 years (range, 33-88). Ethnicity was: 29 White; 2 Black; 1 Hispanic; 1 Asian. Twenty-eight (85%) and 5 patients (15%) were referred for definitive and palliative radiation, respectively. The most common disease sites were head and neck (8 patients), lung (7 patients), and gynecologic (6 patients). The approximate mean time to complete the “RAPID-FT” and COST surveys was 3 minutes and 7 minutes, respectively. Among all patients, 69% had Medicare, 21% had private insurance, and 6% had no insurance. The “RAPID-FT” and COST scores ranged from 0 to 10 and 6 to 40, respectively. The mean score using the “RAPID-FT” and COST instruments were 8.1 ± 5.2 and 24.3 ± 11.0, respectively. A significant correlation was identified between the “RAPID-FT” and COST scores (p<0.001), and a high concordance was established with each patient serving as their own control and data sorted into quartiles. The feasibility of rapid screening for financial toxicity was demonstrated, and the proposed 5-part instrument proved to be reliable and efficient in the radiation oncology clinic. Additional studies with longitudinal follow-up are planned.

Tolerability of oral sorafenib in pet dogs with a diagnosis of cancer.

Sorafenib is a multi-target small molecule inhibitor of the RAF kinase family and VEGFR-2/PDGFR. The US Food and Drug Administration approved sorafenib in human patients with liver, thyroid, or renal carcinoma. The aim of this study was to help guide future pharmacokinetic (PK) studies of sorafenib in dogs with a cancer diagnosis. Client-owned dogs were eligible if they had a cytologic or histologic diagnosis of cancer. Patients were enrolled at escalating doses of sorafenib. Patients were evaluable for the study if they received at least one dose of sorafenib and presented 1 week later for a follow-up examination, blood work, and assessment of drug tolerability. The goal of this study was not to define a maximum tolerated dose as may be reasonable in conventional cytotoxic chemotherapy drugs, but rather to describe the tolerability of this drug in dogs with a cancer diagnosis, as a prequel to future sorafenib PK studies. No patients in the study had any evidence of adverse events that were attributable to sorafenib. Doses of 3 mg/kg were well tolerated and associated with a suggestion of clinical activity, supportive of future PK, and pharmacodynamic analysis. Such future studies are recommended at this dose to define the associated exposure achieved and determine a reasonable schedule for sorafenib administration.

Incidental vs. clinical diagnosis of renal cell carcinoma (RCC): Population, treatment and outcome in a cohort of 828 patients followed at Instituto Oncológico Henry Moore (IOHM).

e16075 Background: For the past three decades, it has been observed in developed countries an increase in the incidence of RCC, at the expense of small tumors incidentally found. This study compares the epidemiology, treatment and evolution of the patients (pt) with incidental RCC (Group A) or clinical RCC (Group B). Methods: Between 1/1/2001 and 11/30/2016, 29,440 new pt with histological diagnosis of cancer were incorporated to the IOHM database. We selected all those coded under the WHO ICD10 code C64. The medical records were reviewed, registering the epidemiological data, treatments and evolution of each patient Results: We identified 828 pt out of 29,940 pt (2.8%) who met the inclusion criteria. Group A = 507 pt (61%) and Group B = 321 pt (39%). The table below shows the characteristics of both groups. Conclusions: 1) In this cohort the incidental diagnosis of RCC represented 60% of the cases and correlated with early stages and less aggressive tumors. 2) The appropriate selection of patients allowed partial nephrectomies in 103/828 Pt. (12% of the cases). 3) With a median follow-up of 30 months the survival rate of this population exceeded 90% in the early stages and was close to 50% in advanced cases. [Table: see text]

PREDOMOS study, impact of a social intervention program for socially isolated elderly cancer patients: study protocol for a randomized controlled trial

BackgroundCancer incidence and social isolation increase along with advanced age, and social isolation potentiates the relative risk of death by cancer. Once spotted, social isolation can be averted with the intervention of a multidisciplinary team. Techniques of automation and remote assistance have already demonstrated their positive impact on falls prevention and quality of life (QoL), though little is known about their impact on socially isolated elderly patients supported for cancer.The primary objective of the PREDOMOS study is to evaluate the impact of establishing a Program of Social intervention associated with techniques of Domotic and Remote assistance (PS-DR) on the improvement of QoL of elderly isolated patients, treated for locally advanced or metastatic cancer. The secondary objectives include treatment failure, tolerance, survival, and autonomy.Methods/designThis trial is a multicenter, prospective, randomized, placebo-controlled, open-label, two-parallel group study. The setting is 10 French oncogeriatric centers. Inclusion criteria are patients aged at least 70 years with a social isolation risk and a histological diagnosis of cancer, locally advanced or metastatic disease. The groups are (1) the control group, receiving usual care; (2) the experimental group, receiving usual care associating with monthly social assistance, domotic, and remote assistance. Participants are randomized in a 1:1 allocation ratio. Evaluation times involve inclusion (randomization) and follow-up (12 months). The primary endpoint is QoL at 3 months (via European Organization for Research and Treatment of Cancer (EORTC) QLQ C30); secondary endpoints are social isolation, time to treatment failure, toxicity, dose response-intensity, survival, autonomy, and QoL at 6 months. For the sample size, 320 individuals are required to obtain 90% power to detect a 10-point difference (standard deviation 25) in QoL score between the two groups (20% loss to follow-up patients expected).DiscussionThe randomized controlled design is the most appropriate design to demonstrate the efficacy of a new experimental strategy (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study.Trial registrationClinicalTrials.gov, NCT02829762. Registered on 29 June 2016.

P2.02-019 Lung Cancer in Young Adults (Age Group 18-50 yrs): Presentation, Clinical Features and Treatment

Non-small cell lung cancer in young adults appears to be increasing over recent years. It’s a devastating illness both for the patient and their family. It has got significant socioeconomic implications. Data were analyzed for the period between 2010 and 2015 from the University Hospitals of Leicester data base. Young adults were defined as age less than 50 and further sub divided into 18-39 years and 40-50 years of age respectively. Data were extracted regarding the histological diagnosis of cancer, performance status, disease staging and the treatment received. From a total of 93 patient’s we found the majority had adenocarcinoma,with 56% in the 18-39 age group and 63.6% in 40-50 age group. A greater proportion of patients in each age group were found to have a performance status of 0.The number of male patients were noted to be slightly higher between 18 and 39 (55%), compared to the 40-50 age groups, where there was a female predominance (57%). The majority of patients in both age groups were found to have a good performance status and a larger proportion of patient’s eGFR status was negative. Young adults were more likely to have surgery and chemotherapy due to their better performance status. In our cohort of young adults with lung cancer, the majority of patients had a good performance status despite late stage disease. They were likely to be fit for treatment and have longer survival outcomes.

Cancer incidence and mortality in rural workers in the Brazilian Western Amazon

Abstract Aim To conduct an exploratory study about cancer incidence and mortality in rural workers in the state of Acre, Brazil. Methods The Proportional Cancer Incidence Ratio (PCIR) was calculated for rural male workers who live in Rio Branco, Acre, with histological diagnosis of cancer, and the Cancer Mortality Odds Ratio (CMOR) comparing cancer deaths occurred in rural workers in the state of Acre with those occurred in people with other occupations in the period from 2007 to 2012. Results High and statistically significant PCIR were observed for tumors of larynx, PCIR = 7.55 (95% CI 4.23-12.46); melanoma, PCIR = 11.44 (95% CI 6.55-18.54); and non – Hodgkin lymphoma, PCIR = 10.00 (95% CI 5.17-17.50) compared to the population of Rio Branco. Regarding the mortality compared analysis, we can observe CMOR = 6.94 (95% CI 1.73-27.89) for pancreatic cancer and CMOR = 13.89 (95% CI 1.25-153.60) for cancer of the urinary tract. Conclusion The results suggest an increase in the incidence estimates of mortality for selected tumor sites among rural workers that are consistent with the literature.

Investigation of Nausea and Vomiting in Cancer Patients Undergoing Chemotherapy.

Nausea and vomiting are the most important problems in patients undergoing chemotherapy, despite the recent improvements in the administration of antiemetic drugs. Through a review of the literature, we found that there are several nursing researches focusing on the effectiveness of interventions for the treatment of nausea and vomiting in cancer patients. The purpose of this study was to investigate the symptom of nausea and vomiting in patients undergoing chemotherapy. The study also investigated the impact of nausea and vomiting on patients’ ability to respond to daily activities. The study is descriptive; the sample included patients with different types of cancer and receiving chemotherapy. The inclusion criteria were: the histological diagnosis of cancer, the administration of chemotherapy and the knowledge of the Greek language. The questionnaires used were: the MASCC (vomiting questionnaire), the Memorial Symptom Assessment Scale and the scale of functional assessment of cancer therapy. Data collection took place in oncological hospitals of Thessaloniki and Athens in Greece. For statistical analysis we used the statistical package SPSS 15.0.

EVALUATION OF OPIOID USE IN CANCER PATIENTS AT NATIONAL HOSPITAL AND CANCER RESEARCH CENTER, KATHMANDU, NEPAL

BackgroundNepal is a developing country with an increasing burden of cancer. Coupled with increasing healthcare costs and lack of health insurance, the focus has always been on treatment of cancer,...

An epidemiologic study of lifestyle of cancer patients presenting at National Hospital and Cancer Research Centre Pvt. Ltd., Jawalakhel, Nepal.

e12572 Background: Nepal being one of the economically challenged developing countries has been lagging behind in all healthcare facilities. Cancer is now emerging as a major Non-communicable (NCD) disease accounting for 9% of all NCDs. Lack of preventive measures, screening and awareness programme is hindrance in the early diagnosis. Hence, we aimed to study the epidemiological variables of various cancers so that risk factors can be identified. Methods: A Prospective, observational, cross sectional study was conducted from July 2012 to December 2012 for a period of six months. All patients with histological diagnosis of cancer attending the National Hospital and Cancer Research Centre were enrolled. A Questionnaire was formed in English and patients were asked to answer the questionnaire. Results: Out of 142 patients diagnosed with cancer, 22 different types of cancer were noticed and the most common was lung cancer in both sex with 28% incidence followed by breast 18%, gynecological cancer 15%, colorectal 9%, hepatobillary 9%, gastrointestinal 8%, lymphoma 6%, Head and neck 4%. Out of them, 61% were females and 39% were males and 96% of patient were married. The most common age group at diagnosis was 41-60 years and comprised of 42% of total. About 37% of the patient earned their living by agriculture. About 44% of the patient has annual income of over USD 2500. The most common ethnic group with cancer was identified as Newar with 48% prevalence of cancer. About 36% of the patients were illiterate, 20% are literate. Total of 51% of the patient were smoker, 19% are taking alcohol till recently and 27% consume alcohol occasionally. Only 9% of the patient are vegetarian and the 91% non-vegetarian group mostly eat red meat. Significant number (64%) of the patient is consuming the commercial, canned food. Very few patients are aware of exercise (22%) and meditation (11%). Conclusions: This is a single institution study and with lots of limitation. However, this can be used to find risk factors associated with our ethnic and cultural variation and thus a multicentric study is advisable to formulate National level preventive and screening programme.

Toward integration of palliative care into cancer care: A study on profile of psychosocial and clinical complications among attendees of a Nigerian oncological center.

e20675 Background: The integration of palliative care into cancer management is abysmal in this context and paucity of empirical evidence constitutes constraint for policy formulation and their translation into cancer care. This study assessed psychosocial and clinical complications among Nigerian cancer subjects. We postulated the interplay of psychosocial and clinical factors would constitute evidence for palliative care. Methods: This is an observational study among 200 adult participants with histological diagnosis of cancer recruited using systematic random sampling. Eligible participants were interviewed by the researchers using socio-demographic/clinical profile questionnaire, Centre for Epidemiological Studies Depression Scale Revised (CES-DR) and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analyses were done using SPSS-15. Results: The commonest type of malignancy was breast cancer (51.0%); cervical cancer 29.5%, colorectal and prostatic cancers were 10.5% and 9.0% respectively. Slightly less than half (49.0%) of subjects had advanced cancer. Most subjects (36.5%) had symptoms for over a year at presentation. Two-thirds (66.0%) had pain, 52% had weight loss and 20.0% had external ulcer. Ninety-eight (49.0%) subjects had depressive symptomatology (CES-DR score ≥16), while prevalence of depression based on SCAN was 27.5%. Depression was significantly associated with higher educational status (p=0.003), unemployment (p=Ÿ0.004), unmarried status (p=0.004), advanced cancer stage (p=0.006), longer duration of cancer (p=0.048), pain (p&lt;0.001), physical complications (p&lt;0.001). However, unmarried status, unemployment, pain and duration of cancer still correlated with depression following logistic regression. Conclusions: In this study, preponderance of physical, psychosocial complications, advanced stage illness and high symptoms burden suggest that integration of palliative care into cancer management should be the rule rather than exception. Lastly, further research on palliative care with translation of resulting research based evidence into cancer care is implied.

1604P - Case-Control Phase II Clinical Trial to Assess Efficacy and Safety, of the Same Antineoplastic Treatment(S) in Elderly “Fit” Compared to Adult Patients with Cancer at Different Sites

ABSTRACT Background We designed a case-control phase II open, prospective non-randomized trial in elderly “fit” (≥65 yo) cancer patients (pts) compared to well-matched adult (45-65 yo) cancer pts to assess whether the same standard antineoplastic treatment could achieve comparable results as for efficacy and safety. Planned sample size: 125 pts per arm. Endpoints: safety, QoL, PFS, ORR, dose intensity. Patients and methods Only elderly “fit” pts at MGA were included. Inclusion criteria for elderly: histological diagnosis of cancer with either advanced disease with measurable lesions or radically resected (adjuvant setting); life expectancy >3 mo.; adequate baseline functional parameters; written informed consent. Inclusion criteria for adults: the same as for elderly plus ECOG-PS 0-1. Results At September 2011, 254 pts were enrolled, 127 elderly and 127 adults, all evaluable for toxicity. Elderly pts clinical characteristics: M/F ratio 69/58; mean age 70.8 ± 4.5 y. Adult pts: M/F ratio, 58/69; mean age 53 ± 5.4 y. Tumor sites: colo-rectal (23.5%), head and neck (16.4%), breast (14.1%), lung (11.7%), ovarian (9.3%); prostate (6.2%), NHL (4.7%), gastric (4.7%), liver (4.7%), uterus (3.9%), pancreas (0.8%); 92.1% of pts were stage IV, 5.9% stage III and 2.0% stage II. In the elderly no grade 4 toxicity were observed, hematological and non hematological grade 3 toxicities were observed in 12.21% and 13.8% of pts, respectively. In the adults, grade 4 hematological and non hematological toxicity were observed in 3.8% and 1.9% of pts, respectively; grade 3 hematological toxicity in 23.2% and non hematological toxicities in 21.3% of pts. The difference was statistically significant (p = 0.042) in favor of the elderly. At September 2011, 234 pts were assessable for response: the ORR was 50.7% for elderly and 51.1% for adults. No differences were observed for quality of life and dose intensity between the two groups. PFS was 10.6 mo. (3-12+ mo) for elderly and 9.05 mo. (3-12+) for adults. Conclusion The promising results of this single Institution study warrant to be confirmed by a larger clinical trial. Disclosure All authors have declared no conflicts of interest.

Epithelial-to-Mesenchymal Transition and Hematogenous Dissemination Precedes Histologic Diagnosis of Cancer in a Genetic Mouse Model of Pancreatic Ductal Adenocarcinoma

Epithelial-to-Mesenchymal Transition and Hematogenous Dissemination Precedes Histologic Diagnosis of Cancer in a Genetic Mouse Model of Pancreatic Ductal Adenocarcinoma