Specialized Cancer Hospital Research Articles

Analysis of Risk Factors for Multidrug-Resistant Organism (MDRO) Infections and Construction of a Risk Prediction Model in a Cancer Specialty Hospital.

Aims/Background Patients receiving treatment in specialized cancer hospitals are particularly susceptible to multidrug-resistant organisms (MDRO) infections due to factors such as weakened immune systems caused by intensive treatments and prolonged hospital stays. This study aims to investigate the risk factors for MDRO infections in the cancer specialty hospital setting and to develop a corresponding risk prediction model. Methods Patients diagnosed with MDRO infections were selected for the MDRO infection group (n = 238), and those without for the non-MDRO infection group (n = 238). Non-parametric tests, chi-square tests, and multivariate logistic regression analysis were used to identify the primary risk factors for MDRO infections. With the aid of analysis utilizing R software 4.4.1 (R Foundation for Statistical Computing, Vienna, Austria), we developed a nomogram prediction model, which was evaluated using the receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA). Results Age, antibiotic application time, and central venous catheterization were independent risk factors for MDRO infection (p < 0.05). The constructed nomogram prediction model for patients with MDRO infection has a C-index of 0.8640. The ROC curve results showed that the prediction model has a specificity of 0.7700, a sensitivity of 0.8800, and an area under the curve (AUC) of 0.8800. Conclusion This study identifies significant risk factors for MDRO infections in a cancer specialty hospital setting and offers a clinically useful prediction model, which may aid in targeted preventive measures and optimization of antibiotics usage, thereby potentially reducing the incidence and impact of these infections.

Questionnaire survey and analysis of drug clinical research implementation capabilities of breast cancer treatment departments in Chinese hospitals.

e23257 Background: Clinical research competence determines the quality of clinical research and the reliability of research findings and is vital in the development of new antitumor drugs and the diagnosis and treatment of breast cancer. Our study aimed to explore the clinical research implementation capabilities of breast cancer treatment departments in China and to analyze the differences among regions, departments and different hospital classifications. Methods: This was a department-based cross-sectional study conducted in the form of electronic questionnaires in China from 7th August to 31st August 2023; this study was initiated by the breast cancer expert committee of the National Cancer Center (NCC). The questionnaire was designed on the Wenjuanxing platform. Our study was conducted among the first batch of breast cancer standardized diagnosis and treatment quality control pilot centers, which includes 200 hospitals selected by the NCC on the basis of the level of breast cancer diagnosis and treatment, surgery volume and other factors. The centers cover 30 provinces, and all of them are tertiary-level general hospitals or cancer hospitals. Results: A total of 127 questionnaires from 122 hospitals were ultimately included in the analysis. Medical personnel involved in the clinical research of 118 (92.9%) departments received good clinical practice (GCP) training. A total of 89.3% (109/122) underwent centralized institutional review board (IRB) review. The steps of the approval process from research initiation to completion lasted 2-4 weeks or longer. The majority of departments initiated or participated in 2 or fewer clinical research projects over the past year. Among the differences between different departments, the Department of Medical Oncology had a better qualification profile and process and greater number of initiated and participated clinical studies than did the Department of Surgical Oncology. There were more patients enrolled in registered clinical trials in specialized cancer hospitals than in general hospitals (50 and below, 50-200, and more than 200 patients from specialized cancer hospitals vs. general hospitals: 39.1%, 52.2%, and 8.7% vs. 76.9%, 16.4%, and 6.7%, respectively; p = 0.001). For needs and problems, most of the departments were strongly willing to undertake clinical research and receive professional training; the most common problem in the process of conducting studies was patient recruitment. Conclusions: Most departments generally exhibited complete capabilities for implementing clinical research. Improvements in implementation efficiency, quality and quantity of research and patient recruitment are still needed. Professional training and communication, as well as the recommendation and implementation of clinical research, are required in future development.

Exceptional Case of Spontaneous Ovarian Hyperstimulation Syndrome in Complete Molar Pregnancy: A Case Study

Spontaneous ovarian hyperstimulation syndrome (OHS) is an uncommon condition. We report the case of a 38-year-old woman admitted to the emergency department with vaginal bleeding, pelvic pain, and an extraordinarily high human chorionic gonadotropin (hCG) level of 1,000,000 mIU/mL. Uterine aspiration confirmed a complete hydatidiform mole. Ten days post-discharge, she returned, exhibiting severe abdominal pain, vomiting, an hCG level of 46,769 mIU/mL, and ultrasound evidence of theca lutein cysts (right ovary: 1329 cm³; left ovary: 500 cm³) along with ascites. Suspected of having OHS, she was hospitalized for clinical management. Treatment included intravenous hydration, analgesia, thromboprophylaxis, and daily laboratory tests, leading to symptomatic improvement despite rising hCG levels. After a 35-day hospital stay, she commenced chemotherapy at a specialized cancer hospital. This case emphasizes the importance of healthcare professionals being alert and aware of the possibility of this diagnostic suspicion in such cases, particularly highlighting the need for hospitalization in moderate to severe instances.

The relationship between psychological distress and the nursing humanistic care demands in postoperative cancer inpatients: a cross-sectional study

PurposeWe aimed to investigate cancer patients' experiences of psychological distress after surgery and the factors that influence it, and to analyze the relationship between this and the nursing humanistic care demands.MethodsThis study used a convenience sampling method to survey 432 cancer patients undergoing surgical treatment in the specialized cancer hospital in Beijing. The survey used socio-demographic information, the Distress Management Screening Measures, and the Nursing Humanistic Care Demands questionnaire. Questionnaire Star was used to collect data online. SPSS24.0 software was used to test the relationship between psychological distress and nursing humanistic care demands.ResultsThe mean scores for psychological distress and nursing humanistic care demands were 3.95 ± 2.71 and 147.02 ± 19.88, respectively, and showed a moderately positive correlation. The main issues that caused psychological distress in patients were: worry, financial problems, surroundings, nervousness, sleep, and pain. Regression analysis showed that gender, financial burden, personality trait, and need for humanistic care in nursing explained 24.5% of the total variance in the model and were independent predictors of psychological distress.ConclusionCancer inpatients have significant psychological distress after surgery and exhibit high levels of nursing humanistic care demands. This study fills the research gap on humanistic care for psychological distress management, nursing humanistic care demands positively predicted psychological distress. Nursing staff should pay attention to the psychological suffering of patients and develop individualized care measures to alleviate their psychological suffering by accurately identifying their nursing humanistic care demands.

Bleeding in Critically Ill Children With Malignancy or Hematopoietic Cell Transplant: A Single-Center Prospective Cohort Study.

To determine the incidence of bleeding in critically ill children with malignancy and to describe associated patient characteristics, interventions, and clinical outcomes. Prospective cohort study. PICU in a specialized cancer hospital. Children with malignancy or hematopoietic cell transplant 0-18 years of age were admitted to the PICU from November 2020 to November 2021. None. Patient demographic data, laboratory values, and PICU outcome data were collected. Bleeding was classified according to the Bleeding Assessment Scale in Critically Ill Children. Ninety-three bleeding patients were enrolled, and a total of 322 bleeding days were recorded. The median (interquartile range [IQR]) age was 5.8 (2.9-11.8) years and 56% (52/93) of the patients were male. There were 121 new bleeding episodes, in 593 at-risk person-days, translating into a 20% incidence rate per day (95% CI, 17-24%). The incidence of severe, moderate, and minimal bleeding was 2% (95% CI, 1-3), 4% (95% CI, 3-6), and 14% (95% CI, 12-17), respectively. Of the new bleeding episodes, 9% were severe, 25% were moderate and 66% were minimal. Thrombocytopenia was the only laboratory value independently associated with severe bleeding ( p = 0.009), as compared to minimal and moderate bleeding episodes. History of radiation therapy was independently associated with severe bleeding ( p = 0.04). We failed to identify an association between a history of stem cell transplant ( p = 0.49) or tumor type ( p = 0.76), and bleeding severity. Patients were transfused any blood product on 28% (95% CI, 22-34) of the bleeding days. Severe bleeding was associated with increased length of mechanical ventilation ( p = 0.003), longer PICU stays ( p = 0.03), and higher PICU mortality ( p = 0.004). In this prospective cohort of children with malignancy, the incidence rate of bleeding was 20%. Most events were classified as minimal bleeding. Low platelet count and radiation therapy were variables independently associated with severe bleeding episodes.

Current prognostic factors of advanced gastric cancer patients treated with chemotherapy: real world data from a Japanese 12 institutions.

Understanding the prognostic factors of advanced gastric cancer before starting chemotherapy is important to determine personalized treatment strategies. However, the details of chemotherapy and the prognosis of advanced gastric cancer patients have changed with the time and environment. The aim of this study was to understand the current reality of chemotherapy and to estimate the prognostic factors of advanced gastric cancer patients before starting chemotherapy at multiple centers. This includes specialized cancer hospitals and community hospitals, with the latest data under the Japanese insurance system. We evaluated the clinical parameters and treatment details of 1025 patients who received systemic chemotherapy for unresectable advanced gastric cancer from 2012 to 2018 at 12 institutions in Japan. Prognostic factors were analyzed using the Cox proportional hazards regression model. As of April 2021, 953 (93%) patients had died, while 72 (7%) patients survived. The median overall survival and progression-free survival of first-line chemotherapy was 11.8months (95% confidence interval, 10.8-12.3months) and 6.3months (95% confidence interval, 5.9-6.9months), respectively. Multivariate analysis revealed eight prognostic factors: age<40years, performance status ≥2, no gastrectomy, diffuse histological type, albumin <3.6, alkaline phosphatase ≥300, creatinine ≥1.0 and neutrophil-to-lymphocyte ratio>3.0. Patients using trastuzumab showed better survival than patients without (16.1months vs. 11.1months; P=0.0005). We identified eight prognostic factors for patients with advanced gastric cancer undergoing Japanese standard chemotherapy. Our results will help clinicians develop treatment strategies for every patient.

Work Engagement and Safety Behavior of Nurses in Specialized Cancer Hospitals: The Mediating Role of Self-Efficacy

Aim. This paper aimed to examine the current state of nurse safety behavior, and the effect of work engagement on it, and to explore the mediating effect of self-efficacy between work engagement and nurse safety behavior in specialized cancer hospitals. Background. Nurse safety behavior affects the quality of care and outcomes for patients with cancer. The research proves that self-efficacy is associated with work engagement, but the relationship between self-efficacy, work engagement, and nurse safety behavior needs to be clarified. Methods. This study used a convenience sampling method to survey 957 nurses from January to February 2023. The survey included tertiary specialized cancer hospitals in five provinces in China. Sociodemography information, the Work Engagement Scale, the Self-Efficacy Scale, and the Nurse Safety Behavior Scale were used for the survey. A Questionnaire Star program collected all the data automatically. The Statistical Package for the Social Sciences version 24 was employed for Pearson correlation and multiple regression analysis to examine the association between work engagement, self-efficacy, and nurse safety behavior. Structural equation models were built using Analysis of Moment Structures version 24.0 software. Results. The results showed that the nurse safety behavior was at a high level in specialized cancer hospitals. There was a significant positive relationship between the variables work engagement, self-efficacy, and nurse safety behavior with coefficients ranging from 0.244 to 0.564. The results of structural equation modeling revealed that self-efficacy partially mediated the effect between work engagement and nurse safety behavior, accounting for 25.3% of the total effect. Conclusion. Self-efficacy mediates the relationship between work engagement and nurse safety behavior, and by increasing self-efficacy, nurse safety behavior can be improved, thus ensuring patient safety. Implications for Nursing Management. Managers should promote high work engagement and nurse safety behaviors by fostering nurses’ self-efficacy.

Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.

The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.

SURVEY ON FACTORS ASSOCIATED WITH CERVICAL CANCER AMONG FEMALE INDIVIDUALS IN BANGLADESH

Cervical cancer is a health crisis affecting women and their families worldwide. Globally 604,237 women were diagnosed with cervical cancer worldwide, representing 6.5% of all cancers in women in 2020. This survey aims to resolve associative factors of Cervical Cancer among female individuals in Bangladesh. A cross-sectional study was conducted among female individuals aged between 30-70 years &amp; above in Specialized Cancer Hospital, Dhanmondi 27 in Dhaka, from January 2014 to July 2014. There were 180 female participants in our study from SCH, and their age range was 30-70 years &amp; above. The socio-demographic profile, risk factors related status, cervical cancer-related status &amp; related psychological status were also revealed. Almost half of the respondents, 56.1% (n=101), were in the age group of fewer than 53 years, which is the reproductive age group. And rest of the respondents comprised more than an equal 55 years. Almost eight in every ten female respondents are suffering from Cervical Cancer. The results indicate that there are associations between cervical cancer and multiple variables such as marital status, occupation of husbands, monthly income, parity, HTN, DM, thyroid abnormalities, source of knowledge about cervical cancer, knowledge of cervical cancer screening &amp; HPV vaccine, HPV vaccination status, menstrual cycle status, vaginal discharge, genital hygiene during menstruation &amp; in a normal day, duration of cervical cancer &amp; treatment and few psychological states of the respondents which are highly significant as P&lt;0.00.

Pharmacist-led olaparib follow-up service for ambulatory ovarian cancer patients: A prospective study in a tertiary specialized cancer hospital in China.

Purpose: To establish a pharmacist-led olaparib follow-up program for ovarian cancer patients, provide patient education, get information on adverse drug reactions (ADRs), and identify and manage drug-related problems. Methods: Ambulatory adult patients with ovarian cancer receiving olaparib were enrolled. At least one follow-up session was conducted by clinical pharmacists. Pharmacists collected data on the type and grade of ADRs, drug adherence, olaparib dosing, concomitant medications, and pharmacists' suggestions. Results: 83 patients were enrolled with the median age of 58. The average number of the follow-up sessions provided to each patient was 1.31, and the average duration of each follow-up was 17.78min. The olaparib starting dose for most patients (97.59%) was 600mg/d. 36.14% of the patients had missed olaparib doses and 27.71% of the patients had dose adjustments due to ADRs. The most common ADRs (incidence≥10%) were: fatigue (40.96%), anemia (36.14%), leukopenia (36.14%), nausea (28.92%), thrombocytopenia (16.87%), anorexia (16.87%), dyspepsia (15.66%). The tolerability profiles were generally similar between patients treated for "first-line maintenance" and those treated for "recurrence maintenance" (p > .05). There were 42% of the patients who were concomitantly taking medications without exact chemical contents (such as formulated Chinese medicines and Chinese decoctions), and common types of concomitant medications with exact drug names were antihypertensive, anti-hyperglycemic, and anti-hyperlipidemic medications. The pharmacists identified 4 clinically significant drug-drug interactions (DDIs) in two patients. Pharmacists made 196 suggestions mainly related to rational use of the medications and management of ADRs. Conclusion: The study provides the first report about pharmacist-led follow-up service for olaparib. The types of ADRs were similar to those previously observed in clinical trials, and the profiles of ADRs in different types of patients (first-line maintenance vs. recurrence maintenance) were also similar. Pharmacists identified drug-related problems (such as adherence, DDIs and management of ADRs) and offer suggestions for the patients.

Bacterial antibiotic resistance among cancer inpatients in China: 2016-20.

The incidence of infections among cancer patients is as high as 23.2-33.2% in China. However, the lack of information and data on the number of antibiotics used by cancer patients is an obstacle to implementing antibiotic management plans. This study aimed to investigate bacterial infections and antibiotic resistance in Chinese cancer patients to provide a reference for the rational use of antibiotics. This was a 5-year retrospective study on the antibiotic resistance of cancer patients. In this 5-year surveillance study, we collected bacterial and antibiotic resistance data from 20 provincial cancer diagnosis and treatment centers and three specialized cancer hospitals in China. We analyzed the resistance of common bacteria to antibiotics, compared to common clinical drug-resistant bacteria, evaluated the evolution of critical drug-resistant bacteria and conducted data analysis. Between 2016 and 2020, 216 219 bacterial strains were clinically isolated. The resistance trend of Escherichia coli and Klebsiella pneumoniae to amikacin, ciprofloxacin, cefotaxime, piperacillin/tazobactam and imipenem was relatively stable and did not significantly increase over time. The resistance of Pseudomonas aeruginosa strains to all antibiotics tested, including imipenem and meropenem, decreased over time. In contrast, the resistance of Acinetobacter baumannii strains to carbapenems increased from 4.7% to 14.7%. Methicillin-resistant Staphylococcus aureus (MRSA) significantly decreased from 65.2% in 2016 to 48.9% in 2020. The bacterial prevalence and antibiotic resistance rates of E. coli, K. pneumoniae, P. aeruginosa, A. baumannii, S. aureus and MRSA were significantly lower than the national average.

Measuring Occupational Fatigue among Higher and Middle Management at a Specialized Cancer Center during the COVID-19 Pandemic.

This study aims to measure the occupational fatigue level and describe the sources and consequences of occupational fatigue among middle and higher management at an international specialized cancer center during the COVID-19 pandemic. A mixed-method design was used in this study. A convenience sampling technique was utilized to select the participants from King Hussein Cancer Center, Amman, Jordan. The data was collected through a self-administered questionnaire. This questionnaire included both quantitative and qualitative sections. We utilized Fatigue Risk Assessment and Management in High-Risk Environments (FRAME)-26 items scale for the quantitative section. Two main questions were included in the survey to identify the sources and consequences of occupational fatigue. The results show that the average mean of occupational fatigue was 2.95/5 (SD=0.70). The level of changes in fatigue levels after the COVID-19 pandemic increased by 0.87/3 (SD=1.45). The sources of occupational fatigue could be categorized into five themes: workload, work environment, staffing, psychological, and physical sources. There are four themes categorizing occupational fatigue: social, economic, health, and daily activity and lifestyle. This study affords valuable insight into the level, source, and consequences of occupational fatigue among middle and higher management at an international specialized cancer hospital in developing countries. The results indicate that the occupational fatigue level was moderate, and the fatigue level was negatively impacted by the COVID-19 pandemic.

Pretreatment neutrophil-lymphocyte ratio has prognosis value in breast cancer patients

Objectives: This study aimed to determine the prognostic value of the pretreatment inflammatory indexes neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratio in breast cancer. Methods: A retrospective cohort of patients with breast cancer receiving treatment at a specialized cancer hospital were collected from 2016. Pretreatment complete blood cell counts were evaluated to assess inflammatory indexes. The outcome variable was 5-year overall survival. Kaplan-Meier curves, log-rank test, and Cox regression (hazard ratio; 95% confidence interval) were used. Results: A total of 312 women (mean age 51.9 years; histopathological grade II 61.6%; tumor stage III 50.0%) were included in the study. Of these, 169 (54.2%) died within 5 years, the majority of whom had neutrophil-lymphocyte ratio ≥ 2.5 (62.5%; p= 0.002), histopathological grades II and III (60.4%; p= 0.024), more advanced tumor stages (87.7%; p&lt;0.001), and significantly lower overall survival. Neutrophil-lymphocyte ratio ≥ 2.5 (hazard ratio, 1.53; 95% CI, 1.11-2.11) was an independent prognostic factor for overall survival. In addition, histopathological grades II (hazard ratio, 3.53; 95% confidence interval, 1.29-9.68) and III stage (hazard ratio, 2.50; 95% confidence interval, 1.45-4.34) and stage IV (hazard ratio, 6.07; 95% confidence interval, 3.43-10.73) demonstrated predictive power. Conclusion: Pretreatment neutrophil-lymphocyte ratio was considered a useful predictor of overall survival in breast cancer.

Proactive Innovation in a Prolonged Conflict Setting: Facing COVID-19 in a Specialized Cancer Hospital in Palestine.

The prolonged ongoing conflict in Palestine exacerbated socioeconomic conditions and weakened the health system, complicating the management of COVID-19 pandemic, especially for cancer patients who are doubly-at risk. Augusta Victoria Hospital (AVH) is Palestine's only specialized cancer hospital, receiving patients from the Gaza Strip and the West Bank for oncology, nephrology, hematology, and radiotherapy. AVH's preparedness measures enabled its agile response. These proactive and innovative preparedness measures included: implementing a facility-level preparedness and response plan; utilizing multidisciplinary team-based and evidence-informed approaches to decision making; prioritizing health workers' safety and education; establishing in-house PCR testing to scale up timely screenings; and accommodating health workers, patients, and their relatives at hospital hotels, to maintain daily, continuous and critical health care for cancer patients and limit the spread of infection. At the facility-level, the biggest challenge faced by AVH was continuing essential and daily care for immunocompromised patients while protecting them from potential infection from relatives, hospital staff and other suspected patients. At the national level, the lack of preparedness, inequalities in vaccine distribution, political instability, violence, delays in obtaining medical exit permits to reach Jerusalem, weakened AVH's response. AVH's flexible financing, hospital accreditation, and strong leadership and coordination enabled its agility and resilience. Despite compiling challenges, the hospital's proactive and innovative interventions minimized the risk of infection among two high-risk groups: the immunocompromised patients and their health workers, providing invaluable lessons for health facilities in other fragile-and-conflict-affected settings.

Different Primary Sites of Hypopharyngeal Cancer Have Different Lymph Node Metastasis Patterns: A Retrospective Analysis From Multi-Center Data.

BackgroundMost hypopharyngeal cancers (HPCs) develop lymph node metastasis (LNM) at initial diagnosis. Understanding the pattern of LNM in HPC could help both surgeons and radiologists make decisions in the management of cervical lymph nodes.MethodsA total of 244 newly diagnosed HPC patients between January 2010 and December 2018 were recruited from three specialized cancer hospitals in mainland China. All patients received pre-treatment magnetic resonance imaging (MRI), and definitive radiotherapy with or without concurrent chemotherapy. We reassessed the features of the primary tumor (tumor size, primary location, and extent of invasion) and the involvement of lymph nodes at each level. According to the incidence of LNM, these levels were sequenced and sorted into drainage stations. Univariate and multivariate analyses were used to determine the risk factors for bilateral and regional lymph node metastasis.ResultsThe cohort consisted of 195 piriform sinus cancers (PSC), 47 posterior wall cancers (PWC), and 2 post-cricoid cancers (PCC). A total of 176 patients (72.1%) presented with MRI-detectable LNMs. The overall LNM rates for level II-VI and retropharyngeal lymph nodes (RPLNs) were 59.0%, 52.9%, 14.3%, 1.6%, 2.9%, and 16.4%, respectively. Based on the prevalence of LNM at each level, we hypothesize that the lymphatic drainage of PSC was carried out in sequence along three stations: Level II and III (61.0% and 55.4%), Level IV and RPLN (15.9% and 11.3%), and Level V and VI (1.5% and 3.1%). For PWCs, lymphatic drainage is carried out at two stations: Level II, III, and RPLN (48.9%, 40.4%, and 34.0%) and Level IV-VI (6.4%, 0%, and 2.1%). According to univariate and multivariate analyses, posterior wall invasion was significantly correlated with bilateral LNM (P = 0.030, HR = 2.853 95%CI, 1.110-7.338) and RPLN metastasis (P = 0.017, HR = 2.880 95%CI, 1.209-6.862). However, pyriform sinus invasion was less likely to present with bilateral LNM (P = 0.027, HR = 0.311, 95%CI, 0.111-0.875) and RPLN metastasis (P = 0.028, HR = 0.346, 95%CI, 0.134-0.891).Conclusions and RelevanceThe primary tumor site and extent of invasion are related to the pattern of lymph node metastasis. That is, the metastasis would drainage station by station along different directions.

Progressive Increase Trend in HPV-Related Oropharyngeal Squamous Cell Carcinoma in Brazil.

Introduction The prevalence of oropharyngeal squamous cell carcinoma (OSCC) related to Human Papillomavirus (HPV) is rising in the whole world. Objective To access the prevalence and temporal trend of HPV infection in oropharyngeal cancer by analyzing the expression of the p16 protein. Methods We conducted a transversal study in a Brazilian reference oncology center. The sample consisted of 254 patients with OSCC. The analyzed period was from 2013 to 2017. All patients underwent p16 immunohistochemistry analysis. Results The overall prevalence of HPV-related OSCC was of 31.9%. During the analyzed period, we observed a trend of increasing rates of OSCC that marked positive for p16 immunohistochemistry. The annual prevalence of p16-positive cases was of 20.6% in 2013, 23.9% in 2014, 33.3% in 2015, 38.3% in 2016, and 34.2% in 2017. Most of the patients were stage III and IV (84%). Female patients (odds ratio [OR] = 2.43; 95% confidence interval [CI]: 1.003–5.888; p = 0.049) and younger patients (OR = 2.919; 95%CI: 1.682–5.067; p < 0.005) were associated with a higher risk of HPV-related OSCC. Tobacco consumption had a proportional lower risk of HPV-related OSCC (OR = 0.152; 95%CI: 0063–0.366; p < 0.005). Conclusion We observed an increasing prevalence of HPV-related OSCC in a specialized cancer hospital in Brazil.

Evaluation of Different Types of Pain in Patients with Breast Cancer

Background: Cancer, a common disease in the world, is considered the second cause of mortality in developed countries. In the management of symptoms created by breast cancer (BC), pain is the most important. So, this study aimed to evaluate different dimensions of pain in patients using the McGill Pain Questionnaire. In this way, physicians could perform effective treatment for patients. Methods: This case study was done on BC patients aged 30-60 years old in some specialized cancer hospitals in Tehran. The utilized research instrument in this study was the McGill Pain Questionnaire. Data were analyzed by SPSS Software. Conclusion: According to these results, it is possible to use effective and better treatment to reduce BC patients’ pain.

Contemporary trends on expenditure of hospital care on total cancer and its subtypes in China during 2008-2017.

ObjectiveTo describe the contemporary trends in total, inpatient, and outpatient expenditure on major subtypes of cancer in different classifications of hospitals in mainland China.MethodsHome page of Inpatient Medical Records (HIMRs) and Hospital Annual Reports (HARs) were used to estimate hospital care expenditure on cancer. Inpatient payments and their share of cancer were calculated with the top-down method. Kriging spatial interpolation methods were used at the county level and summed at the province level. Outpatient expenditure was estimated with inpatient expenditure and the ratios of outpatient to inpatient payments in specialized cancer hospitals, stratified by province. Total expenditure on cancer was the sum of both payments. Log-linear regression was applied to estimate annual percentage change (APC) of expenditure.ResultsTotal expenses for cancer of Chinese residents reached up to 304.84 billion Chinese Yuan (CNY) in 2017, accounting for 5.8% of the total health expenses (THE). After adjusting for consumer price index (CPI), medical expenses for cancer have increased from 63.30 billion CNY in 2008 to 249.56 billion CNY in 2017 [APC: 15.2%, 95% confidence interval (95% CI): 13.4%−17.0%]. The APC was slightly higher than THE around 2013, while was lower after 2013. During 2008−2017, the ratio of inpatient to outpatient costs for cancer decreased from 4.3:1 to 3.8:1. The inpatient payments for cancer mainly happened in grade 3 general hospitals, East China, and among lung, colorectal, and stomach cancer; while the fastest increase was found in West China, and among thyroid, prostate, and colorectal cancer.ConclusionsDuring 2008−2017, the rapid growth trend of medical expenses for cancer has been effectively controlled with the continuous deepening of medical reform and improvements of residents’ health care. More attention should be paid to potential increases of medical costs caused by technological progress and demand release. Socialized and multi-channel insurance financing modes should be explored in the future.

Oncological Outcomes of Non-Urothelial Bladder Cancers in a Specialized Cancer Hospital of a Developing Country.

BackgroundNon-urothelial bladder cancers (NUBCs) constitute only 5% of all bladder cancers. Because of the scarcity of data, no standardized treatment can be offered to these patients. Surgical treatment can be offered to patients with localized disease; however, generally, the prognosis is unfavorable.MethodologyPatients with histology-proven NUBC presenting to the Department of Uro-oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan, from January 2002 to July 2017 were identified and assessed retrospectively.ResultsA total of 20 patients with a median presenting age of 52 years (range: 34-87 years) were identified. Clinically, T3 was the commonest stage of presentation, i.e., in 11 (55%), whereas 1 (7.1%) patient had metastatic disease. Four types of NUBCs were identified: adenocarcinoma, squamous cell carcinoma, small cell carcinoma, and inflammatory myofibroblastic tumor. Most of the patients with adenocarcinoma were offered surgical treatment in the form of either partial (64.3%) or radical (28.6%) cystectomy. Two patients with small cell carcinoma and two of the three patients with SCC could only be offered palliative chemotherapy. During a median follow-up of 40 months, 14 (70%) patients developed disease progression or recurrence. All these patients succumbed to their disease during a median period of 37.5 months (range: 5-84 months). Furthermore, three- and five-year disease-free survival was 60% and 51%, respectively, and overall survival was 65% and 31%, respectively.ConclusionsNUBC is a rare but aggressive disease that presents at an advanced stage in many cases. Treatment protocols are not uniform; therefore, further collaborative research is needed to improve survival outcomes.

Expert Consensus for Treating Cancer Patients During the Pandemic of SARS-CoV-2.

The sudden pandemic of SARS-Cov-2 (also known as novel coronavirus disease 2019, COVID-19) poses a severe threat to hundreds of millions of lives in the world. The complete cure of the virus largely relies on the immune system, which becomes particularly a challenge for the cancer subjects, whose immunity is generally compromised. However, in a constant evolving situation, the clinical data on the prevalence of SARS-Cov-2 for cancer patients is still limited. On top of a wide range of medical references and interim guidelines including CDC, NCI, ASCO, ESMO, NCCN, AACR, ESMO, and the National Health Commission of China, etc., we formed into a guideline based on our experience in our specialized cancer hospital in Wuhan, the originally endemic center of the virus. Furthermore, we formulated an expert consensus which was developed by all contributors from different disciplines after fully discussion based on our understanding and analysis of limited information of COVID-19. The consensus highlighted a multidisciplinary team diagnostic model with assessment of the balance between risks and benefits prior to treatment, individualizing satisfaction of patients’ medical needs, and acceptability in ethics and patients’ socio-economic conditions.