Background

The number of people who are 60 years and older is projected to grow 56%between 2015 and 2030, and by 2050 it is expected to be more than double its current number according to United Nations report[1] .It is estimated that 35.6% of cancer cases occur in the elderly in Egypt [2]. According to National Cancer Registry Program (NCRP) of Egypt, cancer incidence is expected to increase nearly threefold by 2050 [2]. This study evaluates VES 13 as a geriatric screening functional assessment tool and assesses other factors associated with functional decline after first line of chemotherapy.

Methods

This observational study was planned to include a minimum of 50 newly diagnosed, histologically proved female breast cancer patients, older than 65 years. Patients were assessed by VES13 score at presentation and before the fourth cycle of chemotherapy. The type of chemotherapy and dose modification was decided by the treating physician without considering VES13 score.

Results

The commonest comorbidities were diabetes mellitus, hypertension. Multiple comorbidities occurred in 46% of the cases. The relation between VES-13 score pre and post chemotherapy were analyzed by using Wilcoxon Rank test and it shows a highly significant difference with P value equal to 0.0001. Regression analysis was conducted with the difference between pre-chemotherapy and post chemotherapy VES 13 score as outcome variables and five explanatory variables (age, multiple comorbidities, PS, type of treatment adjuvant or palliative and pre-chemotherapy VES 13). The five variables have an association with the outcome variables but were only significant with pre-chemotherapy VES 13 score and multiple comorbidities. It showed a highly significant impact predicting risk of functional decline. The regression model was calculated and found to predict 72% of the result. Table: 358O

Regression analysis result estimated by Stata

Conclusions

The value of VES 13 score pre-chemotherapy and associated multiple comorbidities were highly significant in predicting functional decline after three cycles of chemotherapy. Age and performance status were not associated with significant difference in functional decline. 1. United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing. 2015 (ST/ESA/SER.A/390). 2. Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014:437971.

Editorial acknowledgement

References:

1. United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing. 2015 (ST/ESA/SER.A/390). 2. Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014:437971.

Legal entity responsible for the study

Department of Clinical Oncology and Nuclear Medicine Faculty of Medicine, Alexandria University.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Patients with chronic or resolved hepatitis B virus (HBV) infection have a risk of reactivation after chemotherapy. Japanese guidelines recommend that all patients on chemotherapy should be screened for HBV infection. Although Asian peoples are considered to be a high risk population of HBV infection, little is known about the screening rate in Japan.

Methods

We analyzed health insurance claims data linked with hospital-based cancer registry. Patients diagnosed with cancer in 2014, 20 years and older, who received at least one dose of systemic anticancer therapy in 2014-15 entered the analyses. We assessed the HBV screening rates by HBsAg or anti-HBc test ordered around initial treatment, HBV-DNA test and entecavir prescription. A multiple logistic regression model was used to identify factors related to the receipt of screening.

Results

Of 177636 patients (mean [SD] age, 65.6 [12.2] years), 82.6%, 12.9%, 4.5% patients had solid tumor other than hepatocellular carcinoma (HCC), hematologic malignancy and HCC, respectively. Among them, 88.5%, 8.8%, 2.6% patients received cytotoxic chemotherapy, targeted therapy and anti-CD20 antibody, respectively. Overall, 70.6% of patients were screened but 34.5% were tested HBsAg only. The positive predictors of the HBV screening were hematologic malignancy (OR 2.45; 95%CI, 2.35-2.55) and negative predictors were age ≥85 (OR 0.75 compared to age <65, 95%CI, 0.71-0.80), age 75-84 (OR 0.77; 95%CI, 0.75-0.79), targeted therapy (OR 0.79; 95%CI, 0.76-0.82). Among the screened patients, 13.2% were tested HBV-DNA and 1.49% were prescribed prophylactic entecavir.

Conclusions

This is the largest study to evaluate the HBV screening rate before systemic anticancer therapy in Japan. Although the screening rate is higher than previous reports from other countries (13-19%), half of the screened patients were tested HBsAg only. The elderly patients and patients who received targeted therapy were less screened.

Legal entity responsible for the study

Takahiro Higashi.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

In the management of febrile neutropenia (FN) several models were developed to yield an objective and reproducible prediction of complications and outcomes. The most widely used predictive model is the Multinational Association for Supportive Care in Cancer (MASCC) model which has several limitations. To overcome some of these limitations a new prognostic score known as the Clinical Index of Stable Febrile Neutropenia (CISNE) score was developed. We have attempted to compare MASCC model and CISNE model in predicting the risk of serious complications in clinically stable febrile neutropenia patients.

Methods

A prospective study was conducted from January 2016 to December 2017 at Kidwai Cancer Institute. Clinical data regarding the covariates of both CISNE and MASCC models were obtained. The outcome measure was the appearance of major complications associated with FN episodes. The discriminatory ability of the scales on the basis of their areas under the receiver operating characteristic curves (ROC), using the Hanley method was analyzed.

Results

Two hundred apparently clinically stable febrile neutropenia patients were evaluated. Thirty-one patients had serious complications of which 4 patients died. The MASCC score ≤ 20 had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of 41.94%, 85.8%, 35.1%, and 89.0% respectively for detecting complications. The CISNE score cutoff > 2 had a sensitivity, specificity, PPV, NPV of 80.6%, 72.8%, 35.2%, and 95.3% respectively for detecting complications. Areas under ROC curves were 0.686 (C.I. 0.581 to 0.792) for MASCC, and 0.846 (C.I. 0.781-0.911) for CISNE score. The area difference between the CISNE ROC and MASCC ROC was 0.16 and this difference was statistically significant (p = 0.0003).Table: 421O

Comparison of CISNE model versus MASCC model

Conclusions

In apparently clinically stable febrile neutropenia patient with solid malignancies, the CISNE score has a better accuracy in predicting serious complications compared to the MASCC score. Thus patients with high-risk CISNE score need inpatient management and should not be discharged early.

Legal entity responsible for the study

Deepak Koppaka.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

The control of nausea in HEC therapy is still a challenge. Hence, we evaluated the efficacy and toxicity of olanzapine for the prevention of nausea and vomiting in patients receiving HEC.

Methods

In a randomized study, we compared three regimens for CINV in various combinations of olanzapine (O), dexamethasone (D), aprepitant (A) and 5-HT₃ antagonist (H). The groups were Group A (AHD), Group B (AHDO) & Group C (HDO). Patients receiving cisplatin, cyclophosphamide–doxorubicin & any other HEC as per guidelines were enrolled. The standard doses of the concomitant drugs were administered before and after chemotherapy. The two groups received 10 mg of olanzapine orally daily on day 1 through 4. Complete response (no emesis and no use of rescue medication) & prevention of nausea were primary end points. The toxicities were secondary end points.

Results

We included 171 patients (58 in Group A, 57 in Group B & 56 in Group C). The percentage of patients with no chemotherapy induced nausea was significantly greater in group B for the first 24 hours after chemotherapy (82% vs 74% vs 71%, p < 0.01), the period from 25 to 120 hours after chemotherapy (73% vs 69% vs 70%, p < 0.05) and the overall 120-hour period (72% vs 67% vs 66%, p < 0.05). The complete-response rate for vomiting was also significantly increased in group B during the three periods 87% vs 79% vs 78% (p < 0.05), 82% vs 76% vs 77% (p = 0.07) and 79% vs 74% vs 73% (p < 0.05), respectively. 5% patients receiving olanzapine had grade 2 sedation although there were no differences between QTc & RBS (random blood sugar).

Conclusions

Incorporation of olanzapine into the current regimen significantly improved nausea prevention as well as the complete-response rate in HEC.

Legal entity responsible for the study

Kidawi Cancer Institute, Bengaluru, India.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Teenage and Young Adult (TYA) cancer patients bring to cancer experience several unique psychosocial circumstances. Along with illness related stressors, TYAs face rapid social, biological, and cognitive changes, rendering them reliant on their caregivers. The purpose of this study is to determine the demographic, psycho-social profile and impact of caregiving in primary caregivers of Teenage and Young Adult Cancer patients, exploring their personal narratives of the cancer experience looking back on the entire experience from diagnosis, through treatment, and beyond at a rural cancer centre in India.

Methods

Our study examines responses of 200 TYA cancer caregivers(TCGs) to pretested structured proforma including questionnaire on various aspects of care-giving between September 2016 and April 2018. Respondents must have self-identified as an unpaid primary TCG either currently or at some point in twelve months prior to study period.

Results

TCGs have diverse backgrounds and characteristics. Majority are women(66%), 78% in age group 18-49yrs and most(58%) have less than a high school certificate. Majority(60%) from rural area, 13% required change in residence and 64% from lower/upper lower socioeconomic status. On average, TCGs help their recipient with 5 out of 9 activities of daily living(ADL) and 82% of TCGs required help with key activities. Health status reported as fair/poor by 36%. On average, 32% reported anxiety levels, whereas depression, fatigue and sleep disturbances reported by 25%,37% and 34% respectively, each of 3 on a 5 point scale. 22% reported as not satisfied with their social activity. These factors led to delay in diagnosis in 8%, delay in treatment initiation in 10%, non-adherence to treatment in 10% and 6% abandonment rate.

Conclusions

To date, there is a dearth of research examining effects of providing care for a TYA with cancer in developing countries, and India in particular, where family members are more important resource for healthcare. TCGs data are vital for development and implementation of future programs to improve caregiver and patient health throughout the care trajectory.

Legal entity responsible for the study

Department of Medical Oncology, Sri Aurobindo Institute of Medical Sciences.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.