Management Of Cancer Patients Research Articles

Role of 18F-FDG PET/CT in the management of head and neck cancer patients with persistent cervical lymphadenopathy following chemoradiation.

We aim to describe the management and outcomes of patients with persistent lymphadenopathy (LAD) after primary chemoradiation for head and neck squamous cell carcinoma (HNSCC) based on post-treatment PET/CT results. Retrospective chart review was conducted of all patients who underwent primary concurrent chemoradiation for HNSCC at a tertiary care center from 2010 to 2022 and had persistent post-treatment LAD. Nearly 62% of patients were managed conservatively, and 27.0% underwent neck dissection. PET-positive patients were more likely to undergo neck dissection than PET-negative patients (p = 0.042). Positive predictive value (PPV) and negative predictive values (NPV) of PET/CT in detecting residual disease in the neck were 48.0% and 73.7%, respectively. PPV and NPV of PET/CT for detecting residual neck disease in patients with post-treatment LAD was lower than those of HNSCC patients with and without persistent LAD reported in other studies.

Clinical observation of the treatment of refractory cancer pain with cancer pain information platform and IDDS under home analgesia mode: A retrospective study.

To evaluate the effectiveness and safety of a cancer pain information platform combined with semi-implantable intrathecal drug delivery systems among the patients with refractory cancer pain under a "home analgesia" model. This was a retrospective study. A total of 49 patients underwent semi-implantable intrathecal drug delivery systems with patient-controlled analgesia in conjunction with the establishment of a cancer pain information platform. Numeric rating scales (NRS), Bruggrmann comfort scale (BCS), high-quality sleep duration, and opioid-related adverse effects were recorded at various time points and analyzed: the day on admission (T0), the day of discharge (T1), 30 days post-discharge (T2), 60 days post-discharge (T3), 90 days post-discharge (T4), 120 days post-discharge (T5), 150 days post-discharge (T6), 180 days post-discharge (T7), and the day before death (T8). Compared with T0, NRS significantly decreased and BCS significantly increased at T1 to T8 time points (P < .05). However, NRS and BCS did not show differences at T1 to T8 time points (P > .05). The duration of high-quality sleep was significantly extended, and the incidence of opioid-related adverse effects was significantly reduced. Postoperative complications included 1 case of cerebrospinal fluid leakage, 3 cases of infection at the butterfly needle insertion site, 6 cases of hospital readmission for equipment malfunction, and no cases of respiratory depression. Eleven patients continued standardized antitreatment after IDDS surgery. The mean survival time for all patients was 135.51 ± 102.69 days, and the survival rate at T7 was 30.61%. The cancer pain information platform combined with semi-implantable IDDS is beneficial for the pain management of refractory cancer patients under the "home analgesia" model, improving their quality of life.

Clinical observation of the treatment of refractory cancer pain with cancer pain information platform and IDDS under home analgesia mode: A retrospective study.

To evaluate the effectiveness and safety of a cancer pain information platform combined with semi-implantable intrathecal drug delivery systems among the patients with refractory cancer pain under a "home analgesia" model. This was a retrospective study. A total of 49 patients underwent semi-implantable intrathecal drug delivery systems with patient-controlled analgesia in conjunction with the establishment of a cancer pain information platform. Numeric rating scales (NRS), Bruggrmann comfort scale (BCS), high-quality sleep duration, and opioid-related adverse effects were recorded at various time points and analyzed: the day on admission (T0), the day of discharge (T1), 30 days post-discharge (T2), 60 days post-discharge (T3), 90 days post-discharge (T4), 120 days post-discharge (T5), 150 days post-discharge (T6), 180 days post-discharge (T7), and the day before death (T8). Compared with T0, NRS significantly decreased and BCS significantly increased at T1 to T8 time points (P < .05). However, NRS and BCS did not show differences at T1 to T8 time points (P > .05). The duration of high-quality sleep was significantly extended, and the incidence of opioid-related adverse effects was significantly reduced. Postoperative complications included 1 case of cerebrospinal fluid leakage, 3 cases of infection at the butterfly needle insertion site, 6 cases of hospital readmission for equipment malfunction, and no cases of respiratory depression. Eleven patients continued standardized antitreatment after IDDS surgery. The mean survival time for all patients was 135.51 ± 102.69 days, and the survival rate at T7 was 30.61%. The cancer pain information platform combined with semi-implantable IDDS is beneficial for the pain management of refractory cancer patients under the "home analgesia" model, improving their quality of life.

Role of Neo-Adjuvant Chemotherapy in Decision Making for Surgical Management of Cancer Stomach

Abstract Background Gastric cancer is the second most common cause of cancer related death worldwide. In Egypt, gastric cancer is the 12th most common cancer. The incidence rises with age and 55% of cases occur between 50 and 70 years of age. The complete resection partial or total gastrectomy is based on tumor location, stage, histology, and surgical margins. The extent of regional lymphadenectomy required has been a matter of debate. Neo-adjuvant chemotherapy could increase the curative resection rate, improve the tumor down staging possibilities. Aim of Work assess the role of the neo-adjuvant chemotherapy for surgical management of gastric cancer patients. Patients and Methods A prospective analysis of sixty patients with ranging age (18-60 years) who are diagnosed with gastric adenocarcinoma, received neo-adjuvant chemotherapy patients with minimal follow up 16 months, treated at the upper gastro-intestinal surgeries unit, Ain Shams University Hospitals. Primary end points include assessing overall survival, R0 resection rate, local recurrence, rate of pathological complete response. Results Patients aged (22-60 years old), mean age 46.67 ±12.76, the median DFS was 6 months, the mean OS is 26.3 months, recorded 1 year, 2 years OS rate was 75.8% and 67.9% respectively. However, the median OS was not reached. Conclusion This study favors the idea of Neo-adjuvant chemotherapy usage prior to surgical intervention in multiple stages of gastric cancer. However, there were other studies that questions its role and demand a reconsideration about the clinical outcome which require further investigation.

Central Lung Cancer Location Along with Bronchoscopic Correlation- A Retrospective Cross-Sectional Study

Background: Lung cancer is currently the leading cause of death from neoplastic diseases worldwide. During the preceding decades, it was the most commonly occurring malignant disease, both in terms of impact and mortality. Fiberoptic bronchoscopy is the most important diagnostic tool for lung cancer. Early tissue diagnosis and proper staging remains the key to the management of the lung cancer patient. Endobronchial forceps biopsy has high diagnostic yield from the visible lesions. The aim of the study was to evaluate diagnostic yield of endobronchial biopsy. Methods: A Cross Sectional Retrospective study of all patients with provisional diagnosis of lung cancer based on computed tomography (CT) scan of chest undergoing fiberoptic bronchoscopy was done at Department of Respiratory Medicine, Ibn Sina Diagnostic &amp; Consultation Center, Chattogram, Bangladesh from July 2022 to June 2023. All fiberoptic bronchoscopy was done in endoscopy suite under local anesthesia. Patients were explained about the procedure thoroughly. Endobronchial biopsy was the main procedure performed. Results: A total of 120 patients underwent bronchoscopy for suspected lung cancer. The mean age of the patients was 58 years with range of 18 to 75 years. Among them 93 (77.5%) were male and 27 (22.5%) were female. Majority of the patients, 108 (90%) were smoker with a mean pack year of 42. The lesion was present more in right side (N=65) than the left side (N=55). Majority of the lesion was present in lobar bronchus followed by main bronchus. Bronchoscopy was normal in 10 patients (8.3%). 12 patients had lesion in multiple locations. The diagnostic yield of endobronchial biopsy was 75%. The diagnostic yield for central tumor was 81.6% which was statistically significant (p&lt;0.001) compared to peripheral tumor and extrinsic compression. Conclusion: Endobronchial biopsy provides good diagnostic yield especially in central tumors. Fiberoptic bronchoscopy is a safe procedure.

Expression of Intragenic LCAL4 Long Non-Coding RNAs as a Potential Diagnostic and Prognostic Marker in Female Breast Cancer.

In breast cancer early detection is associated with reduced mortality and it is essential to identify new biomarkers for early detection and appropriate management of cancer patients with the best response to treatment. Long non-coding RNAs (LncRNAs) have attracted much attention as potential diagnostic, prognostic, or predictive biomarkers due to their high specificity, easy access to non-invasive methods, and their aberrant expression under various pathological and physiological conditions. Have attracted the aim of this study is to investigate the expression profile of intragenic non-coding LncRNAs LCAL4 as a biomarker as potential diagnostic and prognostic biomarkers in cancer. In this research, 62 tissue samples were obtained from patients undergoing therapeutic surgery in Khatam al-Anbia Hospital and the normal peripheral tissue that was removed for prevention was used as a control by Real-time PCR method. The expression pattern of LCAL4 long non-coding RNA gene is significantly different between two groups of healthy control samples and samples obtained from patients with different breast cancer subtypes, Also its expression between samples obtained from different subgroups and different stages showed significant differences. The studied LncRNAs can act as a factor to identify tumor tissue from healthy tissue, and the diagnosis of cancer grades can be different depending on the type of LncRNA. These results can be proposed in the introduction of LncRNA LCAL4 as a new marker in the diagnosis of breast cancer. In addition, by interpreting the results, it can be concluded that these LncRNAs can be considered as influential factors in the process of breast cancer.

Advancing cancer drug development with mechanistic mathematical modeling: bridging the gap between theory and practice.

Quantitative predictive modeling of cancer growth, progression, and individual response to therapy is a rapidly growing field. Researchers from mathematical modeling, systems biology, pharmaceutical industry, and regulatory bodies, are collaboratively working on predictive models that could be applied for drug development and, ultimately, the clinical management of cancer patients. A plethora of modeling paradigms and approaches have emerged, making it challenging to compile a comprehensive review across all subdisciplines. It is therefore critical to gauge fundamental design aspects against requirements, and weigh opportunities and limitations of the different model types. In this review,we discuss three fundamental types of cancer models: space-structured models, ecological models, and immune system focused models. For each type, it is our goal to illustrate which mechanisms contribute to variability and heterogeneity in cancer growth and response, so that the appropriate architecture and complexity of a new model becomes clearer. We present the main features addressed by each of the three exemplary modeling types through a subjective collection of literature and illustrative exercises to facilitate inspiration and exchange, with a focus on providing a didactic rather than exhaustive overview. We close by imagining a future multi-scale model design to impact critical decisions in oncology drug development.

Radiologists' Communicative Role in Breast Cancer Patient Management: Beyond Diagnosis.

In the landscape of cancer treatment, particularly in the realm of breast cancer management, effective communication emerges as a pivotal factor influencing patient outcomes. This article delves into the nuanced intricacies of communication skills, specifically spotlighting the strategies embraced by breast radiologists. By examining the ramifications of communication on patient experience, interdisciplinary collaboration, and legal ramifications, this study underscores the paramount importance of empathetic and comprehensive communication approaches. A special emphasis is placed on the utilization of the SPIKES protocol, a structured method for conveying sensitive health information, and the deployment of strategies for navigating challenging conversations. Furthermore, the work encompasses the significance of communication with caregivers, the integration of artificial intelligence, and the acknowledgement of patients' psychological needs. By adopting empathetic communication methodologies and fostering multidisciplinary collaboration, healthcare practitioners have the potential to enhance patient satisfaction, promote treatment adherence, and augment the overall outcomes within breast cancer diagnosis. This paper advocates for the implementation of guidelines pertaining to psychological support and the allocation of sufficient resources to ensure the provision of holistic and patient-centered cancer care. The article stresses the need for a holistic approach that addresses patients' emotional and psychological well-being alongside medical treatment. Through thoughtful and empathetic communication practices, healthcare providers can profoundly impact patient experiences and breast cancer journeys in a positive manner.

Healthcare professional perspectives following implementation of an infection management care pathway for pediatric patients with cancer: a qualitative study.

The Pediatric Oncology Group of Ontario (POGO) supported an effort to implement infection management care pathways based on clinical practice guidelines, to improve the consistency of infection management in pediatric cancer patients. The objective of this qualitative study was to describe the perspective of healthcare professionals (HCPs) following implementation. Four tertiary pediatric oncology centers in Ontario, Canada, implemented the pathways. We randomly identified three HCPs per group (clinical pharmacists; nurse case managers, educators or practitioners and physician assistants; pediatric oncology fellows; or pediatric oncology staff physicians) per site and invited them to participate in a qualitative interview. One-on-one interviews were conducted remotely, followed by thematic analysis of interview transcripts. A total of 66 invitations were extended and 42 HCPs participated. Identified themes were: (1) implementation approach, (2) access and navigation, (3) engagement, (4) concerns, (5) workplace benefits, (6) reception, and (7) provincial harmonization. HCPs preferred in-person implementation strategies over e-mail communication. They identified teaching/educational utility and benefits to non-oncology departments and non-tertiary centers participating in shared care of patients. Other positive aspects related to evidence-based practice, safety, supporting oncology HCPs, and benefits to patients and families. Concerns included need to ensure users applied clinical judgement and loss of autonomy. Provincial harmonization of practice was viewed positively, although potential logistical and institutional cultural barriers were raised. Following infection management care pathway implementation, HCPs described educational utility and benefits to non-oncology departments, oncology HCPs, patients, and families. Our findings may facilitate future infection management care pathway provincial harmonization.

The role of HOTAIR in the modulation of resistance to anticancer therapy.

Leading anti-tumour therapeutic strategies typically involve surgery and radiotherapy for locally advanced (non-metastatic) cancers, while hormone therapy, chemotherapy, and molecular targeted therapy are the current treatment options for metastatic cancer. Despite the initially high sensitivity rate to anticancer therapies, a large number of patients develop resistance, leading to a poor prognosis. The mechanisms related to drug resistance are highly complex, and long non-coding RNAs appear to play a crucial role in these processes. Among these, the lncRNA homeobox transcript antisense intergenic RNA (HOTAIR), widely implicated in cancer initiation and progression, likewise plays a significant role in anticancer drug resistance. It can modulate cell activities such as proliferation, apoptosis, hypoxia, autophagy, as well as epithelial-mesenchymal transition, thereby contributing to the development of resistant tumour cells. In this manuscript, we describe different mechanisms of antitumor drug resistance in which HOTAIR is involved and suggest its potential as a therapeutic predictive biomarker for the management of cancer patients.

Incidence and outcomes of atrial fibrillation in different cancer subtypes: A propensity-matched analysis of Nationwide Readmissions Database.

e23324 Background: Significant concern exists over the cardiotoxic effects of chemo &amp; radiation therapy used in the management of cancer patients. With different cancers requiring different chemo-radiotherapy regimens, cardiotoxicity risk is quite variable. We aim to evaluate the rates of atrial fibrillation (AF) in various cancers. Methods: The national readmission database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 1.5 million (14%) developed atrial fibrillation (AF). On propensity-matched cohorts, AF had its highest incidence in hospitalizations associated with hematological malignancies (17%), followed by prostate (16.5%), lung (15.9%), renal (12.5%), colorectal (11.5%) &amp; breast (10.5%) malignancies [p &lt; 0.05]. Moreover, cancer hospitalizations complicated by AF were associated with higher mortality. AF was associated with the highest odds of mortality in breast cancer (aOR:1.60), followed by colorectal (aOR:1.59), hematological (aOR:1.55), prostrate (aOR:1.52), renal (aOR:1.51) &amp; lung (aOR:1.51) malignancies [p &lt; 0.001]. The rates of 30-day AF-related readmission were highest in hematological malignancies (21%), followed by lung (18.8%), colorectal (17.1%), breast (16.1%), prostate (15.7%) &amp; renal (12.5%) malignancies [p &lt; 0.05]. Conclusions: The rate of AF in nationwide hospitalizations among cancer patients was ~ 14%. AF was found to have the highest incidence &amp; readmission in hematological malignancies, while AF-related mortality was highest among breast cancer.

Commissioning of the first hospital-based PET radiopharmaceutical cyclotron in Greece: personnel dose assessment

The role of 18F–fluoro–deoxy–glucose in positron emission tomography (PET) imaging is well established in diagnosis and management of cancer patients. Installations of on-site self-shielded mini cyclotrons are increasing. The Dose on Demand Biomarker Generator BG-75 was installed at Metaxa Cancer Hospital, Greece, in May 2021 and is the first hospital-based PET radiopharmaceutical cyclotron in the country. Personnel expected external exposure was established during commissioning; internal exposure is not expected. Personnel dose was estimated with two methods: survey meter measurements in various locations combined with the time spent in each location, and direct measurement using electronic personal dosemeters. Gamma and neutron radiation readings outside the cyclotron vault were at background levels. Inside the cyclotron vault, the highest recorded radiation readings by the target were 18 μSv h−1 for both gammas and neutrons with cyclotron in operational mode; at one meter, the values were 5 μSv h−1 and 4 μSv h−1, respectively. The annual expected whole body dose per cyclotron operator is 0.6 mSv, and the respective extremity dose 16 mSv. The annual expected whole body and extremity dose for the radiochemist is 0.3 mSv and 25 mSv, respectively. The respective annual dose estimates for the medical physicists are < 1 mSv. The expected personnel doses are well below the regulatory limits and local as low as reasonably achievable (ALARA) levels. With experience and a robust ALARA program, personnel exposure could be further reduced.

Prevalence of polypharmacy, drug-drug interactions, and inappropriate prescription in elderly patients with urological cancers.

e23312 Background: Around 50% of new cancer diagnoses occur in patients (pts) &gt; 65 years. Older adults tend to have more comorbidities and therefore prescription of several drugs. Polypharmacy (PP) [defined as prescription of &gt; 5 drugs] has been identified as a prognostic factor and might also lead to relevant drug-drug interactions (DDI) and it is also associated in occasions with inappropriate prescriptions (IP). This study aims to determine prevalence of PP, DDI and potential IP in a uro-oncology clinic. Methods: Pts ≥ 70 years with urological tumors consecutively seen in a medical oncology clinic [May 1st- August31st2023] were offered to complete a questionnaire that included questions about drugs regularly taken, doses, frequency, objective of the treatment along with some key epidemiological data. A descriptive analysis of this information was performed to identify PF along with a search for DDI ( DrugDex ®) and IP (STAR/STOPP criteria). Results: 91 pts agreed to participate and 87 complete the questionnaires. Mean age was 76 years (range 70-91) and 84.5% were men; 64%, 31 and 5% had ECOG 0,1 and 2 respectively. The predominant cancer type was bladder (41%), followed by prostate (40%) and kidney cancer (19%). Polypharmacy was identified in 54 pts (62%), with 12 pts (22%) having ≥ 10 drugs prescribed. Two cases (2%) of duplicity of treatment were found (laxative; hypnotic). Ninety-five major and 37 moderate DDI were detected, of which 8 occurred between anticancer drugs (abiraterone, pazopanib, everolimus and carboplatin) and outpatient treatments. An IP analysis is being currently conducted and data will be presented at the meeting. Conclusions: Our study shows a high prevalence of polypharmacy in older adults with urological tumors and a significant rate of drug-drug interactions including interferences with oncological treatments. These results highlight the need for careful reviewing and monitoring the drugs prescribed to our patients in the clinic and calls for strengthen collaborations with pharmacists and nurses to optimize integral management of GU cancer patients.

ChatGPT vs Expert-Guided Care Pathways for Postesophagectomy Symptom Management

BackgroundThe objective of this study was to compare generative artificial intelligence–initiated care pathways, using ChatGPT, with expert-guided consensus-initiated care pathways from AskMayoExpert (AME) for symptom management of esophageal cancer patients after esophagectomy. MethodsA formal protocol for development of 9 AME care pathways was followed for specific patient-identified domains after esophagectomy for esophageal cancer. Domain scores were measured and assessed through the Upper Digestive Disease tool. These care pathways were developed by experts validated by a consensus-driven methodology. ChatGPT was used to answer specific questions similar to the AME care pathway on April 9, 2023, and March 28, 2024. To compare outcomes, answers were recorded, and algorithms were compared with a survey tool composed of 5 questions. ResultsBoth modalities were able to provide a clear definition with multidirectional management options for all 9 domains: dysphagia, generalized dumping, gastrointestinal dumping, pain, regurgitation, heartburn, nausea, physical health, and mental health. When provided with a simple prompt, ChatGPT 3.5 failed to provide a comprehensive stepwise approach for providers, any testing recommendations, or any form of triage process. However, ChatGPT 4.0 provided plans, similar to AME care pathways, when a sophisticated prompt was used. ConclusionsGenerative artificial intelligence–initiated care pathways can be used by physicians as a supplementary tool to guide provider management of patients with complex symptoms after esophagectomy. This technology will continue to advance but is currently insufficient to solely guide clinical management of complex patients with severe symptoms.

Efficacy of a combined diet and exercise intervention in patients with breast cancer undergoing chemotherapy: A meta-analysis of randomized controlled trials.

e12517 Background: Breast cancer treatment presents challenging side effects that may compromise patients’ health and quality of life (QoL). While exercise programmes have been shown to improve survival, the impact of combined exercise and dietary interventions compared to usual practices alongside chemotherapy remains controversial. Methods: PubMed, Embase, Cochrane Central, and ClinicalTrials.gov were systematically searched up to October 2023. We included randomized controlled trials (RCTs) involving adult breast cancer patients undergoing chemotherapy and comparing combined diet and exercise interventions with usual care. Outcomes of interest included weight change, relative dose intensity (RDI), and Functional Assessment of Cancer Therapy-General scale (FACT-G) score for QoL. Statistical analysis was performed using Review Manager 5.4.1 and RStudio version 4.1.2. The protocol was registered on PROSPERO (ID: CRD42023463543). Results: Seven RCTs with 960 patients undergoing breast cancer therapy were included, of whom 506 (53%) were assigned to combined exercise and dietary interventions. Participants had a mean BMI of 26.6 kg/m2, and approximately 52% were postmenopausal. Combined exercise and dietary interventions resulted in significant reductions in weight loss (MD -1.06 kg, 95% CI -1.68 to -0.44; p&lt;0.01), BMI (MD -0.44; 95% CI -1.76 to -0.13; p&lt;0.01), body fat (MD -2.12%; 95% CI -3.99 to -0.26; p=0.03), and FACT-G (MD -3.40; 95% CI -6.25 to -0.55; p=0.02) compared to usual care. No significant differences were observed in waist circumference (p=0.05), RDI (p=0.23), or fatigue levels (p=0.98) between groups. Conclusions: In this meta-analysis of randomized trials, combined exercise and dietary interventions improved weight management in breast cancer patients undergoing chemotherapy but did not significantly impact chemotherapy completion, fatigue levels, and worsened FACT-G score (QoL). Findings can help to further holistic cancer care, taking into account both physical and psychosocial dimensions of patient health.

Breast cancer outcomes and treatment toxicity in geriatric patients compared to other patients at the Cancer Disease Hospital in Zambia.

e13773 Background: Breast cancer is the second most common cancer in women in Zambia and the most common cancer in older women. Management of geriatric cancer patients can be challenging due to physiological changes and multiple comorbidities. Methods: Data was extracted from the CDH electronic database of breast cancer patients for November 2005 - November 2022. Geriatric patients were defined as those 65 years old or older. Data was analyzed using descriptive statistics. Clinical-pathologic characteristics and outcomes for geriatric (GP) and younger patients were compared using the Chi Squared Test/Fisher’s exact test for discrete and Student’s T-test for continuous variables. All p-values were two-sided. Results: Of 1981 patients, 493 (24.9%) were geriatric. 374 (18.9%) had Stage I/II cancer, 607 (30.6%) Stage III, 579 (29.2%) de novo Stage IV, with no differences between geriatric and younger patients. 441 (22.2%) had hormone receptor-positive (HR+) disease, 115 (5.8%) had HER2+ by IHC, 195 (9.3%) were triple-negative, 52 (2.6%) HR+HER2+. Geriatric patients were more likely to have invasive lobular carcinoma (4.6% v. 2.4%), less likely to have grade 3 (42.0% v 50.6%) or HER2+ (11.6% v 19.3%) cancer. 1889 (94.8%) received systemic treatment, 1188 (60.0%) surgery, and 844(42.6%) radiation (RT), with no differences in geriatric and younger patients. Geriatric patients were less likely to receive palliative RT (9.6% v 15.7%), to receive a lower total RT dose and had similar rates of RT dermatitis as younger patients. Geriatric patients were less likely to be treated with doxorubicin, docetaxel and more likely with methotrexate. After median follow-up of 1.1 years (st. dev 2.6), 301(15.2%) were alive without disease, 826 (41.7%) alive with cancer, 203 (10.2%) died from cancer, with no difference in local, distal recurrence, or survival for geriatric patients. Geriatric patients were less likely to be in good physical condition (33.9% v 39.4%) and more likely to have a worse ECOG (1.0% v 0.4% for ECOG 4, 4.1% v 2.4% for ECOG 3, 14.0% v 10.9% for ECOG 2, 73.4% v 75.8% for ECOG 1, 7.4% v 10.4% for ECOG 0). Geriatric patients had a lower number of total treatment toxicities (OR 0.95, 95% CI 0.91-0.98) and were less likely to have leukopenia (OR 0.89, 95% CI 0.83-0.94) and neutropenia (OR 0.88, 95% CI 0.82-0.95). (for similar outcomes p-value &gt; 0.05; all where differences are noted p-value &lt; 0.05). Conclusions: GPs were similar to other patients in terms of cancer stage and outcomes and had less aggressive disease. GPs had worse functional status, received less toxic chemotherapy, were less likely to receive surgery and RT. GPs had either a similar amount or less treatment toxicity compared to other patients. Results are limited by short follow-up of about 1.5 years. Results are limited by incomplete non-hematologic toxicity data.

Application of multidisciplinary team model based on full-course management in health promotion of patients with breast cancer.

e13546 Background: To explore the application effectiveness of the multidisciplinary team model based on full-course management, in advancing the health promotion of breast cancer patients. Methods: This research involved a cohort of 84 breast cancer patients, recruited from the First Affiliated Hospital of Nanjing Medical University, spanning December 2022 and June 2023. These participants were divided into a control group and an intervention group using a convenience sampling method. The control group accepted routine nursing care, while the intervention group was treated with the multidisciplinary team approaches based on full-course management. These approaches included informal pre-admission interventions and multi-dimensional improvements to peri-operative patient comfort, integrated regimens combining Chinese and Western medicine to alleviate chemotherapy complications, diversified and extended nursing care focused on improving patients' quality of life, and facilitating physical and psychological rehabilitation. The two groups of patients were evaluated in satisfaction, comfort, quality of life, psychological state and other aspects. The results were evaluated by self-made satisfaction scale, breast cancer complications during chemotherapy questionnaire, Kolcaba Comfort Scale, Quality of Life Scale (QLQ-C30), self-rating Anxiety Scale (SAS) and self-rating Depression Scale (SDS). Patient outcomes were assessed in terms of satisfaction, comfort, quality of life, and psychological state. The results were evaluated by the self-made satisfaction scale, the breast cancer chemotherapy complications questionnaire, the Kolcaba Comfort Scale, the Quality of Life Scale (QLQ-C30), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS). Results: The intervention group showed statistically significant improvements in patient satisfaction, comfort and quality of life scores compared to the control group (P&lt;0.05). Additionally, they exhibited a lower incidence of chemotherapy complications, severe anxiety and depression during the extended care period (P&lt;0.05). Conclusions: The multi-disciplinary team model based on the full-course management demonstrated significant clinical benefits in the application of the full-course management of breast cancer patients. It effectively reduced chemotherapy-related complications, improved peri-operative comfort, decreased the incidence of severe anxiety and depression during the period of extended care, improved the physical and mental well-being of patients, leading to greater satisfaction and an enhanced quality of life.

Quantification of treatment-related time toxicity in patients with advanced stage cancer.

12137 Background: Treatment-related Time Toxicity (TrTT) in cancer patients is a recently proposed metric to describe the burden of time spent in pursuing medical care, including office/hospital visits, side effect management, lab tests, imaging scans, and travel time. Time toxicity is a valuable concept in patient-centered shared-decision making, especially in the palliative management of end-stage cancer patients with limited life expectancy. Despite tremendous progress in cancer treatment, most of the guideline-recommended treatment options convey short survival benefits of around 3-6 months when compared to supportive care. While medication toxicities are meticulously reviewed with patients, the cumulative burden and impact of time are rarely included in the discussion, partly due to the lack of standardized measurement of TrTT, and the absence of data from clinical trials. Thus, there is a compelling need for the quantification of time toxicity to guide clinical practice and patient preference. Methods: This was an observational analysis of the time toxicity from palliative treatment for patients with incurable solid tumors at a regional safety-net oncology office that focuses on underserved communities. Time toxicity is calculated as the number of days a patient spent with any healthcare-related encounters during a 3-month period from our medical record system. Results: The median age of the total 94 included patients was 57. 54% of the population were Hispanic. The ratios for mild, moderate, and severe time toxicity were 38%, 44%, and 18%, respectively. Immunotherapy was associated with significantly less time toxicity (TrTT = 8.5 days, 95% CI = 6.3-9.7) compared to chemotherapy (26.3 days, 95% CI = 18.3-34.4, P &lt; 0.001), while targeted therapy (13.4, 95% CI = 7.0-19.8, P = 0.01) and hormone therapy (11.9, 95% CI = 4.1-19.7, P &lt; 0.01) also has lower TrTT than chemotherapy. Patients with a worse performance status (ECOG PS 3-4, 30.1 days, 95% CI = 18.3-41.9) experienced higher time toxicity than fitter patients (PS 0-2, 16.7 days, 95% CI = 13.2-20.2, P &lt; 0.05). Among different cancer types, gastrointestinal malignancies were associated with the highest time toxicity with average TrTT of 30.2 days/3 months (95% CI =22.5-37.2). Conclusions: This is the first comprehensive study to quantify real-world Treatment-Related Time Toxicity across multiple cancer and therapy types in an underserved population. We found 18% of patients with incurable solid malignancies experienced severe time toxicity (&gt; 1 in 3 days). Higher TrTT was associated with cytotoxic chemotherapies, GI malignancies, and poor performance status. Time toxicity should be taken into account with other quality-of-life outcomes in treatment pathways and patient-centered oncology care.

Clinical significance of circulating tumor DNA in neoadjuvant-treated HER2-negative luminal B breast cancer.

e12616 Background: Circulating tumor DNA (ctDNA) holds significant value in the comprehensive management of breast cancer (BC) patients, whereas long-standing questions have been raised concerning the practical utility of ctDNA in HR+/HER2- subtype. Herein, we evaluated the clinical activity of ctDNA in luminal B (HR+/HER2-, with either Ki67≥20% and/or PR&lt;20%) BC patients receiving neoadjuvant therapy. Methods: Patients received neoadjuvant chemotherapy (NCT) or neoadjuvant endocrine therapy combined with CDK4/6 inhibitors (NET) were enrolled. Tumor tissue and plasma samples were collected and subjected to sequencing. Blood was collected for ctDNA analysis before treatment (T0), 2-3 weeks after treatment (T1), at the midpoint of neoadjuvant treatment (T2), prior to surgery (S), and postoperatively (PO). The tumor tissues were biopsied or surgically excised at T0, T1, and S to assess somatic mutation profiling and pathological markers. NGS assays were performed with a custom-designed panel that covered 769 cancer-related genes. Results: As of Jan 7, 2024, 448 tumor tissue and plasma samples from 80 BC patients undergoing NCT (n = 57) or NET (n = 23) were sequenced and analyzed. At T0, positive ctDNA was detected in 62.8% (49/78, another two failed quality control) of the patients. Furthermore, ctDNA detection and the higher concentration had a significant correlation with clinicopathologic characteristics that confer aggressiveness, including larger tumor size, more lymph node metastases, and lower hormone receptor expression. There was also a certain relativity between ctDNA positivity and tumor grading as well as MammaPrint index ( P &lt; 0.1). With the progression of neoadjuvant therapy, the ctDNA positive rate decreased over time (T1: 32/80, 40.0%; T2: 11/61, 18.0%; S: 7/65, 10.8%; and PO: 6/64, 9.4%). Although no correlation was found between pretherapeutic Ki67 expression and T0 ctDNA status ( P = 0.871), the Ki67 expression in early cycles of neoadjuvant therapy (T1) was significantly higher in patients with inter-therapeutic detectable ctDNA. Moreover, the expression and decline of Ki67 after neoadjuvant therapy were significantly correlated with ctDNA positivity at T2, S, and PO. Among the patients who had undergone surgery, 8 patients were classified as RCB 0/1 and the rest 57 as RCB 2/3. All patients who exhibited RCB 0/1 were ctDNA negative at S and PO. Compared to RCB 2/3, patients with RCB 0/1 tumors showed a significant increase in ctDNA concentration at T0 ( P = 0.027). Subgroup analysis revealed similar trends in ctDNA status and concentration changes in the NCT group and NET group. Conclusions: We reported an unprecedented baseline ctDNA positivity in luminal B BC, and the ctDNA levels were closely associated with the clinicopathologic characteristics of patients. As the research progresses, more predictive and prognostic information is expected to be discovered. Clinical trial information: NCT05649475 .

Landscape of genomic alterations in patients with chemoradiation resistant cervical cancer using whole-genome sequencing.

e17531 Background: Cervical cancer is a pressing global health concern and ranks as the second most prevalent female malignancy in India. Unfortunately, 80% of cases are diagnosed at locally advanced stages, leading to significant morbidity and mortality. Standard treatment for locally advanced cervical cancer involves concurrent pelvic radiotherapy and chemotherapy (CCRT). However, a substantial 30%-40% of patients experience CCRT treatment failure. The genomic alterations owing to CCRT resistance are largely unknown. This pilot study aims to identify genomic alterations associated with differential responses to concurrent chemoradiotherapy in cervical cancer patients. Methods: We collected 36 fresh tissue biopsies along with 5 ml of blood from stage IIIB cervical cancer patients. From the total of 36 cervical cancer patients, based on RECIST (Response evaluation criteria in solid tumors) criteria 19 patients were classified as responders and 17 patients were categorized as non-responders to CCRT. Genomic DNA was extracted from both tumor tissue and paired blood samples. Subsequently, whole genome sequencing was performed using the Novaseq 6000 platform, achieving a sequencing depth of 30x-50x coverage with 2x150bp paired reads. The data was further analyzed for Single Nucleotide Variants (SNVs), Copy Number Alterations (CNAs), Structural Variants (SVs), and mutational signatures. Results: In our study, we identified several notable mutated genes, with MUC12 (35%), MUC4 (31%), MACF1 (27%), and OBSCN (27%) being the most prominent. The mutational spectrum encompassed well-known significantly mutated genes such as FBXW7, SPEN, PIK3CA, KMT2C, KMT2D, ARID1A, and STK11, as well as potential novel candidates, genes not previously associated with cervical cancer, such as PKHD1L1, PLEC, and LRP1B. Pathway analysis revealed that several signaling pathways were enriched in cervical cancer, including Notch signaling, Hippo signaling, and RTK/RAS signaling pathways. Mutational signature analysis revealed a prevalence of APOBEC mutagenesis pattern. Copy number alterations displayed amplifications in regions such as 3q, 9p, 14q, and 11p which encompass genes like PIK3CA, JAK2, CD274, and AKT1. Comparative analysis of genomic alterations between chemoradiation resistant and sensitive patients identified mutations in genes related to Notch signaling and TNF signaling, which were exclusively present in the non-responder group. Conclusions: This study represents an initial attempt to understand the genomic landscape of cervical cancer in Indian population using whole genome sequencing approach and its association with responses to CCRT. These findings not only pave the way for further research but also hold promise for the development of targeted therapies, offering potential enhancements in the management of chemoradiation-resistant cervical cancer patients.