Oesophageal cancer magnitude and presentation in Ethiopia 2012–2017

The aim of this study was to assess the magnitude, socio-demographic, and clinical characteristics of oesophageal cancer patients in selected referral hospitals of Ethiopia. A retrospective document review was employed in ten referral hospitals in different regions of Ethiopia. A structured data extraction tool was used to extract data from clinical care records of all clinically and pathologically confirmed oesophageal cancer patients who were diagnosed and treated in those hospitals from 2012 to 2017. During the study period, a total of 777 oesophageal cancer cases were identified, and the median age of these patients was 55 years, with an interquartile range of 19. More than half (55.1%, n = 428) of the cases were males, and the majority of them were reported from Oromia (49.9%, n = 388) and Somali (25.9%, n = 202) regional states. The highest numbers of oesophageal cancer cases were recorded in 2016 (23.8%, n = 185), while the lowest were in 2012 (12.6%, n = 98). Eighty per cent of oesophageal cancer cases were diagnosed in later stages of the disease. More than one-fourth (27.0%, n = 210) of patients had surgical procedures where the majority (74.3%, n = 156) required insertion of a feeding tube followed by transhiatal oesophagectomy (10.9%, n = 23). Of the 118 patients for which there was histology data, squamous cell carcinoma (56.7%, n = 67) and adenocarcinoma (36.4%, n = 43) were the predominant histologic type. One-fourth (25.0%, n = 194) of the patients were alive, and more than two-thirds (71.7%, n = 557) of the patients’ current status was unknown at the time of the review. In these referral hospitals of Ethiopia, many oesophageal cancer patients presented during later stages of the disease and needed palliative care measures. The number of patients seen in Oromia and Somali hospitals by far exceeded hospitals of the other regions, thus postulating possibly unique risk factors in those geographic areas.

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Oesophageal Cancer Magnitude and Presentation in Ethiopia

10.21203/rs.2.13716/v1 ◽

2019 ◽

Author(s):

Abigiya Wondimagegnehu ◽

Selamawit Hirpa ◽

Samson Wakuma Abaya ◽

Muluken Gizaw ◽

Sefonias Getachew ◽

...

Keyword(s):

Cancer Patients ◽

Oesophageal Cancer ◽

Late Stage ◽

Data Extraction ◽

Clinical Care ◽

Public Health Problem ◽

Feeding Tube ◽

Current Status ◽

Number Of Patients ◽

Referral Hospitals

Abstract Background Although oesophageal cancer is a public health problem in Ethiopia, there are limited data on the magnitude and distribution of the disease in the country. The aim of this study is to assess the magnitude, socio-demographic and clinical characteristics of oesophageal cancer patients in selected referral hospitals of Ethiopia.Methods A retrospective document review was employed in ten referral hospitals in different regions of Ethiopia. Data were extracted from clinical care records of all clinically and pathologically confirmed oesophageal cancer patients who were diagnosed and treated in those hospitals from 2012 - 2017. A structured data extraction tool was used to collect important variables. Descriptive statistics such as median, interquartile range (IQR) and percentages were computed to describe the regional and national distribution of the disease.Results Over the past six years, a total of 777 oesophageal cancer cases were identified and the median age of these patients was 55 years with IQR of 19. More than half 428 (55.1%) of the cases were males and majority of them were reported from Oromia and Somali regional states with 388 (49.9%) and 202 (25.9%) respectively. The highest number of oesophageal cancer cases were recorded in 2016 with a total number of 185 (23.8%) while the lowest 98 (12.6%) was in 2012. Eighty percent of oesophageal cancer cases were diagnosed at late stage of the disease. More than one-fourth 210 (27.0%) of patients were operated with the majority 156 (74.3%) to insert a feeding tube followed by trans-hiatal oesophagostomy 23 (10.9%). Of the 118 results analysed, squamous cell carcinoma and adeno carcinoma were the predominant histologic type with 67(56.7%), and 43(36.4%) respectively. One fourth 194 (25.0%) of the patients were alive and more than two third 557 (71.7%) patients’ current status were unknown at the time of the review.Conclusions In referral hospitals of Ethiopia, many oesophageal cancer patients came at late stage of the disease and needed palliative care measures. The number of patients seen in Oromia and Somali region hospitals by far exceeds hospitals of the other regions thus postulating possibly unique risk factors in those geographic areas.

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Weight Loss in Breast Cancer Patient Management

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.4.1128 ◽

2002 ◽

Vol 20 (4) ◽

pp. 1128-1143 ◽

Cited By ~ 205

Author(s):

Rowan T. Chlebowski ◽

Erin Aiello ◽

Anne McTiernan

Keyword(s):

Breast Cancer ◽

Weight Loss ◽

Clinical Outcome ◽

Cancer Patients ◽

Clinical Care ◽

Current Status ◽

Current Evidence ◽

Dietary Therapy ◽

Breast Cancer Patients ◽

Breast Cancer Outcome

PURPOSE: To systematically review and summarize evidence relevant to obesity and breast cancer clinical outcome, potential hormonal mediating mechanisms, and the current status of weight loss interventions for chronic disease management. METHODS: A comprehensive, formal literature review was conducted to identify 5,687 citations with key information from 159 references summarized in text and tables. This process included a search for all breast cancer studies exploring associations among survival or recurrence and obesity at diagnosis or weight gain after diagnosis using prospective criteria. RESULTS: On the basis of observational studies, women with breast cancer who are overweight or gain weight after diagnosis are found to be at greater risk for breast cancer recurrence and death compared with lighter women. Obesity is also associated with hormonal profiles likely to stimulate breast cancer growth. Recently, use of weight loss algorithms proven successful in other clinical settings that incorporate dietary therapy, physical activity, and ongoing behavior therapy have been endorsed by the National Institutes of Health and other health agencies. CONCLUSION: Although definitive weight loss intervention trials in breast cancer patients remain to be conducted, the current evidence relating increased body weight to adverse breast cancer outcome and the documented favorable effects of weight loss on clinical outcome in other comorbid conditions support consideration of programs for weight loss in breast cancer patients. Recommendations for the clinical care of overweight or obese breast cancer patients are offered.

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Pharmacist-Led Annual Wellness Visits: A Review

Journal of Pharmacy Practice ◽

10.1177/0897190019882869 ◽

2019 ◽

pp. 089719001988286

Author(s):

Sharmon P. Osae ◽

Alaina Rotelli

Keyword(s):

Positive Impact ◽

Data Extraction ◽

Cochrane Library ◽

Care Clinic ◽

Financial Outcomes ◽

Study Selection ◽

High Satisfaction ◽

Number Of Patients ◽

Collaborative Practice Agreement ◽

Data Extraction Tool

Objective: To summarize findings of pharmacist involvement with Medicare Annual Wellness Visits (AWV), including the number of pharmacist interventions, patient/provider satisfaction, and billing models. Data Sources: A literature search was conducted using PubMed, ScienceDirect College Edition Journals Collection-Health and Life Sciences, Cochrane Library, CINAHL, Medline, and Academic Search Complete, including dates between January 01, 2011, and November 05, 2018. Study Selection: Search was limited to full-text, peer-reviewed articles, published in English which were relevant based on identification of a pharmacist’s role in AWV. Search terms included “Medicare annual wellness visits” and “Pharmacists.” Data Extraction: A data extraction tool was used to collect study authors, year published, study design, description of intervention, objectives, primary outcome measures, model of care, clinic setting, location, results, number of patients, and overall effect. Results: Of the 139 returned citations, 11 met inclusion criteria. Of the practice settings, 7 (72.72%) utilized a collaborative practice agreement for conducting AWV. Six (54.54%) of the studies measured financial outcomes, 3 (27.27%) measured satisfaction of students/patients/physicians, 2 (18.18%) measured clinical outcomes, and finally 4 (36.36%) measured number and types of interventions. Review revealed that 6 (54.54%) articles had more medication-related interventions than nonmedication-related interventions. Studies evaluating finances as it relates to AWVs had various findings including 38% return on investment, higher reimbursement for pharmacist-led visits, and an increase in revenue. Conclusion: In a variety of outpatient health centers, AWV were conducted by pharmacists, had a positive impact on patient care, and had high satisfaction rates between patients and physicians.

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Preoperative nutritional counselling in patients undergoing oesophagectomy

Journal of Perioperative Practice ◽

10.1177/17504589211006026 ◽

2021 ◽

pp. 175045892110060

Author(s):

M AlleaBelle Gongola ◽

Rebecca J Reif ◽

Peggy C Cosgrove ◽

Kevin W Sexton ◽

Katy A Marino ◽

...

Keyword(s):

Weight Loss ◽

High Risk ◽

Length Of Stay ◽

Cancer Patients ◽

Clinical Outcomes ◽

Oesophageal Cancer ◽

Feeding Tube ◽

Nutritional Counselling

Background Patients undergoing surgery for oesophageal cancer are at high risk of malnutrition due to pathology and neoadjuvent therapy. This study sought to determine if oesophageal cancer patients undergoing oesophagectomy achieve superior clinical outcomes when preoperative nutritional counselling is performed. Methods Oesophageal cancer patients undergoing oesophagectomy were retrospectively divided into cohorts based on those who received ( n = 48) and did not receive ( n = 58) preoperative nutritional counselling. We compared weight loss, length of stay, 30-day readmission related to nutrition or feeding tube problems, and 90-day mortality. Results Per cent weight loss was less in patients who received preoperative nutritional counselling. There was a trend toward decreased mean length of stay and there were fewer readmissions for feeding tube-related complications in patients who received counselling. Conclusions Nutritional counselling before surgery may lead to decreased weight loss and reduced readmissions for feeding tube-related complications in patients with oesophageal cancer undergoing oesophagectomy.

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Current status of vascular access in Japan—from Dialysis Access Symposium 2017

The Journal of Vascular Access ◽

10.1177/1129729818762982 ◽

2019 ◽

Vol 20 (1_suppl) ◽

pp. 38-44

Author(s):

Mizuya Fukasawa

Keyword(s):

Vascular Access ◽

Current Status ◽

Good Survival ◽

Chronic Glomerulonephritis ◽

Dialysis Access ◽

Dialysis Patients ◽

Survival Prognosis ◽

Access Methods ◽

Number Of Patients ◽

Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

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Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

Journal of Clinical Medicine ◽

10.3390/jcm8040555 ◽

2019 ◽

Vol 8 (4) ◽

pp. 555 ◽

Cited By ~ 5

Author(s):

Cátia Caneiras ◽

Cristina Jácome ◽

Sagrario Mayoralas-Alises ◽

José Ramon Calvo ◽

João Almeida Fonseca ◽

...

Keyword(s):

Clinical Research ◽

Patient Experience ◽

Clinical Care ◽

Research Priorities ◽

Specific Patient ◽

Quality Healthcare ◽

Body Of Knowledge ◽

Number Of Patients ◽

Patient Reported ◽

System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

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“SQiD, the Single Question in Delirium; can a single question help clinicians to detect delirium in hospitalised cancer patients?” running heading Single Question in Delirium” (Bcan-D-20-01665)

BMC Cancer ◽

10.1186/s12885-020-07504-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Megan B. Sands ◽

Swapnil Sharma ◽

Lindsay Carpenter ◽

Andrew Hartshorn ◽

Jessica T. Lee ◽

...

Keyword(s):

Cancer Patients ◽

Clinical Care ◽

Length Of Hospital Stay ◽

Confusion Assessment Method ◽

Assessment Method ◽

Clinical Staff ◽

Screening Tools ◽

Diagnostic Values ◽

D 20 ◽

Single Question

Abstract Aim A serious syndrome for cancer in-patients, delirium risk increases with age and medical acuity. Screening tools exist but detection is frequently delayed or missed. We test the ‘Single Question in Delirium’ (SQiD), in comparison to psychiatrist clinical interview. Methods Inpatients in two comprehensive cancer centres were prospectively screened. Clinical staff asked informants to respond to the SQiD: “Do you feel that [patient’s name] has been more confused lately?”. The primary endpoint was negative predictive value (NPV) of the SQiD versus psychiatrist diagnosis (Diagnostic and Statistics Manual criteria). Secondary endpoints included: NPV of the Confusion Assessment Method (CAM), sensitivity, specificity and Cohen’s Kappa coefficient. Results Between May 2012 and July 2015, the SQiD plus CAM was applied to 122 patients; 73 had the SQiD and psychiatrist interview. Median age was 65 yrs. (interquartile range 54–74), 46% were female; median length of hospital stay was 12 days (5–18 days). Major cancer types were lung (19%), gastric or other upper GI (15%) and breast (14%). 70% of participants had stage 4 cancer. Diagnostic values were similar between the SQiD (NPV = 74, 95% CI 67–81; kappa = 0.32) and CAM (NPV = 72, 95% CI 67–77, kappa = 0.32), compared with psychiatrist interview. Overall the CAM identified only a small number of delirious cases but all were true positives. The specificity of the SQiD was 87% (74–95) The SQiD had higher sensitivity than CAM (44% [95% CI 41–80] vs 26% [10–48]). Conclusion The SQiD, administered by bedside clinical staff, was feasible and its psychometric properties are now better understood. The SQiD can contribute to delirium detection and clinical care for hospitalised cancer patients.

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Cardiovascular risk factors during cancer treatment: prevalence, incidence and prognostic relevance

European Heart Journal ◽

10.1093/ehjci/ehaa946.3251 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Caro Codon ◽

T Lopez-Fernandez ◽

C Alvarez-Ortega ◽

P Zamora Aunon ◽

I Rodriguez Rodriguez ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cancer Therapy ◽

Cancer Patients ◽

Individual Risk ◽

Funding Source ◽

Number Of Patients ◽

All Cause Mortality

Abstract Background The actual usefulness of CV risk factor assessment in the prognostic evaluation of cancer patients treated with cardiotoxic treatment remains largely unknown. Design Prospective multicenter study in patients scheduled to receive anticancer therapy related with moderate/high cardiotoxic risk. Methods A total of 1324 patients underwent follow-up in a dedicated cardio-oncology clinic from April 2012 to October 2017. Special care was given to the identification and control of CV risk factors. Clinical data, blood samples and echocardiographic parameters were prospectively collected according to protocol, at baseline before cancer therapy and then at 3 weeks, 3 months, 6 months, 1 year, 1.5 years and 2 years after initiation of cancer therapy. Results At baseline, 893 patients (67.4%) presented at least 1 risk factor, with a significant number of patients newly diagnosed during follow-up. Individual risk factors were not related with worse prognosis during a 2-year follow-up. However, a higher Systemic Coronary Risk Estimation (SCORE) was significantly associated with higher rates of severe cardiotoxicity and all-cause mortality [HR 1.79 (95% CI 1.16–2.76) for SCORE 5–9 and HR 4.90 (95% CI 2.44–9.82) for SCORE ≥10 when compared with patients with lower SCORE (0–4)]. Conclusions This large cohort of patients treated with a potentially cardiotoxic regimen showed a significant prevalence of CV risk factors at baseline and significant incidence during follow-up. Baseline cardiovascular risk assessment using SCORE predicted severe cardiotoxicity and all-cause mortality. Therefore, its use should be recommended in the evaluation of cancer patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was partially funded by the Fondo Investigaciones Sanitarias (Spain), Centro de Investigaciόn Biomédica en Red Cardiovascular CIBER-CV (Spain)

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Clinical CYP2D6 Genotyping to Personalize Adjuvant Tamoxifen Treatment in ER-Positive Breast Cancer Patients: Current Status of a Controversy

Cancers ◽

10.3390/cancers13040771 ◽

2021 ◽

Vol 13 (4) ◽

pp. 771

Author(s):

Tessa A. M. Mulder ◽

Mirjam de With ◽

Marzia del Re ◽

Romano Danesi ◽

Ron H. J. Mathijssen ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Outcome ◽

Cancer Patients ◽

Plasma Concentrations ◽

Tamoxifen Treatment ◽

Current Status ◽

Endocrine Treatment ◽

Breast Cancer Patients ◽

Er Positive ◽

Positive Breast Cancer

Tamoxifen is a major option for adjuvant endocrine treatment in estrogen receptor (ER) positive breast cancer patients. The conversion of the prodrug tamoxifen into the most active metabolite endoxifen is mainly catalyzed by the enzyme cytochrome P450 2D6 (CYP2D6). Genetic variation in the CYP2D6 gene leads to altered enzyme activity, which influences endoxifen formation and thereby potentially therapy outcome. The association between genetically compromised CYP2D6 activity and low endoxifen plasma concentrations is generally accepted, and it was shown that tamoxifen dose increments in compromised patients resulted in higher endoxifen concentrations. However, the correlation between CYP2D6 genotype and clinical outcome is still under debate. This has led to genotype-based tamoxifen dosing recommendations by the Clinical Pharmacogenetic Implementation Consortium (CPIC) in 2018, whereas in 2019, the European Society of Medical Oncology (ESMO) discouraged the use of CYP2D6 genotyping in clinical practice for tamoxifen therapy. This paper describes the latest developments on CYP2D6 genotyping in relation to endoxifen plasma concentrations and tamoxifen-related clinical outcome. Therefore, we focused on Pharmacogenetic publications from 2018 (CPIC publication) to 2021 in order to shed a light on the current status of this debate.

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Adverse reactions of targeted therapy in cancer patients: a retrospective study of hospital medical data in China

BMC Cancer ◽

10.1186/s12885-021-07946-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruofei Du ◽

Xin Wang ◽

Lixia Ma ◽

Leon M. Larcher ◽

Han Tang ◽

...

Keyword(s):

Targeted Therapy ◽

Cancer Patients ◽

Adverse Reactions ◽

Cox Regression ◽

Target Therapy ◽

Skin Damage ◽

Data Set ◽

Patients With Cancer ◽

Number Of Patients ◽

Significant Difference

Abstract Background The adverse reactions (ADRs) of targeted therapy were closely associated with treatment response, clinical outcome, quality of life (QoL) of patients with cancer. However, few studies presented the correlation between ADRs of targeted therapy and treatment effects among cancer patients. This study was to explore the characteristics of ADRs with targeted therapy and the prognosis of cancer patients based on the clinical data. Methods A retrospective secondary data analysis was conducted within an ADR data set including 2703 patients with targeted therapy from three Henan medical centers of China between January 2018 and December 2019. The significance was evaluated with chi-square test between groups with or without ADRs. Univariate and multivariate logistic regression with backward stepwise method were applied to assess the difference of pathological characteristics in patients with cancer. Using the univariate Cox regression method, the actuarial probability of overall survival was performed to compare the clinical outcomes between these two groups. Results A total of 485 patients were enrolled in this study. Of all patients, 61.0% (n = 296) occurred ADRs including skin damage, fatigue, mucosal damage, hypertension and gastrointestinal discomfort as the top 5 complications during the target therapy. And 62.1% of ADRs were mild to moderate, more than half of the ADRs occurred within one month, 68.6% ADRs lasted more than one month. Older patients (P = 0.022) and patients with lower education level (P = 0.036), more than 2 comorbidities (P = 0.021), longer medication time (P = 0.022), drug combination (P = 0.033) and intravenous administration (P = 0.019) were more likely to have ADRs. Those with ADRs were more likely to stop taking (P = 0.000), change (P = 0.000), adjust (P = 0.000), or not take the medicine on time (P = 0.000). The number of patients with recurrence (P = 0.000) and metastasis (P = 0.006) were statistically significant difference between ADRs and non-ADRs group. And the patients were significantly poor prognosis in ADRs groups compared with non-ADRs group. Conclusion The high incidence of ADRs would affect the treatment and prognosis of patients with cancer. We should pay more attention to these ADRs and develop effective management strategies.

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