Impact of service re-configuration according to NICE guidance on the management and clinical outcomes of malignant spinal cord compression in a tertiary care centre

2017 ◽  
Vol 17 (3) ◽  
pp. S20
Author(s):  
Ganapathy Raman Perianayagam ◽  
Annie Law ◽  
Sanjay Dhiran ◽  
Omar A. Gabbar
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Spinal Cord Compression ◽  
Tertiary Care ◽  
Cord Compression ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Nice Guidance

Patterns of care and clinical outcomes in stage IVA cervical cancer: 14-year experience from a tertiary care centre in South India

2021 ◽  
pp. 1-7
Author(s):  
Neenu Oliver John ◽  
Arvind Sathyamurthy ◽  
Shanthi Prasoona ◽  
Jeba Karunya Ramireddy ◽  
Grace Rebekah ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Clinical Outcomes ◽  
South India ◽  
Tertiary Care ◽  
Progression Free Survival ◽  
Concurrent Chemotherapy ◽  
Patterns Of Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Gynecology And Obstetrics

Abstract Aim: To analyse the patterns of care and clinical outcomes of patients diagnosed with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IVA treated at a tertiary care centre in South India. Materials and methods: The electronic medical records of 2,476 patients diagnosed with cervical cancer at a tertiary care institution between January 2005 and December 2018 were reviewed. Among them, 96 patients diagnosed with histologically proven carcinoma cervix stage IVA established by either cystoscopy or proctoscopy were included. Four patients who did not receive treatment at the study centre were excluded and 92 patients were available for final analysis. Results: The median follow-up period was 12 months (2–131 months). Of the 92 patients, 59 patients (64·13%) received radiation therapy (RT) alone, 22 patients (23·9%) received chemoradiation (CRT), three patients (3·26%) received neoadjuvant chemotherapy (NACT) followed by RT, one (1·08%) received NACT followed by CRT, four patients (4·35%) received chemotherapy alone, while three (3·26%) were offered best supportive care. The median progression-free survival (PFS) was 12 months (95% CI: 9·6–14·4 months) and median overall survival (OS) was 25 months (95% CI: 16·6–33·4 months). The 2-year and 3-year PFS was 30 and 20%, respectively, and the OS was 50 and 32%, respectively. Conclusion: The management of stage IVA cervical cancer needs to be individualised to achieve a fine balance between local control, toxicity, and quality of life. RT is the mainstay of treatment with concurrent chemotherapy in carefully selected patients. Involvement of palliative care team early in the course of treatment adds a holistic approach to the continuum of oncological care.

Clinical outcomes of a Dutch prospective observational registry of metastatic castration resistant prostate cancer (mCRPC) patients treated with radium-223 (Ra-223).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 323-323
Author(s):  
Rebecca Louhanepessy ◽  
Sushil Badrising ◽  
Vincent van der Noort ◽  
Jules L. L. M. Coenen ◽  
Paul Hamberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Spinal Cord Compression ◽  
Survival Data ◽  
Cord Compression ◽  
Subsequent Treatment ◽  
Castration Resistant Prostate Cancer ◽  
Bone Surgery ◽  
Radium 223 ◽  
Pathologic Fractures

323 Background: In 2012 the ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit of mCRPC patients treated with Ra-223 over placebo. To date clinical outcomes of Ra-223 treatment in a non-study population have not been prospectively evaluated. Methods: The ROTOR registry aimed to include 300 patients in 20 Dutch hospitals prior to Ra-223 treatment at the physician’s discretion. Clinical parameters collected included: positioning of Ra-223, Adverse Events (AE’s; CTCAE v4.03), Skeletal Related Events (SRE) and survival data. SRE was defined as radiotherapy to a bone metastasis, a new pathological fracture, spinal cord compression and/or bone surgery. Progression-Free Survival (PFS) was defined as survival until radiological or clinical progression, subsequent treatment or death. Results: Between April 2014 and September 2017, 305 patients were included of whom 300 were evaluable. The mean age of patients was 72.6 (range 46.3-91.5) years, 255 (85%) had ≥ 6 bone metastases and 197 (65.5%) were pretreated with taxanes and/or abiraterone or enzalutamide (214 (71.3%)). Two-hundred and ninety (96.7%) patients were treated with Ra-223. Twenty-nine (9.7%), 104 (34.7%), 96 (32%) and 66 (22%) patients received Ra-223 as a first, second, third, ≥ fourth mCRPC treatment line, respectively. Patients received an average of 4.6 (SD 1.8) cycles of Ra-223, while 140 (46.7%) completed all six cycles. After a median follow-up of 13.2 months, PFS was 5.1 (CI 4.5-5.8) months and OS 15.2 (CI 12.8-17.6) months. Eighty-two (27.3%) patients were hospitalized during Ra-223 treatment (Serious AE). Grade ≥ 3 anemia, neutropenia and thrombocytopenia was found in 54 (18.0%), 8 (2.7%) and 11 (3.7%) patients, respectively. Other frequent AE’s (all grades) were nausea (90 (30%)), diarrhea (83 (27.7%)) and fatigue (178 (59.3%)). SREs were observed in 46 (15.3%) patients; 22 (7.3%) received radiotherapy, 6 (2%) developed pathologic fractures, 17 (5.6%) spinal cord compression and 1 (0.3%) received bone surgery during Ra-223 therapy. Conclusions: The non-study ROTOR population had characteristics, all grade AEs and OS comparable with the treatment arm of ALSYMPCA. Clinical trial information: NCT03223597.

A study on the clinical outcomes and management of meningitis at a tertiary care centre

2017 ◽  
Vol 65 (5) ◽  
pp. 1006 ◽  
Author(s):  
Aparna Yerramilli ◽  
Priya Mangapati ◽  
Subhashini Prabhakar ◽  
Harish Sirimulla ◽  
Shravani Vanam ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre

Steroid tapering for patients with spinal cord compression or symptomatic brain metastases at Jackson Memorial Hospital.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 238-238
Author(s):  
David Asher ◽  
Benjamin Farnia ◽  
Stephen Ramey ◽  
Sarah Francis ◽  
Shahil Mehta ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Brain Metastases ◽  
Spinal Cord Compression ◽  
Critical Role ◽  
Tertiary Care ◽  
Care Facility ◽  
Cord Compression ◽  
Grand Round ◽  
Use Of Resources ◽  
Practitioner Education

238 Background: Metastases to the spinal column and brain for patients with cancer are common occurrences seen in oncology practices. Steroids play a critical role in symptom management upon patient presentation and proper tapering of steroids is necessary to minimize risk of recurrent symptoms. Within our institution, which is a tertiary care facility primarily for the poor and near-poor of a large urban environment, 78% of patients with spinal cord compression or symptomatic brain metastases do not receive appropriate tapering of steroids following completion of radiation treatment. This leads to unnecessary side effects from continued steroid use, ultimately leading to an inefficient use of resources, including time and money. Methods: Through the guidance of American Society of Clinical Oncology (ASCO) Quality Training Program, we created a process map, cause and effect diagram, and acquired preliminary diagnostic data. This data was acquired via electronic medical record (EMR) review including evaluation of inpatient notes, discharge summaries, medication orders and prescriptions, and outpatient clinic visit notes. We then completed several PDSA cycles including grand round presentation, tapering template incorporation into clinic, and template creation within our EMR. Results: We identified that a single physician primarily was responsible for the patients that appropriately received steroids. We utilized this physician's expertise to help create meaningful interventions. By the complete of our last PDSA cycle, we have reduced the percentage of patients who do not receive an adequate steroid taper form 78% to 20%. Conclusions: Practitioner education and incorporation of steroid tapering templates into an outpatient radiation oncology clinic can reduce the percentage of patients with spinal cord compression or symptomatic brain metastases, who do not receive and adequate steroid tapering regimen.

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