Multinational Association Of Supportive Care In Cancer Research Articles

Financial Toxicity in Cancer Supportive Care: An International Survey.

The study aims to explore unmet social needs and sources of financial toxicities in patients as noted by health care professionals and researchers in cancer supportive care, shedding light on potential health disparities. In this cross-sectional survey, we anonymously surveyed active members of the Multinational Association of Supportive Care in Cancer (MASCC). The survey, structured in three sections, included questions regarding the routine assessment of social needs during patient consultations, sociodemographic aspects, factors influencing financial toxicity (FT), perceived support for managing FT, and available/desirable resources. A total of 218 MASCC members were included, predominantly from high-income countries (HIC, 73.4%), with many age 41-60 years (56.5%) and female (56.9%). Drug/treatment cost and insurance coverage were the main sources for FT among the HIC, whereas participants from low-middle-income countries (LMIC) considered transportation cost, loss of employment because of cancer diagnosis, and unavailability of return-to-work services as the top three sources of FT. Respondents from LMIC (adjusted odds ratio [aOR], 3.01 [95% CI, 1.15 to 7.93]) and physicians (aOR, 2.67 [95% CI, 1.15 to 6.21]) were more likely to routinely assess financial coverages. Socioeconomic status was consistently ranked as one of the top three sources of financial toxicities by participants from LMIC (34%), HIC excluding the United States (38%), those who do not self-identify as racial/ethnic minority (36%), and physicians (40%). This global survey of health care professionals and researchers in HIC and LMIC revealed varying approaches to assessing financial coverage and social needs. Socioeconomic status emerged as a consistent concern across countries, affecting financial toxicities. The study highlights the need for tailored approaches and improved resource visibility while emphasizing clinicians' pivotal role in addressing financial aspects of cancer care.

Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-induced Nausea and Vomiting.

Chemotherapy-induced nausea and vomiting (CINV) refers to the nausea and vomiting experienced by patients after the application of chemotherapy drugs, significantly affecting their quality of life and physical recovery, as well as increasing the pain of the patients. Basic medicine primarily focuses on acid suppression, gastric protection, and vomiting suppression, but there are still many patients with nausea and vomiting symptoms that cannot be alleviated. Traditional Chinese medicine (TCM) can effectively alleviate nausea and vomiting through acupoint stimulation and pressure, while also offering advantages such as simplicity, affordability, and fewer side effects. The aim of this article is to introduce the method of using acupoint application combined with acupressure as an adjunctive therapy for CINV, using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT) tablet scale as a questionnaire. The article details aspects such as acupoint selection, production, and the use of acupoint application, massage techniques, and operating procedures, all with the goal of ensuring the safety and efficacy of acupoint application combined with acupressure as an adjuvant therapy, thereby improving patients' clinical symptoms and quality of life.

The predictive value of the MASCC score in patients with febrile neutropenia.

e23059 Background: Febrile neutropenia (FN) is a life-threatening complication in patients receiving cytotoxic chemotherapy. Guidelines classify FN as a one-time oral temperature of greater than 38.3°C or sustained temperature greater than 38°C for ≥ 1 hour with an absolute neutrophil count (ANC) of less than 500 cells/μL or an ANC expected to decrease to less than 500 cells/μL within a 48-hour period. This condition has a high rate of hospitalization and mortality. Currently, the Multinational Association of Supportive Care in Cancer (MASCC) risk score is used to classify patients as high or low risk. The current study outlines the predictive role of MASCC scoring in risk stratifying patients with FN at our institution. Methods: This is a single-center, retrospective observational study. IRB approval was obtained for this study. Electronic medical record data was reviewed to record mortality, length of stay (LOS), and antimicrobial use as primary outcomes with age at time of admission, sex, race, type of malignancy, any confirmed infection diagnosis, MASCC risk score, and subspecialist consultation as predictors of outcomes. Results: 220 records of possible FN episodes were screened, 160 were excluded leaving a total of 60 patients for review. The median age was 72.5 with 28 males and 32 females. Overall mortality rate was 10%.33 patients (55%) did not have an identifiable source of infection. Among the 27 patients with confirmed infection, 7 were associated with COVID-19, 12 had gram negative rod (GNR) sepsis and 8 were other bacterial infections. Patients with GNR sepsis had the highest mortality risk in which 4 of the 12 (33%) died. LOS was also significantly longer in patients with GNR sepsis. Lower MASCC scores were associated with identification of GNR sepsis. Of the patients with MASCC score of < 24, significantly more patients 7/20 (35%) developed GNR sepsis compared to 5/40 (12.5%) of those with MASCC score of 24 or greater (p = .004). Patients with GNR sepsis received a mean 5.7 days of broad spectrum antibiotics compared to 3 days in those without, (p < 0.001). Those with no identified infection had significantly lower LOS (4.5 days) compared to the groups with GNR sepsis (11.1 days) or other bacterial infections (10.1 days). Conclusions: Febrile neutropenia is a complication of cytotoxic chemotherapy that warrants special attention due to high mortality rates. We found lower MASCC scores were associated with GNR sepsis and that in the setting of FN these patients had higher mortality rates and longer LOS. This highlights the importance of risk stratification with MASCC index scoring as early recognition and treatment of high risk patients could lead to improved patient outcomes.

Retrospective study on the correlation between MASCC score and the evolution of febrile neutropenia for patients with solid cancer.

e13570 Retrospective study on the correlation between MASCC score and the evolution of febrile neutropenia for patients with solid cancer. Background: The Multinational Association for Supportive Care in Cancer (MASCC) score is used to risk-stratify outpatients with febrile neutropenia. Currently, data on the use of the MASCC score are based on studies with a small number of patients. Our primary aim was to determine whether a MASCC score ≥ 21 identifies patients with solid tumors who would evolve without complications. Methods: We conducted a retrospective cohort study of patients admitted with febrile neutropenia and solid cancer at Sherbrooke University Hospital from 2011 to 2022. We collected patients' demographics, type of cancer, current chemotherapy regimen, whether patients were candidates for outpatient treatment, MASCC score, duration of IV antibiotic therapy, complications (intensive care unit admission, hypotension, hypoxemia, acute kidney failure, bacteriemia (persistent or developing after 48h of IV antibiotics) and escalation in antimicrobial regimen after hospital admission), and inpatient deaths. We used chi-square analysis and multivariate analysis to determine factors other than MASCC that predict complications. Results: A total of 290 febrile neutropenia patients with solid tumors were identified. 93 patients had a MASCC score <21 and 196 were identified as low risk (MASCC score ≥ 21). The preliminary results showed that the MASCC score had a specificity of 58,3% [95% CI 48,4%-67,8%], a sensibility of 83,0% [95% CI 76,7%-88,1%], a positive predictive value of 77,0% [95% CI 72,7%-80,9%] and a negative predictive value of 67,0 [95% CI 58,7%-74,4%] to identify complications. A low risk MASCC score showed statistically significative reduction in duration of neutropenia, IV antibiotics, fever and length of hospitalisation. Conclusions: The MASCC score did not demonstrate high enough accuracy to precisely identify patients which would have evolved without complications. However, a low-risk score identified by using the MASCC score was found to have strong association with reduction of duration of hospitalisation burden. Furter data will be collected to increase the strength of the study.

MASCC 2023 Patient-Centered Antiemetic Guidelines and Education Statements: an evidence-based and consensus resource for patients.

The Multinational Association of Supportive Care in Cancer (MASCC)/European Society of Medical Oncology (ESMO) Patient Antiemetic Guideline Committee aimed to (1) adapt the updated evidence-based, clinical guidelines to patient-centered antiemetic guidelines and (2) develop patient education materials and statements. The MASCC 2023 Patient Antiemetic Guidelines were created and reviewed by antiemetic experts and patient advocates by incorporating the 2023 MASCC/ESMO antiemetic guidelines into patient-friendly language. Patient Education Statements were developed based on current literature and by utilizing an expert modified Delphi consensus (≥ 75% agreement). Patient advocate/focus group input and patient survey results were further integrated into Patient-Centered Antiemetic Guidelines and Education Statements. Patient-Centered Antiemetic Guidelines were created using patient-friendly language and visual slides. Patient-friendly language was also utilized to communicate the Educational Statements. Key content categories identified for the Educational Statements included the following: nausea/vomiting definitions, causes, risk factors, categories, complications, accompanying symptoms, prophylactic antiemetic treatment, general management, when to call/what to ask the healthcare team, what caregivers can do, and available resources. All identified content met the ≥ 75% expert agreement threshold. Fifteen (15) items demonstrated 100% agreement, 11 items achieved ≥ 90% agreement, and three content items demonstrated 80 ~ 82% agreement. The inaugural MASCC 2023 Patient Antiemetic Guidelines can help patients and caregivers understand the prevention of nausea and vomiting related to their cancer treatment. Educational Statements provide further patient information. Educating patients on how to utilize guideline antiemetics and the education statements can contribute improvements in the control of anticancer treatment-related nausea and vomiting.

Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations.

People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared with those with early-stage disease or those nearing the end of life. These Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer. A MASCC-ASCO expert panel was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process. A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including eight people with lived experience) across 33 countries (33% were low- to middle-resource countries) participated in the Delphi study and achieved ≥94.8% agreement for seven standards, (1) Person-Centered Care; (2) Coordinated and Integrated Care; (3) Evidence-Based and Comprehensive Care; (4) Evaluated and Communicated Care; (5) Accessible and Equitable Care; (6) Sustainable and Resourced Care; and (7) Research and Data-Driven Care, and ≥84.2% agreement across 45 practice recommendations. Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards support optimization of health outcomes and care experiences by providing guidance to stakeholders (health care professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers). Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.Additional information is available at www.mascc.org, www.asco.org/standards and www.asco.org/survivorship-guidelines.

Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy.

This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.

Equity, diversity, and inclusion in the Multinational Association for Supportive Care in Cancer: a global membership survey.

Equity, diversity, and inclusion (EDI) are essential for healthcare organizations since they allow for the development of programs and initiatives that bring together diverse perspectives and knowledge. Global multidisciplinary organizations, such as the Multinational Association for Supportive Care in Cancer (MASCC), need to understand the perspective of their members regarding EDI to identify opportunities to enhance diversity and inclusiveness and to better meet the needs of members from different backgrounds and resources. The MASCC Health Disparities Committee designed a survey to identify issues related to disparities faced by MASCC members when providing supportive care to patients with cancer and to examine the EDI landscape within the organization. Here, we report results related to EDI initiatives within the organization. Two-hundred and eighteen MASCC members responded to the survey (response rate 10.2%). The results indicated that respondents were generally satisfied with how MASCC manages leadership, membership, and organization-related EDI issues. Opportunities for improvement noted by respondents included developing strategies to foster a more diverse membership, improving communication regarding diversity in the organization, and increasing EDI content in educational sessions and publications. The results of this survey represent the first attempt at understanding how to improve EDI within MASCC and will be utilized to guide further initiatives and programs.

Shedding light on the management of acute radiation dermatitis: insight from the MASCC Oncodermatology study group.

This paper highlights a collection of eleven recently published manuscripts on the prevention and management of acute radiation dermatitis. These meta-analyses provide additional evidence for the updated clinical practice guidelines by the Multinational Association of Supportive Care in Cancer (MASCC) Oncodermatology study group for prevention and management of acute radiation dermatitis. The collection of papers elucidate the currently available evidence on acute radiation dermatitis, highlighting consolidated knowledge, effective treatments, and proposed areas for future clinical trials. Overall, a total of 51 randomized controlled trials were retrieved and included for quantitative analysis of an initial systematic review of literature from 1946 to January 2023. Discussion of the clinical impact of various therapeutic interventions include: antiperspirant and deodorant use, barrier films and dressings, natural and miscellaneous agents, photobiomodulation therapy, topical corticosteroids, topical non-steroidal agents, skin hygiene and washing, as well as StrataXRT and Mepitel film in breast cancer patients. The comprehensive nature of the meta-analyses and their related findings may help reduce the discrepancies in in treatment of acute radiation dermatitis and facilitate consistency of therapeutic interventions employed in clinical practice worldwide.

Chinese clinical practice guidelines for the prevention and treatment of radiation‐induced dermatitis

AbstractRadiation‐induced dermatitis is one of the most prevalent complications in patients undergoing cancer radiotherapy and poses a significant challenge to cancer therapy. The symptoms include erythema, dry desquamation, and moist desquamation, which are frequently observed in patients with breast, head and neck, anal, and vulvar cancers. Early skin reactions typically manifest within 2–4 weeks following the initiation of radiotherapy. In severe cases, acute dermatitis can cause radiotherapy interruptions, prolong treatment time, and ultimately affect patient outcomes and quality of life. Currently, there are numerous guidelines on radiation dermatitis, including the Multinational Association of Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Oncology Nursing Society (ONS), and UK Society of Radiographers (SCoR) guidelines. In China, dermatology experts have drafted a consensus. However, due to the differing backgrounds of experts, recommendations among guidelines vary. These guidelines were first developed by Chinese radiation oncologists. The evidence‐based guideline in this paper fully considers and adopts China's national conditions; hence, it can be easily applied in daily practice.

Supportive Care: The "Keystone" of Modern Oncology Practice.

The Multinational Association of Supportive Care in Cancer (MASCC) defines supportive care as "the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer journey from diagnosis through treatment to post-treatment care. Supportive care aims to improve the quality of rehabilitation, secondary cancer prevention, survivorship, and end-of-life care". This article will provide an overview of modern supportive care in cancer, discussing its definition, its relationship with palliative care, models of care, "core" service elements (multi-professional/multidisciplinary involvement), the evidence that supportive care improves morbidity, quality of life, and mortality in various groups of patients with cancer, and the health economic benefits of supportive care. The article will also discuss the current and future challenges to providing optimal supportive care to all oncology patients.

Application of comprehensive unit-based safety program model to improve chemotherapy-induced nausea and vomiting in patients with ovarian cancer: a retrospective study

BackgroundTo explore the effect of intervention programs constructed under the guidance of the comprehensive unit-based safety program (CUSP) model on chemotherapy-induced nausea and vomiting (CINV) in patients with ovarian cancer.MethodAccording to the time of admission, 90 ovarian cancer chemotherapy patients in the first affiliated Hospital of Anhui Medical University from June 2019 to September 2020 were divided into an intervention group and a control group with 45 cases each. Both groups of patients received routine intervention, and the intervention group implemented the CUSP program on this basis. The intervention lasted 8 months. Before and after the intervention, the patients in the ward were used the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool, the Functional Living Index-Emesis (FLIE), and the Hospital Anxiety and Depression Scale (HADS) for the effect evaluation.ResultsAfter the intervention, the degree of nausea and vomiting frequency in the intervention group were significantly lower than that in the control group, especially the degree of nausea in the delayed phase (P < 0.05). The score of the functional living index-emesis in the intervention group was significantly higher than that in the control group (P < 0.05), and the anxiety and depression in the intervention group were significantly relieved compared to the control group (P < 0.05).ConclusionThe intervention program guided by the CUSP model can significantly alleviate patients’ nausea and vomiting, improve the quality of life, and relieve anxiety and depression. The CUSP model is suitable for clinical practice and has guiding significance for clinical work.

Editorial introductions.

Editorial introductions.

Unmasking the MASCC score: A retrospective study.

e18763 Background: Febrile neutropenia (FN) is a common oncological emergency in patients receiving anticancer treatments. The Multinational Association for Supportive Care in Cancer (MASCC) and the Clinical Index of the Stable Febrile Neutropenia (CISNE) are validated risk assessment tools widely used to guide the need for hospital admission. There is sparse research regarding the utility of these scores in predicting in-hospital outcomes. Methods: We conducted a retrospective chart review of patients admitted with FN from 2012 to 2022 in our community-based teaching hospital and compared the performances of MASCC and CISNE scores on in-hospital outcomes such as length of hospital stay, duration of intravenous (IV) antibiotics, intensive care unit (ICU) admission, pressor use, length of ICU stay, in-hospital mortality and cost of hospital stay. Logistic regression was applied to calculate the unadjusted odds ratio for qualitative outcomes and linear regression to calculate the association for quantitative outcomes. Results: Among 139 patients screened, 100 met the inclusion criteria. Sixty eight percent of patients were 65 years or older, 53% were females, the most common presenting complaint was fever/chills (46%) and 67% had underlying hematologic malignancies. Patients with high-risk MASCC scores (HM) were noted to have higher odds of ICU admission (OR 20.3), pressor use (OR 5.09), and in-hospital mortality (OR 4.11) compared to those with low-risk MASCC scores (LM). Patients with HM had 3.3 days longer hospital stay and 2.3 days longer ICU stay compared to patients with LM with the mean duration being 6.5 days and 1.59 days, respectively. Patients with HM required 3.1 additional days of IV antibiotics compared to those with LM, with the mean duration of 5.23 days. The mean cost of stay was 52,890 USD, with an additional cost of 42,086.95 USD for patients with HM than for patients with LM. Comparisons of CISNE scores showed no statistical significance for any of the above-mentioned hospital outcomes and cost of the stay. Conclusions: FN patients with HM were found to have worse in-hospital outcomes and more expensive hospital stay than patients with LM. Our study highlighted the utility of MASCC score as a potential screening tool at the time of admission to predict severity of illness and guide resource utilization. [Table: see text]

Dermocosmetics in management of cancer-related skin toxicities: International expert consensus.

e24115 Background: Skin toxicities – one of the most frequent adverse events associated with cancer therapies – can occur with all types of cancer therapeutic interventions. New side effects emerge as new oncology drugs are approved (eg, targeted therapies, immunotherapies), which are associated with a negative impact on quality of life, oncologic treatment dose reductions and/or treatment discontinuation. From a pathophysiologic point of view, skin toxicities during cancer treatment result mostly from alterations in skin barrier function, inflammation, altered immune responses, and phototoxicity. Minimizing alterations in skin barrier function and photoprotection facilitate prevention and management of adverse events to optimize treatment outcomes. Methods: In partnership with the Association Francophone des Soins Oncologiques de Support (AFSOS) and Multinational Association of Supportive Care in Cancer (MASCC), a group of international experts (dermatologists, oncologist, radiation oncologist, oncology nurse) involved in management of cancer patients performed a literature review and a consensus meeting to discuss the role of dermocosmetics to prevent or manage skin adverse events induced by oncology treatments. Dermocosmetics, or cosmeceuticals, include a range of products that can have both therapeutic and cosmetic value. These products help support and maintain the epidermal skin barrier and cutaneous microbiome. Some have been formulated for skin that is fragile, pathological, and sensitive. Results: General recommendations: 1) skin care should be implemented at initiation of therapy for drugs associated with skin toxicities, since prevention is a crucial aspect of management. 2) Skin hydration relieves symptoms and reduces exacerbations of xerosis. 3) Cleansers should have a pH close to 5, while basic and neutral pH cleansers should be avoided. 4) Urea, particularly in the case of some oncology treatments leading to hand foot syndrome, is important due to its exfoliating and hydrating actions. Urea should be avoided with irritated skin. The group also developed recommendations for the management of specific skin toxicities. Conclusions: Emerging evidence is providing support for the beneficial impact of dermocosmetics in management of treatment-related skin toxicities.

Systematic review and meta-analysis on interventions for radiation dermatitis prevention and management: an overview of the methods.

Over several decades, research on the prevention and management of acute radiation dermatitis (RD) has continued to emerge, yet there remains no "gold standard" treatment for RD care. Recent guidelines on RD prevention and management were published in 2022 by the Oncodermatology Study Group of the Multinational Association of Supportive Care in Cancer (MASCC). As part of this guideline process, a collaborative effort was undertaken by international RD experts to quantitatively compare commonly studied RD skin interventions through meta-analyses and discern superiority of interventional treatments over another intervention, standard-of-care, or placebo in RD prevention and management. This paper summarizes the materials and methodology used in a set of meta-analysis studies that supplement the 2022 MASCC Clinical Practice Guidelines on RD Prevention and Management.

Multinational Association of Supportive Care in Cancer (MASCC) clinical practice guidelines for the prevention and management of acute radiation dermatitis: international Delphi consensus-based recommendations.

Acute radiation dermatitis is a frequent adverse effect of radiotherapy, but standardisation of care for acute radiation dermatitis is lacking. Due to the conflicting evidence and variability in current guidelines, a four-round Delphi consensus process was used to compile opinions of 42 international experts on care for people with acute radiation dermatitis on the basis of the evidence in existing medical literature. Interventions for acute radiation dermatitis prevention or management that reached at least 75% consensus were recommended for clinical use. Six interventions could be recommended for the prevention of acute radiation dermatitis: photobiomodulation therapy and Mepitel film in people with breast cancer, Hydrofilm, mometasone, betamethasone, and olive oil. Mepilex Lite dressings were recommended for the management of acute radiation dermatitis. Most interventions were not recommended due to insufficient evidence, conflicting evidence, or lack of consensus to support use, suggesting a need for further research. Clinicians can consider implementing recommended interventions in their practice to prevent and manage acute radiation dermatitis until additional evidence becomes available.

OLANZAPINE AS PROPHYLACTIC ANTIEMETIC IN BREAST CANCER PATIENTS: A PROSPECTIVE COMPARATIVE STUDY IN A TERTIARY CARE CENTRE

Context: Aims The prevention of chemotherapy induced nausea and vomiting (CINV) by olanzapine can improve patients adherence to treatment. and objectives: To study the efcacy of olanzapine as prophylactic antiemetic in parenteral highly emetogenic chemotherapy (HEC) regimen of breast cancer and to compare its side effects with aprepitant. Prospect Settings and Design: ive, comparative, open-label, non randomized study was conducted on 146 eligible breast cancer patients, equally distributed into aprepitant and olanzapine groups. The Methods and Material: Multinational Association of Supportive Care in Cancer (MASCC) Tool (MAT) and Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 was used for evaluation. Chi-square test and unpaired t test was applied to test for sta Statistical analysis used: tistical signicance using ©2021 GraphPad Prism. P value ≤ 0.05 was considered signicant. Data were represented using frequency distribution table and bar diagrams. Patients achieving Complete Response (CR, no emesis and no rescue me Results: dication) was signicantly higher in olanzapine treated group. Nausea was signicantly controlled but vomiting wasn't signicantly controlled with olanzapine when compared with aprepitant. Assessment of side effects showed signicantly increased sedation on day 2 on those receiving olanzapine in comparison to aprepitant. Conclusions: Olanzapine has signicant results in controlling CINV caused by parenteral HEC regimens when compared with aprepitant in acute, delayed and overall period with minimal increase in sedation

Abstract PD8-01: PantoCIN: Pantoprazole’s effectiveness as prophylaxis against delayed Chemotherapy-Induced Nausea and Vomiting (CINV) in patients receiving adjuvant or neoadjuvant breast cancer chemotherapy

Abstract Background: Rates of delayed CINV remain high at over 50% following adjuvant chemotherapy for breast cancer, despite the use of multiple antiemetics. Delayed CINV is complex, distressing to patients and it’s incidence is underestimated by physicians. Anti-emetics used with early breast cancer chemotherapy are often directed against acute rather than delayed CINV. Chemotherapy is virtually eliminated from the circulation prior to the delayed phase (24-120 hours post-chemotherapy), suggesting the etiologies for acute and delayed CINV may differ. Chemotherapy and steroids can alter the gastric environment and acid secretion, while chemotherapy can cause gastroesophageal mucositis. We hypothesized that the altered gastric environment, combined with disrupted gastroesophageal mucosa, could contribute to delayed nausea in a proportion of patients. Anecdotal experience suggested proton pump inhibitors, such as Pantoprazole, reduced symptoms in this setting. Methods: This study incorporated a double-blinded crossover design to determine whether Pantoprazole would reduce the incidence of delayed CINV in patients receiving adjuvant, or neoadjuvant breast cancer chemotherapy. Patients were randomized to either pantoprazole or placebo from Day 1-5 after cycle 1, changing to the other intervention for cycle 2. CINV symptoms during the delayed phase were assessed using the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool and recorded in real time by patients using the PantoCIN ePRO application. With 160 patients, this approach had an 80% power to detect a statistically significant effect (one-sided α (type 1) error of 0.025) of Pantoprazole, if the true effect of Pantoprazole is a 10% reduction in the rates of any delayed CINV compared to placebo. The primary endpoint was the proportion of patients with complete absence of both nausea and vomiting during days 2-5, with severity of CINV and patient preference for intervention described as secondary endpoints. Results: 160 patients were recruited between June 2019 and October 2021, from 10 different cancer centers in New Zealand. Primary statistical analysis has shown a significant reduction in absolute CINV with pantoprazole as the primary end point, with incidence of any CINV symptoms reducing from 61.0% to 49.6% (OR=1.8, 95% confidence interval (1.0 to 3.3); p-value=0.04), in patients with full data. There was also a clear preference for patients to prefer the blinded pantoprazole arm of the 2 cycles of treatment under study, with the proportion of participants who preferred pantoprazole to placebo being 49% and the proportion who preferred placebo to pantoprazole was 25.2%, (difference in proportions 23.8% and 95% confidence interval 12.4 to 35.2; p=0.0017). Conclusion: CINV is a common and distressing complication of early breast cancer chemotherapy, which persists despite the use of a range of current antiemetics. Pantoprazole is a cheap, well-tolerated agent without significant drug interactions, which clearly ameliorates this symptom in a significant proportion of patients and should be considered as a standard prophylactic intervention. Citation Format: Navin Wewala, Katrina Sharples, Yujin Kim, Sarah Benge, Robert Cartwright, Louise Clement, Ying Huang, Richard Isaacs. PantoCIN: Pantoprazole’s effectiveness as prophylaxis against delayed Chemotherapy-Induced Nausea and Vomiting (CINV) in patients receiving adjuvant or neoadjuvant breast cancer chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-01.

MANAGEMENT OF FEBRILE NEUTROPENIA IN LUNG CANCER

Febrile neutropenia (FN) is defined as an oral temperature of &gt;38.3° C or two consecutive measures &gt; 38° C within 2 hours accompanied by an absolute neutrophil count (ANC) of 500/L or a predicted decrease below 500/L in individuals undergoing systemic chemotherapy for cancer. FN is one of the oncological emergencies that can influence cancer patients' outcomes since it can increase morbidity, treatment delays, decreased survival, and expanded costs. The incidence of FN is 3.7-28% in lung cancer patients. Mortality associated with FN episodes is 15%. FN risk factors include chemotherapy regimen, age, comorbidities, mucositis, performance status, and previous FN history. Validated predicted instruments such as The Multinational Association for Supportive Care in Cancer (MASCC) or The Clinical Index of Stable Febrile Neutropenia (CISNE) score could assist in risk assessment of FN and determine advanced management. Effective therapy of FN requires investigation of diagnosis as soon as possible and acknowledging the potential source of infection. The prophylactic granulocyte colony-stimulating factors (G-CSF) and anti-microbials successfully reduced mortality due to FN.