Multidisciplinary Oncology Team Research Articles

Case 1 – Stage IV low-grade serous ovarian carcinoma management in an elderly patient

Recurrent low-grade serous ovarian cancer (LGSOC) is considered relatively chemoresistant; until more effective chemotherapy approaches become available, surgical management remains the mainstay of treatment. However, some subtypes of LGSOC behave distinctly differently from high-grade SOC. The upregulation of estrogen and progesterone receptors in ovarian cancer suggests hormone therapy as a possible treatment modality. Our patient was a 75-year-old woman with advanced low-grade papillary serous ovarian cancer. In consultation, supported by appropriate histopathological examination and immunohistochemical study to guide the treatment decisions, our Gynaecological Oncology Multi-Disciplinary Team recommended primary debulking surgery. The patient underwent surgery followed by hormone therapy with letrozole, after declining bevacizumab-containing adjuvant chemotherapy. Eighteen months of ongoing monitoring has shown no signs of progressive disease and stable tumor markers. This case highlights the importance of initial assessment by a multidisciplinary team experienced in gynecological oncology, together with knowledge of the tumor biology, to determine effective treatment strategies for the management of advanced LGSOC.

Experiences of hospital-based multidisciplinary team meetings in oncology: An interview study among participating general practitioners

Background: Cancer care has become complex, requiring healthcare professionals to collaborate to provide high-quality care. Multidisciplinary oncological team (MDT) meetings in the hospital have been implemented to coordinate individual cancer patients’ care. General practitioners (GPs) are invited to join, but their participation is minimal.Objectives: Aim of this study is to explore participating GPs’ perceptions of their current role and to understand their preferences towards effective role execution during MDT meetings.Methods: In May to June 2014, semi-structured interviews (n = 16) were conducted involving GPs with MDT experience in Belgium. The analysis was done according to qualitative content analysis principles.Results: Attendance of an MDT meeting is perceived as part of the GP’s work, especially for complex patient care situations. Interprofessional collaborative relationships and the GP’s perceived benefit to the MDT meeting discussions are important motivators to participate. Enhanced continuity of information flow and optimized organizational time management were practical aspects triggering the GP’s intention to participate. GPs valued the communication with the patient before and after the meeting as an integral part of the MDT dynamics.Conclusion: GPs perceive attendance of the MDT meeting as an integral part of their job. Suggestions are made to enhance the efficiency of the meetings.

Therapeutic results of patients with endometriosis and ovarian cancer

Introduction. The aim of this study is to compare the therapeutic results of patients with ovarian cancer coexisting with endometriosis with a group of patients with cancer formed in the endometriosis focus in the scar after caesarean section. Methods. We analysed the therapeutic results of patients with ovarian cancer coexisting with endometriosis with a group of patients with cancer formed in the endometriosis focus in the scar after caesarean section. They were operated in the Oncology Centre in Bydgoszcz. All the patients had endometriosis and ovarian cancer confirmed in one tissue preparation. Results. The probability of death at any time is 7.826-times higher in the group with scar cancer than in the group with endometriosis and ovarian cancer. Conclusions. Because scar cancer that arises in the background of endometriosis is an extremely rare condition and also because the prognosis for this group of patients is poor we consider it necessary to plan combination therapy by a multidisciplinary oncological team.

The Head and Neck Cancer Patient Concern Inventory©: Patient Concerns’ Prevalence, Dental Concerns’ Impact, and Relationships of Concerns with Quality of Life Measures

The Patient Concern Inventory© (PCI) is a clinical tool of self-reported patient concerns to be used by the clinician to structure the patient-oncologist visit. It was developed in the United Kingdom to address the issues of quality of life (QOL) in head and neck cancer (HNC) patients. The purpose of the study reported here was to determine the prevalence of PCI© items, the associations between PCI© items and QOL, and to explore the importance of oral/dental issues in the patient's well-being. The PCI© and the University of Washington (UW-QOLv4) instruments were self-administered by an HNC population in a cross-sectional study. Following an a priori sample size estimate, consecutive HNC patients attending at the University of Florida's Oral Medicine and the ENT Clinics had the study described, eligibility assessed, and if eligible, were invited to participate in the study. Participants completed the PCI© and UW-QOL. PCI© issues prevalence was determined, and for those with a ≥10% prevalence: 1) Fisher's exact test was used to test for statistical differences between treatments, and 2) multivariable regression was used to test each of the prevalent PCI© issues across four QOL measures, health in the last 7 days, overall QOL in the last 7 days, and the physical and social domain scores. Twenty of 45 PCI© issues had a prevalence ≥10%. Of the 15 prevalent items statistically associated with a QOL measure, four issues are the clinical responsibility of the dental profession: 1) chewing/eating, 2) dental health/teeth, 3) mouth opening, and 4) salivation. An additional four (eight total, 50%) are of clinical concern for dental clinicians: 5) pain in head/neck, 6) swallowing, 7) speech/voice/being understood, and 8) taste. Dental concerns represent almost half of all PCI© concerns observed in 10% or more of the sample patients. Prosthodontists should support our maxillofacial prosthodontics specialists in joining other oral oncologists and advocate for comprehensive, integrated dental support for HNC patients by assuring dental involvement/inclusion with the multidisciplinary oncology team and a research agenda to established best patient-centered outcomes.

Geographic and socioeconomic factors in patients with malignant pleural mesothelioma in New South Wales and their impact upon clinical outcomes.

Whilst the impact of clinicopathological factors on the prognosis of malignant pleural mesothelioma (MPM) is well understood, socioeconomic and geographic factors have received less attention. We analysed the relationship between geographic and socioeconomic factors upon survival and treatment provision in a large series of patients with MPM. We assessed MPM patients awarded compensation between 2002 and 2009 with additional MPM incidence data from the New South Wales (NSW) Cancer Registry. The impact of geographic remoteness, distance from oncological multidisciplinary team (MDT) and Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) upon survival, clinical features and treatment received was analysed. We identified 910 patients (67% residing in major cities; 92% <50 km from MDT). Median overall survival was 10.0 months. On multivariate analysis, age >70 (hazard ratio (HR) = 1.39), male gender (HR =1.36), non-epithelioid histological subtype (HR = 2.18) and IRSAD status by decreasing quintile (HR = 1.06) were independent prognostic factors. There was no significant advantage for patients residing in major cities (10.6 months vs 8.8 months; P = 0.162) or within 50 km of MDT (10.3 months vs 7.8 months; P = 0.539). Patient's geographic location and distance to MDT did not impact chemotherapy, adjuvant radiotherapy or extrapleural pneumonectomy provision. Socioeconomically disadvantaged patients were significantly less likely to receive chemotherapy (37.4% vs 54.8%; P = 0.001). This study provides evidence for differences in the treatment and survival according to socioeconomic status for compensated MPM patients in NSW. Further research is warranted to seek additional explanations for the differences noted by comparing the treatments and outcomes of compensated and non-compensated MPM patients in NSW.

The Impact of Radiotherapy in the Treatment of Recurrent Desmoid Tumor of Neck: A Case Report with Literature Review

Background: Extra-abdominal desmoid tumor of the head and neck in particular commonly infiltrate vital neurovascular structures. we report a case of a large and recurrent extra-abdominal desmoid tumor causing significant morbidity and who was treated successfully by radiotherapy. Case presentation: A 34-year-old male patient presented with a history of right neck mass for 15 months, which was gradually increasing in size. Cervical CT scan revealed a large mass of the posterior soft tissues of the neck extended to the soft tissues of the posterior thoracic wall. The CT density of the mass was that of fat tissue. It was measuring 12.4 × 85.9 mm and enhanced after injection of the contrast product. A biopsy was taken. The histopathological findings were suggestive of desmoid tumor. Discussion: This case was discussed in multidisciplinary oncological team and radiotherapy was planned. The surgery was proposed but not performed due to the recurring character of the tumor and the risk of a high postoperative morbidity. After 4 weeks of treatment, the clinical evaluation showed a good response. Conclusion: Alternative treatment modalities such as primary radiotherapy may be preferable to mutilating surgery.

Liposarcoma of the Pelvis and Soft Tissues

A 49-year-old man presented in the hospital with a large mass of the right buttock slowly growing for 2 years. It was associated to worsening low back pain radiating to the posterior aspect of the right hip, buttock and down to the postero-lateral aspect of the left foot. It was aggraved by sitting and walking. The patient presented also chronic constipation, dysuria and pelvic pain. A loss of appetite with weight loss was noted too. On physical assessment, a large tumor deforming the right buttock was found. It was measuring 20 cm long axis. Pelvis palpation showed a painless mass measuring 10 cm long axis simulating a full bladder. The pelvic CT scan showed a large mass of the right buttock measuring 250 mm × 140 mm. It was extending inside the pelvis through the sciatic notch. It was also well limited. The pelvic component was measuring 120 mm × 106 mm, deplacing the rectum to the left, bladder anterioly. The CT density of the mass was that of fat. Except at the posterior aspect, where there was an irregular area of higher CT density. In the view of higher CT density in one area, the diagnosis of liposarcoma was strongly suspected. No bone lysis or lymphadenopathy was found (Figures 1 and 2). CT scan of the chest and abdomen was negative for distal metastasis. The case was discussed in multidisciplinary oncological team and primary surgery was planned. At surgery, a large pelvic mass herniating through the right greater sciatic notch into the left buttock and thigh was found. Patient underwent a surgical resection. The postoperative histopathological findings confirmed the diagnosis of liposarcoma lipoma like with positive surgical margins. One month after surgery, a Pelvic Magnetic Resonance Imaging (MRI) was performed. It showed a tumor residue measuring 36 mm × 28 mm (Figure 3). No surgical recovery was done. External beam radiotherapy of tumor bed at a radiation dose of 2 Grays (Gy) /fraction given five times weekly (Monday to Friday) to a dose of 50 Gy. A boost at the dose of 15 Gy was delivered to the tumor residue. Patient completed the treatment without any major untoward event. At the time this report was written, the patient had 6 months of follow-up. No evidence of malignacy is found.

Changing patterns of referrals and outcomes of genetic participation in gynaecological-oncology multidisciplinary care.

Genetic participation in gynaecological oncology multidisciplinary team meetings (MDT) may identify the sentinel cancer in women with hereditary breast-ovarian cancer syndrome or Lynch syndrome. To identify the changing patterns of genetic referral from 2010 to 2014 and the outcomes of referrals through clinical MDT case review. Medical records of cases of gynaecological cancer presented at the MDT meetings and genetics databases were reviewed to determine the frequency and outcomes of recommendations for genetic referral between 2010 and 2014. Four hundred and sixty-two women of 2523 cases reviewed were recommended for referral, increasing from 8% in 2010 to 25% in 2014. However, 167 of 462 patients (36%) had not registered with a Hereditary Cancer Clinic in NSW/ACT, including 11 women with high-grade serous ovarian cancer and seven women with abnormal MMR immunohistochemistry. Mutations were identified in 40 of 165 women (24%) undergoing breast cancer BRCA1/2 testing and in ten of 25 women (40%) who underwent MMR genetic testing. Eighty-one first- or second-degree relatives of these women have undergone predictive testing, identifying 48 mutation carriers and 33 non-carriers. Changing indications and increased participation by a genetic consultant in the weekly MDT meeting has led to increasing genetic referrals over the last five years. Follow up of referrals needs to be addressed. With decreasing costs of genetic testing and use of readily transportable DNA collected through saliva or mouth swabs, we propose that distance should not be a barrier to this model being extended to all centres providing care to gynaecological cancer patients.

Transvaginal ultrasound (TVUS)-guided biopsy is safe and effective in diagnosing peritoneal carcinomatosis and recurrent pelvic malignancy

To assess safety and accuracy of transvaginal ultrasound (TVUS)-guided biopsy in achieving a diagnosis of peritoneal carcinomatosis (PC). This was a retrospective study comprising a cohort of 54 consecutive women aged 18-85 years referred from the gynaecological oncology multidisciplinary team meeting (MDTM) who attended for TVUS-guided biopsy procedures in a tertiary oncology centre over a 4-year period (2010-2014). Clinicopathological validation was assessed using online patient records and radiological information systems. An independent oncologist assessed patient outcomes. The procedure was successful in all 19 patients with suspected recurrent malignancy with diagnosis validated against previous histology. Successful histological confirmation was achieved in 31 of 35 patients with suspected PC, which was thereafter validated by histology from subsequent surgery and favourable response to site-specific therapies (n=22). In three patients with suspected PC, the procedure did not result in biopsy as a suitable target could not be identified. Another woman had two false-negative biopsies. Thus overall a site-specific and subtype cancer diagnosis was obtained for 50 women giving an overall patient success rate of 93% (50/54). There were no procedure-related complications. TVUS core biopsy is a safe, effective, well-tolerated, and valuable technique in modern oncological management of PC when other diagnostic options are unavailable.

RO-05IMPROVING INFORMATION FOR PAEDIATRIC CANCER PATIENTS

RO-05. IMPROVING INFORMATION FOR PAEDIATRIC CANCER PATIENTS Shona Mackie1, Krishnachandran Chandrasekharan2, Inga Driver2, Omar Al-Salihi2, and Jenna Everett2; Paediatric Oncology, Southampton Children’s Hospital, Southampton, UK; Clinical Oncology, Southampton University Hospital, Southampton, UK Southampton Children’s Hospital Oncology service treats children from across the south of England and sees approximately 100 new diagnoses per year. Of these, an average of 35 patients per year receive radiotherapy as part of their treatment. Preparation is essential for patient compliance and the key to successful treatment. In 2014 the paediatric oncology Multidisciplinary team identified that younger children had excellent materials, however the resources for older children were outdated and unfit for purpose. OBJECTIVE: To produce a modular information DVD for children over eight years old. METHOD: Six children on or recently completed radiotherapy consented to participate. Loaded Productions, a company specialising in medical films, produced the DVD. RESULTS: Filming took place during weekends to minimise disruption to the clinical service and included local departmental staff. Treatments including head and neck mask, vac bag and limb board were filmed to show a variety of immobilisation forms. Informal unstructured interviews enabled the participants to describe their experiences in their own words and their personalities and experiences became an important part of the final product. The DVD was designed in a module format for easeofviewingandtoavoid informationoverload.Newpatientshavereported that the DVD relieved some of their fears and uncertainties, parents have also found it gives them the information they needed to support their child. CONCLUSION: The formulation of a DVD linked to local practices and personnel that children will encounter can support radiotherapy preparation, reduce parental and patient anxiety and improve compliance. Neuro-Oncology 18:iii159–iii164, 2016. doi:10.1093/neuonc/now082.5 #The Author(s) 2016. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Patients' Non-Medical Characteristics Contribute to Collective Medical Decision-Making at Multidisciplinary Oncological Team Meetings.

BackgroundThe contribution of patients’ non-medical characteristics to individual physicians’ decision-making has attracted considerable attention, but little information is available on this topic in the context of collective decision-making. Medical decision-making at cancer centres is currently carried out using a collective approach, at MultiDisciplinary Team (MDT) meetings. The aim of this study was to determine how patients’ non-medical characteristics are presented at MDT meetings and how this information may affect the team’s final medical decisions.DesignObservations were conducted at a French Cancer Centre during MDT meetings at which non-standard cases involving some uncertainty were discussed from March to May 2014. Physicians’ verbal statements and predefined contextual parameters were collected with a non-participant observational approach. Non numerical data collected in the form of open notes were then coded for quantitative analysis. Univariate and multivariate statistical analyses were performed.ResultsIn the final sample of patients’ records included and discussed (N = 290), non-medical characteristics were mentioned in 32.8% (n = 95) of the cases. These characteristics corresponded to demographics in 22.8% (n = 66) of the cases, psychological data in 11.7% (n = 34), and relational data in 6.2% (n = 18). The patient’s age and his/her “likeability” were the most frequently mentioned characteristics. In 17.9% of the cases discussed, the final decision was deferred: this outcome was positively associated with the patients’ non-medical characteristics and with uncertainty about the outcome of the therapeutic options available.LimitationsThe design of the study made it difficult to draw definite cause-and-effect conclusions.ConclusionThe Social Representations approach suggests that patients’ non-medical characteristics constitute a kind of tacit professional knowledge that may be frequently mobilised in physicians’ everyday professional practice. The links observed between patients’ attributes and the medical decisions made at these meetings show that these attributes should be taken into account in order to understand how medical decisions are reached in difficult situations of this kind.

Is there a Benefit of Multidisciplinary Cancer Team Meetings for Patients with Gastrointestinal Malignancies?

BackgroundMultidisciplinary cancer team meetings are intended to optimize the diagnosis of a patient with a malignancy. The aim of this study was to assess the number of correct diagnoses formulated by the multidisciplinary team (MDT) and whether MDT decisions were implemented.MethodsIn a prospective study, data of consecutive patients discussed at gastrointestinal oncology MDT meetings were studied, and MDT diagnoses were validated with pathology or follow-up. Factors of influence on the correct diagnosis were identified by use of a Poisson regression model. Electronic patient records were used to assess whether MDT decisions were implemented, and reasons to deviate from these decisions were hand-searched within these records.ResultsIn 74 MDT meetings, 551 patients were discussed a total of 691 times. The MDTs formulated a correct diagnosis for 515/551 patients (93.4 %), and for 120/551 (21.8 %) patients the MDT changed the referral diagnosis. Of the MDT diagnoses, 451/515 (87.6 %) were validated with pathology. Patients presented to the MDT by their treating physician were 20 % more likely to receive a correct diagnosis [relative risk (RR) 1.2, 95 % confidence interval (CI) 1.1–1.5], while the number of patients discussed or the duration of the meeting had no influence on this (RR 1.0, 95 % CI 0.99–1.0; RR 1.0, 95 % CI 0.9–1.1; resp.). MDT decisions were implemented in 94.4 % of cases. Deviations of MDT decisions occurred when a patient’s wishes or physical condition were not taken into account.ConclusionsMDTs rectify 20 % of the referral diagnoses. The presence of the treating physician is the most important factor to ensure a correct diagnosis and adherence to the treatment plan.

Do Radiologists Have Stage Fright? Tumor Staging and How We Can Add Value to the Care of Patients with Cancer.

With current shifts in our health care system and a growing national discussion around the concept of the value of imaging, it is time for radiologists and nuclear medicine physicians to recognize and accept our role in the multidisciplinary oncology team.

Salivary Gland Neoplasms in Children and Adolescents.

Salivary gland neoplasms (SGNs) in children are uncommon. Epithelial SGNs (ESGNs) comprise the majority (95%), with the remaining being mesenchymal SGNs (MeSGNs). Pleomorphic adenoma is the most frequently encountered benign neoplasm, mucoepidermoid carcinoma is the most frequent malignant ESGN, and rhabdomyosarcoma is the most frequent malignant MeSGN. ESGN presents in the second decade, whereas MeSGN presents in the first and second decades. Swelling without pain or neurological signs is the main presentation of both benign and malignant neoplasms. Making an accurate preoperative histological diagnosis is important, so a needle biopsy or a perioperative frozen section is useful when there is doubt about the disease status of the patient; the excised tumour margin is also important. Surgical excision should aim to achieve clear margin excision in benign and malignant ESGNs, minimising the need for adjuvant radiotherapy and maximising the long-term likelihood of patient cure. Benign ESGNs are uncommon, and excision is curative, whereas malignant ESGN and MeSGN should be managed by a multidisciplinary paediatric oncology team.

Endoscopic Appearance of Benign Versus Malignant Appendiceal Mucocele

Introduction: Appendiceal mucoceles are group of rare non-neoplastic or neoplastic cystic lesions characterized by an enlarged, mucus-filled appendix. Here we present two cases of incidentally found benign and malignant mucoceles. Case 1: A 62-year-old male underwent screening colonoscopy. He denied any gastrointestinal symptoms. Physical exam was unremarkable. The colonoscopy exam was normal except for a glossy, rounded, protruding mass arising from the appendiceal orifice that didn't flatten with air insufflations (Fig. 1-A). Overlying mucosa was normal. Probing with the biopsy forceps revealed a hard lesion. The biopsy revealed normal mucosa. Abdominal computed tomography (CT) scan showed a low attenuation, wellencapsulated round cystic mass in the right lower quadrant adjacent to the cecum with no other abnormalities (Fig. 1-B). The patient was diagnosed with appendiceal mucocele and underwent laparoscopic appendectomy. Intraoperative evaluation and surgical pathology confirmed the diagnosis of benign appendiceal mucocele (Fig. 1-C).Figure 1Case 2: 70-year-old Caucasian male with history of Barrett's esophagus was recently diagnosed with welldiff erentiated adenocarcinoma of the esophagus. As a part of tumor staging, he had abdominal CT scan which incidentally revealed cystic mass in the right lower quadrant adjacent to the cecum. So the patient underwent colonoscopy which showed ulcerated mass involving the appendiceal orifice measuring 1.5 cm in diameter (Fig. 2). The mass was highly suspicious for malignant mucocele. Multiple biopsies were obtained. The rest of the colon examination was not significant. Histopathology exam showed adenocarcinoma. The patient was referred for evaluation by multidisciplinary oncology team for further evaluation of the malignant esophageal and malignant appendiceal mucocele.Figure 2Conclusion: The diagnosis of appendiceal mucocele can be suspected during colonoscopic exam of the appendiceal orifice. Mucosal ulceration favors the diagnosis of malignant rather than benign appendiceal mucocele.

Barriers to radiotherapy utilisation in New South Wales Australia: Health professionals' perceptions of impacting factors.

Utilisation of radiation therapy (RT) in Australia is below recommended evidence-based benchmarks. Barriers to the referral of patients for RT and the uptake of RT by patients may be affecting RT utilisation. The current study aimed to examine health professionals' (HPs) perceptions of potential barriers to RT referral and uptake. A custom survey was developed to assess perceptions regarding the degree to which a range of issues affect decisions regarding RT. Hard copy surveys were disseminated to HPs involved in the care of cancer patients across New South Wales (NSW): medical, radiation and surgical oncologists, physicians (including palliative care), and general practitioners with an interest in oncology. Electronic versions of the survey were disseminated via oncology multidisciplinary teams and professional networks at participating hospitals. Two hundred fifty-three HPs participated via hard copy (n = 208) or electronic (n = 45) surveys. Two-thirds of HPs perceived acute side effects of RT, their management and impact on daily commitments, as well as fear and anxiety about RT, to exert moderate to significant influence on RT decisions. Treatment-related travel, need for accommodation and relocation were also perceived by 64% of HPs to do the same. Over half of HPs rated concern regarding late effects of RT, disruption to family and work life, and the ability to organise family and work commitments around RT, as moderate to significant influences on RT uptake. Perceptions of HPs in NSW reveal potential important influencers of RT decisions by patients and clinicians. An understanding of these additional issues and their actual impact on RT-related decisions may inform future interventions to improve RT access and utilisation.

The role of pharmaceutical care in the oncology department

BackgroundA multidisciplinary approach to care has been applied in a variety of settings in clinical oncology, particularly among patients with stomach and colorectal cancer. Multidisciplinary care integrates various disciplines and...

Multidisciplinary decision-making on chemotherapy for colorectal cancer: an age-based comparison.

With the ageing of society, optimising decision-making for older patients with cancer becomes increasingly important. A first step is awareness of current clinical practice. We analysed how treatment decisions regarding chemotherapy for older and younger patients with colorectal cancer are currently being made by the multidisciplinary team, the oncologist and the patient. A total of 316 patients with colorectal cancer (median age 68.3 years), discussed at the multidisciplinary gastrointestinal oncology team meetings between 2010 and 2013, were reviewed to select patients for whom guidelines recommended chemotherapy. Multidisciplinary decision-making and subsequent clinical course were extracted from medical files. The multidisciplinary team recommended chemotherapy in 97% of younger patients treated with curative intent, compared to 65% of older patients; 86% of younger patients and 42% of older patients subsequently received chemotherapy. In a palliative setting, the multidisciplinary team recommended chemotherapy in 98% of younger and 69% of older patients and 81% and 45%, respectively, subsequently received this treatment. In addition to comorbidity and the patient's physical condition, chronological age was an important reason for withholding chemotherapy. When older patients did receive chemotherapy, reduced intensity regimens were often effectuated. Multidisciplinary decision-making regarding chemotherapy for older patients with colorectal cancer is still frequently based on clinical impressions, preconceptions or chronological age alone. Rather, treatment decisions should be made after thorough evaluation of the patient's health status across multiple domains, either by a geriatrician or within the oncology team itself. Given the preference-sensitive nature of chemotherapy decisions in the elderly, shared decision-making should be strived for whenever possible.

Impact of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography scan on initial evaluation of head and neck squamous cell carcinoma: our experience at a tertiary care center in India.

The efficacy of the whole body (WB) 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) as a part of conventional initial staging in all cases of head and neck squamous cell carcinoma (HNSCC) is still controversial with various studies in literature giving contradictory reports. We conducted this study at a government tertiary care oncology center in India to identify the impact of WB 18F-FDG PET-CT scan on HNSCC staging and treatment. A prospective clinical study of patients of HNSCC who were evaluated and treated at our center was performed. The patients included in the study were HNSCC of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, and carcinoma of unknown primary site (CUPS) with cervical metastasis. The study design was to evaluate the cases of HNSCC initially by staging with conventional investigations followed by staging with the information derived from WB 18F-FDG PET-CT scan. At the end of the conventional investigations, a tumor, node, metastasis (TNM) staging as per AJCC 7th edition, and a detailed treatment plan as per NCCN 2012 guidelines was decided in consultation with the multidisciplinary oncology team of the hospital. WB 18F-FDG PET-CT scan was carried out in all these patients. The findings of WB 18F-FDG PET-CT were then interpreted with the staging with conventional investigations to identify the cases with change in staging and also those in whom the treatment protocol would be affected. Descriptive analysis of demographic data and analytical analysis of the sensitivity and specificity of WB 18F-FDG PET-CT scan and also the change in staging and treatment plan after WB 18F-FDG PET-CT scan was analyzed using SPSS version 18. A total of 131 patients met the inclusion criteria, which included 123 males and 8 females. The various sites involved among the study group are oral cavity 11 (8.3%), oropharyn × 39 (29.7%), hypopharyn × 31 (23.6%), laryn × 34 (25.9%), nasopharyn × 4 (3%), and CUPS 12 (9.1%). The majority of cases studied were of T2 and T3 stage, and changes in T staging after WB 18F-FDG PET-CT scan were minimal and not statistically significant (P > 0.5). In the nodal staging after WB 18F-FDG PET-CT scan, there was a statistically significant change in identification of nodal metastasis in N0 group and also identification of additional multiple/bilateral nodes (N2b and N2c). 3 (2.2%) patients had a change in M status with identification of distant metastasis in lungs (2 patients) and in the liver and lung (1 patient). Of the 131 patients, 75 (57.25%) underwent surgical management with or without adjuvant treatment (Group I) and 56 (42.74%) patients underwent nonsurgical management (Group II). There was no significant statistical difference in sensitivity and specificity of 18F-FDG PET-CT scan in detecting cancer among the two groups. Considering all the patients in this study, WB 18F-FDG PET-CT scan showed an overall sensitivity of 95.2% and specificity of 80%. In this study, change in TNM staging after WB 18F-FDG PET-CT was seen in 22 (16.8%) patients and an alteration in the treatment in 21 (16.1%) patients, which were both found to be statistically significant (P < 0.5). In our study, WB 18F-FDG PET-CT scan has shown to have an impact on initial staging of disease affecting the change in treatment protocol in a significant number of patients. The effect of this change in staging and treatment on the eventual morbidity and mortality rates is not known. In practice, the use of 18F-FDG PET-CT scan is limited, owing to the high cost and low availability. A realistic evaluation of cost versus benefit needs to be undertaken to identify the impact of using 18F-FDG PET-CT scan as a mode for initial evaluation of HNSCC.

79 Chemobrain – a qualitative study of women experiencing cognitive side effects after chemotherapy

across Ireland to support this cohort of patients; a working group was formed to address this deficit. Method: The working group identified available resources. The oncology multidisciplinary team and the Irish Cancer Society’s Daffodil Centre were invited to be involved. We conducted a literature review and liaised with colleagues who participated in other hospital based support groups. It was agreed that the structure of a single support day to be held off site. Patients with a primary cancer who had completed their treatments were invited to attend along with their main support/partner. The aim and structure of the day was designed to be patient focused. It opened with a psychologist’s presentation, followed by a choice of workshops: Diet and Cancer, Exercise and Cancer, Fatigue, Complimentary therapies, Emotional effects of cancer. The final part of the day focused on Life after Therapy. Each participant was asked to complete an evaluation form for each section of the program. Results: All talks and workshops were individually evaluated. Feedback from the day was very positive and all talks and workshops scored very high. Each section scored an average of 4.5/5 indicating a high level of appropriateness and satisfaction across the various workshops. Conclusion: The evaluation highlighted patients’ need for support on completion of cancer treatment. This support day helped to empower our patients to adapt to life after cancer. Participants found that acknowledgement and sharing of the difficulties they faced to be extremely helpful. This day was made possible by the support of the ‘Ross Nugent Foundation’ and the Irish Cancer Society. No conflict of interest.