scholarly journals Low Vitamin C Status in Patients with Cancer Is Associated with Patient and Tumor Characteristics

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2338 ◽  
Author(s):  
Rebecca White ◽  
Maria Nonis ◽  
John F. Pearson ◽  
Eleanor Burgess ◽  
Helen R. Morrin ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Vitamin C ◽  
Human Health ◽  
Cancer Patients ◽  
Vital Role ◽  
Tumor Characteristics ◽  
Patients With Cancer ◽  
Plasma Ascorbate ◽  
Number Of Patients ◽  
Low Levels

Vitamin C (ascorbate) acts as an antioxidant and enzyme cofactor, and plays a vital role in human health. Vitamin C status can be affected by illness, with low levels being associated with disease due to accelerated turnover. However, robust data on the ascorbate status of patients with cancer are sparse. This study aimed to accurately measure ascorbate concentrations in plasma from patients with cancer, and determine associations with patient or tumor characteristics. We recruited 150 fasting patients with cancer (of 199 total recruited) from two cohorts, either prior to cancer surgery or during cancer chemo- or immunotherapy. A significant number of patients with cancer had inadequate plasma ascorbate concentrations. Low plasma status was more prevalent in patients undergoing cancer therapy. Ascorbate status was higher in women than in men, and exercising patients had higher levels than sedentary patients. Our study may prompt increased vigilance of ascorbate status in cancer patients.

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

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)

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

BMC Cancer ◽  
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.

Gene Expression Patterns Identify Patients with Non-Small Cell Lung Cancer (NSCLC) and Ovarian Cancer Who Are at Increased Risk for Venous Thromboembolism (VTE).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1470-1470
Author(s):  
Veshana S. Ramiah ◽  
Anil Potti ◽  
Rebecca Peterson ◽  
David Harpole ◽  
Andrew Berchuck ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ovarian Cancer ◽  
At Risk ◽  
Cancer Patients ◽  
Thrombotic Risk ◽  
Gene Set ◽  
Patients With Cancer ◽  
Number Of Patients ◽  
Diagnosis Of Cancer ◽  
Discriminator Gene

Abstract Background: VTE is the leading cause of death in patients with cancer. The 1-year survival rate in patients diagnosed with cancer at time of VTE is 12% compared to 36% in cancer patients without thrombosis. Cancer patients who develop VTE have higher mortality during hospitalization and during surgery. VTE in cancer patients portends a poorer prognosis and may indicate a more aggressive phenotype. There are, as yet, no clinical or laboratory parameters that have clinical utility in identifying this important group of patients with cancer who are at risk for developing VTE. Methods: We explored whether gene expression profiling could define phenotype-specific metagenes (aggregate patterns of gene expression) that distinguish cancer patients with and without VTE. The medical history of 95 patients with NSCLC and 37 patients with ovarian cancer was reviewed to identify patients with VTE after the initial diagnosis of cancer but not within 6 weeks of surgery. Separate sets of controls with NSCLC and ovarian cancer, respectively, were identified from the same groups, matched by age, gender and clinical stage, but without VTE for at least 2 years following the diagnosis of cancer. RNA was extracted and gene array data obtained using Affymetrix U133 GeneChips. Gene expression data was analyzed using binary regression methodologies. Results: 13/95 (13.5%) patients with NSCLC and 6/37 (16%) with ovarian cancer had VTE and met inclusion criteria. Using the metagene approach, a discriminator gene set (n=50) that differentiated patients with NSCLC and VTE from patients with NSCLC without VTE was identified. A separate discriminator gene set was identified for the ovarian cancer group. A leave-one-out cross validation performed to validate the reliability of the discriminator metagene set was 85% accurate in identifying patients with NSCLC and VTE. Similar analysis for the ovarian cancer patients was limited by the small number of patients identified. Significant biological differences were seen between the comparison groups in the NSCLC subset, including genes such as P53, VEGFC, E2F4, TFPI and EPHB2. Expression differences in the ovarian subset similarly included P53, but also included genes not seen in the NSCLC group, such as H-ras, Tissue factor and Factor X. Conclusions: Our data suggests that a genomic approach can identify patients with cancer at risk for VTE. In addition, these results also suggest that different tumor types might possess unique expression signatures associated with increased thrombotic risk.

Effectiveness and safety of LMWH treatment in patients with cancer diagnosed with nonhigh-risk venous thromboembolism (VTE): Results of the Turkish observational study (TREBECA).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21656-e21656
Author(s):  
Ersin Ozaslan ◽  
Metin Ozkan ◽  
Irfan Cicin ◽  
Mustafa Benekli ◽  
Murat Kocer ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Observational Study ◽  
Cancer Patients ◽  
Normal Population ◽  
Treatment Protocol ◽  
Low Risk ◽  
Entire Study ◽  
Patients With Cancer ◽  
Primary Endpoints ◽  
Number Of Patients

e21656 Background: Venous thromboembolism (VTE) is one of the most important causes of death in cancer patients, with VTE risk being 4-7 times higher among these patients compared to normal population. TREBECA is an observational study on cancer outpatients with low risk VTE treated with LMWH. Methods: Patients were treated by medical oncologists in Turkey at 15 sites, where they were enrolled and followed-up for a period of 12 months. Each center used their own treatment protocol. Primary endpoints were efficacy and the time to a change inVTE status (dissolution of thrombosis). The doses of LMWHs have been calculated according to patients’ body weights based on the dosage scheme and administered subcutaneously once or twice daily. Results: Data for 250 patients who met the study inclusion criteria were examined and analyzed. Of the included patients; 239 patients (95.6%) completed their Day 15 visit, 176 (70.4%) completed their Month 3 visit, 130 (52.0%) completed their Month 6 visit, and 91 (36.4%) completed the entire study. The mean age of the patients was 60.2 ± 13.7, while 53.2% (n = 133) of the patients were women. Colorectal (21.2%), lung (16.8%) and breast (14.8%) cancers were the most common forms of cancer. One hundred thirty-three patients were treated with enoxaparin, 112 patients were treated with bemiparin and 5 patients were treated with tinzaparin. Bemiparin resulted thrombosis resolution in more patients than enoxaparin, during day 15, month 3 and month 6 visits (table 1; p < 0.05). Conclusions: The observation that bemiparin is more effective in resolution of thrombosis was noteworthy. Thrombosis could not be effectively treated within the first 15 days in a significant number of patients, but could effectively be treated in most patients by Month 3. We can conclude that a treatment of at least 3 months is appropriate for cancer patients, even among those who are at low risk for venous thromboembolism. [Table: see text]

scholarly journals Mammographic density is a potential predictive marker of pathological response after neoadjuvant chemotherapy in breast cancer

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ida Skarping ◽  
Daniel Förnvik ◽  
Hanna Sartor ◽  
Uffe Heide-Jørgensen ◽  
Sophia Zackrisson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Patients ◽  
Mammographic Density ◽  
Clinical Decision Making ◽  
Tumor Characteristics ◽  
Breast Cancer Patients ◽  
Number Of Patients ◽  
Treated Breast ◽  
Treated Breast Cancer

Abstract Background Our aim is to study if mammographic density (MD) prior to neoadjuvant chemotherapy is a predictive factor in accomplishing a pathological complete response (pCR) in neoadjuvant-treated breast cancer patients. Methods Data on all neoadjuvant treated breast cancer patients in Southern Sweden (2005–2016) were retrospectively identified, with patient and tumor characteristics retrieved from their medical charts. Diagnostic mammograms were used to evaluate and score MD as categorized by breast composition with the Breast Imaging-Reporting and Data System (BI-RADS) 5th edition. Logistic regression was used in complete cases to assess the odds ratios (OR) for pCR compared to BI-RADS categories (a vs b-d), adjusting for patient and pre-treatment tumor characteristics. Results A total of 302 patients were included in the study population, of which 57 (18.9%) patients accomplished pCR following neoadjuvant chemotherapy. The number of patients in the BI-RADS category a, b, c, and d were separately 16, 120, 140, and 26, respectively. In comparison to patients with BI-RADS breast composition a, patients with denser breasts had a lower OR of accomplishing pCR: BI-RADS b 0.32 (95%CI 0.07–0.1.5), BI-RADS c 0.30 (95%CI 0.06–1.45), and BI-RADS d 0.06 (95%CI 0.01–0.56). These associations were measured with lower point estimates, but wider confidence interval, in premenopausal patients; OR of accomplishing pCR for BI-RADS d in comparison to BI-RADS a: 0.03 (95%CI 0.00–0.76). Conclusions The likelihood of accomplishing pCR is indicated to be lower in breast cancer patients with higher MD, which need to be analysed in future studies for improved clinical decision-making regarding neoadjuvant treatment.

scholarly journals 1418. Clinical Characteristics of Vertebral Osteomyelitis in Cancer Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S516-S517
Author(s):  
Kazuaki Fukushima ◽  
Masao Horiuchi ◽  
Noritaka Sekiya
Keyword(s):  
Intervertebral Disc ◽  
Cancer Patients ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Vertebral Osteomyelitis ◽  
Lesion Site ◽  
Entry Site ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
Number Of Patients

Abstract Background Vertebral osteomyelitis (VOM) is an infection of vertebrae or intervertebral disc and associated with high mortality, decreased functional status, prolonged antibiotic use and recurrent infection. Although most of the patients with VOM often embody immunodeficiency or other comorbidities, characteristics of VOM in cancer patients remain to be fully elucidated. The aim of this study was to describe clinical profile, underlying disease, lesion site, pathogen, comorbidities, treatment, and outcome in patients with cancer. Methods This study was a retrospective observational study in a tertiary care cancer hospital with 801 beds. All patients with VOM were diagnosed by computed tomography or magnetic resonance imaging from July 2004 to March 2019. Culture-confirmed VOM was defined when causative pathogens were identified from the lesion site including vertebra, intervertebral disc, paravertebral or epidural abscess or when the result of blood culture was positive with compatible clinical symptoms. Data including patient characteristics, underlying diseases, lesion sites, type of infection, entry site of infection, results of bacterial culture, treatment, and outcome were collected by electronic medical records. We analyzed data of patients with culture-confirmed VOM between patients with cancer (C-VOM) and patients without cancer (NC-VOM). Death or re-treatment was the primary outcome. Statistical analysis was performed by STATA Version 15. Results Total number of patients diagnosed with VOM was 101, of which culture-confirmed VOM was 61 (C-VOM: 30 and NC-VOM: 31). Age, lesion sites, pathogen, or comorbidities were not significantly different between two groups (table). On the other hand, the rate of contiguous infection in C-VOM was significantly higher than NC-VOM (20.0 % vs. 0.0 %; P = 0.01). Univariate cox proportional hazard model revealed that cancer was risk of death or re-treatment (HR:3.14, 95% CI:1.07–9.24). Conclusion Poor prognosis and contiguous infection from adjacent infection sites should be concerned cancer patients with culture-confirmed VOM. Disclosures All authors: No reported disclosures.

scholarly journals Complementary and Alternative Medicine application in cancer patients in Iran

2021 ◽  
Author(s):  
Nazi Nejat ◽  
Amir Rahbarian ◽  
Fatemeh Mehrabi ◽  
Fatemeh Rafiei
Keyword(s):  
Medicinal Plants ◽  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Cancer Patients ◽  
Clinical Information ◽  
Care Program ◽  
Diet Therapy ◽  
Patients With Cancer ◽  
Number Of Patients ◽  
Complementary And Alternative

Abstract Purpose Nowadays, complementary and alternative medicine (CAM) is used by cancer patients all over the world. The aim of this study was to investigate the prevalence of CAM use in patients with cancer in Iran. Methods This descriptive-analytical study was conducted on 320 cancer patients in Arak. For gathering information, a researcher-made questionnaire was used. This questionnaire was consisted of two parts: demographic and clinical information; and patient’s attitude toward using complementary and alternative medicine treatments and their effectiveness, as well as how much they used different kinds of these treatments. The data was analyzed using SPSS software version 16. Results Our findings showed that average age of participants was 55.11 ± 15.58. Most of them had leukemia (25.9%) and underwent chemotherapy (55%), and 141 (44.3%) of individuals were using CAM. Majority of patients (73.2%) were using CAM to improve physical conditions, 61.4% were using it simultaneously with conventional medical treatments, and 25% to reduce pain. Participants have reported visiting holy places, yoga, prayer therapy, and using medicinal plants and special diets, respectively. Conclusion considering the high number of patients using CAM treatments, proper planning and implementation to educate professional members of health team, especially doctors and nurses about CAM treatments is essential. The most important CAM treatments to be educated are spiritual therapies, yoga, medicinal plants and diet therapy. Moreover, support and education about using these kinds of treatment, should be considered in the supportive care program for patients with cancer.

Thrombo-Embolism in Patients Receiving Erythropoeitic Stimulating Agents.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4005-4005
Author(s):  
Donald Doll
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Central Catheter ◽  
Label Change ◽  
Patients With Cancer ◽  
Catheter Occlusion ◽  
Time Period ◽  
Number Of Patients ◽  
Increased Risk

Abstract 4005 Poster Board III-941 Background There is an increased risk of thrombo-embolism in patients receiving erythropoeitic stimulating agents (ESAs) in the treatment of anemia due to cancer and chemotherapy as well as in patients with chronic renal failure. This fact coupled with evidence of the negative impact on survival in some patients with cancer has prompted a change in the FDA label and restricted the use of ESAs. The exact incidence of thrombo-embolism etiologically related to ESAs in community cancer practices is not known. In this retrospective study we examined the relationship between the administration of ESAs and thrombo-embolism in patients treated after initiating the more conservative use of such agents based on label change. Methods One-hundred fifty-eight cases of thrombo-embolism and central catheter occlusion observed between August 2007 and May 2009 were identified through the electronic medical records (EMR) database at Gabrail Cancer Center. Likewise, all patients who received ESAs during the same time period were identified through the EMR. Records of all patients were examined to verify diagnosis, confirm data, and validate timing of administration of the ESAs. Results A total of 496 patients received ESAs during the study period. Of these patients, 158 developed thrombo-embolism or central catheter occlusion. There were 128 patients with cancer and 34 had non-cancerous diagnoses with mean age of 62 and M:F of 4:1. Of the 128 patients with cancer 99 patients developed uncomplicated catheter occlusion and 39 developed DVT and/or pulmonary embolism. Seventy-four of the 99 patients who had catheter occlusion had received ESAs (74%). Of the 39 patients who developed DVT and pulmonary embolism 26 were treated with ESAs (67%). Of the 99 patients who developed catheter occlusion 51 (51%) received ESAs prior to catheter occlusion of the 39 patients who had DVT and PE 19 (48%) of the events happened after ESAs were initiated. The total number of patients who received ESAs during the same time period was 496. Only 32% of these patients developed thrombo-embolism and catheter occlusion. However, only 114 patients (23%) experienced a thrombotic episode after ESAs were initiated. This did not differ significantly from the incidence of thrombosis either in the form of catheter occlusion, deep vein thrombosis, or pulmonary embolism in this patient population. Conclusion Although some studies have shown an increased incidence of thromboembolism in cancer patients receiving ESAs, such studies were performed at a time when the use of these agents was more liberal in order to increase the Hb to normal or above normal levels. In this community-based practice study that included patients treated after the label change, the incidence was not greater than that seen in cancer patients not receiving ESAs. However, a prospective clinical trial is needed to confirm these findings especially after the label change that has restricted the use of ESAs. 3(Transmittal 80, Pub 100-03 Medicare National Coverage Decision, eff. 7/30/2007) Disclosures: No relevant conflicts of interest to declare.

scholarly journals Pain and Distress in Cancer Patients

2015 ◽  
Vol 61 (3) ◽  
pp. 213-216
Author(s):  
Burger-Szabo Anna ◽  
Gabos-Grecu Marieta ◽  
Moica Theodor ◽  
Finta Hajnal ◽  
Ferencz Melinda ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cancer Patients ◽  
Emotional Distress ◽  
Pain Treatment ◽  
Psychiatric Treatment ◽  
Clinical Information ◽  
Patients With Cancer ◽  
Distress Score ◽  
Number Of Patients ◽  
Before And After

AbstractBackground: A significant number of patients with cancer suffer from anxiety and depressive disorder. Perceived emotional distress, anxiety and depressive symptoms are significantly more frequent in cancer patients with pain than in patients without pain. Despite their high prevalence cancer pain and distress are frequently undertreated.Material and method: Thirty two oncology patients were included in the study who were receiving concurrent oncologic and pain treatment in the Oncology Clinic TgMures. Patient demographic and clinical information was obtained from medical records and patient report. Patients were screened for pain scores using the Visual Analog Scale and distress scores, using the Distress Thermometer.Results: The gender proportion of the sample is: 38% female, 62% male. More than 75% of the sample was over 50 years of age, and more than half of the patients (59.3%) had metastatic disease. Significant decreasing trend were seen for pain score difference before and after the pain treatment was reassessed (dosage increase or conversion) (p<0.0001), and decreasing trend seen for distress score (p<0.0001) also.Conclusions: Pain and distress occurred concomitant in this population. An adequate pain management and pain reassessment contributes to improve the cancer patient emotional distress score, anxiety and depressive symptoms. An accurate screening instrument can facilitate the recognition of patients who needs further assessment and psychiatric treatment.

Treatment and secondary prevention of venous thromboembolism in cancer patients

2012 ◽  
Vol 03 (03) ◽  
pp. 121-125
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Patients With Cancer ◽  
Potential Use

SummaryCancer is a major and independent risk factor of venous thromboembolism (VTE). In clinical practice, a high number of VTE events occurs in patients with cancer, and treatment of cancerassociated VTE differs in several aspects from treatment of VTE in the general population. However, treatment in cancer patients remains a major challenge, as the risk of recurrence of VTE as well as the risk of major bleeding during anticoagulation is substantially higher in patients with cancer than in those without cancer. In several clinical trials, different anticoagulants and regimens have been investigated for treatment of acute VTE and secondary prophylaxis in cancer patients to prevent recurrence. Based on the results of these trials, anticoagulant therapy with low-molecular-weight heparins (LMWH) has become the treatment of choice in cancer patients with acute VTE in the initial period and for extended and long-term anticoagulation for 3-6 months. New oral anticoagulants directly inhibiting thrombin or factor Xa, have been developed in the past decade and studied in large phase III clinical trials. Results from currently completed trials are promising and indicate their potential use for treatment of VTE. However, the role of the new oral thrombin and factor Xa inhibitors for VTE treatment in cancer patients still has to be clarified in further studies specifically focusing on cancer-associated VTE. This brief review will summarize the current strategies of initial and long-term VTE treatment in patients with cancer and discuss the potential use of the new oral anticoagulants.

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