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Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression-A New Integrative Flowchart for Patient Management.

Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The ma

Corneal Findings in Patients Treated with Belantamab Mafodotin: A Prospective Case Series Focusing on Corneal Nerves.

IntroductionThis prospective case series investigated corneal epithelial and subbasal nerve plexus changes associated with belantamab mafodotin (Belamaf) therapy in patients with refractory/relapsed multiple myeloma using a multimodal imaging approach.MethodsWe included eight patients (mean age 66 ± 10) scheduled for Belamaf who were monitored for at least three treatment cycles. Standard clinical eye exams with Snellen best corrected visual acuity (BCVA) measurements were complemented by epithelial thickness mapping, slit lamp photography, corneal sensitivity testing, and corneal confocal mic

Health status and infections in patients with symptomatic primary and secondary immunoglobulin G (IgG) deficiencies receiving intravenous IgG replacement.

BackgroundThe effects of intravenous immunoglobulin G replacement on perceived health and infection susceptibility of patients suffering from immunoglobulin G (IgG) deficiencies should be evaluated in a prospective analysis.MethodsPatients with symptomatic primary or secondary IgG deficiencies were interviewed prior to the first IgG infusion (t0) and over the course of their treatment (t1 - t6). The respondents rated their current health using a 100 point scale (EQ-5D-5L), ranging from 0 ('worst imaginable health') to 100 ('best imaginable health'). The patients also provided information on th

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… Treatment data and assessments of the oncologists in charge of treatment were linked with the data gained from the interviews. … In most cases, oncologists could not think of ways of optimizing the therapy (95%). …

The State of Cancer Care in the United Arab Emirates in 2022.

Cancer is the third-leading cause of death in the United Arab Emirates (UAE); cancer care in the UAE has evolved dramatically over the last 40 years, from a single center in Al Ain in 1981 to more than 30 cancer centers and clinics across the UAE, with at least four comprehensive cancer centers in the UAE nowadays. Despite the significant progress in medical care, cancer quality control across the UAE is still lacking, with significant variations in cancer care across the cancer centers. Access to clinical trials is still hampered by a lack of expertise and research infrastructure and a small

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… Oncology Manpower in the UAE There are an estimated 100 medical oncologists, radiation oncologists, and malignant hematology physicians in the UAE as of August 2022. Most oncologists are in the Abu Dhabi and Dubai emirates. … The number of local UAE oncologists is around 10–12 (10% of all oncologists in the UAE). Most local UAE oncologists are Canadian- and American-trained physicians, including advanced fellowships from top institutions such as MD Anderson Cancer Centers. …

A retrospective study to evaluate the time burden associated with outpatient red blood transfusions indicated for anemia due to concomitantly administered chemotherapy in cancer patients.

PurposeAnemia in cancer patients can be treated with red blood cell (RBC) transfusions. The patient burden associated with a treatment in terms of total time spent is an important factor to consider when measuring the benefits and challenges of a therapy. This study estimates the time-related patient burden associated with outpatient RBC transfusion.MethodsA retrospective chart review of outpatient cancer patients receiving a RBC transfusion was conducted at 10 US centers. RBC transfusion time was measured as time elapsed from pre- to post-transfusion vital sign assessment and from transfusion

A Patient-Specific Fracture Risk Assessment Tool for Femoral Bone Metastases: Using the Bone Strength (BOS) Score in Clinical Practice.

Patients with femoral metastases are at risk of fracturing bones. It is important to prevent fractures in order to maintain mobility and quality of life. The BOne Strength (BOS) score is based on a computed tomography (CT)-based patient-specific finite element (FE) computer model that objectively calculates bone strength. In this pilot study, the added clinical value of the BOS score towards treatment-related decision making was assessed. In December 2019, the BOS score was implemented in four radiotherapy centers. The BOS scores and fracture risks of individual patients were calculated and re

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… The radiation oncologist estimated the fracture risk as low and requested a BOS score, which also indicated a low fracture risk. The patient was treated with 1 × 8 Gy radiotherapy. … We showed that the BOS score can facilitate a more multidisciplinary fracture risk assessment, as radiation oncologists and orthopedic surgeons together discussed the BOS score and possible treatments. …

Быстрый обзор мер по улучшению ухода за людьми, страдающими множественным склерозом, диабетической ретинопатией и раком легких.

В Соединенных Штатах пациенты, страдающие хроническими заболеваниями, сталкиваются с различиями в показателях здоровья по всему спектру услуг по уходу. Среди пациентов с множественным склерозом, диабетической ретинопатией и раком легких не хватает доказательств, резюмирующих меры по улучшению ухода и сокращению этих различий. Цель этого оперативного обзора литературы заключалась в том, чтобы определить меры, принимаемые пациентами с такими хроническими заболеваниями в целях улучшения состояния здоровья и сокращения неравенства в плане выявления, диагностики, доступа к лечению и специалистам, с

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… Otto, 2021 [ 51 ] | Presence of a companion at a patient care encounter with a medical oncologist | When a companion was present, oncologists provided more patient-centered communication and spent more time with patients. … Oncologists perceived patients to be more active participants and to have more social support. …

Challenge of cancer in the elderly.

Despite the sustained trend of decreasing overall cancer incidence, the number of elderly patients with cancer will considerably increase in the coming years, as the incidence of cancer is elevated 11-fold after the age of 65 years compared to adults up to 65 years. This soon-to-erupt tsunami of elderly patients with cancer requires adequate treatment, for which guidelines and evidence-based data are still scarce, given the longlasting under-representation of elderly patients with cancer in cancer trials. Older adults present not only with the physiological decreases of organ functions related

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… Even in a country with a low-threshold healthcare system, and with one of the highest densities of physicians per population in Europe, this will result in a severe shortage of trained healthcare professionals, for example, not only cancer surgeons, radiation oncologists and medical oncologists, but … For oncologists, treating the tumour is the primary goal of their expertise, and waiting for a significant number of oncologists to acquire, in addition, the holistic expertise of geriatricians to the always rapidly changing field of oncology is highly improbable, and even if an increased number of colleagues …

A systematic review of patient and healthcare professional perceptions of the barriers and facilitators to embedding exercise in the adjuvant cancer treatment pathway.

PurposeEvidence suggests that physical activity and exercise interventions can mitigate cancer treatment side effects. However, an improved understanding of how physical activity/exercise can be embedded within cancer care pathways is needed. We examined what is known about the barriers and facilitators to implementing physical activity/exercise interventions in the adjuvant cancer treatment pathway from a patient and healthcare professional perspective. The protocol was registered a priori with PROSPERO in March 2023.MethodsElectronic databases (CINAHL Plus, MEDLINE, PsycINFO and Cochrane) we

Assessing the reliability and validity of comprehensive score for financial toxicity (COST) among radiation oncology patients in India: a cross-sectional pilot study.

BackgroundBesides physical toxicity, cancer care imposes significant financial distress referred to as financial toxicity (FT). FT has become a growing concern among cancer patients. Researchers have associated FT among cancer patients with clinical outcomes like mortality, poor quality of life and non-adherence. Currently, no reliable tools are available for assessing FT among cancer patients in India. The aim of this pilot study was to test the reliability and validity of the Comprehensive Score for Financial Toxicity (COST) questionnaire among patients undergoing radiotherapy in India.Mater

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… Patient-oncologist cost communication behaviour and cost coping strategies were also assessed during interview process ( Table 6 ). Almost 90% of the patients discussed their financial situation and affordability of radiation therapy and associated tests to their radiation oncologist. … About 90% of the patients talked to attending oncologists regarding their financial hardships. …

What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study.

OBJECTIVES: The objective of this study was to investigate the use of, and predictors for, pharmaceutical anticancer treatment (PACT) towards the end of a patient's life in a country with a public healthcare system. DESIGN: Retrospective registry study. SETTING: Secondary care in Norway. PARTICIPANTS: All Norwegian patients with cancer (International Classification of Diseases tenth revision (ICD-10) codes C00-99, D00-09, D37-48) in contact with a somatic hospital in Norway between 2009 and 2017 (N=420 655). Analyses were performed on a subsample of decedents with follow-back time of more t

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… Whether oncologists should prescribe PACT near the end of life raises controversial ethical issues concerning the potential prolongation of life, quality of life for patient and their families, and the use of scarce healthcare resources. … Having a public healthcare system, where oncologist have no financial incentive to prescribe, may explain the lower rates in Norway. Additionally, due to strict priority setting for pharmaceuticals, not all new treatment options are available to Norwegian patients. …

An inpatient Serious Illness Care Program for older patients with hematologic malignancies: a single-arm pilot study.

AbstractThe Serious Illness Care Program (SICP) is an evidence-based intervention designed to systemically implement serious illness conversations (SICs) into clinical practice. We previously piloted the SICP via telehealth for patients in the ambulatory setting. However, many patients with hematologic malignancies experience frequent hospitalizations, providing a key opportunity to conduct SICs in the inpatient setting. The purpose of this study was to assess the feasibility of an inpatient SICP and describe completion of advance directives and SIC documentation after SICP implementation. Thi

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… APP-initiated SICs can enhance patients' understanding of their values and increase the completion of advance directives. 18 Despite their brief relationships with hospitalized patients, APPs and hematology-oncology fellows may offer particular benefits in conducting SICs compared with the patients' primary oncologists … The primary outpatient oncologist for the patient provided permission to approach. The primary inpatient oncologist for the patient and the APP/fellow teams were notified of patient eligibility and that approach for consent would take place. …

Management of cytotoxic chemotherapy in patients undergoing dialysis: a still unresolved issue of onconephrology.

The incidence of tumors increases significantly in individuals with chronic kidney disease (CKD), particularly among those undergoing dialysis. This dialysis-associated condition not only impacts therapy but also influences the prognosis of oncological patients, contributing to heightened mortality rates related to both cancer and non-cancer causes. Importantly, it stands as a primary factor leading to suboptimal utilization of therapies. Dosage adjustment for many types of chemotherapy is a necessity in patients with kidney impairment. However, due to a lack of comprehensive knowledge about t

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… For these patient categories, a multidisciplinary approach involving nephrologists, oncologists/hematologists, and pharmacologists is recommended. … Many patients on dialysis are often denied appropriate treatment due to an already mentioned nihilistic attitude, not only among oncologists but also, regrettably, among nephrologists. …

A review of recently published radiotherapy treatment guidelines for bone metastases: Contrasts or convergence?

Bone metastases are a common manifestation of malignancy, and external beam radiotherapy (EBRT) effectively and safely palliates the pain caused by this clinical circumstance. The myriad of EBRT dosing schemes and complexities involved with coordinating radiotherapy with other interventions necessitated the need for bone metastases treatment guidelines. Here we compare and contrast the bone metastases radiotherapy treatment guidelines recently published by the American Society for Radiation Oncology (ASTRO) and the American College of Radiology (ACR). These evaluations acknowledge current cont

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… The work-up and treatment of bone metastases requires input and interventions from many medical disciplines, including radiologists, orthopedic surgeons or neurosurgeons, radiation oncologists, medical oncologists, pain medicine specialists, physical medicine and rehabilitation physicians, and palliative … Furthermore, while radiation oncologists make up the majority of panel members on the ACR and ASTRO committees, radiation oncologists generally make up a distinct minority, or are a singular member, of the NCCN committees. …

Primary prevention of venous thromboembolism in medical and surgical oncology patients.

Recent data suggest that patients with a malignancy have a seven-fold increased risk for venous thromboembolism (VTE) compared with those without cancer, suggesting that these patients may benefit from thromboprophylaxis. Mechanisms for the prevention of thromboembolism can be divided into two broad categories: mechanical and pharmacological. Although generally used in combination with pharmacotherapy, little evidence exists for the efficacy of mechanical modalities either in the broader population of patients at risk for VTE or for patients with cancer specifically. A recent study using gradu

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… More than 50% of surgeons reported that they initiated thromboprophylaxis routinely; in contrast, medical oncologists reported using thromboprophylaxis in less than 5% of medical patients ( Kakkar et al , 2003 ). … A recent publication suggested that 25% of breast surgeons and oncologists are not aware of the thromboembolic risks associated with cancer. In qualitative studies with oncologists and palliative care physicians, perception is that VTE is not a major problem. …

The Burden of a Multiple Myeloma Diagnosis on Patients and Caregivers in the First Year: Western European Findings.

BACKGROUND: This research aimed to quantify the burden of illness (BoI) in transplant eligible (TE) and transplant non-eligible (TNE) newly diagnosed multiple myeloma (NDMM) patients and their caregivers, in the first year after diagnosis: at months 0, 3, and 12. METHODS: Prospective, cross-sectional, observational NDMM study of TE and TNE patients and their caregivers from France, Germany, Italy, and Spain was conducted between May 2019 and January 2021. A structured, online questionnaire measuring disease burden, direct and costs, out-of-pocket expenses, and health-related quality of life (

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… The hematologists/hemato-oncologists recruited patients and caregivers until the target sample was reached. … Hematologists / hemato-oncologists | Must treat/diagnose NDMM patients. …

The Immuno-oncology-Induced Cytokine Release Syndrome Patient Diary: A Content-Valid, Patient-Reported Outcome Measure.

INTRODUCTION: Cytokine release syndrome (CRS) occurs when the immune system reacts excessively to infections or certain immunotherapies, leading to a systemic inflammatory response. The clinical presentation of CRS is highly variable, ranging from mild symptoms, such as fever and fatigue, to severe, life-threatening conditions. Currently, there is no standardized method for collecting patient-reported data on CRS experiences. This study aims to develop a novel patient-reported outcome measure (PROM) to capture patients' experience with CRS. METHODS: A comprehensive, multistep evidence-generat

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… Refinement of the PROM Cognitive Debriefing Interviews with Clinical Oncologists CD interviews were held with three clinical oncologists who participated in the advisory board to obtain feedback on the draft PROM. … Refinement and Finalization of the Patient-Reported Outcome Measure Cognitive Debriefing Interviews with Clinical Oncologists Clinical oncologists proposed adding headache to the draft PROM, and to separate chills and shaking. …

Late decisions about treatment limitation in patients with cancer: empirical analysis of end-of-life practices in a haematology and oncology unit at a German university hospital.

BackgroundDecisions to limit treatment (DLTs) are important to protect patients from overtreatment but constitute one of the most ethically challenging situations in oncology practice. In the Ethics Policy for Advance Care Planning and Limiting Treatment study (EPAL), we examined how often DLT preceded a patient's death and how early they were determined before (T1) and after (T2) the implementation of an intrainstitutional ethics policy on DLT.MethodsThis prospective quantitative study recruited 1.134 patients with haematological/oncological neoplasia in a period of 2×6 months at the Universi

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… Towards the end of a cancer disease trajectory, oncologists and their patients often have to decide when to shift therapy from tumour-specific to standard palliative care. … What keeps oncologists from addressing palliative care early on with incurable cancer patients? An active stance seems key. Oncologist 2015;20:56–61. 10.1634/theoncologist.2014-0031 42. Laryionava K, Heußner P, Hiddemann W, et al. …

Immune checkpoint inhibitors in cancer therapy: Review of orofacial adverse events and role of the oral healthcare provider.

Immune checkpoint inhibitors (ICIs) are a revolutionary class of antineoplastic therapy that restore anti-tumor immunity. Consequences of this enhanced immune response include a multitude of immune related adverse events (irAEs) that can affect any body system, including the mouth. Orofacial irAEs reproduce features of numerous immune-mediated conditions, including oral lichen planus, mucous membrane pemphigoid, and Sjögren syndrome, among others. The aim of this review is to summarize known orofacial irAEs and to familiarize oral healthcare providers with how to identify and manage these toxi

Perspective recommendations on geriatric support for older adults with multiple myeloma based on challenges faced by a multidisciplinary team.

BACKGROUND: Multiple Myeloma (MM) predominantly affects older adults, with a median diagnosis age of 70 years, posing challenges in management due to frailty, comorbidities, and age-related physiological changes. As the aging population grows, the prevalence of MM in older patients is expected to rise, requiring improved clinical strategies. METHODS: This consensus report outlines a multidisciplinary framework for the identification, geriatric assessment (GA), and management of older adults with MM, emphasizing the role of frailty assessments, such as the IMWG frailty score, in tailoring trea

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… The involvement of geriatricians and geriatric oncologists in the management of older adults with MM is crucial ( 31 , 32 ). … In some regions, the lack of collaboration between hematologists, oncologists, and geriatricians creates barriers to comprehensive care. …