scholarly journals Cancer History and Systemic Anti-Cancer Therapy Independently Predict COVID-19 Mortality: A UK Tertiary Hospital Experience

2020 ◽  
Vol 10 ◽  
Author(s):  
Christopher C. T. Sng ◽  
Yien Ning Sophia Wong ◽  
Anjui Wu ◽  
Diego Ottaviani ◽  
Neha Chopra ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Tertiary Hospital ◽  
Solid Cancer ◽  
Cancer History ◽  
Asian Ethnicity ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
South Asian Ethnicity ◽  
History Of ◽  
Second Peak

BackgroundThe COVID-19 pandemic remains a pressing concern to patients with cancer as countries enter the second peak of the pandemic and beyond. It remains unclear whether cancer and its treatment contribute an independent risk for mortality in COVID-19.MethodsWe included patients at a London tertiary hospital with laboratory confirmed SARS-CoV-2 infection. All patients with a history of solid cancer were included. Age- and sex-matched patients without cancer were randomly selected. Patients with hematological malignancies were excluded.ResultsWe identified 94 patients with cancer, matched to 226 patients without cancer. After adjusting for age, ethnicity, and co-morbidities, patients with cancer had increased mortality following COVID-19 (HR 1.57, 95% CI:1.04–2.4, p = 0.03). Increasing age (HR 1.49 every 10 years, 95% CI:1.25–1.8, p < 0.001), South Asian ethnicity (HR 2.92, 95% CI:1.73–4.9, p < 0.001), and cerebrovascular disease (HR 1.93, 95% CI:1.18–3.2, p = 0.008) also predicted mortality. Within the cancer cohort, systemic anti-cancer therapy (SACT) within 60 days of COVID-19 diagnosis was an independent risk factor for mortality (HR 2.30, 95% CI: 1.16–4.6, p = 0.02).ConclusionsAlong with known risk factors, cancer and SACT confer an independent risk for mortality following COVID-19. Further studies are needed to understand the socio-economic influences and pathophysiology of these associations.

scholarly journals Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6085
Author(s):  
Yien Ning Sophia Wong ◽  
Christopher C. T. Sng ◽  
Diego Ottaviani ◽  
Grisma Patel ◽  
Amani Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Treatment ◽  
Mortality Risk ◽  
Metastatic Cancer ◽  
Hospitalized Patients ◽  
Solid Cancer ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
History Of ◽  
University College London

An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.

The complex comorbidities of uninsured cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19054-e19054
Author(s):  
Shreni Shah ◽  
Madeline MacDonald ◽  
Yuanyuan Lu ◽  
Smitha Pabbathi ◽  
Abu-Sayeef Mirza
Keyword(s):  
Chronic Disease ◽  
Cancer Patients ◽  
Chronic Conditions ◽  
Retrospective Chart Review ◽  
Free Clinics ◽  
Uninsured Patients ◽  
Cancer History ◽  
Patients With Cancer ◽  
History Of ◽  
History Of Cancer

e19054 Background: Uninsured patients diagnosed with cancer receive fewer screenings, frequently present with later-stage cancer, and are often unable to access standard-of-care treatment when compared to insured patients. We previously performed a study demonstrating that uninsured patients with cancer histories have higher levels of comorbidity. However, there is limited data on long-term studies describing comorbid chronic conditions among uninsured cancer patients. Here we examine socioeconomic factors and comorbid chronic conditions in uninsured patients with a cancer history over a period of three years. Methods: A retrospective chart review was conducted from 10 free clinics around the Tampa Bay region. Patients with any documented history of cancer who utilized a free clinic between 2016 and 2018 were included. Patients with no documentation of cancer history were excluded. Demographics, chronic disease parameters, and Charlson Comorbidity Index (CCI) scores were extracted and analyzed. Results: Between 2016 – 2018, a total of 17,003 uninsured patients were treated at 10 free clinics. Of these patients, 455 (2.7%) had a documented history of cancer, 9021 (53.1%) had no history of cancer, and 7527 (44.3%) had no documentation of cancer in their charts. Cancer patients were mostly women (305, 67.0%) and the average age was 55.2 years. Patients with cancer had significantly higher CCI scores compared to patients without cancer in 2016 (3.0 [2.0 SD] versus 0.94 [1.2 SD]), 2017 (2.71 [2.38 SD] versus 0.93 [1.26 SD]), and 2018 (3.27 [2.22 SD] versus 1.08 [1.26 SD]), p < 0.001. Patients with a cancer history were also more likely to be current drinkers (16.9% versus 13.0%) or smokers (17.8% versus 11.0%) compared to patients without a history of cancer. Conclusions: The results demonstrate that uninsured cancer patients consistently have higher levels of chronic disease and comorbidity compared to uninsured patients without a cancer diagnosis. This study increases awareness of the disease burden and mortality risk specific to uninsured cancer survivors which could inform free clinics and volunteer providers to better address the needs of this vulnerable population.

scholarly journals Mortality among Cancer Patients within 90 Days of Therapy in a Tertiary Hospital, Tanzania: Is Our Pretherapy Screening Effective?

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Marygoreth J. Changalucha ◽  
Martha F. Mushi ◽  
Rodrick Kabangila ◽  
Vitus Silago ◽  
Beda Likonda ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Medical Center ◽  
Performance Status ◽  
Tertiary Hospital ◽  
Poor Performance Status ◽  
Solid Cancer ◽  
Karnofsky Score ◽  
Bugando Medical ◽  
Days Of Therapy

Background. A high mortality has been reported during the first ninety days of cancer therapy and is more pronounced in patients with febrile neutropenia. The Bugando Medical Center oncology department offers cancer diagnosis and treatment services to the population of the Lake Zone of Tanzania with limited data on the outcome within 90 days of therapy. Here, we report the 90-day mortality and factors associated with it among cancer patients attending the oncology department of the tertiary hospital in Tanzania. Methodology. Enrolled participants underwent baseline physical examinations, and their functional status was assessed using Karnofsky score. On each clinic visit, full blood picture was taken and patients were investigated for infections. Data were entered in the Microsoft Excel, cleaned and coded and then transferred to STATA version 13 for analysis. Results. A total of 102 participants were included in the final analysis. Their median age was 50 years (38-60). The majority of the study participants were females 76 (75%), and 82 (80.4%) had primary school education. The majority of the patients had solid cancer 96 (94.1%). A total of 12 (11.8%) patients died within 90 days of starting therapy. Low hemoglobin level at the start of cancer therapy, Karnofsky score below 80%, and using 5-fluorouracil-containing therapy were statistically significantly found to be associated with mortality within 90 days of therapy among cancer patients. Conclusion. One tenth of cancer patients at Bugando Medical Center do not survive within 90 days of therapy; the mortality is significantly high among anemic patients, with poor performance status, on 5-fluorouracil regimen, and diagnosed with head and neck cancer, necessitating close follow-up of these patients.

Factors Associated with a Longer Time to Access Pediatric Rheumatologists in Canadian Children with Juvenile Idiopathic Arthritis

2010 ◽  
Vol 37 (11) ◽  
pp. 2415-2421 ◽  
Author(s):  
NATALIE J. SHIFF ◽  
LORI B. TUCKER ◽  
JAIME GUZMAN ◽  
KIEM OEN ◽  
RAE S.M. YEUNG ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
South Asian ◽  
Symptom Onset ◽  
Laboratory Evaluation ◽  
Asian Ethnicity ◽  
Factors Associated ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
South Asian Ethnicity ◽  
History Of

Objective.The Research on Arthritis in Canadian Children Emphasizing Outcomes (ReACCh Out) cohort is a prospective inception cohort of patients with newly diagnosed juvenile idiopathic arthritis (JIA) seen in 16 Canadian pediatric rheumatology (PR) centers. We used data from this cohort to explore factors associated with longer time from symptom onset to the first visit to (PR), and with longer time from first visit to a diagnosis of JIA.Methods.We included children enrolled in ReACCh Out within 6 months of JIA diagnosis, for whom the dates of symptom onset and first PR visit were recorded. We used Cox proportional hazard modeling to investigate the effects of history, physical examination, and laboratory evaluation on the interval from JIA symptom onset to first PR assessment.Results.In total, 319 children from the cohort were included. Having a fever (hazard ratio 1.80, 95% CI 1.10, 2.93), any part South Asian ethnicity (HR 1.75, 95% CI 1.04, 2.95), highly educated parents (HR 1.69, 95% CI 1.18, 2.44), and limp (HR 1.55, 95% 1.16, 2.06) were significantly associated with shorter time from symptom onset to first PR assessment, while a history of heel pain or enthesitis (HR 0.61, 95% 0.38, 0.97) was significantly associated with a longer time to first PR visit.Conclusion.Children with a history of a fever, limp, any part South Asian ethnicity, or highly educated parents were more likely to see PR sooner than patients without these features, while children with a history of enthesitis received PR care later than those without enthesitis.

Assessment of Clinical Risk Factors for Symptomatic Venous Thromboembolism in Common Cancers: A VERITY Registry Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3826-3826
Author(s):  
Shankaranarayana Paneesha ◽  
Aidan McManus ◽  
Roopen Arya ◽  
Nicholas Scriven ◽  
Tim Nokes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Family History ◽  
Cancer History ◽  
Patients With Cancer ◽  
Thrombosis Risk ◽  
History Of ◽  
Age And Sex

Abstract The association between venous thromboembolism (VTE) and cancer is well-recognised, but the thrombosis risk factor profile of patients with cancer-associated VTE is poorly characterised; it is unclear if additional risk factors contribute to the risk of thrombosis beyond the cancer itself, or if the risk factor profile is tumour-specific. Our aim was to compare the thrombosis risk factor profiles of cancer patients with or without symptomatic VTE enrolled in VERITY, an ongoing UK prospective VTE registry. The VERITY registry records data on patients with VTE and those in whom the diagnosis of VTE is excluded. Between Jun 05 and Mar 08, 49044 patient entries were made. Individual case data for patients with cancer were extracted. Using available risk factor data, univariate analysis of 9 established risk factors for VTE (medical in-patient history/immobilisation >3 days within last 4 weeks; major surgery in the last 4 weeks; hormonal risk factor; previous history of VTE; family history of VTE; known thrombophilia; intravenous drug abuse; current smoking; and leg paralysis), comparing VTE and non-VTE cancer cases, was performed for the 4 most common cancers using SPSS. To account for the potential impact of age and sex on VTE risk, age-adjusted values were calculated for breast and prostate cancer, and age- and sex-adjusted values for colorectal and lung. A nominal level of 5% statistical significance was assumed. Of 2825 cancer cases, 1382 had an objectively confirmed diagnosis of VTE and in 1443 the diagnosis of VTE was excluded. Breast (n=498), prostate (n=374), colorectal (n=343) and lung cancer (n=275) accounted for 53% of cancer cases. Univariate associations between risk factors and symptomatic VTE were found only for prostate cancer: history of VTE (odds ratio [OR] = 3.48; 95% CI, 2.01, 6.02; p < 0.00001), family history of VTE (OR = 2.56; 95% CI, 1.02, 6.44; p = 0.046), hormonal risk factor (OR = 2.22; 95% CI, 1.00, 4.92; p = 0.049). In colorectal cancer, smoking was less likely in VTE cases (OR = 0.54; 95% CI, 0.34, 0.87; p = 0.012). Adjusting for age (and sex), univariate associations between risk factors and symptomatic VTE were again found only for prostate cancer: history of VTE (OR = 3.23; 95% CI, 1.56, 6.68; p = 0.002), with smoking less likely in age-adjusted VTE cases (OR = 0.50; 95% CI, 0.28, 0.91; p = 0.022). Our analysis of a registry population found few associations between known thrombosis risk factors and symptomatic VTE in patients with common cancers, suggesting these factors impact little on thromboembolic risk in these cancers.

scholarly journals Participation of MicroRNAs in the Treatment of Cancer with Phytochemicals

Molecules ◽  
2020 ◽  
Vol 25 (20) ◽  
pp. 4701 ◽  
Author(s):  
Seung Wan Son ◽  
Han Yeoung Lee ◽  
Sokviseth Moeng ◽  
Hyo Jeong Kuh ◽  
Soo Young Choi ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Health Concern ◽  
Promising Candidate ◽  
Medical Treatments ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
Causes Of Disease ◽  
The Relationship ◽  
Effective Cancer Therapy

Cancer is a global health concern and one of the main causes of disease-related death. Even with considerable progress in investigations on cancer therapy, effective anti-cancer agents and regimens have thus far been insufficient. There has been compelling evidence that natural phytochemicals and their derivatives have potent anti-cancer activities. Plant-based anti-cancer agents, such as etoposide, irinotecan, paclitaxel, and vincristine, are currently being applied in medical treatments for patients with cancer. Further, the efficacy of plenty of phytochemicals has been evaluated to discover a promising candidate for cancer therapy. For developing more effective cancer therapy, it is required to apprehend the molecular mechanism deployed by natural compounds. MicroRNAs (miRNAs) have been realized to play a pivotal role in regulating cellular signaling pathways, affecting the efficacy of therapeutic agents in cancer. This review presents a feature of phytochemicals with anti-cancer activity, focusing mainly on the relationship between phytochemicals and miRNAs, with insights into the role of miRNAs as the mediators and the regulators of anti-cancer effects of phytochemicals.

Rare case of obstetric cholestasis presenting in the first trimester following in vitro fertilisation

2021 ◽  
Vol 14 (7) ◽  
pp. e244254
Author(s):  
Krystal Koh ◽  
Rajeswari Kathirvel ◽  
Manisha Mathur
Keyword(s):  
Rare Case ◽  
First Trimester ◽  
In Vitro Fertilisation ◽  
High Dose ◽  
Third Trimester ◽  
Asian Ethnicity ◽  
The Third ◽  
South Asian Ethnicity ◽  
History Of

Intrahepatic cholestasis of pregnancy (ICP) generally presents in the third trimester with pruritus without a rash, characterised by elevated bile acids, with or without transaminitis and hyperbilirubinaemia. Risk factors include a family history of cholestasis, South Asian ethnicity, multifetal gestation, in vitro fertilisation (IVF) and history of hepatitis or biliary disorders.IVF involves the use of high dose gonadotropin stimulation and human chorionic gonadotropin trigger. High doses of progesterone supplementation are additionally given after embryo transfer. The increase in oestrogen and progesterone levels early on in the pregnancy is a possible explanation for the development of ICP in IVF pregnancies at earlier gestations.We present a rare case of iatrogenic ICP presenting in the first trimester in a pregnancy conceived by IVF. Unlike other cases reported, our patient did not have recurrence of ICP in the third trimester, and also had no history of ICP in her first pregnancy.

A ROLE OF DENDRIMERS IN DRUG DELIVERY FOR CANCER THERAPY

2021 ◽  
pp. 09-16
Author(s):  
KRISHNA KUMAR ◽  
ARPITA SINGH ◽  
AMRESH GUPTA
Keyword(s):  
Drug Delivery ◽  
Cancer Therapy ◽  
Electrostatic Interactions ◽  
Tumor Targeting ◽  
Therapeutic Agents ◽  
Conventional Chemotherapy ◽  
Anti Cancer ◽  
Different Types ◽  
History Of

In the history of nanotechnology, Dendrimers are rolling in as a highly tempting class of drug delivery system for cancer therapy. Dendrimers are the best and smart choice as Nanocarriers to deliver one or more therapeutic agents safely and selectively to cancer cells. Dendrimers that have remarkable properties including membrane interaction, monodispersity, well-defined size, shape and molecular weight, etc. Functional groups that are present in the Dendrimers exterior also permit other chemical moieties that can actively target certain diseases which are now widely used as tumor-targeting strategies. There are three ways by which drugs interact with dendrimers, (a) physical encapsulation, (b) electrostatic interactions, and (c) covalent conjugations. This review represents the advantages of Dendrimers over conventional chemotherapy, toxicity, and its management. The anti-cancer drugs are delivered by using Dendrimers and recent advances in drug delivery by different types of Dendrimers.

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