Multinational Association Of Supportive Care In Cancer Research Articles

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 >38.3° C or two consecutive measures > 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.

Can Risk Stratification Tools Be Utilized to Safely Discharge Low-Risk Febrile Neutropenic Patients from the Emergency Department?

BackgroundChemotherapy-induced febrile neutropenia (FN) is one of the more common oncological emergencies. Despite evidence in the oncology literature suggesting that low-risk cases of FN can be managed safely at home, most patients with FN who present to the emergency department (ED) are admitted. FN risk stratification methods, such as Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores, may be useful when considering patient disposition. We sought to address whether the existing body of literature is adequate to support the use of these methods when treating patients with FN in the ED. MethodsA PubMed search from January 1, 2016 to March 19, 2021 was performed using the following search strategy: “febrile neutropenia” OR (fever AND neutropenia)) AND (emerg* OR outpatient) AND (admit OR admission OR hospitalization). General review articles and case reports were omitted. Each of the articles selected underwent a structured review. ResultsThe search yielded 371 articles, which were independently screened for relevance by two authors, and 23 articles were selected for inclusion. MASCC score was used in 10 of the identified studies and each of these studies concluded that the score was useful in the ED. Most of the identified studies found that CISNE score had a higher sensitivity than MASCC score (96.7% vs. 32.9%, respectively), but a lower specificity (22.2% vs. 89.5%). ConclusionsFN risk stratifications tools, such as MASCC and CISNE scores, are supported by the existing literature and may be included as part of the decision-making process when considering patient disposition.

Topikalne farmaceutske formulacije za negu kože izložene jonizujućem zračenju

Radiotherapy as the application of ionizing radiation is one of the main current therapeutic modalities for cancer. However, one of the most frequent adverse effects of this therapeutic strategy is radiodermatitis, which significantly affects quality of patients' lives. Nowadays, there is no consensus on the appropriate therapy of radiodermatitis, however there are basic recommendations that should be followed. The aim of this study was to make a review of current recommendations during radiotherapy for the prevention of radiodermatitis through application or avoidance of application of certain topical pharmaceutical formulations. Most studies proposed the adequate personal hygiene as a general preventive measure. Basic recommendations also include wearing loose-fitting clothing, using an electric shaver, sunscreens, moisturizers, and avoiding alcohol and cigarettes. According to the Multinational Association of Supportive Care in Cancer (MASCC), the only recommendation for the prevention and treatment of radiodermatitis is gentle washing using mild soap, as well as the use of topical steroids and silver sulfadiazine. Some studies report the possibility of using photobiomodulatory therapy in the prevention of radiodermatitis, as well as non-corticosteroid creams based on aloe, hyaluronic acid, calendula and comfrey. The use of comedogenic topical preparations, those containing alcohol, benzoyl peroxide and/or alpha-hydroxy acids, as well as those containing potential contact allergens and irritants, should be avoided. Adequate guidelines supported by strong evidence and consensus do not exist, and many recommendations were later refuted. Therefore, further research in this field is necessary to find a satisfying solution for an issue of radiation dermatitis.

Can MASCC and CISNE scores predict delays of lung cancer chemotherapy after febrile neutropenia?

Febrile neutropenia (FN) during cancer chemotherapy can lead to morbidity and mortality. The Multinational Association of Supportive Care in Cancer (MASCC) and clinical index of stable febrile neutropenia (CISNE) scores have been widely used to predict the risk of severe medical complications in patients with FN; however, there are few tools for predicting chemotherapy delays or discontinuation after FN. Patients admitted to two university hospitals between 2014 and 2018 with a FN diagnosis during the first cycle of chemotherapy for lung cancer were reviewed retrospectively. Among 539 patients who received 813 courses of chemotherapy for lung cancer, 49 (9%) developed FN during the first treatment cycle. Although all the patients recovered from their primary infection, 19 patients (38.8%) developed serious medical complications, 11 (22.4%) were unable to resume chemotherapy and one (2.0%) declined to resume chemotherapy, and nine (18.4%) died within 90 days. Patients who failed to resume chemotherapy had a lower MASCC score (median 8.5 vs. 17, p < 0.01) and a higher CISNE score (median 3 vs. 1, p < 0.01) at the onset of FN. The specificity to predict the patient who failed to resume chemotherapy was 90% or more with MASCC score ≤9 or CISNE score ≥3, with the sensitivity of 61%. MASCC score ≤ 16 can also be a sensitive indicator with the sensitivity and specificity of 89 and 52%, respectively. The MASCC and CISNE scores are useful in identifying lung cancer patients who are unable to resume chemotherapy as scheduled after the onset of FN.

‘Share your views’—international consultation informs a patient engagement strategy for the Multinational Association of Supportive Care in Cancer

IntroductionEngaging with patients and the public (consumers and community) enhances the relevance of cancer control developments; however, challenges remain to integrate into processes. Medical and other professional societies are well-positioned to foster and endorse best practice.MethodsBetween October and December 2021, the Multinational Association of Supportive Care in Cancer (MASCC) conducted a global consultation with those who identified as “people affected by cancer”. Recruitment to an online cross-sectional survey was by a combination of purposive and convenience sampling to determine preferred terminologies and experiences with MASCC and other cancer-related societies.ResultsThe survey was completed by 343 respondents from 29 countries, a majority being female (78.1%) and younger than 60 years of age (62.1%). Respondents preferred to be identified as ‘patient’ from a set of defined terms; however, this only accounted for 49–67% of selected response across geographical regions. Only 22.2% of respondents had engaged previously with MASCC, of whom 90.8% reported a positive experience through involvement with education and information, networking and collaboration, and practice guidelines. Respondents perceived areas of opportunity as early involvement in decision-making, educational initiatives, open communication, and information sharing. Across all geographical regions, responders chose a preference to contribute to future consumer research (53.0%), policy (31.7%) or consumer engagement activities (56.9%) including participation in a conference session (65.0%) or patient day (47.9%).ConclusionsThis survey provides a first insight into how consumers wish to engage with MASCC. These values will be embedded into a strategy that aims for effective and sustainable partnerships with multinational consumers.

Pseudomonas aeruginosa Bloodstream Infections in Patients with Cancer: Differences between Patients with Hematological Malignancies and Solid Tumors.

Objectives: To assess the clinical features and outcomes of Pseudomonas aeruginosa bloodstream infection (PA BSI) in neutropenic patients with hematological malignancies (HM) and with solid tumors (ST), and identify the risk factors for 30-day mortality. Methods: We performed a large multicenter, retrospective cohort study including onco-hematological neutropenic patients with PA BSI conducted across 34 centers in 12 countries (January 2006–May 2018). Episodes occurring in hematologic patients were compared to those developing in patients with ST. Risk factors associated with 30-day mortality were investigated in both groups. Results: Of 1217 episodes of PA BSI, 917 occurred in patients with HM and 300 in patients with ST. Hematological patients had more commonly profound neutropenia (0.1 × 109 cells/mm) (67% vs. 44.6%; p < 0.001), and a high risk Multinational Association for Supportive Care in Cancer (MASCC) index score (32.2% vs. 26.7%; p = 0.05). Catheter-infection (10.7% vs. 4.7%; p = 0.001), mucositis (2.4% vs. 0.7%; p = 0.042), and perianal infection (3.6% vs. 0.3%; p = 0.001) predominated as BSI sources in the hematological patients, whereas pneumonia (22.9% vs. 33.7%; p < 0.001) and other abdominal sites (2.8% vs. 6.3%; p = 0.006) were more common in patients with ST. Hematological patients had more frequent BSI due to multidrug-resistant P. aeruginosa (MDRPA) (23.2% vs. 7.7%; p < 0.001), and were more likely to receive inadequate initial antibiotic therapy (IEAT) (20.1% vs. 12%; p < 0.001). Patients with ST presented more frequently with septic shock (45.8% vs. 30%; p < 0.001), and presented worse outcomes, with increased 7-day (38% vs. 24.2%; p < 0.001) and 30-day (49% vs. 37.3%; p < 0.001) case-fatality rates. Risk factors for 30-day mortality in hematologic patients were high risk MASCC index score, IEAT, pneumonia, infection due to MDRPA, and septic shock. Risk factors for 30-day mortality in patients with ST were high risk MASCC index score, IEAT, persistent BSI, and septic shock. Therapy with granulocyte colony-stimulating factor was associated with survival in both groups. Conclusions: The clinical features and outcomes of PA BSI in neutropenic cancer patients showed some differences depending on the underlying malignancy. Considering these differences and the risk factors for mortality may be useful to optimize their therapeutic management. Among the risk factors associated with overall mortality, IEAT and the administration of granulocyte colony-stimulating factor were the only modifiable variables.

Editorial introductions.

Editorial introductions.

MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer

PurposeTo provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer.MethodsThe Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival, and quality of life. The review was restricted to studies published in English, but no restrictions were placed on publication year, country, and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions.ResultsThe systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about the management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression, and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided.ConclusionThis MASCC Guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.

Usefulness of complete blood count parameters to predict poor outcomes in cancer patients with febrile neutropenia presenting to the emergency department

Introduction Febrile neutropenia (FN) is one of the major complications with high mortality rates in cancer patients undergoing chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk-index score has limited applicability for routine use in the emergency department (ED). This study aimed to develop simplified new nomograms that can predict 28-day mortality and the development of serious medical complications in patients with FN by using a combination of complete blood count (CBC) parameters with quick Sequential Organ Failure Assessment (qSOFA). Methods In this retrospective observational study, various models comprising qSOFA score and individual CBC parameters (red cell distribution width, delta neutrophil index, mean platelet volume (MPV)) were evaluated for association with outcomes by a multivariate logistic analysis. Subsequently, nomograms were developed for outcome prediction. The primary outcome was mortality at 28 days from ED presentation; the secondary outcome was the development of serious medical complications. Results A total of 378 patients were included. Among the CBC parameters, only MPV was significantly associated with 28-day mortality and serious medical complications in patients with FN. The nomogram developed to predict 28-day mortality and serious medical complications showed good discrimination with area under the receiver-operating characteristic curve (AUC) values of 0.729 and 0.862 (95% CI, 0.780–0.943), respectively, which were not different from those of the MASCC score (0.814, 95% CI, 0.705–0.922; p = .07 and 0.921, 95% CI, 0.863–0.979; p = .11, respectively) in the validation set. The calibration of both nomograms demonstrated good agreement in the validation set. Conclusion In this study, a novel prognostic nomogram using qSOFA score and MPV to identify cancer patients with FN with high risk of 28-day mortality and serious medical complications was verified and validated. Prompt management of fatal complications of FN can be possible through early prediction of poor outcomes with these new nomograms. KEY MESSAGES Among the evaluated CBC parameters, only mean platelet volume was associated with 28-day mortality and serious medical complications in cancer patients with febrile neutropenia. A novel and rapid prognostic nomogram was developed using quick Sequential Organ Failure Assessment score and mean platelet volume to identify cancer patients with febrile neutropenia having high risk of 28-day mortality and serious medical complications. The nomogram developed to predict 28-day mortality and serious medical complications in patients with febrile neutropenia showed good discrimination and provides rapid patient evaluation that is especially applicable in the emergency department.

Interpretation of medication-related osteonecrosis of the jaw: MASCC/ISOO/ASCO clinical practice guideline

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse event related to administration of antiresorptive or antiangiogenic medications. With the increasing usage of bone-modifying agents in cancer therapy, the incidence of MRONJ enhanced gradually, which affects the life quality of patients and interferes with cancer therapy. In 2019, Multinational Association of Supportive Care in Cancer (MASCC), International Society of Oral Oncology (ISOO) and American Society of Clinical Oncology (ASCO) convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations on practices in the prevention and management of MRONJ in patients with cancer. The present article made an interpretation of Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline so as to provide clinicians with diagnostic and therapeutic approaches for cancer patients with MRONJ.

Comparison of clinical practice guidelines on radiation dermatitis: a narrative review.

Radiation dermatitis (RD) is a common side effect of radiation therapy (RT). While many different treatment strategies are currently used to address RD, there is a lack of consensus and RD prophylaxis and management guidelines have remained largely unchanged over the last 10years. This review aims to formulate unambiguous supportive care interventions by comparing RD clinical practice guidelines published between 2010 and 2021 by several organizations: Multinational Association for Supportive Care in Cancer (MASCC), British Columbia Cancer Agency (BCCA), Cancer Care Manitoba (CCMB), Oncology Nursing Society (ONS), Society and College of Radiographers (SCoR), and International Society of Nurses in Cancer Care (ISNCC). Areas of agreement and discordance were assessed among the MASCC, BCCA, CCMB, ONS, SCoR, and ISNCC guidelines. Treatment recommendations across guidelines for acute RD and chronic RT-induced skin toxicities have been summarized. The strongest agreement among the guidelines exists for the use of topical corticosteroids, silver sulfadiazine, washing, and deodorant. All guidelines recommend the use of topical corticosteroids, and washing with water and soap is consistently supported. There is minimal consensus on an optimal dressing or barrier film for RD prophylaxis or management. MASCC weakly recommends prophylactic use of silver sulfadiazine to reduce RD, while BCCA, CCMB, and SCoR recommend its use upon signs of infection. MASCC and CCMB recommend the use of a long-pulsed dye laser to manage telangiectasia, a late effect of RT. Given the extent of discordance among guideline recommendations, further research is recommended to establish optimal treatments for RD prophylaxis and management.

Emergency department management of chemotherapy related febrile neutropenia: An opportunity to improve care.

Febrile neutropenia (FN) is an important oncological emergency seen in the emergency department (ED), and the American Society of Clinical Oncology recommends risk stratification of patients with febrile neutropenia using the Multinational Association for Supportive Care in Cancer (MASCC) Index, with ED discharge on oral antibiotics recommended for low-risk patients. To determine the prevalence of FN neutropenia and medical system wide ED treatment guideline adherence. We performed a retrospective chart review of all patients with an ICD-10 confirmed diagnosis of FN from January 2016-2019at 13 affiliated EDs within one medical system. Only cancer/chemotherapy related FN were included. Following the MASCC guidelines, we used post-hoc calculations to classify patients as low/high-risk, and compared key clinical variables (mortality, blood culture positivity, interventions). 203 patients were found to have FN. 97.9% (184/203) received broad spectrum antibiotics, including 92% of the low-risk group (60/65). All patients were admitted, and no observed in-hospital mortality was noted in the low-risk group, meanwhile 5.1% (7/138) of the high-risk group died. 14/203 patients had positive blood cultures, none in the low-risk group. The prevalence of FN is low among 13 EDs that had almost 1.7 million ED visits over a 3-year period. Guideline compliance for low-risk FN was poor. All patients were admitted, and nearly all patients received IV fluids and IV antibiotics. Improving FN management to align with national guidelines represents an opportunity to improved ED care of patients with cancer by reducing unnecessary hospitalizations.

Scoring Systems Identifying the Low-Risk Febril Neutropenia Patients in the Emergency Department: Usefulness of MASCC, CISNE and qSOFA

Objective: We aimed to investigate the effectiveness of quick Sequential Organ Failure Assessment (qSOFA), Multinational Association for Supportive Care in Cancer (MASCC), and Clinical Index of Stable Febrile Neutropenia (CISNE) scores in identifying the low-risk febrile neutropenia patients among patients with chemotherapy-associated neutropenia in the emergency department setting.&#x0D; Material and Method: The risk scores of the patients were calculated and divided into low-risk and high-risk categories according to the guidelines. Serious complications and 30-day mortality were recorded. Patients who survived and did not develop any serious complications were defined as low risk FN.&#x0D; Results: The median age of the patients was 63 years, and 56.3% were male. Of all patients, 50.6% had hematological malignancy. Blood culture positivity was detected in 31% of the patients. Of all patients, 51 (58.6%) were low-risk FN. The complication rate in patients was 40.2%, while the mortality rate was 25.3%. When evaluated according to the risk scores, 69 (79.3%) patients with qSOFA, 40 (46%) patients with MASCC and 7 (8.1%) patients with CISNE were classified as low risk. The qSOFA score had the highest sensitivity with 96.08%, MASCC had the highest PPV with 85%, and the CISNE score had the highest specificity with 88.89% in patients with low-risk febrile neutropenia.&#x0D; Conclusion: MASCC, CISNE and qSOFA scores have reasonable discriminating power in identifying low-risk neutropenia patients. The combined use of scoring systems with the clinical gestalt and communication with oncologists will further increase the percentage of the recognized low-risk neutropenia patients in the emergency department.

The role of procalcitonin in identifying high-risk cancer patients with febrile neutropenia: A useful alternative to the multinational association for supportive care in cancer score.

BackgroundThe Multinational Association for Supportive Care in Cancer (MASCC) risk index has been utilized to determine the risk for poor clinical outcomes in patients with febrile neutropenia (FN) in an emergency center (EC). However, this index comprises subjective elements and elaborated metrics limiting its use in ECs. We sought to determine whether procalcitonin (PCT) level (biomarker of bacterial infection) with or without lactate level (marker of inadequate tissue perfusion) offers a potential alternative to MASSC score in predicting the outcomes of patients with FN presenting to an EC.MethodsWe retrospectively identified 550 cancer patients with FN who presented to our EC between April 2018, and April 2019, and had serum PCT and lactate levels measured.ResultsCompared with patients with PCT levels <0.25 ng/ml, those with levels ≥0.25 ng/ml had a significantly higher 14‐day mortality rate (5.2% vs. 0.7%; p = 0.002), a higher bloodstream infection (BSI) rate, and a longer hospital length of stay (LOS). Logistic regression analysis showed that patients with PCT levels ≥0.25 ng/ml and lactate levels >2.2 mmol/L were more likely to be admitted and have an LOS >7 days, BSI, and 14‐day mortality than patients with lower levels. PCT level was a significantly better predictor of BSI than MASSC score (p = 0.003) or lactate level (p < 0.0001).ConclusionsProcalcitonin level is superior to MASCC index in predicting BSI. The combination of PCT and lactate levels is a good predictor of BSI, hospital admission, and 14‐day mortality and could be useful in identifying high‐risk FN patients who require hospital admission.