Years In Cancer Patients Research Articles

6857 Adrenal Incidentaloma In A Patient With Surgically Treated Lung Adenocarcinoma A Decade After Complete Remission

Abstract Disclosure: L. Kaur: None. R. Kaur: None. F. Haider: None. A. Iqbal: None. N. Patel: None. Adrenal incidentaloma is an adrenal mass >1 cm in size commonly discovered incidentally in up to 5-7% of patients on imaging performed for reasons other than adrenal causes. Metastasis to the adrenal glands is common due to their rich blood supply, with lung cancer being the most common primary site, followed by the stomach, esophagus and the liver. Bilateral adrenal metastasis is common, however isolated metachronous or synchronous adrenal metastasis is rare, with an incidence of 1-6%. We present a case of incidentally discovered isolated right adrenal mass ten years after curative surgical resection of right lung adenocarcinoma. A 74 year old male with history significant for adenocarcinoma of the right upper lung lobe stage 1A , negative for metastasis status post lobectomy and no adjuvant chemotherapy or radiation 10 years ago presented to the hospital for his routine follow up evaluation. His vitals were within normal limits and physical examination was unremarkable. The follow up diagnostic CT imaging was done which showed an incidental 2.1 x 1.6 x 1.2 cm right adrenal mass without any pathological lesion or lymphadenopathy. A review of CT scan done one year ago revealed no prior adrenal mass or other suspicious findings. The patient was referred to endocrinology for evaluation of the adrenal mass. He denied abdominal or right flank pain, headaches, palpitations, elevated blood pressure, sweating, muscle weakness, weight gain/loss and was healthy appearing. Lab work up including biochemical studies for hormonal over production, including aldosterone-renin ratio, adrenocorticotropic hormone, plasma catecholamines with urine metanephrines and urine cortisol were within physiological ranges. CT scan was repeated after 2 months which revealed right adrenal mass of 3.2 x 1.8 x 1.7 cm in size with heterogeneity and high pre contrast density. Given the patient's history of lung cancer, imaging characteristics and rapid interval increase in size, there was high suspicion for metastatic disease. Other differentials considered due to fast growth rate included adrenocortical carcinoma and less likely adrenal adenoma. A decision was made to proceed with right adrenalectomy for definitive resection and histological diagnosis secondary to quickly growing adrenal mass with no lymphadenopathy. The patient underwent laparoscopic adrenalectomy and the final pathological report was consistent with metastatic lung adenocarcinoma. Postoperatively the patient recovered well. At 2 week and 3 month follow up he reported no concerns. Isolated adrenal metastasis is unusual and rare but may occur in lung cancer patients years after curative resection of the primary tumor and hence long term annual follow up imaging and monitoring is recommended for prompt diagnosis and timely treatment. Presentation: 6/2/2024

A-212 Comparison of formulas for measuring LDL in cancer patients with hypertriglyceridemia

Abstract Background Treatments in recent years in cancer patients have been very favorable. However, some data suggest that dyslipidemia plays a role in carcinogenesis through the deregulation of the lipid signal, and this possibly leads to the development of cardiovascular diseases. A marker for the diagnosis and treatment of dyslipidemias is low density lipoproteins (LDL), and currently, the primary care level still calculates LDL due to the high costs of the direct method; Friedewald has been used since 1972, and in recent years, new equations have appeared such as Sampson and Martin - Hopkins (MH). These formulas use total cholesterol (TC), high-density lipoproteins (HDL), and triglycerides (TG). Objective was to compare the formulas for measuring LDL in cancer patients with hypertriglyceridemia. Methods It´s an observational, cross-sectional - and analytical study. The sample size was 880 lipid profiles processed in an automated dry chemistry analyzer between January and March 2023 at an Oncology Institute in Lima, Peru. The population was divided into several groups of triglyceride levels (<200 mg/dl, 200- 399 mg/dl, ≥ 400 mg/dl), and LDL was stratified according to ATP III to evaluate the classification of patients with respect to LDL formulas. The statistical analysis was performed by descriptive analysis of the categorical and numerical variables; The correlation was performed using Pearson, and a comparison of the LDL formulas was used by Bland Altman to determine the bias and percentage bias. To clinical relevance, it was compared with the biological variation of the Westgard table. A p-value <0.05 was considered significant, and the data were processed in MedCalc v20.027. Results The average age of the patients was 55.02 ± 13.92 years, and the frequency of female sex was 77.39% (n = 681). The average measured TC, HDL, and LDL were 208.95 ± 54.84 mg/dl, 41.53 ± 13.83 mg/dl, and 115.70 ±45.53 mg/dl, respectively, while the calculated average LDL in Friedewald was 120.40 ± 48.57, MH was 130.49 ± 44.15 mg/dl and Sampson was 125.97 ± 45.53 mg/dl. The correlations of measured versus calculated LDL were strong (r > 0.89) at different TG levels; Statistical (p<0.05) and clinical relevance was observed in the Friedewald formula when TG ≥ 400 mg/dl, while the MH and Sampson formulas presented clinical and significant relevance at all triglyceride levels. Patients with an LDL level between 130 and 159 mg/dl presented a more substantial classification error according to the Friedewald, MH, and Sampson formulas. Conclusions Friedewald formula presented a clinically acceptable bias up to 400 mg/dl, unlike the MH and Sampson formulas, which were affected by triglycerides ≥ 150 mg/dl.

Abstract A058: Investigating the role of race/ethnicity on the association between neighborhood deprivation and breast cancer outcomes among Kentucky breast cancer patients years 2010-2022

Abstract Background: Despite advances in medical knowledge and treatment, disparities in breast cancer outcomes persist along demographic and socioeconomic lines. To quantify these disparities, the Area Deprivation Index (ADI) emerges as a powerful metric. It offers insights into the interplay between neighborhood socioeconomic status and breast cancer outcomes by encompassing factors pertaining to income, education, employment, and housing quality. There have been limited studies to examine the role of race and neighborhood disadvantage on specific breast cancer outcomes. Kentucky also faces a unique burden as it has the third highest breast cancer mortality rate in the United States. This study aims to examine the association between neighborhood socioeconomic disadvantage, and breast cancer outcomes including receipt of surgical treatment, radiation therapy, chemotherapy, and breast cancer-specific survival. While also examining how any associations are modified by race and ethnicity among Kentucky breast cancer patients. Methods: We conducted a retrospective cohort analysis using data from the Kentucky Cancer Registry (KCR) among breast cancer patients diagnosed between 2010 and 2017 with follow-up data through December 31, 2022. The KCR dataset was then linked with census tract data to examine ADI. We conducted consecutive multilevel logistic regression for binary outcomes and Cox Proportional hazard models using SAS (version 9.4, SAS Institute, Inc., Cary, North Carolina, USA) for time-to-event of breast cancer survival. Results: Women in the most disadvantaged quartile (4th quartile) were more likely to be Non-Hispanic Black (NH-Black), Appalachian residents, current tobacco users, divorced and using government insurance. Compared to women in the least disadvantaged neighborhoods (1st quartile) women living in the most disadvantaged neighborhoods (4th quartile) were 50% more likely to die from breast cancer (HR: 1.50, 95 CI: 1.28-1.76). Women in the most disadvantaged neighborhoods (4th quartile) were also more likely to be diagnosed at later stages (aOR:1.26, 95 CI:1.13-1.42). These associations were all observed after adjusting for age, race, tobacco use, marital status, insurance status, family history, and residence in Appalachia. Conclusions: Women living in areas of greater disadvantage had significantly increased odds of late-stage diagnosis and risk of breast cancer death regardless of race suggesting that neighborhood-level factors contribute to breast cancer disparities. Our findings underscore the need for neighborhood-level interventions to improve cancer outcomes. Citation Format: Breyanna E. Walker, Elinita Pollard, Justin Moore, Sydney Howard, Pamela Hull, Kathleen O'Connor, Samantha Jones, Lovoria Williams, Adebola Adegboyega, Veronica Jones, Eric Durban, Xiaoqin Wang, Wendi Owen. Investigating the role of race/ethnicity on the association between neighborhood deprivation and breast cancer outcomes among Kentucky breast cancer patients years 2010-2022 [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A058.

Impact of cancer and other causes of death on mortality of cancer patients: A study based on Japanese population-based registry data.

Cancer registry data provide a very important source of information for improving our understanding of the epidemiology of various cancers. In this work, we estimated the 5-year crude probabilities of death from cancer and from other causes for five common cancers, namely stomach, lung, colon-rectum, prostate and breast, in Japan, using population-based registry data. Based on data on 344 676 patients diagnosed with one of these cancers between 2006 and 2008 in 21 prefectures participating in the Monitoring of Cancer Incidence in Japan (MCIJ) and followed-up for at least 5 years, we used a flexible excess hazard model to compute the crude probabilities of death for different combinations of sex, age and stage at diagnosis. For tumours diagnosed at the distant stage, as well as for regional lung tumours, the vast majority of deaths at 5 years in cancer patients were attributable to the disease itself (although this proportion was only around 60% in older prostate cancer patients). For localised and most regional tumours, the impact of other causes of death on the total mortality increased with age at diagnosis, especially for localised breast, colorectal and gastric cancer. By allowing the partition of the mortality experience of cancer patients into a cancer- and an other-cause-specific component, crude probability of death estimates provide insight into how the impact of cancer on mortality might differ among populations with different background mortality risks. This might be useful for informing discussions between clinicians and patients about treatment options.

Needs of cancer patients during the period of treatment of late complications of cancer

Cancer is the most common cause of death worldwide. Nursing services provided in the late stage of cancer complications improve the quality of life of patients, accelerate the recovery process or help them find inner spiritual peace. The ability of nurses to express empathy and apply motivational interviews has an impact on patients becoming stronger psychologically and physically. The psychological need is effective when a teamwork model is used.
 The aim of the research – to analyze scientific literature on the needs of patients in the stage of late complications of cancer treatment.
 Methods of research. Systematic research of the scientific literature was conducted using PubMed, BMJ, Elsevier, The Lancet oncology, IMJ, Google Scholar, World Health Organisation electronic databases. The results showed that the side effects of treatment can last for years in cancer patients in the late stage of complications. The nursing needs are directed to the continuous care of oncological patients, assessment of health status. Teamwork helps to involve the patient in the services provided, to motivate the patient's actions, feedback is important too. Educational activities of the nursing staff are aimed at promoting a healthy lifestyle, planning daily activities that help reduce fatigue, pain, and maintain muscle mass.

The association between two genetic polymorphisms in ITGB3 and increase risk of venous thromboembolism in cancer patients in Eastern Province of Saudi Arabia.

Venous thromboembolism (VTE) is one of the major complications in most cancer patients leading to poor prognosis and short survival. Several common clinical risk factors coexist in cancer patients are used as risk predictive biomarkers to help in the management and prevention of VTE. These include cancer site and stage, chemotherapy regimen and elevated biological markers. However, Genetic polymorphisms in genes controlling coagulation and fibrinolysis are significantly associated with VTE if detected, then they might be more sensitive individual predictive biomarkers for VTE risk assessment. This study was conducted to evaluate the association between ITGB3 rs3809865 and rs5918 with VTE risk as well as monitor the effect of VTE on overall survival of these cancer patients. In this retrospective case-control study, 195 cancer patients’ formalin-fixed paraffin embedded tissue (FFPE) samples were collected (controls n = 157, case n = 38) using the stored data through Jan 2010 to Sep 2018 from King Fahad Specialist Hospital in Dammam. Samples were genotyped using TaqMan genotyping assay, then logistic regression analysis and Chi-square were used to predict the association between risk factors and VTE. Survival Comparison was tested by the log-rank test. Genetic polymorphisms in ITGB3 (rs3809865 and rs5918) found not to be associated with VTE increasing risk in cancer patients (p>0.05). While the advanced stage was potentially increasing the risk of VTE events (OR 5.1 CI 2.01–12.9p = 0.001). Patients with VTE showed a poor overall survival reflected by the median survival rate of only three years compared to seven years for cancer patients without VTE. This study highlighted the potential influence of VTE on prognosis and survival of cancer patients and raised the importance of exploring risk predictive biomarkers in our population. This will improve the risk prediction biomarkers leading to implementing safe and effective thrombosis prophylaxis strategies.

Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.

IntroductionGiven clinicians’ frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision making, we studied the survival and performance status of cancer patients 2 years following an unplanned ICU admission.Materials and methodsThis was a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned ICU admission in 2017 into two groups: patients with or without an active malignancy. Descriptive statistics, Pearson’s Chi-square tests and the Mann-Whitney U tests were used to evaluate the primary objective 2-year mortality and performance status. A good performance status was defined as ECOG performance status 0 (fully active) or 1 (restricted in physically strenuous activity but ambulatory and able to carry out light work). A multivariable binary logistic regression analysis was used to identify factors associated with 2-year mortality within cancer patients.ResultsOf the 1046 unplanned ICU admissions, 125 (12%) patients had cancer. The 2-year mortality in patients with cancer was significantly higher than in patients without cancer (72% and 42.5%, P <0.001). The median performance status at 2 years in cancer patients was 1 (IQR 0–2). Only an ECOG performance status of 2 (OR 8.94; 95% CI 1.21–65.89) was independently associated with 2-year mortality.ConclusionsIn our study, the majority of the survivors have a good performance status 2 years after ICU admission. However, at that point, three-quarter of these cancer patients had died, and mortality in cancer patients was significantly higher than in patients without cancer. ICU admission decisions in acutely ill cancer patients should be based on performance status, severity of illness and long-term prognosis, and this should be communicated in the shared decision making. An ICU admission decision should not solely be based on the presence of a malignancy.

Bisphosphonate-Related Osteonecrosis of the Jaw.

Antiresorptive agents for bone pain were widely used to treat patients with advanced osteoporosis, multiple myeloma, and bone metastatic cancer. In recent years, however, bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been a rare but major complication of this therapy. Most patients with BRONJ undergo dental procedures during treatment with antiresorptive agents. However, BRONJ may also occur spontaneously. This study reports 13 BRONJ patient cases at Kaohsiung Veterans General Hospital, Taiwan, and their related treatments. We also compare patients with cancer with patients with osteoporosis in treatment outcomes. Thirteen symptomatic patients with BRONJ were reviewed between 1985 and 2018 at Kaohsiung Veterans General Hospital. We included patients at advanced stage who were hospitalized for infection control of osteonecrosis of the jaw and excluded asymptomatic patients at stage 0 and stage 1. Four multiple myeloma, 3 patients with bone metastatic breast cancer and 6 patients with advanced osteoporosis (average ages, 63.57 ± 14.54 years in cancer patients and 79.5 ± 9.31 years in osteoporosis patients; average drug durations, 25.86 ± 27.23 months in cancer patients and 58.33 ± 23.87 months in osteoporosis patients; average follow-up times, 22.71 ± 14.46 months in cancer patients and 28.08 ± 36.35 months in osteoporosis patients) were included. Seven patients were defined as having stage 3 (53.8%) and 6 as having stage 2 (46.2%) medication-related osteonecrosis of the jaw, according to the American Association of Oral and Maxillofacial Surgeons classification. The complete response rate with totally healed mucosa was 61.5%. Four cancer patients received free fibular flap (FFF) reconstruction with a high complete response rate (100%). All of them had a relatively better performance status, and the average age was also younger than osteoporosis patients. Free fibular flap with a high complete response rate may improve pain relief and infection control for patients with BRONJ. Younger age is seemed to be a great indicator for FFF, but poor self-care ability (Eastern Cooperative Oncology Group status >3) is not suitable for these surgical treatments.

Active Mycobacterium tuberculosis infection at a comprehensive cancer center, 2006\u20132014

BackgroundMorbidity and mortality from Mycobacterium tuberculosis (Mtb) infection remain significant in cancer patients. We evaluated clinical characteristics, management, and outcomes in patients with active Mtb infection at our institution who had cancer or suspicion of cancer.MethodsWe retrospectively examined medical records of all patients with laboratory-confirmed active Mtb infection diagnosed between 2006 and 2014.ResultsA total of 52 patients with laboratory-confirmed active Mtb infection were identified during the study period, resulting in an average rate of 6 new cases per year. Thirty-two (62%) patients had underlying cancer, while 20 (38%) patients did not have cancer but were referred to the institution because of suspicion of underlying malignancy. Among patients with cancer, 18 (56%) had solid tumors; 8 (25%) had active hematologic malignancies; and 6 (19%) had undergone hematopoietic-cell transplantation (HCT). Patients with and without cancer were overall similar with the exception of median age (61 years in cancer patients compared to 53 years in noncancer patients). Pulmonary disease was identified in 32 (62%) patients, extrapulmonary disease in 10 (19%) patients, and disseminated disease in 10 (19%) patients. Chemotherapy was delayed in 53% of patients who were to receive such treatment. Eleven patients (all of whom had cancer) died; 3 of these deaths were attributable to Mtb infection.ConclusionsAlthough not common, tuberculosis remains an important infection in patients with cancer. Approximately one-third of patients were referred to our institution for suspicion of cancer but were ultimately diagnosed with active Mtb infection rather than malignancy.

Depression, Anxiety and Coping Strategies in Cancer Patients: A Case Control Study

Objectives: Psychiatric disorders frequently accompany chronic diseases especially cancer. The aim of this study was to investigate the depression and anxiety levels and the coping strategies in cancer patients. Materials and Methods: This was a case control study conducted in Karabuk University Research Hospital ( KURH) between January 2018 and December 2018. Case group constituted of patients with an established diagnosis of cancer and control group included healthy individuals. Coping Strategies Questionnaire (COPE), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were performed for all participants. Statistical analyzes were carried out using Minitab 17 Statistical Software. Case versus control comparison for continues variables was conducted using Mann Whitney U test. Degree of relationship between continues variables were measured using Spearman's rank correlation. Chi-Squared test was used to evaluate cross tabulated categorical data. Results: 94 individuals were included in the study. Both cancer and control groups consisted of 23 males and 24 females. Mean age was found 59.77±12.01 years for cancer patients and 59.06±12.36 for control group. BDI and BAI scores of the patients were significantly higher compared to healthy individuals. Considering the cut-off values; 60% (28/47) of the cancer patients were found depressed and 62% (29/47) of them were found to have anxiety while in the control group both the depression and anxiety prevalence was 28% (13/47) (p=0.004 and p=0.002 respectively). Both groups were similar regarding the coping strategies total score (p=0.779). Turning to religion, humor, mental disengagement, denial and substance use were seen more frequently in cancer patients compared to control group (p=0.004, p=0.001, p=0.005, p=0.001 and p=0.004 respectively); whereas active coping, restraint coping, acceptance and behavioral disengagement were significantly more frequent in control group (p=0.001, p=0.039, p=0.026 and p=0.055 respectively). Humor, mental disengagement, denial and substance use were positively correlated with BDI scores (r=0.30 p=0.003, r=0.38 p=0.001, r=0.29 p=0.004, r=0.22 p=0.03 respectively). Turning to religion, humor, mental disengagement and substance use were positively correlated with BAI scores (r=0.24 p=0.015, r=0.25 p=0.013, r=0.31 p=0.001, r=0.23 p=0.024 respectively). Conclusion: The results of the current study revealed that cancer patients had higher levels of depression and anxiety compared to healthy individuals and they had higher risk of being depressed or anxious. Furthermore, the patients developed different strategies in order to cope with the burden of this catastrophic disease. Therefore, cancer a multifaceted condition which must be approached in a multidimensional manner, taking psychological features of each individual into account.

Oncosuppressor-Mutated Cells as a Liquid Biopsy Test for Cancer-Screening

We reported on the ability of immortalized or oncosuppressor-mutated cells (OMCs) to uptake circulating cancer-factors and give tumors when transplanted into mice. This led to the first biological based liquid biopsy test, which we called MATER-D platform. In the present study, we showed for the first time that a different type of OMCs (PTEN-deficient human epithelial MCF10A cells) turn malignant when exposed to cancer patient’s sera, confirming the concept that different cells with diverse oncosuppressor mutations can uptake cancer factors and be used in biological based liquid biopsy tests. Our observations were confirmed in a large variety of solid and haematological malignancies. This test was able to detect dysplasia and carcinomas in situ lesions in different organs and circulating factors in cancer patients years after the removal of their lesions. To our knowledge, this ability is unique and not shared by other liquid biopsy platforms. Immunohistochemistry analysis of the xenotransplants revealed identical patterns of differentiation regardless of the cancer type, showing that differentiation through horizontal transfer might be dependent on the nature of the target cells rather than the type of cancer factors. These data strengthen the notion that OMC-based liquid biopsy tests might be promising platforms for cancer screening.

Psychopathological Profile of Women with Breast Cancer Based on the Symptom Checklist-90-R

With effective early treatments, many breast cancer patients suffer from psychological distress due to adverse effects and lifelong physical disfigurement. Our study aimed to evaluate the psychopathological profile of breast cancer patients in comparison with healthy women and explored demographic correlates. We consecutively enrolled breast cancer patients who came to the hospital for follow-up or rehabilitation care after primary treatment, and healthy female relatives or friends of inpatients in the Cancer Institute of Chinese Academy of Medical Sciences between August 30, 2010 and January 1, 2012. Psychopathological profile was assessed based on the Symptom Checklist-90-R (SCL-90-R) for patients and controls. We compared demographics such as age, ethnicity, education, marriage, and occupation, and incorporated these data plus cancer status for the association with the general SCL-90-R index and scores for 9 major symptom dimensions in multiple regression analysis. We surveyed a total of 291 female breast cancer patients and 531 healthy women. The average age was 55.1 ± 6.40 years for breast cancer patients and 43.1 ± 12.8 for healthy controls (P<0.01). The mean survival was 5.20 years for cancer patients (range, 0.60-9.90 years). There were statistically significant differences in education, marriage, and occupation between the two groups (P<0.01). General index (1.45 ± 0.45 versus 1.32 ± 0.37) and 8 dimension scores (excluding anxiety) on SCL-90-R were significantly higher in patients (P<0.05). Multiple regression analysis showed that the breast cancer status was positively correlated with general SCL-90-R index and 6 dimension scores (excluding the anxiety, phobic anxiety and paranoid ideation dimensions) (P<0.05). Regression coefficients ranged from 0.10 (depression) to 0.19 (somatization). Higher interpersonal sensitivity was noticed in single women compared to married women. Chinese patients with breast cancer demonstrate greater psychopathology compared to healthy controls. The breast cancer status is an independent contributing factor to the general psychopathological profile. Breast cancer patients should be given particular counseling and care to alleviate their psychological distress.

Long-term management of chronic pain with transdermal buprenorphine: A multicenter, open-label, follow-up study in patients from three short-term clinical trials

Transdermal buprenorphine is available in Europe for the treatment of moderate to severe chronic pain. It has been evaluated at doses of 35, 52.5, and 70 microg/h for the management of moderate to severe chronic cancer and noncancer pain in 3 randomized, double-blind, placebo-controlled trials, each of limited duration (approximately 14 days each). Long-term data are essential to determining the performance of an analgesic in the management of chronic pain. The purpose of this follow-up study was to obtain data on the efficacy and tolerability of long-term treatment with transdermal buprenorphine in cancer and noncancer patients with chronic persistent pain of moderate to severe intensity. This was an open-label, uncontrolled, follow-up study in patients from the 3 previous clinical trials who elected to continue treatment with transdermal buprenorphine 35 microg/h and sublingual buprenorphine tablets (0.2 mg) as needed for breakthrough pain. The patch was to be changed every 72 hours throughout the patient's course of pain therapy. At visits every 2 weeks for the first 4 weeks and every 4 weeks for the remainder of study participation, patients evaluated their pain relief retrospectively on a 4-point verbal rating scale. They also rated the ease of patch handling using a 3-point verbal rating scale. Patterns of dose escalation and dose stability were monitored over time. Adherence to therapy was determined based on the number of patients who complied with the dosing schedule. Adverse events were documented by type, intensity, location (systemic or local), and relationship to study medication. Two hundred thirty-nine patients were included in this follow-up study (120 women, 119 men; 100% white; mean [SD] age, 58 [11.3] years; mean weight, 70.8 [14.7] kg). One hundred thirty-four had cancer-related pain and 105 had pain of noncancerous origin. The mean duration of participation was 7.5 months, and 37 (15.5%) patients participated for >12 months. Maximum study participation was 3.4 years in cancer patients and 5.7 years in noncancer patients. One hundred eighty-eight (78.7%) patients were considered adherent to therapy. The majority (65.9%) of patients managed their pain with the patchalone or took no more than 1 additional sublingual tablet daily for breakthrough pain. At least satisfactory pain relief was reported by 215 (90.0%) patients, and the buprenorphine patch was generally well tolerated. The most common systemic adverse drug reactions were nausea (9.2%), dizziness (4.6%), vomiting (4.2%), constipation (3.8%), and tiredness (2.9%), whereas the most common local adverse drug reactions were erythema (12.1%), pruritus (10.5%), and exanthema (8.8%). Transdermal buprenorphine was generally well tolerated and effective for the long-term treatment of chronic cancer or noncancer pain in these patients who had previously received buprenorphine in 3 short-term clinical trials.

Endoscopic colorectal cancer screening—can supply meet demand?

Endoscopic colorectal cancer screening—can supply meet demand?

Significance of the duration of menstrual life in the onset of breast cancer in women

Menarche and menopause age and duration of menstrual life have been examined in a series of 4,000 consecutive cases of breast carcinoma, hospitalized in the Cancer Institute of Milan from 1928 to 1957. The same examination was performed on 2,788 patients hospitalized in the same period for non-tumour affections or for benign and malignant tumours in organs non dependent on endocrine stimulation. A good agreement was found in the age distribution of breast cancer patients and controls. In breast cancer patients the average age of menarche and menopause was observed to be 13.646 and 47.905 years respectively; in control patients, 13.831 and 47.220. 1 out of 4,000 cases of breast cancer (0.025 per cent) and 6 out of 2,788 controls (0.36 per cent) had never been menstruated. The duration of the menstrual life was 34.256 years for breast cancer patiens and 33.389 years for control patients (with a prolongation of 0.867 years for cancer patients).