Multinational Association Of Supportive Care In Cancer Research Articles

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe gastrointestinal and hepatic toxicities from checkpoint inhibitors.

Immune-related adverse events (IrAEs) affecting the gastrointestinal (GI) tract and liver are among the most frequent and most severe inflammatory toxicities from contemporary immunotherapy. Inflammation of the colon and or small intestines (entero)colitis is the single most common GI IrAE and is an important cause of delay of discontinuation of immunotherapy. The severity of these GI IrAEs can range from manageable with symptomatic treatment alone to life-threatening complications, including perforation and liver failure. The frequency and severity of GI IrAEs is dependent on the specific immunotherapy given, with cytotoxic T lymphocyte antigen (CTLA)-4 blockade more likely to induce severe GI IrAEs than blockade of either programmed cell death protein 1 (PD-1) or PD-1 ligand (PD-L1), and combination therapy showing the highest rate of GI IrAEs, particularly in the liver. To date, we have minimal prospective data on the appropriate diagnosis and management of GI IrAEs, and recommendations are based largely on retrospective data and expert opinion. Although clinical diagnoses of GI IrAEs are common, biopsy is the gold standard for diagnosis of both immunotherapy-induced enterocolitis and hepatitis and can play an important role in excluding competing, though less common, diagnoses and ensuring optimal management. GI IrAEs typically respond to high-dose corticosteroids, though a significant fraction of patients requires secondary immune suppression. For colitis, both TNF-α blockade with infliximab and integrin inhibition with vedolizumab have proved highly effective in corticosteroid-refractory cases. Detailed guidelines have been published for the management of low-grade GI IrAEs. In the setting of more severe toxicities, involvement of a GI specialist is generally recommended. The purpose of this review is to survey the available literature and provide management recommendations focused on the GI specialist.

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune-mediated cardiovascular, rheumatic, and renal toxicities from checkpoint inhibitors.

Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Although they are of variable occurrence, cardiovascular, rheumatic, and renal immune-mediated toxicities are among the most serious of these adverse events. We present MASCC recommendations with respect to the workup and management of cardiovascular, rheumatic, and renal immune-mediated toxicities with a focus on presentations that require treatment with immunomodulating agents.

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of immune checkpoint inhibitor endocrinopathies and the role of advanced practice providers in the management of immune-mediated toxicities.

Immune checkpoint inhibitors (ICIs) have emerged as the newest pillar of cancer treatment, transforming outcomes in melanoma and showing benefit in a range of malignancies. Immune-mediated toxicities, stemming from increased activity within the T cell lineage, range from asymptomatic or mild complications to those that are fulminant and potentially fatal. Immune-mediated endocrinopathies include hypophysitis, thyroiditis, and insulin-dependent diabetes mellitus. These presentations, which may be vague and non-specific, can be life-threatening if not diagnosed and treated appropriately. This review considers the work-up and management of immune-mediated endocrinopathies and also considers the role of advanced practice practitioners in the management of immune-mediated toxicities. These state-of-the-art MASCC recommendations represent a comprehensive overview of the management and clinical work-up in those in whom the diagnosis should be considered.

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe dermatological toxicities from checkpoint inhibitors

Immune checkpoint inhibitors (ICIs) frequently result in cutaneous immune-related adverse events (IrAEs). Although the majority of these events are mild-to-moderate in severity, up to 5% are severe, which may lead to morbidity and dose interruption or discontinuation of ICI therapy. In addition, up to 25% of dermatologic IrAEs are corticosteroid-refractory or corticosteroid-dependent. These 2020 MASCC recommendations cover the diagnosis and management of cutaneous IrAEs with a focus on moderate-to-severe and corticosteroid-resistant events. Although the usage of immune-suppressive therapy has been advocated in this setting, there is a lack of randomized clinical trial data to provide a compelling level of evidence of its therapeutic benefit.

Editorial introductions

Editorial introductions

Effect of serum uric acid level and Multinational Association for Supportive Care in Cancer risk score on febrile neutropenia mortality.

The study was aimed to evaluate the effect of uric acid (UA) on the 30-day mortality of patients admitted to the tertiary referral hospital with a complaint of febrile neutropenia (FEN). The secondary aim was to evaluate the use of combining serum UA levels with the Multinational Association for Supportive Care in Cancer (MASCC) risk score. A retrospective study in which the MASCC score and serum UA levels were used to evaluate the mortality risk within 30days among patients with FEN. A total of 118 FEN episodes were included in the study and 17 (14%) of these patients died. While this rate is 23% in the high-risk group according to the MASCC score, it is 7% in the low-risk group (p= 0.011). In multivariate analysis of the parameters that significantly affect the 30-day FEN mortality, MASCC risk score (OR, 4.28; CI 95% 1.19-15.39, p= 0.013) and having a level of serum UA > 7mg/dL (OR, 4.46; CI 95% 1.19-15.38, p= 0.032) was significantly increased the risk of in 30-day mortality of FEN. The rate of 30-day mortality of FEN was 0% in patients with a low MASCC risk score and UA level compared with 50% in the high MASCC risk score and high UA level group, and the difference was statistically significant (p< 0.001). Increased level of UA at the time of FEN diagnosis was independently associated with an increased rate of 30-day mortality of FEN. The combination of the MASCC risk score and serum UA level might thoroughly predict the 30-day mortality of FEN.

Symptom and Anxiety Assessment in Gynecologic Cancer Patients Receiving Chemotherapy

Background: Side effects of chemotherapy usually disturbed the daily life of patients. During chemotherapy, quality of life of patients is affected by the severity of symptoms experienced. Objective: To evaluate the side effects experienced by gynecologic cancer patients receiving chemotherapy.Methods: Gynecologic cancer patients receiving chemotherapy (at least 1 cycle with standard premedication that included antiemetic drugs) between 18 June and 25 September 2019 were invited to this study. Participants were interviewed by our team for personal data and attitudes toward their disease and treatment. In addition, the Edmonton Symptom Assessment System (ESAS-Thai version) tool, and Multinational Association for Supportive Care in Cancer (MASCC) antiemetic tool were used to assess the symptoms during chemotherapy. Results: One hundred sixty-five participants entered this study. The mean age was 53.5. The three most common type of cancer were ovarian (37.6%), cervical (37.6%) and uterine cancer (21.8%). Most common chemotherapy was carboplatin plus paclitaxel (64.8%). Two-thirds of the participants believed they could be cured. The most common severe symptom from the ESAS tool was pain (20.6%), followed by fatigue (18.8%), appetite change (16.4%) and numbness (10.3%). In addition, 10.9% of patients experienced nausea/vomiting in acute phase, while 20.6% experienced it in the delayed phase. Conclusion: Our participants revealed positive attitudes toward cancer and treatment. Some patients experienced nausea and vomiting despite using antiemetic drugs. The most frequent self-reported symptom was pain. Therefore, pain control was necessary to improve their quality of life.

Early switch from intravenous to oral antibiotic therapy in patients with cancer who have low-risk neutropenic sepsis (the EASI-SWITCH trial): study protocol for a randomised controlled trial

BackgroundNeutropenic sepsis remains a common treatment complication for patients receiving systemic anti-cancer treatment. The UK National Institute for Health and Care Excellence have not recommended switching from empirical intravenous antibiotics to oral antibiotics within 48 h for patients assessed as low risk for septic complications because of uncertainty about whether this would achieve comparable outcomes to using intravenous antibiotics for longer. The UK National Institute for Health Research funded the EASI-SWITCH trial to tackle this uncertainty.MethodsThe trial is a pragmatic, randomised, non-inferiority trial that aims to establish the clinical and cost-effectiveness of early switching from intravenous to oral antibiotics in cancer patients with low-risk neutropenic sepsis. Patients ≥ 16 years, receiving systemic anti-cancer treatment (acute leukaemics/stem cell transplants excluded), with a temperature of > 38 °C, neutrophil count ≤ 1.0 × 109/L, MASCC (Multinational Association of Supportive Care in Cancer) score ≥ 21 and receiving IV piperacillin/tazobactam or meropenem for less than 24 h are eligible to participate. Patients are randomised 1:1 either (i) to switch to oral ciprofloxacin and co-amoxiclav within 12–24 h of commencing intravenous antibiotics, completing at least 5 days total antibiotics (intervention), or (ii) to continue intravenous antibiotics for at least 48 h, with ongoing antibiotics being continued at the physician’s discretion (control). Patients are discharged home when their physician deems it appropriate. The primary outcome measure is a composite of treatment failures as assessed at day 14. The criteria for treatment failure include fever persistence or recurrence 72 h after starting intravenous antibiotics, escalation from protocolised antibiotics, hospital readmission related to infection/antibiotics, critical care support or death. Based on a 15% treatment failure rate in the control group and a 15% non-inferiority margin, the recruitment target is 230 patients.DiscussionIf the trial demonstrates non-inferiority of early switching to oral antibiotics, with potential benefits for patient quality of life and resource savings, this finding will have significant implications for the routine clinical management of those with low-risk neutropenic sepsis.Trial registrationISRCTN: 84288963. Registered on the 1 July 2015. https://doi.org/10.1186/ISRCTN84288963.EudraCT: 2015-002830-35.

Retrospective study of the evaluation and management of febrile neutropenia in cancer patients in a tertiary center.

e19100 Background: Febrile neutropenia is a medical emergency often managed by internists, but adherence to guidelines has not been well-described. We aimed to describe care and outcomes of a retrospective cohort of patients hospitalized with febrile neutropenia at a single tertiary care hospital. Methods: We included adults ≥18 years old who had a cancer diagnosis and required hospital admission for a principal diagnosis of fever and neutropenia (ANC &lt; 500) from October 2015 - April 2019. We reviewed records to identify demographics, cancer diagnosis and stage, and outcomes, including death. Results: We included 193 patients; all were cared for by hospitalists. About half (52%) were classified as high risk [ &lt; 21 Multinational Association of Supportive Care in Cancer (MASCC)score], but only 1 patient had a documented MASCC score in hospital progress notes. The majority of patients were female (55%) and white (84%). Twenty-three percent had a stage IV diagnosis. Most (89.1%) patients were within their first chemotherapy cycle, and 23% received GCSF. Approximately half (47%) had solid tumors; the remainder had hematologic malignancies. About one quarter (27%) had positive blood cultures (of these, 43.4 % were gram positive cocci (GPC); 49.1% were gram negative rods (GNR)). Most patients received empiric coverage for GPC and GNR: 82% received cefepime and 42% received empiric MRSA coverage. Few patients had cultures positive for resistant organisms such as MRSA (n = 3) or pseudomonas (n = 4). Hematology/Oncology was consulted for most (82%) cases. Inpatient mortality occurred in 12% of patients. Compared to those who survived, patients who died had lower MASCC score 13.9 (vs. 19.1) and were more likely to receive critical care therapies during hospitalization (70% vs. 14%). Few patients (n = 24, 12%) had documented goals of care (GOC) discussions. Conclusions: Although MASCC is predictive of outcomes, internists caring for patients with fever and neutropenia do not document this score. Hospitalist-focused education efforts about MASCC score could improve care. Few patients had documented GOC discussions. Oncologists should maintain good communication with internal medicine colleagues, who may be hesitant to address GOC in patients receiving chemotherapy.

Accuracy of the Multinational Association of Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for predicting serious complications in adult patients with febrile neutropenia: A systematic review and meta-analysis.

We compared the Multinational Association of Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for identifying serious complications in febrile neutropenia patients. We searched MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception to March 19, 2019. Two reviewers independently screened citations, extracted data, and assessed quality. We included 26 studies, totalling 6617 patients. Pooled sensitivity and specificity for MASCC < 21 was 55.6 % (95 % CI: 46.2 %-64.5%) and 86.0 % (95 % CI: 81.3 %-89.7 %), respectively. Pooled sensitivity and specificity for CISNE ≥ 3 was 78.9 % (95 % CI: 65.3 %-88.1 %) and 64.9 % (95 % CI: 49.6 %-77.7 %), respectively. Pooled sensitivity and specificity for CISNE ≥ 1 was 96.7 % (95 % CI: 93.6 %-98.3 %) and 22.2 % (95 % CI: 15.6 %-30.4 %), respectively. The CISNE score had higher sensitivity and may be more useful than the MASCC score in the acute setting.

Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department.

IntroductionThe benefit of reducing the time of antibiotic initiation in the emergency department (ED) for neutropenic patients is controversial and the research on the impact of antibiotic adherence to international guidelines in the ED is scarce. We aimed to investigate the effect of antibiotic timing and appropriateness on outcomes in patients with febrile neutropenia (FN) and to assess the performance of the MASCC risk-index to risk-stratify such patients in the ED.MethodsWe prospectively identified patients with FN who presented to our ED and assessed their Multinational Association of Supportive Care in Cancer (MASCC) risk-index. The time to parenteral antibiotic initiation and the appropriateness of the antibiotic regimen according to international guidelines were retrospectively abstracted. The performance of the MASCC risk-index in predicting the absence of complication was assessed with sensitivity, specificity and the area under the receiver operating characteristics curve (AUC). We investigated the effect of the time to antibiotic initiation and the appropriateness of the antibiotic regimen on the outcome (ICU admission or death) by logistic regression analyses.ResultsWe included 249 patients. Median age was 60 years and 67.9% had hematological malignancies, 26 (10.4%) were admitted to the ICU and 23 (9.8%) died during hospital stay. Among the 173 patients at low risk according to the MASCC risk-index, 56 (32.4%) presented at least one complication including 11 deaths. The MASCC risk-index had a sensitivity and a specificity of 0.78% and 0.43%, respectively, in predicting the absence of complication and the AUC was 0.67. The time to antibiotic initiation in the ED was not associated with the outcome after adjusting for performance status and shock-index. Conversely, an inadequate ED antibiotic regimen was associated with higher ICU admission or death during hospital stay (OR = 3.50; 95% CI = 1.49 to 8.28).ConclusionAn inadequate ED antibiotic regimen in patients with FN was significantly associated with higher ICU admission or death during hospital stay.

Antiemetic prophylaxis in patients undergoing hematopoietic stem cell transplantation: a multicenter survey of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) transplant programs.

A survey within hematopoietic stem cell transplant (HSCT) centers of the Gruppo Italiano Trapianto Midollo Osseo (GITMO) was performed in order to describe current antiemetic prophylaxis in patients undergoing HSCT. The multicenter survey was performed by a questionnaire, covering the main areas on chemotherapy-induced nausea and vomiting (CINV): antiemetic prophylaxis guidelines used, antiemetic prophylaxis in different conditioning regimens, and methods of CINV evaluation. The survey was carried out in November 2016, and it was repeated 6months after the publication of the Multinational Association of Supportive Care in Cancer (MASCC)/European Society for Medical Oncology (ESMO) specific guidelines on antiemetic prophylaxis in HSCT. The results show a remarkable heterogeneity of prophylaxis among the various centers and a significant difference between the guidelines and the clinical practice. In the main conditioning regimens, the combination of a serotonin3 receptor antagonist (5-HT3-RA) with dexamethasone and neurokin1 receptor antagonist (NK1-RA), as recommended by MASCC/ESMO guidelines, increased from 0 to 15% (before the publication of the guidelines) to 9-30% (after the publication of the guidelines). This study shows a lack of compliance with specific antiemetic guidelines, resulting mainly in under-prophylaxis. Concerted strategies are required to improve the current CINV prophylaxis, to draft shared common guidelines, and to increase the knowledge and the adherence to the current recommendations for CINV prophylaxis in the specific field of HSCT.

Psychometric assessment of the Persian version of short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemetic tool.

Managing chemotherapy-induced nausea and vomiting (CINV) in patients with cancer is still a challenge for the patients and also the clinicians. The Multinational Association of Supportive Care in Cancer (MASCC) has developed a scale for better measurement and management of CINV. Thus, this paper aims at translating the scale into Persian and assessing the psychometric properties of the proposed translated version of MASCC Antiemesis Tool (MAT). Having received the necessary permissions and complying with the Forward-Backward translation protocol, we conducted a qualitative assessment of the face validity through cognitive interviewing and content validity assess with 5 experts in Persian Literature. Internal consistency using Cronbach's Alpha Coefficient was applied to determine the scale reliability. In order to determine the construct validity, the three methods of exploratory factor analysis, known group analysis, and convergent validity (assessment of the correlation between Rhodes Index of Nausea, Vomiting and Retching (INVR) scale and the Persian version of MAT scale) were conducted on 300 participants. About 300 patients with a mean age of 50.73 ± 0.81 participated in the study. The results showed a significant difference in the index of nausea and vomiting between the patients who are below 50years old and those who are above 50 (P = 0.0001). The Cronbach's Alpha Coefficient was reported 0.88 for the whole MAT questionnaire. Due to the low factor load (fewer than 0.5) for question 1, it was removed in the factor analysis. Besides, exploratory factor analysis (EFA) led to the exploration of the two factors of nausea and vomiting. According to the results of the study, the Persian version of the MAT questionnaire is considered as a highly reliable and valid tool, in order to efficiently and accurately measure chemotherapy-induced nausea and vomiting and to better manage this side effect.

Editorial introductions

Current Opinion in Oncology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR Jean A. KlasterskyJean A. Klastersky was born March 3, 1940, in Prague. Professor Klastersky was Head of the Department of Medicine at the Institut Jules Bordet in Brussels, Belgium, and Professor of Medicine, Medical Oncology and Physical Diagnosis at the Université Libre de Bruxelles, Belgium, from 1977. He retired from these positions in 2005. Currently, he is the coordinator of the “Programme des Soins Oncologiques” for the Public Hospitals in Brussels and consultant in medical oncology at the Institut Jules Bordet, Belgium. Professor Klastersky was an intern and resident at the University Hospitals of the Université Libre de Bruxelles between 1962 and 1965, where he gained his MD (Docteur en Médecine, Chirurgie et Accouchements). From 1967 to 1968, he was Chief-Resident at Boston City Hospital, USA, and then a Research Fellow and Assistant in Medicine at Thorndike Memorial Laboratory Harvard Medical School, USA. He became Chief of the Section of Infectious Diseases at the Institut Jules Bordet in 1970, before taking up the position of Head of the Department of Medicine in 1977. Professor Klastersky was a founder member of the European Lung Cancer Working Party and has been his President since 1978 until 2003. He was President (and founder member) of the International EORTC Antimicrobial Therapy Project Group between 1979 and 1987 and the Group's Secretary General from 1987 to 2000. He was President (and founder member) of the Multinational Association for Supportive Care in Cancer (MASCC) from 1990 to 2000. He has been Visiting Professor of Medical Oncology at the Charles University in Prague, Czech Republic, since 1994. Professor Klastersky is a member of the American Society of Clinical Oncology, the American Association of Cancer Research, the European Society of Medical Oncology, the American Society of Microbiology, the Infectious Diseases Society of America, the International Association for the Study of Lung Cancer, the “Royale Académie de Médecine” of Belgium and various other international and national medical and/or oncological societies. Professor Klastersky is the author of over 400 original articles, nearly 400 review articles and 17 scientific books. He is the Editor of Current Opinion in Oncology. SECTION EDITORS Christiane JungelsChristiane Jungels, MD, is a Medical Oncologist at the Jules Bordet Institute in Brussels, Belgium. A Luxembourgish citizen, she came to Belgium in 2004 for Medical School at the Université Libre de Bruxelles (ULB), where she graduated as a Medical Doctor in 2010. She first trained in internal medicine, and later did her training in medical oncology at the Jules Bordet Institute, and graduated as a medical oncologist in 2016. She has been working in the Institute as a specialist since the end of 2016, with a primary interest the management of rare tumors, including sarcomas and endocrine tumors. Besides coordinating projects focusing on rare tumors, her main activity is clinical research, especially early drug development for patients with solid tumors with a special commitment to rare tumors. She is local Principal Investigator for several phase 1 trials and co-investigator in many phase 1 to 3 studies. She is member of the Belgian Society for Medical Oncology (BSMO) and the European Society for Medical Oncology (ESMO). Robert PirkerRobert Pirker obtained a master's degree in biochemistry in 1978 and his medical degree in 1979 from the University of Vienna, Austria. Robert Pirker trained in internal medicine, hemato-oncology and nuclear medicine at the University of Vienna. He also worked as NIH Visiting Fellow at the Laboratory of Molecular Biology (Chief: Dr Ira Pastan), National Cancer Institute, Bethesda, MD, USA (1983–86). His research interests are chemotherapy and targeted therapy of lung cancer, drug resistance mechanisms of cancer, and management of chemotherapy-induced anemia. He has published more than 200 articles, reviews or book chapters. He was a member of the IASLC Board of Directors (2015–2019). He was Congress President of the 8th and 14th Central European Lung Cancer Congresses, Chair of the Scientific Committee of the European Multidisciplinary Conference on Thoracic Oncology in 2009, and Conference President of the IASLC 17th World Conference on Lung Cancer in 2016 in Vienna. He is the current President of the Central European Lung Cancer Association and as Professor of Medicine teaches Medical and Experimental Oncology at the Medical University of Vienna, Austria.

Current management of chemotherapy-induced neutropenia in adults: key points and new challenges: Committee of Neoplastic Supportive-Care (CONS), China Anti-Cancer Association Committee of Clinical Chemotherapy, China Anti-Cancer Association.

Chemotherapy-induced neutropenia (CIN) is a potentially fatal and common complication in myelosuppressive chemotherapy. The timing and grade of CIN may play prognostic and predictive roles in cancer therapy. CIN is associated with older age, poor functional and nutritional status, the presence of significant comorbidities, the type of cancer, previous chemotherapy cycles, the stage of the disease, specific chemotherapy regimens, and combined therapies. There are many key points and new challenges in the management of CIN in adults including: (1) Genetic risk factors to evaluate the patient’s risk for CIN remain unclear. However, these risk factors urgently need to be identified. (2) Febrile neutropenia (FN) remains one of the most common reasons for oncological emergency. No consensus nomogram for FN risk assessment has been established. (3) Different assessment tools [e.g., Multinational Association for Supportive Care in Cancer (MASCC), the Clinical Index of Stable Febrile Neutropenia (CISNE) score model, and other tools] have been suggested to help stratify the risk of complications in patients with FN. However, current tools have limitations. The CISNE score model is useful to support decision-making, especially for patients with stable FN. (4) There are still some challenges, including the benefits of granulocyte colony stimulating factor treatment and the optimal antibiotic regimen in emergency management of FN. In view of the current reports, our group discusses the key points, new challenges, and management of CIN.

Febrile Neutropenia in Acute Leukemia. Epidemiology, Etiology, Pathophysiology and Treatment.

Acute leukemias are a group of aggressive malignant diseases associated with a high degree of morbidity and mortality. An important cause of both the latter is infectious complications. Patients with acute leukemia are highly susceptible to infectious diseases due to factors related to the disease itself, factors attributed to treatment, and specific individual risk factors in each patient. Patients with chemotherapy-induced neutropenia are at particularly high risk, and microbiological agents include viral, bacterial, and fungal agents. The etiology is often unknown in infectious complications, although adequate patient evaluation and sampling have diagnostic, prognostic and treatment-related consequences. Bacterial infections include a wide range of potential microbes, both Gram-negative and Gram-positive species, while fungal infections include both mold and yeast. A recurring problem is increasing resistance to antimicrobial agents, and in particular, this applies to extended-spectrum beta-lactamase resistance (ESBL), Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and even carbapenemase-producing Enterobacteriaceae (CPE). International guidelines for the treatment of sepsis in leukemia patients include the use of broad-spectrum Pseudomonas-acting antibiotics. However, one should implant the knowledge of local microbiological epidemiology and resistance conditions in treatment decisions. In this review, we discuss infectious diseases in acute leukemia with a major focus on febrile neutropenia and sepsis, and we problematize the diagnostic, prognostic, and therapeutic aspects of infectious complications in this patient group. Meticulously and thorough clinical and radiological examination combined with adequate microbiology samples are cornerstones of the examination. Diagnostic and prognostic evaluation includes patient review according to the multinational association for supportive care in cancer (MASCC) and sequential organ failure assessment (SOFA) scoring system. Antimicrobial treatments for important etiological agents are presented. The main challenge for reducing the spread of resistant microbes is to avoid unnecessary antibiotic treatment, but without giving to narrow treatment to the febrile neutropenic patient that reduce the prognosis.

Predictive Factors for Survival Outcomes of High-Risk Febrile Neutropenic Patients: a 3-Year Study at a Single Center in Thailand

Objective: This study aimed to identify the risk factors associated with mortality in febrile neutropenic patients.  Materials and Methods: This 3-year, single center, retrospective, observational study was conducted at Chiangrai Prachanukroh Hospital, Chiangrai Province, Thailand. The inclusion criteria consisted of a patient age of over 15 years and a diagnosis of febrile neutropenia. Results: Most of the 303 febrile neutropenic inpatients had a Multinational Association for Supportive Care in Cancer (MASCC) risk score &lt; 21. The median length of stay was 6 days (interquartile range: 4-11 days). During 30 days of admission, 24.8% of the patients succumbed. In a univariate analysis, patients receiving G-CSF, the post-chemotherapy-related group, patients with MASCC score &gt; 16, and patients admitted in private had significantly higher survival rate. In a multivariate analysis, a MASCC score ≤ 16 and non-chemotherapy-related groups were associated with an increased mortality risk. Conclusion: The 30-day survival rate of febrile neutropenic patients in Thailand is seventy-five percent. Low MASCC score and non-chemotherapy-related neutropenia are associated with a higher risk of unfavorable outcomes.

Quality Assessment in Supportive Care in Head and Neck Cancer.

Quality assessment is a key issue in every clinical intervention, to be periodically performed so to measure the adherence to standard and to possibly implement strategies to improve its performance. This topic is rarely discussed for what concerns supportive care; however, it is necessary to verify the quality of the supportive measures; “supportive care makes excellent cancer care possible,” as stated by the Multinational Association of Supportive Care in Cancer (MASCC). In this regard, the quality of supportive care in head and neck cancer patients is a crucial topic, both to allow administration of treatments according to planned dose intensity or surgical indications and to maintain or improve patients' quality of life. This paper aims to provide insight on state of the art supportive care and its future developments for locally advanced and recurrent/metastatic head and neck cancer, with a focus on quality assessment in relation to surgery, radiotherapy, and systemic therapy.

Editorial introductions

Current Opinion in Oncology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jean A. KlasterskyJean A. KlasterskyProfessor Klastersky was Head of the Department of Medicine at the Institut Jules Bordet in Brussels, Belgium, and Professor of Medicine, Medical Oncology and Physical Diagnosis at the Université Libre de Bruxelles, Belgium, from 1977. He retired from these positions in 2005. Currently, he is the coordinator of the “Programme des Soins Oncologiques” for the Public Hospitals in Brussels and consultant in medical oncology at the Institut Jules Bordet, Belgium. Professor Klastersky was an intern and resident at the University Hospitals of the Université Libre de Bruxelles between 1962 and 1965, where he gained his MD (Docteur en Médecine, Chirurgie et Accouchements). From 1967 to 1968, he was Chief-Resident at Boston City Hospital, USA, and then a Research Fellow and Assistant in Medicine at Thorndike Memorial Laboratory Harvard Medical School, USA. He became Chief of the Section of Infectious Diseases at the Institut Jules Bordet in 1970, before taking up the position of Head of the Department of Medicine in 1977. Professor Klastersky was a founder member of the European Lung Cancer Working Party and was President from 1978 until 2003. He was President (and founder member) of the International EORTC Antimicrobial Therapy Project Group between 1979 and 1987 and the Group's Secretary General from 1987 to 2000. He was President (and founder member) of the Multinational Association for Supportive Care in Cancer (MASCC) from 1990 to 2000. He has been Visiting Professor of Medical Oncology at the Charles University in Prague, Czech Republic, since 1994. Professor Klastersky is a member of the American Society of Clinical Oncology, the American Association of Cancer Research, the European Society of Medical Oncology, the American Society of Microbiology, the Infectious Diseases Society of America, the International Association for the Study of Lung Cancer, the “Royale Académie de Médecine” of Belgium and various other international and national medical and/or oncological societies. Professor Klastersky is the author of over 400 original articles, nearly 400 review articles and 17 scientific books. He is the Editor of Current Opinion in Oncology. Jean-Yves BlayJean-Yves BlayPr. Blay has published over 600 peer-reviewed articles. He was President of the European Organization for Research and Treatment of Cancer (EORTC) from 2009 to 2012. He has also received numerous awards such as the Hamilton Fairley Award in 2012 from the ESMO and the Henry and Mary-Jane Mitjavile prize in 2013 from the National Academy of Medicine. Currently President of the French Sarcoma Group GETO, he is the network leader of the NETSARC network of reference centers for sarcoma treatment certified by the French National Cancer Institute, the former PI of Conticanet (a FP6 network of excellence), and the current PI of the FP7 project EuroSARC). He is the Director of the Integrated Centre for innovation on Cancer Research of Lyon (LYRIC). He is the Network Director of the European Reference Network EURACAN (euracan.org). His research interests focus on clinical and basic research in sarcomas, targeted treatment of cancer, the biology of breast carcinoma and relation between tumor immunologic microenvironment and malignant cells with the goal of clinical applications in the fields of diagnosis, prognosis and treatment. Alain HendliszAlain HendliszDr Alain Hendlisz is a gastro-enterologist. He gained his MD (Docteur en Médecine, Chirurgie et Accouchements) at the Université Libre de Bruxelles, Belgium in 1988 and has been a specialist in gastroenterology since 1993. He earned his PhD in Medical Sciences at the ULB in 2015. He is currently Head of the Gastroenterology Unit at the Institut Jules Bordet, Anti-Cancer Center of the Université Libre de Bruxelles He is a founding member and is currently serving on the Board of the BGDO (Belgian Group for Digestive Oncology). He is a member of the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO), the Société Royale Belge de Gastro-entérologie (SRBG) and European Organization for Research and Treatment of Cancer (EORTC). He is involved as principal investigator or co-investigator in numerous national and international clinical studies.

Potential length of stay reduction with outpatient management of low risk febrile neutropenia in a regional cancer centre.

e18000 Background: Febrile neutropenia is a serious complication of chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score can reliably identify patients with febrile neutropenia at low risk of serious complications. Outpatient management programs utilising protocol based risk stratification, daily ambulatory nursing visits, telephone follow up and early outpatient review have been successfully piloted in other Australian cancer treatment centres. Methods: We performed a retrospective review of medical records for all patients admitted at our institution with febrile neutropenia between January 1 2016 and December 31 2018. We collected information regarding patient characteristics, cancer diagnosis and treatment, determined the MASCC risk index score, and if low risk, we determined the potential eligibility for outpatient care and potential reduction in length of stay. Results: A total of 98 hospital admissions with febrile neutropenia were analysed. Of these, 66 were determined to have a MASCC low risk index score. 58 patients met the eligibility criteria for outpatient management. The median age was 67 years. 71% were female. The most common tumour type was breast cancer. 52% were treated with palliative intent. The median length of stay was 3 days. The median potential reduction in length of stay for each admission was 2 days. The total potential reduction in length of stay was 198 days. No admission resulted in serious complications indicating the safety of outpatient care. Conclusions: Febrile neutropenia is a common complication of chemotherapy and a leading cause of hospital admission. This review demonstrates a significant number of hospital admission days can be avoided with outpatient care. We intend to conduct a prospective pilot study at our centre to institute an outpatient febrile neutropenia program for such low risk groups with potential reduction in hospital bed length of stay. This has significant implications on health resource usage, service provision planning and patient quality of life.