scholarly journals Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 618 ◽  
Author(s):  
Dominique Farge ◽  
Barbara Bournet ◽  
Thierry Conroy ◽  
Eric Vicaut ◽  
Janusz Rak ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Practice ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Randomized Trials ◽  
Treatment Options ◽  
Locally Advanced ◽  
Ductal Adenocarcinoma ◽  
Recent Advances

Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options.

Transducer array layout optimization for the treatment of pancreatic cancer using Tumor Treating Fields (TTFields) in the phase 3 PANOVA-3 trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15766-e15766
Author(s):  
Ariel Naveh ◽  
Hadas Sara Hershkovich ◽  
Eilon David Kirson ◽  
Uri Weinberg ◽  
Zeev Bomzon
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Practice ◽  
Electric Fields ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Intermediate Frequency ◽  
The Body ◽  
Phase 3

e15766 Background: TTFields is an antimitotic cancer treatment that utilizes low intensity (1-3 V/cm) alternating electric fields in the intermediate frequency (100-300 kHz), which are delivered in two orthogonal directions using 2 pairs of transducer arrays. Based on favorable results in a Phase 2 study in locally-advanced pancreatic cancer (LAPC), an ongoing Phase 3 PANOVA-3 trial [NCT03377491] is investigating the efficacy of adding TTFields to nab-paclitaxel and gemcitabine in LAPC. Preclinical studies show that the effect of TTFields is intensity-dependent with a therapeutic threshold of 1 V/cm. The field distribution within the body is known to changes with array placement. The current study was designed to develop clinical practice guidelines for optimizing the layout of arrays applied to patients participating in the TTFields arm of the PANOVA-3 study. Methods: Three realistic computerized models of a male, a female and an obese male were used to simulate delivery of TTFields to the abdomen. For each model, 6-8 different layouts utilizing combinations of arrays with either 13 or 20 disks per-array were tested. The arrays were placed over the upper 6 standard abdominopelvic regions, and field intensity distributions within these regions were evaluated. Results: In all simulations, the large arrays generated higher field intensities than the smaller arrays. However, models with lower BMI were almost covered entirely using large arrays, increasing the potential of skin toxicity from TTFields. However, these Low BMI models were able to receive TTFields at an anti-mitotic intensity with smaller arrays. The clinical guidelines were formulated based on the following principles: the target tumor region should be directly between the arrays, (b) the extent of disease as well as the anatomy of the patient determines the size of arrays determined using waist circumference measurements. Conclusions: A matrix for selecting between 8 individual array layouts was generated based on these principles. The clinical practice guidelines allow the optimization of TTFields delivery to individual patients treated in the PANOVA-3 Study.

Clinical practice guidelines for prophylaxis of venous thomboembolism in cancer patients

2016 ◽  
Vol 116 (10) ◽  
pp. 618-625 ◽  
Author(s):  
Corinne Frere ◽  
Dominique Farge
Keyword(s):  
Clinical Practice ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Locally Advanced ◽  
Mobile App ◽  
Medical Illness ◽  
Risk Assessment Models ◽  
Implementation And Dissemination ◽  
Lower Mobility

SummarySymptomatic venous thromboembolism (VTE) occurs 4-7 times more frequently in cancer patients as compared to non-cancer patients. A significant number of risk factors, which can be subcategorised as patient-, cancer- or treatment-related, have been shown to influence the risk of VTE during malignancy and further incorporated in risk-assessment models. Safe and efficient thromboprophylaxis regimens allow substantial decreased in VTE rates, since VTE is most often a largely preventable disease, but thromboprophylaxis remains underused in cancer compared to non-cancer patients. If thromboprophylaxis is warranted in cancer patients undergoing surgery or hospitalised for acute medical illness or with a lower mobility in the absence of contraindications to anticoagulants, its benefit remains controversial in outpatients and may be limited to locally advanced or metastatic pancreatic or lung cancer treated with chemotherapy. The International Initiative on Thrombosis and Cancer-CME free mobile app (ios and android), based on the International Clinical Practice Guidelines (CPG), facilitates their implementation and dissemination of knowledge worldwide so as to improve VTE treatment and prophylaxis in cancer patients.

scholarly journals Clinical Practice Guidelines for Cryosurgery of Pancreatic Cancer

Pancreas ◽  
2017 ◽  
Vol 46 (8) ◽  
pp. 967-972 ◽  
Author(s):  
Lihua He ◽  
Lizhi Niu ◽  
Nikolai N. Korpan ◽  
Sajio Sumida ◽  
Yueyong Xiao ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines

Distress Management

2007 ◽  
Vol 5 (1) ◽  
pp. 66 ◽  
Author(s):  
_ _
Keyword(s):  
Clinical Practice ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cancer Care ◽  
Diagnosis And Treatment ◽  
Ambulatory Setting ◽  
Waiting Room ◽  
Patients Experience ◽  
Recent Version

All patients experience some level of distress at various stages of the diagnosis and treatment of cancer. Physicians' ability to recognize patients' distress has become more challenging as cancer care has shifted to the ambulatory setting, where visits are often short and rushed. Therefore, using clinical practice guidelines for managing psychosocial distress in cancer patients is critical. These guidelines recommend that each new patient be rapidly assessed in the office or clinic waiting room for evidence of distress. For the most recent version of the guidelines, please visit NCCN.org

Adult Cancer Pain

2007 ◽  
Vol 5 (8) ◽  
pp. 824
Author(s):  
_ _
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Cancer Pain ◽  
National Comprehensive Cancer Network ◽  
Cancer Patients ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cancer Network ◽  
Recent Version

Pain is one of the most common symptoms associated with cancer and one of the symptoms patients fear most; unrelieved pain denies them comfort and greatly affects their activities, motivation, interactions with family and friends, and overall quality of life. The importance of relieving pain and availability of effective therapies make it imperative that clinicians caring for cancer patients to be adept at assessing and treating cancer pain. The National Comprehensive Cancer Network Adult Cancer Pain Clinical Practice Guidelines in Oncology acknowledge the range of complex decisions faced in caring for these patients. As a result, they provide dosing guidelines for NSAIDs, opioids, and adjuvant analgesics. They also provide specific suggestions for escalating opioid dosage, managing opioid toxicity, and when and how to proceed to other techniques to manage cancer pain. For the most recent version of the guidelines, please visit NCCN.org

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