Awareness of Cancer-Related Malnutrition and Its Management: Analysis of the Results From a Survey Conducted Among Medical Oncologists

Cancer is a global major public health problem, particularly in Western countries, where it represents the second leading cause of death after cardiovascular disease. Malnutrition is common in cancer patients and differs from starvation-related malnutrition, as it results from a combination of anorexia and metabolic dysregulation, caused by the tumor itself or by its treatment, and causing cachexia. Cancer-associated malnutrition can lead to several negative consequences, including poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatments, and diminished response to antineoplastic drugs. Guidelines issued by the Ministry of Health in 2017, the most recent ESPEN guidelines and the PreMiO study highlighted an inadequate nutritional support in cancer patients since their first visit, and recommended an optimization of the quality of life of cancer patients in each stage of the disease, also through specific nutritional interventions by multidisciplinary teams. Based on the evidences summarized above, a survey has been carried out on a sample of 300 Italian hospital medical oncologists to evaluate their level of awareness and perception of cancer-related malnutrition and their proposals to implement effective strategies to improve nutritional care in the setting of hospital oncology departments in Italy. The survey results indicate that, despite high levels of awareness among Italian oncologists, malnutrition in cancer patients remains, at least in part, an unmet medical need, and additional efforts are necessary in terms of increased training and hiring of personnel, and of creation of organizational pathways aimed at treatment optimization based on available evidences.

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Dark or Bright Half of the Moon: A Qualitative Study Exploring the Experience of Iranian Heart Failure Patients Regarding their Quality of Life

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.189 ◽

2019 ◽

Vol 7 (5) ◽

pp. 824-830 ◽

Cited By ~ 2

Author(s):

Mahdi Moshki ◽

Abdoljavad Khajavi ◽

Haydeh Hashemizadeh ◽

Farveh Vakilian ◽

Shima Minaee ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Functional Limitations ◽

Public Health Problem ◽

Study Data ◽

Major Public Health Problem ◽

Negative Consequences ◽

Framework Analysis ◽

Positive Effects

BACKGROUND: Heart failure (HF) is a major public health problem in different societies and has numerous impacts on quality of life (QOL). AIM: The present study was carried out with the aim to explore the experience of HF patients regarding the negative effects of the disease on their QOL. METHODS: In this qualitative exploratory study data collection was performed through face-to-face, semi-structured, in-depth interviews with 19 patients with HF, who were selected through purposive sampling method from April to September 2017. Data analysis was carried out based on the framework analysis method. RESULTS: The negative consequences of HF on QOL emerged in the form of 6 main themes including symptoms, disease complications, cognitive impairment, psychological distress, functional limitations and economic problems. Most of the participants (14 out of 19) assessed their QOL as well or very well. CONCLUSION: The majority of the patients in this study, despite the many negative impacts of HF, had a high QOL that could indicate their satisfaction and effective coping with HF by creating a positive outlook and the perceived positive effects of the disease.

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A Life Course Approach to the Prevention of Iron Deficiency Anemia in Indonesia

Nutrients ◽

10.3390/nu14020277 ◽

2022 ◽

Vol 14 (2) ◽

pp. 277

Author(s):

Ali Sungkar ◽

Saptawati Bardosono ◽

Rima Irwinda ◽

Nurul R. M. Manikam ◽

Rini Sekartini ◽

...

Keyword(s):

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Life Stage ◽

Public Health Problem ◽

Nutritional Intervention ◽

Deficiency Anemia ◽

Clinical Psychologist ◽

Major Public Health Problem ◽

Nutritional Interventions ◽

Long Term Impact

Iron deficiency anemia (IDA) has a long-term impact on each life stage and remains worldwide a major public health problem. Eleven experts were invited to participate in a virtual meeting to discuss the present situation and the available intervention to prevent iron deficiency anemia in Indonesia. The experts consisted of obstetric gynecologists, pediatricians, nutritionists, midwives, a clinical psychologist, and an education expert. Existing interventions focus attention on preconception and early childhood stages. Considering the inter-generational effects of IDA, we call attention to expanding strategies to all life stages through integrating political, educational, and nutritional interventions. The experts agreed that health education and nutritional intervention should be started since adolescence. Further research to explore the effectiveness of these interventions would be important for many regions in the world. The outcome of this Indonesian consensus is applicable worldwide.

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Capturing discrete complete staging elements in EPIC for new and progressing breast (B) and prostate (P) cancer patients: A quality training program pilot.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.117 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 117-117

Author(s):

Linda D. Bosserman ◽

Denise Morse ◽

Kathleen McNeese ◽

Ridaa Atcha ◽

Niki Himat Patel

Keyword(s):

Cancer Patients ◽

Clinical Decision Making ◽

Clinical Decision ◽

Discrete Elements ◽

Quality Metric ◽

Clinical Notes ◽

Leadership Support ◽

Medical Oncologists ◽

Abstract Data ◽

Survey Results

117 Background: Staging is a fundamental quality metric. Entry of discrete elements of staging in the EHR supports & improves efficiencies for clinical notes, therapy summaries, survivorship plans, clinical decision making, pathway use, timely authorizations, clinical trial eligibility evaluations, as well as clinical, financial & quality outcomes. Staging of all new & progressing patients in our EPIC EHR was set as a priority in 2018 but baseline entry through 2018 was below target goals. Methods: A Staging QTP project group was formed & participated in the COH-ASCO QTP Fall training. Baseline capture of staging data in EPIC for campus and community (enterprise) sites for Breast (B) & Prostate (P) patients was collected. QTP processes were used to develop and implement a 12-week pilot with PDSA cycles at weeks 8 and 12. B & P cancer patients seen by 3 B & 2 P medical oncologists (MO), 5B surgeons (S) & 3P urologists (U) agreed to participate in a pilot study. Disease leads determined the elements of complete staging: 9-10 for B & 8 for P. Training was done for all campus APPs & for doctors in the pilot. Follow up by the QTP team was done at clinics during the pilot. Reports were built to capture specific staging elements for B & P patients by doctor. Reports were sent out starting week 9 indicating patients without complete staging with missing elements. A survey about the process was done by participant MDs & APPS weeks 8 & 12. Results: Baseline enterprise wide complete staging in Epic was 6% for B cancer & 3% for P cancer. 6 week PDSA showed capture of complete staging for B-MO & S was 20% and for P-MO & U was 12%. QTP Pilot ends 6/19 & abstract data will be updated for the staging & survey results. Additional results on complete staging for progressing patients is being captured. Conclusions: Complete staging in the EHR requires definition, training, resourcing, leadership support and feedback. Initial results show all new patients had initial staging data entered and complete staging rates increased significantly for new B & P cancer patients before weekly feedback was sent. Analysis of survey results will inform future PDSA cycles & plans for complete staging enterprise wide.

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The Long Noncoding RNA MEG3 Is Downregulated and Inversely Associated with VEGF Levels in Osteoarthritis

BioMed Research International ◽

10.1155/2015/356893 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 61

Author(s):

Wei Su ◽

Wen Xie ◽

Qingkun Shang ◽

Bing Su

Keyword(s):

Noncoding Rna ◽

Public Health Problem ◽

Major Public Health Problem ◽

Rt Pcr ◽

Average Life Expectancy ◽

Vegf Mrna ◽

Normal Cartilage ◽

Effective Strategies ◽

Inhibition Of Angiogenesis ◽

Bone And Cartilage Development

Osteoarthritis (OA) is becoming a major public health problem in China, especially considering the increase in average life expectancy of the population. Thus, enhanced understanding of the molecular changes associated with OA is urgently needed to develop more effective strategies for the diagnosis and treatment of this debilitating disease. LncRNAs play an important role in the processes of bone and cartilage development. Maternally expressed gene 3 (MEG3) is a maternally expressed lncRNA and may function as a tumor suppressor by inhibiting angiogenesis. OA is closely associated with angiogenesis and the inhibition of angiogenesis presents a novel therapeutic approach to reduce inflammation and pain in OA. In this study, we detected the mRNA expression of MEG3 and VEGF in articular cartilage samples from 20 OA patients and 10 healthy volunteers by real-time RT-PCR. VEGF protein is detected by ELISA in cartilage samples. The results show that human MEG3 is significantly downregulated in OA patients compared to normal cartilage samples. However, higher levels of VEGF mRNA and protein are found in OA compared to the control. Moreover, MEG3 levels are inversely associated with VEGF levels, suggesting that MEG3 may be involved in OA development through the regulation of angiogenesis.

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PP553 Study On The Utilization Of Medical Resources In Patients With Malignant Tumors in China

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320002007 ◽

2020 ◽

Vol 36 (S1) ◽

pp. 42-42

Author(s):

Yuehua Liu ◽

Tiantian Du ◽

Fan Zhang ◽

Kun Zhao

Keyword(s):

Cancer Patients ◽

Treatment Period ◽

Malignant Tumors ◽

Public Health Problem ◽

Medical Expenditure ◽

Utilization Efficiency ◽

Major Public Health Problem ◽

Medical Resource ◽

Medical Resources ◽

End Stage

IntroductionMalignant tumors have become a major public health problem and their treatment cost is increasing rapidly in China, but treatment aimed at healing diseases or extending patients’ life. There is little empirical research on utilization of healthcare resources of terminally ill cancer patients. In order to explore the optimal treatment decision for patients and provide information for relevant decision makers, this study analyzed the consumption status of medical resources in patients with cancer during the whole treatment period, and the current medical resource utilization efficiency in different levels of hospital for end-stage cancer patients.MethodsThis study was based on the clinical treatment and payment data of 2,536 cases of patients with lung cancer from the medical insurance database during the period of 2007 to 2014 in Hubei province. We retrospectively analyzed patients’ medical expenditure and utilization of different medical resources during their whole treatment period as well as at the end stage.ResultsThe per capita inpatient expenditures of patients under 50 years old was 193,000 CNY (27,451 USD), while that of the patients over 70 years were 80,000–90,000 CNY (11,379–12,802 USD). Secondly, the medical expenditures spent during the last 6 months of life accounted for 66.1 percent of the total expenditures. Lastly, the medical expenditure spent in tertiary hospitals accounted for 95.3 percent of the total expenditure, and the expenditure was 14,200 ± 17,030 CNY (2,019.82 ± 2,422.36 USD) per visit.ConclusionsPopulation aging is not the only factor causing the rise of medical expenditure. The unclear objectives of treatment and the reverse of medical resource allocation are also important factors to boost the growth of medical expenditure. It is necessary to improve the healthcare insurance payment system, strengthen the capacity of primary medical institutions, and develop the palliative care system in China.

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Ruxolitinib for Severe COVID-19-Related Hyperinflammation in Nonresponders to Steroids

Acta Haematologica ◽

10.1159/000516464 ◽

2021 ◽

pp. 1-7

Author(s):

Mauricio Sarmiento ◽

Patricio Rojas ◽

Joaquin Jerez ◽

Pablo Bertín ◽

James Campbell ◽

...

Keyword(s):

Respiratory Failure ◽

Severe Disease ◽

Public Health Problem ◽

Early Discharge ◽

Complete Regression ◽

Major Public Health Problem ◽

Severe Respiratory Failure ◽

Effective Strategies ◽

Previously Treated ◽

Slow Evolution

Introduction: Currently, severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is a major public health problem worldwide. Although most patients present a mild infection, effective strategies are required for patients who develop the severe disease. Anti-inflammatory treatment with JAK inhibitors has been considered in SARS-CoV-2. Methods: In this study, we presented our experience in a group of severe SARS-CoV-2 Chilean patients. This prospective study was performed on consecutive patients presenting severe respiratory failure owing to COVID-19 or high-risk clinical condition associated with SARS-CoV-2, and who were treated with ruxolitinib for management of associated inflammation. Overall, 18 patients presenting SARS-CoV-2 viral-induced hyperinflammation were treated with ruxolitinib, with 16 patients previously treated with steroids, 4 with tocilizumab, and 3 with both treatments. Results: Ten patients evolved with favorable response, including 7 patients admitted with severe respiratory failure (PaFi less than 200 mm Hg in high-flow nasal cannula), presenting complete regression of hyperinflammation, regression of the lung lesions, and subsequent discharge. In the remaining 8 patients, 25% showed reduced inflammation, but early discharge was not achieved owing to the slow evolution of respiratory failure. Unfortunately, 3 patients demonstrated a severe respiratory failure. The early initiation of ruxolitinib was found to be associated with better clinical evolution (p < 0.005). Conclusion: In this study, ruxolitinib resolved hyperinflammatory state in 55% of the patients, regardless of the previous steroid or tocilizumab therapy. Unfortunately, few patients demonstrated severe evolution despite ruxolitinib therapy. Notably, the treatment starting time appears to play an important role in achieving good outcomes. Further validation in randomized controlled trials is crucial.

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Anaemia among Pregnant Women Attending Antenatal Care in Kyenjojo and Kole Districts in Uganda: Prevalence and Associated Factors

TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH ◽

10.21522/tijph.2013.09.04.art011 ◽

2021 ◽

Vol 9 (4) ◽

pp. 119-129

Author(s):

James Ssekitooleko

Keyword(s):

Pregnant Women ◽

Associated Factors ◽

Haemoglobin Concentration ◽

Public Health Problem ◽

Cross Sectional Study ◽

High Morbidity ◽

Major Public Health Problem ◽

Negative Consequences ◽

Chi Square ◽

Cross Sectional

Anemia during pregnancy is a major public health problem, with a global prevalence of 41.8%. It is associated with high morbidity and mortality. Information on the prevalence of anemia and associated factors among pregnant women in the study area is limited. This study aimed at determining the prevalence and predictors of anemia among pregnant women attending antenatal clinics (ANC) in Kyenjojo and Kole Districts, Uganda. Cross-sectional study was conducted among randomly selected pregnant women. Quantitative data was collected using a structured questionnaire that captured demographic and obstetric characteristics. Haemoglobin concentration (Hb) was determined using HemoCue 201+. The study outcome was the prevalence of anaemia (Hb <11 g/dl). Chi-square, odds ratio, and logistic regression were used to test for associations. Of the total 760 pregnant women who participated in this study, 20.1% were anaemic. The prevalence varied from 13.4% in Kyenjojo to 26.9% in Kole District. Of 153 anaemic women, 121 (97%) were mildly anaemic, 27 (18%) moderately anemic, and 5(3%) severely anemic. Malaria infection [AOR: 0.46, 95% CI (0.26 – 0.83)], primigravida [AOR: 0.52, 95% CI: 0.29-0.93], and residing in Kole [AOR: 0.50, 95% CI: 0.32-0.76] were significant predictors of low haemoglobin concentration. This study highlighted the high prevalence of anaemia in our settings and the significant association between anaemia and malaria among pregnant women. Therefore, routine screening of pregnant women for anemia, malaria, and other risk factors during their first ANC visit is recommended to identify those at risk and prompt management provided to curb their negative consequences.

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Pathway-Based Drug-Repurposing Schemes in Cancer: The Role of Translational Bioinformatics

Frontiers in Oncology ◽

10.3389/fonc.2020.605680 ◽

2021 ◽

Vol 10 ◽

Author(s):

Enrique Hernández-Lemus ◽

Mireya Martínez-García

Keyword(s):

Public Health Problem ◽

Cancer Therapeutics ◽

Response To Therapy ◽

Driver Mutations ◽

Multi Drug Resistance ◽

Multidisciplinary Teams ◽

Major Public Health Problem ◽

Translational Bioinformatics ◽

Driver Genes ◽

Silver Bullet

Cancer is a set of complex pathologies that has been recognized as a major public health problem worldwide for decades. A myriad of therapeutic strategies is indeed available. However, the wide variability in tumor physiology, response to therapy, added to multi-drug resistance poses enormous challenges in clinical oncology. The last years have witnessed a fast-paced development of novel experimental and translational approaches to therapeutics, that supplemented with computational and theoretical advances are opening promising avenues to cope with cancer defiances. At the core of these advances, there is a strong conceptual shift from gene-centric emphasis on driver mutations in specific oncogenes and tumor suppressors—let us call that the silver bullet approach to cancer therapeutics—to a systemic, semi-mechanistic approach based on pathway perturbations and global molecular and physiological regulatory patterns—we will call this the shrapnel approach. The silver bullet approach is still the best one to follow when clonal mutations in driver genes are present in the patient, and when there are targeted therapies to tackle those. Unfortunately, due to the heterogeneous nature of tumors this is not the common case. The wide molecular variability in the mutational level often is reduced to a much smaller set of pathway-based dysfunctions as evidenced by the well-known hallmarks of cancer. In such cases “shrapnel gunshots” may become more effective than “silver bullets”. Here, we will briefly present both approaches and will abound on the discussion on the state of the art of pathway-based therapeutic designs from a translational bioinformatics and computational oncology perspective. Further development of these approaches depends on building collaborative, multidisciplinary teams to resort to the expertise of clinical oncologists, oncological surgeons, and molecular oncologists, but also of cancer cell biologists and pharmacologists, as well as bioinformaticians, computational biologists and data scientists. These teams will be capable of engaging on a cycle of analyzing high-throughput experiments, mining databases, researching on clinical data, validating the findings, and improving clinical outcomes for the benefits of the oncological patients.

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Pain in Gynecological Cancer

BioScientia Medicina ◽

10.32539/bsm.v5i3.322 ◽

2021 ◽

Vol 5 (3) ◽

pp. 580-598

Author(s):

Patiyus Agustiansyah ◽

Aidyl Fitrisyah ◽

Sartika Nopradilova

Keyword(s):

Cancer Patients ◽

Pain Control ◽

International Association ◽

Gynecological Cancer ◽

Public Health Problem ◽

Major Public Health Problem ◽

Patients With Cancer ◽

Anticancer Treatment ◽

Prevalence Of Pain ◽

Experience Pain

The International Association for the Study of Pain defines pain as “unpleasant sensory and emotional experiences associated with actual or potential tissue damage.” Pain is common among patients with cancer, with the prevalence of pain being 66.4% in advanced metastatic disease or terminal, 55% during anticancer treatment, 39.3% after curative treatment, and moderate to severe pain were reported in 38.0% of all patients. Pain is one of the most common and dreaded symptoms in cancer sufferers, but the exact number of cancer patients who experience pain is difficult to determine. There are a wide variety of studies in defining pain and the tools they use to measure the complexity of this symptom. Good or complete pain control can be achieved in 80-90% of cancer patients. Nevertheless, despite major advances in pain control, cancer-related pain continues to be a major public health problem globally.

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