Oncological Profile Research Articles

Onco-specific sleep disorders and fatigue: tactics of psychological test and cognitive behavioral therapy

Introduction. Sleep disorders are widespread throughout the entire period of treatment of an oncological patient from the moment of diagnosis, and in many patients persist after completion of treatment. The nature of cancer and its treatment expose patients to many potential provoking and/or supportive factors that are atypical for the general population. In addition, sleep disturbance rarely manifests as a separate symptom, but more often occurs together with such symptoms as fatigue, pain, depression and/or cognitive impairment. This complicates the assessment and often requires an individual treatment plan with a team approach.
 AIM. of the work is to acquaint mental health specialists, oncologists, chemotherapists with the specifics of the examination of cancer-specific insomnia and fatigue, the construction of team treatment tactics, the organization of psychotherapeutic care for cancer patients.
 Results. The article describes for the first time the specifics of onco-specific insomnia and fatigue. The general predisposing and supporting factors of insomnia characteristic of cancer patients are systematized. The relationship between onco-specific fatigue and sleep disorders is shown. The role of pro-inflammatory cytokines as a common neuroendocrine-immune mechanism underlying the behavioral symptoms of sleep disorders, fatigue, depression and cognitive dysfunction in people with cancer is noted. Due to the limitations of the pharmacological approach, the purpose, forms, modes and approaches of using cognitive behavioral therapy protocols to minimize insomnia and fatigue are described. Based on the data of our foreign colleagues, we have proposed an algorithm for assessing sleep disorders in a patient with an oncological profile. The effectiveness of the standard protocol of cognitive behavioral psychotherapy of insomnia (SCBT-I) in a patient of the oncological profile Lavini Fiorentino is described in detail and shown; as well as the short protocol of CBT of cancer-specific insomnia by Eric Zo et al.; remote protocol of mindfulness enhancement therapy to minimize onco-specific fatigue Z.by Fieke et al.
 Conclusions. CBT in the framework of complex treatment has a positive effect on the immune system, reducing inflammation mediated through the hypothalamic-pituitary-adrenal axis. Despite the accumulation of evidence confirming the effectiveness of this form of psychological assistance, its availability in Russia remains extremely limited and not fully appreciated.

ПОТЕНЦИАЛ УЛУЧШЕНИЯ КАЧЕСТВА ОНКОЛОГИЧЕСКОЙ ПОМОЩИ

The quality of medical care is one of the leading problems of both foreign and domestic healthcare. The purpose of the study: to assess the potential of the quality of medical care of the oncological profile and to give recommendations for its improvement. Materials and methods. A study was conducted on the basis of the oncological service of the Ivanovo region. The research program included the use of expert, sociological and statistical methods. A survey of 120 doctors and an expert assessment of 410 cases of oncological care were conducted. A feature of the study was the use of an original method of integral assessment of the quality potential of oncological care. The potential for improving the quality of medical care was assessed in three components: infrastructure (personnel, logistics and drug support), procedural (compliance of the technology of assistance with standards and clinical recommendations), expert (quality of examination of the quality of medical care). Outcomes. It is established that the infrastructure component of the quality of medical care is of priority importance from the point of position of improvement (reserve 11,0%), in second place – the procedural component (9,0%), on the third – expert (5,0%). The survey showed that among medical personnel there is a high prevalence of adverse socio-hygienic factors: unsatisfactory housing conditions; a high percentage of unmarried personnel; a significant number of people suffering from chronic diseases; not observing the principles of a healthy lifestyle. Findings. The developed approach to improving the quality of medical care of the oncological profile, tested in the conditions of medical organizations of the Ivanovo region, will ensure targeted correction of factors associated with quality and a steady trend towards improving the quality of medical care. The set of proposals developed during the study was tested in an organizational experiment conducted on the basis of medical organizations that provide assistance to patients of the oncological profile of the Ivanovo region in 2019. According to the results of the implementation, a positive dynamic of the potential for the quality of medical care was obtained - from 91,7% to 98,5%.

PD34-02 THE KEY ROLE OF PSA DOUBLING TIME IN PATIENTS TREATED WITH SALVAGE RADIATION THERAPY AFTER RADICAL PROSTATECTOMY: IMPLICATIONS FOR THE EXTENT OF RADIATION AND THE CONCOMITANT USE OF HORMONAL THERAPY

PD34-02 THE KEY ROLE OF PSA DOUBLING TIME IN PATIENTS TREATED WITH SALVAGE RADIATION THERAPY AFTER RADICAL PROSTATECTOMY: IMPLICATIONS FOR THE EXTENT OF RADIATION AND THE CONCOMITANT USE OF HORMONAL THERAPY

PCN139 Value Frameworks and Innovative Contracting for Comprehensive Genomic Profiling

Appropriate use of comprehensive genomic profiling (CGP) in oncology has been shown to impact treatment decisions and improve patient outcomes. However, due to its complexity and impact uncertainties, value assessment and reimbursement decisions can be challenging. Leveraging a broad value perspective and innovative contracting may provide a framework for improved decision-making about the reimbursement and use of CGP. Our objective was to identify the elements of value and potential for innovative contracting for CGP in cancer.

Balloon occluded TACE (B-TACE) vs DEM-TACE for HCC: a single center retrospective case control study

BackgroundTo compare oncological results and safety profile of balloon micro-catheter trans-arterial chemoembolization (b-TACE) and drug-eluting-microsphere (DEM-TACE) in patients with hepatocellular-carcinoma (HCC).MethodsThis is a case–control, retrospective, single-center study. Between January-2015/March-2019, 149 patients (131 males [87.9%]) with 226 HCC were treated, 22 patients (35 HCC; 19 [86.4%] males) with b-TACE and 127 with DEM-TACE (191 HCC, 112 [88.2%] males). Embolization protocol was standardized (sequential 100 ± 25 and 200 ± 25 μm microspheres). Results were evaluated by modified-response-evaluation-criteria-in-solid-tumor [mRECIST] at 1, 3–6 and 9–12 months and time to recurrence after complete response [TTR] at 1 years. Cox’s regression weighted with tumor dimensions was performed. Adverse events (AEs) were recorded.ResultsmRECIST oncological response at all time points (1, 3–6 and 9–12 months) for both treatments were similar, with the exception of Objective response rate at 9-12 months. Objective response at 1 and 3–6 months between b-TACE vs DEM-TACE [23/35 (65.7%) vs 119/191 (62.3%), 21/29 (72.4%) vs 78/136 (57.4%) (p > 0.05), respectively]. On the contrary, at 9–12 months, it was significantly higher in b-TACE subgroup than DEM-TACE (15/19 [78.9%] vs 48/89 [53.9%], p = 0.05). TTR for complete response at 1 year had a better trend for b-TACE vs DEM-TACE (278.0 days [196.0–342.0] vs 219.0 days [161.0–238.0], OR 0.68 [0.4–1.0], p = 0.10). The use of balloon micro-catheter reduced the relative risk of the event of recurrence by 0.63 [CI95% 0.38–1.04]; p = 0.07). No significant differences were found in AEs rate.Conclusionb-TACE showed a trend of better oncological response over DEM-TACE with and longer TTR with a similar adverse events rate, in patients presenting with larger tumors.

Hepatitis C in immunocompromised pediatric patients: an epidemiological analysis of data from a center of pediatric hematology, oncology and immunology

Objective. To analyze the incidence of HCV in patients of the «Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology» (Center), to compare with the overall population incidence of HCV, to identify risk factors and risk groups of HCV infection in the Center’s patients. Materials and Methods. A retrospective analysis of the HCV incidence of HCV patients of the Center who were admitted to the Center between 01.07.2014 and 31.12.2020 was carried out. The study included patients aged 0 to 18 years, from all regions of the country, who had previously received therapy at their place of residence. Patient profile: hematological, oncological, immunological and surgical. The indications for testing for HCV were: hospitalization at the Center, stay at the center for 4–6 months, clinical indications. To assess risk factors and identify risk groups for HCV incidence, the main epidemiological aspects (age, sex, disease characteristics, geographical prevalence) were analyzed. Results. The incidence of HCV in the Center’s patients was 1.7%, which is 5 times higher than the incidence of the entire population of the country, and 50 times higher than that of the pediatric population. The highest incidence rate was observed in children aged 1 to 2 years – 2.8%. When comparing the risks of infection of the Center’s patients with the children’s population of the country in age groups under 1 year, from 1 to 14 years, and from 14 to 19 years, an excess of 29, 24 and 9 times was revealed, respectively. When analyzing nosological forms, it was found that the highest HCV incidence was in patients with primary immunodeficiencies – 3.2%, while in patients with malignant neoplasms – 1.8%. The region with the highest prevalence of HCV in our study was the Far Eastern Federal District (9%), namely the Amur Region (14%). Conclusions. Thus, the morbidity of patients with oncological and hematological profiles and patients with primary immunodeficiencies clearly demonstrates the problem of implementing the artificial mechanism of HCV transmission, which requires taking measures regarding the safety of invasive manipulations.

Деятельность дневных стационаров онкологического профиля в Российской Федерации и её субъектах за 2010–2019 годы

Relevance. Oncological diseases both in our country and in other countries of the world make a significant negative contribution to the overall mortality and disability of the population. Moreover, in the last decade, oncopathology is significantly more often affects the younger, employable population. One of the factors improving medical care is the provision of the population with specialists and hospital beds of oncological profile, including day care, where patients with this class of diseases could undergo a full course of pre-treatment, treatment, rehabilitation and recovery. Aim. To identify the dynamics of the main activity indicators of daily stay oncological hospitals of the public health sector in the Russian Federation, federal districts and regions of the Russian Federation for 2010–2019. Materials and methods. Using the data of federal statistical observation (form № 14DS) by the method of descriptive statistics, the main activity indicators of daily stay oncological hospitals in the Russian Federation, federal districts and regions of the Russian Federation in dynamics for 2010–2019 were analyzed. Results and discussion. In General, in the Russian Federation, the absolute number of oncologic hospital beds in daily stay hospitals of medical organizations providing inpatient care for the period from 2010 to 2019 increased by 3,5 times (from 1,448 to 5,013 beds), in daily stay hospitals of medical organizations providing outpatient care for the period from 2014 to 2019 by 67,1% (from 2,465 to 4,120 beds). At the same time the number of patients treated in oncological hospital beds in inpatient daily stay hospitals for the period 2010–2019 increased by 405,245 (from 78,120 to 483,365 people), and in outpatient daily stay hospitals for the period from 2014 to 2017 increased by 93939 (from 218,502 to 312,441 people). The average occupancy of an oncological hospital bed per year and the average duration of treatment in Russia in inpatient daily stay hospitals decreased from 409 days in 2010 to 380 days in 2019 and from 7,7 to 5,6 days, respectively, in outpatient daily stay hospitals from 407 days in 2014 to 386 days in 2017 and from 4,7 to 4,6 days, respectively. Conclusion. The expansion of the bed fund of daily stay hospitals of oncological profile is timely and justified, but its development in different regions of the Russian Federation is characterized by a pronounced disproportion. At present there are all the necessary reserves to continue the active development of the network of daily stay hospitals of this profile.

Status and dynamics of parameters of use of bed capacity of oncological profile in Russian Federation

In the Russian Federation (RF) a steady growth of morbidity with oncologic diseases is observed. An important factor of reduction of negative influence of oncopathology on the parameters of public health is provision of the population with specialists and beds of oncological profile, as well as their effective use.
 Aim. To determine the status and identify dynamics of the main parameters of use of beds of oncological profile of the state healthcare system of RF, federal districts and constituent entities of RF in comparison with tendencies of parameters of morbidity with malignant neoplasms, and also of provision of the population with medical personnel in the period from 2010 to 2019.
 Materials and Methods. Using the data of the Federal statistical observation forms (№30, 47, 14LC, 7) based on the calculation of absolute and relative parameters by the descriptive statistics method, the analysis of the main parameters of the use of bed resources of oncology profile was carried out in comparison with the parameters of morbidity with malignant neoplasms and provision of the population with medical personnel in 24-hour and day-stay hospitals in the Russian Federation, federal districts and constituent entities of the Russian Federation in 2010-2019.
 Results. During the study period, with the underlying increase in the morbidity of the population with diseases of neoplasm class (primarily, malignant) in the Russian Federation, there was found a regular increase in: the absolute number of oncological beds for 24-hour stay by 5.216 beds (+16.8%), provision with these beds from 2.17 to 2.47 per 10 000 population (+13.8%), hospitalization rate from 6.1 to 9.6 per 1000 population (+57.4%); and a decrease in: average stay in an oncological bed by 3.7 days (-30.6%, from 12.1 to 8.4 days), and the average bed occupancy by 15 days per year (-4.3%, from 345 to 330 days). Mortality in cancer beds increased from 0.76% in 2010 to 0.95% in 2019 (by 25.0%). There was an increase in the provision of the population with oncological beds in day-stay hospitals by 3.4 times, in day-stay hospitals of polyclinics by 63.6%.
 Conclusion. With the underlying growth of oncological morbidity in the country, the bed capacity of the oncological profile of 24-hour and day hospitals has significantly increased, with a high level of disproportional development of the bed capacity both between federal districts and between the subjects of the Russian Federation.

Abstract 1092: A systematic analysis of BRAF mutations and their sensitivity to different BRAF inhibitors

Abstract The MAPK-ERK signaling cascade is among the most frequently mutated pathways in human cancer, with the BRAF V600 mutation being the most common alteration. FDA-approved BRAF inhibitors as well as combination therapies of BRAF and MEK inhibitors are available and provide survival benefits to patients with a BRAF V600 mutation in several indications. Yet non-V600 BRAF mutations are found in many cancers and are even more prevalent than V600 mutations in certain tumor types. As the use of NGS profiling in precision oncology is becoming more common, novel alterations in BRAF are being uncovered. This has led to the classification of BRAF mutations, which is dependent on its biochemical properties and affects it sensitivity to inhibitors. Therefore, annotation of these novel variants is crucial for assigning correct treatment. Using a high throughput method for functional annotation of MAPK activity, we profiled 151 different BRAF mutations identified in the AACR Project GENIE dataset, and their response to 4 different BRAF inhibitors- vemurafenib and 3 different exploratory 2nd generation inhibitors. The system is based on rapid synthesis of the mutations and expression of the mutated protein together with fluorescently labeled reporters in a cell-based assay. Our results show that from the 151 different BRAF mutations, ~25% were found to activate the MAPK pathway. All of the class 1 and 2 mutations tested were found to be active, providing positive validation for the method. Additionally, many novel activating mutations were identified, some outside of the known domains. When testing the response of the active mutations to different classes of BRAF inhibitors, we show that while vemurafenib efficiently inhibited V600 mutations, other types of mutations and specifically BRAF fusions were not inhibited by this drug. Alternatively, the second-generation experimental inhibitors were effective against both V600 as well as non-V600 mutations. Using this large-scale approach to characterize BRAF mutations, we were able to functionally annotate the largest number of BRAF mutations to date. Our results show that the number of activating variants is large and that they possess differential sensitivity to different types of direct inhibitors. This data can serve as a basis for rational drug design as well as more accurate treatment options for patients. Citation Format: Zohar Barbash, Dikla Haham, Liat Hafzadi, Ron Zipor, Shaul Barth, Arie Aizenman, Lior Zimmerman, Gabi Tarcic. A systematic analysis of BRAF mutations and their sensitivity to different BRAF inhibitors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1092.

Costs of in-house genomic profiling and implications for economic evaluation: a case example of non-small cell lung cancer (NSCLC)

Objectives Genomic profiling in oncology is vital for determining eligible patients for mutation-specific targeted therapies. Use of commercial genomic testing has the potential to improve patient outcomes. Economic evaluations of in-house genomic profiling typically only include material costs while external commercial services include many other factors. Using non-small cell lung cancer (NSCLC) as an example, this study sought to characterize the unique challenges of costing testing services and their impact on results of economic evaluations. Methods Structured interviews with Canadian oncologists, pathologists, and laboratory directors were conducted to identify material and non-material costs associated with genomic-testing laboratories to allow estimation of a more complete cost of in-house testing, with NSCLC cost-per-test calculated using annual operational costs and NSCLC-specific testing volume. A health and budget impact model of in-house versus external commercial profiling services was used to compare the impact of non-material costs on results. Results In-house testing costs, limited to materials, was $133/single-gene test and $1,400/panel. For a laboratory running 1,300 in-house tests/year, total annual non-material costs included equipment maintenance ($6,842), labor ($502,313; technicians, administrative, and medical staff), shipping/reporting and software updates ($146,050), for an additional $519/test. The combined cost of $652/single-gene and $1,919/panel was compared to a cost of $6,194 for a commercial external test. Based on current Canadian testing patterns and anticipated utilization of external testing, inclusion of in-house non-material costs reduced the estimated 3-year budget impact by 12%. Conclusion When conducting economic evaluation to assess the value of introducing external tests, it is critical that non-material costs of standard testing strategies be measured and incorporated.

Objective methods for assessing the severity of patients condition in a surgical intensive care unit

Purpose of the review. Analysis of the objective methods to evaluate the need for prognostic scalesin the intensive care unit for predicting the risk of complications and mortality of cancer patients after elective surgery. The review considers methods for an objective assessment of the severity of the condition of patients in the intensive care unit of the oncological surgical profile: prognostic scales and expert evaluations. We have analyzed studies of foreign and Russian experts about comparing the best of the different prognostic scales in clinical practice for post-elective surgical cancer patients.Conclusion. Our review considers the need for an objective value of the severity of patients on admission to the intensive care unit for elective oncological surgeries by using prognostic scales. Further researchand selection of the most effective prognostic score complying with the principles of evidence-based medicine for this group of patients have a goodprospect.

Meta-analysis and trial sequential analysis of robotic versus laparoscopic total mesorectal excision in management of rectal cancer.

We aimed to evaluate comparative outcomes of robotic and laparoscopic total mesorectal excision (TME) in patients with rectal cancer. We systematically searched electronic data sources with application of combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators, and limits. Perioperative clinical and short-term oncological outcomes were evaluated. Trial Sequential Analysis of the outcomes was conducted. Nine randomised-controlled trials reporting 1463 patients evaluating outcomes of robotic TME (n = 728) and laparoscopic TME (n = 735) were included. Although the robotic approach was associated with significantly longer operative time (MD 31.64, P = 0.002), it was associated with significantly longer DRM (MD 0.8, P = 0.004) and shorter time to soft diet (MD - 0.50, P = 0.03) compared to the laparoscopic approach. Moreover, there was no significant difference in intraoperative (RR 1.07, P = 0.76)) and postoperative (RR 0.97, P = 0.81) complications, anastomotic leak (RR 0.93, P = 0.69), conversion to open rate (RR 0.46, P = 0.05), blood loss (MD 19.65, P = 0.74), time to first flatus (MD - 0.30, P = 0.37), LARS (RR 0.83, P = 0.41), ileus (RR 0.72, P = 0.39), positive CRM (RR 0.82, P = 0.49), PRM (MD - 0.5, P = 0.55), number of harvested lymph nodes (MD 0.33, P = 0.58), or length of stay (MD - 0.60, P = 0.12) between two groups. The Trial Sequential Analysis demonstrated that the risk of type 1 and type 2 errors was minimal in most outcomes. Moderate-quality evidence suggested that robotic and laparoscopic TME may be comparable in terms of clinical and short-term oncological profile but the robotic approach may be associated with longer procedure time. Future high-quality randomised studies are encouraged to compare the functional, long-term oncological, and cost-effectiveness outcomes of both approaches.

No significant risk of hematological malignancy in patients with neurofibromatosis type 1: single center study of children and adults

AbstractBackground/AimNeurofibromatosis type 1 (NF1) is characterized by the occurrence of multisystem tumors. The objective of this study was to analyze the demographic and oncological profile of 830 NF1-individuals regarding prevalence, type, and spectrum of malignancy.Patients and methodsThe medical records of patients diagnosed with NF1 with a median age of 22.1 years (range: 0.8–81.6 years) who were followed up for malignancies from 1999 to 2018 were retrospectively reviewed.ResultsThe prevalence of malignancy occurring in patients diagnosed with NF1 was 34.8% (289/830). The most common types of neoplasia encompassed tumors strictly associated with NF1, including plexiform neurofibromas (PNF; 200/830; 24.1%) and optic pathway gliomas (91/830; 11%). The prevalence of PNFs-transforming to malignant peripheral nerve sheath tumors (MPNST) was 3.5% (7/200). The prevalence of other tumors was 4.8% (40/830). One patient was diagnosed with acute myeloid leukemia (AML), thus the risk of hematological malignancies among all patients with NF1 was 0.1% (1/830). In the population of patients with malignancies, 43/289 (14.9%) individuals were diagnosed with more than one malignancy.ConclusionsThe odds ratio (OR) of malignancy in a studied cohort of patients with NF1 was 23 (p < 0.001), while the OR of hematological malignancy was 5.1 (p = 0.1) in comparison with the general population.

Plasma ctDNA sequencing supplementary to tissue-based molecular profiling as a source of additional actionable information in advanced cancers.

e15554 Background: The standard for tumor molecular profiling in precision oncology is the tissue-based biopsy. However, tissue biopsies are limited in the ability to capture the bulk of heterogeneity in advanced cancers. The integration of liquid biopsy diagnostics complementary to tissue-based sequencing may provide a broader perspective of heterogeneity and actionability. Methods: Patients with metastatic solid tumors were evaluated in the Indiana University Health Precision Genomics (PG) Program. We retrospectively analyzed existing genomic data from matched plasma and tissue that were collected within a 90-day window. Plasma sequencing was generated with a CLIA-certified test: FoundationACT/FoundationLiquid. Tumor tissue sequencing was performed either with CLIA-grade whole exome or a gene-panel. All sequencing data was reviewed by a molecular tumor board for the determination of a personalized treatment strategy. Molecular data for this analysis was concatenated and analyzed for mutations present in ctDNA but absent in tissue. Clinical actionability was defined based on clinical evidence of a biomarker to guide therapy or match a patient to a clinical trial. Results: 288 subjects with tissue- and plasma-derived mutation data were analyzed. Discordance, defined by the presence of a somatic mutation in the plasma that was not present in the tumor tissue, was detected in 156/288 (54%) of pairs. Interestingly, the discordance was clinically actionable in 26/288 (9%) subjects. In the 32 gene-level instances of actionable discordance, the 3 top mutated genes were PIK3CA (7), PTEN (4), and EGFR (4). Discordant mutations in ATM and CHEK2, which are actionable with PARP inhibitors, but also frequently mutated in clonal hematopoiesis of indeterminant potential (CHIP) represented 4/26 (15%) instances. A complete and formal CHIP analysis is ongoing. As a result of plasma discordance, targeted interventions were employed in 3/26 (12%) subjects targeting high TMB with immunotherapy, an ERBB2 mutation with ado-trastuzumab emtansine, and a BRCA1 mutation with olaparib. All 3 patients were non-responders. Conclusions: Discordant mutations that appear in ctDNA but not in matched tumor tissue is a common occurrence. The majority of these mutations are either not druggable or variants of unknown significance, but a significant subset would be deemed clinically actionable. Clinical efficacy of targeted intervention based on actionable liquid biopsy discordance warrants further investigation.

Abstract 42: The Influence Of Fat Grafting On Breast Imaging After Post-mastectomy Reconstruction: A Matched Cohort Analysis

Purpose: Fat grafting is a common adjunct procedure in breast reconstruction. While shown to have a safe oncologic profile, it may result in the development of palpable masses on physical exam, prompting further investigation with imaging and biopsy. The aim of this study was to assess the influence of fat grafting on the incidences of palpable masses, imaging, and biopsies after post-mastectomy breast reconstruction. Methods: Patients who underwent autologous or implant-based reconstruction following mastectomy from 2010-2018 were identified. Those receiving fat grafting as part of their reconstructive course were propensity matched in a 1:1 ratio to those that did not undergo a fat grafting procedure with BMI, reconstruction timing, and reconstruction type as covariates in a multivariable logistic regression model. Results: A total of 186 patients were identified, yielding 93 propensity-matched pairs. Patients that underwent fat grafting had higher incidences of palpable masses (38.0% vs. 18.3%; p=0.003) and post-reconstruction imaging (47.3% vs. 29.0%; p=0.01). However, there was no significant difference in the number of biopsies performed between patients who did and did not receive fat grafting (11.8% vs. 7.5%; p=0.32). When looking at imaging characteristics amongst the fat grafted cohort, imaging was predominately interpreted as normal (BIRADS 1, 27.9%) or benign (BIRADS 2, 48.8%), with fat necrosis being the most common finding (n=20, 45.5%). No demographic, oncologic, reconstructive, or fat grafting-specific variables were independently predictive of receiving post-reconstruction imaging in multivariate analysis when controlling for follow-up time. On Kaplan-Meier analysis, fat grafting was not associated with decreased 5-year overall survival or locoregional recurrence-free survival. Conclusions: Fat grafting to the reconstructed breast is associated with increased incidences of palpable masses and subsequent post-reconstruction imaging. However, fat grafted patients do not undergo more biopsies, owing to the successful identification of fat-related changes on imaging. Thus, patients should be counseled in the preoperative period that they may be more likely to detect a palpable mass following fat grafting, and may be subject to more diagnostic imaging. Patients should be reassured, however, that fat grafting has a safe oncologic profile and does not affect overall or locoregional recurrence-free survival.

Patient comfort and safety principles

The purpose of the work is to identify important directions for restoration and/or maintenance of the quality of life of the patient of oncological profile. At different stages of disease development, importance of nursing care, priority of care measures will change. The nurse needs to identify in a timely manner the problems of the patient suffering from malignant tumor and find ways to solve them.

ДИНАМИКА ОСНОВНЫХ ПОКАЗАТЕЛЕЙ РАБОТЫ КОЕК ОНКОЛОГИЧЕСКОГО ПРОФИЛЯ КРУГЛОСУТОЧНОГО И ДНЕВНОГО ПРЕБЫВАНИЯ В РОССИЙСКОЙ ФЕДЕРАЦИИ И ЕЁ СУБЪЕКТАХ

The incidence of malignant neoplasms in Russia is growing and in 2018 amounted to 425.4 cases per 100000 population, what is 23.1% higher than the level of 2008, this requires optimization of the provision of both outpatient and inpatient medical care to this contingent. The main efficiency indicators of the oncologic profile bed fund of both round-the-clock and daily stay hospitals in the Russian Federation, in dynamics for 2010-2018 years are analyzed in the article.

Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study.

Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroupofAb-negative-AE. This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P=0.045), responded more frequently to treatments (92.3% vs. 65.6%, P<0.001) and received second-line therapies more often (33.3% vs. 10.8%, P=0.01). Delays in first-line therapy initiation were associated with poor response (P=0.022; odds ratio 1.02; confidence interval 1.00-1.04). In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.

Особенности распределенного хранения медицинских изображений в онкологической службе в рамках создания единого цифрового контура

The development of an effective unified information space of the regional radiology diagnostics service is possible by connecting all outpatient cancer care centers and medical organizations to distributed medical image storage systems under the management of regional radiological information systems within the framework of the regional programs “Creation of the unified digital circuit in healthcare based on the unified state health information system” of the territorial subjects of the Russian Federation. The aim of the research is to study the features of using radiological information systems in the oncological profile and develop recommendations for creating distributed archives of medical images in the oncology service within the framework of the federal project. The paper considers the results of the implementation of software products “LINS LookInside”, “LINS Makhaon” in the framework of implementation of local and regional projects in cancer clinics. The data on the connected diagnostic equipment and integration with medical information systems are provided. It has been established that each medical organization with an oncological profile should have its own local PACS installed. Using the example of federal cancer centers, it is recommended to include endoscopic departments, radionuclide and ultrasound diagnostics rooms in radiological information systems, as well as to install and connect systems for automatic publication of CD/DVD discs with DICOM studies.

Genomic profiling in gynaecological oncology: the future is now!

Genomic profiling in gynaecological oncology: the future is now!