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Maximizing the impact of real-world evidence on cancer treatment: what do we need to achieve it?

There is an increasing number of studies using real-world data to examine outcomes of drugs in clinical practice. Therefore, it is crucial to carefully evaluate their quality and findings, extract valuable insights, acknowledge their limitations and identify gaps to advance further their use in decision-making. Here we provide an overview of the opportunities offered throughout drug lifecycle, and challenges presented by real-world evidence (RWE) studies. We also highlight the importance of the culture of transparency, along with the development of good practices for reporting RWE studies. In

Борьба с травматической деформацией подбородка на чехле в недавно диагностированном миеломе: пример.

Обычно фонопатенты с множественной миеломой (ММ) управляются многодисциплинарными командами по онкологии в соответствии с неврологической, онкологической, механической и систематической системой принятия решений. Хирургия указывается на механическую нестабильность и/или неврологические недостатки. В неврологических и механически стабильных пациентах химиотерапия и радиотерапия часто являются основным лечением. 66-year-old Пациент мужского пола получил кифотическое повреждение подбородка на чехле из-за недиагностированной спинной мышцы ММ. Он испытывал постепенную боль в шее и трудности в повсе

Unusual Prostate-Specific Membrane Antigen (PSMA) Splenic Uptake in a Patient With Prostate Cancer.

There are many benefits to early detection of prostate cancer, including improved survival rates, less invasive treatment options, and better quality of life. Apart from traditional tests and imaging (including the prostate-specific antigen (PSA) test, digital rectal exam, biopsy, computed tomography (CT), and magnetic resonance imaging (MRI)), an imaging technique called prostate-specific membrane antigen positron emission tomography (PSMA PET) is more specific and sensitive, targeting PSMA expressed by prostate cancer cells on their surface. This case report describes a 62-year-old male with

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… It is important to note that a team-based approach with urologists, radiation oncologists, radiologists, medical oncologists, and pathologists, along with multiple imaging modalities including PSMA PET/CT and MRI, and biopsy plus laboratory data, are required to make a proper diagnosis and stage prostate …

Prevalence and determinants of polypharmacy among cancer patients: a systematic review and meta-analysis.

BACKGROUND: Polypharmacy (PP) is a rising clinical challenge among patients with a cancer diagnosis. Uncertainty remains regarding its exact burden, exact prevalence estimates, and definitional themes in this vulnerable cohort of patients. METHODS: We searched PubMed, EMBASE, Scopus, the Cochrane Database of Systematic Reviews (CDSR), and Google Scholar, for studies published between 2000 and 2025 for eligible studies reporting on polypharmacy in cancer patients. These were critically appraised for eligibility and inclusion by two independent reviewers. Using quality and random effect models,

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… , surgeons, radiation oncologists, primary care physicians, and palliative specialists. … Oncologist. 2022;27(7):E580–8. 27. Lavan AH, O’Mahony D, Buckley M, O’Mahony D, Gallagher P. Adverse drug reactions in an oncological population: prevalence, predictability, and preventability. Oncologist. 2019;24(9):e968–77. 28. Hakozaki T, Matsuo T, Shimizu A, Ishihara Y, Hosomi Y. …

Efficacy of a high-dose antiresorptive drug holiday to reduce the risk of medication-related osteonecrosis of the jaw (MRONJ): A systematic review.

A temporary discontinuation (drug holiday) of high-dose antiresorptive (AR) agents has been proposed to reduce the risk of medication-related osteonecrosis of the jaw (MRONJ). The aim of this systematic review was to answer the question: Is high-dose AR drug holiday, at the time of tooth extraction or dentoalveolar surgery, necessary to prevent the development of MRONJ in patients with cancer? This protocol was registered in the PROSPERO database. Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for relevant studies up to and including April 2019.

Severe toxicity with a generic formulation of zoledronic Acid: a case report.

Intravenous zoledronic acid (ZOL) is an integral component for the management of patients with bone metastases, but can be associated with transient flu-like symptoms, which generally occur only with the first infusion and are typically manageable with nonprescription analgesics. A 50-year-old woman with a bone metastasis secondary to breast cancer received radiation therapy, brand-name ZOL (Zometa(®)), and letrozole. During the first 3 cycles of Zometa (4 mg every 3-4 weeks), no acute adverse events were reported. For the next 2 cycles she was switched to generic ZOL and experienced severe to

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… Treatment of patients with bone metastases should involve a multidisciplinary team of experts, including oncologists, radiation oncologists, and orthopedic surgeons, with the primary goals of relieving pain, improving quality of life, preventing SREs, and restoring functional independence, to minimize … Clearly, more information is needed to validate the safety and efficacy of generic ZOL formulations, and this will be of direct interest to oncologists, but will also have relevance to all healthcare professionals who are confronted by decisions regarding the increasing number of generic drug choices …

Role of Decompressive Surgery in Neurologically Intact Patients with Low to Intermediate Intraspinal Metastatic Tumor Burden.

BackgroundSurgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD.MethodsThis single-center, multidepartment retrospective analysis includes patient

Interventional and Non-interventional Medical Rehabilitation Approaches to Axial Spine Pain in Vertebral Metastatic Disease.

As targeted therapies help patients with advanced cancer live longer, interventions for management of axial spine pain will become more common. Unfortunately, the indications for and safety of these procedures have been relatively unexplored compared with non-cancer adults. This review focuses on the following aspects of axial spine pain management in patients with vertebral metastatic disease: (1) pathophysiology and symptoms of cancer- and non-cancer-related spine pain; (2) safety and efficacy of non-interventional rehabilitation approaches to treat this pain; (3) considerations for interven

Principles of Management of Extremity Skeletal Metastasis.

Understanding the epidemiology of extremity skeletal metastasis and the factors deciding the treatment decision-making are essential in developing a diagnostic and treatment strategy. This leads to optimum care and reduces disease-related burden. With the evolution of medical, radiation therapy, and surgical methods, cancer care has improved the quality of life for patients with improved survival and functional status in patients with skeletal metastasis. Based on the currently available literature, we have described a step-wise evaluation and management strategy of metastatic extremity bone d

Hemato- Oncology Care in COVID-19 Pandemic: Crisis within a Crisis.

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… Oncologists should decide to postpone, discontinue or modify radiation therapy for the patients undergoing or planned for it, keeping an individualized risk/benefit assessment in mind (Shankar et al., 2020). … This pandemic is going to have long term serious consequences, and the oncologists must prepare for that in the coming time. References American Society of Hematology. COVID-19 Resources. [Online] [[Accessed May 6 2020]]. Available: https://www.hematology.org/covid-19 . …

Characteristics of Patients and Treatment Recommendations from a Multidisciplinary Spinal Tumor Program.

Objective: We describe characteristics of patient and treatment recommendations from a spinal tumor board at one institution, including representation from palliative care. Background: The impact of prospective multidisciplinary input for patients with spinal tumors is poorly understood despite their increasing complexity. Methods: We retrospectively reviewed 622 cases sequentially discussed at a weekly spinal tumor board, and abstracted patient and treatment information from the medical record and meeting minutes. Results: From April 2017 to February 2019, 622 cases representing 438 unique pa

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… The disciplines represented in the tumor boards vary by institution, but medical oncologists, surgeons, and radiation oncologists are usually represented and less commonly include representation from adult palliative care. … In cases wherein prognosis or goals of care could not be easily ascertained, further input from the patient's primary oncologist was sought. …

Nuances in the treatment of malignant tumors of the clival and petroclival region.

Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnost

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… Discussion between a team including neurosurgeons, medical oncologists, and radiation oncologist should ensue. As with any other malignancies, the patient should then be educated regarding the goals of care and reasonable, expected outcomes from the treatment paradigm. … All skull base cases should be discussed in conference until a consensus on surgical approach and overall management is reached among radiologists, neuro-oncologists, neurosurgeons, otolaryngologists, head and neck surgeons, and radiation oncologists. …

Development of a Practice Standard for Monitoring Adult Patients Receiving Bone-Modifying Agents at a Community Cancer Center.

The purpose of this study is to develop a standard for monitoring outpatients starting bone-modifying agents (BMAs) at a community cancer center. The National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO) guidelines recommend the monitoring of serum magnesium and phosphorus during BMA therapy but do not define a standard interval. The risk of hypomagnesemia and hypophosphatemia was assessed for the BMAs denosumab, pamidronate, and zoledronic acid. Compliance with dental clearance was also evaluated. Adult cancer outpatients newly started on BMAs between J

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… Compliance with dental clearance was achieved in 100% of patients based on oncologist documentation and dentist letters. No patients were diagnosed with ONJ over the 1-year period. … Data was unavailable for patients treated at another institution, although they were followed by the oncologists at the study site. Study strengths are exclusion of patients treated for HCM, use of CTCAE version 4.0, and evaluation of patients newly initiated on BMAs. …

Онко@home: сопоставление стоимости и возмещения расходов на лечение рака на дому со стандартом медицинского обслуживания.

СПРАВОЧНАЯ ИНФОРМАЦИЯ: Онкологическая госпитализация на дому (HH) была осуществлена в бельгийском контексте для оценки осуществимости онкологической госпитализации на дому. В первой модели HH (HH1), реализованной three Бельгийские больницы, two Организации по уходу на дому и группа независимых медсестер, анализ крови и наблюдение перед внутривенной терапией проводились квалифицированной домашней медсестрой в доме пациента за день до посещения дневной больницы. В рамках второй модели HH (HH2), внедренной в one госпиталь, администрация two Лечение подкожного (Azacitidine and Bortezomib) миэлодип

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… By conducting these assessments one day prior to therapy administration (i.e., on day -1), oncologists were able to prescribe therapy and the pharmacy department could prepare treatments in advance of patient arrival at the hospital, which reduces the waiting time before the administration of chemotherapy … | + €33.58 | + €33.58 | -€67.88 | -€89.42 Hospital | + €0.00 | + €0.00 | -€70.91 | -€93.07 Home care | + €33.58 | + €33.58 | + €3.03 | €3.65 RESULT (Revenues – Costs), excluding lab tests and MD oncologist | - €16.84 | - €16.84 | - €77.38 | - €101.89 Hospital | + €23.84 | + €23.84 | - €46.84 | - €61.48 …

Health care professionals' understanding of contraindications for physical activity advice in the setting of stem cell transplantation.

PURPOSE: Most patients receiving a hematopoietic stem cell transplantation (HSCT) are able to tolerate and benefit from physical activity (PA). Therefore, it is important that health care professionals (HCPs) advise patients to perform PA before, during, and after transplantation. By understanding which medical conditions and safety issues are associated with the (non-) promotion of PA, concrete actions and interventions can be planned and implemented. METHODS: Physicians (N = 51), nurses (N = 52), and physical therapists (N = 26) participated in a nationwide cross-sectional online survey. HC

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… Promotion of physical activity among oncologists in the United States. J Support Oncol. 2010;8:35–41. 42. Park J-H, Oh M, Yoon YJ, et al. Characteristics of attitude and recommendation of oncologists toward exercise in South Korea: a cross sectional survey study. … Oncologists’ opinions towards recommending exercise to patients with cancer: a Canadian national survey. Support Care Cancer. 2005;13:929–937. doi: 10.1007/s00520-005-0805-8. 45. Ungar N, Tsiouris A, Haussmann A, et al. …

Optimizing Oral Targeted Anticancer Therapies Study for Patients With Solid Cancer: Protocol for a Randomized Controlled Medication Adherence Program Along With Systematic Collection and Modeling of Pharmacokinetic and Pharmacodynamic Data.

BackgroundThe strengthening or substitution of intravenous cytotoxic chemotherapy cycles by oral targeted anticancer therapies, such as protein kinase inhibitors (PKIs), has provided impressive clinical benefits and autonomy as well as a better quality of life for patients with cancer. Despite these advances, adverse event management at home and medication adherence remain challenging. In addition, PKI plasma concentrations vary significantly among patients with cancer receiving the same dosage, which could explain part of the observed variability in the therapeutic response.ObjectiveThe aim o

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… No payment or compensation will be provided to the patients or to the oncologists as the patients are being seen as part of their routine follow-up clinical care. … Interprofessionality is a cornerstone of the program, and pharmacists will summarize the intervention in a semistructured report sent to the oncologist after each intervention. …

Indian Expert Opinion on Cancer Care during COVID-19 Pandemic.

Coronavirus pandemic has increased human disease burden, as well as economic distress globally. Being in an immunocompromised state, patients with cancer comprise an important at-risk population for novel coronavirus disease 2019 (COVID-19) infection. It is necessary to modify individualized clinical management for every cancer patient in the context of the ongoing COVID-19 pandemic. Simultaneously, additional safety precautions for the cancer care providers are mandatory. This review will provide general recommendations in the Indian context optimizing the same.

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… Methods A group of nine Indian subject experts (medical, surgical, radiation, and hemato oncologists) met virtually (video conference) to discuss available data, personal experience, and developed the consensus review document. … Modifying practices in GI Oncology in the face of COVID-19: Recommendations from expert oncologists on minimizing patient risk. JCO Oncol Pract. 2020;16(07):383–388. doi: 10.1200/OP.20.00239. 37. …

Healthcare disparities in cardio oncology: patients receive same level of surveillance regardless of race at a safety net hospital.

BackgroundCardiotoxicity remains a dreaded complication for patients undergoing chemotherapy with human epidermal growth factor (HER)-2 receptor antagonists and anthracyclines. Though many studies have looked at racial disparities in heart failure patients, minimal data is present for the cardio-oncology population.MethodsWe queried the echocardiogram database at a safety net hospital, defined by a high proportion of patients with Medicaid or no insurance, for patients who received HER2 receptor antagonists and/or anthracyclines from January 2016 to December 2018. Patient demographics, clinica

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… Due to lack of established referral guidelines, the decision for oncologists to refer patients to cardiologists can be varied. … The future role of cardio-oncologists. Card Fail Rev. 2017;3(2):140–142. doi: 10.15420/cfr.2017:16:1. 2. Magdy T, Burmeister BT, Burridge PW. Validating the pharmacogenomics of chemotherapy-induced cardiotoxicity: what is missing? …

Comparing conVEntional RadioTherapy with stereotactIC body radiotherapy in patients with spinAL metastases: study protocol for an randomized controlled trial following the cohort multiple randomized controlled trial design.

BackgroundStandard radiotherapy is the treatment of first choice in patients with symptomatic spinal metastases, but is only moderately effective. Stereotactic body radiation therapy is increasingly used to treat spinal metastases, without randomized evidence of superiority over standard radiotherapy. The VERTICAL study aims to quantify the effect of stereotactic radiation therapy in patients with metastatic spinal disease.Methods/designThis study follows the 'cohort multiple Randomized Controlled Trial' design. The VERTICAL study is conducted within the PRESENT cohort. In PRESENT, all patient

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… A radiation oncologist records toxicity according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 4.0 [ 21 ] six weeks after radiation treatment. … They also have strict instructions on how to apply the standard and stereotactic body radiotherapy in contrast to our more pragmatic approach, offering radiation oncologists leeway in fractionation schedule. …

Implementation of Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) Within Mixed Diagnosis Population.

BackgroundIntegrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated.ObjectiveWe created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOS

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… Bari et al 2 reported that most underserved minorities with cancer were interested in gaining more information from reputable sources (their oncologist) and to learn about the safety and potential complementary benefit in the management of cancer and associated symptoms. … Finally, the multi-disciplinary collaborative relationship with oncology departments (grand rounds invitations, tumor board invitations, patient feedback to oncologists, and referrals) provided a steady stream of interested patients. …