1515P Common presenting symptoms in cancer patients that mimic tuberculosis leading to erroneous diagnosis in Pakistan

6566 Background: Hospitalized cancer patients (pts) with COVID-19 have a severe disease course and high mortality. Pts with lung cancer, hematologic malignancies and metastatic disease may be at higher risk. Detailed prospective inpatient data may help to identify those at greatest risk for poor outcomes. Methods: NCCAPS is a longitudinal study aiming to accrue 2,000 cancer pts undergoing treatment for hematologic malignancy or solid tumor with COVID-19. For pts’ first COVID-19 hospitalization, clinical data, research blood specimens and imaging are collected, and additional clinical data are collected during subsequent hospitalizations. Results: As of Jan. 22, 2021, among 757 enrolled adult patients from 204 sites, 124 (16.3%) reported at least one hospitalization for COVID-19, and discharge data was available for 98 hospitalizations in 88 patients. The median age was 67 (range 21-93, 1Q:56, 3Q:72), 35/88 (40%) were female. The most common malignancies in hospitalized adult pts were lymphoma (18.2%), lung cancer (15.9%) and multiple myeloma (10.2%). The most common presenting symptoms were shortness of breath (65%), fatigue/malaise (64%), and fever (49%). 8/88 (9%) pts were neutropenic (ANC < 1000) at presentation; 17/88 (19%) were thrombocytopenic. Median length of stay was 6.5 days (range 1-41, 1Q:4, 3Q:12). Among those hospitalized, 20/88 (22.7%) received care in the ICU or high dependency unit, with a median ICU stay of 7 days (range 1-22, 1Q:2.5, 3Q:9.5); of those admitted to the ICU, 25% (5/20) received invasive mechanical ventilation. Of those in whom inpatient medications were recorded (n = 63), 63% received corticosteroids, 46% received remdesivir, and 14% received convalescent plasma. One pt received bamlanivimab and 2 patients received tocilizumab. Most (46/63; 73%) received anticoagulation, primarily prophylactic low molecular weight heparin; 11/63 (17%) received therapeutic dose anticoagulation. Inpatient D-dimer values were recorded in 43 inpatients, 26 of whom had multiple measurements. 16/98 hospitalizations ended with death (16%). Conclusions: Preliminary analysis of NCCAPS data reveals that inpatient hospital admission is common among oncology patients with COVID-19 and mortality rates appear high within this cohort. Hematologic malignancies and lung cancer are the most common underlying diagnoses in patients requiring hospitalization. Corticosteroids and anti-coagulation were the most commonly used therapies. Despite high rates of ICU admission, invasive mechanical ventilation may be instituted less often in an oncology cohort. These observations may inform decisions about vaccine policy and decisions to limit life sustaining treatment. Clinical trial information: NCT04387656.

Download Full-text

Lower extremity deep venous thrombosis in cancer patients: correlation of presenting symptoms with venous sonographic findings.

Journal of Ultrasound in Medicine ◽

10.7863/jum.1998.17.11.693 ◽

1998 ◽

Vol 17 (11) ◽

pp. 693-696 ◽

Cited By ~ 4

Author(s):

P A Loud ◽

D L Klippenstein

Keyword(s):

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Cancer Patients ◽

Presenting Symptoms

Download Full-text

Reasons for emergency department visits among advanced cancer patients in their last week of life

Proceedings of Singapore Healthcare ◽

10.1177/2010105817713024 ◽

2017 ◽

Vol 27 (1) ◽

pp. 59-62

Author(s):

Grace Meijuan Yang ◽

Eeyang Ng ◽

Sherman Lian ◽

Marcus Eng Hock Ong

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Advanced Cancer ◽

Demographic Data ◽

Emergency Department Visits ◽

Advanced Cancer Patients ◽

Record System ◽

Cross Sectional ◽

Presenting Symptoms ◽

Singapore General Hospital

For advanced cancer patients, an emergency department (ED) visit in the last week of life may result in aggressive care that is inappropriate and futile. The objective of this study is to explore the characteristics of advanced cancer patients who present to ED in the last week of life. Specifically, we describe the spectrum of presenting symptoms. This was a retrospective cross-sectional study of ED attendances in the Singapore General Hospital during a one-year period. The electronic medical record system was used to retrieve demographic data, characteristics of the ED visits and presenting complaints. A total of 145 patients with advanced cancer dying in hospital within seven days of an ED visit were included. Breathlessness was the most common reason for presenting to ED (85 patients, 58.62%), followed by pain (50 patients, 34.48%), generalised weakness or lethargy (39 patients, 26.90%) and decreased appetite or anorexia (35 patients, 24.14%). Strategies to improve end-of-life care can focus on pre-emptive management of breathlessness and pain. Community programmes can also help prepare families for symptoms like generalised weakness and appetite loss which may signal a progression of the disease. Supportive and palliative care interventions will need to be implemented in the ED setting to better manage the symptoms suffered by these advanced cancer patients.

Download Full-text

COVID‐19 post hematopoietic cell transplant, a report of 11 cases from a single center.

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2020.070 ◽

2020 ◽

Vol 12 (1) ◽

pp. e2020070 ◽

Cited By ~ 3

Author(s):

Afadil Adam

Keyword(s):

Mechanical Ventilation ◽

Cancer Patients ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Single Center ◽

Sars Coronavirus ◽

Oxygen Supplementation ◽

Hematopoietic Cell Transplant ◽

Presenting Symptoms ◽

Complicated Course

In late 2019 the coronavirus disease‐2019 (COVID‐19) pandemic caused by SARS Coronavirus 2 (SARS‐CoV‐2) started in Wuhan, China. Cancer patients are immunosuppressed from their disease and the therapy they receive.Hematopoietic cell transplant (HCT) recipients are a subgroup of patients that are severely immunocompromised and may be at an even higher risk of a complicated course during this infection.We herein report the outcomes and course of 11 sequential cases of HCT recipients infected by SARS‐CoV‐2 treated in our center.The patients age ranged from 17 to 60 years, the duration from transplant to infection ranged from day +5 to 192 months, 6 patients were post allo-HCT, 4 post auto-HCT and one had both allo and auto-HCT. The presenting symptoms were not different from other viral illnesses. The majority had mild COVID-19 stage, while 3 had moderate stage on presentation. None of the patients required oxygen supplementation nor mechanical ventilation.

Download Full-text

Barriers to care for women with low-grade endometrial cancer and morbid obesity: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-026872 ◽

2019 ◽

Vol 9 (6) ◽

pp. e026872 ◽

Cited By ~ 1

Author(s):

Maria C Cusimano ◽

Andrea N Simpson ◽

Angela Han ◽

Robin Hayeems ◽

Marcus Q Bernardini ◽

...

Keyword(s):

Morbid Obesity ◽

Endometrial Cancer ◽

Qualitative Study ◽

Cancer Patients ◽

Quality Care ◽

Tertiary Care ◽

Low Grade ◽

Structured Interviews ◽

Presenting Symptoms ◽

The Impact

ObjectiveObesity is a major risk factor for low-grade endometrial cancer. The surgical management of patients with obesity is challenging, and they may face unique barriers to accessing care. We completed a qualitative study to understand the experiences of low-grade endometrial cancer patients with morbid obesity, from symptom onset to diagnosis to surgery.DesignSemi-structured interviews were performed with endometrial cancer patients with morbid obesity (body mass index (BMI)>40 kg/m2) referred for primary surgery. Transcribed interviews were coded line-by-line and analysed using an interpretive descriptive approach that drew on labelling theory to understand patients’ experiences. Thematic sufficiency was confirmed after 15 interviews.SettingTwo tertiary care centres in Toronto, Ontario, Canada.ParticipantsFifteen endometrial cancer patients with a median age of 61 years (range: 50–74) and a median BMI of 50 kg/m2(range: 44–70) were interviewed.ResultsThematic analysis identified that (1) both patients and providers lack knowledge on endometrial cancer and its presenting symptoms and risk factors; (2) patients with morbid obesity are subject to stigma and poor communication in the healthcare system and (3, 4) although clinical, administrative, financial, geographic and facility-related barriers exist, quality care for patients with morbid obesity is an achievable goal.ConclusionsImproved education on the prevention and identification of endometrial cancer is needed for both patients and providers. Delivery of cancer care to patients with morbid obesity may be improved through provider awareness of the impact of weight stigma and establishing streamlined care pathways at centres equipped to manage surgical complexity.

Download Full-text

Long Non-Coding RNA- PVT1 in Ovarian Cancer as Predictors for Platinum Analogues Resistance

QJM ◽

10.1093/qjmed/hcab103.002 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Walid Abd Almonem Biomy ◽

Mohamed Yassin Mostafa ◽

Nashwa Nagy EL-Khazragy ◽

Khaled Kamal Eldein Ghonem ◽

Amr Attia Hewety

Keyword(s):

Ovarian Cancer ◽

Retrospective Study ◽

Cancer Patients ◽

Complete Blood Count ◽

Ovarian Tissue ◽

Treatment Modalities ◽

Control Group ◽

Presenting Symptoms ◽

Significant Difference ◽

Normally Distributed

Abstract Background Ovarian cancer is the fifth most common type of cancer and the most common cause of death among women with gynecological malignancies. Objectives The aim of this retrospective study was to assess expression of the Lnc_PVT1 in the studied subjects. The expression of Lnc_PVT1 biomarker; was compared in ovarian cancer patients versus the non-cancerous tissue. The data normalization was tested by normality test which shows that the biomarker expression is not normally distributed; thus, a Mann Whitney statistics test for non -parametric values was applied. Our results showed a high significant difference in the expression of Lnc-PVT1 (p < 0.01). Lnc_PVT1 expression is upregulated by 2.4 folds in ovarian cancer patients (median: 32.0; range: 11 – 92) compared to control group (median: 13.0; range: 11 – 16). Methods and Materials This is a retrospective study. Include patients with advanced epithelial ovarian cancer (stage II and IV) who received chemotherapy platinum based and taxines from 2014-2017. Setting: Clinical oncology department Ain Shams University, Egypt, Demerdash hospital. Data collection: The following information will be ANONYMOUSLY extracted from the patient medical files: age at diagnosis, presenting symptoms, laboratory investigations: (Liver function, kidney function, complete blood count &tumor markers), tumor histological type, tumor FIGO stage& degree of differentiation, treatment modalities, type of surgery, chemotherapy regimens (Adjuvant, Neoadjuvant or palliative), chemotherapy responsiveness or resistance, disease recurrence and disease-free period, and patients' survival. Results The current study was enrolled on 55 subjects, they classified into two subgroups. The ovarian cancer cases constitute 45 patients; samples collected from patients after diagnosis has been confirmed by histopathology based on immune-histochemical analysis as well as Computerized axial tomography (CT scan) and Magnetic resonance imaging (MRI). The cancer ovary patients were compared to ten non- malignant ovarian tissues. Table 1 illustrates the demographic and clinical data of the studied subjects. We test the normality for age; the data was normally distributed. For this reason, we represent the data in mean value and standard deviation form. Matched age and gender was observed between ovarian cancer patients and healthy control. The mean age for the studied subjects was 47.7±9.1. In our study; the Cisplatin resistant patients (n = 25) had a mean age of 46±5 compared to Cisplatin sensitive which were older (mean: 50 ±11.5). Regarding the age subgroups; the majority of the studied subjects were younger than 48 years old. The ovarian cancer patients were subcategorized into subgroups (Cisplatin sensitive/resistant). Conclusion Comparative analysis between Cisplatin sensitive and resistant ovarian cancer tissues for the Lnc_PVT1, TGF-b and Caspase-3. A high significant difference was observed by Mann- Whitney test (p = 0.001) between Cisplatin sensitive and resistant ovarian cancer patients; Cisplatin resistant tissues showed higher expression levels of the Lnc_PVT1 expression (median 20.0, range: 10 - 92) in Cisplatin sensitive ovarian tissue compared to Cisplatin resistant tissue (median: 83; range: 46-86).

Download Full-text

Correction to: Carpén et al., Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients

Acta Oto-Laryngologica ◽

10.1080/00016489.2018.1427494 ◽

2018 ◽

Vol 138 (7) ◽

pp. 675-675

Keyword(s):

Cancer Patients ◽

Oropharyngeal Cancer ◽

Clinical Findings ◽

Presenting Symptoms

Download Full-text

542. Use of Bamlanivimab in Cancer Patients with Mild-to-Moderate COVID-19

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.741 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S372-S373

Author(s):

Patricia Brock ◽

Hiba Dagher ◽

Adriana H Wechsler ◽

Demis N Lipe ◽

Patrick Chaftari ◽

...

Keyword(s):

Cancer Patients ◽

Patient Population ◽

Care Center ◽

Severe Disease ◽

Hematologic Malignancies ◽

Emergency Department Visits ◽

Oxygen Desaturation ◽

Control Group ◽

Presenting Symptoms ◽

The Difference

Abstract Background Bamlanivimab is a monoclonal antibody that was granted an emergency use authorization by the US Food and Drug Administration in November 2020 for patients with mild to moderate coronavirus disease 2019 (COVID-19). It initially showed promising results with decreasing hospitalizations and return emergency department visits in immunocompetent patients. We evaluated the role of bamlanivimab in the cancer patient population. Methods We conducted a retrospective matched study of all cancer patients diagnosed with mild to moderate COVID-19 who received bamlanivimab in our acute cancer care center (ACCC) from December 2020 to February 2021. These patients were compared to a control group of cancer patients who presented to our ACCC and were diagnosed with mild to moderate COVID-19 from March to November 2020 before the introduction of bamlanivimab. Control patients were matched by age and underlying malignancy. All patients had a baseline oxygen saturation ≥ 94% and an absolute neutrophil count > 500 mm3. Demographics, clinical characteristics, and outcome that included COVID-related admissions, oxygen desaturation, ICU admission and 30-day mortality were compared in both groups. Results A total of 108 patients were analyzed with 54 patients in each group, of which 59% consisted of hematologic malignancies, and 33% were ≥ 65 years. The presenting symptoms were similar in both groups and mainly consisted of cough, fever, and dyspnea. Patients who received bamlanivimab were less likely to be admitted to the hospital (24% vs. 91%; p< 0.0001), experience oxygen desaturation < 94% during follow-up (11% vs 44%; p=0.0001), require oxygen supplement (7% vs. 44%; p< 0.0001), or be admitted to the ICU (4% vs 15%; p=0.046). No 30-day mortality was observed in the bamlanivimab group with 2 (4%) occurring in the control group. However, the difference was not significant. Conclusion Bamlanivimab decreased hospital and ICU admissions in cancer patients. In addition, bamlanivimab reduced oxygen requirement and the risk of hypoxia and progression to severe disease in this patient population. Disclosures Samuel L. Aitken, PharmD, MPH, BCIDP, Melinta Therapeutoics (Individual(s) Involved: Self): Consultant, Grant/Research Support

Download Full-text

COVID-19 Mortality in Cancer Patients: A Report from a Tertiary Cancer Centre in India

10.1101/2020.09.14.20194092 ◽

2020 ◽

Author(s):

Anurag Mehta ◽

Smreti Vasudevan ◽

Anuj Parkash ◽

Anurag Sharma ◽

Tanu Vashist ◽

...

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Univariate Analysis ◽

Significant Risk ◽

Case Fatality ◽

Nucleic Acid Amplification ◽

Presenting Symptoms ◽

Risk Of Death ◽

Oropharyngeal Swab ◽

Relationship Of

Background: Cancer patients, especially those receiving cytotoxic therapy are assumed to have a higher probability of death from COVID-19. We have conducted this study to identify the Case Fatality Rate (CFR) in cancer patients with COVID-19 and have explored the relationship of various clinical factors to mortality in our patient cohort. Methods: All active cancer cases presented to the hospital from 8th June to 24 August 2020, and developed symptoms/ radiological features suspicious of COVID-19 were tested by Real-time polymerase chain reaction assay and/or cartridge-based nucleic acid amplification test from a combination of naso-oropharyngeal swab for SARS-CoV-2. Clinical data, treatment details, and outcomes were assessed from the medical records. Results: Of the total 3101 cancer patients admitted to the hospital, 1088 patients were tested and 186 patients were positive for SARS-CoV-2. The CFR in the cohort was 27/186 (14.5%). Univariate analysis showed that the risk of death was significantly associated with the presence of comorbidities [OR: 2.68; (95%CI: 1.13-6.32); P=0.02], multiple comorbidities [OR: 3.01; (95%CI: 1.02-9.07); P=0.046 for multiple vs. single], and the severity of COVID-19 presentation [OR: 27.48; (95%CI: 5.34-141.49); P=0.0001 for severe vs. not severe]. Among all comorbidities, diabetes [OR: 3.3; (95%CI: 1.35-8.09); P=0.008] and cardiovascular diseases [OR: 3.77; (95%CI: 1.02-13.91); P=0.045] were significant risk factors for death. The receipt of anticancer treatments including chemotherapy, surgery, radiotherapy, targeted therapy, and immunotherapy within a month before the onset of COVID-19 symptoms had no significant effect on the mortality of cancer patients. Conclusion: To the best of our knowledge, this is the first study from India reporting the CFR, clinical associations, and risk factors for mortality in SARS-CoV-2 infected cancer patients. Our study shows that the frequency of COVID-19 in cancer patients is high, and the CFR is 7.6 times more than the national average. Anticancer therapies did not increase the risk of death. Pre-existing comorbidities specially diabetes, multiple comorbidities, and severity of COVID-19 presenting symptoms are significantly linked with COVID-19 related death in the cohort.

Download Full-text