scholarly journals The Association Between Treatment Interval and Survival in Patients With Colon or Rectal Cancer: A Systematic Review

2021 ◽  
Author(s):  
Ruud F. W. Franssen ◽  
Maud T. A. Strous ◽  
Bart C. Bongers ◽  
F. Jeroen Vogelaar ◽  
Maryska L. G. Janssen-Heijnen
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Optimal Treatment ◽  
Reliable Estimate ◽  
Original Research ◽  
Curative Surgery ◽  
Cancer Specific Survival ◽  
Treatment Interval

Abstract Background Surgery for colon or rectal cancer is associated with a high incidence of complications, especially in patients with a low aerobic fitness. Those patients might benefit from a comprehensive preoperative workup including prehabilitation. However, time between diagnosis and treatment is often limited due to current treatment guidelines. To date, it is unclear whether the treatment interval can be extended without compromising survival. Methods A systematic review concerning the association between treatment intervals and survival in patients who underwent elective curative surgery for colon or rectal cancer was performed. A search up to December 2020 was conducted in PubMed, Cinahl and Embase. Original research articles were eligible. Quality assessment was performed using the Downs and Black checklist. Results Eleven observational studies were included (897 947 patients). In colon cancer, treatment intervals that were statistically significant associated with reduced overall survival or cancer-specific survival ranged between > 30 and > 84 days. In rectal cancer, only one out of four studies showed that treatment intervals > 49 days was associated with reduced cancer-specific survival. Conclusions This systematic review identified that studies investigating the association between treatment intervals and survival are heterogeneous with regard to treatment interval definitions, treatment interval time intervals and used outcome measures. These aspects need standardization before a reliable estimate of an optimal treatment interval can be made. In addition, further research should focus on establishing optimal treatment intervals in patients at high risk for postoperative complications, as particularly these patients might benefit from extended diagnosis to treatment intervals permitting comprehensive preoperative preparation.

scholarly journals Current Treatment Approaches and Outcomes in the Management of Rectal Cancer Above the Age of 80

2021 ◽  
Vol 28 (2) ◽  
pp. 1388-1401
Author(s):  
Ali P. Mourad ◽  
Marie Shella De Robles ◽  
Soni Putnis ◽  
Robert D.R. Winn
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Age Groups ◽  
Neoadjuvant Chemoradiotherapy ◽  
Clinicopathological Characteristics ◽  
Current Treatment ◽  
First Year ◽  
Ageing Population ◽  
Cancer Specific Survival ◽  
Kaplan Meier

Background: The number of cases of rectal cancer in our older cohort is expected to rise with our ageing population. In this study, we analysed patterns in treatment and the long-term outcomes of patients older than 80 years with rectal cancer across a health district. Methods: All cases of rectal cancer managed at the Illawarra Cancer Care Centre, Australia between 2006 and 2018 were analysed from a prospectively maintained database. Patients were stratified into three age groups: ≤65 years, 66–79 years and ≥80 years of age. The clinicopathological characteristics, operative and non-operative treatment approach and survival outcomes of the three groups were compared. Results: Six hundred and ninety-nine patients with rectal cancer were managed, of which 118 (17%) were aged 80 and above. Patients above 80 were less likely to undergo surgery (71% vs. 90%, p < 0.001) or receive adjuvant/neoadjuvant chemoradiotherapy (p < 0.05). Of those that underwent surgical resection, their tumours were on average larger (36.5 vs. 31.5 mm, p = 0.019) and 18 mm closer the anal verge (p = 0.001). On Kaplan–Meier analysis, those above 80 had poorer cancer-specific survival when compared to their younger counterparts (p = 0.032), but this difference was no longer apparent after the first year (p = 0.381). Conclusion: Patients above the age of 80 with rectal cancer exhibit poorer cancer-specific survival, which is accounted for in the first year after diagnosis. Priority should be made to optimise care during this period. There is a need for further research to establish the role of chemoradiotherapy in this population, which appears to be underutilised.

scholarly journals An Expert Opinion Regarding the Management of Lower Gastrointestinal Cancers During COVID-19 Outbreak in Iran: A Brief Report

2021 ◽  
Author(s):  
Seyed Rouhollah Miri ◽  
Habibollah Mahmoodzadeh ◽  
Farimah Hadjilooei ◽  
Parham Khoshdani Farahani ◽  
Mohammad Moradi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Best Practice ◽  
Treatment Guidelines ◽  
Neoadjuvant Chemoradiotherapy ◽  
Spiral Ct ◽  
Pulmonary Involvement ◽  
Current Treatment ◽  
Immunosuppressed Patients ◽  
Severe Infections ◽  
Patient’S Outcome

Lower gastrointestinal cancer patients, like other immunosuppressed patients, are vulnerable to develop more severe infections. Iran is one of the countries with a high incidence of COVID-19, and some modifications are needed to adjust international protocols to deal with this pandemic. Therefore, our cancer institute has implemented some changes in the current treatment guidelines. In each specialty, all members agreed to choose the minimal intervention. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in the epidemic COVID-19 situation in the country. According to the consensus of colorectal and cancer surgery professors, if a patient is a new case of rectal cancer, he or she should be referred to undergo neoadjuvant chemoradiotherapy. But if the patient comes eight to twelve weeks after receiving chemoradiotherapy in accordance with the COVID-19 epidemic phase, it may be possible to delay surgery. A stent can be implanted in a patient with rectal cancer who presents with obstructive symptoms, and surgery can be postponed until resolving the crisis of the COVID-19 epidemic or its downward trend. For colon cancer, we will request a thoracic spiral CT scan. If there was no evidence of pulmonary involvement with COVID-19, the patient would undergo open surgery considering the patient's health and protection tips.

Swedish Rectal Cancer Trial: Long Lasting Benefits From Radiotherapy on Survival and Local Recurrence Rate

2005 ◽  
Vol 23 (24) ◽  
pp. 5644-5650 ◽  
Author(s):  
Joakim Folkesson ◽  
Helgi Birgisson ◽  
Lars Pahlman ◽  
Bjorn Cedermark ◽  
Bengt Glimelius ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Local Recurrence Rate ◽  
Preoperative Radiotherapy ◽  
Recurrence Rates ◽  
Curative Surgery ◽  
Cancer Specific Survival ◽  
Cancer Trial

Purpose To evaluate the long-term effects on survival and recurrence rates of preoperative radiotherapy in the treatment of curatively operated rectal cancer patients. Patients and Methods Of 1,168 randomly assigned patients in the Swedish Rectal Cancer Trial between 1987 and 1990, 908 had curative surgery; 454 of these patients had surgery alone, and 454 were administered preoperative radiotherapy (25 Gy in 5 days) followed by surgery within 1 week. Follow-up was performed by matching against three Swedish nationwide registries (the Swedish Cancer Register, the Hospital Discharge Register, and the Cause of Death Register). Results Median follow-up time was 13 years (range, 3 to 15 years). The overall survival rate in the irradiated group was 38% v 30% in the nonirradiated group (P = .008). The cancer-specific survival rate in the irradiated group was 72% v 62% in the nonirradiated group (P = .03), and the local recurrence rate was 9% v 26% (P < .001), respectively. The reduction of local recurrence rates was observed at all tumor heights, although it was not statistically significant for tumors greater than 10 cm from the anal verge. Conclusion Preoperative radiotherapy with 25 Gy in 1 week before curative surgery for rectal cancer is beneficial for overall and cancer-specific survival and local recurrence rates after long-term follow-up.

scholarly journals Acupuncture for Quality of Life of Patients with Defecation Dysfunction after Sphincter Preserving Surgery for Rectal Cancer: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Guixing Xu ◽  
Hanzhou Lei ◽  
Yuanfang Zhou ◽  
Liuyang Huang ◽  
Hao Tian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Rectal Cancer ◽  
Large Scale ◽  
Risk Of Bias ◽  
Mean Difference ◽  
Original Research ◽  
Life Questionnaire ◽  
Medium Risk

Purpose. To evaluate the effectiveness and safety of acupuncture for quality of life of patients with defecation dysfunction (DD) after sphincter preserving surgery for rectal cancer. Methods. We searched nine online databases from inception to July 1, 2021, and did not restrict the type of language. Then, studies were independently selected by two research team members with screening criteria and risk bias assessment, and the data were extracted. The primary outcome was Quality of Life Questionnaire-Core 29 (QLQ-CR29). The data were then synthesized using the RevMan V.5.2 by random-effects model. Also, we used the standardized mean differences with 95% credible interval (CI) to describe the outcome of the analysis. Results. A total of 6 randomized controlled trials (RCTs) (with 439 patients) were included in the systematic review, and data from 2 RCTs (with 200 patients) were used in the meta-analysis. Five studies (83%) were judged to have a medium risk of bias, and one was at high risk of bias. For synthesis, data from two medium-risk studies found that acupuncture or electropuncture may improve the QLQ-CR29 with urination (mean difference, −0.39 points; 95%CI, −0.46 to −0.32; I2 = 34%), abdominal pain (mean difference, −0.71 points; 95%CI, −0.89 to −0.54; I2 = 9%), stool (mean difference, −0.49 points; 95%CI, −0.77 to −0.20; I2 = 57%), defecation (mean difference, −0.59 points; 95% CI, −0.85 to −0.33; I2 = 51%), sexual function (mean difference, 0.93 points; 95% CI, 0.48 to 1.38; I2 = 90%), and self-feelings (mean difference, 1.04 points; 95% CI, 0.36 to 1.73; I2 = 94%). Conclusion. Findings in this study indicate that acupuncture or electropuncture may be effective and safe for DD, but the quality of included studies was very low. So, more large-scale, multicenter, long-term, and high-quality original research is still expected in the future.

Socioeconomic and Demographic Statuses as Determinants of Adherence to Antiretroviral Treatment in HIV Infected Patients: A Systematic Review of the Literature

2019 ◽  
Vol 17 (3) ◽  
pp. 161-172 ◽  
Author(s):  
Nuredin Nassir Azmach ◽  
Temam Abrar Hamza ◽  
Awel Abdella Husen
Keyword(s):  
Systematic Review ◽  
Occupational Status ◽  
Original Research ◽  
Positive Trend ◽  
Hiv Patients ◽  
Aids Patients ◽  
Pubmed Database ◽  
Education And Employment ◽  
Socio Economic Factors ◽  
Hiv Aids

Background: Socioeconomic and demographic statuses are associated with adherence to the treatment of patients with several chronic diseases. However, there is a controversy regarding their impact on adherence among HIV/AIDS patients. Thus, we performed a systematic review of the evidence regarding the association of socioeconomic and demographic statuses with adherence to antiretroviral therapy (ART) among HIV/AIDS patients. Methods: The PubMed database was used to search and identify studies concerning about socioeconomic and demographic statuses and HIV/AIDS patients. Data were collected on the association between adherence to ART and varies determinants factors of socioeconomic (income, education, and employment/occupation) and socio-demographic (sex and age). Findings: From 393 potentially-relevant articles initially identified, 35 original studies were reviewed in detail, which contained data that were helpful in evaluating the association between socioeconomic/ demographic statuses and adherence to ART among HIV patients. Two original research study has specifically focused on the possible association between socioeconomic status and adherence to ART. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 7 studies (36.8%), 7 studies (28.0%), and 4 studies (23.5%) respectively out of 19, 25, and 17 studies reviewed. Sex (being male), and age (per year increasing) were significantly and positively associated with the level of adherence in 5 studies (14.3%), and 9 studies (25.7%) respectively out of 35 studies reviewed. However, the determinant of socioeconomic and demographic statuses was not found to be significantly associated with adherence in studies related to income 9(47.4%), education 17(68.0%), employment/ occupational 10(58.8%), sex 27(77.1%), and age 25(71.4%). Conclusion: The majority of the reviewed studies reported that there is no association between socio- demographic and economic variables and adherence to therapy. Whereas, some studies show that age of HIV patients (per year increasing) and sex (being male) were positively associated with adherence to ART. Among socio-economic factors, the available evidence does not provide conclusive support for the existence of a clear association with adherence to ART among HIV patients. There seems to be a positive trend between socioeconomic factors and adherence to ART in some of the reviewed studies.

scholarly journals Biomarkers predictive of treatment response in psoriasis and psoriatic arthritis: a systematic review

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110140
Author(s):  
Conor Magee ◽  
Hannah Jethwa ◽  
Oliver M. FitzGerald ◽  
Deepak R. Jadon
Keyword(s):  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Treatment Response ◽  
Unmet Need ◽  
Response To Treatment ◽  
Cochrane Library ◽  
Original Research ◽  
Eligibility Criteria ◽  
Psoriatic Disease ◽  
Subsequent Response

Aims: The ability to predict response to treatment remains a key unmet need in psoriatic disease. We conducted a systematic review of studies relating to biomarkers associated with response to treatment in either psoriasis vulgaris (PsV) or psoriatic arthritis (PsA). Methods: A search was conducted in PubMed, Embase and the Cochrane library from their inception to 2 September 2020, and conference proceedings from four major rheumatology conferences. Original research articles studying pre-treatment biomarker levels associated with subsequent response to pharmacologic treatment in either PsV or PsA were included. Results: A total of 765 articles were retrieved and after review, 44 articles (22 relating to PsV and 22 to PsA) met the systematic review’s eligibility criteria. One study examined the response to methotrexate, one the response to tofacitinib and all the other studies to biologic disease-modifying antirheumatic drugs (DMARDs). Whilst several studies examined the HLA-C*06 allele in PsV, the results were conflicting. Interleukin (IL)-12 serum levels and polymorphisms in the IL-12B gene show promise as biomarkers of treatment response in PsV. Most, but not all, studies found that higher baseline levels of C-reactive protein (CRP) were associated with a better clinical response to treatment in patients with PsA. Conclusion: Several studies have identified biomarkers associated with subsequent response to treatment in psoriatic disease. However, due to the different types of biomarkers, treatments and outcome measures used, firm conclusions cannot be drawn. Further validation is needed before any of these biomarkers translate to clinical practice.

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