scholarly journals Limitations and perceived delays for diagnosis and staging of lung cancer in Portugal: A nationwide survey analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252529
Author(s):  
Fernando Barata ◽  
Paula Fidalgo ◽  
Sara Figueiredo ◽  
Fernanda S. Tonin ◽  
Filipa Duarte-Ramos
Keyword(s):  
Lung Cancer ◽  
Waiting Times ◽  
Performance Status ◽  
Nationwide Survey ◽  
Tumor Burden ◽  
Public Hospitals ◽  
Categorical Variables ◽  
Multidisciplinary Teams ◽  
Continuous Variables ◽  
Survey Analysis

Background We aimed to identify the perception of physicians on the limitations and delays for diagnosing, staging and treatment of lung cancer in Portugal. Methods Portuguese physicians were invited to participate an electronic survey (Feb-Apr-2020). Descriptive statistical analyses were performed, with categorical variables reported as absolute and relative frequencies, and continuous variables with non-normal distribution as median and interquartile range (IQR). The association between categorical variables was assessed through Pearson’s chi-square test. Mann-Whitney test was used to compare categorical and continuous variables (Stata v.15.0). Results Sixty-one physicians participated in the study (45 pulmonologists, 16 oncologists), with n = 26 exclusively assisting lung cancer patients. Most experts work in public hospitals (90.16%) in Lisbon (36.07%). During the last semester of 2019, responders performed a median of 85 (IQR 55–140) diagnoses of lung cancer. Factors preventing faster referral to the specialty included poor articulation between services (60.0%) and patients low economic/cultural level (44.26%). Obtaining National Drugs Authority authorization was one of the main reasons (75.41%) for delaying the begin of treatment. The cumulative lag-time from patients’ admission until treatment ranged from 42–61 days. Experts believe that the time to diagnosis could be optimized in around 11.05 days [IQR 9.61–12.50]. Most physicians (88.52%) started treatment before biomarkers results motivated by performance status deterioration (65.57%) or high tumor burden (52.46%). Clinicians exclusively assisting lung cancer cases reported fewer delays for obtaining authorization for biomarkers analysis (p = 0.023). Higher waiting times for surgery (p = 0.001), radiotherapy (p = 0.004), immunotherapy (p = 0.003) were reported by professionals from public hospitals. Conclusions Physicians believe that is possible to reduce delays in all stages of lung cancer diagnosis with further efforts from multidisciplinary teams and hospital administration.

Predictors of immune-related adverse events associated with checkpoint inhibitors.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15159-e15159
Author(s):  
Alhareth Alsayed ◽  
Ashish Manne ◽  
Daisy E Escobar ◽  
Gaurav Sharma ◽  
Pranitha Prodduturvar ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Events ◽  
Lymphocyte Count ◽  
Checkpoint Inhibitors ◽  
Hematological Parameters ◽  
White Blood Count ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Continuous Variables ◽  
Grade 3

e15159 Background: Immune-related adverse events (irAE) remain a significant challenge with the expansion of checkpoint inhibitors (ICI) indications. Unlike previous studies published, we investigated risk factors for irAE development, including lymphocytes and neutrophils counts in lung cancer and melanoma treated with all available ICIs in current clinical practice. Methods: This is a retrospective study conducted at the University of South Alabama Mitchell Cancer Institute. Between 2015-2019. A total of 160 patients with a diagnosis of melanoma (N = 54) or lung cancer (N = 106) who received at least two doses of ICI including ipilimumab (15%), nivolumab (32%), pembrolizumab (35%), dual nivolumab/ipilimumab (5%), durvalumab (9%) and atezolizumab (4%). The patient's baseline characteristics were extracted with irAE (grade 3/4) details and survival outcomes. Descriptive statistics were used, Fisher exact test to compare categorical variables, and Wilcoxon rank sum test for continuous variables using JMP software. Results: The median age at diagnosis was 64 years (range 17-93), with 51% females. Race distribution with 76% Caucasians and 26% African Americans. Around 30% of the cohort was treated for recurrence, and 39% did receive prior systemic chemotherapy. Median overall survival (OS) was 13.5 months (m) for melanoma and 16 m for lung cancer with CI 95% [16-24] and [15-23], respectively. Twenty-nine (29%) percent of the cohort (N = 46) had grade 3/4 irAEs. Median of baseline hematological parameters including total white blood count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC to ALC ratio, and platelet to ALC ratio of these patients were not statistically different from the cohort without grade 3/4 irAEs. Interestingly, if a patient has baseline ALC < 1K/μL, the risk of irAE recurrence is low when ICI is re-initiated, p = .0143 (after symptomatic recovery from irAEs). Conclusions: Irrespective of ICI used, baseline lymphocyte count, and its relation to other blood counts have no clear impact on irAE. Larger cohorts or prospective studies are needed to make stronger conclusions about the relationship between the immune system and the occurrence of irAEs

PD-L1 ≥ 50% lung cancer refractory to PD-1 inhibition: the role of salvage chemo-immunotherapy combination

Immunotherapy ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 363-369
Author(s):  
Francesco Gelsomino ◽  
Francesco Facchinetti ◽  
Monia Sisi ◽  
Teresa Zielli ◽  
Marcello Tiseo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Performance Status ◽  
Treatment Strategies ◽  
Tumor Burden ◽  
First Line ◽  
Radiological Response ◽  
Novel Treatment Strategies ◽  
Line Setting ◽  
Nsclc Patients

Novel treatment strategies incorporating PD-1/PD-L1 inhibitors in the first-line setting of advanced non-small-cell lung cancer (NSCLC) provided relevant improvements in survival outcomes. Among NSCLC patients with PD-L1 tumor proportion score ≥50%, identifying the ones to be addressed to pembrolizumab monotherapy or chemo-immunotherapy combinations is a matter of debate, taking into account the risks of overtreatment and toxicity. Here we report the clinical stories of four NSCLC patients with PD-L1 tumor proportion score ≥50% and good performance status, sharing high tumor burden including serosal involvement. After having rapidly progressed on first-line PD-1/PD-L1 inhibitors, they achieved major clinical and radiological response to pembrolizumab-chemotherapy combination. These cases prove the feasibility and effectiveness of salvage chemo-immunotherapy in pembrolizumab-refractory NSCLC patients.

Darbepoetin Alfa assessment in chemotherapy induced anemia

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18617-18617
Author(s):  
E. Samantas ◽  
S. K. Rigatos ◽  
A. Konstantinopoulou ◽  
G. Vourli ◽  
M. Siganaki ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Darbepoetin Alfa ◽  
Positive Impact ◽  
Performance Status ◽  
Full Blood Count ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Significant Difference ◽  
Before And After ◽  
Change In Mean

18617 Background: Anemia is a very common complication of cancer and its treatment. Epoetins have been proven effective in correcting anemia in cancer patients resulting to the reduction of the need for blood transfusions and having a positive impact to the quality of life (QoL). Darbepoetin alfa, is a novel erythropoiesis stimulating protein (NESP) with longer half life. Methods: This is a prospective, single-centre, clinical trial. Patients with haemoglobin < 12 g/dl, suffering from cancer (solid tumor or lymphoma), for whom chemotherapy is scheduled for at least 12 weeks and have life expectancy >6 months and performance status ECOG 0–2,are treated with Darbepoetin alfa 150 mg per week subcutaneously for at least 12 weeks. Full blood count should be tested at least every 2 weeks and biochemistry every 4 weeks. QoL was assessed before and after treatment using the FACT-An (Functional Assessment of Cancer Therapy-Anemia) scale. Primary endpoint is the correction of anemia (Hb value above 12 g/dl). Frequency of the demographic and clinical characteristics were reported for the categorical variables, while mean and standard deviation were reported for continuous variables, such as age and Hb levels. Results: Fifty-six (56) patients entered the study, 66% of them female. Median age was 64 years. The more common cancers were colorectal (26.8%) ovarian (17.9%), breast (16.1%), lung (12.5%), and bladder (8.9%). Two thirds of the patients had not received previous chemotherapy. A statistically significant increase for Hb was found between week 0 and 12 [1.48; 95% CI 1.07–1.88; p < 0.001]. The increase was significant from 3rd week onwards. There was no evidence of significant difference in any of the QoL components or for significant change in mean fatigue sub-scale (fatigue, non-fatigue), between the two assessments. Conclusions: Darbepoetin alfa given at 150 mg per week subcutaneously to cancer patients under chemotherapy appears to correct anaemia, but has not positive impact on QoL, within the limits of the sample size of this study. No significant financial relationships to disclose.

scholarly journals Pseudoprogression in lung cancer: a case report

2020 ◽  
Vol 1 (5) ◽  
Author(s):  
Giulia Meoni ◽  
Nicola Libertà Decarli ◽  
Maurizio Benucci ◽  
Claudio Raspanti ◽  
Angela Stefania Ribecco
Keyword(s):  
Lung Cancer ◽  
Small Molecules ◽  
Response Pattern ◽  
Tumor Response ◽  
Checkpoint Inhibitors ◽  
Performance Status ◽  
Inflammatory Cells ◽  
Tumor Burden ◽  
Cytotoxic Agents ◽  
Lung Adenocarcinoma Patient

Immunotherapy dramatically changed the management of several malignancies including non-small cell lung cancer (NSCLC). Since immune checkpoint inhibitors have a different mechanism of action from cytotoxic agents or small molecules against NSCLC, also tumor response may present with atypical features. Pseudoprogression (PP) is a distinct response pattern defined by a transient enlargement of the tumor burden, sustained by inflammatory cells and usually not associated with worsening of performance status (PS). Here the authors describe the case of a lung adenocarcinoma patient treated with pembrolizumab, who developed an early symptomatic PP with a dramatic global worsening of PS. Subsequently an improvement in general condition and a brilliant tumor response were observed. Tumor re-biopsy was collected after the treatment in order to support the identification of PP and to describe microenvironment modifications induce by immunotherapy.

scholarly journals Impact of Free Newborn Care Service package on Out of Pocket Expenditure-Evidence from a multicentric study in Nepal.

2020 ◽  
Author(s):  
Avinash K Sunny ◽  
Omkar Basnet ◽  
Ankit Acharya ◽  
Prajwal Paudel ◽  
Mats Målqvist ◽  
...  
Keyword(s):  
Care Service ◽  
Newborn Care ◽  
Public Hospitals ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Health Coverage ◽  
Multicentric Study ◽  
Sick Newborn ◽  
The Cost

Abstract Background: Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods: Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results: A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17% of mothers paid for sick newborn care while after implementation 15.3% mothers (p-value=0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean±SD: US dollar 14.3+12.1 and after implementation was Mean±SD: USD 13.0±9.6 (p-value=0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value<0.001) while the cost for medicine increased (p-value=0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value=0.04) and neonatal sepsis (p-value<0.001) after the FNC program was implemented.Conclusion: We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal.

Clinical and biologic factors for immune response to sipuleucel-T (SipT) for metastatic castrate-resistant prostate cancer (mCRPC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 219-219
Author(s):  
Mehmet Faith Hepgur ◽  
Tanya B. Dorff ◽  
Lucy Brining ◽  
Jie Cai ◽  
Jacek K. Pinski ◽  
...  
Keyword(s):  
Immune Response ◽  
Serum Alkaline Phosphatase ◽  
Performance Status ◽  
Prostatic Acid Phosphatase ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Opioid Use ◽  
Ecog Performance Status ◽  
Prior Chemotherapy ◽  
Immune Parameters

219 Background: SipT prolongs overall survival of men with asymptomatic or minimally symptomatic mCRPC. Recently, it has been demonstrated that SipT immune parameters correlate with survival. We prospectively collected biological and inflammatory markers as part of an audit to identify possible predictors of immune response in patients (pts) receiving SipT. Methods: Circulating tumor cells (CTC), PSA, prostatic acid phosphatase (PAP), albumin (Alb), hemoglobin (Hb), serum alkaline phosphatase (SAP), LDH, C-reactive protein (CRP) and β2-microglobulin (β2m) were evaluated in reference lab before SipT. Product parameters CD54, CD54 upregulation (UPREG) and total nucleated cells (TNC) were measured by Dendreon. These datasets were analyzed using Spearman coefficients for continuous variables and the Kruskal-Wallis test for categorical variables. Results: 92 pts who received SipT were included. Median age was 69 (48-90). 43% had Gleason 8-9. 42% had ECOG Performance Status (PS) 0, 44% PS 1, and 13% PS 2. 26% had received prior chemotherapy and 18% had used opioids. 84% had bone mets, 42% had lymphadenopathy, 12% had visceral mets. Of clinical factors only PS was inversely correlated with UPREG (p=0.014) and TNC (p= 0.023). Biomarkers which significantly correlated with SipT immune parameters are shown in the Table. Age, location of mets, prior chemotherapy or opioid use did not impact the immune response to SipT Conclusions: Better product parameters correlated with good ECOG PS, lower PSA and SAP, and higher Hgb and Alb, suggesting that SipT induces a greater immune response in men with lower disease burden. The correlation of increased CD54 count with lower CRP, a surrogate for IL-6 activity, warrants investigation. [Table: see text]

Dynamic changes in biomarkers for immune response to sipuleucel-t (SipT) for metastatic castrate-resistant prostate cancer (mCRPC).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 181-181
Author(s):  
Mehmet Faith Hepgur ◽  
Tanya B. Dorff ◽  
Jie Cai ◽  
Mary Reed ◽  
Betty Chan ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune Activation ◽  
Serum Alkaline Phosphatase ◽  
Performance Status ◽  
Prostatic Acid Phosphatase ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Ecog Performance Status ◽  
Before And After ◽  
Castrate Resistant

181 Background: SipT prolongs OS in asymptomatic or minimally symptomatic CRPC without regularly inducing PSA declines. Elevated CD54 count, CD54 upregulation (UPREG) and total nucleated cells (TNC), markers of immune activation in the product, have been shown to correlate with longer survival. We prospectively collected clinical characteristics and inflammatory markers as part of an audit to identify possible predictors of immune response in patients receiving SipT. Methods: 92 men with CRPC had blood drawn routinely before and after SipT treatment at USC. Circulating tumor cells (CTC), PSA, prostatic acid phosphatase (PAP), albumin (Alb), hemoglobin (Hb), serum alkaline phosphatase (SAP), LDH, C-reactive protein (CRP) and β2-microglobulin (β2m) were evaluated in a reference lab. SipT product parameters, CD54, UPREG and TNC were measured by Dendreon. These datasets were analyzed using Spearman coefficients for continuous variables and the Kruskal-Wallis test for categorical variables. Results: 92 pts who received SipT were included. Median age was 69 (48-90). 43% had Gleason 8-9. 42% had ECOG Performance Status (PS) 0, 44% PS 1, and 13% PS 2. 26% had received prior chemotherapy and 18% had used opioids. 84% had bone mets, 42% had lymphadenopathy, and 12% had visceral mets. Increases in the PSA, PAP, LDH and Alb was directly correlated with increased CD54 counts, increases in the CTC was directly correlated with increased TNC, whereas decrease in SAP was correlated with increased upregulation of dendritic cells. Conclusions: Our results show that increased tumor markers immediately after treatment are more common in high CD54 product pts. This may represent a “flare” due to immune activation. [Table: see text]

scholarly journals Levels of Symptom Burden During Chemotherapy for Advanced Lung Cancer: Differences Between Public Hospitals and a Tertiary Cancer Center

2011 ◽  
Vol 29 (21) ◽  
pp. 2859-2865 ◽  
Author(s):  
Charles S. Cleeland ◽  
Tito R. Mendoza ◽  
Xin Shelley Wang ◽  
Jeanie F. Woodruff ◽  
Guadalupe R. Palos ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Symptom Severity ◽  
Performance Status ◽  
Symptom Burden ◽  
Public Hospitals ◽  
Medically Underserved ◽  
Advanced Lung Cancer ◽  
Cancer Center ◽  
Symptom Group ◽  
Tertiary Cancer Center

Purpose We compared risk factors for high disease- and treatment-related symptom burden over 15 weeks of therapy in medically underserved patients with advanced non–small-cell lung cancer and in patients treated at a tertiary cancer center. Patients and Methods We monitored symptom severity weekly during chemotherapy. Patients were recruited from a tertiary cancer center (n=101) and three public hospitals treating the medically underserved (n=80). We used a composite symptom-severity score and group-based trajectory analysis to form two groups: one with consistently more severe symptoms and another with less severe symptoms. We examined predictors of group membership. Results Seventy percent of the sample (n=126) reported low symptom-severity levels that decreased during therapy; 30% (n=55) had consistently severe symptoms throughout the study. In multivariate analysis, patients with good performance status being treated in public hospitals were significantly more likely than patients treated at the tertiary cancer center to be in the high-symptom group (odds ratio, 5.6; 95% CI, 2.1 to 14.6; P =.001) and to report significantly higher symptom interference (P =.001). Other univariate predictors of high-symptom group membership included variables associated with being medically underserved (eg, having less education, being single, and being nonwhite). No group differences by ethnicity were observed in the public hospitals. Medically underserved patients were less likely to receive adequate pain management. Conclusion Patients with advanced lung cancer and good performance status treated at public hospitals were more likely than those treated at a tertiary cancer center to experience substantial symptoms during chemotherapy.

scholarly journals Impact of free newborn care service package on out of pocket expenditure‐evidence from a multicentric study in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Avinash K Sunny ◽  
Omkar Basnet ◽  
Ankit Acharya ◽  
Prajwal Poudel ◽  
Mats Malqvist ◽  
...  
Keyword(s):  
Care Service ◽  
Newborn Care ◽  
Public Hospitals ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Health Coverage ◽  
Post Intervention ◽  
Multicentric Study ◽  
Sick Newborn ◽  
The Cost

Abstract Background Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17 % of mothers paid for sick newborn care while after implementation 15.3 % mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented. Conclusions We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal. Trial registration ISRCTN- 30829654, Registered on May 02, 2017.

scholarly journals The Investigation of EGFR mutation and ALK gene rearrangement rates in lung adenocarcinoma patients in Mardin

2019 ◽  
Vol 6 (11) ◽  
pp. 292-294
Author(s):  
Aydın Aytekin
Keyword(s):  
Lung Cancer ◽  
Lung Adenocarcinoma ◽  
State Hospital ◽  
Egfr Mutation ◽  
Genetic Alterations ◽  
Mutation Rates ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Alk Rearrangement ◽  
Anaplastic Lymphoma

Objective: Non-Small Cell Lung Cancer (NSCLC) is a heterogeneous group of tumors comprising different histologic subtypes and genetic mutations. Important mutations are EGFR (Epidermal Growth Factor Receptor), ALK (Anaplastic Lymphoma Kinase) rearrangement and ROS 1 rearrangement. This study aimed to determine the mutation rates of lung adenocarcinoma patients admitted to Mardin State Hospital Oncology clinic and to review the literature on the term mutually exclusivity. Materials and Methods: The records of patients admitted to Mardin State Hospital Medical Oncology Clinic between 2014-2018 were retrospectively analyzed. The descriptive statistics for continuous variables mean/median; for categorical variables, frequency (n) and percentage (%) were shown. Results: There were 39 lung adenocarcinoma patients (30.2%) among 130 lung cancer patients. The median age of female patients was 49.31 (27-74), while the median age of male patients was 58.87 (43-78). There were 6 EGFR mutant (15.4%) patients and 2 (5.1%) patients with ALK rearrangement. There were no ROS-1 positive patients. Conclusion: This study indicates that EGFR mutation rates may be very low in Turkey compared to the literature and ALK rates may be close to the literature. To determine the actual mutation rates and factors affecting genetic alterations in Turkey, there are needed to further studies.

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