Cancer Treatment Care Research Articles

An ethnography of humor, ritual and defiance in a cancer care setting

PurposeHealth care organizational research should pay greater attention to the specific settings where health is practiced. An ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center. A thick description of the setting and interaction among center staff and patients is offered in an attempt to establish why qualitative research of health care settings is so important. Findings are compared to Ellingson’s work on health care setting. Humor, ritual and defiance have therapeutic value and deserve greater attention in cancer treatment centers and health care organizations more broadly. The paper aims to discuss these issues.Design/methodology/approachAn ethnographic account of humor, ritual and defiance is presented from 29 months spent in a private, concierge-type radiation oncology center through thick description.FindingsThis study reinforces the literature on the value of institutionalizing humor and ritual to improve patients’ experience in cancer care given the dominance of large public institutions, most easily accessed by academic researchers. Suncoast Coast Radiation Center’s “institutionalized humor” is an important finding that should be examine further. Scholarship can also illuminate the use of ritual in settings where health care is practiced.Research limitations/implicationsThis study is limited to a particular research setting which is a private, concierge care radiation oncology treatment center in the Southeastern USA.Practical implicationsCancer care centers should consider carefully institutionalizing humor and ritual into their daily practices. Further, patient defiance should be reinterpreted not as a patient deficiency but as a therapeutic coping mechanism by patients.Social implicationsWhile nearly half of cancer care in the USA is offered in private, for-profit institutions, the vast majority of the understanding of cancer care comes only from non-profit and government-run institutions. Shining a light of these neglected cancer care settings will add to the understanding and the ability to improve the care offered to patients.Originality/valueThis is the first health ethnography in a concierge care, cancer care treatment setting. It tests the proposition that humor, ritual and defiance play an important role in a private concierge cancer care organization.

Treatment, survival, and costs of oropharyngeal cancer care in the elderly.

To examine associations between treatment, survival, and costs in elderly patients with oropharyngeal squamous cell cancer (OPSCC). Retrospective cross-sectional analysis of Surveillance, Epidemiology, and End Results-Medicare data. We evaluated 666 patients diagnosed with OPSCC from 2004 to 2007 using cross-tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis. The majority of patients were nonsmokers (79%), had advanced-stage disease (59%), and received chemoradiation (38%) or radiation (28%). Surgery with postoperative radiation (hazard ratio [HR]: 0.33 [95% CI: 0.20-0.53]) and chemoradiation (HR: 0.45 [95% CI: 0.29-0.71]) were associated with improved survival, whereas stage IV disease was associated with poorer survival (HR: 1.95 [95% CI: 1.13-3.38]). Additional cancer-directed treatment after primary treatment was more likely following chemoradiation (odds ratio [OR]: 3.44 [95% CI: 1.78-6.63]). Salvage surgery was performed in 25% of patients undergoing subsequent additional cancer-directed treatment, and was associated with high-volume hospitals (OR: 2.81 [95% CI: 1.07-7.74]). Additional radiation (HR: 0.47 [95% CI: 0.31-0.72]) and salvage surgery (HR: 0.61 [95% CI: 0.38-0.99]) were associated with improved overall survival when performed >6 months following initial treatment, whereas salvage neck dissection alone was not significantly associated with survival after controlling for time to salvage (HR: 0.38 [95% CI: 0.05-2.78]). Treatment and 5-year overall costs were highest for chemoradiation, surgery with postoperative radiation, and additional cancer-directed treatment. Multimodality treatment in elderly OPSCC patients was associated with improved survival and increased costs. Chemoradiation was associated with an increased likelihood of additional cancer-directed treatment. Salvage surgery was centralized at high-volume hospitals, and was associated with improved survival when performed >6 months after last initial treatment date, but was performed in <20% of patients undergoing additional treatment. 2c. Laryngoscope, 128:1103-1112, 2018.

Overview on Patient Centricity in Cancer Care.

Successful implementation of treatment in cancer care partially depends on how patients' perspectives are taken into account, as preferences of health care professionals and patients may differ. Objectives of this exploratory research were (I) to identify patient preferences and values (PPVs) in cancer care as indicated by patient organizations (POs), (II) to determine how these PPVs are captured in cancer care guidelines and (III) to review how guidelines take into account these PPVs. Based on a survey developed and completed by 19 POs, a literature review was conducted to analyse how patient perspectives are incorporated in oncology treatment guidelines. Based on survey results traditional health technology assessment value propositions of oncology care, such as extended life, treatment-free remission and pain reduction, were also highly rated by POs. However, the heterogeneity of cancer PPVs were clearly reflected in the survey results. PPVs in cancer care guidelines were mostly limited to those micro-level aspects that are strictly related to health care provision, such as side-effects and comorbidities. Patient experience, emotional support and convenience of care were relatively neglected fields in the reviewed guidelines. Patient engagement was rarely presented in the guideline development phase. POs believe that patients should be encouraged to take an active role in their own care due to the heterogeneity of cancer patients and PPVs. Even if patient-centricity is a leading paradigm in cancer policy, based on our research it is not yet standard practice to include patients or POs at all appropriate levels of decision-making processes that are related to their health and well-being. Patient engagement should be an integral part of cancer care decision-making. This complexity must be reflected throughout policy making, avoiding a population level “one-size-fits-all” solution.

Body language and metaphors revealed through applications of Movement Psychotherapy in a hospice: A clinical case of refractory pruritis

Movement psychotherapy (MP), and dance/movement therapy (DMT), are body-orientated psychotherapy approaches that use movement for the integration of emotional, cognitive, physical, social and spiritual aspects of self (European Association Dance Movement Therapy, 2010). It is distinctively a combination of moving and sensing the body with verbal self-reflection (Bloom, 2006). Several papers have presented DMT as a treatment in general medical care and cancer care, but there is still a paucity of evidence-based studies. The authors describe a clinical case illustrative of many of the situations in which facing death was particularly tormenting. The emotional pressure can produce a barrier of communication with the risk of rupturing the therapeutic relationship. The movement therapist’s function is to clarify the elements of body language and this has important implications for clinical practice because the end-of-life decisions are difficult, like palliative sedation therapy (PST). Even if procedural guidelines for PST help physicians and care teams through the decision-making process and make them more comfortable when responding to physical suffering, physicians more frequently report an emotional pressure when their patients experience psychological symptoms, with the risk that PST could become a potential “counterphobic defence to treat”.

IL-8 and CRP as Predictive Markers in Prostate Cancer

Prostate cancer is the most commonly diagnosed malignancy in US men and it is the second leading cause of cancer death in US men. A standard of care treatment for localized prostate cancer includes radiation to the prostate. Reactive oxygen species are an important contributor to the efficacy of radiation therapy, but they also initiate down-stream signaling which eventually leads to resistance of oxidative damage and thus resistance to radiation therapy. One way that this is accomplished is through up-regulation of NF-κB. Rel-B is a member of the NF-κB family and is found in high concentrations in the nuclei of prostate cancer cells of higher Gleason scores (GS). High levels of Rel-B protect prostate cancer from radiation and suppression of Rel-B leads to more radiosensitive tumors, as reported from preclinical studies. There is evidence that overexpression of Rel-B increases interleukin 8 (IL-8) in prostate cancer cell lines and animal models. Serum IL-8 was also found to be increased in men with bone metastases from prostate cancer. Thus IL-8 may be an important tumor marker with prognostic significance in prostate cancer especially with regard to its growth and response to therapy. We conducted a prospective cohort study to document the correlations between IL-8, PSA, inflammatory markers such as C-reactive protein (CRP), clinical stage, and time to progression. Males with biopsy-proven prostate cancer were enrolled prior to definitive treatment. Patients were treated according to the standard of care. Physical exams were performed and blood was collected at baseline and at every follow-up to measure serum PSA, IL-8, and inflammatory markers such as CRP. Imaging studies were performed at diagnosis and then as clinically indicated. One-hundred-and-forty-nine patients were evaluable. Six patients had pathologic/radiologic evidence of disease progression. We found that stage group and baseline CRP is significantly related to time to progression (p=0.0280 and p= 0.0295, respectively). Baseline IL-8 levels significantly predicted stage group (p=0.021). We also found that age was significantly correlated with baseline CRP and GS at diagnosis (correlations: -0.19 & 0.20, p=0.0226&p=0.0134, respectively) and that baseline PSA was significantly related to GS at diagnosis (correlation=0.31, p=0.0002). IL-8 and CRP are tumor markers with potential prognostic significance. IL-8 predicted stage group successfully and CRP was related to time to progression. These discoveries may help build better models to understand prognosis and develop potential precision therapeutic strategies with regard to prostate cancer.

Étude transversale, multicentrique, sur le ressenti des patients concernant le dispositif d’annonce du diagnostic de cancer

We conducted a multicentric, cross-sectional telephone survey. Patients registered on the multidisciplinary cancer consultation platform lists were randomised. Practitioners validated the inclusion criteria of their patients, i.e. age over 18, patient fully informed of his/her diagnosis and able to answer a telephone interview. Two hundred thirty-six patients have been included. Outcome indicators reported as satisfactory were: the general setting of the disclosure consultation, the patient-doctor relationship, the coordination between the different carers and the patient carer relationship. The overall duration of the medical disclosure consultation and the time dedicated to explain the treatment and its adverse effects have been considered as insufficient. The measured indicators, which were by essence subjective, convey useful information on the quality of care in cancer treatment in the initial disclosure phase, as experienced by patients. This study has in particular allowed carers to start exploring ways to improve the experience of care of their patients.

A multidimensional view of racial differences in access to prostate cancer care.

Racial disparities in prostate cancer treatment and outcomes are widespread and poorly understood. In the current study, the authors sought to determine whether access to care, measured across multiple dimensions, contributed to racial differences in prostate cancer. The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer between 2012 and 2014. Men were surveyed to assess their experiences accessing care (response rate of 51.1%). The authors determined appointment availability at 151 urology practices using simulated patient telephone calls and calculated travel distances using geospatial techniques. Multivariable logistic regression models were used to determine the association between 5 different domains of access (availability, accessibility, accommodation, affordability, and acceptability) and receipt of treatment, perceived quality of care, and physician-patient communication. There were 1907 non-Hispanic white and 394 black men in the study cohort. Overall, approximately 85% of the men received definitive treatment with no differences noted by race. Black men were less likely to report a high quality of care (69% vs 81%; P<.001) and good physician-patient communication (60% vs 71%; P<.001) compared with white men. In adjusted models, none of the 5 domains of access were found to be associated with definitive treatment overall or with radical prostatectomy. All access domains were associated with perceived quality of care and communication, although these domains did not mediate racial disparities. To the authors' knowledge, the current study presents the first comprehensive assessment of prostate cancer care access, treatment, and patient experience, demonstrating that although access was related to overall perceived quality of care and better physician-patient communication, it did not appear to explain observed racial differences. Cancer 2017;123:4449-57. © 2017 American Cancer Society.

Anticancer effects of limonene and phosphatidylinositol 3- Kinase (pi3k) inhibitor combination in colon cancer cell lines

Aberrant activation of phosphotidylinositol 3-kinase (PI3K) pathway effectors has been observed in many cancers including colorectal cancer. As cancers develop due to multiple genetic alterations it is seldom possible to treat them with monotherapy. So, combination therapy has been the standard care in cancer treatment. Therefore, the anticancer effects of the combination of limonene which is a natural monoterpene and NVP-BEZ235, a dual inhibitor of PI3K/mammalian target of rapamycin (mTOR) pathway were investigated in colorectal cancer cell lines. In vitro anticancer assays such as cell viability, cell cycle analysis, apoptosis, caspases estimation and Western blot analysis were performed to determine the combination effects on cells. Results showed that both drugs exhibited dose and time dependent cytotoxicity. Drug combination significantly decreased the phosphorylation of p-70S6K, p-AKTSer473andp-AKTThr308. The inhibition of p-70S6K phosphorylation was more sensitive than p-AKTSer473. Disruption of the known S6K1-IRS-1 negative feedback loop may possibly explain the reversal of p-AKT after 48h treatment with either of the drugs alone. However, the combination of limonene and BEZ may help to alleviate the negative feedback activation of PI3K signaling. This combination also induced G1 phase arrest in the cells and increased the expression of Bcl-2 family mediated apoptosis markers. In conclusion, the results indicate that limonene and BEZ combination demonstrated anticancer effects and are mediated by down regulation of PI3K/mTOR signaling and induction of apoptosis by mitochondrial death pathway.

Abstract 3400: Progression of epidermal growth factor receptor (EGFR)-independent colorectal cancer

Abstract When combined with standard of care treatment for colorectal cancer (CRC), the use of monoclonal antibodies or small molecule inhibitors against epidermal growth factor receptor (EGFR) show modest efficacy in the clinic. Early detection efforts and more effective therapies have reduced mortality, yet CRC remains the second mostly deadly cancer in the United States with approximately 50,000 deaths expected this year. Thus, it is imperative to better understand the mechanisms governing molecular progression of CRC. Primary and secondary resistance to anti-EGFR therapies occurs in approximately 80% of the patients with CRC. Mutations in Kras explain some non-responding CRCs, but even in cancers lacking Kras mutations, little is known about which cancers are likely to respond to EGFR targeted treatment, suggesting an alternative and EGFR-independent CRC progression mechanism. In this study, we used a conditional Egfr allele (Egfrf) within the ApcMin/+ mouse model and identified EGFR-independent tumors with faster growth rates than those developing in EGFR-wild type mice. To assess aggressiveness of EGFR-independent tumors, we used a metastatic CRC mouse model containing conditionally inactivated Apc alleles (Apcf/f) in combination with a conditionally active allele of Kras (KrasLSL-G12D). It has been reported that delivery of Cre recombinase-expressing adenovirus to the distal colon of these mice results in tumors that progress to carcinoma within 20 weeks, and liver metastases develop in approximately 20% of mice at 24 weeks. We discovered a 10% increase in the penetrance of tumors arising in the absence of EGFR (Egfrf/f, Apcf/f, KrasLSL-G12D/+). Endoscopic analysis suggests an increase in tumor multiplicity in EGFR-deficient tumors when compared with tumors developing in EGFR-wild-type mice. Biweekly colonoscopies confirmed that colonic tumors have a faster growth rate in the absence of EGFR. High-frequency abdominal ultrasound suggests liver metastasis at 16 weeks in 20% of mice lacking EGFR. These findings demonstrate the existence of an EGFR-independent mechanism by which CRC can arise and progress. Moreover, tumors lacking EGFR grow larger than those developing under normal EGFR activity and may be a more aggressive form of CRC. We also have evidence that ERBB3 and ERBB4, related EGFRs, mediate compensatory and alternative pathways, suggesting an important role for these receptors in the progression of EGFR-independent CRC. This study will advance our understanding of ERBB family biology during colonic tumorigenesis, ultimately contributing to better therapies for CRC. Citation Format: Carolina Mantilla Rojas, Yu Ming, David Threadgill. Progression of epidermal growth factor receptor (EGFR)-independent colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3400. doi:10.1158/1538-7445.AM2017-3400

The Cancer Care Treatment Outcomes Ontology (CCTO): A computable ontology for profiling treatment outcomes of patients with solid tumors.

e18137 Background: Systematic enhancement of knowledge about outcomes of cancer therapy is a central goal for oncology research, practice and audit. However, there is no resource standardizing the disparate vocabulary used to describe treatment outcomes, which prevents translating the data acquired into value-adding information for better cancer care. Methods: To build an application ontology that organizes high-level concepts describing treatment outcomes in solid tumors, provisionally named Cancer Care Treatment Outcomes (CCTO), we extracted all trial endpoints listed in ClinicalTrials.gov, queried it using the keyword ‘cancer’, followed by an expert appraisal. Term definitions and synonyms were automatically imported from the National Cancer Institute thesaurus, and extra terms were imported from Common Toxicity Criteria for Adverse Events. Logical relationships between concepts were represented by forward chaining rules, aiding conversion between concepts. The coverage of CCTO was tested against MEDLINE abstracts, and the applicability of 1825 rules was tested in a case of metastatic colon cancer (index case). Results: After removing duplicated terms from 54705 trial entries, an ontology (CCTO), holding 1145 terms and organized into 13 concept groups (including but not limited to efficacy, safety, and quality of life), was built. CCTO not only captures a comprehensive taxonomic hierarchy (through is_a relationships) but also an evaluative hierarchy ( is_assessed_by) to aid the acquisition of treatment outcome data. At least one CCTO term was mentioned in 29493 of 29951 (98%) MEDLINE abstracts on phase 1-3 cancer trials; concepts about efficacy were mentioned in 7208 (79%) phase 1, 15051 (92%) phase 2, and 3884 (86%) phase 3 trials. We show that, by applying the relationship rules in an expert system shell, the event sequence of the index case can be readily converted into a comprehensive profile that incorporates survival measures, treatment responses, and adverse events. Conclusions: CCTO efficiently captures and categorizes high-level concepts of treatment endpoints in oncologic practice and enables rapid profiling of clinical outcomes for cancer patients.

RAD51 as a potential surrogate marker for DNA repair capacity in solid malignancies

Targeting deficient mechanisms of cellular DNA repair still represents the basis for the treatment of the majority of solid tumors, and increased DNA repair capacity is a hallmark mechanism of resistance not only to DNA-damaging treatments such as cytotoxic drugs and radiotherapy, but also to small molecule targeted drugs such as inhibitors of poly-ADP ribose polymerase (PARP). Hence, there is substantial medical need for potent and convenient biomarkers of individual response to DNA-targeted treatment in personalized cancer care. RAD51 is a highly conserved protein that catalyzes DNA repair via homologous recombination, a major DNA repair pathway which directly modulates cellular sensitivity to DNA-damaging treatments. The clinical and biological significance of RAD51 protein expression is still under investigation. Pre-clinical studies consistently show the important role of nuclear RAD51 immunoreactivity in chemo- and radioresistance. Validating data from clinical trials however is limited at present, and some clinical studies show controversial results. This review gives a comprehensive overview on the current knowledge about the prognostic and predictive value of RAD51 protein expression and genetic variability in patients with solid malignancies.

The International Watch &amp; Wait database (IWWD) for rectal cancer: An update.

521 Background: In 2014 the IWWD was established by EURECCA and the Champalimaud Foundation. The main goal of this database is to collect all available data to expand knowledge on the benefits, risks and oncological safety of organ preserving strategies in rectal cancer. In April 2015 the database was opened for data registration. Methods: An international multicentre observational study. Data was collected by participating centres and stored in a highly secured NEN7510 certified and encrypted research data server. Each centre always retains full ownership of their data. Results: In August 2016 the database included 775 patients from 11 countries and 35 participating institutes. 90% of all patients were included because of a clinical complete response (n = 679). All other reasons for a watch-and-wait regimen were excluded for the present analyses. As shown in table 1, imaging modalities used to assess response after induction therapy were variable. Induction treatment consisted of chemo-radiotherapy in 90% of cases. Median follow-up time is 2.6 years (range 0-24 years). Local regrowth occurred in 25% (n = 167) of all patients, of which 84% in the first 2 years of follow-up. A local regrowth was located endoluminal in 96% (n = 161) and in the loco-regional lymph nodes in 4% (n = 7). Distant metastasis occurred in 7% (n = 49). The overall 3 year-survival of all patients was 91% and for patients with a local regrowth this was 87%. Conclusions: This is the largest series of patients with rectal cancer in which surgery was omitted after induction therapy. These data illustrate differences in induction therapy as well as imaging strategies and provide some crude outcome data. Further data collection on the Watch-and-Wait strategy for rectal cancer is needed to increase knowledge on oncological safety of omitting surgery. This may contribute to international consensus on staging, treatment and surveillance guidelines in rectal cancer care. [Table: see text]

Abstract C09: A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America

Abstract Background: Cancer mortality rates in developing countries such as Mexico are higher than in high-income countries, due in part to failure and delays in access to health care. The median delay from problem identification to start of treatment can be up to 7 months, which is largely related to shortcomings of a fragmented healthcare system. At least 7 public providers coexist within the Mexico City Metropolitan Area (MCMA). A cumbersome and inefficient system requires the referral of patients with suspicion or diagnosis of cancer between hospitals with different health coverage. A more coordinated delivery of cancer care or navigation of cancer patients is needed to achieve timely initiation of treatment. Here we report preliminary results of the first patient navigation (PN) program in Mexico City. We initiated this study with the objective of demonstrating that implementing a PN program at a second level hospital within the MCMA would be feasible and reduce time to initiation of tertiary cancer care treatment. Methods: Patients eligible for PN enrolment were aged &amp;gt;18 with either suspicion or confirmed diagnosis of cancer who required referral to a cancer center for further care. Baseline demographic and psychosocial data were collected. Patients were navigated by a dedicated patient navigator, who assisted them with scheduling; paperwork; obtaining results in a timely manner; transportation; and appropriate oncological diagnosis and/or treatment. Our statistical assumption was a sample size of 40 patients needed to demonstrate it was feasible to successfully navigate at least 70% of the patients within 3 months of the start of navigation. Results: Recruitment began in January 2016. Twenty-six patients have been accrued (median age 57 years [range 22 to 85]; 14 [53%] are male). Most common diagnoses are: genitourinary (35%, N= 9), hematologic (15%, N=4) and head and neck malignancies (15%, N4). Fourteen (53%) have &amp;lt; middle-school education, 22 (85%) are unemployed, 23 (88%) have a monthly income of less than $410 USD and 21 (81%) have public insurance. The most frequently identified barriers to cancer care have been financial (73%, N=19), transportation (38%, N= 10), fear (38%, N=10) and poor communication with healthcare personnel (15%, N = 4); mean time to referral is 12 days (range 1-46, SD 10.1) and time to specialist appointment is 27 days (range 1-77, SD 8.9). To date 84% (N=21) of patients have been successfully referred to a cancer center, all of them within the pre-specified time period of less than 3 months. Conclusion: Preliminary results indicate that a PN program aimed at improving referral between health systems and overcoming access barriers to cancer diagnosis and treatment in Mexico City is feasible, and that it decreases the time to referral to a cancer center. PN may be a solution to overcome barriers to healthcare access for underserved cancer patients and perhaps patients with other non-communicable diseases in developing countries. Citation Format: Yanin Chavarri Guerra, Enrique Soto Perez de Celis, Wendy A. Ramos Lopez, Alexandra Bukowski, Sandra San Miguel, Oscar Sanchez Gutierrez, Jesus A. Sanchez Gonzalez, Paul E. Goss. A Patient Navigation Program in Mexico City as a model for overcoming barriers to accessing cancer care in Latin America. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C09.

Translational Research in Oncology: Implications for Palliative Care.

The label “translational research” (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the laboratory bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific research. The past decade has witnessed a remarkable acceleration in the pace of translational cancer medicine – genome sequencing of various human cancers has been broadly deployed in drug discovery programs, diagnostic tests have been developed to predict molecularly targeted anticancer agents, advent of cancer immunotherapies, an enhanced appreciation of the complex interactions that exist between tumor cells and their microenvironment have revolutionized the management of cancers. Treatment for cancer and palliative care (PC) go hand in hand and the role of TR in PC can no longer be ignored. This paper discusses about the scientific discourse of TR in cancer care and its implications for the practice of PC. It starts with a brief reconstruction of the history of the concept and subsequently unravels how the label is used in clinical/research practice. In conclusion, TR seems to be driven by a changed relationship between science and society. “Translation” has become important because society is thought to deserve a tangible return in terms of health and quality of life on its investment in basic biomedical science.

86P Overview of breast cancer management: Yangon private sector cancer care

Background With the development of advanced technology in the field of oncology, breast cancer treatment becomes individualized nowadays. Breast cancer is the commonest cancer in Myanmar women. Aim of this study is to explore about breast cancer treatment in private sector cancer care in Yangon, Myanmar. Methods Clinical data of breast cancer patients registered at 3 private clinics in Yangon, Myanmar from July 2014 to June 2016 were studied and analyzed. Results Including 2 male breast cancer patients, a total of 488 breast cancer patients were registered .Meanageis 52. 73 yrs (range22 yrs - 87yrs). 13.53% (n = 66) were young age patients under age of 40. Most patients were diagnosed at Stage II = 65.57% (n=320)andStageIII=18.85%(n=92).82.5%(n=407) were investigated for biologicalmarkers(Estrogen,progesteronereceptorsandHer2)using immunohistochemistrymethodwhereas8.23%werenotdonethetestduetofinancial limitations.Ki67,P53statusweredoneinonly11.47%(n=56).Molecularsubtypes wereERpositiveHER2negativein39.8%(n=162),Her2positivein37.59%(n=154) and Triple Negative Breast cancer in 17.93% (n = 73).Total mastectomy and axillary clearancewasdonein94.03%(n=459).Breastconservingsurgerywasdonein3.8% (n=15).SentinelLymphnodeBiopsywasdonein3.6%(n=18).Breastreconstruction surgerywasdonein0.61%(n=3).Radiationtreatmentwasdonein12.09%(n=59). Neoadjuvant and adjuvant chemotherapy using different regimes were done in 96.72%(n=472).AmongHer2positivepatients,27.27%(n=42)canaffordforanti Her2 targeted therapy. Hormonal therapy using Tamoxifen or Aromatase Inhibitors was given to all ER positive cases depend on menopausal status. Conclusions Total mastectomy and axillary lymph node dissection was the treatment of choice in surgical management due to patients preference and limitations to access radiation therapy. Limited number of Her2 positive patients received molecular targeted therapy due to financial difficulities. Overall, access to treatment, financial limitations and insufficient health care system are the barriers to get standard treatment in breast cancer in Myanmar. Legal entity responsible for the study Thurein Clinic, Yangon Funding Thurein Clinic, Yangon Disclosure All authors have declared no conflicts of interest.

African Organization for Research and Training in Cancer: position and vision for cancer research on the African Continent.

The African Organization for Research and training in Cancer (AORTIC) bases the following position statements on a critical appraisal of the state on cancer research and cancer care in Africa including information on the availability of data on cancer burden, screening and prevention for cancer in Africa, cancer care personnel, treatment modalities, and access to cancer care.

Virtual environments in cancer care: Pilot-testing a three-dimensional web-based platform as a tool for support in young cancer patients.

Bringing virtual environments into cancer support may offer a particular potential to engage patients and increase adherence to treatment. Developing and pilot-testing an online real-time multi-user three-dimensional platform, this study tested the use of an early prototype of the platform among adolescent and young adult cancer patients. Data were collected with an online questionnaire and using ethnographic methods of participant observation. The adolescent and young adult patients tested basic features of the virtual environment and some conducted brief in-world interactions with fellow patients during hospitalization. They had no reservations about using the technology and shared their ideas about its use. Our pilot test pointed to a number of areas of development for virtual environment applications as potential platforms for medical or behavioral interventions in cancer care. Overall, the results demonstrate the need for high user involvement in the development of such interventions and early testing of intervention designs.

Using Stable Free Radicals to Obtain Unique and Clinically Useful Data In Vivo in Human Subjects.

This paper attempts to: (1) provide a critical overview of the challenges and opportunities to extend electron paramagnetic resonance (EPR) into practical applications in human subjects, based on EPR measurements made in vivo; (2) summarize the clinical applications of EPR for improving treatments in cancer, wound healing and diabetic care, emphasizing EPR's unique capability to measure tissue oxygen repeatedly and with particular sensitivity to hypoxia and (3) summarize the capabilities of in vivo EPR to measure radiation dose for triage and medical guidance after a large-scale radiation exposure. The conclusion is that while still at a relatively early stage of its development and availability, clinical applications of EPR already have demonstrated significant value and the field is likely to grow in both the extent of its applications and its impact on significant problems.

Psychotropic and Opioid Medication Use in Older Patients With Breast Cancer Across the Care Trajectory: A Population-Based Cohort Study.

Older patients with breast cancer represent a vulnerable population at higher risk of experiencing distress and pain, as well as medication-related adverse events from pharmacological treatment of these symptoms. The purpose of this study is to estimate the prevalence of psychotropic (anxiolytic, antidepressant, and antipsychotic) and opioid medication use by older women diagnosed with breast cancer. This population-based cohort study followed 19,353 women older than 65 years diagnosed with incident, nonmetastatic breast cancer in Quebec, Canada. Data were obtained from provincial, universal health and drug insurance plans covering all medical and pharmaceutical care. Descriptive statistics were calculated for demographic information, breast cancer characteristics, and treatments. Psychotropic and opioid medication use was assessed across the care trajectory: precancer baseline, active care, and first-year survivorship. There was a marked increase in the prevalence of medication use from precancer baseline to active care, followed by a decrease into first-year survivorship. Anxiolytics were used most often across the care trajectory (36.3%, 50.6%, and 44.4% at baseline, active care, and survivorship, respectively). In contrast, antipsychotic and opioid medications were sought primarily during active care (4.5- and 7-fold increases from baseline, respectively), with opioid use during active care increasing dramatically over the study period (9.0% to 40.9% from 1998 to 2010). Unlike other drugs, antidepressant use peaked in active care but persisted into survivorship (14.7%, 22.4%, and 22.3% at baseline, active care, and survivorship, respectively). A substantial proportion of older patients with breast cancer use psychotropic and opioid medications. The different patterns of medication use represent distress and pain experienced by patients across the care trajectory. Given that medication use in this vulnerable population is associated with an increased risk of adverse events, a multidimensional approach integrating psychological interventions in cancer care may better address psychosocial needs of older patients with breast cancer.

Perception of risk and communication among conventional and complementary health care providers involving cancer patients’ use of complementary therapies: a literature review

BackgroundCommunication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients.MethodsSystematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis.ResultsTwenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers.ConclusionThe risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with conventional treatment in cancer care. Health care providers who care for cancer patients should be aware of these risks.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1326-3) contains supplementary material, which is available to authorized users.