Impact of 12 months of immunotherapy for metastatic cancer patients on oncology workload.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 279-279
Author(s):  
Victoria Andreotti ◽  
Marika Cinausero ◽  
Silvio Ken Garattini ◽  
Lucia Bortot ◽  
Lorenza Palmero ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Mean Value ◽  
First Year ◽  
Clinical Episode ◽  
System Data ◽  
Student’S T ◽  
Number Of Treatment

279 Background: In the last years, the introduction of immune checkpoint inhibitors (ICI) in clinical practice translated into major changes in oncology workload. We conducted a study aimed to estimate the shift in workload generated, within 1 year of first consultation, by any new metastatic cancer patient receiving ICI at the Oncology Department of the Academic Hospital of Udine, Italy. Methods: We collected from our electronic accountability system data all new cases of metastatic cancer between 01.01.2017 and 31.12.2018, leading to at least a second clinical episode (treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up, and inpatient oncology advices) during the following year. Patients (pts) were divided into those receiving ICI (anti-CTLA4/PD1/PDL1) versus pts receiving other treatments. Mean number per patient and standard deviation were calculated for clinical episodes, and the mean numbers in each group were compared using Student’s t-test (significance p<0.05). Follow-up continued until 31.12.2019. Results: 969 pts were included: 115 were treated with ICI, 854 received other treatments. In the first group a greater number of treatment sessions, re-evaluations and unplanned presentations was generated, with a statistically significant increased workload. On the other hand, pts receiving other treatments generated a greater workload in terms of follow-up. In detail, data are reported in Table. Conclusions: ICI have transformed the oncology landscape, leading to longer lasting treatment period with emerging toxicities. Estimating the workload generated by ICI is crucial for the implementation of more sustainable systems and for planning clinical activities. Mean number of clinical episodes in the first year of treatment with ICI for metastatic disease. Mean number per patient is represented by mean value and standard deviation (SD). Total number of clinical episodes is shown (N=). Data are reported for ICI versus other treatments group. [Table: see text]

Incremental oncology workload generated by immunotherapy in the first-year of treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14143-e14143
Author(s):  
Marika Cinausero ◽  
Silvio Ken Garattini ◽  
Alessandro Marco Minisini ◽  
Francesca Valent ◽  
Chiara Riosa ◽  
...  
Keyword(s):  
Metastatic Cancer ◽  
Rapid Development ◽  
Cancer Center ◽  
First Year ◽  
Number Of Patients ◽  
Clinical Episode ◽  
Student’S T ◽  
Few Data ◽  
New Diagnosis

e14143 Background: The rapid development of immunotherapy (IO) has transformed the cancer therapy landscape with growing impact on oncology workload. Given the few data on this topic, we conducted a study to estimate the shift in workload generated by any new metastatic cancer patient treated with IO and referred to the Oncology Department of the Academic Academic Cancer Center of Udine, Italy, within the 12 months of first consultation. Methods: We collected from our “Data Warehouse” electronic accountability system all new diagnosis of metastatic cancer between 01.01.2017 and 31.12.2018, resulting in a first consultation and leading to a second clinical episode during the following year, in order to assess the oncology workload. The population was divided into patients that received IO (anti-CTLA-4/PD-1/PDL1) versus patients treated with “other treatments”. Mean number per patient and standard deviation were calculated for clinical episodes (first consultations, treatment sessions, unplanned presentations, hospitalizations, re-evaluations, follow-up and inpatient oncology advices). The total number of patients treated and the number of episodes were recorded. Mean numbers of episodes in the IO group and “other treatments” group were compared using Student’s t-test (significance p < 0.005). Follow-up data was collected up to 31.12.2019. Results: A total number of 969 patients were considered (854 “other treatments” group and 115 IO group), resulting in a total of 12407 clinical episodes over the period of 12 months (first consultations excluded). Compared to “other treatments” group, patients in the IO group generated a greater workload in terms of treatment sessions (9.59 vs 6.83 per patient, p < 0.0001), re-evaluations (2.55 vs 1.88, p = 0.0002), and unplanned presentations (2.19 vs 1.51, p = 0.08). On the other hand, follow-up visits workload was greater for “other treatments” group (0.83 vs 0.63, p = 0.0002). No differences were found regarding hospitalizations and inpatient oncology advices. Further analysis will be presented. Conclusions: IO represents a new frontier in oncology landscape, leading to outcome’s improvement and longer lasting treatment periods. The estimate of oncology workload generated by new diagnosis of metastatic cancer requiring IO, is crucial for implementing more sustainable systems and for planning clinical activities.

Acute kidney injury as a risk factor for mortality in oncological patients receiving check-point inhibitors

2021 ◽  
Author(s):  
Clara García-Carro ◽  
Mónica Bolufer ◽  
Roxana Bury ◽  
Zaira Catañeda ◽  
Eva Muñoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Kidney Injury ◽  
Actuarial Survival ◽  
Oncological Patients ◽  
Check Point Inhibitors ◽  
Independent Risk Factors

Abstract Background Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Methods All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving anti-PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusions 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

scholarly journals MO141ACUTE KIDNEY INJURY AS A RISK FACTOR FOR MORTALITY IN ONCOLOGICAL PATIENTS RECEIVING CHECK-POINT INHIBITORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Clara García Carro ◽  
Mónica Bolufer ◽  
Roxana Bury ◽  
Zaira CAstañeda ◽  
Eva Muñoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Kidney Injury ◽  
Actuarial Survival ◽  
Oncological Patients ◽  
Check Point Inhibitors ◽  
Independent Risk Factors

Abstract Background and Aims Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Method All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusion 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

Analysis of a United States observational registry of gastrointestinal stromal tumor (GIST) patients (pts): reGISTry

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20508-20508
Author(s):  
C. Blanke ◽  
P. W. Pisters ◽  
J. C. Trent ◽  
M. von Mehren ◽  
E. Levine ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Tumor Size ◽  
Management Practices ◽  
Mutational Analysis ◽  
Metastatic Cancer ◽  
First Year ◽  
Site Management ◽  
Community Based ◽  
Sunitinib Malate

20508 Background: Most data on treatment of GIST pts were derived from clinical studies, reflecting practice at academic referral centers. The reGISTry, an observational, internet-based database initiated in 2004, was designed to characterize evolving patterns of care for pts with GIST in both community and university practice settings. It also provides site feedback to allow comparison of site management practices to the aggregate reGISTry data. Methods: Physicians may serially enter data on any enrolled pt with confirmed GIST. Pts must give written informed consent. Collected data include pt demographics, clinical characteristics, clinical/economic outcomes and therapy provided for GIST. Analyses are performed every 6 months. Results: As of Oct 2006, there were 353 pts enrolled from 78 centers. 228 pts (65%) were from community-based practices; 184 pts (52%) were male, and 283 pts (80%) were Caucasian, with a median age of 65 years (range 18–92). Median time from diagnosis to enrollment was 1.1 years (range 0–11.7). At diagnosis, 282 pts (80%) had a localized tumor and 71 (20%) presented with metastatic disease. 335 pts (95%) had immunohistochemical KIT testing, and 1% had genotyping. 274 pts had surgery as first-line treatment (78%), including 84% of pts with primary disease and 52% with metastatic cancer. 14 % and 42% of pts with localized and metastatic disease respectively had systemic therapy as initial treatment. Of the 202 pts with follow-up, 170 (82%) retained the same primary decision-maker, usually the medical oncologist and/or surgeon (57%, 56% respectively). 3 patients reported missing days from work or school due to GIST in their first year since diagnosis. Therapeutic efficacy was assessed by tumor size on CT (53%), tumor size and radiodensity on CT (33%), clinical assessment only (14%) and PET (9%). 161 pts (46%) had been treated with imatinib mesylate and 20 pts (6%) sunitinib malate. Conclusions: The reGISTry remains a useful tool for determining evolving patterns in the management of GIST, and it points out important differences in official practice guidelines and community standards. KIT testing is common in the community, but mutational analysis is rare. Assessment by CT is customary, but PET imaging is rarely utilized in clinical practice. [Table: see text]

Effects of the growing prevalence in oncology: A real-world study on the estimated workload.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14148-e14148
Author(s):  
Silvio Ken Garattini ◽  
Alessandro Marco Minisini ◽  
Francesca Valent ◽  
Chiara Riosa ◽  
Claudia Andreetta ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Mean Value ◽  
Cancer Center ◽  
Number Of Patients ◽  
Clinical Episode ◽  
Pre Treatment ◽  
New Diagnosis ◽  
Oncology Unit ◽  
Prevalence Of Cancer

e14148 Background: The increasing prevalence of cancer patients due to new effective treatments is leading to a growing demand in oncology activities, thus requiring a re-modelling towards more sustainable systems. The aim of this study is to estimate the workload generated by each new cancer patient referred to the Oncology Department of the Academic Cancer Center of Udine, Italy, within the two years from first consultation. Methods: We have utilised our electronic “Data Warehouse” accountability system to retrieve anonymous aggregate data of the 2-year oncology workload generated by each new diagnosis, leading to an initial consultation, occurring between 01.01.2012 and 31.12.2017. Initial consultations with no clinical episode in the following 12 months were excluded. Mean value per patient and standard deviations were calculated for the following clinical activities: treatment sessions, unplanned presentations, hospitalisations, re-assessments, follow-up visits and inpatient oncology advices. The total number of patients treated and of episodes were recorded. Follow-up data was collected up to 31.12.2019. Results: During the observation period, 7,454 newly diagnosed patients were referred to our Oncology Unit, resulting in a total of 92,830 clinical activities occurring over an 8-year period. In 1,788 pts (24.0%) only follow-up was needed; 3,152 pts (42.3%) were referred for adjuvant treatment and 2,514 (33.7%) for advanced disease management. Overall, the mean number of clinical activities per patient within the first 2 years was: 6.04 pre-treatment evaluations (52.9%; SD 8.81; 45,003 total episodes), 2.00 follow-up visits (17.5%; SD 1.89; 14,922 total episodes), 0.42 hospitalisations (3.7%; SD 1.21; 3,141 total episodes), 0.36 inpatient oncology advices (3.2%; SD 0.83; 2,705 total episodes), 1.57 re-assessments (13.8%; SD 2.28; 11,723 total episodes) and 1.02 unplanned presentations (8.9%; SD 2.17; 7,601 total episodes). Subgroup analysis in the different tumors and settings are ongoing. Conclusions: The landscape of cancer care is changing due to the growing prevalence of cancer patients that experience longer overall survival. Trying to estimate the amount of clinical activities generated by any new diagnosis is crucial for implementing new models of oncology management and for programming an adequate workforce supply.

scholarly journals Neurosurgical management of perineural metastases: A case series and review of the literature

2020 ◽  
Vol 11 ◽  
pp. 206
Author(s):  
John D. Patterson ◽  
Matthew Helton ◽  
Mehdi Khani ◽  
Sehrish Sardar ◽  
Kevin Thomas ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Primary Tumor ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Cranial Nerves ◽  
Gamma Knife Radiosurgery ◽  
Case Series ◽  
Disease Process ◽  
Multidisciplinary Care

Background: Perineural invasion (PNI) and spread are one of the grimmest prognostic factors associated with primary skin and head-and-neck cancers, yet remain an often confused, and underreported, phenomenon. Adding complexity to reaching a diagnosis and treating perineural spread (PNS) is the finding that patients may have no known primary tumor, history of skin cancer, and/or incidental PNI in the primary tumor. These delays in diagnosis and treatment are further compounded by an already slow disease process and often require multidisciplinary care with combinations of stereotactic radiosurgery, surgical resection, and novel treatments such as checkpoint inhibitors. Methods: Six patients with metastatic cancer to the cranial nerves who underwent Gamma Knife radiosurgery (GKRS) treatment were chosen for retrospective analysis. This information included age, gender, any past surgeries (both stereotactic and regular surgery), dose of radiation and volume of the tumor treated in the GKRS, date of PNS, comorbidities, the patient follow-up, and pre- and post-GKRS imaging. The goal of the follow-up with radiographing imaging was to assess the efficacy of GKSS. Results: The clinical course of six patients with PNS is presented. Patients followed variable courses with mixed outcomes: two patients remain living, one was lost to follow-up, and three expired with a median survival of 12 months from date of diagnosis. Patients at our institution are ideally followed for life. Conclusion: Given the morbidity and mortality of PNS of cancer, time is limited, and further understanding is required to improve outcomes. Here, we provide a case series of patients with PNS treated with stereotactic radiosurgery, discuss their clinical courses, and review the known literature.

scholarly journals Intervención Contra la Caries Dental a Partir de Acciones de Protección Específica en un Grupo de Escolares de Seis a Once Años de la Alcaldía Iztapalapa de la Ciudad de México

2021 ◽  
Vol 17 (37) ◽  
pp. 233
Author(s):  
Adriano Anaya María del Pilar ◽  
Caudillo Joya Tomás ◽  
Caudillo Adriano Pilar Alejandra ◽  
Murrieta Pruneda José Francisco
Keyword(s):  
Dental Caries ◽  
Primary School ◽  
Control Group ◽  
First Year ◽  
Number Of Children ◽  
School Population ◽  
Student’S T ◽  
Student’S T Test ◽  
Program Version

Objetivo: Implementar un proyecto de intervención contra la caries dental a partir de acciones de protección específica de la salud bucal con el propósito de reducir la incidencia de caries dental en una población escolar de seis a once años, de la Alcaldía Iztapalapa.Material y Métodos: Estudio longitudinal descriptivo y de comparación, conformado por un grupo control, con una muestra de 908 escolares de primer año de primaria que representó el 70% del total de niños de este grado escolar que entregaron su consentimiento firmado previa información a los padres de familia, realizado en 10 escuelas primarias de la Alcaldía Iztapalapa, que se encuentra ubicada en el oriente de la Ciudad de México. Y el grupo testigo conformado por los escolares (3440) que participaron en el diagnóstico base o inicial.Resultados: Tomando como base los resultados del diagnóstico bucal realizado en 3440 escolares, se llevó a cabo una intervención en el grupo control, con la aplicación de un programa de protección específica a partir de acciones de profilaxis, selladores de fosetas y fisuras y técnica de cepillado,así mismo, un seguimiento epidemiológico que inició cuando los escolares se encontraban en primer año y concluyó cuando estos terminaron el cuarto año de primaria, el estudio lo concluyeron 815 escolares. A los escolares que participaron en el grupo testigo no se les realizó ninguna acción odontológica, sus resultados sirvieron sólo de comparación con el propósito de identificar la incidencia de caries dental de los escolares del grupo control una vez concluida la intervención. La información se capturó en el Programa de Cómputo SPSS versión 23.0 en el que se obtuvieron: Estadísticas descriptivas: promedios y DS de caries dental, t de Student, y X2 de Pearson.Conclusiones: La reducción de la caries dental en el grupo control fue del 70.2%. Objective: To implement an intervention project against dental caries based on specific protection actions for oral health in order to reduce the incidence of dental caries in a school population, aged six to eleven years old, of the Iztapalapa Mayor's Office.Material and Methods: Longitudinal descriptive and comparison study, made up of a control group, was used in the study. It was carried out on a sample of 908 schoolchildren in the first year of primary school, which represents 70% of the total number of children of this school grade who gave their signed consent through their parents, The study, however, was carried out in 10 elementary schools of the Iztapalapa Mayor's Office, which is located in the east of Mexico City. The control group is made up of schoolchildren (3440) who participated in the baseline or initial diagnosis.Results: Based on the results of the oral diagnosis carried out in 3440 schoolchildren, an intervention was carried out in the control group with the application of a specific protection program based on prophylactic actions, pit and fissure sealants, and technique of brushing. Likewise, based on an epidemiological follow-up that began when the schoolchildren were in the first year and ended when they finished the fourth year of primary school, the study was completed by 815 schoolchildren. The schoolchildren who participated in the control group did not undergo any dental action, and their results served only as a comparison with the purpose of identifying the incidence of dental caries in the schoolchildren in the control group once the intervention has been concluded. The information was captured using the SPSS Computer Program version 23.0 in which the following were obtained: descriptive statistics such as the means and SD of dental caries, Student's t test, and Pearson's correlation X2.Conclusions: The reduction of dental caries in the control group was 70.2%.

Continuous Entropy Estimation with Different Unsupervised Discretization Methods

2013 ◽  
Vol 380-384 ◽  
pp. 1617-1620
Author(s):  
Jian Fang ◽  
Li Na Sui ◽  
Hong Yi Jian
Keyword(s):  
Standard Deviation ◽  
Mean Value ◽  
Equal Frequency ◽  
Fixed Frequency ◽  
Discretization Methods ◽  
Entropy Estimation ◽  
Density Distributions ◽  
Chi Squared ◽  
Student’S T ◽  
Probability Density Distributions

In this paper, we compare and analyze the performances of nine unsupervised discretization methods, i.e., equal width, equal frequency, k-means clustering discretization, ordinal, fixed frequency, non-disjoint, proportional, weight proportional, mean value and standard deviation discretizations in the framework of continues entropy estimation based on 15 probability density distributions, i.e., Beta, Cauchy, Central Chi-Squared, Exponential, F, Gamma, Laplace, Logistic, Lognormal, Normal, Rayleigh, Student's-t, Triangular, Uniform, and Weibull distributions.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

The First Year Experience of Ankara Child Follow up Center

2012 ◽  
Author(s):  
Fadime Yuksel ◽  
Safa Celik ◽  
Filiz Daskafa ◽  
Nilufer Keser ◽  
Elif Odabas ◽  
...  
Keyword(s):  
First Year Experience ◽  
First Year
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