Factors Related to Advanced Stage of Cancer Presentation in Botswana

Purpose Botswana, a country with a high prevalence of HIV, has an increasing incidence of cancer-related mortality in the post–antiretroviral therapy era. Despite universal access to free health care, the majority of Botswana patients with cancer present at advanced stages. This study was designed to explore the factors related to advanced-stage cancer presentation in Botswana. Methods Patients attending an oncology clinic between December 2015 and January 2017 at Princess Marina Hospital in Gaborone, Botswana, completed a questionnaire on sociodemographic and clinical factors as well as cancer-related fears, attitudes, beliefs, and stigma. Odds ratios (ORs) were calculated to identify factors significantly associated with advanced stage (stage III and IV) at diagnosis. Results Of 214 patients, 18.7% were men and 81.3% were women. The median age at diagnosis was 46 years, with 71.9% of patients older than 40 years. The most commonly represented cancers included cervical (42.3%), breast (16%), and head and neck (15.5%). Cancer stages represented in the study group included 8.4% at stage I, 19.2% at stage II, 24.1% at stage III, 11.9% at stage IV, and 36.4% at an unknown stage. Patients who presented at advanced stages were significantly more likely to not be afraid of having cancer (OR, 3.48; P < .05), believe that their family would not care for them if they needed treatment (OR, 6.35; P = .05), and believe that they could not afford to develop cancer (OR, 2.73; P < .05). The perception that symptoms were less serious was also significantly related to advanced stage ( P < .05). Patients with non–female-specific cancers were more likely to present in advanced stages (OR, 5.67; P < .05). Conclusion Future cancer mortality reduction efforts should emphasize cancer symptom awareness and early detection through routine cancer screening, as well as increasing the acceptability of care-seeking, especially among male patients.

Download Full-text

Surgical Management of Advanced Adrenocortical Carcinoma: A 21-year Population-based Analysis

The American Surgeon ◽

10.1177/000313481307901033 ◽

2013 ◽

Vol 79 (10) ◽

pp. 1115-1118 ◽

Cited By ~ 19

Author(s):

Thuy B. Tran ◽

Douglas Liou ◽

Vijay G. Menon ◽

Nicholas N. Nissen

Keyword(s):

Surgical Resection ◽

Adrenocortical Carcinoma ◽

Univariate Analysis ◽

Survival Rates ◽

Stage Iv ◽

Population Based ◽

Stage Iii ◽

Dismal Prognosis ◽

Advanced Stages ◽

The Impact

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a dismal prognosis. When diagnosed in advanced stages of the disease, the outcomes of surgical resection are not well understood. The objective of this study is to determine the impact of surgery in patients with advanced ACC. Using the Surveillance, Epidemiology and End Results database, we identified patients diagnosed with Stage III and IVACC between 1988 and 2009. A total of 320 patients with Stage III and IV disease were included in our analysis. In patients treated with surgical resection, the Stage III 1- and 5-year survival rates were 77 and 40 per cent, respectively, whereas the Stage IV 1- and 5-year survival rates were 54 and 27.6 per cent, respectively. Patients treated without surgery had poor survival at 1 year for both Stage III (13%) and Stage IV (16%) ( P < 0.01 compared with the surgical groups). Lymph node dissection was performed in 26 per cent of the patients with advanced ACC and was associated with improved survival in univariate analysis of Stage IV patients. Overall, our results indicate that favorable survival outcomes can be achieved even in patients with Stage III and IV disease and surgery should be considered in patients with advanced ACC.

Download Full-text

Eight Cycles of BEACOPP Escalated Compared with 4 Cycles of BEACOPP Escalated Followed by 4 Cycles of BEACOPP Baseline with Our without Radiotherapy in Patients in Advanced Stage Hodgkin Lymphoma (HL): Final Analysis of the Randomised HD12 Trial of the German Hodgkin Study Group (GHSG).

Blood ◽

10.1182/blood.v112.11.1558.1558 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1558-1558 ◽

Cited By ~ 6

Author(s):

Volker Diehl ◽

Heinz Haverkamp ◽

Rolf Peter Mueller ◽

Hans Theodor Eich ◽

Hans Konrad Mueller-Hermelink ◽

...

Keyword(s):

Residual Disease ◽

Stage Iv ◽

Final Analysis ◽

Stage Iii ◽

Rank Test ◽

Advanced Stage ◽

Data Set ◽

Who Grade ◽

Free Survival ◽

Significant Difference

Abstract Purpose: The GHSG HD9 trial had established BEACOPP escalated (BE) as new standard of care for advanced-stage HL patients by showing significant superiority in terms of failure-free survival (FFTF) and overall survival (OS) over COPP/ABVD and BEACOPP baseline (BB) (each 8 cycles). The successor study, HD12, evaluated a possible reduction in toxicity by comparing 8 cycles of BE with 4 cycles BE followed by 4 cycles BB. The second question in this trial related to the need of additional radiotherapy (RT) to initial bulk and residual disease. Patients and methods: HL patients in stage IIB with large mediastinal mass and/or E-lesions or stage III/IV were randomised according to a 2×2-factorial design between: 8BE + RT, 8BE no RT, 4BE+4BB + RT, 4BE+4BB no RT. Reviewing CT-images before and after chemotherapy treatment, fields for RT were centrally planned by a multidisciplinary diagnostic panel blinded for the randomisation arm. Primary endpoint of the trial was FFTF. Between 9/1999 and 1/2003, a total of 1,670 patients aged 16–65 were randomized. For this final analysis at a median follow up of 78 months, 99 patients were excluded (42 HL not confirmed, 20 revision of stage, 20 no study treatment or documentation, 17 others) resulting in 1,571 eligible patients. Results: Patient characteristics in the 4 groups were comparable with 49% of patients in stage III, 35% in stage IV, 68% reporting B-symptoms and 28% having a large mediastinal tumor. An IPS of 3 or greater was reported for 38% of patients, predominant histology was nodular sclerosis with 57% of cases. Treatment-related toxicity of WHO grade III/IV was observed in 97% of patients. Most prominent differences between pooled chemotherapy arms were anemia (65% 8BE vs 51% 4BE+4BB) and thrombopenia (65% vs 51%). Treatment outcome: complete remission 92.4%; early progression 2.2%; progression/relapse 7.8% (6.6% and 8.5%). A total of 156 (9.9%) deaths (72 vs 84) have been observed (22 vs 32 acute or salvage treatment toxicity; 15 vs 24 HL; 22 vs 13 secondary neoplasia). Most treatment related deaths occurred in the >60 years age group, the first 4 cycles and the IPS> 3 RF groups. Secondary neoplasias were observed in 77 patients (4.9%): AML/MDS 1.5% vs 1.4%, NHL 1.4% vs 0.6% and solid tumors/others 2.5% vs 2.3%. At 5 years, OS was 91%, FFTF 85.5% and progression free survival (PFS) 86.2% (Kaplan- Meier estimates). Estimates for the difference at 5 years are 1.8% for OS, 2.3% for FFTF and 2.7% for PFS favoring BE. However, there was no statistical difference between 8x BE and 4BE+4BB in all outcome parameters (p>0.19, log rank test). There is also no significant difference between the RT or no-RT arms in this study with the caveat that a number of high-risk patients receiving RT based on the blinded panel decision. Conclusion: The adoption of 4BE+4BB as a new standard in the future GHSG studies will depend on a refined analysis of the total data set and will be presented.

Download Full-text

Limited Benefit Gained From Inferior Vena Cava Filter Insertion In Patients With Advanced-Stage Cancer

Blood ◽

10.1182/blood.v122.21.1147.1147 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1147-1147

Author(s):

Asem Mansour ◽

Yousef Ismael ◽

Hikmat Abdel-Razeq

Keyword(s):

Cancer Patients ◽

Survival Data ◽

Vena Cava ◽

Stage Iv ◽

Stage Iii ◽

Advanced Stage ◽

Ivc Filter ◽

Filter Placement ◽

Stage Iv Disease ◽

Filter Insertion

Abstract Introduction Cancer and its treatment are recognized risk factors for venous thromboembolism (VTE). Inferior Vena Cava (IVC) filters are utilized to provide mechanical thromboprophylaxis to prevent pulmonary embolism (PE) or to avoid bleeding from systemic anticoagulation in high risk patients. Patients and Methods This study was performed at a stand-alone, Joint Commission International (JCI)-accredited comprehensive cancer center. Hospital database was searched for all patients discharged with IVC filter insertion. Additionally, the radiology database was queried for cancer patients undergoing IVC filter placement. Results A total of 107 cancer patients; 59 (55.1%) males and 48 (44.9%) females who had their IVC filter inserted and followed up at our institution were included. The mean age (±SD) of the whole group was 50.8 (± 14.2) years. All patients had active cancer; the most common primary sites were gastrointestinal 32 (29.9%), brain 16 (15.0%) lung 13 (12.1%) and gynecological tumors 11 (10.3%). Majority of the patients had advanced-stage disease; out of 86 patients with identifiable TNM stage (Tumor, Node, Metastasis), 81 (94.2%) patients had locally-advanced stage III or metastatic stage IV disease, whereas only 5 (5.8%) had stages I or II disease. During the 6 weeks prior to IVC filter placement, 74 (69.2%) patients were on active anticancer therapy with 45 (42.1%) were on chemotherapy and 7 (6.5%) were on radiotherapy. Nineteen (17.8%) of the patients had surgical intervention for their cancer while only 3 (2.8%) were on hormonal therapy. The remaining 33 (30.8%) patients were on hospice and palliative care service with 18 (16.8%) were already placed “DNR” (Don't Resuscitate). Prior to IVC filter insertion, a diagnosis of DVT was made on 76 (71.0%) patients while 14 (13.1%) had PE; the other 17 (15.9%) had both DVT and PE. Contraindication to anticoagulation was the main indication for IVC filter placement reported in 85 (79.4%), while 18 (16.8%) had their filter inserted because of failure of anticoagulation (had DVT and/or PE while on therapeutic doses of anticoagulation). Other indications included large, free-floating iliocaval thrombus and poor compliance with anticoagulation. Filters were placed utilizing the jugular approach in 86 (80.3%) while 18 (16.8%) had their filter placed through a femoral approach. Complications following IVC filter placement occurred in 14 (13.1%); majority were recurrent DVT in 10 (9.3%), PE in 3 (2.8%) and filter thrombosis in one patient. Following IVC filter insertion, 42 (39.3%) were also anticoagulated; majority (86%) with LMWH (enoxaparin or tinzaparin). Twenty (47.6%) of these anticoagulated patients were considered, at the time of IVC filter insertion, as having a contraindication to anticoagulation. Survival data following IVC filter insertion was available for 100 patients. The median survival for the whole group was 2.39 months (range: 0.03-60.2). The median survival for patients with stage III and IV disease were 7.97 (1.90-17.08) and 1.31 months (0.92-2.20), respectively; p=0.0119; (Figure) Few patients had stage I and II disease (two had stage I while three others had stage II disease) and thus were excluded from survival analysis. Among the 59 patients with stage IV disease for whom survival data was available, 23 (39.0%) survived less than a month, while 40 (67.8%) survived less than three months. Survivals of patients with stage III disease were better with only one out of 20 patients (5.0%) survived less than a month, while 14 (70.0%) survived more than three months. Conclusions Cancer patients with advanced-stage disease may gain little benefit from IVC filter insertion, so disease stage and life expectancy should be taken in consideration prior to filter placement. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Limited-Stage Mantle Cell Lymphoma

Blood ◽

10.1182/blood.v128.22.5330.5330 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5330-5330 ◽

Cited By ~ 1

Author(s):

Ritsuro Suzuki ◽

Dai Chihara ◽

Naoko Asano ◽

Ken Ohmachi ◽

Tomohiro Kinoshita ◽

...

Keyword(s):

Research Funding ◽

Cell Lymphoma ◽

Clinical Stage ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Advanced Stage ◽

Limited Stage ◽

Stage Disease

Abstract [Background] Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma, characterized by the overexpression of cyclin D1 derived from t(11;14)(q13;q32) and poor prognosis. Most MCLs show nodal presentation, but also accompany extranodal involvement, such as bone marrow, peripheral blood or gastrointestinal tract. As a result, many MCLs present with advanced stage disease. Since only a small portion of patients show limited-stage disease, minimal data exist on treatment of patients diagnosed with limited stage disease. Nevertheless, the treatment strategy of MCL is recommended according to the clinical stage of limited- (stage I or non-bulky II) vs. advanced-stage, as well as other types of lymphoma. [Patients and methods] We recently collected 633 patient data of MCL (Chihara, et al. Ann Oncol 2015). Information of clinical stage was available in 626 patients. The patient data were retrospectively analyzed the by the clinical stage at initial presentation. [Results] The clinical stage was I in 24 patients (4%), II in 33 (5%), III in 70 (11%), and IV in 499 (80%). Only one patient presented with bulky stage II. Detailed demographic information by the clinical stage are listed in Table. Age and sex were not significantly different by clinical stage. Limited stage patients were associated with better performance status (PS), less B symptoms, no extranodal involvement, and lower lactate dehydrogenase (LDH) level and white blood cell (WBC) count. Most patients in any stage were treated with cytotoxic chemotherapy, but more patients in limited stage received radiotherapy. The proportion of high-dose cytarabine (HDCA)-containing regimen over CHOP/CHOP-like was higher in advanced stage patients. Complete and overall response rates were 92% and 96% in stage I, 58% and 94% in stage II, 66% and 86% in stage III, and 52% and 82% in stage IV, respectively (P = 0.02). However, the higher response rate in limited stage patients did not translate into better prognosis. The median survival was 11.0 years in stage I, 13.4 years in stage II, 11.5 years in stage III, and 5.6 years in stage IV (Figure). The prognosis was not significantly different among patients with stage I, II, and III (P = 0.33). [Conclusion] Prognosis of limited-stage MCL was almost similar to that of stage III MCL. Although the present study includes several limitations including a retrospective nature and limited number of patients, prognosis of patients with limited-stage MCL was not satisfactory. The significance of radiotherapy, as well as the optimal choice of chemotherapy, for limited-stage MCL needs re-evaluation. Table Table. Figure Figure. Disclosures Suzuki: Chugai: Honoraria; Kyowa Hakko kirin: Honoraria; Bristol-Myers Squibb: Honoraria. Asano:Jannsen: Honoraria; Chugai: Honoraria. Kinoshita:Ono: Research Funding; Gilead: Research Funding; Zenyaku: Honoraria, Research Funding; Takeda: Research Funding; Chugai: Honoraria, Research Funding; Eisai: Honoraria, Research Funding; Solasia: Research Funding; Janssen: Honoraria; Kyowa Kirin: Honoraria. Suzumiya:Chugai: Honoraria, Research Funding; Astellas: Research Funding; Eisai: Honoraria, Research Funding; Takeda: Honoraria; Toyama Chemical: Research Funding; Kyowa Hakko kirin: Research Funding. Ogura:SymBio Pharmaceuticals: Consultancy, Honoraria; Celltrion, Inc.: Consultancy, Honoraria.

Download Full-text

Neoadjuvant cytoreductive treatment with BRAF/MEK inhibition of prior unresectable regionally advanced melanoma to allow complete surgical resection: REDUCTOR trial.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.9587 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 9587-9587 ◽

Cited By ~ 1

Author(s):

Stephanie A. Blankenstein ◽

Maartje W. Rohaan ◽

W. Martin. C. Klop ◽

Bernies Van Der Hiel ◽

Bart A. Van De Wiel ◽

...

Keyword(s):

Surgical Resection ◽

Metabolic Response ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Stage Iv ◽

Advanced Melanoma ◽

Stage Iii ◽

Advanced Stage ◽

Pet Ct ◽

Cytoreductive Treatment

9587 Background: The aim of this study is to evaluate the potency of short-term neoadjuvant cytoreductive therapy with dabrafenib and trametinib (BRAF and MEK inhibitor respectively) to allow radical surgical resection in patients with unresectable BRAF-mutated, locally advanced stage III or oligometastatic stage IV melanoma. Methods: A total of 25 patients with BRAF-mutated, unresectable locally advanced stage III or oligometastatic stage IV (≤3 metastases) melanoma will be treated with dabrafenib and trametinib for 8 weeks. Response evaluation by positron emission tomography/computed tomography (PET/CT) will occur at 2 and 8 weeks. If sufficient downsizing occurs, surgical resection will be performed. Biopsies for translational research will be taken at baseline and 2 weeks. The dissection specimen will be stored at 8 weeks. Results: Currently 20 patients have been included. Of these, 2 patients showed PD upon treatment and did not proceed to surgery. In 17/18 (94%) patients resection was possible after neoadjuvant treatment, of which 16 (94%) were R0 resections. Median follow-up time is 28 months with a median recurrence free survival of 9 months in patients undergoing surgery. The 1-year overall survival (OS) was 94% and 2-year OS 82%. Median OS was not reached. Metabolic response rates (RR) on PET/CT at 8 weeks were: 4 (20%) CR, 14 (70%) PR, 0 (0%) SD, 2 (10%) PD. Pathologic RR differed: 7 (35%) CR, 7 (35%) PR, 3 (15%) SD, 0 (0%) PD and in 3 patients (15%) no pathologic response was measured, since no resection was performed. Most patients (85%) experienced any toxicity, of which 50% was grade 1, 20% grade 2 and 3 patients (15%) experienced grade 3 toxicity. The most common reported toxicity was fever. Conclusions: Neoadjuvant dabrafenib and trametinib shows to be a potent cytoreductive treatment, allowing radical resection of metastases in 16/20 (80%) patients with prior unresectable locally advanced melanoma. Patients with no recurrence remained disease-free for a prolonged period of time. If there was recurrent disease, this usually occurred within months after surgery and this may present an opportunity for further tailored adjuvant therapy. Clinical trial information: NTR4654.

Download Full-text

The International Prognostic Factor Project Score (IPS) in Advanced Stage Hodgkin Lymphoma Has Limited Utility in Patients Treated in the Modern Era.

Blood ◽

10.1182/blood.v114.22.1554.1554 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1554-1554 ◽

Cited By ~ 3

Author(s):

Moccia A. Moccia ◽

Jane Donaldson ◽

Mukesh Chhanabhai ◽

Paul Hoskins ◽

Richard Klasa ◽

...

Keyword(s):

Prognostic Factor ◽

Hodgkin Lymphoma ◽

Lymphocyte Count ◽

Standard Therapy ◽

Stage Iv ◽

Stage I ◽

Stage Iii ◽

Advanced Stage ◽

Bulky Disease ◽

Modern Era

Abstract Abstract 1554 Poster Board I-577 Introduction The International Prognostic Factor Project Score (IPS) is the most widely utilized risk stratification index for Hodgkin lymphoma (HL) (Hasenclever, N Engl J Med, 1998). Based on patients treated before 1992, it incorporates 7 adverse risk features (male gender, age ≥45 y, stage IV, hemoglobin <105 g/L, WBC ≥15 × 109/L, lymphocyte count <0.6 × 109/L or <8% of differential, albumin <40 g/L) and predicts for a 5-year freedom-from progression (FFP) ranging from 42-84%.The IPS has not been validated in a more recently treated population, where more accurate pathologic diagnosis, routine use of growth factors and enhanced supportive care may have improved outcomes compared with historic results. Methods This retrospective population-based analysis used the British Columbia Cancer Agency Lymphoid Cancer Database to identify all patients ages 15-65 y diagnosed from January 1st,1990 to June 30th, 2008 with advanced stage HL (stage III/IV, or stage I/II with B symptoms or bulky disease ≥10 cm), who were treated with curative intent with ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) or an ABVD-equivalent regimen and had complete information including all IPS variables. Primary endpoint was FFP, defined as the interval from diagnosis to first progression or relapse or death due to treatment toxicity; deaths from unrelated causes were censored. Results 579 patients were identified. Median age was 29 y (range 15-65); 11 (2%) stage I, 239 (41%) stage II, 202 (35%) stage III and 127 (22%) stage IV; 245 (42.3%) had bulky disease; and 359 (62%) had B symptoms. Histologies included: 455 (79%) nodular sclerosing, 35 (6%) mixed cellularity, 7 (1%) lymphocyte-rich, 11 (2%) lymphocyte depleted, 13 (2%) nodular lymphocyte predominant, 58 (10%) HL NOS. 161 (28%) patients received IFRT with primary treatment. Adverse prognostic factors were present as follows: 119 (21%) age≥45, 375 (65%) albumin <40 g/L, 88 (15%) WBC ≥15 × 109/L, 116 (20%) hemoglobin <105 g/L, 57 (10%) lymphocyte count <0.6 × 109/L or <8%, 302 (52%) male, 127(22%) stage IV. Only 37 (6.4%) patients had a prognostic score ≥5. With a median follow-up of 73 months (range, 1-222), 512 (88.4%) patients were alive and 67 (11.6%) had died (39 with HL, 7 due to toxicity and 21 from unrelated causes). Five year FFP and overall survival (OS) were 79% and 91%, respectively. The IPS was prognostic for both FFP (p=.0035) and OS (p<.0001), with 5-y FFP ranging from 66% to 86% and 5-y OS ranging from 74% to 98% (Table 1). In univariate analysis only stage IV (p=.003) and hemoglobin (P=.001) were prognostic for FFP. Albumin (p=.054), age (p=.082) and WBC (p=.094) were borderline significant, but gender (p=.329) and lymphocyte count (P=.496) appeared to have a weaker prognostic value for FFP. Only stage IV (HR=1.63, CI 1.10-2.40, p=.014) and hemoglobin (HR=1.73, CI 1.17-2.57, p=.006) were prognostic for FFP in a multivariate Cox regression. Conclusion The IPS remains prognostic for patients with advanced stage HL treated in a more modern era. However, it does not identify risk groups with sufficiently good or poor outcome to justify deviation from standard therapy. Identification of truly low or high risk populations will require supplementation with molecular markers and/or the use of early PET scanning. Caution should be used when comparing results from current clinical trials to historic controls, since more recent outcomes with standard therapy are clearly superior to those previously reported. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Outcome of Bone Marrow Biopsy in Patients with Diffuse Large B-Cell Lymphoma Patients Staged by Combined 18 FGD-PET/CT Scan

Blood ◽

10.1182/blood.v128.22.4207.4207 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4207-4207

Author(s):

Rasha Abdel Tawab Hamed ◽

Rami Kotp ◽

Eric Turecotte ◽

Baseem Sawan ◽

Annie Morine

Keyword(s):

Bone Marrow ◽

Bone Marrow Biopsy ◽

Conflicts Of Interest ◽

False Negative ◽

Stage Iv ◽

B Cell Lymphoma ◽

Stage I ◽

Stage Iii ◽

Advanced Stage ◽

Pet Ct

Abstract DLBCL represents 1/3 of non-Hodgkin lymphoma, in 60% of the cases the disease presented in advanced stage (III-IV). Extranodal organs are involved in 40% of cases; BM involvement in 11% to 27% of cases. BMB is an invasive procedure, & it also could represent false negative result in patients with patchy pattern of involvement or if involvement else where the routine biopsy site. Study included 102 patients, above the age of 18 years, confirmed to have newly diagnosed DLBCL with no any other malignancy. Every patient had a baseline PET-Ct, bone marrow biopsy. PET-CT detected BM infiltration in 23 patients, i.e 22.5%. BMB were positive in 20 patients, while PET-CT showed BM involvement in 23 patients.- 94 patients had concordant negative ( 75 patients ) or positive ( 19 patients), PET-CT & BMB results. One patient had positive BMB and negative PET-CT. All patients with stage I & II had concordant PET-CT & BMB results One patient graded stage III by PET-CT showed 1-2% BM infiltration & upstaged to stage IV. Of the 49 patients graded stage IV by PET-CT, 3 had positive BM involvement PET-CT and negative BMB. the sensitivity of PET-CT was 95%, the specificity of PET-CT was 96.2%. the PPV was 86.4% & the NPV was 98.7%. PET-CT showed 95.9% accuracy. Our results suggest PET-CT as a powerful tool to evaluate BM infiltration in patients with DLBCL, with overall concordance exceeding 94% (100%for stage I & II ). For patients with advanced stage IV disease, PET-CT was able to retrieve patients with BM involvement & false negative BMB. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Real-World Treatment Patterns, Survival, and Costs for Ovarian Cancer in Canada: A Retrospective Cohort Study Using Provincial Administrative Data

Journal of Health Economics and Outcomes Research ◽

10.36469/jheor.2021.29145 ◽

2021 ◽

Vol 8 (2) ◽

pp. 114-121

Author(s):

Manjusha Hurry ◽

Shazia Hassan ◽

Soo Jin Seung ◽

Ryan Walton ◽

Ashlie Elnoursi ◽

...

Keyword(s):

Ovarian Cancer ◽

Health System ◽

Advanced Disease ◽

Stage Iv ◽

Treatment Patterns ◽

Stage I ◽

Stage Iii ◽

Advanced Stage ◽

Poor Survival ◽

Stage Disease

**Background:** In 2020, approximately 3100 Canadian women were diagnosed with ovarian cancer (OC), with 1950 women dying of this disease. Prognosis for OC remains poor, with 70% to 75% of cases diagnosed at an advanced stage and an overall 5-year survival of 46%. Current standard of care in Canada involves a combination of cytoreductive surgery and platinum-based chemotherapy. **Objective:** There are few studies reporting current OC costs. This study sought to determine patient characteristics and costs to the health system for OC in Ontario, Canada. **Methods:** Women diagnosed with OC in Ontario between 2010 and 2017 were identified. The cohort was linked to provincial administrative databases to capture treatment patterns, survival, and costs. Overall total and mean cost per patient (unadjusted) were reported in 2017 Canadian dollars, using a macro-based costing methodology called GETCOST. It is programmed to determine the costs of short-term and long-term episodes of health-care resources utilized. **Results:** Of the 2539 OC patients included in the study, the mean age at diagnosis was 60.4±11.35 years. The majority were diagnosed with stage III disease (n=1247). The only treatment required for 74% of stage I patients and 54% of stage II patients was first-line (1L) platinum chemotherapy; in advanced stages (III/IV) 24% and 20%, respectively, did not receive further treatment after 1L therapy. The median overall survival (mOS) for the whole cohort was 5.13 years. Survival was highest in earlier stage disease (mOS not reached in stage I/II), and dropped significantly in advanced stage patients (stage III: mOS=4.09 years; stage IV: mOS=3.47 years). Overall mean costs in patients stage I were CAD $58 099 compared to CAD $124 202 in stage IV. **Discussion:** The majority of OC patients continue to be diagnosed with advanced disease, which is associated with poor survival and increased treatment costs. Increased awareness and screening could facilitate diagnosis of earlier stage disease and reduce high downstream costs for advanced disease. **Conclusion:** Advanced OC is associated with poor survival and increased costs, mainly driven by hospitalizations or cancer clinic visits. The introduction of new targeted therapies such as olaparib could impact health system costs, by offsetting higher downstream costs while also improving survival.

Download Full-text

Presenting features of supraglottic carcinoma of larynx

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v16i2.6845 ◽

1970 ◽

Vol 16 (2) ◽

pp. 106-112

Author(s):

Md Anwar Hossain ◽

SM Tareq Uddin Ahmed ◽

Md Monjurul Alam ◽

Kamrul Hassan Tarafder ◽

Abu Hena Mohammad Parvez Humayun

Keyword(s):

Respiratory Distress ◽

Stage Iv ◽

Stage Iii ◽

Advanced Stage ◽

Cervical Lymph Nodes ◽

Female Ratio ◽

Presenting Symptoms ◽

Supraglottic Carcinoma ◽

Number Of Patients ◽

Stage Stage

Objectives: To find out the presentation of supraglottic carcinoma of larynx.Methods: Fifty cases of supraglottic carcinoma were selected from the in-patient department of Otolaryngology and Head-Neck surgery of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital, Dhaka, during March, 2009 to August, 2009.Results: Among 50 cases in this study male: female ratio 11.5:1 and mean age was 55 years with range 35 years to 80 years. Majority of cases were from the lower socioeconomic group (66%). Regarding habit 94% were smoker, 60% were habituated with chewing betel leaf and betel nuts with or without other ingredient. Only 3 cases (6%) were alcoholic. Most of the cases presented with more than one symptoms and commonest symptoms was change of voice (82%) which was followed by dysphagia (76%), respiratory distress (54%) and neck swelling (42%). 32 (64%) cases had enlarged cervical lymph nodes out of which 27 (84.37%) were homolateral, 4 (12.50%) were bilateral and only 1 (3.12%) was contra-lateral. Vocal cord movement was normal in 23 (46%) cases, impaired in 12 (24%) and fixed in 15 (30%) cases. Most of the cases presented with exophytic lesion 34 (68%) where ulcerative lesion was 16 (32%). (52%) presented with involvement of arytenoid with aryepiglottic folds/vestibule of larynx, 12 cases (24%) had lesion at epiglottis with vestibule/aryepiglottic folds, 8 cases (16%) had lesion at vestibule with false cord, 4 cases (8%) had lesion involving the epiglottis only. Maximum number of patients had T3 lesion (44%) and T2 lesion was 36%. Most of the cases presented at an advanced stage, stage- IV was 42% and stage- III was 36%. Stage- I and stage- II were 6% and 16% respectively. Conclusion: Most common presenting symptoms of supraglottic carcinoma were change of voice, dysphagia and respiratory distress and most of the cases prented in an advanced stage (Stage III and Stage IV). Key words: Supraglottic; personal habit; neck node DOI: 10.3329/bjo.v16i2.6845Bangladesh J Otorhinolaryngol 2010; 16(2): 106-112

Download Full-text

Effect of chemotherapy on serum nitric oxide levels in advanced stage breast cancer patients

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195905 ◽

2019 ◽

Vol 8 (1) ◽

pp. 189

Author(s):

Charushila Y. Kadam ◽

Subodhini A. Abhang

Keyword(s):

Breast Cancer ◽

Nitric Oxide ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Stage Iv ◽

Chemotherapy Cycle ◽

Stage Iii ◽

Healthy Controls ◽

Advanced Stage ◽

Breast Cancer Patients

Background: The role of nitric oxide is still unclear in advanced breast cancer patients undergoing adjuvant chemotherapy. This study was undertaken to investigate the effect of chemotherapy on serum nitric oxide levels in advanced stage breast cancer patients.Methods: In this observational study, clinically and histopathologically proven sixty female patients with advanced stage breast cancer were included. According to Tumor-Node-Metastasis (TNM) classification, patients were further grouped as stage III and stage IV. Thirty healthy and age-matched female controls were selected for comparison. Blood was collected from healthy controls and from breast cancer patients after surgery prior to chemotherapy and after three weeks of administration of first adjuvant chemotherapy cycle. Serum nitric oxide levels were measured by spectrophotometric method.Results: Significantly higher concentrations of serum nitric oxide were observed in breast cancer patients before chemotherapy in stage III (p<0.0001) and stage IV (p<0.0001) of the disease as compare to concentrations in healthy controls. The serum levels of nitric oxide were significantly decreased in stage III as well as stage IV of breast cancer patients after three weeks of receiving first adjuvant chemotherapy cycle as compare to levels before chemotherapy (p<0.0001), however serum nitric oxide levels were higher in stage III (p=0.0036) and stage IV (p<0.0001) of the disease as compare to healthy controls.Conclusions: Chemotherapy drug administration causes decrease in serum nitric oxide levels in advanced stages of breast cancer patients. Monitoring serum nitric oxide levels could be used to predict patients’ response to chemotherapy treatment in breast cancer.

Download Full-text