scholarly journals Prospective Study of Candida Species in Patients at a Comprehensive Cancer Center

2001 ◽  
Vol 45 (7) ◽  
pp. 2129-2133 ◽  
Author(s):  
Amar Safdar ◽  
Vishnu Chaturvedi ◽  
Emily W. Cross ◽  
Steven Park ◽  
Edward M. Bernard ◽  
...  
Keyword(s):  
New York ◽  
Hematological Malignancies ◽  
Antifungal Susceptibility ◽  
Systemic Infection ◽  
Underlying Disease ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Susceptible Patient ◽  
Fluconazole Resistant ◽  
Overall Resistance

ABSTRACT Since most nosocomial systemic yeast infections arise from the endogenous flora of the patient, we prospectively evaluated the species stratification and antifungal susceptibility profile ofCandida spp. associated with heavy colonization and systemic infection in patients at Memorial Sloan-Kettering Cancer Center in New York. A total of 349 Candida isolates were obtained from 223 patients during the later half of 1998. Cancer was the most common underlying disease, occurring in 91% of the patients, including 61.8% with organ and 23.7% with hematological malignancies; 4.4% of the patients had AIDS. Candida albicans was the predominant species (67.3%); among 114 non-albicans Candida spp., C. glabrata (45.6%) was the most frequent, followed by C. tropicalis (18.4%),C. parapsilosis (16.6%), and C. krusei(9.6%). The overall resistance to triazole-based agents among all yeast isolates was 9.4 and 10.8% for fluconazole and itraconazole, respectively. A total of 5% of C. albicansstrains were resistant to triazole antifungals, whereas 30.8 and 46.2% of C. glabrata strains were resistant to fluconazole (MIC ≥ 64 μg/ml) and itraconazole (MIC ≥ 1 μg/ml), respectively. A significant association was observed between prior treatment with triazole and isolation of fluconazole-resistant C. albicans (P = 0.005, OR 36), although this relationship was not seen in C. glabrata isolates (P = 0.4). This study reinforces the importance of periodic, prospective surveillance of clinical fungal isolates to determine appropriate prophylactic, empiric, and preemptive antifungal therapy for the highly susceptible patient population.

Epidemiology and Antifungal Susceptibility in Patients with Candidemia in a University Hospital, Thailand

2020 ◽  
Vol 103 (10) ◽  
pp. 1048-1056
Keyword(s):  
Antifungal Susceptibility ◽  
Underlying Disease ◽  
Outcome Data ◽  
Adult Patients ◽  
Antifungal Treatment ◽  
University Hospital ◽  
Fluconazole Resistance ◽  
Fluconazole Therapy ◽  
Fluconazole Resistant ◽  
High Level

Background: Candidemia is the most common nosocomial invasive fungal infection that causes high mortality. Emergence of drug-resistant Candida is reported worldwide but there are few studies in Thailand. Objective: To determine the epidemiology, antifungal susceptibility of Candida, and outcomes among adult patients with candidemia. Materials and Methods: A prospective, observational study in adult patients with candidemia was conducted in 2015 at a university hospital. Demographic, microbiological, and outcome data were recorded. Results: Fifty-two patients with candidemia were identified, of whom 76.9% had an underlying disease and 69.2% had risks for candidemia. Sixty-four percent of candidemia patients contracted non-albicans Candida and 36% had Candida albicans. C. tropicalis was the most common non-albicans Candida species isolated (35%), followed by C. parapsilosis (19%), and C. glabrata (10%). Fluconazole resistance was found in 12.5% of C. albicans and in 11.1% of C. parapsilosis isolates. Reduced fluconazole susceptibility or high-level fluconazole resistance was found in 68.7% of C. tropicalis isolates. All except C. parapsilosis had excellent susceptibility to echinocandins. Seventy-three percent (38/52) of patients received antifungal treatment, of whom, 78.9% received empiric fluconazole therapy, and 89.7% were started on antifungal treatment 24 hours after the isolation of Candida. The overall mortality rate was 51.9%. Conclusion: Fluconazole-resistant Candida became more prevalent particularly in C. tropicalis, which was the predominant species among non-albicans Candida causing candidemia. Empiric treatment with either amphotericin B or echinocandins would be appropriate in high-risk patients with suspected candidemia. Trial registration: Thai Clinical Trials Registry, TCTR20150605001 Keywords: Candida, Fluconazole, Resistant, Thailand

Impact of Safety Concerns of Erythropoiesis-Stimulating Agents (ESAs) and Regulatory Changes on the Use of ESAs and Red Blood Cell (RBC) Transfusions at a Comprehensive Cancer Center

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1300-1300
Author(s):  
Saroj Vadhan-Raj ◽  
Victoria E. Hawkins ◽  
Xiao Zhou ◽  
Kurt Sizer ◽  
Lincy S. Lal ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Black Box ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Safety Concerns ◽  
Regulatory Changes ◽  
Time Period ◽  
Number Of Patients ◽  
Oncology Clinical Trials ◽  
The Impact

Abstract Safety signals raised in the recent oncology clinical trials have led to various regulatory restrictions including FDA black-box warning, National Coverage Determination (NCD), and updated ASCO/ASH guidelines in 2007. The purpose of this study was to determine the impact of these changes on the utilization of ESAs and on transfusion (Tx) of RBCs in 2006 (prior to changes) and 2007. We identified the total number of unique patients that received any treatment including chemotherapy, radiation, transfusions, or any treatment in the out-patient and in-patient settings during this 2 year time period. All the data on the ESA doses dispensed by the hospital pharmacy and all the RBC transfusions dispensed by the Blood bank were also analyzed. The ESA units were calculated by converting 40,000 units of epoetin alfa or 100 mcg of darbepoetin alfa to one unit of ESA. When comparing 2007 to 2006, the number of patients that received ESAs decreased by 26% and the total ESA units decreased by 30%. The overall usage of ESAs decreased by 55%, from 2398 units in 1/2006 to 1080 units in 12/2007. However, the number of pts that received RBC transfusions increased only by 6% and the total number of RBC units transfused by 2% (from 38,218 units in 2006 to 38,948 units in 2007). The median Hgb on the day of transfusion was same for each year (Hgb 8.2 g/dL for both 2006 and 2007), suggesting that the lack of impact on RBC Tx may not be due to a change in Tx threshold. The total number of unique patients referred and treated at MDACC during 2007 (24,356) increased by 13% from 2006 (21,619), not accounting for a lack of impact on transfusions. We therefore examined Hgb at the initiation of ESAs in a subset of pts (n=212) that had not received ESA for at least 3 months. The median Hgb/HCT values at the initiation of ESAs were 9.5 g/dL/27.4. The most frequent utilization of ESAs and transfusions was in patients with hematological malignancies. Conclusion: These findings indicate that the recent ESA safety concerns and related regulatory changes have significantly affected the ESA utilization. The lack of significant impact of reduced ESA usage on RBC transfusions may be related to a lower Hgb threshold used at initiation of ESAs and/or the targeted patient population (less likely to respond) treated with ESAs. Further research is needed to establish the factors contributing to the lack of correlation and to optimize the use of ESAs.

Health behaviors (HB) and geriatric assessment (GA) in older women with breast cancer (BC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9543-9543
Author(s):  
Trevor Augustus Jolly ◽  
Allison Mary Deal ◽  
Shani Malia Alston ◽  
Brittaney-Belle Elizabeth Gordon ◽  
Samara Ann Dixon ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
High School Graduates ◽  
Social Activity ◽  
Treatment Phase ◽  
Prescription Medication ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Timed Up And Go ◽  
Never Smokers

9543 Background: Physical inactivity (PI), alcohol (A) and tobacco (T) abuse are associated with poor health outcomes in older adults, however, little is known about the prevalence of these HB and their associations with GA domains in older cancer patients (pts). This study explores the relationship between HB and GA in older BC pts. Methods: Between 03/2010-01/2013, 111 pts ≥65 yrs completed a predominantly self-administered GA (Hurria et al. Cancer 2005) comprising measures of comorbidity, polypharmacy, cognitive, functional, psychosocial and nutritional status as well as a nine-item HB questionnaire based on the 2006/7 National Health Interview Survey ( www.cdc.gov/nchs/nhis.htm ) assessing PI, A and T use. Fisher’s Exact and Wilcoxon Rank sum test were used to evaluate associations with GA measures. Results: Median age was 72 (range 65-94). Most pts were white (89%), married (61%), retired (86%) and at least high school graduates (96%). 51% never smoked while 45% were former and 4% current smokers. Former/current smokers were more likely than never smokers to have slower gait speeds (Timed “up and go” >14 second; 32 vs 14%; p=.04) and took more daily prescription medications (mean 5 vs. 4; p=.04). 52% of pts consumed at least one alcoholic drink per week (median 3.5). Modest alcohol consumption was associated with less activity of daily living (ADL) impairment (p=.03), lower mean BMI (29 vs. 26 kg/m2 p=.03) and greater non-prescription medication use (p=.04). 48% never performed vigorous activity and these pts were more likely than those exercising to have one or more functionally impairing comorbidities (p=.03); mainly arthritis. PI correlated with more impairment in both ADL (p<.0001) and instrumental ADL (p=.004). HB were not associated with demographic factors, treatment phase, weight loss, falls, sensory impairment, social activity, anxiety or depression in this dataset. Conclusions: PI, T and A use were common in this cohort of older BC pts and were associated with significant impairments in several GA domains. These findings reinforce the need for interventions to improve HB in older BC pts. Support: Breast Cancer Research Foundation, New York, NY and Lineberger Comprehensive Cancer Center, Chapel Hill, NC.

Patient wishes and physician inquiries regarding spiritual needs in an urban cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8630-8630
Author(s):  
A. B. Astrow ◽  
A. Wexler ◽  
K. Texeira ◽  
D. P. Sulmasy
Keyword(s):  
New York ◽  
Religious Beliefs ◽  
Clinical Information ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Spiritual Needs ◽  
Satisfaction Scale ◽  
Spiritual But Not Religious ◽  
Religious Services ◽  
Tests Of Association

8630 Background: Prior studies have shown much interest in spirituality among patients in the rural South, but little is known about the spiritual needs and views of urban cancer patients. Methods: In Jan-Feb 2005, consecutive outpatients were asked to complete a questionnaire at the St. Vincent’s Comprehensive Cancer Center in New York City. The instrument included the QUEST satisfaction scale, demographic and clinical information, and questions about spiritual and religious beliefs and needs. Tests of association included correlation, t-tests, and χ2. Multivariate models were estimated using logistic techniques. Results: Of the 891 eligible patients, 81 refused, 428 cancelled their appointments or left before being approached. 13 were excluded because of incomplete questionnaires. The 369 participants had a mean age of 57.5 years; 65% were women, 67% white, 65% college-educated, 32% had breast cancer, and 67% were privately insured. Forty-seven percent were Catholic, 19% Jewish, 16% Protestant, and 6% atheist or agnostic. Sixty-six percent reported being “spiritual but not religious,” and 29% attended religious services at least once per week. Nine percent reported that staff had inquired about their spiritual or religious beliefs (0.6% by an MD), and 6% reported inquiries about their spiritual needs (0.9% by an MD). But, 82% reported that their spiritual needs were being met, and being asked about neither religious beliefs (p = .37) nor spiritual needs (p = .72) was associated with satisfaction. Still, 52% thought it appropriate for physicians to inquire about their religious beliefs and 58% thought it appropriate for physicians to inquire about their spiritual needs. Patients who described themselves as “spiritual but not religious” were less likely to think it appropriate for an MD to inquire about their religious beliefs (OR = 0.48, CI = 0.28 to 0.84), while those who attended religious services at least weekly were more likely to think it appropriate (OR = 2.86, CI = 1.45 to 5.62). Conclusions: A majority of patients thought it appropriate to be asked about their spiritual and religious beliefs and needs, but less than that reported in other settings. Few had these needs addressed by staff, especially by MDs. More religious patients were more likely to think such inquiries appropriate. No significant financial relationships to disclose.

Growing Healing Touch as supportive cancer care in western New York.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 176-176
Author(s):  
Suzanne M Hess ◽  
Lynda M. Beaupin
Keyword(s):  
New York ◽  
Cancer Care ◽  
Symptom Relief ◽  
Physical Symptom ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Healing Touch ◽  
Energy Medicine ◽  
Supportive Cancer Care ◽  
Energy Field

176 Background: Healing Touch (HT) is a specific energy medicine modality that incorporates several techniques to balance the human energy field to help promote healing. It is a safe and non-invasive therapy that complements traditional, standard care and is recognized by NIH’s National Center for Complementary and Integrative Health. HT was first introduced to cancer survivors at our NCI-designated Comprehensive Cancer Center in 2013. We demonstrate HT is well-received and easy to integrate into traditional cancer care. Methods: A Certified Healing Touch Practitioner taught pediatric survivors and families HT techniques, as well as trained staff and volunteers to participate in the pilot program and to offer HT sessions throughout the year. Results: See Table. Qualitative analysis of participant’s feedback indicate benefits in the following themes: 1. Physical Symptom Relief 2. Emotional Issue Relief 3. Spiritual/Grief Support 4. Recommendation to Other Patients. Conclusions: Healing Touch is an energy medicine modality that is easy to teach, simple to integrate into routine cancer care, and beneficial for caregivers and survivors alike. [Table: see text]

Is Failure to Meet Spiritual Needs Associated With Cancer Patients' Perceptions of Quality of Care and Their Satisfaction With Care?

2007 ◽  
Vol 25 (36) ◽  
pp. 5753-5757 ◽  
Author(s):  
Alan B. Astrow ◽  
Ann Wexler ◽  
Kenneth Texeira ◽  
M. Kai He ◽  
Daniel P. Sulmasy
Keyword(s):  
New York ◽  
Quality Of Care ◽  
Treatment Quality ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Spiritual Needs ◽  
Satisfaction With Care ◽  
Staff Members ◽  
Spiritual But Not Religious

Purpose Few studies regarding patients' views about spirituality and health care have included patients with cancer who reside in the urban, northeastern United States. Even fewer have investigated the relationship between patients' spiritual needs and perceptions of quality and satisfaction with care. Patients and Methods Outpatients (N = 369) completed a questionnaire at the Saint Vincent's Comprehensive Cancer Center in New York, NY. The instrument included the Quality of End-of-Life Care and Satisfaction with Treatment quality-of-care scale and questions about spiritual and religious beliefs and needs. Results The participants' mean age was 58 years; 65% were female; 67% were white; 65% were college educated; and 32% had breast cancer. Forty-seven percent were Catholic; 19% were Jewish; 16% were Protestant; and 6% were atheist or agnostic. Sixty-six percent reported that they were spiritual but not religious. Only 29% attended religious services at least once per week. Seventy-three percent reported at least one spiritual need; 58% thought it appropriate for physicians to inquire about their spiritual needs. Eighteen percent reported that their spiritual needs were not being met. Only 6% reported that any staff members had inquired about their spiritual needs (0.9% of inquiries by physicians). Patients who reported that their spiritual needs were not being met gave lower ratings of the quality of care (P = .009) and reported lower satisfaction with care (P = .006). Conclusion Most patients had spiritual needs. A slight majority thought it appropriate to be asked about these needs, although fewer thought this compared with reports in other settings. Few had their spiritual needs addressed by the staff. Patients whose spiritual needs were not met reported lower ratings of quality and satisfaction with care.

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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