Oncology Patients Research Articles

Postoperative factors predicting outcomes in patients with Perihilar cholangiocarcinoma undergoing curative resection—a 10-year single-center experience

Background Perihilar cholangiocarcinoma (pCCA) has a 5-year overall survival (OS) ranging from 10–40%, following resection. However, prognostic models for postoperative outcomes are limited by long study timespan and variations in work-up. We investigated postoperative outcomes in patients resected for pCCA in a high-volume center with standardized work-up. Method Patients resected with confirmed pCCA, between 2013 and 2023, were included. Cox-regression investigated association between postoperative factors and OS as well as disease-free survival (DFS). Results Totally, 65 patients were resected for pCCA. The 1-, 3- and 5-year OS rates were 86.1%, 56.5% and 32.6% respectively. The 1-, 3- and 5-year DFS rates were 67.7%, 40.0% and 26.8%, respectively. Portal vein embolization (PVE) (HR 4.52 [CI 1.66–12.27], p = 0.003), lymph node metastasis (LNM) (HR 6.37 [CI 2.06–19.67], p = 0.001) and Clavien-Dindo (CD) ≥3a (HR 2.83 [CI 1.43–5.56], p = 0.002) were associated with inferior OS. Clavien-Dindo (CD) ≥3a (HR 2.10 [CI 1.05–4.22], p = 0.03) and T-stage >2 (HR 2.36 [CI 1.01, 5.05], p = 0.04) were associated with inferior and superior DFS, respectively. Conclusion PVE, T-stage >2, LNM and CD ≥ III were associated with worse prognosis in resected pCCA. Research is needed to improve pre-operative detection of oncological features and patients with risk of major surgical complications.

A snapshot of cancer in Chile II: an update on research, strategies and analytical frameworks for equity, innovation and national development

IntroductionChile has achieved developed nation status and boasts a life expectancy of 81 + years; however, the healthcare and research systems are unprepared for the social and economic burden of cancer. One decade ago, the authors put forward a comprehensive analysis of cancer infrastructure, together with a series of suggestions on research orientated political policy.ObjectivesProvide an update and comment on policy, infrastructure, gender equality, stakeholder participation and new challenges in national oncology. Assess the funding and distribution of cancer investigation. Present actions for the development of oncology research, innovation and patient care.MethodsTriangulating objective system metrics of economic, epidemiological, private and public sector resources together with policy analysis, we assessed cancer burden, infrastructure, and investigation. We analyzed governmental and private-sector cancer databases, complemented by interviews with cancer stakeholders.ResultsGovernmental policy and patient advocacy have led to the recognition of cancer burden, a cancer law, and a national cancer plan. Cancer has become the leading cause of death in Chile (59,876 cases and 31,440 cancer deaths in 2022), yet only 0.36% gross domestic product (GDP) is directed to research and development. Inequalities in treatment regimens persist. Prevention policy has lowered tobacco consumption, sugar intake via soft drinks and offered a high coverage of HPV vaccines. A high-quality cancer research community is expanding, and internationally sponsored clinical oncology trials are increasing.ConclusionsThe cancer law has facilitated advancement in policy. Prevention policies have impacted tobacco and sugar intake, while gender equality and care inequality have entered the public forum. Cancer research is stagnated by the lack of investment. Implementation of a cancer registry and biobanking, reinforcement of prevention strategies, development of human resources, promotion of clinical trial infrastructure and investment in new technologies must be placed as a priority to permit advancements in innovation and equitable cancer care.

The Intersection of Psoriasis and Neoplasia: Risk Factors, Therapeutic Approaches, and Management Strategies

The association between psoriasis and increased cancer risk is gaining recognition as studies reveal shared inflammatory and immune pathways. This review examines the relationship between psoriasis and neoplasia, focusing on cancer risk factors in psoriasis patients, the biological pathways underlying this connection, and the impact of various psoriasis treatments on cancer development. Psoriasis patients have a heightened incidence of certain cancers, such as lymphomas, skin cancers, and urological malignancies, potentially linked to immune dysregulation and chronic inflammation. Immunomodulatory treatments for psoriasis, including conventional systemic therapies and biologics, present varied cancer risks, with others, such as phototherapy, associated with an elevated risk of skin cancers. For oncologic patients with psoriasis, management necessitates a tailored approach, balancing effective psoriasis control with minimizing cancer progression risks. The emergence of IL-17 inhibitors, IL-23 inhibitors, and small-molecule therapies offers promising therapeutic alternatives with favorable safety profiles for these patients. This review underscores the need for interdisciplinary collaboration to optimize care for patients managing both psoriasis and malignancy.

Temporary Flow Diversion in Oncological Embolization Procedures Using Degradable Starch Microspheres

Objectives: This study aims to report on the application of degradable starch microspheres to provide flow diversion by means of temporary embolization of healthy tissues in oncological endovascular procedures when tumor feeding vessels are not selectively accessible. Methods: This is a multicenter retrospective analysis of patients undergoing visceral embolization procedures of malignancies. The inclusion criteria were as follows: flow diversion performed by injection of degradable starch microspheres, visceral embolization procedures with unfeasible superselective catheterism of the target, and a malignant pathology. Technical success was defined as complete flow diversion with temporary exclusion of the non-target district from arterial flow, associated with successful embolization of the target. Clinical success was intended as procedural achievement with patient clinical improvement. Results: Sixteen patients were included in this analysis. Peripheral embolization procedures were performed in the coeliac visceral district all in oncologic patients, including 4 transarterial radioembolization work-up procedures in patients with hepatocarcinoma, 10 chemioembolization procedures in patients with hepatocarcinoma (8) or cholangiocarcinoma (2), and 2 palliative transarterial embolizations in patients with gastric cancer. Technical success was obtained in 100% of the cases, while clinical success was reached in 87.5%: in two chemioembolization procedures, despite technical success, the procedural clinical benefits were partial, with an incomplete target lesion response. Minor complications occurred in five patients (31.2%). Conclusions: In this study, temporary flow diversion with degradable starch microspheres during oncological embolization procedures was safe and effective; this approach is suitable to protect healthy surrounding tissues when vessels feeding the target cannot be selected with the microcatheter.

Comparison of CytoSorb and Jafron HA330 Hemoadsorption Devices in Pediatric Oncological Patients with Sepsis: Retrospective Observational Study

Background: Pediatric sepsis presents a severe risk to immunocompromised children, especially those with cancer or pre-existing conditions, posing a significant threat to their lives. Cytokine hemadsorption has emerged as a promising therapeutic approach for managing sepsis and severe inflammatory conditions in critically ill patients. This innovative method involves eliminating pro-inflammatory cytokines from the bloodstream, targeting the underlying hyper-inflammatory response often seen in critical illnesses. Study aim: The study aim is to examine and compare the efficacy of HA330 and CytoSorb for extracorporeal blood purification in septic children with oncology. Methods: In this retrospective observational study, we examine 20 cases to assess the effectiveness of hemoperfusion therapy using hemoadsorption devices in pediatric septic patients with oncology. Our focus is on the use of HA330 and Cytosorb hemoadsorption devices, both designed to remove bacterial toxins and inflammatory agents from the bloodstream. Results: Our study reveals that hemoadsorption with HA330 and CytoSorb effectively treats septic children with oncological conditions. Conclusions: The presented findings suggest no statistically significant difference between the two devices in reducing the levels of the assessed parameters for extracorporeal blood purification in this patient population.

Basic immunization against diphtheria, tetanus and pertussis within the at-risk population of oncological patients: cross-sectional data from the Berlin Metropolitan area

Abstract Aim Oncological patients are susceptible to severe infectious complications, some of which may be preventable through vaccination. Vaccination rates among oncological patients are generally considered low. While prevalence data on basic immunization for diphtheria, tetanus and pertussis among the general population is available in Germany, such data remains lacking for oncological patients. With this publication, we aim to present the first data. Subject and methods In this study, we examined data collected during the EVO intervention study to assess participants’ vaccination status against DTP. Our analysis focused on the baseline data of all participants and the follow-up data of the control group, thereby excluding data affected by the intervention. We used Pearson’s chi-squared test to explore factors potentially associated with higher or lower vaccination rates (e.g. sex, diagnosis). Results Of the 370 patients included in the study, 78.9% had a solid and 21.1% a haematological tumour; 47.3% were vaccinated against tetanus, 44.9% against diphtheria and 39.7% against pertussis. Patients with haematological cancer had a higher vaccination rate against diphtheria compared to those with solid tumour (55.1% vs. 42.1%). On the other hand, women had higher rates compared to men against tetanus (53.7% vs. 40.7%) and diphtheria (50.0% vs. 39.4%). Additional positive factors included the presence of autoimmune diseases and a diagnosis of multiple myeloma. Conclusion Oncological patients seem to have significantly lower vaccination rates for diphtheria and tetanus compared to the German general population. For pertussis, on the other hand, the vaccination rate is higher than in the general population.

Risankizumab in Oncologic Patients With Psoriasis: A Case Series

Risankizumab in Oncologic Patients With Psoriasis: A Case Series

Assessment of the quality of life of oncological patients with skin toxicity depending on telemedicine technologies

Relevance. Approximately 90–100% of patients have skin toxicity, which manifests itself in the form of acne-like rashes (papulo-pustular rash), paronychia, hair changes, xerosis, itching. Skin manifestations cause psychological, emotional and physical discomfort, which may be the reason for dose reduction or discontinuation of treatment, and may reduce the effectiveness of antitumor therapy. The use of modern telemedicine systems, such as online consultations and remote monitoring, are designed to make life easier for patients and are now increasingly available and in demand among the general population. The aim of the study. Assessment of the quality of life in cancer patients receiving EGFR inhibitors, depending on the use of remote consultations and remote monitoring.Materials and methods. 140 cancer patients were included in the study. All patients were divided into two groups: in group 1 (study group) n=70, the mobile application «My Health» was used for online-consultation with a dermatologist, in group 2 (comparison group) n=70, offline consultations were used. During the consultations, skin toxicity was assessed using CTCAE scales version 5.0. To analyze the level of quality of life, a questionnaire of the dermatological quality of life index (DLQI) was used, which patients of each group filled out on the day of the start of the study, then after 4 weeks.Results. In patients of the first group, there was a positive dynamic in the state of the skin process compared with the initial indicators. There was a statistically significant improvement in the quality of life, a decrease in the average score for all indicators. In patients of the second group, the positive dynamics of the skin process was not so obvious, as evidenced by the results of the questionnaire. There was a statistically significant strong direct correlation between the value of the results of DLQI and the severity of the disease (rs=0.721 p <0.001).Conclusion. Skin toxicity is a complex interdisciplinary problem that requires an integrated approach between oncologists and dermatologists. Remote monitoring is an accessible form of communication between a doctor and a patient, which contributes to the timely control of skin toxicity in cancer patients receiving EGFR inhibitors.

Electrochemical Method for the Design of New Possible Gadolinium-Based Contrast Agents

Magnetic resonance imaging (MRI) is a technique that employs strong magnetic fields and radio frequencies to generate detailed images of the body’s interior. In oncology patients, gadolinium-based contrast agents (GBCAs) are frequently administered to enhance the visualization of tumors. Those contrast agents are gadolinium chelates, characterized by high stability that prevents the release of the toxic gadolinium ion into the body. This work is part of the research for alternative nanoscaled GBCAs. Following the synthesis and characterization of zinc hexacyanoferrate nanoparticles, gadolinium ions were successfully incorporated into a hexacyanoferrate-based matrix, deposited on FTO-coated glass used as working electrode in a gadolinium salt solution, by applying a fixed potential determined through cyclic voltammetry studies. The presence of gadolinium inside the matrix was confirmed by EDX.

Impact of American College of Surgeons Geriatric Surgery Verification Program in Patients Undergoing Major Abdominal Oncologic Operation at a Cancer Center.

Patients older than 65 years have unique needs and treatment outcomes goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients ≥65 years undergoing major abdominal surgeries. We implemented the American College of Surgeons' GSV program protocols for patients 65 and older starting in 2022. A retrospective review was conducted of patients undergoing major abdominal oncologic surgeries from January 2021 through December 2022 to create pre-GSV and post-GSV initiative cohorts. Main outcomes variables were postoperative institutionalization and change in the patient's primary residence disposition (measured as primary residence score, PRS, as a proxy for loss of independence). 57 patients in the control group and 43 patients in the intervention group met inclusion criteria. The average age was 76.5 and 75 years, respectively. Patients were well matched for clinical and sociodemographic characteristics. The intervention group had a shorter mean length of stay (LOS) 4.4 ± 2.5 days vs 6.5 ± 3.6 days in control group (p<.01) and were less likely to be newly discharged to an institution (7.3% vs 24.1%, p=0.03). The GSV initiative was associated with 72% lower odds of increased PRS (i.e. care needs) at time of discharge (OR 0.28, 95% CI 0.1 - 0.81). The GSV initiative intervention in geriatric oncology patients undergoing major abdominal surgeries was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.

Hospital pharmacists' perceived competence in providing care to oncology patients - (HoPP-CoP2).

Previous research has shown community pharmacists do not have high perceived competence or confidence providing care to patients on oral anti-cancer medications. There is a paucity of evidence when it comes to hospital pharmacists providing care to oncology patients admitted to the hospital for a reason other than cancer. To assess the perceived competence of hospital pharmacists not working in oncology in managing patients taking anticancer drugs. Additionally, identify factors impacting, potential interventions increasing, and any factors that improve perceived competence. An anonymous cross-sectional survey distributed to hospital pharmacists throughout Canada. Mean perceived competence results ranged from 2.52 to 3.97 out of 7.00 with respondents reporting most perceived competence managing electrolyte disturbances and least competence managing drug-disease interactions and intervening on hepatic dysfunction. Low confidence in knowledge received from previous oncology training was reported with a mean of 2.82 on the 7-point Likert Scale. Continuing education sessions were perceived as the intervention which would most improve perceived competence with a mean value of 5.92 to 5.94 on a 7-point Likert Scale. The number of CE hours completed in the last five years was the only factor shown to have a statistically significant correlation with perceived competence. Hospital pharmacists do not perceive themselves as competent in providing care to oncology patients. The implementation of a continuing education program related to oncology may improve perceived and actual competence.

Alternative Health and Conventional Medicine Discourse About Cancer on TikTok: Computer Vision Analysis of TikTok Videos.

Health misinformation is abundant online and becoming an increasingly pressing concern for both oncology practitioners and patients with cancer. On social media platforms, including the popular audiovisual app TikTok, the flourishing alternative health industry is further contributing to the spread of misleading and often harmful information, endangering patients' health and outcomes and sowing distrust of the medical community. The prevalence of false and potentially dangerous treatments on a platform that is used as a quasi-search engine by young people poses a serious risk to the health of patients with cancer. This study seeks to examine how cancer discourse on TikTok differs between alternative health and conventional medicine videos. It aims to look beyond mere facts and falsehoods that TikTok users may utter to understand the visual language and format used in the support of both misleading and truthful narratives, as well as other messages. Using computer vision analysis and subsequent qualitative close reading of 831 TikTok videos, this study examined how alternative health and conventional medicine videos on cancer differ with regard to the visual language used. Videos were examined for the length of time and prominence in which faces are displayed, as well as for the background setting, location, and dominant color scheme. The results show that the alt-health and conventional health samples made different use of the audiovisual affordances of TikTok. First, videos from the alternative health sample were more likely to contain a single face that was prominently featured (making up at least 7.5% of the image) for a substantial period of time (35% of the shots), with these testimonial-style videos making up 28.5% (93/326) of the sample compared to 18.6% (94/505) of the conventional medicine sample. Alternative health videos predominantly featured cool tones (P<.001) and were significantly more likely to be filmed outdoors (P<.001), whereas conventional medicine videos were more likely to be shot indoors and feature warm tones such as red, orange, or yellow. The findings of this study contribute to an increased understanding of misinformation as not merely a matter of individual falsehoods but also a phenomenon whose effects might be transported through emotive as well as rational means. They also point to influencer practices and style being an important contributing factor in the declining health of the information environment around cancer and its treatment. The results suggest that public health efforts must extend beyond correcting false statements by injecting factual information into the online cancer discourse and look toward incorporating both visual and rational strategies.

Evaluating the Economic Impact of Novel Oncology Drug Coverage Through Patient Assistance Programs.

Despite a universal public health care system, Canadian oncology patients often enroll in patient assistance programs (PAPs) to access oncology drugs that are awaiting funding decisions. Our multicenter study evaluated the pharmacoeconomic and clinical impact of PAPs for patients with cancer in British Columbia (BC). Eligible patients were diagnosed with cancer and enrolled in a PAP between January 2016 and December 2019 in three BC centers. Charts were reviewed for treatment details and survival data. For each drug indication, the hazard ratio from clinical trial data was multiplied by the median overall survival (mOS) or median progression-free survival (mPFS) of our cohort to estimate the mOS or mPFS if the drug was not received. Person life-years gained (PLYG) was the difference between the actual mOS or mPFS and the estimated mOS or mPFS if the drug was not received. Incremental cost-effectiveness ratios and drug costs were obtained from the Canadian Agency for Drugs and Technologies in Health. A total economic value of quality-adjusted life year (QALY) gained for each cohort was calculated and compared with the cost of drugs associated with the gain. Our cohort consisted of 1,025 patients who accessed 40 oncology drugs via PAP. The median time from Health Canada approval to provincial funding was 2.04 years. In the first PAP exposure group (N = 1,025), median PLYG was 0.38 years for OS and 0.80 years for PFS. The total estimated economic value of QALY gained was $83,068,819.32, with total drug costs of $97,026.661.44. PAPs were involved in covering up to $100 million in costs to bridge gaps between regulatory approval and public funding. Economic value and PLYG gained from PAPs are substantial.

Survey of Oncology Patients' Perceptions on Integrative Medicine and Awareness of Resources at an Academic Cancer Center.

Background: More cancer centers are offering integrative medicine (IM) therapies. However, it is unclear how many patients are aware of, and are utilizing, these therapies to help manage their symptoms. Objectives: This survey study examines patients' knowledge, satisfaction with, and perceptions of available IM resources at an academic cancer center. Methods: An online, anonymous survey was sent to 7,807 patients of the University of California Davis Health Comprehensive Cancer Center using the electronic health record. The survey consisted of 11 primary questions with follow-up questions. Results: One thousand and sixteen respondents initiated the survey (response rate of 13%). Eight hundred and fifty-five respondents (10.9%) completed the survey. Mean age was 65.4 years; 67.3% of respondents were female, 84.9% were Caucasian/White, and 86.8% reported being non-Hispanic. The largest group of responders were patients with breast cancer (25.7%). 78.7% reported no IM use, and 18.9% reported using IM. Although 53.7% of respondents were satisfied with the resources, 42.1% reported not being aware of any IM resources. Those who were unaware of resources were more likely to be female than male (47.8% vs. 30.5%) and non-Hispanic (42.3% vs. 31.2%). 48.7% wanted additional IM resources. Of those who wanted additional resources, 54.7% wanted nutritional counseling, 49.3% wanted manipulative and body-based methods, 44.4% wanted alternative medical systems, and 43.4% wanted counseling on herbs, dietary supplements, and cannabis. Discussion: Forty-two percent of participants were unaware of any IM resources at the institution and an even greater number, 48.7%, voiced a desire for additional IM resources. Conclusion: This is the first study in the United States at an academic comprehensive cancer center to examine patients' perceptions of available IM resources. Although some cancer centers offer a variety of IM resources, many patients may be missing out on potential symptom or quality-of-life benefits due to a lack of awareness of these resources.

Possibilities of remote monitoring to manage skin toxicity in oncology patients

Purpose. Analysis of the effectiveness of remote monitoring in the management of skin toxicity in oncology patients.Materials and methods. A comparative study of 2 cohorts of oncology patients with skin toxicity receiving supportive care through remote monitoring using the PSP “Healthy Skin” and outpatient consultations. Nonparametric statistical methods were used with a significance level of p&lt;0.05.Results. A comparative analysis of 150 patients divided into 2 equal groups showed the effectiveness of using the remote monitoring (group 1) in the form of a reliable decrease in median BSA (%) by 67 %, 5D itching scale by 65 %, DLQI by 70 % compared to 10 %, 22 %, 20 % in group 2, respectively, over 4 weeks of the study. In group 2, deterioration of the skin condition was noted in 13.3 % of patients, 9 % of patients underwent a reduction in the dose of the anticancer therapy, 5 % had a break, while in group 1 such episodes were not noted due to the stability of the condition. Positive dynamics in the form of a decrease in the severity of skin toxicity was noted in 48 % of cases in group 1 and in 10 % of cases in group 2. An assessment of patient satisfaction with the use of the application (B 2C (business-to-consumer) analysis) revealed satisfaction in 91.4 % of respondents.Conclusion. The availability and effectiveness of the use of the PSP «Healthy Skin» will ensure timely supportive care, significantly reduce the severity of skin toxicity and improve the quality of life in oncology patients.

High-Dose Ozone Therapy in Oncology Patients: Efficacy, Mechanisms, and Therapeutic Potential

High-Dose Ozone Therapy in Oncology Patients: Efficacy, Mechanisms, and Therapeutic Potential

Identifying factors associated with disparities in accessing an Integrative Oncology program

Introduction: Integrative oncology (IO) programs provide patients with evidence-based complementary medicine therapies within a supportive and palliative cancer care setting. This study retrospectively examined characteristics of patients with lung cancer predicting utilization of a freely-provided IO consultation at two medical centers in Israel. Methods: Electronic medical files of 832 patients with lung cancer attending/not attending the IO consultation were searched for socio-demographic (age, gender, country of birth, place of residence, primary language spoken) and personal health (Body Mass Index; smoking; disability) characteristics; cancer-related parameters (primary tumor site, localized vs. metastatic); and reported pain- and emotional-related concerns. Results: Only 120 (14.4%) of eligible patients attended the IO consultation, with multivariate analysis finding a significantly lower likelihood of attendance among patients who were older (OR: 0.98, 95%CI=0.96-0.99; p=0.02); male (OR: 0.53, 95%CI=0.34-0.83; p=0.005); primarily non Hebrew-speaking (i.e., primarily Arabic or Russian speakers; OR: 0.34, 95%CI=0.14-0.82; p=0.016); without disability (OR: 0.52, 95%CI=0.33-0.92; p=0.025); and not reporting pain (OR=0.40,95%CI=0.17-0.98-; p=0.046). Conclusions: The present study suggests that age, gender and culture-related factors (reflected by the patient's primary language) may contribute to disparities in accessing a freely-provided IO consultation, as shown in a diverse population of patients with lung cancer from two medical centers in Israel. Further research is needed to better understand the role of these programs within a diverse, equitable and inclusive setting of effective and safe integrative care of oncology patients.

Emergency findings detected by [18F]-FDG PET/contrast-enhanced CT: A translational approach

AbstractObjective2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) can be developed in association with contrast-enhanced CT (ceCT), specifically in oncologic patients. This study aimed to evaluate emergency cases incidentally detected in our clinical practice with [18F]-FDG PET/ceCT.MethodWe retrospectively evaluated 3661 [18F]-FDG PET/ceCT, developed between 2017 and 2023, collecting emergency cases needing prompt treatment.ResultsIn 34/3661 patients (0.9%) an emergency case was recorded, in particular through contrast-enhanced CT, linked to a vascular (65%) or extravascular (35%) disease. The more frequent findings were pulmonary thromboembolism (0.5%). [18F]-FDG PET/CT was positive in 13/34 cases.ConclusionsA significant minority of patients undergoing PET/ceCT present vascular or extravascular emergency diseases. The [18F]-FDG uptake improves confidence in diagnosing inflammatory findings. Properly trained diagnostic physicians approaching PET/ceCT can change the prognosis of a small but significant number of cancer patients through a life-saving approach. Future studies are needed to ensure the possibility of emergency findings with non-[18F]-FDG tracers.

The epidemiology of pediatric oncology and hematopoietic cell transplant admissions to U.S. intensive care units from 2001-2019.

Children with cancer or hematopoietic cell transplant (HCT) frequently require ICU care. We conducted a retrospective cohort study using Healthcare Cost and Utilization Project's State Inpatient Databases from 21 U.S. states from 2001-2019. We included children <18 years with oncologic or HCT diagnosis and used ICD-9-CM and ICD-10-CM codes to identify diagnoses, comorbidities, and organ failures. We used generalized linear Poisson regression and Cuzick's test of trend to evaluate changes from 2001-2019. Among 2,157,991 total pediatric inpatient admissions, 3.9% (n=82,988) were among oncology patients and 0.3% (n=7,381) were among HCT patients. ICU admission prevalence rose from 13.6% in 2001 to 14.4% in 2019 for oncology admissions and declined from 23.9% to 19.5%, for HCT admissions. Between 2001-2019, the prevalence of chronic non-oncologic comorbidities among ICU patients rose from 44.3% to 69.1% for oncology patients (RR 1.60 [95% CI 1.46-1.66]) and from 41.4% to 81.5% (RR 1.94 [95% CI 1.61-2.34]) for HCT patients. The risk of Multiple Organ Dysfunction Syndrome more than tripled for oncology (9.5% to 33.3%; RR 3.52 [95% CI 2.97-4.18]) and HCT (12.4% to 39.7%; RR 3.20 [95% CI 2.09-4.89]) patients. Mortality decreased most for ICU patients with acute myeloid leukemia (AML) (14.6% to 8.5%) and oncology-related HCTs (15.5% to 9.2%). Critically ill pediatric oncology and HCT patients are increasingly medically complex with greater prevalence of chronic comorbidities and organ failure, but mortality did not increase. Pediatric ICUs may require increased financial and staffing support to care for these patients in the future.

Impact of oncologic diseases on outcome in patients with severe isolated tricuspid regurgitation.

Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality. Isolated TR, defined as TR without overt heart disease, is typical and offers limited cardiac treatment options other than interventional repair or replacement. Survival history of cancer or active cancer treatment may lead to an unnecessary delay of TR treatment. We included all patients diagnosed with severe TR at the Medical University of Vienna between 2003 and 2016 who had normal left ventricular function and no other valvular lesions. Outcome analysis was performed on cancer type, status and the number of organs affected by cancer. A total of 973 patients were included. 182 (19%) patients had cancer, 52 were active and 130 had a history of cancer at the time of TR diagnosis. Oncologic patients were divided into subgroups of gastrointestinal, skin, glands, gynaecological, breast, urogenital, lung and other cancers. Ten-year mortality of patients with cancer was higher than those without cancer (p < 0.001). Multivariate analysis adjusting for age did not reveal significantly higher mortality in patients with a history of cancer compared to patients without cancer (p = 0.59). Patients with lung, active, or multi-organ cancer showed the highest mortality. Mortality in patients with severe isolated TR is high and increased by active or multi-organ cancer but not by a history of cancer. These patients should be discussed in interdisciplinary cardio-oncology teams to avoid delaying life-saving treatment of TR and cancer.