scholarly journals LMD-02. Cerebrospinal Fluid Diversion for Metastatic Leptomeningeal Carcinomatosis: Palliative, Procedural and Oncologic Outcomes

2021 ◽  
Vol 3 (Supplement_3) ◽  
pp. iii7-iii7
Author(s):  
Evan D Bander ◽  
Melissa Yuan ◽  
Anne S Reiner ◽  
Andrew Garton ◽  
Katherine S Panageas ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Symptomatic Relief ◽  
Leptomeningeal Carcinomatosis ◽  
Oncologic Outcomes ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Leptomeningeal Disease ◽  
Solid Malignancy ◽  
Csf Diversion

Abstract Background Leptomeningeal disease (LMD) occurs in 3–5% of patients with solid metastatic tumors and often portends a severe prognosis including symptomatic hydrocephalus and intracranial hypertension. Cerebrospinal fluid (CSF) shunting can provide symptomatic relief in this patient subset; however, few studies have examined the role of shunting in the palliation, prognosis and overall oncologic care of these patients. Objective To identify and evaluate risk factors associated with prognosis after CSF diversion and assess surgical, symptomatic and oncologic outcomes in this population. Methods A retrospective study was conducted on patients with solid-malignancy LMD treated with a shunt at an NCI-designated Comprehensive Cancer Center between 2010–2019. Results One hundred and ninety patients with metastatic LMD underwent CSF diversion. Overall survival was 4.14 months from LMD diagnosis (95%CI:3.29–4.70) and 2.43 months (95%CI:2.01–3.09) from shunting. KPS at time of shunting and BrM number at LMD diagnosis demonstrated significant associations with survival (HR=0.66; 95%CI[0.51–0.86], p=0.002; HR=1.40; 95%CI[1.01–1.93] per 10 BrM, p=0.04, respectively). Eighty-three percent of patients experienced symptomatic relief, and 79% were discharged home or to rehabilitation facilities post-shunting. Post-shunt, 56% of patients received additional systemic therapy or started or completed WBRT. Complications included infection (5%), symptomatic subdural hygroma/hematoma (6.3%), and shunt externalization/removal/repair (8%). Abdominal seeding was not identified. Conclusions CSF diversion for LMD with hydrocephalus and intracranial hypertension secondary to metastasis can achieve symptomatic relief, hospital discharge, and return to further oncologic therapy, with a complication profile unique to this pathophysiology. However, decision-making in this population must incorporate end-of-life goals of care given limited prognosis.

Implementation of an oral chemotherapy adherence tool at an NCCN comprehensive cancer center.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 265-265
Author(s):  
Peter D. Whooley ◽  
Fumei Cerecino ◽  
Joy Kaye Weaver ◽  
Maria Market ◽  
Marie Riehl ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Critical Factor ◽  
Dose Schedule ◽  
Clinic Visit ◽  
Oral Chemotherapy ◽  
Oncologic Outcomes ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Number Of Patients ◽  
Specialty Pharmacy

265 Background: Adherence to oral chemotherapy (OC) is a critical factor in achieving optimal oncologic outcomes. Correct dosing, education, and symptom management are essential to maximizing adherence. As part of the 2020 Quality Oncology Practice Initiative Certification Program Fox Chase Cancer Center (FCCC), a NCCN Comprehensive Cancer Center, learned that only 33% of patients on OC had a documented OC plan, 7% were assessed for adherence, and 0% had documentation reflecting efforts to address non-adherence. Methods: Our goal was to create and implement an electronic medical record (EMR) tool (Oral Chemo Smart Form) to address the variance and deficiencies in monitoring adherence to OC. The Smart Form (SF) was designed to include fields to document the OC plan (drug, indication, dose, schedule, duration of cycle, initial start/end date) as well as provide a standard for documentation of education, management of toxicity and non-adherence. We integrated the SF into nursing, pharmacy, and physician workflows to capitalize on shared EMR tools. A series of Plan-Do-Study-Act cycles were conducted over 8 weeks within pilot clinics. Weekly review of the SF and feedback forms generated real-time progress reports which were serially appraised and shared with stakeholders. Results: Two oncologists (piloted in Genitourinary and Breast Cancer clinics), two pharmacists, and several nurses used the SF March 15, 2021 to May 7, 2021. Over these 8 weeks, 223 patients on OC were seen in clinic. If the OC was dispensed from FCCC, pharmacists were to complete the SF at the time of initial OC prescription, 7 days after dispensing, and with each refill. Pharmacists also identified patients receiving OC through a specialty pharmacy and routed a message to clinic nurses via an EMR message pool. The message became the trigger for nurses to call patients within two weeks to troubleshoot dispensing issues and/or complete the SF. Oncologists were to complete the SF with each clinic visit for a patient on OC. Feedback from the clinical and pharmacy teams motivated changes in the content fields of the SF and workflow. Ultimately, 45% of patients on OC had the SF completed. An OC plan was documented in 41% of patients, compared to 33% at baseline; 87% had an administration schedule compared to 81%. There was an increase in the number of patients contacted following start of OC, 35% from 4%. Medication adherence was assessed in 35% of patients, up from 7%. Documented discussions addressing medication adherence increased to 78%, from 0%. Conclusions: Introduction of the Oral Chemo SF in pilot clinics improved documented OC plans and administration schedules. Its use introduced a standard process for monitoring safety, assessing and addressing non-adherence, while troubleshooting specialty pharmacy dispensing issues. The SF will be implemented throughout FCCC and further evaluated with efforts focused on adopting and streamlining this as standard work.

scholarly journals LPTO-10. ASSESSMENT OF LEPTOMENINGEAL CARCINOMATOSIS DIAGNOSIS AND OUTCOMES FROM 2005 TO 2015 AT THE OHIO STATE UNIVERSITY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i8-i8
Author(s):  
Nicole Williams ◽  
Hannah Rinehardt ◽  
Evan Morgan ◽  
Mahmoud Kassem ◽  
Marilly Palettas ◽  
...  
Keyword(s):  
Leptomeningeal Carcinomatosis ◽  
Ohio State University ◽  
Diagnostic Methods ◽  
Detection Methods ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Primary Cancer ◽  
State University ◽  
Csf Cytology ◽  
The Ohio State University

Abstract BACKGROUND: Leptomeningeal carcinomatosis (LMC) is a complication of solid tumor malignancies where tumors metastasize to the leptomeninges. LMC complicates 4–15% of malignancies with incidence increasing as survival of patients with advanced cancer improves. Diagnostic methods include magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology. We assessed detection methods, incidence, and outcomes of LMC at The Ohio State University Comprehensive Cancer Center from 2005–2015. METHODS: This was a single-institution retrospective study of 160 patients with confirmed diagnosis of LMC. Patients with hematologic and central nervous system malignancies were excluded. Descriptive statistics were used to summarize demographic and clinical characteristics. Overall survival (OS) was defined as time from LMC diagnosis to death or last known follow-up, and was generated using Kaplan-Meier methods. RESULTS: Median age of LMC diagnosis was 55.8 years (range: 48, 62.5). 69 (43%) patients had primary breast cancer, 41 (26%) had lung cancer, and 17 (11%) had melanoma. 73 patients (46%) presented with stage IV disease at initial diagnosis of the primary cancer, 41 (26%) with stage III disease, and 26 (16%) with stage II disease. Median time from diagnosis of primary cancer to diagnosis of LMC was 2 years (range: 0, 31.2). 158 (99%) patients had metastases at the time of LMC diagnosis, predominantly in bone (36%) or brain (36%). Median OS was 1.9 months (CI: 1.3, 2.5). 160 (100%) patients had an MRI of the brain or spine and 155 (97%) had MRI findings consistent with LMC. 75 (47%) patients underwent lumbar puncture, and 39 (52%) had CSF cytology positive for malignancy. CONCLUSIONS: Despite treatment, prognosis remains poor and confirmation of diagnosis can be challenging. This study highlights the need for novel therapeutics and improved diagnostic techniques for patients with LMC.

scholarly journals Care as Usual: An Acceptable Strategy to Apply During the COVID-19 Pandemic in a French Tertiary Gynecologic Oncology Department

2021 ◽  
Vol 11 ◽  
Author(s):  
Guillaume Blache ◽  
Houssein El Hajj ◽  
Camille Jauffret ◽  
Gilles Houvenaeghel ◽  
Laura Sabiani ◽  
...  
Keyword(s):  
Gynecological Cancer ◽  
Gynecologic Oncology ◽  
Surgical Patients ◽  
Oncologic Outcomes ◽  
Comprehensive Cancer Center ◽  
Surgical Approaches ◽  
Cancer Center ◽  
Complication Rates ◽  
Oncological Treatment ◽  
The Impact

We describe and analyze a “care as usual” strategy of a French Comprehensive Cancer Center during the COVID-19 pandemic to manage surgical patients with gynecological cancer. We conducted a retrospective analysis evaluating the surgical activity in our gynecologic oncology department between January 21 and May 12, 2020. We compared the surgical activity and surgical and oncologic outcomes during the pre-lockdown period and the pandemic period. The main objective was to evaluate the impact of the COVID-19 pandemic on surgical activity. The secondary objectives were to analyze the surgical and the oncologic outcomes. We compared the surgical activity during the 8 weeks after the national lockdown (85 procedures) to the surgical activity in the 8 weeks preceding the lockdown (127 procedures). We observed a 33% decrease in activity between the two periods. The clinical and epidemiologic characteristics were similar between the two periods. There were no differences between the surgical approaches (p = 0.592), the surgical complexity (p = 0.323), the length of stay (p = 0.85), and even for the complex procedure (p = 0.96) and the perioperative (p = 0.791) and postoperative complication rates (p = 0.102). We observed a significant decrease in the time of return to intended oncological treatment (RIOT) during the lockdown period with an average of 31.9 days compared to 46.9 days in the pre-lockdown period (p = 0.003). During the COVID-19 pandemic, “care as usual” represents an acceptable strategy without impairing the oncologic outcome in a Comprehensive Cancer Center with a patient-centered clinical pathway for gynecologic oncologic surgical patients.

Is cerebrospinal fluid shunting in idiopathic intracranial hypertension worthwhile? A 10-year review

Cephalalgia ◽  
2011 ◽  
Vol 31 (16) ◽  
pp. 1627-1633 ◽  
Author(s):  
Alexandra J Sinclair ◽  
Sarin Kuruvath ◽  
Diptasri Sen ◽  
Peter G Nightingale ◽  
Michael A Burdon ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Visual Acuity ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Low Pressure ◽  
Shunt Revision ◽  
Common Symptom ◽  
Csf Diversion ◽  
Low Pressure Headache ◽  
Pressure Headache

Background: The role of cerebrospinal fluid (CSF) diversion in treating idiopathic intracranial hypertension (IIH) is disputed. Method: We conducted a 10-year, retrospective case note review to evaluate the effects of CSF diversion in IIH. Symptoms, signs and details of shunt type, complications and revisions were documented at baseline, 6, 12 and 24 months post-operatively. Results: Fifty-three IIH patients were shunted [predominantly lumboperitoneal (92%)]. The most common symptom pre-surgery was headache (96%). Post-operatively, significantly fewer patients experienced declining vision and visual acuity improved at 6 ( p = 0.001) and 12 months ( p = 0.016). Headache continued in 68% at 6 months, 77% at 12 months and 79% at 2 years post-operatively. Additionally, post-operative low-pressure headache occurred in 28%. Shunt revision occurred in 51% of patients, with 30% requiring multiple revisions. Conclusion: We conclude that CSF diversion reduces visual decline and improves visual acuity. Unfortunately, headache remained in the majority of patients and low-pressure headache frequently complicated surgery. Over half of the patients required shunt revision with the majority of these requiring multiple revisions. We suggest that CSF shunting should be conducted as a last resort in those with otherwise untreatable, rapidly declining vision. Alternative treatments, such as weight reduction, may be more effective with less associated morbidity.

scholarly journals 11. ASSOCIATION OF TUMOR EXPOSURE TO CEREBROSPINAL FLUID SPACES TO LEPTOMENINGEAL DISEASE IN PATIENTS WITH BRAIN METASTASES

2020 ◽  
Vol 2 (Supplement_2) ◽  
pp. ii1-ii1
Author(s):  
Kunal Patel ◽  
Rebecca Levin-Epstein ◽  
Nader Pouratian ◽  
Tania Kaprealian ◽  
Won Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Brain Metastases ◽  
Surgical Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Leptomeningeal Disease ◽  
Retrospective Case ◽  
En Bloc ◽  
Solid Malignancy ◽  
Whole Brain Radiation

Abstract BACKGROUND Development of leptomeningeal disease in patients with brain metastases is associated with extremely poor survival. Identification of the underlying pathogenesis of leptomeningeal disease is unknown. METHODS This retrospective case control study included consecutive adult patients with at least one cerebral metastasis from a known extracranial primary solid malignancy and at least 3 month follow up (n=366). Patients were treated with radiotherapy with or without surgical resection and primary outcome was development of leptomeningeal disease. RESULTS The overall rate of leptomeningeal disease was 15.0%. Rates of development of leptomeningeal disease correlated with the presence of a dural based lesion (65.7% vs. 9.7%; P<0.0001), intraventricular lesion (29.4% vs. 14.3%; P=0.0897), and with dural based lesions with sulcal or cortical enhancement (100% vs. 12.9%; P<0.0001). Rates of developing leptomeningeal disease were not independently associated with surgical resection (17.2% vs. 14.2%; P=0.4859), however did occur significantly more often with piecemeal, as opposed to en bloc, resection (31.3% vs. 8.1%; P=0.0138) or when the ventricle was entered (61.5% vs. 18.9%; P<0.0001). CONCLUSIONS Metastases that are in contact with cerebrospinal fluid spaces are associated with a higher rate of subsequent leptomeningeal disease, with or without surgical resection. Future studies should investigate the use of neoadjuvant radiation, whole brain radiation therapy or adherence to strict surgical technique in high risk brain metastasis patients to mitigate this probability.

Oncology massage impact on patient with cancer and caregiver self-reported symptoms as part of an integrative oncology program at a comprehensive cancer center.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 79-79
Author(s):  
Gabriel Lopez ◽  
Kathrin Milbury ◽  
Amy Spelman ◽  
Qi Wei ◽  
Pamela A Sumler ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Symptomatic Relief ◽  
Psychological Symptom ◽  
Well Being ◽  
Physical Symptoms ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Edmonton Symptom Assessment Scale ◽  
Oncology Massage ◽  
The Impact

79 Background: Massage as a manual therapy has shown benefit for symptomatic relief in patients with cancer and their caregivers. We explored the impact of a single massage session on self-reported symptoms in an outpatient clinic at a comprehensive cancer center. Methods: Patients and caregivers received oncology massage treatments (30 or 60-min duration) at our Integrative Medicine Center outpatient clinic from Sep 2012-Jan 2015. Participants completed a modified Edmonton Symptom Assessment Scale (ESAS; 0-10 scale, 10 most severe) pre- and post-massage. ESAS individual items and subscales scores of Physical Distress (PHS), Psychological Distress (PSS), and Global Distress (GSD) were analyzed. We used paired t-tests with a Bonferroni correction (i.e., p < .001) to examine pre/post massage self-reported symptoms. Results: Initial massage visits for 164 patients and 39 caregivers were analyzed. Highest symptoms burden (means) at baseline for patients were Sleep 3.93, Fatigue 3.70, and poor sense of Well-Being 3.62; for caregivers Distress 4.14, Sadness 3.43, and Sleep 3.21. Although patients reported significantly more physical symptoms (F = 27.56, P < .0001) compared to caregivers at baseline, groups did not differ in regard to psychological symptom burden (P = .75). Massage therapy was associated with significant improvements in PHS, PSS, and GSD for both patients and caregivers at P < .0001. Including participants with symptom report ≥ 1, massage resulted in a clinically significant improvement (reduction ≥ 1) in pain, fatigue, sleep, distress, dry mouth, sadness, numbness, anxiety, wellbeing for patients; pain, fatigue, distress, sadness, numbness, anxiety, wellbeing for caregivers. Regarding massage duration, there were no significant effects for 30 vs 60-min duration on pre/post ESAS difference scores. Conclusions: A single 30- or 60-minute massage session resulted in acute relief of self-reported symptoms in patients and caregivers. Further study is warranted regarding optimal massage dose and frequency.

ASCO-GU 2019: Fortgeschrittenes Nierenzellkarzinom

2019 ◽  
Vol 10 (02) ◽  
pp. 75-76
Author(s):  
Ine Schmale
Keyword(s):  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Washington Dc

Das Armamentarium zur Behandlung des Nierenzellkarzinoms (RCC) hat sich um effektive Therapien erweitert, durch die der Therapiealgorithmus komplett umgestellt werden musste. Prof. Michael B. Atkins vom Georgetown-Lombardi Comprehensive Cancer Center, Washington DC/USA, und Prof. Daniel Y. C. Heng vom Tom Baker Cancer Center, Calgary/Kanada, teilten beim ASCO-GU ihre Einschätzung zur optimalen Behandlung des Nierenzellkarzinoms in der Erst- und Zweitlinientherapie für das Jahr 2019.

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