Impact of surveillance among patients with resected pancreatic cancer following adjuvant chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16795-e16795
Author(s):  
Selina Wong ◽  
Lovedeep Gondara ◽  
Daniel John Renouf ◽  
Howard John Lim ◽  
Sharlene Gill
Keyword(s):  
Adjuvant Chemotherapy ◽  
Statistical Significance ◽  
Curative Intent ◽  
Node Positive ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Cancer Agency ◽  
To Receive ◽  
Asymptomatic Disease

e16795 Background: Pancreatic adenocarcinoma carries a poor prognosis and high risk of recurrence even after surgery and adjuvant chemotherapy (AC). Guidelines recommend against routine surveillance imaging due to lack of evidence supporting a survival benefit. With current first-line chemotherapy options, it is unclear whether surveillance scans allow for early detection of asymptomatic disease and therefore an opportunity to offer fit patients chemotherapy. We describe the patterns of surveillance in patients followed at a Canadian provincial cancer agency and determine whether routine imaging after AC is associated with receipt of palliative chemotherapy (PC). Methods: A retrospective review was completed to identify patients treated at British Columbia (BC) Cancer centres between January 1, 2010 and December 31, 2016 who had undergone curative intent resection and received at least one cycle of AC. Baseline characteristics, number of scans done after completing AC to recurrence, and PC were collected. Logistic regression analysis was performed. Results: A total of 151 patients followed at BC Cancer were identified. Patients who recurred within 28 days after AC were excluded, leaving 142 patients, of which 115 patients had recurrence (81%). We defined 2 cohorts based on number of scans done between completion of AC and recurrence: those with 0-1 scans were “symptomatic” recurrences (22 patients, median age 68y, 64% female, and 91% node-positive) and those with > 1 scan were “surveillance” recurrences (93 patients, median age 64y, 43% female, and 81% node-positive). Patients who underwent surveillance scans were more likely to receive PC at time of recurrence, though statistical significance was not reached (OR 2.11, 95% CI 0.75-6.58, p = 0.17). Conclusions: Despite guidelines, the majority of patients treated in BC underwent surveillance imaging. Within the limits of our sample size, we demonstrated a trend towards increased likelihood of receiving PC in patients who receive surveillance scans following AC. With efficacious PC options available, studies to determine whether receipt of PC in asymptomatic recurrences detected on imaging translates into improved survival and/or quality of life are warranted.

Impact of surveillance among patients with resected pancreatic cancer following adjuvant chemotherapy.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 768-768
Author(s):  
Selina Wong ◽  
Lovedeep Gondara ◽  
Daniel John Renouf ◽  
Howard John Lim ◽  
Sharlene Gill
Keyword(s):  
Adjuvant Chemotherapy ◽  
Statistical Significance ◽  
Curative Intent ◽  
Node Positive ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Cancer Agency ◽  
To Receive ◽  
Asymptomatic Disease

768 Background: Pancreatic adenocarcinoma carries a poor prognosis and high risk of recurrence even after surgery and adjuvant chemotherapy (AC). Guidelines recommend against routine surveillance imaging due to lack of evidence supporting a survival benefit. With current first-line chemotherapy options, it is unclear whether surveillance scans allow for early detection of asymptomatic disease and therefore an opportunity to offer fit patients chemotherapy. We describe the patterns of surveillance in patients followed at a Canadian provincial cancer agency and determine whether routine imaging after AC is associated with receipt of palliative chemotherapy (PC). Methods: A retrospective review was completed to identify patients treated at British Columbia (BC) Cancer centres between January 1, 2010 and December 31, 2016 who had undergone curative intent resection and received at least one cycle of AC. Baseline characteristics, number of scans done after completing AC to recurrence, and PC were collected. Logistic regression analysis was performed. Results: A total of 151 patients followed at BC Cancer were identified. Patients who recurred within 28 days after AC were excluded, leaving 142 patients, of which 115 patients had recurrence. We defined 2 cohorts based on number of scans done between completion of AC and recurrence: those with 0-1 scans were “symptomatic” recurrences (22 patients, median age 68y, 64% female, and 91% node-positive) and those with > 1 scan were “surveillance” recurrences (93 patients, median age 64y, 43% female, and 81% node-positive). Patients who underwent surveillance scans were more likely to receive PC at time of recurrence, though statistical significance was not reached (OR 2.11, 95% CI 0.75-6.58, p = 0.17). Conclusions: Despite guidelines, the majority of patients treated in BC underwent surveillance imaging. Within the limits of our sample size, we demonstrated a trend towards increased likelihood of receiving PC in patients who receive surveillance scans following AC. With efficacious PC options available, studies to determine whether receipt of PC in asymptomatic recurrences detected on imaging translates into improved survival and/or quality of life are warranted.

Identifying opportunities to improve quality of cancer care: An evaluation of the use of routine surveillance imaging scans in women with early breast cancer (EBC) treated in Ontario, Canada.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 115-115
Author(s):  
Katherine Enright ◽  
Mohammed Ghannam ◽  
Lingsong Yun ◽  
Nathan Taback ◽  
Christopher M. Booth ◽  
...  
Keyword(s):  
Cancer Care ◽  
Advanced Imaging ◽  
X Ray ◽  
Imaging Test ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Second Year ◽  
Bone Scans

115 Background: Over use of routine surveillance imaging to detect recurrence in women with EBC was recently identified as one of the top five opportunities to improve the quality of cancer care by the American Society of Clinical Oncology. We undertook a population level assessment of the current practice of surveillance imaging in EBC women treated in Ontario Canada. Methods: Incident EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial health care databases to provide comprehensive medical follow-up. Basic (chest x-ray, abdominal x-ray and abdominal ultrasound) and advanced (computed tomography [CT] or bone scans) surveillance imaging scans completed during the first and second year of follow-up (starting 6 months after surgery or upon completion of chemotherapy) were identified. Logistic regression models were used to identify covariates associated with advanced surveillance imaging. Results: 16,981 EBC patients were included in the analysis of which 7,907(46.6%) received chemotherapy. In the first year of follow up care, 8,311 (48.9%) had at least 1 basic imaging test, while 4,916 (29.0%) had advanced imaging. This fell to 45.7% (basic) and 25.1% (advanced) in the second year of follow-up. Bone scans were the most common advanced imaging test (14.5%), followed by CT thorax (10.8%). On multivariable analysis age, stage, the use of chemotherapy and comorbidity were associated with increased use of advanced surveillance imaging (Table). Conclusions: Surveillance imaging was common in the first two years of follow-up for EBC patients. While appropriate for symptom driven investigation, the high rate of advanced imaging scans suggests an opportunity for improvement with the Ontario cancer system. [Table: see text]

Clinical utility of routine surveillance CT/MRI imaging in patients with localized soft tissue sarcoma (STS) following curative resection.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 11069-11069
Author(s):  
Chiew Woon Lim ◽  
Mohamad Farid Rin Harunal Rashid ◽  
Wei Lin Goh ◽  
Sze Huey Tan ◽  
Steven Bak Siew Wong ◽  
...  
Keyword(s):  
Curative Resection ◽  
Mri Imaging ◽  
Curative Intent ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Metastatic Relapse ◽  
Mode Of Detection ◽  
Imaging Strategy ◽  
Mri Surveillance ◽  
The Impact

11069 Background: Guidelines recommend routine surveillance imaging in patients (pts) following curative resection of STS. However the benefit of such an approach is unclear. We sought to evaluate the utility of a surveillance imaging strategy in pts with localized STS treated with curative intent. Methods: Pts with localized non-indolent STS, seen between 2010 – 2016, who had undergone surgery with R0/R1 surgical margins were included. Epidemiology, treatment and relapse data were collected as was the mode of detection. We defined optimal surveillance as CT/ MRI performed at least 6-mthly following surgery; suboptimal surveillance was defined as CT/ MRI imaging performed less frequently than 6mthly. Results: Of 294 pts included, 31% (n = 92) vs 34% (n = 100) vs 35% (n = 102) had optimal, suboptimal and no routine CT/MRI surveillance imaging respectively. At a median follow-up of 27mths (range 0-79), 36% (n = 105) experienced a relapse; 43% (n = 45) local and 57% (n = 60) had metastatic relapse. More relapses were noted in the optimal surveillance group, 57% (n = 52) vs 28% (n = 28) and 25% (n = 25) in the suboptimal and no surveillance groups respectively (p < 0.001). Within each cohort, relapses detected directly by routine surveillance imaging vs outside of surveillance imaging were as follows: 35% (n = 32) / 22% (n = 20) in the optimal, 17% (n = 17) / 11% (n = 11) in the suboptimal and 0 / 25% (n = 25) in the no surveillance arms respectively. Comparing the 3 strategies, the proportion of pts who then went on to receive curative resection/ metastacectomy was not significantly different, 38% (n = 20), 57% (n = 16) and 32% (n = 8) of relapses, in the optimal vs suboptimal vs no surveillance cohorts respectively (p = 0.1). Notably, routine surveillance imaging directly leading to curative resection occurred only in 15% (n = 14) of pts in the optimal and 9% (n = 9) in the suboptimal surveillance groups. Conclusions: While an intensive routine CT/MRI surveillance imaging strategy detected more recurrences, the impact it has on subsequent resection is less certain. Optimal frequency of surveillance imaging remains unclear.

Quality of life (QOL) in patients with esophageal cancer treated with radiation (RT) in the radical setting.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 186-186
Author(s):  
Anita Choudhary ◽  
Geoffrey Liu ◽  
Pravin Philip Chacko ◽  
Ehab Fadhel ◽  
Charles Cho ◽  
...  
Keyword(s):  
Esophageal Carcinoma ◽  
Statistical Significance ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Shortness Of Breath ◽  
Curative Intent ◽  
Trimodality Therapy ◽  
Clinically Significant ◽  
One Year

186 Background: QOL is poorly documented in patients with esophageal carcinoma treated with curative intent, especially trimodality therapy. QOL and survival outcomes were evaluated in a single centre prospective cohort study of esophageal carcinoma patients treated with RT in the radical setting. Methods: Patients completed the EORTC-QLQC30 at baseline, the end of RT, 6 months and 1 year after RT. A 10-point difference in scores was considered clinically significant. Results: Thirty-three of 45 consequently treated patients between February 2012 and June 2014 participated, all male, median age 63 years (range 40-76), with T1-4N1-3M0 disease (AJCC 7thedn), median follow up 0.9 years (range 0.1-2.3). Four patients were treated definitively with chemoradiation 45-50Gy in 25 fractions; 14 neoadjuvantly 45-50Gy in 25 fractions; 15 neoadjuvantly 41.4Gy in 23 fractions, with concurrent chemotherapy. Compliance for questionnaire completion was 80-100%. 2 year overall survival (OS) and disease free survival (DFS) were 77% and 63%. Median scores on role, social, fatigue and appetite showed clinically significant worsening at the end of RT; in addition statistical significance was found for global QOL, physical, nausea/vomiting, and shortness of breath [median difference (MD): global -8.3 p=0.004, physical -6.6 p=0.003, role -16.6 p=0.001, social -16.6 p=0.78, nausea/vomiting 8.3 p=0.02, fatigue 22.2 p=0.001, shortness of breath 0 p=0.037, appetite 33.3 p=0.009]. At 6 months post RT global QOL (MD -16.6 p=0.23), physical (MD -13.3 p=0.007), role (MD -16.7 p=0.11) and fatigue (MD 11.1 p=0.18) were clinically significantly depressed. At one year all scores had returned to baseline, except pain, which was clinically significantly worse (MD 16.7 p=0.41); 64% of the cohort reported worse pain compared to baseline. Although global QOL on average returned to normal, 46% reported this to be clinically worse at one year compared to baseline. No association was found between baseline global QOL and OS (p=0.15) or DFS (p=0.57). Conclusions: QOL was worsened in several domains during and up to 6 months post RT. At one year all scores had returned to baseline except for pain which was significantly worsened in 64% of patients.

scholarly journals Electroacupuncture for Women with Chronic Severe Functional Constipation: Subgroup Analysis of a Randomized Controlled Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Jing Zhou ◽  
Yan Liu ◽  
Kehua Zhou ◽  
Baoyan Liu ◽  
Tongsheng Su ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Functional Constipation ◽  
Sham Acupuncture ◽  
Bowel Movements ◽  
Stopping Treatment ◽  
To Receive

Background. Acupuncture has been found to be effective for treating chronic constipation. Objective. The objective of this exploratory study was to evaluate the efficacy of electroacupuncture (EA) in the subgroup of women with chronic severe functional constipation. Methods. This is a subgroup analysis of the multicenter, randomized, sham-acupuncture (SA) controlled trial. The efficacy of 822 (76%) female patients of the 1075 randomized patients with chronic severe functional constipation was evaluated. Patients were randomly assigned to receive 28 sessions of EA or SA over 8 weeks with 12 weeks’ follow-up. This study focused on sustained complete spontaneous bowel movements (CSBMs) responders over the 8-week treatment. Results. The primary outcome which was percentage of the sustained CSBMs responders for the subset of women with severe constipation was significantly higher in the EA group (24.3%) than in the SA group (8.1%) with difference of 13.1% (95%CI, 6.5% to 19.7%; P<0.001). As for the secondary outcomes, responders for ≥9 of 12 weeks of follow-up were higher in the EA group than in the SA group. Additionally, EA had significantly better improvement in mean weekly CSBMs, mean weekly spontaneous bowel movements (SBMs), and mean score changes of stool consistency and straining as well as quality of life of patients. The incidence of adverse events (AEs) related to acupuncture was rare and no statistical significance was found between two groups. Conclusion. EA improved the spontaneity and the completeness of the bowel movement of women with severe functional constipation during 8-week treatment and the effect sustained for 12 weeks after stopping treatment.

scholarly journals A multi-center, signal-arm study on cancer patients’ perception of chemotherapy side effects, depression, and decision regret at the end of adjuvant treatment

2020 ◽  
pp. 1-7
Author(s):  
Caterina Calderon ◽  
Raquel Hernández ◽  
María del Mar Muñoz ◽  
Alba Rosa Díez
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adjuvant Chemotherapy ◽  
Healthcare Professional ◽  
Metastatic Cancer ◽  
Decision Regret ◽  
Chemotherapy Side Effects ◽  
To Receive ◽  
The Relationship

Purpose The aim was to assess patients’ perception of chemotherapy side effects and analyze the relationship between these, depression, and treatment rejection. Methods A multi-center, signal-arm study in 456 patients with resected, non-metastatic cancer. Conducted upon completion of adjuvant chemotherapy. Participants answered questionnaires evaluating chemotherapy side effects (EORTC-QLC-C30), depression (BSI), and decision regret (DRS). Results The three most common symptoms reported by the patients were fatigue (57.5%), insomnia (56.7%), and pain (31%). Only 7.6% (n=35) expressed regret over having opted to receive adjuvant chemotherapy. Fatigue, insomnia, dyspnea, and pain were associated with more depression, while fatigue, pain, and age were associated with decision regret. Conclusion Healthcare professional should consider decreasing fatigue, insomnia, and pain a priority if quality of life is to be improved for patients receiving chemotherapy. The treatment of the side effects of chemotherapy for cancer is essential to improve the quality of life and compliance with the treatment.

1317: Significance of Lymph Node Positive Disease in Patients Treated with Neoadjuvant Chemotherapy: Is Adjuvant Chemotherapy Beneficial?

2005 ◽  
Vol 173 (4S) ◽  
pp. 358-358
Author(s):  
Wassim Kassouf ◽  
Dan Leibovici ◽  
Xian Zhou ◽  
Colin P.N. Dinney ◽  
G.H. Barton ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Node Positive ◽  
Node Positive Disease ◽  
Lymph Node Positive

Lesson Study dan Implikasinya Terhadap Pembelajaran Berbasis Kurikulum Tingkat Satuan Pendidikan

2016 ◽  
Vol 1 ◽  
pp. 189-196
Author(s):  
Vian Harsution
Keyword(s):  
Learning Environment ◽  
Learning Process ◽  
Lesson Study ◽  
Learning Difficulties ◽  
Learning Needs ◽  
Democratic Leadership ◽  
Entrepreneurial Spirit ◽  
To Receive

Lesson study is a systematic, collaborative, and sustainable method of improving the quality of learning. Lesson study emphasizes the exploration of students’ learning needs; teacher openness towards learning difficulties encountered; the willingness of teachers to receive and provide advice and solutions to the difficulties encountered; and the consistency of the various parties to follow up the suggestions and solutions. Implementation of lesson study involving teachers, principals, and experts in the field of education. Kurikulum tingkat satuan pendidikan or abbreviated KTSP is operational curriculum formulated and implemented by each educational unit. KTSP has the characteristics, namely: giving broad autonomy to the educational unit, involving the community and parent participation, involving the democratic leadership of the principal, and require the support of a working team that is synergistic and transparent. KTSP based on the learning process, needs to be supported by a conducive learning environment and fun to be created by teachers.Teachers and principals in a professional, systematic and collaborative create an atmosphere that fosters independence, tenacity, entrepreneurial spirit, adaptive and proactive nature of the learning process. Thus, the learning needs of students who fulfilled optimally and professional ability of teacher who have increased on an ongoing basis, may usher in success – based learning KTSP. It means that the lesson study provides positive implications for the KTSP – based learning.

ASSECSSING MOCA TEST IN SUBACUTE STROKE PATIENTS AND COMPARE MOCA VERSUS MMSE

2016 ◽  
pp. 120-127
Author(s):  
Dinh Toan Nguyen
Keyword(s):  
Human Life ◽  
Statistical Significance ◽  
High Sensitivity ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Female Age ◽  
Subacute Stroke ◽  
Duration Of Illness ◽  
Dsm Iv

Background: Dementia after stroke, particularly subacute period is often overlooked. Today the quality of human life is increasingly high, finding scales that have high value for detection of dementia in patients with stroke is increasingly interested. MoCA test is high sensitivity with mild dementia and identify more abnormalities of awareness caused by vascular, but MoCA have not been studied much in Vietnam. Objective: Assessing MoCA test in subacute stroke patients and compare MoCA versus MMSE in these patients. Subjects: 90 patients with subacute stroke period, these people are being treated at Department of cardiovascular internal medicine at Hue Central Hospital, from 7/2014 - 7/2015. Methods: cross-sectional description and analysis. Results: The mean age is 65.57 ± 13.38, accounting for 54.4% male and 45.6% female. Age, duration of illness has weak correlation with MoCA. The risk factors: hypertension, stroke ischemic transient, alcoholism, smoking, heart disease, diabetes, dyslipidemia related no statistical significance with MoCA. The proportion of dementia in subacute stroke according MoCA is 82.2%. The concordance between MoCA and MMSE was good (kappa = 0.684). Using DSM-IV criteria as the gold standard we found MoCA more valuable in the dementia diagnosis than MMSE (AUC 0.864 versus 0.774, p <0.05). Conclusion: The rate of dementia in stroke subacute period according MoCA is quite high. MoCA is valuable than MMSE in detecting dementia in patients with stroke subacute period, this scale is short, easy to implement so should put into using widely in clinical practice. Key words: MoCA test, subacute stroke, dementia

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