This study assessed the prognostic value of pre-treatment neutrophil-to-lymphocyte ratio (NLR) in patients with metastatic solid tumors. Clinical and biological data for patients with metastatic ...solid tumors treated in an oncology outpatient department and prospectively followed by a call center (PROCHE program) between January 2008 and December 2011 were analyzed. All patients with an NLR value within 28 days before the first cycle of first-line of chemotherapy were included (cohort 1). To assess influence of chemotherapy line on NLR prognostic value, data from patients treated with later chemotherapy lines were also analyzed (cohort 2). Adjusted multivariate Cox regressions with or without non-linear and time-dependent effects were performed. Optimal NLR cut-off was investigated by time-dependent sensitivity analysis using several indices. There were 317 and 134 patients in cohorts 1 and 2, respectively. Elevated NLR was associated with worse survival (hazard ratio HR for death, 1.35 95% confidence interval 1.19-1.54; p<0.0001). The optimal NLR cut-off in cohort 1 was dependent on index used and time of assessment: HR values were non-significant at a cut-off of 3.0 (1.34 0.99-1.32, but significant when the cut-off was 4.0 (1.53 1.11-2.10). NLR was linearly related to mortality risk; in subgroup analysis, no significant interaction was found with co-variables or tumor localization overall (cohorts 1+2). Pre-treatment NLR is a useful prognostic tool in patients with metastatic solid tumors, irrespective of primary tumor site, chemotherapy line, age, gender and performance status. However, using an NLR cut-off value for clinical decision-making requires extreme caution.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose:
To investigate whether a combination of radiomics and automatic machine learning applied to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of primary breast cancer can ...non-invasively predict axillary sentinel lymph node (SLN) metastasis.
Methods:
62 patients who received a DCE-MRI breast scan were enrolled. Tumor resection and sentinel lymph node (SLN) biopsy were performed within 1 week after the DCE-MRI examination. According to the time signal intensity curve, the volumes of interest (VOIs) were delineated on the whole tumor in the images with the strongest enhanced phase. Datasets were randomly divided into two sets including a training set (~80%) and a validation set (~20%). A total of 1,409 quantitative imaging features were extracted from each VOI. The select K best and least absolute shrinkage and selection operator (Lasso) were used to obtain the optimal features. Three classification models based on the logistic regression (LR), XGboost, and support vector machine (SVM) classifiers were constructed. Receiver Operating Curve (ROC) analysis was used to analyze the prediction performance of the models. Both feature selection and models construction were firstly performed in the training set, then were further tested in the validation set by the same thresholds.
Results:
There is no significant difference between all clinical and pathological variables in breast cancer patients with and without SLN metastasis (
P
> 0.05), except histological grade (
P
= 0.03). Six features were obtained as optimal features for models construction. In the validation set, with respect to the accuracy and MSE, the SVM demonstrated the highest performance, with an accuracy, AUC, sensitivity (for positive SLN), specificity (for positive SLN) and Mean Squared Error (MSE) of 0.85, 0.83, 0.71, 1, 0.26, respectively.
Conclusions:
We demonstrated the feasibility of combining artificial intelligence and radiomics from DCE-MRI of primary tumors to predict axillary SLN metastasis in breast cancer. This non-invasive approach could be very promising in application.
Purpose To identify factors associated with (perceived) access to health care among (ex-)breast cancer patients during the COVID-19 pandemic. Methods Cross-sectional study within a large prospective, ...multicenter cohort of (ex-)breast cancer patients, i.e., UMBRELLA. All participants enrolled in the UMBRELLA cohort between October 2013 and April 2020 were sent a COVID-19-specific survey, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Results In total, 1051 (66.0%) participants completed the survey. During COVID-19, 284 (27.0%) participants reported clinically relevant increased levels of anxiety and/or depression, i.e., total HADS score greater than or equal to 12. Participants with anxiety and/or depression reported statistically significant higher barriers to contact their general practitioner (47.5% vs. 25.0%, resp.) and breast cancer physicians (26.8% vs. 11.2%, resp.) compared to participants without these symptoms. In addition, a higher proportion of participants with anxiety and/or depression reported that their current treatment or (after)care was affected by COVID-19 compared to those without these symptoms (32.7% vs. 20.5%, resp.). Factors independently associated with symptoms of anxiety and/or depression during COVID-19 were pre-existent anxiety (OR 6.1, 95% CI 4.1-9.2) or depression (OR 6.0, 95% CI 3.5-10.2). Conclusion During the COVID-19 pandemic, (ex-)breast cancer patients with symptoms of anxiety and/or depression experience higher barriers to contact health care providers. Also, they more often report that their health care was affected by COVID-19. Risk factors for anxiety and/or depression during COVID-19 are pre-existent symptoms of anxiety or depression. Extra attention-including mental health support-is needed for this group.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We identified a rare missense germline mutation in BARD1 (c.403G>A or p.Asp135Asn) as pathogenic using integrated genomics and transcriptomics profiling of germline and tumor samples from an ...early-onset triple-negative breast cancer patient who later was administrated with a PARP inhibitor for 2 months. We demonstrated in cell and mouse models that, compared to the wild-type, (1) c.403G>A mutant cell lines were more sensitive to irradiation, a DNA damage agent, and a PARP inhibitor; (2) c.403G>A mutation inhibited interaction between BARD1 and RAD51 (but not BRCA1); and (3) c.403G>A mutant mice were hypersensitive to ionizing radiation. Our study shed lights on the clinical interpretation of rare germline mutations of BARD1. Keywords: BARD1, Rare mutation, c.403G>A, p.Asp135Asn, Integrated genomics profiling, Triple-negative breast cancer, Irradiation, DNA damage, PARP inhibitor, Functional assay
Spiritual care is recognised as an essential element of the care of patients with serious illness such as cancer. Spiritual distress can result in poorer health outcomes including quality of life. ...The American Society of Clinical Oncology and other organisations recommend addressing spiritual needs in the clinical setting. This paper reviews the literature findings and proposes recommendations for interprofessional spiritual care.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ
Background
Investigations about the impact and consequences of the COVID-19 infection on the mental health of patients with chronic diseases and those with immunosuppressive conditions are growing. ...The current study aimed to systematically review and meta-analysis of studies that evaluated the level of depression and anxiety in cancer patients during the COVID-19 pandemic.
Methods
The PubMed, Scopus and Web of Sciences databases were searched to retrieve potential studies from January 2020 to 3 January 2021. Summary data on frequency and mean of depression and anxiety were extracted. Random-effect meta-analysis was conducted to estimate overall prevalence, mean and standardized mean difference.
Results
Thirty-four studies were included in the systematic review, of them 21 studies included in meta-analysis. Overall depression and anxiety were 0.37 (0.27, 0.47);
I
2
= 99.05%,
P
value < 0.001 and 0.38 (0.31, 0.46);
I
2
= 99.08%,
P
value < 0.001, respectively. Compared to controls, cancer patients had higher anxiety level standard mean difference (SMD 0.25 (95% CI 0.08, 0.42).
Conclusion
Overall, the findings of this study suggest that the prevalence of depression and anxiety among patients with cancer during the COVID-19 pandemic can reach considerable levels, although observed substantial heterogeneity should be considered when interpreting the results.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Concomitant medications are known to impact on clinical outcomes of patients treated with immune checkpoint inhibitors (ICIs). We aimed weighing the role of different concomitant baseline ...medications to create a drug-based prognostic score.
We evaluated concomitant baseline medications at immunotherapy initiation for their impact on objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) in a single-institution cohort of patients with advanced cancer treated with ICIs (training cohort, N = 217), and a drug-based prognostic score with the drugs resulting significantly impacting the OS was computed. Secondly, we externally validated the score in a large multicenter external cohort (n = 1012).
In the training cohort (n = 217), the median age was 69 years (range: 32–89), and the primary tumours were non–small-cell lung cancer (70%), melanoma (14.7%), renal cell carcinoma (9.2%) and others (6%). Among baseline medications, corticosteroids (hazard ratio HR = 2.3; 95% confidence interval CI: 1.60–3.30), systemic antibiotics (HR = 2.07; 95% CI: 1.31–3.25) and proton-pump inhibitors (PPIs) (HR = 1.57; 95% CI: 1.13–2.18) were significantly associated with OS. The prognostic score was calculated using these three drug classes, defining good, intermediate and poor prognosis patients. Within the training cohort, OS (p < 0.0001), PFS (p < 0.0001) and ORR (p = 0.0297) were significantly distinguished by the score stratification. The prognostic value of the score was also demonstrated in terms of OS (p < 0.0001), PFS (p < 0.0001) and ORR (p = 0.0006) within the external cohort.
Cumulative exposure to corticosteroids, antibiotics and PPIs (three likely microbiota-modulating drugs) leads to progressively worse outcomes after ICI therapy. We propose a simple score that can help stratifying patients in routine practice and clinical trials of ICIs.
•The impact of concomitant drugs was investigated in patients with advanced cancer treated with immune checkpoint inhibitors.•We firstly tested a single-institution cohort of 217 patients with advanced cancer.•Corticosteroids, antibiotics and proton-pump inhibitors were related to shorter overall survival (OS).•We created a drug-based prognostic score predicting OS, progression-free survival and objective response rate.•The score was externally validated in a multicenter cohort of 1012 patients.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ
499.
Bad Medicine Is What I Need? Quaranta, Brian P
The oncologist (Dayton, Ohio),
01/2024, Volume:
29, Issue:
1
Journal Article
Peer reviewed
Open access
This narrative suggests that a proper recognition of “bad medicine” may need to take into consideration the needs of the patient.
We aimed to explore the determinants of muscle fat infiltration and to investigate whether myosteatosis, assessed as muscle fat infiltration percentage (%MFI) and muscle attenuation from computed ...tomography (CT), is associated with frailty in a group of patients with colorectal cancer (CRC).
Cross sectional study including CRC patients. CT scan of the third lumbar vertebra was used to quantify body composition and the degree of %MFI (reported as percentage of fat within muscle area). Frailty was defined by Fried et al. (2001) as the presence of more than 3 criteria: unintentional weight loss, self-reported exhaustion, weakness (low handgrip strength), slow walking speed (gait speed) and low physical activity. Obesity was defined according to sex-and-age-specific body fat percentage (%BF) cutoff.
A sample of 184 patients (age 60 ± 11 years; 58% men; 29% of patients with frailty) was studied. The sample was divided according to tertiles of MFI% (1st tertile 0 to 2.89%, n = 60; 2nd tertile ≥ 3.9–8.19%, n = 64; 3rd tertile ≥ 8.2–26%, n = 60). Age, females, body mass index, %BF, subcutaneous and visceral adipose tissue and the proportion of patients with frailty were significantly higher in the 3rd %MFI tertile. Phase angle and muscle attenuation were significantly lower in the 3rd %MFI tertile. The determinants of %MFI (r2 = 0.49), which was log transformed due to its normal distribution, were %BF (β = 0.54; eβ = 1.72; 95% CI: 0.032 to 0.051; P < 0.01), age (β = 0.34; eβ = 1.40; 95% CI: 0.016 to 0.032; P < 0.01) and gait speed (β = −0.12; eβ = 0.87; 95% CI: −0.84 to −0.001; P = 0.049). In addition, in obese patients (n = 74) presenting 4 or 5 frailty criteria increased the chance of having higher %MFI and lower muscle attenuation, after adjustment for sex, age and comorbidities when compared to none or 1 criteria.
In a sample of CRC patients, %BF and gait speed were the determinants of %MFI. In addition, markers of myostetatosis were associated with frailty in the obese patients.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
You have reached the maximum number of search results that are displayed.
For better performance, the search offers a maximum of 1,000 results per query (or 50 pages if the option 10/page is selected).
Consider using result filters or changing the sort order to explore your results further.
PDF
