Practice patterns in radiation therapy for bone metastases in multiple histologies.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 151-151
Author(s):  
Trent N Taylor ◽  
Catherine Lee Kinchen ◽  
Candice Aitken Johnstone ◽  
Jared R. Robbins
Keyword(s):  
Radiation Therapy ◽  
Practice Patterns ◽  
Background Radiation ◽  
Patient Comfort ◽  
Remaining Life ◽  
Treatment Regimens ◽  
More Care ◽  
Multiple Treatments ◽  
Metastatic Sites ◽  
The Impact

151 Background: Radiation therapy (RT) is a common palliative treatment for bone metastasis. Despite copious evidence of palliative equipoise between single and multiple fractions, practice patterns vary widely amongst physicians. We evaluate practice patterns and the impact of treatment regimens on percentage of remaining life spent receiving RT (PRLSRT) and overall survival. Methods: Patients with metastases from Prostate, Lung, Breast, and Kidney to the bone who received RT were identified from the National Cancer Database. The percentage of remaining life spent receiving RT (PRLSRT) was calculated by dividing the elapse days of RT by the number of days they survive from starting RT to death. Results: 43516 patients met the inclusion criteria. The majority were non-small cell lung (64.7%), while breast (13.5%), prostate (11.0%), and kidney (10.8%) had almost equal amounts. Median patient age was 67 years old (18-90). Treated metastatic sites included the spine (61.9%), hip/pelvis (11.2%), and extremity (8.13%). A higher percentage of patients had a PRLSRT over 50% depending on the primary site of their cancer: Lung was the highest (14.4%), followed by kidney (8.9%), breast (6.2%), and prostate (1.4%). Prostate cancer was most often treated with 11+ treatments (38.4%), followed by breast (34.1%), Kidney (33.1%), and finally lung (28.5%) PRLSRT was highest in those who received multiple treatments, with 11.4% of patients receiving 11+ fractions and 11.5% of those receiving 6-10 treatments with a PRLSRT above 50% compared to 1.2% of those receiving a single treatment. Conclusions: Despite the increased burden on patients with more fractions of therapy and the lack of clinical benefit, multiple fractionations remains a common practice , which can impact the way patients spend the end of their lives. More care should be taken to reduce fractionation whenever possible to allow for patient comfort and autonomy.

Intermediate versus short-course hormone therapy and mortality in men with high-risk prostate cancer treated with radiation therapy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 83-83
Author(s):  
Akash Nanda ◽  
Ming-Hui Chen ◽  
Brian Joseph Moran ◽  
Michelle H. Braccioforte ◽  
Anthony Victor D'Amico
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
High Risk ◽  
Background Radiation ◽  
Multivariable Analysis ◽  
Study Cohort ◽  
High Risk Prostate Cancer ◽  
Short Course ◽  
Risk Prostate Cancer ◽  
The Impact

83 Background: Radiation therapy (RT) plus 28-36 months of hormonal therapy (HT) is standard-of-care for men with high-risk prostate cancer (HRPC) based on randomized trials comparing these HT durations to 4-6 months. However, it is unknown whether shorter durations of HT may also decrease mortality. We evaluate the impact of intermediate-course HT on the risk of all-cause mortality (ACM) in men with HRPC treated with RT. Methods: The study cohort comprised 554 men with HRPC (PSA > 20; Gleason score 8 or higher; or clinical stage T2c or higher) consecutively treated at the Chicago Prostate Cancer Center between 1997 and 2007. All men received brachytherapy with or without external beam RT and HT of intermediate (> 6 to 24; median 12 months) or short (up to 6; median 4 months) duration. A Cox regression multivariable analysis was performed assessing whether intermediate compared to short-course HT was associated with a decreased risk of ACM, adjusting for age, year and type of RT, treatment propensity score, and known PC prognostic factors. Results: After a median follow up of 4.3 years a total of 64 (11.6%) men died. Intermediate compared to short-course HT was associated with a significantly decreased risk of ACM (adjusted hazard ratio 0.44, 95% confidence interval 0.20 - 0.94, P = 0.03). Other significant covariates are shown in the table. The 5-year estimates of ACM for intermediate versus short-course HT were 7.0% and 15.7%, respectively. Conclusions: In men with HRPC treated with RT, a median HT duration of 12 months was associated with a significantly decreased risk of ACM when compared to a median HT duration of 4 months. This raises the hypothesis that HT durations shorter than 28-36 months may be sufficient to decrease mortality in men with HRPC. The ongoing RADAR trial by the Trans Tasman Radiation Oncology Group comparing 18 to 6 months of HT may provide level I evidence to validate this hypothesis. [Table: see text]

scholarly journals Role of the Pharmacist in Managing Treatment-Resistant Depression: A Focus on Ketamine

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 118
Author(s):  
Linda Xing Yu Liu ◽  
Marina Golts ◽  
Virginia Fernandes
Keyword(s):  
Current Practice ◽  
Quality Care ◽  
Treatment Options ◽  
Critical Role ◽  
Transitions Of Care ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression ◽  
Multiple Treatments ◽  
The Impact

The impact of depression is well described in the literature, and it is most prominent in patients who have trialed multiple treatments. Treatment-resistant depression (TRD) is particularly debilitating, and it is associated with significant morbidity and mortality. Despite this, there seems to be therapeutic inertia in adopting novel therapies in current practice. Ketamine is an N-methyl-D-aspartate receptor antagonist and anesthetic agent which has recently been shown to be effective in the management of TRD when administered intravenously or intranasally. The treatments, however, are not easily accessible due to restrictions in prescribing and dispensing, high costs, and the slow uptake of evidence-based practice involving ketamine within the Canadian healthcare system. Given the limited treatment options for TRD, novel approaches should be considered and adopted into practice, and facilitated by a multi-disciplinary approach. Pharmacists play a critical role in ensuring access to quality care. This includes dissemination of evidence supporting pharmacological treatments and facilitating translation into current practice. Pharmacists are uniquely positioned to collaborate with prescribers and assess novel treatment options, such as ketamine, address modifiable barriers to treatment, and triage access to medications during transitions of care. Extending the reach of these novel psychiatric treatments in both tertiary and primary care settings creates an emerging role for pharmacists in the collaborative effort to better manage treatment-resistant depression.

scholarly journals Determining the Impact of Thickened Liquids on Swallowing in Patients Undergoing Irradiation for Oropharynx Cancer

2021 ◽  
pp. 019459982110104
Author(s):  
Carly E. A. Barbon ◽  
Douglas B. Chepeha ◽  
Andrew J. Hope ◽  
Melanie Peladeau-Pigeon ◽  
Ashley A. Waito ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Clinical Benefit ◽  
Oropharyngeal Cancer ◽  
Thickened Liquids ◽  
Current Standard ◽  
Oropharynx Cancer ◽  
Post Radiation ◽  
Thin Liquids ◽  
The Impact

The current standard for the treatment of oropharynx cancers is radiation therapy. However, patients are frequently left with dysphagia characterized by penetration-aspiration (impaired safety) and residue (impaired efficiency). Although thickened liquids are commonly used to manage dysphagia, we lack evidence to guide the modification of liquids for clinical benefit in the head and neck cancer population. The objective of this study was to assess the impact of slightly and mildly thick liquids on penetration-aspiration and residue in 12 patients with oropharyngeal cancer who displayed penetration-aspiration on thin liquid within 3 to 6 months after completion of radiotherapy. Significantly fewer instances of penetration-aspiration were seen with slightly and mildly thick liquids as compared with thin ( P < .05). No differences were found across stimuli in the frequency of residue. Patients with oropharyngeal cancers who present with post–radiation therapy dysphagia involving penetration-aspiration on thin liquids may benefit from slightly and mildly thick liquids without risk of worse residue.

scholarly journals The impact of sociodemographic factors on the utilization of radiation therapy in breast cancer patients in Estonia: a register-based study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Fereshteh Shahrabi Farahani ◽  
Keiu Paapsi ◽  
Kaire Innos
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Cancer Registry ◽  
Psychosocial Support ◽  
Sociodemographic Factors ◽  
Stage I ◽  
Equal Access ◽  
Administrative Databases ◽  
The Impact ◽  
Over Time

Abstract Background Radiation therapy is an important part of multimodal breast cancer treatment. The aim was to examine the impact of sociodemographic factors on radiation therapy use in breast cancer (BC) patients in Estonia, linking cancer registry data to administrative databases. Methods Estonian Cancer Registry provided data on women diagnosed with BC in Estonia in 2007–2018, including TNM stage at diagnosis. Use of radiation therapy within 12 months of diagnosis was determined from Estonian Health Insurance Funds claims, and sociodemographic characteristics from population registry. Receipt of radiation therapy was evaluated over time and by clinical and sociodemographic factors. Poisson regression with robust variance was used to calculate univariate and multivariate prevalence rate ratios (PRR) with 95 % confidence intervals (CI) for receipt of radiation therapy among stage I–III BC patients age < 70 years who underwent primary surgery. Results Overall, of 8637 women included in the study, 4310 (50 %) received radiation therapy within 12 months of diagnosis. This proportion increased from 39 to 58 % from 2007 to 2009 to 2016–2018 (p < 0.001). Multivariate regression analysis showed that compared to women with stage I BC, those with more advanced stage were less likely to receive radiation therapy. Receipt of radiation therapy increased significantly over time and was nearly 40 % higher in 2016–2018 than in 2007–2009. Use of radiation therapy was significantly lower for women with the lowest level of education compared to those with a university degree (PRR 0.88, 95 % CI 0.80–0.97), and for divorced/widowed women (PRR 0.95, 95 % CI 0.91–0.99) and single women (PRR 0.92, 95 % CI 0.86–0.99), compared to married women. Age at diagnosis, nationality and place of residence were not associated with receipt of radiation therapy. Conclusions The study showed considerable increase in the use of radiation therapy in Estonia over the study period, which is in line with increases in available equipment. The lack of geographic variations suggests equal access to therapy for patients living in remote regions. However, educational level and marital status were significantly associated with receipt of radiation therapy, highlighting the importance of psychosocial support in ensuring equal access to care.

scholarly journals The metabolic adaptation mechanism of metastatic organotropism

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Chao Wang ◽  
Daya Luo
Keyword(s):  
Cancer Cells ◽  
Cancer Cell ◽  
Cancer Progression ◽  
Cancer Metabolism ◽  
Cancer Metastasis ◽  
Tumour Microenvironment ◽  
Metabolic Adaptation ◽  
Adaptation Mechanism ◽  
Metastatic Sites ◽  
The Impact

AbstractMetastasis is a complex multistep cascade of cancer cell extravasation and invasion, in which metabolism plays an important role. Recently, a metabolic adaptation mechanism of cancer metastasis has been proposed as an emerging model of the interaction between cancer cells and the host microenvironment, revealing a deep and extensive relationship between cancer metabolism and cancer metastasis. However, research on how the host microenvironment affects cancer metabolism is mostly limited to the impact of the local tumour microenvironment at the primary site. There are few studies on how differences between the primary and secondary microenvironments promote metabolic changes during cancer progression or how secondary microenvironments affect cancer cell metastasis preference. Hence, we discuss how cancer cells adapt to and colonize in the metabolic microenvironments of different metastatic sites to establish a metastatic organotropism phenotype. The mechanism is expected to accelerate the research of cancer metabolism in the secondary microenvironment, and provides theoretical support for the generation of innovative therapeutic targets for clinical metastatic diseases.

scholarly journals FUGACITY AND REHEATING OF PRIMORDIAL NEUTRINOS

2013 ◽  
Vol 28 (40) ◽  
pp. 1350188 ◽  
Author(s):  
JEREMIAH BIRRELL ◽  
CHENG-TAO YANG ◽  
PISIN CHEN ◽  
JOHANN RAFELSKI
Keyword(s):  
Cosmological Model ◽  
Background Radiation ◽  
Chemical Nonequilibrium ◽  
Model Parameter ◽  
Standard Cosmological Model ◽  
Cmb Fluctuations ◽  
The Impact ◽  
Freeze Out

We clarify in a quantitative way the impact that distinct chemical Tc and kinetic Tk freeze-out temperatures have on the reduction of the neutrino fugacity ϒν below equilibrium, i.e. ϒν<1, and the increase of the neutrino temperature Tν via partial reheating. We establish the connection between ϒν and Tk via the modified reheating relation Tν(ϒν)/Tγ, where Tγ is the temperature of the background radiation. Our results demonstrate that one must introduce the chemical nonequilibrium parameter, i.e. the fugacity, ϒν, as an additional standard cosmological model parameter in the evaluation of CMB fluctuations as its value allows measurement of Tk.

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