Supportive Care Issues Research Articles

Electronic Patient-Reported Outcome-Driven Symptom Management by Oncology Pharmacists in a Majority-Minority Population: An Implementation Study.

There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)-driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention. This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations. We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; P = .008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; P = .008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; P = .04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits. Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM.

Prevalence of Possible Dementia in Patients with Maxillofacial Defects and Difficulty of Inserting Obturator in Maxillectomy Patients: Toward Better Provision of Supportive Care.

As society ages, it is important to understand the prevalence of dementia and the difficulties of inserting prostheses in patients with maxillofacial defects in order to clarify issues in supportive care. We screened 183 patients for dementia using the revised Hasegawa's dementia scale (HDS-R) at the Clinic for Maxillofacial prosthetics, Tokyo Medical and Dental University, and investigated age and sex differences in HDS-R score. We asked 47 of the 183 participants about the difficulty of inserting a maxillofacial obturator prosthesis and collected subjective comments, information about the prosthesis, and data from five assessments. Multiple regression analysis was used to reveal factors associated with insertion difficulty. Overall, 8.7% of the participants were judged to have possible dementia. Men were more likely than women to have possible dementia, and the risk increased with age. Of the 47 participants, 26 reported difficulty inserting their prosthesis, 12 of whom attributed it to their oral defect. Fourteen patients advised following doctor's instructions to practice insertion in order to become accustomed to it. A lower HDS-R score had a significant impact on insertion difficulty. Cognitive function and difficulty inserting maxillary obturator prostheses should be considered in the provision of continuous supportive care to patients with maxillary defects.

Young Women with Breast Cancer in Resource-Limited Settings: What We Know and What We Need to Do Better.

Young women with breast cancer (YWBC) account for a variable proportion of patients diagnosed with breast cancer around the globe, with a higher prevalence in resource-limited settings than in high-income countries. This group represents a unique population that warrants special attention due to specific biological considerations and age-specific supportive care issues. This review aims to explore existing knowledge regarding YWBC’s needs, particularly in resource-restricted settings. To date, scarce information regarding the care of YWBC in resource-constrained countries is available, with most reports describing suboptimal care in terms of survivorship needs. Health care providers should implement actions to improve endocrine treatment adherence, referrals for fertility counseling and preservation, contraceptive use compliance, timely body image and sexual function interventions, comprehensive genetic risk assessments, and early quality of life and psychosocial health interventions. While high costs act as a barrier for optimal care in resource-limited settings, improving patient education represents a promising and cost-effective solution to improve patient care. Future research on developing tailored educational resources for YWBC in resource-limited settings should be considered a priority.

Evaluating the Impact of Therapy Related Healthcare Team Burden on Selection of Novel Therapies for Chronic Lymphocytic Leukemia and Lymphoid Malignancies

IntroductionMultiple factors drive specific therapy selection for patients with hematologic malignancies including efficacy, toxicity, patient and physician preferences, comorbid conditions, cost, and logistics. However, the advent of many highly effective and generally well-tolerated targeted therapies for chronic lymphocytic leukemia (CLL) and lymphoid malignancies makes objective distinction between various therapeutic agents more difficult. As a result, the eventual therapy selection is often based on physician preference.Secure electronic communication portals (ECP) are federally mandated and frequently used in health care. Although important, ECPs impose a significant burden on the entire healthcare team. However, the extent of ECP use on healthcare burden is poorly ascertained particularly in hematology. While limited available data suggests that cancer patients are more likely than urology or family medicine patients to use ECP, healthcare utilization studies have historically not included this metric as a measure of therapy-related healthcare team burden (THTB). Our study not only uniquely evaluates the quantitative impact of ECP use on THTB, it also addresses qualitative domains that are used in ECPs to provide a holistic and granular assessment of THTB.MethodsPatient and ECP data were retrospectively collected at a comprehensive cancer center after institutional IRB approval. The dataset included 412 patients with CLL and lymphoid malignancies treated with ibrutinib (n=237), acalabrutinib (n=70), and venetoclax (n=105). A subset of these patients with AML treated with venetoclax were also included to address disease and therapy specific issues. By leveraging common taxonomy from published literature, we created multiple domains specific to the evaluable metrics as detailed in the tables and utilized the Naranjo adverse drug reaction probability scale and provider documentation to code each message.ResultsPatients who had at least one patient-initiated or clinician-initiated ECP message thread were included in the final analysis (n=95, 23.06%). Table 1 shows patient, treatment, and disease characteristics. Ibrutinib was used mostly as initial or second-line therapy, while acalabrutinib and venetoclax were mostly used for later lines. We coded 3338 message threads, comprising 3272 patient-generated messages, and 2050 messages generated by 354 unique clinical staff. Our sampled population generated an average of 25.83 messages per patient and our healthcare clinical staff generated an average of 17.96 messages. Table 2 contains domain specific ECP interactions. Patient and healthcare team-generated messages were highest in the first six months of starting therapy and varied with treatment (p<0.01). Venetoclax use was associated with the highest frequency of interactions during the first 6 months of starting therapy. Both treatment-related and unrelated adverse events domains, as well as administrative and supportive care domains, as coded from the ECP, were highest in patients with CLL treated with venetoclax (p=0.005). This was similar for patients with AML treated with venetoclax (p=0.07), suggesting a drug effect rather than the disease process. Patients on venetoclax were also more likely to discuss supportive care and scheduling issues. Adverse event domain specific qualitative measures included comments like “have a scalloped tongue and metallic taste since starting acalabrutinib”, “diarrhea, nausea, and vomiting persists since starting the ibrutinib”, and “watery diarrhea persists despite the loperamide since starting the venetoclax”.ConclusionOur study highlights an important but poorly described measure of THTB that can significantly impact therapy selection, especially when multiple therapeutic options with comparable outcomes are available. A non-reimbursed increase in ECP utilization poses significant THTB which is not easily offset by increased staffing efforts and might result in under-utilization of potentially effective therapies, especially in resource limited settings. In addition, our domain-specific appraisal of ECP allows for identification for improvements in healthcare delivery and intervention with structured enhancements that can maximize patient-centered care while decreasing THTB. THTB should therefore include ECP use and be evaluated as part of a comprehensive assessment tool. [Display omitted] DisclosuresMadanat: Geron Pharmaceutical: Consultancy; Blue Print Pharmaceutical: Honoraria; Stem line pharmaceutical: Honoraria; Onc Live: Honoraria. Patel: PVI: Honoraria; Celgene-BMS: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees. Anderson: Celgene, BMS, Janssen, GSK, Karyopharm, Oncopeptides, Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Awan: Beigene: Consultancy; Incyte: Consultancy; Celgene: Consultancy; Karyopharm: Consultancy; Kite pharma: Consultancy; Dava Oncology: Consultancy; Johnson and Johnson: Consultancy; Verastem: Consultancy; MEI Pharma: Consultancy; Gilead sciences: Consultancy; Pharmacyclics: Consultancy; Janssen: Consultancy; BMS: Consultancy; Cardinal Health: Consultancy; Merck: Consultancy; ADCT therapeutics: Consultancy; Abbvie: Consultancy; Astrazeneca: Consultancy; Genentech: Consultancy.

Association of high adherence to vegetables and fruits dietary pattern with quality of life among Chinese women with early-stage breast cancer

PurposeDietary intake and patients’ quality of life (QoL) are important supportive care issues in breast cancer survivorship. This study aimed to identify dietary pattern before and after breast cancer diagnosis. In addition, the association between dietary patterns and QoL were cross-sectionally and longitudinally investigated.MethodsA breast cancer cohort which included 1462 Chinese women were longitudinally interviewed at four time-points, namely baseline, 18-, 36-, and 60 months after diagnosis. At each follow-up, validated food frequency questionnaires (FFQ) were used to assess patients’ dietary intake, and factor analysis was used to derive dietary patterns. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) were used to measure QoL at each follow-up. This study included 1368, 1226, 1079 and 1095 patients with invasive disease who completed assessment at baseline, 18-, 36- and 60-month follow-up and had detailed data of dietary intake and QoL.ResultsBased on data obtained at 18-month follow-up, two major dietary patterns were identified: “grain and animal food pattern” and “vegetables and fruits pattern”. Similar dietary patterns were obtained at baseline, 36- and 60- month follow-up. Generalized Estimating Equations (GEE) were used to analyze the longitudinal associations between dietary patterns and QoL over the four follow-ups. High intake of grain and animal food was inversely associated with scores for role functioning (B = − 0.744; 95%CI − 0.147 to − 0.017), dyspnea (B = − 0.092; 95%CI − 0.092 to − 0.092) and constipation (B = − 1.355; 95%CI − 2.174 to − 0.536). Vegetables and fruits intake were positively associated with scores for global health status/QoL (B = 1.282; 95%CI 0.545–2.019), physical functioning (B = 0.545; 95%CI: 0.037–1.053), emotional functioning (B = 1.426; 95%CI 0.653–2.200) and cognitive functioning (B = 0.822; 95%CI 0.007–1.637), while inversely associated with scores for nausea and vomiting (B = − 0.382; 95%CI − 0.694 to − 0.071), dyspnea (B = − 0.570; 95%CI − 0.570 to − 0.570), insomnia (B = − 1.412; 95%CI − 2.647 to − 0.177), loss of appetite (B = − 0.722; 95%CI − 1.311 to − 0.132), constipation (B = − 2.028; 95%CI − 2.775 to − 1.281) and diarrhea (B = − 0.929; 95%CI − 1.481 to − 0.377).ConclusionThis study suggested that high adherence to “grain and animal food pattern” or “vegetables and fruits pattern” was significantly associated with several aspects of QoL. For instance, vegetables and fruits pattern appears to have beneficial effect on global health status/QoL among Chinese breast cancer patients. Prospective follow-up data could further confirm whether a specific dietary pattern has impact on cancer outcomes.

Effect of Postsurgical Nurse-led Follow-ups on Quality of Life in Head-and-Neck Cancer Patients: A Pilot Randomized Controlled Trial

Objective:Burden of head-and-neck cancer is disproportionately bigger in India and can be regarded as “tip of iceberg” situation. Postoperatively, head-and-neck cancer patients report tremendous challenges conversely, affects quality of their life. Oncology nurses contribute significantly in supportive care issues encountered by patients in the postoperative period. However, there is a paucity of the literature on effect of nurse-led postsurgical education program on quality of life (QOL) of head-and-neck cancer patients.Methods:In this pilot randomized controlled, parallel group trial, 64 head-and-neck cancer patients; who were electively planned for surgery were randomized in experimental (n1 = 32) and control group (n2 = 32). In the experimental group, participants received structured nurse-led postsurgical education program through virtual mode and control group participants received standard of care. The QOL as an outcome variable was assessed through face-to-face interview at baseline on first postoperative day and postoperative day-4, 15, and 30 follow-ups by using standardized instruments, i.e., EORTC QLQ-C30 and H and N35 questionnaire.Results:The experimental group had a significant improvement in global health (P = 0.02), role functioning (P = 0.02), emotional functioning (P = 0.01), swallowing (P = 0.01), and opening mouth (P = 0.02). Postoperative pain and speech problems were most distressing symptoms in participants of both groups.Conclusions:The nurse-led postsurgical virtual education programme was found effective to improve the selected domains of QOL and may be used as an adjuvant intervention for head-and-neck cancer patients.

Supportive care for new cancer therapies.

The past decade has witnessed unprecedented delivery to the clinical arena of a range of novel, innovative, and effective targeted anticancer therapies. These include immunotherapies, most prominently immune checkpoint inhibitors, as well as agents that target growth factors and cancer-related mutations. Many of these new cancer therapies are, however, associated with an array of toxicities, necessitating insight and vigilance on the part of attending physicians to achieve high-quality supportive care alongside toxicity management. In this review, we consider some of the key supportive care issues in toxicity management. Although both supportive care and targeted therapies have brought significant benefits to cancer care, the management of novel cancer therapy toxicities is nevertheless often complex. This is due in large part to the fact that target organs differ widely, particularly in the case of checkpoint inhibitors, with minor dermatological disorders being most common, while others, such as pneumonitis, are more severe and potentially life threatening. Accordingly, efficient management of these immune-related adverse events requires collaboration between multiple medical specialists. Supportive care is a key component in the management of new cancer therapy toxicities and needs to be incorporated into treatment pathways.

Pediatric Aggressive Mature B-Cell Lymphomas, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology.

Pediatric aggressive mature B-cell lymphomas are the most common types of non-Hodgkin lymphoma in children, and they include Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL). These diseases are highly aggressive but curable, the treatment is complex, and patients may have many complicated supportive care issues. The NCCN Guidelines for Pediatric Aggressive Mature B-Cell Lymphomas provide guidance regarding pathology and diagnosis, staging, initial treatment, disease reassessment, surveillance, therapy for relapsed/refractory disease, and supportive care for clinicians who treat sporadic pediatric BL and DLBCL.

Additional considerations for "checklists to guide the supportive and critical care of tuberculous meningitis".

Checklists are pivotal in the systematic assessment of critically ill patients, pre-operative assessments and for patients with multisystem involvements. Management of tuberculous meningitis is challenging due to prolonged hospital stay, multiple neurological complications like seizures, stroke, raised intracranial tension, stroke, neurosurgical interventions, multiple invasive procedures, health-care-associated sepsis, and ventilation. All these complications are managed by separate checklists to avoid treatment-related errors. The current manuscript aims to ensure completeness of inpatient care addressing issues addressing diagnostic issues, supportive care, and intensive care related issues.

Palliative Care Needs of Young and Middle Age Adults (20-59) with Cancer: A Pilot Study (FR460C)

•Identify three unique palliative care needs of an adult (20-59) with a life limiting cancer.•Discuss quality of life issues related to this cancer population. The diagnosis of a potentially life-threatening cancer is a documented stress that encompasses biological, cognitive and socioemotional dimensions. Early introduction to palliative care is important in addressing stress and its outcomes. For young and middle-aged adult (20-59), this diagnosis creates unique needs of which little is known. This mixed methods descriptive research pilot study explores and describes the palliative and supportive care issues and needs of young and middle age adults (20-29) with a potentially life limiting cancer diagnosis. A convenience sample of 8 oncology patients completed a demographic survey and two questionnaires relating to quality of life and functional health status. In addition, they were asked seven open ended structured survey questions relating to personal descriptions of quality of life, available resources, and personal understanding of palliative care. Quality of Life Dimensions are significantly impacted including physical, psychological, and social factors. Several reoccurring themes associated with their age and diagnosis also emerged including delayed diagnosis, employment and financial issues. The majority of this population lives in rural communities with limited access to resources. Finally, none of the participants could accurately describe palliative care and only 15% had been introduced to palliative care services while being treated for their cancer. All dimensions associated with quality of life are impacted by the diagnosis of cancer for a young and middle age adult. Palliative care is a resource that could help address some of these needs. Clearly for this population, palliative care is not being well communicated or integrated in this primarily rural young cancer population

Listeria monocytogenes Meningitis in a Female Patient with Primary Mediastinal (Thymic) Large B-Cell Lymphoma: A Case Report

Listeriosis with severe clinical manifestations in the form of bacteraemia, sepsis, and meningitis/meningoencephalitis is a rare but a challenging issue of supportive care in oncohematology. Early diagnosis of listeriosis, as well as any other infection, is hampered by severe general manifestations of a malignant lymphoproliferative disorder or tumor complications and its treatment. In patients with pronounced decreased drug-induced immunity listeriosis is usually characterized as a rapidly developing and, as a rule, severe disease with high immediate mortality. The present article offers a case report of severe listeria infection in a female patient admitted to the intensive care unit for the treatment of primary mediastinal (thymic) large B-cell lymphoma with a large tumor mass in anterior mediastinum complicated by mediastinal and superior vena cava compression syndromes.

A telephone outcall program to support caregivers of people diagnosed with cancer: utility, changes in levels of distress, and unmet needs.

To evaluate the utility of a telephone outcall program for cancer caregivers and to examine longitudinal changes in their distress levels and supportive care needs. As part of the PROTECT trial, caregivers assigned to the intervention arm (N = 108) received three telephone outcalls from a Cancer Council 13 11 20 nurse at three time points (7-10days post-randomization, 1 and 4months later). During each call, caregivers were screened for distress using the Distress Thermometer (range: 0-10) then six supportive care issues were raised for discussion. Participants completed a utility survey 1month post-intervention. The outcall program was highly acceptable and perceived as beneficial by caregivers. Overall, 95% reported it was worth their time to take part in the outcall program and 82% stated that the program was very relevant to them. Level of distress and impact of distress decreased over time (p = 0.0031, p < 0.0001, respectively). Average call duration decreased over time (p < 0.0001) and was longer for female than male caregivers (p = 0.0009). The frequency of caregivers discussing issues related to psychological distress (p = 0.0003), health literacy (p < 0.0001), financial (p = 0.0014), and practical concerns (p = 0.0121) decreased over time. Psychological distress was more often discussed by female than male caregivers (p = 0.0153), and family issues more often by younger (< 55years) than older caregivers (p = 0.0071). Utility of this outcall program was high. Caregivers' level of distress and unmet needs decreased over time. Gender and age differences emerged, which warrants the need for tailored support. Further research is necessary to identify the best method of improving access to 13 11 20 services for caregivers.

Young Adults with Multiple Myeloma.

To identify the salient issues of young adults (YAs) diagnosed with multiple myeloma (MM), a hematologic disease of older adults, that is rare in patients 19-40 years of age. Peer-reviewed journal articles, case reports, single-institution series, and national guidelines. Compared to older adults with MM, YAs live longer and are at higher risk for survivorship-related issues, which include treatment adherence, infertility, reproductive concerns, risk of second primary cancers, treatment-related cardiotoxicity, and higher risk of non-cancer-related mortality. In addition to understanding disease biology, the oncology nurse should have an understanding of the unique developmental, psychosocial, and medical and psychosocial needs of the young adult with MM. The oncology nurse will then be able to provide targeted education about the disease, its treatment trajectory, and supportive care issues, as well as advocate for therapies, and based on response, toxicities, while taking into consideration patient-centered needs.

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

Older adults with head and neck squamous cell carcinoma (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced disease, for which combined-modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and a higher risk of functional impairments remains challenging and is exacerbated by the paucity of studies involving older adults. The purpose of this article is to identify knowledge gaps in the evaluation and management of older adults with HNSCC-particularly those undergoing concurrent chemoradiation therapy-and their caregivers through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with locoregionally advanced HNSCC. On the basis of our findings, we prioritize these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

What oncologists, patients, and families want from published clinical trials and office visits.

e18192 Background: When oncology-related professionals &amp; patients are reading their publications such words as: "may, possibly, might, could, hopefully &amp; perhaps" are used to describe potential improvements in treatment &amp; outcome. Similarly the terms "significant inprovement" &amp; "approval" have different meanings to professionals &amp; their patients &amp; toxicity issues are often not clearly defined. This often leads to misunderstandings about treatment. Methods: To better understand these issues, 4 round table discussions with 16 community oncologists &amp; 4 discussions with 26 patients or family member were held. The basic question was "what's missing" to help make a better treatment decison? Results: From physicians: a lack of clarity on the order of treatment, especially dealing with non-chemotherapy agents was seen. Issues of how &amp; when to judge response to therapy &amp; whether treatment should continue, stop or be changed were clear. There was much confusion as to when &amp; what to order to evaluate diagnostic, prognostic&amp; therapeutic options. Questions on proper randomization based on solid tumor load &amp; location (quality &amp; quantity of disease) and the aggressiveness of supportive care for patients on study vs "standard of care" led to questions on the comparability of reported results &amp; their own clinical practice. Discussing "statistical" vs "clinical" significance &amp; FDA drug "approval" was confusing in discussions with patients. The cost &amp; reimbursement of drugs, whether oral or IV was problematic. From patients &amp; their families, similar concerns were raised. Their frustration was seen by unknown "out of pocket" financial costs &amp; the "hidden costs" of treatment, like supportive care issues, transportation &amp; psychosocial support to the family. However, what the patients and their families wanted more than anything else was for them to be respected: appointments kept on time, empathy &amp; honesty in their discussions with &amp; from caregivers. Conclusions: Clinical articles should have a summary section with information on how to treat today's patients &amp; when possible, treatment costs should be included to help with these discussions. Patients need to be seen as a person with a disease rather than as a disease attached to a person.

NCCN NewsTreatment Disparities, Significance of the Doctor-Patient Relationship, Supportive Care Issues, and the Latest Guidelines UpdatesPatient, Provider, Caregiver: Physicians Share Lessons Learned When the Tables Are TurnedNCCN Imaging Appropriate Use Criteria Published for 13 Additional GuidelinesNew Supportive Care Resources From NCCN Help Patients With Cancer Confront Distress

NCCN NewsTreatment Disparities, Significance of the Doctor-Patient Relationship, Supportive Care Issues, and the Latest Guidelines UpdatesPatient, Provider, Caregiver: Physicians Share Lessons Learned When the Tables Are TurnedNCCN Imaging Appropriate Use Criteria Published for 13 Additional GuidelinesNew Supportive Care Resources From NCCN Help Patients With Cancer Confront Distress

Efficacy and safety of fosaprepitant in the prevention of nausea and vomiting following highly emetogenic chemotherapy in Chinese people: A randomized, double-blind, phase III study

The prevention of chemotherapy‐induced nausea and vomiting was one of the most challenging supportive care issues in oncology, especially to highly emetogenic chemotherapy (HEC). A total of 645 patients were randomized into fosaprepitant group (fosaprepitant/placebo 150 mg d1 in combination with granisetron and dexamethasone) or aprepitant group (aprepitant/placebo 125 mg d1; 80 mg d2‐d3 plus granisetron and dexamethasone).The primary endpoint was the percentage of patients who had a complete response (CR) over the entire treatment course (0–120 hr, overall phase [OP]). It was assessed by using a non‐inferiority model, with a non‐inferiority margin of 10%. The difference of the CR rate was compared between two groups with chi‐square analysis. Six hundred and twenty‐six patients were included in the per protocol analysis. The percentage of patients with a CR in the fosaprepitant group was not inferior to that in the aprepitant group (90.85% versus 94.17%, p = .1302) during OP. Whether the cisplatin‐based chemotherapy or not, the CR rate of the fosaprepitant group was not inferior to that of the aprepitant group. Both regimens were well tolerated. The most common adverse event was constipation. Fosaprepitant provided effective and well‐tolerated control of nausea and vomiting associated with HEC in Chinese patients.

An Australasian perspective on the curative treatment of patients with pancreatic cancer, supportive care, and future directions for management.

The management of patients with pancreatic cancer requires an individualised approach and the support of a multidisciplinary team to accurately stage patients and determine their suitability for curative treatment. Guidelines have been developed in Australasia to define the operability for patients who have been diagnosed with pancreatic cancer. This is supported by advances in pancreatic cancer genetics, which show potential for developing targeted therapies for pancreatic cancer. Both surgery and targeted therapies aim to extend the overall survival of patients. Patients who are cured of their cancer may live with permanent changes in gut anatomy and physiology leading to distressing symptoms that may not be addressed. Patients who cannot be cured of pancreatic cancer may have supportive care issues that are often complex, and a strategic approach to manage these needs for patients with pancreatic cancer is underdeveloped in Australasia. Supportive care services need to be in a position to adapt patient care as the evidence base develops.

Palliative and supportive care in neuro-oncology

Brain tumor (BT) patients are different from other cancer patients population due to the complexity of supportive care needs, the trajectory of disease, the very short life expectancy, the presence of specific symptoms related to neurological deterioration and therefore they need a specific palliative approach. Studies specifically addressing palliative care and end of life (EoL) issues in BT patients are lacking, but early integration of palliative care into the ongoing care of patients living with BT may improve quality of life (QOL) and symptom management. Needs of care of malignant BT patients, particularly at the EoL, require specific palliative interventions, with a multidisciplinary approach performed by a well-trained neuro-oncological team, for the control of pain, confusion, agitation, delirium or seizures management with the aim to allow the patient to experience a peaceful death. There is a great need for education in palliative care and EoL decision-making in neuro-oncology setting. A better knowledge of clinical and ethical issues could help to improve the educational training and quality of care of neuro-oncology services. In this paper, we will address the emerging role of supportive and palliative care issues in BTs.

Cancer Awareness in Aotearoa New Zealand (CAANZ), 2001 and 2015: Study Protocols.

Population cancer awareness is of interest worldwide, as efforts are made to reduce cancer incidence via changes in risk and protective behaviours. To date, few studies have described changes in awareness over time, despite significant investment in raising awareness about various cancer types and risk behaviours. This paper describes the Cancer Awareness in Aotearoa New Zealand (CAANZ) survey, a cross-sectional telephone survey of adult New Zealanders conducted in 2014/2015 (CAANZ15, n = 1064) and its comparison with a similar 2001 study (CAANZ01, n = 438). Both aimed to describe current cancer awareness among a national sample of New Zealand (NZ) adults, with additional aims for CAANZ15 being to explore emerging issues in information provision and supportive care. Follow-up studies are challenged by changes in communication technologies and, in turn, potential issues in sampling. However, given the value of information about changing awareness, pragmatic steps were taken in CAANZ15 to maximise the response rate and comparability of the surveys. A response rate of 64% was achieved for both samples. When compared to the adult NZ population, the CAANZ15 sample tended to be older, of higher socioeconomic status and under-representative of people with Pacific, Asian or, to a lesser extent, Māori (the indigenous population of NZ) ethnicity. To compensate for possible disproportionate age-by-ethnicity (Māori/non-Māori) groups in the sample, poststratification weighting was adopted. While caution will need to be exercised in drawing conclusions from comparisons made between these two cohorts, the dearth of such studies means that insights gained should be useful for guiding reflection on future cancer control directions and the generation of new hypotheses.