Oncology Service Research Articles

Assess and improve (AAIM) implementation of corticosteroid sick day rules in transplant and oncology services. A single-centre steroid safety project

Assess and improve (AAIM) implementation of corticosteroid sick day rules in transplant and oncology services. A single-centre steroid safety project

PAEDIATRIC-15 MANAGEMENT OF PEDIATRIC CENTRAL NERVOUS SYSTEM TUMORS BY A NEURO-ONCOLOGY MULTIDISCIPLINARY TEAM : OUR EXPERIENCE

Abstract The outcome of pediatric central nervous system tumors has improved over the past decades due to advances in diagnostic testing, treatment and increased understanding of the disease biology. Nevertheless, the probability of survival of this tumors remains much lower in low-to middle-income countries. The gaps that prevent optimal clinical management of brain tumors are multifactorial and mostly related to underdiagnosis; a lack of specialized and dedicated radiologic, histopathologic, neurosurgical, radiotherapeutic, and oncology services, and a deficiency of coordinated multidisciplinary care in many centers. The aim of this report was to evaluate the impact of multidisciplinary team meetings on the clinical management of pediatric central nervous system tumors in Abidjan (Côte d'Ivoire). We retrospectively reviewed the clinical data of pediatric patients (aged <15 years) with central nervous system tumors diagnosed and treated in the Neurosurgery Department and National Center of Radiotherapy between 2019 (the year a neuro-oncological multidisciplinary staff was established) and 2023. Data on patient demographics, clinical notes, imaging studies, tumor characteristics and multidisciplinary team decision were collected from the multidisciplinary team database. During the multidisciplinary team meetings era, 40 pediatric central nervous system tumors were diagnosed and treated. The median age at diagnosis was 8.5 years. The mostly histological types were high grade and low grade gliomas. Decision-making was largely consistent with available guidelines. Therapeutic were surgery, external beam radiation treatment with concurrent and adjuvant chemotherapy. Benefits of neuro-oncology multidisciplinary team include coordination, direction for complicated cases, education, and a forum for communication, and clinical trials.

Cost-effectiveness of drug therapy prescribed in special situations at hospital

ObjectiveThe Pharmacy and Therapeutics Committee is an advisory body to the medical management of our hospital. Following Royal Decree 86/2015, which regulates the Pharmacy and Therapeutics Committee of the Balearic Islands, this committee prepared a technical report in which it assessed the possible internal use of off-label drugs, drugs for compassionate use, and drugs not included in the hospital's pharmacotherapeutic guide. The objective was to analyse the clinical response achieved with the use of these drugs and their associated costs. MethodRetrospective study of drugs whose use was requested from the hospital's Pharmacy and Therapeutics Committee hospital between January and December 2018. We analysed whether the requested treatment achieved the objective established by the physician. The cost was calculated based on the duration of the treatment until the objective was achieved or until treatment was discontinued. ResultsIn total, 70 requests were analysed: 59% achieved the expected therapeutic goal, 34% were considered to be therapeutic failures, and 7% were lost to follow-up. The overall cost of the 70 authorized treatments was €1,140,240. The average cost per request was €16,288. Oncology and Haematology services submitted more than 50% of the requests, and more than 75% of the budget was allocated to these medical services. ConclusionsMore than half of the treatments analysed by the Pharmacy and Therapeutics Committee of the hospital achieved their therapeutic goal, although the economic cost of their use was high.

GLIOMA-15 RETROSPECTIVE REVIEW OF GLIOBLASTOMA MULTIFORME CASES MANAGED AT A TERTIARY LEVEL HOSPITAL IN KENYA

Abstract Glioblastoma Multiforme(GBM) is one of the most aggressive tumors of the central nervous system. Though rare, it accounts for the commonest primary brain tumor in adults. Despite recent advances in the treatment of patients with GBM, it portends a poor prognosis. There is limited published data of GBM from sub-Saharan Africa(SSA). We performed a retrospective chart review of 24 patients seen in the Medical Oncology service at the Aga Khan University Hospital between January 2018 and December 2020. Clinical, radiological, pathological outcomes were investigated, analyzed and compared with data from the literature. A total of twenty-four patients were seen at the medical oncology clinic over the 3-year period. The median age of the patients was 54 years (IQR 44.7-65) and majority of patients (>80%) were of African descent. Of the 24 patients, 13(54.2%) were male and 11(45.8%) were female. Headaches were the commonest clinical presentation and frontal lobe was commonest tumor location on imaging. The median size of the tumor was 4.5cm (IQR 3.8-6.45). Following diagnosis, eighteen(75%) patients underwent maximal safe resection of the tumor with presence of residual tumor in thirteen (56%) of the post-operative scans. Nineteen patients(83%) were initiated on concurrent chemotherapy (Temozolamide) and Radiation therapy (CCRT) as part of adjuvant treatment. Of those initiated on adjuvant Temozolamide following CCRT, more than one-third completed one year of treatment. At 6 months following diagnosis, 25% of patients remained stable while 25% had disease progression. Our study adds to the literature which demonstrates that patients seen in SSA with GBM present at younger age, with bigger tumor size but tend to do better compared to those in the west. Understanding of the molecular alterations within the tumor and larger prospective studies are needed to define the behavior of GBM in SSA.

PATIENT ADVOCACY-01 WHY IS NEURO- ONCOLOGY MISSING FROM CIVIL SOCIETY CANCER ADVOCACY AGENDA?

Abstract BACKGROUND Cancer civil society and patient groups across Africa play a major role in pressuring governments to develop, fund, and implement national cancer control plans and to keep their commitments to international declarations. Additionally, community cancer awareness is mainly driven by lay cancer advocates and cancer survivors. The cancer policy and legislation landscape in Kenya has largely been shaped by the civil society through consistent advocacy OBJECTIVE Explore barriers and enablers to meaningful engagement of cancer civil society advocates in advancing neuro-oncology in Africa. METHODOLOGY This is a desk review of current developments and literature in advocacy for neuro-oncology with insights and perspectives of practicing oncology nurses and civil society cancer advocates in Kenya. FINDINGS Cancer advocacy in Kenya has traditionally focused on creating awareness on the more common cancers, breast, cervical prostate and Gastro-intestinal cancers. Over the last 10 years’ attention has gradually shifted to access and cost of care. Cancers of the central nervous system such as gliomas, neuroblastomas and meningiomas, though not uncommon do not feature prominently in advocacy discourses. This is due the fact that they are perceived as ‘rare’, complex, difficult to explain and with poor outcomes. DISCUSSION AND IMPLICATIONS There is a growing appreciation of the need to develop a framework through which civil society can contribute to the development of quality neuro oncology services. Cancer civil society organizations, neurosurgeons, neurologists, oncologists, academicians, and other healthcare professionals must work together to overcome structural barriers so that neuro oncology is not left behind in the national cancer plans. Stakeholders will need to establish guidelines with well defined mechanism for engaging, involving and acknowledging the contribution of cancer advocates in advancing neuro-oncology. This will require a cultural shift from neuro-oncology professionals to accommodate the input of lay civil society advocates.

Observational study of drug-drug interactions in oncological inpatients

ObjectiveTo determine the prevalence of potential clinically relevant drug-drug interactions in adult oncological inpatients, as well as to describe the most frequent interactions. A standard database was used. MethodAn observational, transversal, and descriptive study including patients admitted to the Oncology Service of a reference hospital. All prescriptions were collected twice a week during a month. They were analysed using Lexicomp® database, recording all interactions classified with a level of risk: C, D or X. ResultsA total of 1 850 drug-drug interactions were detected in 218 treatments. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 94.5% for those at level C and 26.1% for levels D and X. The drugs most commonly involved in the interactions detected were opioid analgesics, antipsychotics (butyrophenones), benzodiazepines, pyrazolones, glucocorticoids and heparins, whereas interactions with antineoplastics were minimal, highlighting those related to paclitaxel and between metamizole and various antineoplastics. ConclusionsThe prevalence of clinically relevant drug-drug interactions rate was very high, highlighting the high risk percentage of them related to level of risk X. Due to the frequency of onset and potential severity, highlighted the concomitant use of central nervous system depressants drugs with risk of respiratory depression, the risk of onset of anticholinergic symptoms when combining morphine or haloperidol with butylscopolamine, ipratropium bromide or dexchlorpheniramine and the multiple interactions involving metamizole.

Exploring the Psychosocial Needs of Adults with Haematological Cancer under Watch-and-Wait: A Qualitative Study

Objective. Research reporting the unmet needs of individuals with haematological cancers under watch-and-wait is scarce, despite reports of elevated levels of psychological distress. This qualitative study aimed to explore the psychosocial needs of these individuals, and when these were met, if so at all. Methods. A longitudinal design using semistructured interviews was used. Individuals with a diagnosis of haematological cancer living under watch-and-wait were recruited through online support groups. Participants were each invited to two semistructured interviews, six months apart. Interviews took place in March 2022 and September 2022 and were therefore in the context of the COVID-19 pandemic. All interviews were recorded and transcribed verbatim. Reflexive thematic analysis and pattern-oriented longitudinal analysis were used to analyse the data. Results. Of the fifteen participants interviewed initially, twelve attended a second interview. The sample was predominantly White and female. Across participants and time points, a theme was generated that individuals experienced a “Psychological battle of watch-and-wait.” Under this overarching theme, four themes were constructed: “Understanding the impossible: Cancer that does not require treatment;” “Sense of abandonment under watch and wait;” “The importance of peer connection;” and “Trying to live after COVID-19.” The themes were understood to predominantly represent needs for information, communication, peer support, and emotional support and were most often met when individuals engaged with relevant charities. Conclusion. People living with haematological cancer under watch-and-wait may be at risk of having unmet needs across domains, and without support, these needs will likely remain unmet over time. The findings add to the growing literature base how Oncology and Haematology services can holistically support individuals with indolent cancers to live well alongside their diagnosis.

Variability in expenses related to spine oncology care: comparison of payer-negotiated rates at National Cancer Institute-Designated Cancer Centers

BACKGROUNDAs of 2021, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals to publish their commercially negotiated prices. To our knowledge, price variation of spine oncology diagnosis and treatments has not been previously investigated. PURPOSEThe aim of this study is to characterize the availability and variation of prices for spinal oncology services among National Cancer Institute-Designated Cancer Centers (NCI-DCC). STUDY DESIGNCross-sectional analysis. METHODSCancer centers were identified; those that did not provide patient care or participate in Medicare's Inpatient Prospective System were excluded. A cross-sectional analysis was conducted to gather commercially negotiated prices by searching online for “[center name] price transparency OR machine-readable file OR chargemaster.” Data obtained was queried using 44 current procedural terminology (CPT) codes for imaging, procedures, and surgeries relevant to spine oncology. Comparison of prices was achieved by normalizing the median price for each service at each center to the estimated 2022 Medicare reimbursement for the center's Medicare Administrator Contractor. The ratios between the lowest and highest median commercial negotiated price within a center and across all centers were defined as “within-center ratio” and “across-center ratio” respectively. RESULTSIn total, 49 centers disclosed commercial payer-negotiated rates. Mean rate (±SD) for cervical corpectomy was $9,134 (±$10,034), thoracic laminectomy for neoplasm excision was $5,382 (±$5502), superficial bone biopsy was $1,853 (±$1,717), and single-photon emission computerized tomography (SPECT) was $813 (±$232). Within-center ratios ranged from 5.0 (SPECT scan) to 17.8 (radiofrequency bone ablation). Across-center ratios (for codes with > 10 centers reporting) ranged from 9.0 (corpectomy, thoracic, lateral extra-cavitary) to 418.7 (anterior approach cervical corpectomy). CONCLUSIONSPrice transparency for spinal oncology remains elusive despite recent CMS regulatory oversight, with marked heterogeneity in the quality of published rates complicating patients' ability to “shop” for care. Additionally, there continues to be significant variation in commercial rates for spine oncology diagnosis and treatment. CLINICAL SIGNIFICANCEDespite regulation by CMS, prices for spinal oncology services are not uniformly available to patients and vary between NCI-DCC. The findings of this manuscript present potential barriers for patients to compare and obtain affordable care.

Impact of childhood and adolescence cancer on family caregivers: a qualitative analysis of strains, resources and coping behaviours

BackgroundThe physical demands of caring for children and adolescents diagnosed with cancer, over a lengthy period, exert significant strain on the health and well-being of family caregivers. The capacity of family caregivers to surmount and cope with the various strains they experience due to the diagnosis and treatment trajectory is essential to the quality of life of the child and adolescent who has been diagnosed with cancer. However, the experiences of family caregivers have been under-explored. This study explored the strains, resources, and coping strategies of family caregivers of children and adolescents diagnosed with cancer in Ghana.MethodsGuided by a descriptive phenomenological design, 20 semi-structured interviews with family caregivers were conducted at a tertiary health facility that provides paediatric oncology services. The study was conducted between June and October 2022. The interviews were transcribed verbatim, translated and coded using NVivo software. An inductive thematic analysis approach using Vaismoradi et al.’s thematic analysis framework was followed in analysing the data.ResultsThe study revealed that family caregivers of children diagnosed with cancer experienced three main strains: somatic strains (poor sleep quality, loss of appetite, and unintended weight loss), economic strains (financial burden and loss of economic livelihood), and psychosocial strains (isolation from social activities and network, frustration and helplessness, and balancing multiple family needs). The following themes emerged as coping resources: family cohesiveness, community support, and support from health care providers. Coping strategies that emerged included trusting in God and being self-motivated.ConclusionThe study concludes that family caregivers experience somatic, economic, and psychosocial strains. However, they can leverage available resources (family cohesiveness, community support, and support from healthcare providers) to cope with these strains. There is a need to educate and sensitize family caregivers about the potential strains that they are likely to experience prior to the assumption of care roles. Also, the formal inclusion of non-governmental organizations and religious bodies will ensure that family caregivers receive sufficient community support to cope with the strains of caregiving.

Demand-oriented design of telemedical services in gynecologic oncology

BackgroundThe medical field is in the midst of a massive expansion in telemedical services. However, it is not possible to say to what extent telemedical offerings can be designed to meet needs in the German healthcare system. This study provides insights into demand-oriented care using telemedical services for gynecological patients.MethodsA total of 262 patients who received systemic therapy for gynecological oncology were surveyed anonymously using a questionnaire regarding their acceptance of telemedicine from February 2021 to April 2021.ResultsInsufficient computer skills were associated with less acceptance of telemedicine treatment by gynecological oncology patients and presented a barrier. However, the patient’s level of education was not related to the level of acceptance. Long travel distances from medical facilities and some types of patient occupations significantly increased the acceptance of telemedicine services. A high level of education, on the other hand, was not associated with the approval of telemedical approaches. Long journeys and work commitments increased the acceptance of telemedical visits.ConclusionsThe results of this study show that the factors investigated have an influence on the acceptance of telemedical offerings by patients. Barriers such as insufficient computer skills must be taken into account when implementing telemedicine services. Telemedicine can provide physical and economic relief for patients if telemedical planning is tailored to their needs.

The state of cancer care in Russia: breast cancer. Epidemiology and survival of patients. The impact of the SARS-CoV-2-beta-coronavirus epidemic (clinical and population study)

Background. Breast cancer is the main cause of morbidity and mortality of the female population among economically developed countries, including in Russia. Despite the continued increase in morbidity, mortality is decreasing, which is confirmed by a decrease in the index of accuracy (the ratio of the number of deaths to the sick). Calculations of survival at the population level (the most important criterion for evaluating the activities of the oncological service) in Russia are carried out only on the basis of databases of the population cancer registry of the North-Western Federal District. The accumulated 1.5 million primary cases of malignant tumors allowed for the in-depth development of data on rare tumor localities, including breast cancer among the male population.Aim. To study the impact of the coronavirus pandemic on the dynamics of the process of detection, mortality and survival of breast cancer patients in Russia and in the North-Western Federal District of the Russian Federation.Materials and methods. The material of the study is the reference books of the P. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia, and the N.N. Petrov National Medical Research Oncology Center, Ministry of Health of Russia, and the database of the population cancer registry of the North-Western Federal District, clinical materials of the surgical department of breast tumors of theN.N. Petrov National Medical Research Oncology Center. More than 110 thousand primary cases of breast cancer were selected. Data processing was carried out by standard methods of oncology statistics recommended by the International Association of Cancer Registries (Eurocare program).Results. A significant impact of the coronavirus pandemic on the primary registration of breast cancer in Russia from 2019 to 2020 has been established, with some weakening of its impact in the subsequent period. The pandemic has had a significant impact on the quality of primary registration of patients. The value of the index of accuracy has been set back five years, but there is a sign of its improvement in 2021. The positive dynamics of one-year and five-year survival of patients with breast cancer is shown. The quality of registration of patients with breast cancer by detailed localization and histological structures of breast cancer was investigated. A significant decrease in the mortality of patients was noted when studying the patterns of dynamics in annual mortality over three follow-up periods.Conclusion. A steady increase in the incidence of breast cancer among women has been established, and the negative impact of the coronavirus pandemic has been noted. The mortality rate of the Russian population from breast cancer continues to decrease. The localization and histological structure of the incidence of breast cancer in women remains unchanged. The one-year and five-year survival rate of breast cancer patients continues to grow.

A role of National Cancer Control Programme during COVID-19 pandemics - experience from Slovenia

Abstract Issue Cancer is a major public health issue. Countries should tackle it with setting up National Cancer Control Programmes (NCCP), which are especially important during extreme circumstances. In Slovenia, during the COVID-19 pandemic, we managed to follow the direction set out in the NCCP. Description of the problem Slovenia has had a NCCP since 2010. The program's activities are already yielding results at a national level. During the COVID-19 pandemic, oncology services in Slovenia were designated as an exception that should not be interrupted. However, the functioning of primary care level has been modified due to COVID-19 management. This reflected in the drop of new cancer diagnoses and temporary stop of cancer screening programmes. Results During pandemics timely monitoring of cancer care has been set up by Slovenian Cancer Registry. During the first wave more than 30% drop in new cancer diagnoses has been observed. The results have been presented to policy makers and general public. Appeals to the policy makers to resume cancer screening as soon as possible, communication campaigns urging people to see a doctor, if they notice any signs of cancer, and support for all providers to maintain cancer care uninterrupted have been initiated by the NCCP. These activities resulted in only 3 months stop of the three national cancer screening programmes, and enhanced activities after their restart; the cancer awareness was raised in the next COVID-19 waves, since the drop in the new cancer diagnoses during following waves (autumn 2020- spring 2021) reached to “only” 10%. And institutions related to cancer care have remained dedicated to cancer throughout the whole pandemic period. Lessons Coordinated national cancer strategy can have important influence on policy makers and general population, raising awareness and preventing major disruptions. Coordinated support for cancer care was crucial to avoid worse long-term cancer outcomes. Key messages • Strategic framework of activities through NCCP have important impacts on the provision of cancer care, especially during extreme circumstances, such was COVID-19, which diminish health care delivery. • Strategic framework of activities through NCCP have important impacts on the provision of cancer care, especially during extreme circumstances, such was COVID-19, which diminish health care delivery.

Prevalence and types of drug interactions in hospitalized pediatric patients in Mexico City

ObjectiveDrug-drug interactions may modify the therapeutic effect or the safety profile of the medicines used in pediatric populations. Although interest on potential drug interactions in these age groups has increased, information on clinically relevant drug-drug interactions is still scarce. The aim of this study was to explore the prevalence and characteristics of potential and clinically relevant drug-drug interactions among pediatric patients hospitalized in two pediatric hospitals of Mexico City. MethodA cross-sectional study was conducted on patient records in critical, oncological, burns and other non-critical services by a pediatric resident physician at both hospitals. Micromedex® was used as a source of potential drug-drug interactions data. Subsequently, each interaction's prevalence, severity and evidence level were estimated. Additionally, drug-drug interaction causality with regard to diverse clinical outcomes of hospitalized patients was determined through the Drug Interaction Probability Scale. The clinical consequences of each interaction were classified by severity. ResultsThe observed prevalence of one or more potential drug-drug interactions in hospitalized patients was 61.3% (52.2-70.4%), whilst the prevalence of real drug-drug interactions was 3.6% (0.1-7.1%). Of potential drug-drug interactions, 60.5% were considered major and only 5.1% contraindicated. These were generally more common in intensive care and burn units. The main pharmacological agents involved in potential drug-drug interactions were opioids analgesics and anti-infective and neurologic agents. Four clinically relevant drug-drug interactions required a regimen change and another prompted an extension of the patient's hospital stay. ConclusionsPotential drug-drug interactions were common in the pediatric patients studied, whereas the frequency of real drug-drug interactions was low. However, some drug-drug interactions required medical actions in addition to routine monitoring. More information is needed on real drug-drug interactions as those related to failed efficacy might be underestimated.

Advancing health information during interhospital transfer: An interrupted time series.

Although the transfer of patients between acute care hospitals (interhospital transfer, IHT) is common, health information exchange (HIE) during IHT remains inadequate, with fragmented communication and unreliable access to clinical information. This study aims to design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT. Study subjects include patients aged >18 transferred to the medical, cardiology, oncology, or intensive care unit (ICU) services at an 800-bed quaternary care hospital; and healthcare workers involved in their care. The first aim of this study is to optimize clinician workflow, data visualization, and interoperability through user-centered design sessions for HIE platform development. The second aim is to evaluate the impact of the intervention on clinician-reported medical errors among 500 pre- and 500 postintervention IHT patients using interrupted time series methodology, adjusting for confounding variables and temporal trends. The third aim is to evaluate intervention fidelity, use and perceived usability of the platform, and barriers and facilitators of implementation from interprofessional stakeholder input, using mixed-methods evaluation. The fourth aim is to consolidate key findings to create a toolkit for spread and sustainability. We will track patient safety endpoints and clinician workflow burdens and ensure the protection of patient data throughout the study. We will disseminate our findings via the creation of a toolkit for spread and sustainability, partnering with our funder (AHRQ) for dissemination, and communicating our results via abstracts and publications.

Establishment of Surgical Oncology Services at ANTH: Challenges & Outcomes

Establishment of Surgical Oncology Services at ANTH: Challenges & Outcomes

Dedicated to the Memory of Academician Grigory Vasilievich Bondar and the 80th Anniversary of the Oncological Service of Donbass

The oncological service of Donbass has a rich history. The path of its formation began in 1943, when on September 9, 1943, Professor M.K. Afanasiev signed an order to restore the activities of the Stalin X-ray station and the oncological hospital.The first organizer of the radiological service in the Donbass is considered to be Ekaterina Vladimirovna Stelling, who was appointed in 1946 to the post of head of the oncological hospital in Stalino. The radiological service appeared in 1947, when the Regional Oncological Dispensary was organized. Soon the institution was renamed the Donetsk Regional Oncological Dispensary (DROD). Soon the institution was renamed the Donetsk Regional Oncological Dispensary. In 1955, DROD, in order to increase the number of beds, was transferred to the base of the Regional Clinical Hospital. M.I. Kalinin.Under the leadership of Grigory Vasilyevich Bondar, in September 1968, an oncology course was organized, the clinical base of which was DROD. August 19, 1975 Grigory Vasilyevich headed the Department of Oncology, established at the Donetsk State Medical Institute. M. Gorky. October 12, 1992 Donetsk Regional Oncology Center received the status of an antitumor center. Academician of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Grigory Vasilyevich Bondar has been appointed its General Director.The center, which subsequently became the leading one in Ukraine, had the greatest experience in surgical and combined treatment of tumors of various localizations using the methods proposed in the clinic. In 2006, the first radiotherapy complex in Ukraine was installed in the Donetsk Regional Cancer Center.At the beginning of 2014, our teacher passed away. Students with dignity continue the work of Bondar Grigory Vasilyevich. At the end of 2014, on the basis of the Donetsk Regional Antitumor Center, the Republican Cancer Center of the Ministry of Health of the Donetsk People’s Republic was created, which was named after Professor Grigory Vasilyevich Bondar. The Center proudly bears the name of the great Teacher Grigory Vasilyevich Bondar! And in our present life, he is still a mentor and assistant!We are sure that the symbiosis of science and practice of a team of professionals who selflessly give their knowledge, experience and skills for the benefit of patients will give a powerful impetus to the further development of the oncological service of Donbass.

THU106 Malignant Epithelioid Neoplasm As The Cause Of A Rapidly Growing Pituitary Mass

Abstract Disclosure: S. Riahi: None. S.S. Chaidarun: None. Background: Malignant epithelioid neoplasm is a rare cause of a pituitary mass, and should be kept on the differential whenever evaluating patients with evidence of rapid pituitary enlargement. Clinical Case: A 43 year-old man presents with 3-month history of worsening severe headaches, decreased libido, erectile dysfunction, polydipsia, polyuria (6L/day) with nocturia every hour, and fatigue. He also noted some blurry vision without loss of his peripheral vision. MRI of the brain showed a 1.5cm mass in the sellar and suprasellar region abutting the optic chiasm. Of note, he had a brain MRI performed 18 months prior for vertigo which did not demonstrate any mass in the pituitary. He presented to the endocrinology office for evaluation. His laboratory tests demonstrated mildly elevated prolactin 31.2 ng/mL (n 4.0-15.2), and findings consistent with panhypopituitarism and central diabetes insipidus, including low FT4 of 0.46 ng/dL (n 0.93-1.70), FSH 0.7 mIU/mL (n 1.5-12.4), an undetectable LH (n 1.7-8.6mIU/mL), random cortisol of 1mcg/dL (n 4.8-19.5) ACTH 6.2 pg/mL (n 7.2-63), IGF-1 of 139 ng/mL (n 44-275), total testosterone undetectable (n 240-950 ng/dL), sodium 144mmol/L (n 135-145) with low urine specific gravity 1.008 and urine osmolality of 143mOsm/Kg (n 60-1200). HCG was undetectable (n 0-2mIU/mL) but LDH was elevated at 313 unit/L (n 110-220). He was started on corticosteroids, levothyroxine, DDAVP, and referred to neurosurgery. Specimens from his transphenoidal biopsy demonstrated findings consistent with a malignant epithelioid neoplasm. Further analysis and genetic testing is still pending. He has been referred to oncology service for further management and care. Conclusion: A rapidly growing symptomatic pituitary mass with central diabetes insipidus should raise suspicion for malignant etiology beyond the more prevalent pituitary adenoma. Malignant epithelioid neoplasm are uncommon tumors of the brain, however they are known to be aggressive tumors with high mortality. Treatment commonly includes some combination of surgery, radiotherapy, and chemotherapy1. Reference: (1) Jog AP, Ronderos DM, Ali A, Niazi M, Diaz-Fuentes G. Malignant Epithelioid Neoplasm of the Brain. Cureus. 2020 Aug 27;12(8):e10079. doi: 10.7759/cureus.10079. PMID: 33005505; PMCID: PMC7523542. Presentation: Thursday, June 15, 2023

Identifying the Risk Factors for Malignant Mammary Tumors in Dogs: A Retrospective Study.

Mammary cancer is one of the main causes of death in female dogs worldwide, considering that many risk factors are involved in its development. This study aimed to elucidate the relationship between epidemiological and clinical risk factors with the histopathological diagnosis of malignant mammary tumors in dogs treated at the Veterinary Hospital of the Federal University of Uberlândia, which has one of the first veterinary oncology services in Brazil. A retrospective matched case-control study was conducted to identify risk factors for the development of malignant mammary tumors in dogs. The variables analyzed were size dog, breed, housing, type of diet, and body score. Potential risk factors were selected by univariate analysis (p < 0.25) before multivariate forward binary logistic regression. The most frequent benign tumor was the benign mixed tumor (35.2%), and the most frequent malignant tumor was the mixed carcinoma (27.4%). Size dog, breed, housing, and overweight are predictors of malignant mammary tumors in dogs. The highest risk of developing malignant mammary tumors is associated with large female dogs, Yorkshire or Poodle breeds, living outside the home, or being overweight.

Pesquisa documental dos aspectos clínicos e epidemiológicos do linfoma em cães atendidos na Universidade Federal Rural do Rio de Janeiro

Lymphomas, malignant neoplasms that originate in the lymphocytes, have a high incidence in domestic animals. This paper aimed to describe the clinical and epidemiological findings of 200 cases of canine lymphoma evaluated over nine years (2011–2019) at the Oncology Service of the Veterinary Hospital at The Federal Rural University of Rio de Janeiro. A majority of mixed-breed canines (84/200-42%) were observed, followed by the Labrador Retriever, Pitbull, and Rottweiler with similar incidence (15/200-7.5%). The average age was 7.7 years and the most affected canines were aged approximately 3 and 11 years old (146/200-73%). As for the anatomical classification, the cases classified as multicentric (131/200-65,5%) were the most common, followed by cases of the cutaneous form (44/200-22%), alimentary form (7/200 - 3.5%), mediastinal form (5/200-2.5%), and extranodal form (16/200-6,5%). Among extranodal cases were described cases of ocular involvement (5/200-2.5%), oral cavity involvement (4/200-2%), cardiac involvement (3/200-1.5%), and pulmonary involvement (1/200-0.5%). The clinical manifestation observed was related to the affected region in the different anatomical forms. More studies of this nature are needed to profile the disease presentation and contribute to clinical identification and diagnosis.

Routine, molecular point-of-care testing for SARS-CoV-2 and other respiratory viruses within an acute oncology service improves patient care

COVID-19 has caused significant challenges for infection prevention measures and patient flow in hospital admission pathways. We aimed to assess the impact of replacing laboratory PCR with molecular point-of-care testing (mPOCT) for respiratory viruses including SARS-CoV-2, within an Acute Oncology Service (AOS). This pre- and post-implementation study took place in the AOS of a large teaching hospital, in Southampton, UK. We collected data from two periods: November 25th, 2019 to November 24th, 2020, when respiratory virus testing utilised laboratory PCR, and December 1st, 2020 to May 31st, 2021 following the introduction of mPOCT. The primary outcome was the time to results. 2189 patients were tested in the pre-implementation period and 1540 in the post implementation period. Median (IQR) time to results was 5.8h (4.2-10.6) pre-implementation and 1.9h (1.5-3.0) post-implementation (difference -3.6h [95%CI to -3.8 to -3.5]; p<0.0001). Median time spent in assessment areas was 6.0h (4.1-7.9) pre-implementation and 5.5h (3.8-7.4) post-implementation (p<0.0001). 20 (0.9%) patients admitted via AOS assessment unit developed hospital-acquired respiratory virus infection pre-implementation versus 0 (0%) post-implementation (p=0.031). Routine mPOCT for respiratory viruses, including SARS-CoV-2, was associated with a reduced time to results, reduced time in assessment areas, and a reduction in the rates of hospital-acquired respiratory virus infection in an acute oncology assessment unit.