Procedures In Cancer Patients Research Articles

Fertility Preservation in the Era of Immuno-Oncology: Lights and Shadows.

In recent years, immuno-oncology has revolutionized the cancer treatment field by harnessing the immune system's power to counteract cancer cells. While this innovative approach holds great promise for improving cancer outcomes, it also raises important considerations related to fertility and reproductive toxicity. In fact, most young females receiving gonadotoxic anti-cancer treatments undergo iatrogenic ovarian exhaustion, resulting in a permanent illness that precludes the vocation of motherhood as a natural female sexual identity. Although commonly used, oocyte cryopreservation for future in vitro fertilization and even ovarian cortex transplantation are considered unsafe procedures in cancer patients due to their oncogenic risks; whereas, ovarian stem cells might support neo-oogenesis, providing a novel stemness model of regenerative medicine for future fertility preservation programs in oncology. Recent scientific evidence has postulated that immune checkpoint inhibitors (ICIs) might in some way reduce fertility by inducing either primary or secondary hypogonadism, whose incidence and mechanisms are not yet known. Therefore, considering the lack of data, it is currently not possible to define the most suitable FP procedure for young patients who are candidates for ICIs. In this report, we will investigate the few available data concerning the molecular regulation of ICI therapy and their resulting gonadal toxicity, to hypothesize the most suitable fertility preservation strategy for patients receiving these drugs.

Učestalost kontrolnih pregleda i kliničkih postupaka kod onkoloških pacijenata prije i za vrijeme pandemije bolesti Covid-19 u klinici za ženske bolesti i porode KBC-a Zagreb

Introduction. At the end of 2019, an epidemic caused by a coronavirus broke out in China. A certain number of female cancer patients neglected their regular oncology treatment during the pandemic, at first because of quarantine, and later due to their incompetence in applying online medicine. The majority of cancer patients demand permanent care and diagnostic/therapeutic procedures. The coronavirus pandemic (COVID-19) led to numerous check-up cancellations and surgery postponements in healthcare, yet it is unknown to what extent it has affected the healthcare of female cancer patients. Aim. To determine the frequency of check-ups and clinical procedures that female cancer patients underwent prior to and during the coronavirus (COVID-19) epidemic. Methods. Gathering data on the number of clinical procedures in cancer patients was conducted through the hospital information system (BIS) of the Department of Gynaecology and Obstetrics of KBC Zagreb in the period of two years. The study group included female cancer patients during one year of the pandemic (March 11, 2020 to March 11, 2021), and the control group consisted of female cancer patients during the period of one year preceding the pandemic.Results. In the Department of Obstetrics and Gynaecology of KBC Zagreb there were less laparoscopic procedures (LPSC) in 2020 than in 2019, with 24.6% less procedures administered in 2020. There were also fewer other gynaecological procedures in 2020, however, the difference was not statistically significant p>0.05. In the same period in Zagreb in 2020 there were 13.9% fewer patients treated for cancer than in 2019. Also in 2020, there were statistically significantly fewer patients treated throughout Croatia p<0.001, with a decrease of 16.3%.Conclusion. All aspects of healthcare, from diagnostics and therapy to research, have been distressed by the emergence of COVID-19. During the crisis caused by this disease, healthcare workers dealt with the problem of thorough and rapid reorganisation of the system, not only with the purpose of treating newly infected patients, but also in trying to maintain the quality of healthcare for cancer patients. The adjustment of the healthcare system with timely organisation in the Department of Obstetrics and Gynaecology managed to preserve the level of quality healthcare for its female cancer patients. For the future it would be necessary to prepare action plans which will assure adequate health care service without decreasing number of examinations.

To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients.

The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction. We aimed to compare the efficacy and safety of both PEG procedures in cancer patients. We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG. We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] =2.9; 95% CI=1.9-4.3, p<0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio=2.7, 95% CI=1.0-7.2, p=0.042). The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.

Utilization and short-term outcomes of percutaneous left atrial appendage occlusion in patients with cancer

BackgroundPercutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA’s approval in 2015 and has become more of a same-day-discharge procedure. Cancer patient with atrial fibrillation/flutter (AF) population can benefit from the procedure but the in-hospital outcomes and readmission data were rarely studied.ObjectivesWe investigated the utilization, in-hospital and readmission outcomes in cancer patients with AF who underwent LAAO.MethodsData were derived from the National Inpatient Sample and National Readmissions Database from 2016 to 2019. Patients with primary diagnosis of AF admitted for LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed in-hospital mortality, length of stay, total hospital charges, and complications. Thirty-day readmission rates were compared.ResultsLAAO was performed in 60,380 patients with AF and 3% were cancer patients. There were no differences in in-hospital mortality and total hospital charges; however, cancer patients tended to have longer hospital stay (1.59 ± 0.11 vs. 1.32 ± 0.02, p = 0.013). Among complications, cancer patients had higher rates in open or percutaneous pericardial drainage (adjusted odds ratio [aOR] 2.38; 95% confidence interval [CI] 1.19–4.76) and major bleeding events (aOR 7.07; 95% CI 1.82–27.38). There was no statistical significance of 30-day readmission rates between patients with and without cancer (10.0% vs. 9.1%, p = 0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding.ConclusionsLAAO is a promising procedure in cancer patients complicated by AF with contraindication to anticoagulation. Readmission rate is comparable between patients with and without cancer.

Freezing techniques as fertility preservation strategies: a narrative review

Advances in the development of new chemotherapy and radiotherapy regimens have significantly improved the survival of cancer patients but many of these treatments have detrimental effects on gonadal function. These treatments may cause premature ovarian failure in females and azoospermia in males. Non-oncological conditions may also require therapies that put women's and men´s reproductive potential at risk. Moreover, an increasing number of women today decide to postpone maternity beyond the age of 35 due to social reasons with a possible affectation of future fertility due to the effect of age. The development and evolution of assisted reproductive techniques offer these patients new alternatives to preserve their fertility. The objective of this review is to describe the different options of fertility preservation. Oocyte vitrification for female and sperm banking for male are the first line for fertility preservation at the present time. Other techniques such as ovarian and testis tissue preservation, in vitro maturation of gametes, pharmacological protection (GnRH agonists and antiapoptotic agents) and surgical treatments (oophoropexy, selective radical trachelectomy) will be described. One of the most important steps in optimizing the results of these fertility preservation procedures in cancer patients is the need for prompt and timely referral to reproductive medicine specialists. Fertility preservation should be integrated as part of the oncological healthcare. Optimal counselling from healthcare professionals should always be present.

Prevalence, characteristics and mortality of cancer patients undergoing pericardiocentesis in the United States between 2004 and 2017.

Pericardiocentesis is undertaken in patients with cancer for diagnostic and therapeutic purposes. However, there are limited data on the frequency, characteristics and mortality of patients with different cancers undergoing pericardiocentesis. All hospitalisations of adult cancer patients (≥18 years) in the US National Inpatient Sample between January 2004 and December 2017 were included. The cohort was stratified by discharge code of pericardiocentesis and cancer, using the International Classification of Diseases. The prevalence of pericardiocentesis, patient characteristics, cancer types and in-hospital all-cause mortality were analysed between cancer patients undergoing pericardiocentesis versus not. A total of 19,773,597 weighted cancer discharges were analysed, out of which 18,847 (0.1%) underwent pericardiocentesis. The most common cancer types amongst the patients receiving pericardiocentesis were lung (51.3%), haematological (15.9%), breast (5.4%), mediastinum/heart (3.2%), gastroesophageal (2.2%) and female genital cancer (1.8%), whilst 'other' cancer types were present in 20.2% patients. Patients undergoing pericardiocentesis had significantly higher mortality (15.6% vs. 4.2%, p < 0.001) compared to their counterparts. The presence of metastatic disease (aOR 2.67 95% CI 1.79-3.97), weight loss (aOR 1.48 95% CI 1.33-1.65) and coagulopathy (aOR 3.22 95% CI 1.63-6.37) were each independently associated with higher mortality in patients who underwent pericardiocentesis. Pericardiocentesis is an infrequent procedure in cancer patients and is most commonly performed in patients with lung, haematological and breast cancer. Cancer patients undergoing pericardiocentesis have increased mortality, irrespective of the underlying cancer type.

In vitro maturation of immature oocytes for fertility preservation in cancer patients compared to control patients with fertility problems in an in vitro fertilization program.

BackgroundThe aim of this study was to determine whether in vitro maturation (IVM) of immature oocytes after controlled hormonal stimulation of the ovaries could be important in cancer patients to improve their chances of conception in the future.Patients and methodsAfter ovarian stimulation in cancer patients, the number of oocytes and their quality and maturity were compared to control patients with fertility problems in the in vitro fertilization (IVF) program. In both groups of patients, immature oocytes at the developmental stage of germinal vesicle were matured in vitro and the proportion of oocytes that matured in vitro was compared between groups. In a subset of women with fertility problems, intracytoplasmic sperm injection (ICSI) was performed on IVM oocytes to assess their ability to be fertilized and develop into an embryo compared to vivo matured oocytes in the same cycles and consider the procedure in cancer patients.ResultsIn patients with different cancers, the disease did not affect the number and quality of retrieved oocytes. In cancer patients, there was even a significantly lower proportion of immature oocytes than in patients with fertility problems (30.0% vs. 43.6%; P < 0.05). However, in patients with cancer, fewer oocytes per patient matured in vitro than in patients with fertility problems (1.39 ± 1.04 vs. 2.48 ± 1.83; P < 0.05). After ICSI, the proportions of fertilized oocytes and fertilized oocytes developing into an embryo did not differ between oocytes matured in vitro and in vivo in the same cycles.ConclusionsOocyte IVM is proving to be a reliable procedure for resolving immature oocytes after controlled ovarian stimulation in cancer patients.

Coronavirus disease 2019 pandemic and its impact on assisted reproductive technologies

Coronavirus diease-2019 (COVID-19), a global pandemic, has imposed a lot of challenges and potential risk to women who are planning a pregnancy and women who are pregnant in the COVID era. After the World Health Organization (WHO) declared COVID-19, a global pandemic, pregnancies achieved through medically assisted reproduction/Assisted Reproductive Technologies (ARTs) services experienced a major hit as couples became even more anxious to embark on pregnancy, the obvious reasons being the vertical transmission to the fetus, and use of critical health-care support system if required. Although the effects of coronavirus in terms of pregnancies conceived through the above measures are not known, retrospective studies will be needed to assess the outcomes of pregnancies conceived either naturally or any of the above mentioned procedures. As a precautionary measure, many professional societies worldwide recommended a ban on fertility treatments 1 week after WHO declared this as a pandemic. All reproductive medicine societies had published guidelines regarding stopping of infertility services except for poor responders and oocyte/sperm cryopreservation procedures in cancer patients – undergoing chemotherapy/radiation as there could be a reduction in gamete numbers. The possible reasons being to avoid complications of ART, like virus-induced complications of pregnancy and vertical transmission to fetus in severe respiratory distress syndrome COVID-positive mothers. The measures required to be taken are physical social distancing and critical health-care accessibility services. It has caused a major blow with respect to economic and social framework of our societies.

Abstract 12820: Beta Blocker Use and Peri-operative Outcomes in Cancer Patients Receiving Immunotherapy

Introduction: The impact of beta blocker use on surgical outcomes of cancer patients receiving immunotherapy is unknown. Hypothesis: Beta blocker use is associated with lower post-operative mortality in cancer patients on immunotherapy. Methods: We used an institutional Advanced Cohort Explorer to identify all patients who underwent any surgical procedure less than 90 days after receiving immunotherapy. Data on the procedure performed as well as the post-operative outcome were collected and analyzed per the pre-operative beta blocker use status. Results: A total of 233 patients underwent surgery between 09/2011-06/2019. Mean age was 64.7 years (range: 16-92). The most common cancer diagnoses were lung (48, 44.4%), melanoma (49, 45.4%) and kidney (11, 10.2%). Immunotherapy medications were pembrolizumab ( 127, 54.5%), nivolumab (51, 21.9%), ipilimumab (43, 18.5%), atezolizumab (11, 4.7%) and avelumab (1, 0.43%). Pre-operative beta blocker use was documented in 140 (60.1%) patients. Most common surgical procedures were skin resection (75, 32.1%), wound repair (47, 20.2%), vascular procedures (36, 15.5%), urethral procedures 16 (6.9%) and sentinel lymph node biopsies (10, 4.3%). The 30-day mortality rate was 10.3% (24 deaths). In a multi-variable logistic regression analysis, pre-operative use of beta blockers was associated with a lower risk of death within 30 days from surgery (OR 0.34, CI 0.13-0.87, P=0.024). 30-day mortality rates were higher in patients undergoing vascular (50%, 17 of 34) versus non-vascular (3.5%, 7 of 199) procedures (P&lt;0.0001) in a Chi Square test. Conclusions: Beta blocker use is associated with a lower 30-day mortality rate after surgical procedures in cancer patients treated with immunotherapy. Further investigation is warranted.

Reasons for failure to perform interventional pain procedures in cancer patients: an analysis of pain clinic consultations.

BackgroundInterventional pain procedures (IPPs) may be necessary for some cancer patients when conservative treatment fails. However, many IPPs are often delayed or cancelled for cancer patients who are referred to the pain clinic.MethodsWe retrospectively analyzed the reasons for such cancellations to identify clinically avoidable causes of the delay in IPP.ResultsWe enrolled 350 cancer patients who were referred to our pain clinic for an IPP between March 2016 and February 2018. There were 213 (60.9%) cases that were cancelled, among which 115 (54%) cases were potentially avoidable and 98 (46%) were unavoidable. The most common reasons for cancellation were patient-derived factors, which accounted for 85 (39.9%) cases. Patient refusal was a common reason for cancellation, with 33 (15.5%) cases attributed to this cause. The primary avoidable causes of cancellation were a recommendation that the patient continue with their current pharmacological pain treatment, conflict with another planned treatment, and pain characteristics that were not suitable for an IPP. Together, these accounted for 76.5% of all avoidable cancellations.ConclusionsComprehensive and accurate pain assessments before IPP may result in more favorable outcomes for the efficient use of medical resource and effective pain relief in cancer patients.

Initial experience of complete laparoscopic radical nephroureterectomy combined with transvesical laparoscopic excision of distal ureter in patients with upper urinary tract cancer

BackgroundSelecting the treatment procedure for cancer patients is a challenging task. We report our initial experience of complete laparoscopic radical nephroureterectomy (RNU) for patients with upper urinary tract urothelial cancer (UTUC).MethodsA total of four patients with UTUC underwent complete laparoscopic RNU combined with transvesical laparoscopic excision of the distal ureter using three 5-mm ports. Transvaginal specimen extraction was applied in female patients to reduce incisional pain and improve cosmesis. Peri-operative complications were evaluated using the Clavien-Dindo classification system. Postoperative pain was evaluated during hospitalization using a numeric pain rating scale (scales of 1 to 10). Patients who underwent retroperitoneal laparoscopic surgery combined with open excision of the distal ureter during the same period were included as a control group (conventional RNU, consisting of laparoscopic nephrectomy combined with open bladder cuff excision) for pain scale evaluation.ResultsThe novel surgery was successfully completed for all four patients (two males and two females). The mean pneumoperitoneum time for retroperitoneoscopic nephroureterectomy and specimen extraction was 174 min, while the mean pneumovesicum time for the ureteral orifice excision was 88 min. One male patient had bladder leakage at the suture site of the bladder wall, which lasted for 2 weeks. No patient experienced recurrent disease during the follow-up period (median, 10 months). Mild to moderate pain lasted for 5 or 6 days after RNU. A couple of days after surgery, the numeric pain rating scale of complete laparoscopic RNU and conventional RNU group reached its peak level at 3.0 ± 1.8 and 5.3 ± 2.8, respectively. There was no statistical difference in the degree of postoperative pain (P = 0.31).ConclusionsWe described our initial experience and outcome of complete laparoscopic RNU for UTUC. Further experience and research are required to determine whether this advanced laparoscopic technique yields better outcomes and has true clinical value.

Palliative surgery of malignant small bowel obstruction after colorectal cancer

Although invasive surgical procedures in cancer patients can possibly cure malignancy, these strategies are potentially harmful by restricting quality of life and lifetime. Surgical therapies in palliative situations have to be carefully considered and well planned for every individual patient. The case report of the following patient suffering from malignant small bowel obstruction caused by local recurrence of colorectal cancer may make aware of difficulties and doubts in decision-making. After research oft the literature on this topic it is obvious that standards of therapy currently do not exist.

P2271Contemporary trends and outcomes of percutaneous vs. surgical aortic valve replacement in cancer patients

Abstract Importance Cancer patients with severe AS are often ineligible for surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) is an emerging non-invasive treatment option for severe AS. Cancer patients likely stand to benefit from TAVR given its non-invasive nature; however, there is a paucity of data regarding the comparative effectiveness of TAVR vs. SAVR in cancer. We sought to assess the relative utilization, outcomes, and dispositions associated with TAVR vs. SAVR in cancer and non-cancer patients. Methods The US-based National Inpatient Sample was queried between 2012 and 2015 using ICD-9 codes for adults&gt;18 years with comorbid AS and cancer without metastatic disease. Multiple in-hospital and disposition outcomes were evaluated. Comparison of TAVR vs SAVR required propensity score estimation using demographic, socio-economic, comorbidity, and hospital specific variables. A standardized morbidity ratio (SMR) weight was calculated by assigning TAVR a weight of 1, and those undergoing SAVR weight of PS/(1-PS). SMR-weighted generalized logistic regression was conducted to estimate the average effect of TAVR compared with SAVR. Finally, the Cochran–Mantel–Haenszel (CMH) test for propensity-matched data was utilized to compare the effect modification of cancer on these outcomes. Results A total of 979,912 out of 5,611,173 patients with AS were found to have non-metastatic cancer (17.5%). Average Elixhauser's mortality score of patients undergoing TAVR and SAVR was 8.9 vs. 8.1 and 8.5 vs. 7.1 for cancer vs. non-cancer respectively (p&lt;0.0001). Over time, patients undergoing AVR increased in both groups, primarily driven by significantly increased rates of TAVR utilization in the cancer group. Over the study time period, an increase in the proportion of patients undergoing TAVR among all patients undergoing AVR was noted (figure) with 21.8% and 19.6% patient with prostate and breast cancer in 2015. TAVR in cancer patients was associated with lower odds of acute kidney injury [AKI; odds ratio (OR): 0.6, 95% confidence interval (CI): 0.5- 0.8], cardiogenic shock [OR: 0.6 (0.4–0.8)] and major bleeding [OR: 0.4 (0.3–0.5)] with no difference in in-hospital mortality and stroke compared to SAVR. Additionally, TAVR was associated with higher odds of home-discharge [OR: 1.9 (1.7–2.2)], and lower need for nursing facility transfer [OR: 0.7 (0.6–0.8) compared to SAVR among cancer patients. Similar outcomes are noted in the non-cancer cohort upon comparing TAVR to SAVR. However, favorable effect-modification of cancer was noted in regard to AKI (p=0.003), home discharge (p&lt;0.0001), and less nursing facility transfer (p=0.0003), suggesting safety. Conclusions Compared to patients without cancer, the utilization of AVR in cancer patients has steadily increased. The benefits of TAVR over SAVR appear to extend to patients, regardless of cancer status. TAVR might be a more suitable procedure for cancer patients with AS.

Comparison of analgesia, adverse effects, and quality of life in cancer patients during treatment of procedural pain with intravenous morphine, fentanyl nasal spray, and fentanyl buccal tablets.

AimComparison of analgesia, adverse effects, and quality of life (QoL) of cancer patients in the treatment of procedural pain induced by nursing procedures with the use of intravenous morphine, fentanyl nasal spray, and fentanyl buccal tablets.MethodsIn adults with cancer with opioid tolerance and suffering procedural pain, intravenous morphine was used at an inpatient palliative medicine unit (20 patients) and fentanyl by intranasal (15 patients) and buccal routes (nine patients) at home. Five procedural pain episodes were examined: the Mini-Mental State Examination was used to assess cognitive function, the Brief Pain Inventory – short form (BPI-SF) to assess intensity and impact of pain on daily activities, a pain and adverse-effect questionnaire to assess the intensity of pain and adverse effects, and the European Organisation for Research and Treatment of Cancer QLQ-C15-PAL to assess QoL.ResultsAll five procedural pain episodes were completed by 32 patients. Twelve patients stopped treatment due to death or referral to the hospital (four patients in each group), changes in the treatment of background pain (three patients), and intense drowsiness (one patient). Similar beneficial analgesic effects were observed in all patient groups. During fentanyl therapy, a smaller negative effect of pain on patients’ activity, walking, and work (BPI-SF) was observed. Among adverse effects, fewer breaths (10–14 per minute) were observed in 17 patients and slight disturbances of consciousness in seven. For QoL, an improvement in emotional functioning, overall QoL, and fatigue was observed. Patients treated with intranasal and buccal fentanyl had higher physical functioning and were more active.ConclusionIn the treatment of procedural pain induced by nursing procedures in cancer patients, intravenous morphine and rapid-onset fentanyl show similarly high analgesic efficacy, with good tolerance of treatment and improvement in QoL.

Infective Endocarditis in Cancer Patients - Causative Organisms, Predisposing Procedures, and Prognosis Differ From Infective Endocarditis in Non-Cancer Patients.

Infective endocarditis (IE) in cancer patients is increasing, but because little is known about it in these patients, we analyzed patient characteristics and outcomes and compared these factors in IE patients with and without cancer. Methods and Results: This retrospective cohort study included 170 patients with IE newly diagnosed between January 2011 and December 2015. Among 170 patients, 30 (17.6%) had active cancer. The median age of IE patients with cancer was higher than that of non-cancer patients. Nosocomial IE was more common in cancer patients. Non-dental procedures, such as intravenous catheter insertion and invasive endoscopic or genitourinary procedures, were more frequently performed before IE developed in cancer patients. Staphylococcus was the most common pathogen in cancer patients, whereas Streptococcus was the most common in non-cancer patients. In-hospital mortality was significantly higher in cancer patients with IE (34.4% vs. 12.4%, P<0.001). IE was an important reason for discontinuing antitumor therapy and withholding additional aggressive treatment in nearly all deceased cancer patients. IE is common in cancer patients and is associated with poorer outcomes. Patients with IE and cancer have different clinical characteristics. Additional studies regarding antibiotic prophylaxis before non-dental invasive procedures in cancer patients are needed, as cancer patients are not considered to be at higher risk of IE.

Safety of endoscopy in cancer patients with thrombocytopenia and neutropenia

Cancer patients are prone to thrombocytopenia and neutropenia, which increase the risk of bleeding and infection. We assessed the safety of endoscopic procedures in cancer patients with thrombocytopenia and/or neutropenia. We studied consecutive cancer patients with thrombocytopenia and/or neutropenia who underwent endoscopic procedures from 2010 through 2015. Neutropenia was defined as an absolute neutrophil count (ANC)<1000 cells/μL, and thrombocytopenia as a platelet count<100× 103/μL. Univariate and multivariate generalized estimating equation models were used to assess factors associated with risk of adverse events (AEs) or death. We identified 588 patients who underwent 783 procedures; 608 procedures were performed in the setting of thrombocytopenia and 675 procedures in the setting of neutropenia. Concurrent neutropenia and thrombocytopenia were recorded in 500 endoscopies. Twenty-four patients (4.1%) experienced infectious AEs, whereas 29 (4.9%) experienced bleeding AEs within 1 week of the procedure. On multivariate analysis, platelet count≤50× 103/μL was associated with risk of bleeding AEs. In contrast, poor performance status was associated with increased risk of infection AEs (P< .01). No association was observed between low ANC and infectious AEs. Poor performance status (P< .01) and platelet count≤100× 103/μL (P< .05) were associated with increased risk of 30-day mortality. A persistent platelet count<20× 103/μL after the procedure, with a baseline platelet count of≤20× 103/μL before the procedure, was associated with significant risk of bleeding AEs compared with a platelet count >20× 103/μL after the procedure (P< .01); furthermore, if the platelet count increased to >50× 103/μL after the procedure, the bleeding risk after the procedure was greatly reduced (P< .01). Endoscopic procedures are relatively safe in cancer patients with platelet count >50× 103/μL. Nevertheless, a platelet count of≥20× 103/μL could be an appropriate threshold for platelet transfusion if50× 103/μL is difficult to achieve. The functional status of the patient, in the absence of the need for urgent or necessary endoscopic interventions, should be considered when deciding whether to perform endoscopy. The risk of procedure and the ANC did not seem to affect the outcomes.

Effects of relaxing therapies on patient's pain during percutaneous interventional radiology procedures.

Interventional radiology procedures in cancer patients cause stress and anxiety. Our objective was to relate our experience in the use of sophrology techniques during interventional radiology procedures and evaluate the effects on patient's pain and anxiety. We present a prospective observational study on 60 consecutive patients who underwent interventional radiology procedures in a context of oncologic management from September 2017 to March 2018. Forty-two patients were asked if they wished to benefit from the sophrology and hypnosis techniques during their procedure. A control group was also made including 18 patients. Anxiety level and pain were evaluated using the visual analog scale (VAS) before and during procedures. We observed a significant decrease in anxiety experienced by patients during interventional radiology procedures compared to before procedures in the sophrology group (P=3.318E-08), and a level of anxiety and pain during gestures inferior to that of the control group (P=2.035E-06 and 7.03E-05 respectively). Relaxing therapies, such as sophrology and hypnosis, seems to be an interesting additional tool for the management of patients in interventional oncology, inducing a decrease of stress, pain, and anxiety in patients.

541 "Do Surgeons performing cytoreductive therapy, such as HPEC and PIPAC, in peritoneal cancer patients adress troubled sexual health in disease-management-programs? Igls-Vienna-SexMed-Survey-Program: Participants' self-assessment-results at the HIPEC/PIPAC-Symposium, Salzburg, November 2017

Hypertherme peritoneal chemoperfusion, HIPEC, as well as pressurized intraperitoneal aerosol chemotherapy, PIPAC, have an impact on pelvine structures and reproductive organs during surgical procedure in cancer patients. Due to chemotoxicity, heat as well as surgery, not always be performable in a nerve-sparing way in order to reduce cancer-cells sexual health can be heavily troubled in these patients. Life-expectancy of patients increases after successful therapy. Thus, the importance of their quality of life, living with cancer and sexual health increases, too. HIPEC/PIPAC are mainly offered in defined centers providing multidisciplinary, –professional expertise and high-end health care structures to be able to treat patients state-of-the-art. Little is known about these cancer patients’ sexual health. Thus, at the HIPEC/PIPAC-symposium, Salzburg, November 2017, 10 of 53 surgeons (19,86%) from Austria and Germany, accepted the invitation to participate in the Igls-Vienna-SexMed-Survey-Program and self-assess the integration of sexual health in their patient-management-concepts via questionnaire.

Raman-Encoded Molecular Imaging with Topically Applied SERS Nanoparticles for Intraoperative Guidance of Lumpectomy

Intraoperative identification of carcinoma at lumpectomy margins would enable reduced re-excision rates, which are currently as high as 20% to 50%. Although imaging of disease-associated biomarkers can identify malignancies with high specificity, multiplexed imaging of such biomarkers is necessary to detect molecularly heterogeneous carcinomas with high sensitivity. We have developed a Raman-encoded molecular imaging (REMI) technique in which targeted nanoparticles are topically applied on excised tissues to enable rapid visualization of a multiplexed panel of cell surface biomarkers at surgical margin surfaces. A first-ever clinical study was performed in which 57 fresh specimens were imaged with REMI to simultaneously quantify the expression of four biomarkers HER2, ER, EGFR, and CD44. Combined detection of these biomarkers enabled REMI to achieve 89.3% sensitivity and 92.1% specificity for the detection of breast carcinoma. These results highlight the sensitivity and specificity of REMI to detect biomarkers in freshly resected tissue, which has the potential to reduce the rate of re-excision procedures in cancer patients. Cancer Res; 77(16); 4506-16. ©2017 AACR.

Evidence of an application of a variable MEMS capacitive sensor for detecting shunt occlusions

A sensor was tested subdural and in vitro, simulating a supine infant with a ventricular-peritoneal shunt and controlled occlusions. The variable MEMS capacitive device is able to detect and forecast blockages, similar to early detection procedures in cancer patients. For example, with gradual occlusion development over a year, the method forecasts a danger over one month ahead of blockage. The method also distinguishes between ventricular and peritoneal occlusions. Because the sensor provides quantitative data on the dynamics of the cerebrospinal fluid, it can help test new therapies and work toward understanding hydrocephalus as well as idiopathic normal pressure hydrocephalus. The sensor appears to be a substantial advance in treating brain injuries treated with shunts and has the potential to bring significant impact in a clinical setting.