key: cord-0005087-uje7bwrw
authors: nan
title: Abstracts for MASCC/ISOO Annual Meeting 2019
date: 2019-05-18
journal: Support Care Cancer
DOI: 10.1007/s00520-019-04813-1
sha: aeb9146863243875e24500cfa2fbe4a3ff314a4d
doc_id: 5087
cord_uid: uje7bwrw

nan

in the ambulatory setting. Patients themselves do not always mention their symptoms, because they are afraid of getting medication or distracting their oncologist from the anticancer treatment. Professionals do not always recognize symptoms because they do not systematically monitor them. Symptom assessment commonly takes place retrospectively, relaying on patient recall. As a result, adequate adjustments of symptom management are often delayed, resulting in symptom burden and less than optimal care and quality of life. The relevance of this problem is reinforced by the fact that cancer treatments are increasingly provided in the ambulatory setting. Patients stay at home for most of the time and they have to take a more active role themselves in monitoring and communication about their symptoms. They should be able to recognize symptoms in a timely manner and they need to know what to do. The internet offers the possibility to monitor patient-related symptoms in real-time and the opportunity to enhance patients' self-management skills. Various eHealth applications exist to monitor patients' symptoms, or to enhance the mutual communication between patients and health care professionals. However, it is hard to implement such systems in daily practice. It is important to know patients' opinions about eHealth applications, what are the barriers and facilitators of patients regarding the use of eHealth to monitor their symptoms when they are at home.

Personalizing Virtual Environments through Immersive Virtual Reality: The Patient Perspective on Achieving the Goal of Patient-Centeredness A. Charalambous 1 1 Cyprus University of Technology, Nursing, Limassol, Cyprus

To evaluate whether VR imaging application of virtual environments provide a more effective treatment of mood disturbances experienced by cancer patients during chemotherapy sessions over Guided Imagery.

A secondary aim of this study was to elicit the patients' perceptions on the intervention's level of patient-centreness.

This was a randomised, double blind crossover trial with 40 patients. Eligible patients were those in active treatment requiring to receive intravenous chemotherapy within the cancer care setting. Eligible participants were able to speak and understand Greek and they had given written informed consent. Participants should also have a score of >60 on the POMS total mood disturbance scale, a >50 on the Karnofsky Performance Scale Index and a mean of >50 on the Attentional Function Index (AFI). Patients were excluded if they were diagnosed with brain tumours (due to seizures), receiving palliative care, they had an impaired cognitive ability or they had an impaired visual ability. Data were collected with the POMS, and FACT-G. Patients' perceptions on the individuality of the intervention were collected through open ended questions.

In regards to patients' perceptions, they reported that these intervention was something that covered their needs and expectations during chemotherapy. Explicitly, this was achieved through 3 identified themes: "Relaxing Experience", "Altered perception of time" and "Distraction from the hospital environment". Conclusion VR is an efficacious tool, can highly correspond to patients' expectations and preferences, compares favorably to comparison conditions such as Guided Imagery, and has lasting effects that generalize to the real world.

Using Patient-Reported Outcomes for Patient Decision-Making D. Berry 1 1 University of Washington, Biobehavioral Nursing and Health Informatics, Seattle-WA, USA Patient-report of subjective data is not only useful in monitoring status after cancer therapy, but also for tailoring relevant information for newly diagnosed patients. The Personal Patient Profile-Prostate (P3P) is a webbased intervention consisting of a query component in which patientreported variables are collected and an intervention component in which the patient-reported data drives the focus of a decision aid. The development of the P3P included qualitative and quantitative descriptive research which identified the influential factors brought forward by men soon after diagnosis. The P3P has been shown efficacious, reducing conflict associated with decision making for localized prostate cancer, in two national randomized trials. Available to the public free of charge at: p3p4me.org

Using a Community-based, Nurse-led Cancer Information and Support Line to Deliver Phone-based Supportive Care Interventions: An Australian Experience K. Lane 1 1 Cancer Council Victoria, Cancer Information and Support Services, Melbourne, Australia

Evidence shows that distress or persistent unmet needs can significantly impact an individual's ability to cope and indeed live with and beyond a diagnosis of cancer. Current guidelines for supportive care screening in people affected by cancer recommend pathways based on individual's levels of distress at any given timepoint in their trajectory, and it is well acknowledged that nurses play a critical role in the assessment and delivery of effective supportive care interventions. Whilst several approaches to screening have been trialled in clinical settings, we know that there are varying levels of implementation, adherence and follow up.

In a time where clinical services are stretched, and capacity is challenged, there is an increasing and demonstrated need for the integration of referral pathways to Non-Government and Not-For-Profit cancer support organisations to help meet the needs of cancer patients, their carers and families. Similarly, these community-based services have a responsibility to provide supportive care services that are dynamic, responsive, evidence-based and able to meet these identified needs in an innovative and sustainable way. This presentation will profile Cancer Council's experience in an Australian context of utilising oncology nurses who staff the Cancer Council 13 11 20 Information and Support line to deliver nurse-led, phone based supportive care interventions for people affected by cancer. Two interventions will be discussed including the Healthy Living after Cancer program, and the START trial, which looks at the use of distress screening and structured care to improve the uptake of services as a complement to clinical care.

M. Aapro 1 1 biosimilars is significantly more complex than the development of small molecule generic drugs, which have also been cause of some concern in the past. There seems to be a need to explain better about the principles of biosimilar development and approval, based on a 'totality of evidence' approach. Properly manufactured, to the correct standards, and used appropriately (with both the physician and patient being well informed), biosimilars can positively impact the financial sustainability of healthcare systems. Aapro M. Biosimilars in oncology: much ado about nothing? Ann Oncol. 29 (1) Biosimilars in Supportive Care Biosimilars have been used in the supportive care of cancer patients since 2007, beginning with the introduction of the biosimilar haematopoietic growth factors epoetin and filgrastim and followed more recently by biosimilar infliximab, used for the treatment of immunotherapy-induced colitis. These products have been shown to improve access to safe and effective supportive care at a lower cost, delivering budgetary savings which can be invested in innovative new cancer treatments. In spite of this, there are differences in the uptake of biosimilars around the world due to challenges such as lack of product availability, funding arrangements or clinician acceptability. This session will reflect on the UK experience of biosimilar adoption in the supportive care setting, compared to the findings of a recent survey conducted by the International Society of Oncology Pharmacy Practitioners (ISOPP) on biosimilar implementation practice worldwide. Current guidelines on the use of biosimilars Biosimilars present a necessary opportunity for physicians, patients, payers and healthcare systems. With the emergence of biosimilars worldwide, guidelines are much needed to ensure the proper usage of these group of drugs. There are many guidelines available at the moment, namely the European Medicines Agency (EMA) which has as overarching guidelines on biosimilars. These guidelines outline the quality, non-clinical and clinical data requirements specific to biosimilar drugs. The World Health Organisation (WHO) also has guidelines on biosimilars, which provide globally acceptable principles for licensing biotherapeutic products and can be adopted as a whole or partially by National Regulatory Agencies worldwide. The British Oncology Pharmacy Association (BOPA) has a position statement for the use of monoclonal antibodies. The European Society for Medical Oncology (ESMO) also has a position paper for biosimilars. Many countries have biosimilar guidelines which includes the USA, Canada, Europe, Australia and many countries in Asia and South America. According to the US Food and Drug Administration (FDA), once a biosimilar has been approved by the FDA, patients and health care providers can be assured of the safety and effectiveness of the biosimilar, just as they would for the reference product.

With potential savings and an increasing number of biosimilars on the market, national health authorities can potentially adopt other new innovative medicines and thus biosimilars do represent one of the ways forward to obtain financial sustainability.

Overview of the Issues This was constructed to provide context for the presentations to follow. Current definitions of both cancer survivorship and AYA cancer survivors will first be presented followed by views expressed in regarding the age categorization often used to bracket this widely heterogeneous group of cancer survivors. The global epidemiology with reference to incidence, mortality, and age will then be provided. The world-wide burden of cancer in AYAs will be followed by a careful consideration of the world's literature on major concerns of AYA survivors as determined in their own words. No conflict of interest

The Impact of Cancer on Adolescent and Young Adult Survivors' Work-Related Issues

Takahashi M. 1 1 Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Japan

Work is an essential component in the quality of life of cancer survivors, including those of the adolescent and young adult (AYA) generation. The impact of cancer on work may vary based on the survivor's age at which the cancer is diagnosed. A cancer diagnosis while attending school may disrupt schoolwork and alter the student's readiness for employment and for choosing an occupation. It also impacts first-time job seeking. Even when young adult survivors hold a job, their cancer diagnosis may affect continuation of work and further career development. Work is also an area in which healthcare providers cannot act as 'specialists.' Support for AYA survivors who want to work should be comprehensive and multi-level; various stakeholderssuch as family, school, workplace, and governmental administration-should work in co-operation, and healthcare providers need to act in co-operation with these stakeholders. This presentation reviews the impact of having cancer on AYA survivors' work-related issues, particularly job seeking and continuation of work. It also introduces examples of multi-level support activities in Japan for addressing AYA cancer survivors' work-related unmet needs, and discusses universal implications of those activities.

& Geriatric Assessment in Day To Day Practice

Oncology teams have limited knowledge of the aging and cancer interface, leaving the needs of older adults often unmet, leading to poor health outcomes. Multidimensional screening and assessment is key to identifying and addressing concerns. Comprehensive geriatric assessment (CGA) process can address the needs of older adults through the process of screening, assessment, implementation of interventions, and reassessment. Conducted by a multidisciplinary team, the CGA assesses for frailty, geriatric syndromes, comorbidities, cognition, nutritional, functional, and psychosocial status, to assist in providing recommendations to reduce over and under treatment. Research has demonstrated that after CGA, 39% of treatment plans were modified, supporting the need for CGA in oncology settings.

The presentation objectives as follows:

1. Discuss CGA as an approach to informing recommendations for personalized cancer treatment and supportive care plans. 2. Provide an overview of geriatric oncology screening and assessment tools, highlighting those most relevant to oncology practice. 3. Provide insight regarding how to introduce geriatric oncology into day-to-day practice through case presentation.

Oncology nurses have a crucial role in the cancer care of older adults, as the effectiveness of the CGA process lays within a well-established follow-up plan. Shifting care models toward proactive approaches enhances the oncology care of older adults through care facilitation, close monitoring, assessment, and care facilitation. Conclusion Impact of geriatric assessment in day-to-day oncology practice supports older adults with cancer and their caregivers for better health-related outcomes. Geriatric oncology education and training is imperative to advance cancer care for older adults.

Polypharmacy and potentially inappropriate medications (PIM) are prevalent in older adults with cancer but associations with outcomes are understudied. We evaluated the optimal cut-off value for polypharmacy, and examined the association of polypharmacy and PIM with physical function in older adults with cancer. Methods Secondary analysis of baseline data of a randomized study enrolling patients ≥70 with advanced cancer receiving a new chemotherapy line (URCC 13059; PI: Mohile). Prescription and non-prescription medications were captured prior to chemotherapy. PIM were categorized using 2015 Beers criteria. One objective and 3 patient reported functional measures were assessed: 1) OARS Physical Health (PH), 2) Time Up and Go (TUG), 3) Activity of Daily Living (ADL), and 4) Instrumental Activity of Daily Living (IADL) ( Table 1) . Optimal cut-point for polypharmacy in relation to functional measures was determined by maximizing Youden's index. Multivariate stepwise logistic regressions were performed to examine the association of polypharmacy and PIM with physical function, adjusting for relevant covariates.

In 439 patients (mean age 77), Youden's index identified ≥8 medications as the optimal cut-point for polypharmacy; 43% had ≥8 medications and 62% had ≥ 1 PIM. On multivariate analysis, being on ≥8 medications was associated (P<0.05) with PH, TUG and ADL impairments. PIM was associated with PH and IADL impairments. A cut-off of 5 medications was not associated with functional measures ( Table 2) .

In this cohort, defining polypharmacy as ≥8 medications identified patients with functional impairment. Future studies should evaluate if decreasing polypharmacy and PIM will improve physical function in this population.

Radiation therapy is offered to half of all cancer patients and in the realm of head and neck cancer, it can be given either following initial surgery or as a curative intent treatment on its own. The techniques used to plan and deliver radiation therapy have evolved dramatically since the mid-1990s, benefiting from rapid parallel developments in radiologic imaging and computational capacity and algorithms. Modern radiation therapy is typically delivered based on a highly precise, volumetrically calculated, intensity-modulated radiation therapy (IMRT) plan. Head and neck cancer, because of the sensitive anatomic structures that are usually located in very close proximity to tumor targets, is a special case that demands exceptionally complex radiation planning and delivery. Excellent functional outcomes are a major goal in addition to cancer cure. The development of patient-reported outcomes and functional assessments capable of cataloguing the effects of radiation therapy more accurately are important to better understand the effects of treatment. Major national and international consortia have made concerted efforts to assess and reduce of the toxicity of head and neck cancer radiation therapy. Practical efforts have included standardization of dose prescriptions and target delineation guidelines across groups. There has also been substantial clinical trial development to support evolving approaches such as novel systemic therapies, novel sequencing of therapies, or personalization of therapeutic intensity based on validated biomarkers. Promising recent technical developments include planning based on positron-emission tomography (PET) or magnetic resonance imaging (MRI) and the increasingly sophisticated investigation of proton therapy and other particle therapies.

O. Palesh 1 1 Stanford University, Psychiatry and Behavioral Sciences, Stanford, USA

The Circadian Timing System (CTS) coordinates major physiological processes and synchrony between hormonal, behavioral and autonomic nervous system functions. Circadian disruption associated with shift-work has been implicated in higher incidence of hormonally-driven cancers and is considered to be a carcinogen by the World Health Organization. Emerging evidence suggests that circadian rhythm disruption is common in cancer patients, and the precise mechanisms behind circadian disruption and tumor growth are currently being investigated by several research groups. Additionally, circadian disruption may contribute to increased symptom burden. Sleep-wake disruptions (e.g., insomnia), reduced quality of life, glucose dysregulation, lowered immunity, and cardiac symptoms are among many that are linked or associated with disrupted circadian rhythm in cancer patients. In spite of the mounting evidence supporting the link between circadian rhythm disruption and poorer overall health, few interventions have been developed to specifically focus on addressing and regulating circadian rhythm. Chronotherapy and chronorehabilitation interventions will be discussed and future directions will be offered.

The Truth Is Out There! Untangling the Evidence Around the Anticancer Effects of Anticoagulants The coagulation pathway and the dissemnination of metastases are inextricably linked through tissue factor/ thrombin mediated mechanisms. For many years there has been in vitro and invivo data suggesting antithrombotics have anticancer effects, more specifically act by inhibiting the haematogenous spread of metastases. Furthermore, this mechanism may act as an adjunct to concommitant chemotherapy use through the inhibition of P-selectin. This presentation shall critically review the data supporting the belief that heparins in particular have a role in the prevention of cancer progression. It will consider the clinical trials which have been designed to test the hypothesis and consider the impact of cognitive dissonace in our belief that like in the X-Files "The Truth is Still Out There"

Decrements in Health Related Quality of Life (HRQOL) and sexual difficulties are a recognised consequence of prostate cancer (PCa) treatment.

However little is known about the experience of gay and bisexual (GB) men.

Chemotherapy-associated gastrointestinal side-effects such as nausea, vomiting, diarrhoea, constipation are experienced by 80-90% of patients and limit the dose of chemotherapy reducing the efficacy of anti-cancer treatment. Chronic intestinal dysfunction persists >10 years posttreatment in most cancer survivors. Persistence of gastrointestinal symptoms long after treatment suggests long-term damage to gastrointestinal innervation. We aimed to study mechanisms underlying damage to gastrointestinal innervation, and test therapies alleviating chemotherapyinduced enteric neuropathy and gastrointestinal dysfunction.

Fresh colon specimens from non-obstructive colorectal carcinoma patients treated and untreated with chemotherapeutic agents and animal models of colorectal cancer were used in this study. Intracellular electrophysiology, immunohistochemistry, in vivo gastrointestinal transit, exvivo colonic motility and secretion, qPCR and Western blot were used.

In samples from chemotherapy-treated patients we observed functional and morphological changes in enteric neurons. In animal models, damage and death of enteric neurons persisted long after chemotherapy cessation when mucosal damage has subsided. Enteric neuropathy was associated with long-term changes in gastrointestinal transit, colonic dysmotility, chronic diarrhoea (5-FU, irinotecan-treated), chronic constipation (oxaliplatin-treated), lack of weight gain and pica. Co-treatment of cancer-baring mice with oxaliplatin and novel compounds targeting oxidative stress pathway attenuated enteric neuropathy and gastrointestinal dysfunction and potentiated anti-cancer efficacy of oxaliplatin.

Our studies revealed that chemotherapy-induced oxidative stress, direct toxicity and inflammation leading to mitochondrial and nuclear damage contribute to enteric neuropathy in both humans and animal models. Our results provide evidence that treatments targeting oxidative stress pathway attenuate enteric neuropathy and gastrointestinal dysfunction without reducing efficacy of anti-cancer treatment.

Fatigue is the most common symptom experienced by oncology patients and demonstrates a large amount of inter-individual and diurnal variability. While stress has significant negative effects on physical and emotional well-being, little is known about the effects of stress on fatigue severity. The objective was to evaluate for differences in stress measures among patients with distinct morning and evening fatigue profiles.

Outpatients (n=1332) completed questionnaires six times over two cycles of CTX. Latent profile analysis was used to identify distinct subgroups using ratings of morning (MF) and evening (EF) fatigue from the Lee Fatigue Scale. Subjective measures of stress included: Life Stressor Checklist-Revised (LSC-R), Perceived Stress Scale (PSS), and Impact of Event Scale-Revised (IES-R). Differences among the latent classes were evaluated using analysis of variance.

Four distinct MF classes (Very Low (19.6%), Low (30.2%), High (39.6%), Very High (10.6%)) and four distinct EF classes (Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Patients in the Very High and High MF classes reported higher LSC-R Affected and LSC-R total scores compared to the Low and Very Low classes. Patients had higher PSS, IES-R subscale and total scores associated with increasing MF class (i.e. Very High>High>Low>Very Low) . Patients in the Very High EF class had significantly higher LSC-R Affected subscale and total scores, PSS score, IES-R Intrusion, Hyperarousal, and total scores compared to the Moderate and High classes.

First study to describe associations between acute and chronic stress and diurnal variations in fatigue in patients undergoing CTX.

Exercise is safe and effective during cancer treatment and a valid option for health care providers to address the short and long-term effects of current cancer therapy and minimize toxicities. However, nationally, less than 5% of cancer patients exercise during treatment. Therefore, the purpose of this investigation was to promote the standardization of exercise oncology as part of clinical practice by examining its effect on symptom severity, program outcome, and cost savings.

Oncokompas is an eHealth self-management application to monitor health-related quality of life (HRQOL) and to provide personalized information on and access to supportive care. Oncokompas comprises generic cancer topics and tumor-specific topics in modules targeting breast, colorectal, head and neck cancer and lymphoma survivors. The aim of this study was to assess the efficacy of Oncokompas among cancer survivors.

In a randomized controlled trial (RCT), cancer survivors (breast, colorectal, head and neck cancer, lymphoma) up to 5 years after treatment were randomly assigned into the intervention group or a wait-list control group. The primary outcome was patient activation, and secondary outcomes were health-related quality of life, self-efficacy, personal control, perceived patient-physician interaction, supportive care needs and mental adjustment to cancer. Questionnaires were administered at baseline, post-intervention and at 3-and 6-months follow-up. Linear mixed-effect models (intention to treat) were used to compare longitudinal changes in the outcomes between both groups.

In total, 627 cancer survivors participated. Significant differences between the intervention and control group over time were found on HRQOL (EORTC QLQ-C30 Summary score and subscale Diarrhoea). Furthermore, effects of Oncokompas were found on several (tumorspecific) topics in survivors of head and neck cancer (Emotional function, Fatigue, Dyspnoe, Oral pain, Swallowing, Coughing, Trismus, Social eating), colorectal cancer (Loss of appetite, Diarrhoea, Weight, Health system, information and patient support needs) and lymphoma (Constipation, Emotional impact).

In today's healthcare system, there is less time available for providers to see patients, but increasing responsibilities for both. This results in unsupported patients with poorer health outcomes, and providers with low job satisfaction and high burnout rates. As technology makes its way into healthcare, there is a fear that the communication gap will continue to widen and decrease closeness. However, fully-developed AI solutions that address intrinsic and extrinsic needs can add value by making efficient use of the time patients and clinicians have together, with the purpose of bringing them closer.

Helpsy's SAN is the world's first AI Nurse that can anticipate, educate, and escalate care for her patients using real time symptom management and care navigation. This companion app for patients enables nurse navigators to track patients in real-time.

In a Helpsy pilot, clinicians found the use of smart templates like Helpsy helpful, and made them feel more connected to their patients. On average a clinician served 2x her patient capacity with 30x more touch points with each patient. Alternatively, patients felt a lot more connected to their provider, and were engaged in their own symptom management by interacting with the chatbot regularly.

Developing technology that has deep clinical expertise and intent to do good, can be harnessed to help bridge the communication gap and improve our patients outcomes and reduce clinician burnout. The Helpsy platform is able to transform healthcare delivery so patients receive better care and can have closer, more meaningful relationships with their healthcare teams.

Juggling Career and Family While Avoiding Burnout: The Challenge of Pediatric Oncology

A. Orsey 1 1 Connecticut Children's Medical Center, Hematology/Oncology, Hartford, USA Juggling career and family while avoiding burnout: the challenge of pediatric oncology As a paediatric oncologist and a mother, Andrea Orsey will address carergiver burnout from the perspective of both the parents of her patients and as a parent oncologist. Burnout is epidemic among pediatric oncology. The emotional impact of caring for children with cancer can be overwhelming for both their families as well as their medical professionals. Juggling the care of your ill patients with the needs of your own children can be challenging and exhausting. How do we recognize compassion fatigue and burnout in the carers of our patients, in our colleagues and in ourselves? For both informal carers' and professionals, burnout and fatigue have far-reaching impacts on the quality of patient care, physical health and the wellbeing of our families. How can we preserve true wellness for our patients, their loved ones, ourselves and our own families? How can we balance the demands of our career with the needs of our family? Dr. Orsey will review strategies to identify, prevent and manage burnout and compassion fatigue among parents of pediatric oncology patients and cancer professionals. Burnout and other Challenges in Palliative Care: When you are a Survivor and Carer That moment when you are given the news: YOU have cancer, everything changes.

As clinicians, we often underestimate the impact of those three little words.

There is a tendency to separate our feelings from the work we do and the words we speak on a daily basis. This is completely understandable, because of the need for emotional and psychological boundaries. And yet, the more we deny our feelings, compartmentalizing our "work lives" and our "personal/internal lives," the less authentic our humanity. Dr. Michael Kearney states: "There is within medical and nursing education a growing body of opinion which challenges an educational approach that fosters the knowledge and skills of students, while ignoring their personal experience and attitudes as narrow and limited, resulting in patient care that may be efficient but is ultimately de-humanized and de-humanizing. At the core of this view is the proposal that there is a direct link between who we are as individuals and the quality of our work as professionals." What creative ways can we find to integrate our inner selves and our professional selves, so that we do not "burn out?" How do we maintain a sense of passion for our work and compassion for those we care for? As part of this panel I will discuss the idea of "poetic medicine" as a means to access our feelings and re-kindle our hope and purpose in our work. Soaring rates of burnout and emotional exhaustion reported by healthcare professionals have captured the attention of administrators, educators and leaders of physician groups. In this presentation we will review organizational and structural elements identified as major contributors, and focus on innovative approaches being implemented to mitigate professional stress.

Introduction Impaired immunity, stress, and reduced quality of life are common problems that affect cancer patients. Although many studies have investigated the effects of laughter on cancer-related symptoms, the beneficial evidence of laughter for cancer patients is still inconclusive. Objectives This study aimed to conduct a meta-analysis to determine the efficacy of laughter on immunity, stress, and quality of life in cancer patients.

Four electronic databases (PubMed, Cochrane Library, EBSCO, and Airiti Library) from inception until January 2019 were searched. All randomized controlled trials using laughter as a primary intervention for patients with cancer were included for this meta-analysis. The pooled effect sizes (Standardized mean difference, SMD) were calculated to determine the magnitude of the laughter. Random-effect models were used to estimate pooled relative risks. Publication bias was evaluated by Egger's test.

Of the 60 searched studies reviewed, 15 clinical trials met the criteria of this meta-analysis, but seven articles were excluded due to language limitations and different measured outcomes. Overall results revealed that laughter significantly improved immunity (SMD = 1.16, 95% CI 0.60-1.80, p < 0.001, I 2 = 60.96%), stress (SMD = 0.48, 95% CI 0.15-0.77, p < 0.01, I 2 = 32.77%), and quality of life (SMD = 0.60, 95% CI 0.26-0.96, p < 0.001, I 2 = 50.22%). Egger's test indicated no publication bias (p = 0.06).

This meta-analysis suggests that laughter is beneficial to cancer-related symptoms. Nonetheless, available research evidence is insufficient to conclude that laughter is a complementary treatment in cancer patients. 

Intravenous administration of truncated rHuKGF (Palifermin) has been permitted by FDA to treat and prevent chemotherapy and radiotherapyinduced oral mucositis. The unstable structure and short circulation time of rHuKGF are the main obstacles that reduce the bioavailability of such growth factor at the mucositis sites.

The rHuKGF incorporated chitosan nanoparticles (CNPs) were prepared by ionotropic gelation method. The molecular docking algorithm based on shape complementarity principles, FHs 74 Int cells proliferation and fluorescent microscopic studies were conducted using rHuKGF-CNPs. Further, the prepared rHuKGF-CNPs was lyophilized and filled in the kolicoat coated capsules for oral delivery. The pharmacokinetics parameters of rHuKGF were determined using rabbits as an animal model following single oral or IV administration of the prepared formulations.

The molecular docking algorithm based on shape complementarity principles revealed that rHuKGF and rHuKGF-Chitosan complex strongly binds to the FGFR2b (1NUN, RCSB PDB) receptor shown in Figure. Fluorescent microscope image of rHuKGF-CNPs tagged with fluorochrome and rhodamine 6G confirmed that CNPs could deliver the loaded rHuKGF to the intercellular compartments of the FHs 74 Int cells. The MTT assay results shows that significant increase of the proliferation rate of FHs 74 Int cells compared with the positive control, p < 0.05. The absolute bio-availability of orally administered enteric capsules filled with rHuKGF oaded CNPs, using rabbit as animal model, was found to be 69%.

Gastrointestinal mucositis remains a significant obstacle in the provision of optimal cancer care. Whilst the microbiota has received significant attention for its therapeutic potential, the exact microbial traits linked with treatment outcomes remain unclear.

We therefore aimed to 1) characterise the pre-treatment microbiota of patients scheduled to receive chemotherapy to identify microbes associated with treatment outcomes, and 2) investigate identified microbes in vitro.

Patients undergoing standard-dose chemotherapy were protectively recruited from the Royal Adelaide Hospital. Stool was collected on the day of chemotherapy. Clinical case notes were used to determine clinical toxicity scores. 'Toxic' patients were defined as Grade III/IV diarrhea. Microbial composition was assessed by 16S rRNA sequencing. Bacterial supernatants (SPNs) were prepared by centrifuging anaerobic cultures. SCFA profiles were determined by GC-HPLC. Human T84 cells were used for all in vitro experiments. Results 12 patients were recruited, 4 of which were defined as toxic. Bacteria belonging to the Blautia genera were significantly higher in patients that did not develop toxicity (*P=0.018), with Blautia luti (BL) strongly correlating with toxicity outcomes (R2=-0.744**). BL preferentially produced acetate, with no other detectable SCFAs. BL-SPN increased T84 proliferation and enhanced T84 trans-epithelial resistance.

These results reinforce the emerging role of the microbiota in the development of GI toxicity. Unlike previous studies, we demonstrate the importance of an individual's pre-treatment microbiota in determining the outcomes of treatment, with Blautia luti protecting against toxicity development potentially by promoting mucosal recovery and intestinal barrier function. Further investigation is now warranted for therapeutic translation.

Venous thromboembolism (VTE) is an important complication of cancer. The initial intravenous heparin followed by an oral anti-coagulant is one of the standard treatments for VTE. Since direct oral anticoagulants (DOACs) were introduced, single drug therapy with DOAC is becoming an alternative treatment because of freedom from heparin injection. However, the safety and efficacy of edoxaban, one of the DOACs, as a monotherapy has not been well evaluated.

We retrospectively reviewed 83 VTE patients with cancer who were treated with edoxaban in our hospital from January 2008 to December 2017. The patients were classified into two groups, treated with edoxaban alone (E) and those treated with heparin followed by edoxaban (H+E). Disappearance of VTE, VTE-related death, and major bleeding events were assessed. Differences of two groups were analyzed by chi-square test and Fisher's exact test as appropriate.

The patient's characteristics were as follows; group E/H+E = 64/19, female/male = 39/44, and median age 70 (range 27-87). Disappearance of VTE was confirmed in 16 (25%) of group E and 5 (26%) of group H+E (p = 0.908). There is no VTE-related death in both groups. Major bleeding events were confirmed in 4 (6%) of group E and 1 (5%) of group H+E (p = 1). There were no statistically significant differences of the safety and efficacy between group E and H+E.

Edoxaban monotherapy is as effective and safe as heparin combination therapy. VTE patients with cancer may receive benefit by sparing heparin injection.

Empowering cancer patients for non-pharmacological primary prevention and early recognition of cancer-associated venous thromboembolism (VTE): the EMPATIC-CP survey.

Venous thromboembolism (VTE) is a leading cause of death and morbidity in patients with cancer. The aim of the present study was to explore the current practices regarding non-pharmacological primary VTE prevention and education for early recognition of potential VTE-related symptoms in cancer patients. Methods A specific electronic questionnaire was designed to assess the current practices in a sample of 52 Medical Oncology Departments from different healthcare institutions in Spain.

The preliminary data from 30 centres were analysed. Education specifically addressed to recognizing alarm symptoms for cancer-associated emergencies was routinely performed: always (48%) or only for specific situations (52%). The rates regarding specific patient education programmes for primary prevention and early recognition of VTE were: never (18%), always

Oxaliplatin frequently induces severe neuropathy which results in treatment discontinuation and impacts on patient's quality of life. This was the first trial to investigate ART-123 effect in preventing OIPN. Methods pStage II/III colon cancer patients planning mFOLFOX6 as an adjuvant chemotherapy were randomly allocated to PLACEBO (placebo polysorbate on day1-3), 1-DAY ART (ART-123 380 U/kg on day1 and placebo on day2 and day3), and 3-DAY ART (ART-123 380 U/kg on day1-3) group in a double-blind manner. Study drug was given intravenously for 30 minutes once daily before oxaliplatin administration. Neuropathy was evaluated using FACT/GOG-NTX-12 (range: 0-48, lower score indicating severe symptom) and NRS (range: 0-10, higher value indicating severe pain) by a patient, and NCI-CTCAE by a physician. FACT/GOG-NTX-12 and NRS were assessed at baseline, day1 and day8 of every cycle, and day15 and day43 of Cycle12. NCI-CTCAE was assessed at baseline, on day1-3 of every cycle and day15 and day43 of Cycle12.

Eighty patients were randomized and 79 patients (PLACEBO n=28, 1-DAY ART n=27, and 3-DAY ART n=24) were received study drug and analyzed. FACT/GOG-NTX-12 score showed both 1-DAY ART and 3-DAY ART had less severe neuropathy compared to PLACEBO. Same trend favoring ART group was observed with NRS. The cumulative incidence of NCI-CTCAE Grade2 or higher in sensory and motor neuropathy were numerically less in ART group compared to PLACEBO. No substantial difference in adverse events observed.

Introduction FN and its complications remain a major problem in CT-treated patients irrespective of the risk of developing FN in relationship to the given CT. Moreover, there are indications that the G-CSF prophylaxis may be effective even when the risk of FN is low. Papaldo et al. suggested, in a retrospective study, that a limited number of G-CSF administrations might be as effective as standard regimens in patients with low risk of FN.

We compared 2 injections of Tevagrastim to no prophylaxis in breast cancer patients receiving a first course of adjuvant or neo-adjuvant chemotherapy. Female patients, aged <65, were randomly allocated to receive Tevagrastim (300 or 480μg) on Day+8 and Day +12 after CT or to a control approach without prophylaxis. Results 110 patients were included between 15/6/2012 to 25/5/2018; this trial (initially planned to include 71 patients per arm) had to be discontinued due to radical changes regarding G-CSF prescription in Belgium early in 2018. Among the patients who received prophylactic G-CSF after CT(53) we observed 2(3.8%) cases of FN while among those allocated to the no-prophylaxis group (57) 5(8.8%) episodes of FN were observed. The difference is not statistically significant (p=0.44). The overall incidence of FN in this trial was 6.4% (95% CI: 2.8%-13.1%).

Our trial failed to confirm the Papaldo's observations suggesting that a limited number of G-CSF prophylactic administrations would be beneficial in patients treated with CT regimens associated with a low risk of FN. Overall, the incidence of FN in our population was very low (6.4%).

Despite the development of new targeted anticancer treatments and immunotherapy, febrile neutropenia (FN) due to myelosuppressive chemotherapy is still a common potentially life-threatening complication in daily oncology practice. The aim of the present study was to assess the rate and clinical and microbiological characteristics associated with FNrelated mortality in our setting.

We reviewed the clinical features and microbiological strains of consecutive patients with FN related to chemotherapy for solid non-hematological tumors in a general tertiary care urban hospital (January 2012-December 2018). In each patient, one single FN episode was randomly selected.

In 521 consecutive patients (45% men; mean age: 61 y), 596 FN episodes were analyzed. Thirty-one patients died due to FN-related complications, with an overall FN-related mortality rate of 5.95% (CI 95%, 3.96% to 8.04%) which remained stable during the study period (4% in 2012; 3% in 2013; 5% in 2014; 6% in 2015; 6% in 2016; 6% in 2017; and 6% in 2018) . Specific infectious agents were identified in 17 out of 31 (54%) patients who died including 7 positive blood cultures for Gram-negative bacilli (4 multisensitive Pseudomona aeruginosa, 2 multisensitive Stenotrophomona maltophilia and 1 extended spectrum beta lactamaseproducing Escherichia coli), 1 sputum isolation of Haemophilus influenza, 2 influenza A virus in nasopharyngeal secretions and 3 cases of invasive aspergillosis.

The mortality rate due to FN-related complications remained stable over the study period. Specific infectious agents were identified in only half of the patient who died mostly involving multisensitive Gram-negative bacilli.

Research is needed on sexual dysfunction among adolescent and young adult cancer survivors. Ten studies published since 2010 concur that survivors have elevated rates of sexual dysfunction. Eight surveyed cohorts ranging from 95 to 599 survivors, often recruited for broader studies. Response rates varied from 47% to 77%. Two studies matched survivors to sibling controls. Most included mixed cancer types, but one focused on young breast cancer survivors, one on women at high genetic risk for breast cancer, and one on men after acute lymphoblastic leukemia. Questionnaires measuring sexual function were very brief. Only two studies utilized questionnaires considered gold standards, making it difficult to estimate rates of specific sexual dysfunctions. Prevalence of dysfunction appears to increase with aging and may be correlated with measures of physical health or emotional distress. Women report more sexual dysfunction than men.

Only two pilot studies have examined interventions to improve sexual health in this population, both demonstrating feasibility. Programs in the United States for Adolescent and Young Adult (AYA) patients typically have oncofertility education and referral, but only a minority offer special services for sexual health. Every patient should be asked about sexual problems and staff experts should be trained to do assessments. Multidisciplinary treatment is important. Psychosocial factors often include damaged body image, social isolation, and fears about dating. Unintended pregnancy and resorting to emergency contraception are too common among young women. On the medical side, hypogonadism in men and premature ovarian failure in women are major contributors to sexual dysfunction.

The negative impact of cancer on sexuality is widely known. In adolescents and young adults with cancer (AYAs), treatment can even have a bigger impact as it interfere with sexual development. AYAs report unmet psychosexual needs. Inadequate support from physicians and lack of information regarding sexuality-related issues may contribute to unmet needs. The aim of this study was to explore AYAs view on information received regarding sexuality-related issues, to determine what information patients want and the optimal timing to discuss sexuality-related issues.

Methods 39-item questionnaire was developed in co-creation with AYAs. The questionnaire was administered among AYAs(15-39 years) who attended Dutch AYA congress and members of secured Dutch AYA online community in March 2018.

The questionnaire was completed by 56 AYAs, mean age of 29. 4(20-41) at the moment of the questionnaire. Three-quarter of them reported sexuality-related issues as result of cancertreatment. Information regarding these issues was considered as important by 91%. 41.1% did receive information from a professional. 79% of this group was unsatisfied with

Malnutrition is a common complication in children with cancer. Few studies have compared the dietary intakes between children with solid tumors and healthy controls. This study aimed to compare the dietary intakes between children with solid tumors after completing chemotherapy and healthy controls. Methods Children (7-18 years) with solid tumors were recruited during year 1 after completing chemotherapy. Healthy controls were recruited via flyers. Children completed the Block Kids Food Screener for dietary intakes in the past week. Mann-Whitney U tests were conducted to answer the research question.

Forty-nine children (25 cancers/24 controls) were analyzed. No differences were found in age, race, sex and BMI levels between two groups. For macronutrient intakes, children with solid tumors reported significantly higher mean daily intakes of calories (1503kcal vs 1059kcal), protein (63g vs 45g), fat (63g vs 44g), carbohydrate (176g vs 123g), and fiber (13g vs 8g) than controls. No differences were found for energy ratios (%kcal) of protein (17% vs 17%), fat (37% vs 38%) and carbohydrate (48% vs 46%) between two groups. Children with cancer also reported significantly higher mean intakes of antioxidant nutrients: vitaminE (4mg vs 3mg), vitaminC (88mg vs 57mg) and selenium (72mcg vs 52mcg).

Children with cancer reported significantly higher intakes of macronutrients and antioxidant nutrients than healthy children, but no differences in major energy ratios. Higher dietary intakes among cancer children may be due to fatigue and weight change associated with cancer and cancer treatment. Future work should explore associations between dietary intakes and fatigue and weight change.

Pain and dysphagia are substantive factors in the quality of life of head and neck cancer (HNC) patients. Preliminary evidence exists that gabapentin can be effective for the management of some HNC-related pain. We have undertaken a randomized trial in HNC patients undergoing primary or adjuvant concurrent chemoradiation therapy (CCR). The primary outcome is pain with exploratory outcomes being measured via the Vanderbilt Head and Neck Symptom Survey+ Generalized Symptom Survey (VHNSS+ GSS). We report the interim analysis of the exploratory endpoints. Because pain is the primary outcome of the study, it will not be reported until the study is completed. Methods HNC patients planned for CCR were randomized to standard management or standard care plus escalating doses of gabapentin as tolerated up to 900 mg thrice daily. Participants completed the VHNSS+GSS weekly during treatment and quality of life assessments at baseline and end of treatment.

Data from 71 patients (5.5 average surveys completed) were included. The gabapentin arm experienced a reduction in overall systemic symptoms as measured by the GSS (11-items, p=0.0073), fatigue (two-items, p=0.013), sleep disturbance (five items, p <0.0001), neurosensory eating (3 items, p=0 .026), phlegm-related symptoms (4 items, p=0 .004), and trend to better smell (2 items, p=0.055) .

This analysis suggests that gabapentin may be useful for mitigating local and systemic neuropsychiatric symptoms in patients undergoing CCR. Further studies specifically targeted at these exploratory findings are warranted.

Fixed-Dose 7.5 mg Rasburicase Is Safe and Cost-Effective in Preventing Tumour Lysis Syndrome in Adult Haematology Patients at University College London Hospitals (UCLH) NHS Trust

Haematological malignancies with a high tumour burden and/or cell turnover are at risk of tumour lysis syndrome (TLS) which is an oncological emergency. Rasburicase prophylaxis is recommended for patients at high risk of TLS development (Cairo et al 2010) and the licensed TLS prophylactic and treatment dose is 200micrograms/kg/day. At UCLH Rasburicase prophylaxis is recommended at 7.5mg fixed dose in high risk patients (see Figure 1 ). A retrospective audit was conducted to assess the efficacy of Rasburicase 7.5mg fixed dose in the prevention of TLS in high risk adult haematology patients.

High risk adult haematology patients who received 7.5mg Rasburicase prophylaxis over a 12-month period from April 2017 were audited. Patients were identified using electronic records and reviewed for TLS development. Cost of fixed dose Rasburicase was compared to the licensed dose. Results Fixed dose 7.5mg Rasburicase was administered to 57 high risk patients (see Table 1 ). Only 3 out of 57 patients (5.3%) developed TLS (see Table 2 ). Over 12 months at UCLH, using a Rasburicase 7.5mg fixed dose in high risk patients resulted in a 54% cost saving compared to the licensed dose (see Table 1 ).

A meta-analysis of adults who received Rasburicase prophylaxis reported 7.4% of patients (n=768) developed clinical TLS (Lopez-Olivo et al 2013) . This is similar to the incidence of TLS in our institution in high risk patients who received fixed dose Rasburicase. Prophylactic fixed dose 7.5mg Rasburicase in patients at high risk of TLS development is safe and cost-effective.

Breast cancer patients often experience multiple symptoms which negatively impact their quality of life (QOL). Patient-reported scores on symptom screening tools are used by healthcare professionals to manage QOL. The objective of this analysis is to examine which symptoms from the Edmonton Symptom Assessment Scale (ESAS) are most predictive of overall wellbeing (QOL) in breast cancer patients over the course of radiation therapy (RT).

All non-metastatic breast cancer patients completed the ESAS before, during, and after RT. Simple univariate linear regression analysis, followed by backward stepwise selection was applied to select the most significant ESAS symptoms related to overall QOL at all three time points.

A total of 1224 patients were included in the study. Before RT, multivariable analysis identified five symptoms that were strongly associated with

Despite noteworthy improvements in the outcome of children with acute lymphoblastic leukemia (ALL), treatment-related mortality (TRM) is a common cause of treatment failure. The objectives of this study were to determine the frequency, etiology and factors associated with TRM in children with ALL in a low-middle income country (LMIC). Methods An observational; retrospective, cohort study conducted in the department of Pediatric Hematology-Oncology, The Children's Hospital Lahore, Pakistan.

During the study period of 21 months, total 742 new patients of ALL were registered while 247 patients (33.28%) expired. We enrolled 159 patients who fulfilled the inclusion criteria. The incidence of TRM was 64.4%. The median age was 5 years with male-to-female ratio of 1.3:1. The most common cause of TRM was sepsis (n=126, 79.2%), followed by hemorrhagic complications (n=11, 6.9%), drug toxicity (n=4, 2.5%), tumor lysis syndrome (n=2, 1.3%) and thromboembolism (n=1, 0.6%). Fifteen patients (9.4%) expired due to progressive disease during remission induction chemotherapy. Significant factors associated with TRM were weight-for-age (WFA), primary diagnosis and reason for admission. WFA less than 25th percentile was found in 89 patients (60.1 %), commonest diagnosis was Bcell ALL (n=137, 86.2%) and majority of patients (n=109, 68.6%) were admitted for remission induction chemotherapy.

The incidence of mortality is quite high in patients with ALL in LMIC. TRM though potentially avoidable is still a significant cause of treatment failure. Infections are a major challenge in managing TRM and infection control is imperative in improving the outcome. Continued smoking after a cancer diagnosis can worsen clinical outcomes. As part of a Cancer Care Ontario province wide strategy, tobacco screening and cessation programs for cancer survivors have been implemented across all major cancer centres in Ontario since 2014. During this process, we have identified multiple myths related to tobacco cessation interventions and identified professional perceptions related to tobacco cessation for cancer survivors. In this session we will review some of the specific challenges of the oncology setting including timing of discussions, achieving institutional support and motivation towards change among front-line staff, clinicians and policy makers. We also discuss about the opt-out approach that has been implemented by cancer centres to help encourage patients to take part in cessation programs being offered and the impact this strategy has had on tobacco screening and referral rates. Specific strategies that have helped with local implementation including using a multi-disciplinary approach will be reviewed during the session. Lastly, professional perceptions and factors that motivate clinicians to encourage patients to quit smoking will be also discussed. Background Continued smoking after a cancer diagnosis is associated with poorer outcomes. Understanding factors influencing tobacco cessation and patient perceptions of tobacco can help with developing tobacco cessation strategies for cancer survivors.

Cancer survivors at Princess Margaret Cancer Centre (2012-2017) completed survey studies evaluating tobacco use, second-hand smoke (SHS) exposure, patient awareness and perceptions of the harms of continued smoking and their preferences and attitudes towards tobacco cessation.

Many cancer patients self-reported being unaware that continued smoking can result in greater cancer surgical complications (53%), increased radiation side-effects (62%), decreased quality-of-life during chemotherapy (51%), decreased chemotherapy or radiation efficacy (57%), increased risk of death (40%) and increased development of second primaries (38%). Despite this, many patients (>65%) perceived tobacco as harmful on quality-of-life, fatigue and survival and these risk perceptions were associated with tobacco cessation after diagnosis. Most patients (>95%) felt tobacco should be assessed at the first visit, were comfortable with being assessed and felt it was important for healthcare providers to be aware of their tobacco use. Patients exposed SHS were less likely (aOR 2-8) to quit smoking after a cancer diagnosis; most patients who quit, did so during the peri-diagnosis period. Many patients felt that oncologists have a role in screening, assessing and managing SHS exposure around them.

Many patients self-report being unaware of the harms of continued smoking. Risk perceptions and SHS exposure were associated with tobacco cessation after cancer diagnosis. Cessation strategies should focus on improving patient education and reducing SHS exposure.

T. Cooksley 1 1 The Christie, Acute Medicine, Manchester, United Kingdom Checkpoint inhibitors have significantly improved outcomes for patients in a number of malignancies. These treatments are associated with toxicities which stem from increased activity within T cell lineage similar to that observed in autoimmunity. These immune-related toxicities can affect virtually any organ system and are potentially fatal. The timing of the onset of the adverse events is dependent on the organ system affected and can be delayed significantly after initiation or completion of therapy. The critical first step in the emergency management of immune-related toxicities is their recognition. The increasing indications for, and usage of, checkpoint inhibitors means that more patients on these therapies will present to emergency settings. Determining if these patients have an immunerelated toxicity requires careful clinical workup and necessitates education of health care professionals working in acute care settings. Early recognition and intervention can reduce the duration and severity of the complications. This necessitates that consideration is given to the models of acute care utilised in the emergency management of patients on checkpoint inhibitors. Guidelines for the acute management of immune-related toxicities have been developed and published. The basics of treatment are to withhold the checkpoint inhibitor, supportive treatment of the organ system affected and potentially the use of immune modulating medications, such as corticosteroid therapy. This presentation will consider the emergency management of immune-related toxicities, the clinical workup of acute presentations in patients on checkpoint inhibitors and the challenges of ensuring safe care for these patients in various emergency oncology models. 

 

 


A. Bass 1 1 Hospital for Special Surgery/Weill Cornell Medicine, Rheumatology, New York, USA Rheumatological side effects of immune checkpoint inhibitors (CI) occur in only 5-10% of treated patients but can be 1. refractory, requiring long-term immunosuppression (e.g. CI-associated arthritis), or 2. life-threatening (e.g. CI-associated myositis). Half of patients with CI-associated joint pain have a condition identical to rheumatoid arthritis ("RA-phenotype") with positive rheumatoid factor and/or anti-cyclic citrullinated peptide antibody (CCP) in 60%, and a high prevalence of the RA-associated HLA-DRB1 "shared epitope". The remaining patients with CI-associated joint pain have a large-joint inflammatory arthritis (± tenosynovitis), polymyalgia rheumatica, or arthralgia without arthritis. Early treatment of high-grade "RA phenotype" CIarthritis with TNF inhibitors can help to minimize long term exposure to high-dose corticosteroids. CI-associated myositis can take an aggressive course requiring treatment with high dose corticosteroids, IVIG and mycophenolate mofetil. Anti-striated muscle antibodies are sometimes found in these patients, but myositis-specific auto-antibodies are not usually present. Cancer patients who have an underlying rheumatic disease can be treated with CI. Half of them will experience a flare of their underlying disease, and a third will experience de novo immune related adverse events (IRAE), but their overall rate of IRAE is not increased. Anti-rheumatic drugs should be held at the time of CI-initiation in order to maximize cancer responses.

Opioids for Cancer Pain -What Is the Evidence?

M. Davis 1 1 Geisinger Medical Center, Palliative Care, Danville-PA, USA

What is the Evidence for Opioids in the Management of Cancer Pain Mellar P Davis There have been 120 unique studies involving 13,254 patients with pain from cancer, yet despite numbers of studies and patients the evidence has been rated as low t o very low 1 . Why? First there are no placebocontrolled trials which seems to be an unethical approach but in fact enrichment enrollment with randomized withdrawal trials (allowing for rescue) have been done for chronic pain with a SMD 0f -0.42 (p<0.0001) (NNT 6) 2 . Cancer pain trials suffer largely from imprecision due to small numbers of participants per trial and outcomes which may not have clinical relevance such as mean differences in pain severity, pain intensity reductions of 30 and 50%. The Cochrane Reviews use no more than mild pain at 14 days which has clinical relevance because of time frame. Metaanalysis often included < 10 trials, missing data was accounted for by either including completers only or by LOCF rather than BOCF which biases responses. Many trials have > 10% missing data. Non-statistical differences were interpreted as "non-inferiority" where the absences of statistical differences do not mean there are not differences. Despite low quality evidence, 95 % of patients should have no more than mild pain at 14 days with 1 out of 10 discontinuing their opioid for adverse effects 1 . This lecture will review the evidence for individual opioids and make recommendations regarding trial design. 

Two clinical scenarios may present:

A new cancer diagnosis +/-pain in the setting of prior opioid addiction 2. Concerns around inappropriate opioid use -or diversion -in someone with a current (or past) cancer diagnosis on opioids for cancer-related pain.

The two scenarios require different approaches, but effective pain control is still possible. Current concerns about the opioid epidemic are well-founded in the wider society but lessons from other patient populations cannot automatically be applied to cancer. Experiences in various cancer sub-populations, e.g. postoperative pain, cannot be applied to metastatic disease. Good documentation is essential to protect physicians from excess regulatory zeal. There is frequent confusion between the concepts of Opioid Dependency and Opioid Addiction. Pseudo-Addiction refers to ineffective pain management leading to drug-seeking behavior as a rational response to distress. Clinicians should know the criteria for Opioid Use Disorder and Opioid Withdrawal Syndrome. Opioid management in established addiction is often complicated by simultaneous alcohol, benzodiazepine or cannabinoid use/abuse. Opioids have significant gastrointestinal and neuropsychological effects which must be considered in addition to the pain. It is also important to remember that not all pain in cancer patients is due to the cancer. Buprenorphine, methadone, naloxone, naltrexone and lofexidine are important drugs in management. They are effective and safe in expert hands. Addiction as a clinical problem occurs only in a minority of cancer patients (family members can be more problematic).

The aim of this study was to investigate the prevalence of opioid-induced constipation (OIC) using different diagnostic criteria, and specifically the new Rome IV criteria.

This was a prospective, multi-centre, observational study of 350 patients with cancer who were receiving regular opioid analgesia for cancer pain. Patients were assessed for OIC using: a) Simple question ("are you constipated?"); b) Camilleri definition; c) EAPC definition (constipation); d) Rome IV criteria; e) comprehensive Specialist Palliative Care (SPC) clinician assessment. Patients also completed the Bowel Function Index (to assess adequacy of treatment), the PAC-QOL (to assess related quality of life), and the MSAS-SF (to assess correlation between constipation and other physical and psychological symptoms).

The prevalence of OIC according to different diagnostic criteria was: -"Simple" question: 32.8% -EAPC definition: 27.7% -Camilleri definition: 59.4% -Rome IV criteria: 23.4% -SPC clinician assessment: 60.8% Of the 213 patients who were deemed to have OIC by comprehensive SPC clinician assessment, only 79 were Rome IV positive (and 134 were Rome IV negative). Thus, the sensitivity of Rome IV criteria was only 37.4%, (specificity 98%). In contrast, there was a good correlation between the SPC clinician assessment and the Camilleri definition (sensitivity 85.7%; specificity 73.2%).

Asking a simple question ("are you constipated") will miss many patients with OIC. The "gold standard" appears to be a comprehensive SPC clinician assessment, although the Camilleri definition appears to be a useful screening question. The Rome IV criteria does not appear to be a sensitive method for diagnosing OIC.

Incidence of opioid-induced constipation was reported to be between 17-88% in the literature and very important.

This study, which is a single-blind randomized controlled trial, was conducted between February 2017 and January 2018 with the participation of 204 patients with opioid-induced constipation complaint. 102 patients were assigned to experimental group and 102 patients were to control group using the previously prepared randomization checklist. Patients in the experimental group were given a 15-minute video-guided abdominal massage training by the researcher, and the patients in this group were asked to perform abdominal massage for 4 weeks, twice a day, 30 minutes after breakfast and dinner. In the control group, the standard approach of the clinic was applied. Patient Data Form, Defecation Diary, Visual Scale, Patient Assesment of Constipation Quality of Life Questionnaire were used to obtain the study data.

The study showed that abdominal massage decreases the severity of constipation, the feeling of incomplete bowel emptying, the severity of straining, the severity of anal pain and bloating (p <0.05), provides better stool consistency (p <0.05) and increases the number of defecation as well as the score of quality of life (p <0.05).

As a result, it was determined that abdominal massage application increased the number of defecation by 13% and it is an effective approach in the managing opioid-induced constipation symptoms.

M. Jefford 1 1 Peter MacCallum Cancer Centre, Medical Oncology / Australian Cancer Survivorship Centre, Melbourne, Australia

The ageing of the population, increasing cancer incidence and improved treatments are leading to a growing number of people living with and beyond cancer; that is 'cancer survivors.' The majority of survivors are aged 70 years or over and the vast majority have coexisting illnesses. Unfortunately, current models of post-treatment care are suboptimal. Survivors report significant unmet needs, including for improved symptom management, and greater levels of information and support across physical, psychosocial and practical domains. A new approach to follow-up care is needed to better meet the needs of survivors while also dealing with the challenges of provider shortages and increasing healthcare costs. Models of post-treatment care should address the holistic healthcare needs of survivors through provision of optimal cancerspecific follow up, management of comorbid conditions, and general preventive health care. Over a decade ago, the Institute of Medicine made recommendations for improved survivorship care that include surveillance and prevention of recurrence, new cancers and late and long-term effects, as well as interventions for the various issues that cancer survivors may experience. Survivors should be provided with a treatment summary and a plan for follow up, and care should be coordinated between specialists and primary care providers to ensure that survivors' needs are met. Care needs to move from a 'one-size-fits-all' approach to one that is more personalised, better utilises primary care and other available services, and supports self-management. There is growing evidence that such models are feasible, can improve patient outcomes and reduce costs.

In Australia, pilot programs to date have identified issues with sustainability of Survivorship Programs due to heavy resource requirements in the preparation of Survivorship Care Plans (SCP), documentation and communication between health professionals and services. These pilots have recommended the utilisation of IT systems to improve access, communication, collate information and reduce resource requirements. We have implemented a web based patient portal (WBPP) to create structured SCP's, enable population based research and measure long-term outcomes.

Patients complete validated screening tools at key points via the WBPP. In consultation with the patient a Clinical Nurse Consultant (CNC) will make appropriate allied health referrals and surveillance recommendations. Relevant information is extracted electronically from the patients Electronic Medical Record (EMR) into a SCP reducing the time required for the CNC to complete. The patient controls access to their information. Data collection informs resource allocation, referral and communication pathways.

100% of patients that have come through the program have registered on the WBPP. Within a 12 month periods 123 patients were introduced to the survivorship program, 97 patients completed their initial consults with 97 SCP provided. The program has been sustainable with one nurse working three 8 hour shifts/week..

The use of the WBPP offers an efficient, sustainable solution. The WBPP reduces time spent configuring SCP's and manually completing paper based questionnaires and assessments, allowing resources to be focused on patient contact and program development. Decreasing time pressure on resources through the use of an online portal will ensure sustainability of the Survivorship Program. Dysphagia is one of the most common acute and late effects of head and neck cancer therapy. This may be due to tissue damage from cancer, extirpation of neuromuscular structures critical for swallow function during primary surgery or the effects of radiation therapy. During this invited session, the pathophysiology of swallow dysfunction and methods for swallow assessment will be reviewed. The session will also provide an evidence-based algorithm for interdisciplinary management of dysphagia from a speech pathology perspective, and review proactive and reactive therapy models.

Routine early palliative care (EPC) improves quality of life for patients with advanced cancer, but may not be scalable. We conducted a phase 2 trial of STEP to plan for a larger trial.

Participants with advanced cancer were recruited from medical oncology clinics. Symptoms were screened at each visit using the Edmonton Symptom Assessment System-revised (ESAS-r); moderate/severe scores (≥4/10: pain, nausea, dyspnea, depression, anxiety; ≥7/10: fatigue, appetite, drowsiness, well-being) triggered an e-mail to a nurse, who called the patient, offering an EPC consultation. Participants completed measures at baseline, 2, 4 and 6 months (primary endpoint). Trial feasibility criteria were: i) ≥100 patients accrued in 12 months; ii) ≥70% complete screening for ≥70% of visits; iii) ≥60% of those for whom a call is triggered meet at least once with EPC; iv) ≥60% complete measures.

From 11/2016-1/2018, 116 patients were enrolled; 89/116 (77%) completed screening for ≥70% of visits. Of those receiving a call, 62% (43/69) received EPC; 3 further patients were referred by their oncologist. Measure completion was 79%/2 months, 61%/4 months, 57%/6 months. By 6 months, patients who received a call and accepted EPC had better symptom control than those deferring EPC (ESAS-r-CS: -0.07±16.9 vs 11.8±13.7, p=0.02) and less deterioration in mood (change in PHQ-9: 0.4 ±3.4 vs 2.6±2.3, p=0.003); there was no difference in quality of life or satisfaction with care. Conclusions STEP is feasible in patients with advanced cancer. More than half of patients have moderate/severe symptoms, and acceptance of the triggered EPC involvement should be encouraged.

The aim is to examine whether early and systematic integration of palliative care (PC) alongside to standard psychosocial oncological care provides added benefit.

We randomly assigned advanced cancer patients with a life expectancy of one year to either early and systematic integration of PC into oncological care (intervention) or standard oncological care alone (control [4.96-6 .07], P < 0.001). The number of consultations with psychologists was significantly higher in the intervention group (Control: median =0, IQR 0-0, Intervention: median=0, IQR 0-1.75, P= 0.02).

Early and systematic integration of PC in oncological care is more beneficial for cancer patients than PC consultations offered on demand, even when psychosocial support has already been offered.

Cancer patients and survivors needs regarding discussing sexuality are frequently unmet, with many not receiving adequate information. To optimize information about sexuality and cancer, patients' perspective is needed. The goals of this study was to investigate information needs regarding sexuality-related issues of Dutch cancer patients.

The Dutch Federation of Cancer Patient Organizations (NFK) developed and conducted a nationwide 28-item online survey, regarding influence of cancer on sexuality and information needs. The survey was distributed among cancer patients and survivors in March 2017, through the 19 cancer patient organizations that are member of NFK and social media.

In total, 2657 (ex)cancer patients participated, with a mean age of 59.7. Half were male(45.2%). The majority(66.7%) stated their sexuality had changed negatively due to cancer. Of the respondents, 65% were in need of information about sexuality. Half of them (46%) did not find useful information. Most information was considered as too general. When focusing on content, patients were most in need of practical tips regarding sexual problems(60%) and experiences from others(54%). A small part was in need of a referral to a professional(16%). To make information more widely available, 57% suggested that it would be of help if care providers give information systematically, not only if asked by the patient.

This study shows that the respondents are mostly in need of practical information specific to their disease. Cancer patient and survivors prefer to get standard information by their care providers. Further research will focus on development of suitable information regarding sexuality-related issues.

Women surviving cancer value their ability to maintain sexual activity and intimacy despite physical and psychosocial impacts of cancer treatment. Studies highlight the importance of partner communication within women's sexual wellbeing interventions. The Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale is a newlydeveloped valid and reliable measure assessing women's confidence to communicate with their partner about sex and intimacy following cancer treatment. The purpose of this study was to examine predictors of SECSI scores in women treated for cancer.

Stepwise block regression was used to predict SECSI scores using secondary data analysis of survey data from 226 adult women treated for cancer. Independent variables in blocks included: 1) Dyadic Adjustment Scale and Dyadic Sexual Communication Scale, 2) Female Sexual Function Index and Female Sexual Distress Scale, 3) Generalized Anxiety Disorder and Patient Health Questionnaire, 4) cancer-related characteristics, 5) Functional Assessment of Cancer Therapy-General subscales, and 6) sociodemographic characteristics.

The model explained 57.8% of variance in SECSI scores. Two blocks contributed significant incremental variance: Block 1, adjR2= 0.55, p<.001, and Block 5, adjR2=0.59, p<.05. Individual variables of satisfaction with sexual communication (β=.59, p<.001), and social/family wellbeing (β=.34, p<.001) predicted SECSI scores.

Measures of satisfaction with sexual communication and social/family wellbeing were significantly associated, but not redundant with the conceptually unique newly-developed SECSI measure. Future research will determine clinically meaningfully SECSI scale cut point scores which may be used to guide interventions for intimate partner communication following cancer treatment.

'Enhanced supportive care' (ESC) is a new NHS England initiative that promotes better access to supportive and palliative care services in cancer centres. Implementation of ESC aims to achieve: 1. Improved patient experience / reduced symptom burden. 2. Reduction in overall healthcare costs (primarily through reduction in emergency hospital admissions). Methods 14 cancer centres across England signed up to a 3-yr ESC pilot. All adopted the 6 ESC principles: 1. earlier involvement of supportive (and palliative) care servicesall patients offered referral within 6 weeks of diagnosis of incurable cancer; 2. Supportive care teams that work together; 3. A positive approach (with rebranding from 'palliative care' to 'supportive care' or 'symptom team'); 4. Evidence-based practice in supportive / palliative care; 5. Technology in communication 6. Best practice in chemotherapy care, including management of treatment-related problems.

Analysis of data from ESC providers indicated that between 2016-2018, 500 unplanned admissions were avoided. This equated to savings of £1,967,000 ($2.5m). Outcome data showed positive changes (reduction) in IPOS scores (i.e. improved symptoms) following ESC assessment, across a range of symptoms. A retrospective single-system design study demonstrated improvement in several patient and system outcomes, many of which were statistically significant -prolonged survival, reduction in chemotherapy deferral rates, improved physical symptoms, less psychological distress and reduced 30-day chemotherapy mortality.

Data from this national ESC programme aligns with growing evidence that good supportive care, provided early to patients with incurable cancer, can improve quality of life, reduce symptom burden and benefit the health economy. The most effective models were: 1) multiple setting improved HRQoL (7 studies, SMD 0.22, 95% CI 0.10 to 0.33, I2 = 15%), symptom burden (5 studies, SMD -0.16, 95% CI -0.29 to -0.03, I2 = 0%) and home deaths (3 studies, OR 1.46, 95% CI 1.00 to 2.13, I2 = 0%) 2) Early HPC improved HRQoL (8 studies, SMD 0.26, 95% CI 0.16 to 0.37, I2 = 0%), symptom burden (7 studies, SMD -0.21, 95% CI -0.33 to -0.09, I2 = 0%) and home deaths (4 studies, OR 1.43, 95% CI 1.02 to 2.02, I2 = 0%) 3) multidisciplinary team (MDT) improved HRQoL (9 studies, SMD 0.26, 95% CI 0.10 to 0.42, I2 = 51%), symptom burden (5 studies, SMD -0.25, 95% CI -0.39 to -0.11, I2 = 0%) and home deaths (3 studies, OR 1.58, 95% CI 1.02 to 2.43, I2 = 0%). HPC did not cost more or cause harm.

HPC, particularly models that are provided early, MDT focused, and traverse multiple settings are most effective.

Are There Strategies to Improve Antiemetic Access?

M. Saito 1 1 Juntendo University, Breast Oncology, Tokyo, Japan

To provide the best antiemetic treatment to each patient regardless of availability Background and Purpose Worldwide, adherence to guidelines and accessibility to medicines varies markedly among countries, institutions, physicians and patients.

To provide the best antiemetics to every patient, regardless of individual situations, we must recognize the present status including differences in policy, drug supplies and physician knowledge and preferences all over the world.

We aimed to investigate the present situation of CINV globally, to the extent possible. We initially sought information from regulatory agencies, several world-wide trading pharmaceutical companies. The next step in our research was reviewing published articles related to drug access and adherence to guideline recommended medicines.

The information obtained from regulatory agencies and pharmaceutical companies was very limited due to their rules and territorial restrictions. On the other hand, several reports were useful for our research.

Reviewing these publications, we were able to draw a conclusion. While providing drugs is both time-and money-consuming, information such as updated guidelines is not always readily available. Once such information is obtained, awareness of what must be done rises. Until oncologists in developing countries have caught up with practices in the industrialized world, they will seek to review past evidence when resources are limited or they might be encouraged to launch trials possibly contributing to the optimization of patient care in their own countries given the resources available. My talk will present reported examples of such efforts together with considerations on how to move forward in these endeavors.

Olanzapine, Do the Guidelines Have It Right? There is no longer any dispute about whether olanzapine is an effective antiemetic hence it is included in the major antiemetic guidelines. Unlike 5-HT3 RA, NK1 RA and corticosteroids, sedation is very common with the recommended olanzapine dose (10 mg daily). Although grade 3 sedation is uncommon, lesser degrees of sedation can be important to patients as it can impair function for several days. This talk will review the evidence for efficacy, the prevalence of sedation and evidence about dose-response.

It is important to remember that the goal of antiemetic therapy is NOT to minimize nausea/vomiting but to maximize quality of life.

Despite current advances in antiemetic treatments,~50% of oncology patients experience chemotherapy-induced nausea (CIN) . The aim of this study was to evaluate for differentially expressed genes (DEGs) and perturbed pathways associated with the gut-brain axis (GBA) across two independent samples of oncology patients who did and did not experience CIN.

Oncology patients (n=709) completed study questionnaires in the week prior to their next cycle of chemotherapy (CTX). CIN occurrence was assessed using the Memorial Symptom Assessment Scale. Gene expression analyses, that controlled for significant demographic and clinical characteristics, were performed in two independent samples using RNA-sequencing (sample 1, n=357) and microarray (sample 2, n=352) methodologies. Fisher's combined probability method was used to determine genes that were significantly differentially expressed and pathways that were significantly perturbed between the two nausea groups across both samples. Results CIN was reported by 63.6% of the patients in sample 1 and by 48.9% of the patients in sample 2. Across the two samples, 703 genes were differentially expressed and 37 pathways were found to be perturbed between the two CIN groups. We identified nine perturbed pathways that are involved in mechanisms associated with alterations in the GBA (i.e., mucosal inflammation, disruption of gut microbiome).

Persistent CIN remains a significant clinical problem. Our study is the first to identify novel GBA-related pathways associated with the occurrence of CIN. Our findings warrant confirmation and suggest directions for future clinical studies to decrease CIN occurrence.

Introduction MASCC, NCCN and ASCO antiemetic guidelines recently classified carboplatin AUC ≥4 as HEC, recommending upfront triple prophylaxis (NK1 receptor antagonist (RA) + 5HT3 RA + dexamethasone). US physician concordance, and consequences for avoidable post-chemotherapy acute care, merit study.

In IBM Explorys electronic health records, we identified carboplatin courses (≥14-day cycles as proxy for AUC ≥4) and ≥7-day cycles of other HEC and non-HEC from October 2012 through August 2018. Guideline concordance (triple prophylaxis at HEC initiation) was evaluated. We assessed 30-day post-chemotherapy acute care (inpatient or emergency department) involving nausea or vomiting (NV) or eight other toxicities deemed avoidable by US Centers for Medicare & Medicaid's oncology outcome measure OP-35.

Among 11,554 carboplatin courses identified, upfront triple prophylaxis grew from 14% in 2013 to 16% in mid-2017. Rates then rose to 15%-26% following the guideline changes. In 31% of carboplatin courses we noted acute care, of which 75% involved ≥1 of the OP-35 toxicities. NV (+/acute care) occurred in 24% of courses; 27% of total OP-35 acute care involved NV. Rates for NV, and acute care after carboplatin, matched HEC chemotherapy, and exceeded non-HEC chemotherapy.

Upfront triple antiemetic prophylaxis grew marginally for carboplatin AUC ≥ 4 since re-classification as HEC, perhaps due to low awareness of the guideline changes. NV and related 30-day acute care event rates for carboplatin matched those for other HEC, validating the HEC classification. More triple prophylaxis is needed to reduce NV and NV-related avoidable acute care with carboplatin AUC ≥ 4. There is controversy about whether terminal agitation as a diagnosis exists. There are different nomenclatures and definitions about confusion and delirium as death approaches. There is varied evidence about the diagnosis and possible interventions for delirium. There is heated dispute about indications for pharmacological and non-pharmacological interventions. There are widely differing views about safety and efficacy of pharmacological therapies, many with historical use as justification. A review of the literature and gaps in knowledge will be presented with a pragmatic plan about how to manage delirium and agitation as the end of life actively approaches.

How did the introduction of Medical Assistance in Dying impacted palliative care in Canada?

Medical Assistance in Dying (MAID) describes interventions that can be provided by medical practitioners to cause death. In June 2016, MAID became legal in Canada for patients who meet pre-defined criteria. The introduction of MAID has sparked an intense debate about its impact on palliative care (PC). The study aims to qualitatively explore the impact of the introduction of MAID on PC professionals and practice.

We interviewed PC physicians and nurses who practiced for six months, or more, before and after MAID legalization in MAID accessible PC settings. Purposeful sampling was used to recruit participants with diverse personal views and experiences with MAID. Semi-structured interviews were conducted. Interviews were transcribed and analyzed using a modified grounded-theory approach.

Conceptual saturation achieved after interviewing 21 PC professionals -11 MDs and 10 nurses. Different themes emerged from PC professionals' experience with MIAD. Participants felt that MAID had created many opportunities including increasing patient's choices, encouraging open dialogue about death, higher satisfaction, improving access to PC, building strong trust in PC providers. Participants identified many themes of challenges including lack of laws clarity, blocking PC and symptoms management, lack of skilled communication, greater demands of patients and families, added burden on PC professionals. All participants cited a need for additional support resources. Many expressed reluctance to engage in individual support sessions.

The practice of PC has been affected as a result of the legalization of MAID. A better understanding of PC professionals' distress and more resources are needed to support PC providers. 

Access to medical cannabis is becoming a common request by patients and caregivers in oncology and palliative care worldwide, however health care providers (HCPs) still face critical challenges to integrate it as a complementary treatment for symptom control.

The Cannabis Pilot Project (CPP) aimed to implement a medical cannabis clinicat the MUHC and evaluate its feasibility. Referral to the CPP was reserved for patients who were already receiving supportive care but without adequate symptom relief. An interdisciplinary team was established to systematically assess patients, prescribe and monitor cannabis treatments ( Figure 1 ). The development and evaluation of the CPP was based on the Guiding Principles of Models of Care (MoC, Agency for Clinical Innovation2013).

Sixty-fivepatients have been enrolled (mean age 61 years; 52% female) in the CPP over seven months. Gastrointestinal cancer (29%) and pain (68%), were respectively the most frequent diagnosis and symptom. Cannabis products rich in Cannabidiol (53%) and oral administration (i.e. cannabis oil) (88%) were most frequently prescribed. 30.8% of patients had only a baseline visit, 27.7% 2 visits, 24.6% 3 visits, 7.7% 4 visits, 4.6% 5 visits, and 4.6% 6 visits. Up to 4 patients were seen per halfday clinic. Resources required to support direct patient care included: 3 hours (nurse), 2.7 hours (research coordinator), 2.2 hours (palliative care physician) per clinic. MoC evaluation is reported in Table 1 .

To ensure sustainability of the CPP, a transition from a stand-alone clinic to a fully integrated consultation model is recommended.

Psychosocial Consequences of Skeletal Toxicity, Fractures, and BRONJ N. Watts 1 1 Mercy Health, Osteoporosis and Bone Health Services, Cincinnati, USA Consequences of fractures due to osteoporosis may be self evident but are often underappreciated. Many fractures are painful. Most limit function of the area involved, temporarily in some cases, life-long in others. Affected patients may need help with activities of daily living (eating, dressing, continence/ toileting, transferring, and ambulation). Not so obvious are the psychosocial complications: anxiety (fear of falling, avoiding crowds), withdrawal from social activities (how long before the next pain medication), diminished self worth (feeling non-productive), anxiety and depression. These complications can lead to a cycle of deconditioning, solitude, and depression (and depression further increases the risk of fracture). It is important to recognize and try to deal with these issues when they are present. Some cancer treatments are known to increase bone loss and fracture risk (e.g., aromatase inhibitors, androgen deprivation therapy). Cancer does not protect against osteoporosis; even if treatment for cancer doesn't cause bone loss, cancer patients may already be at high risk of fracture. These psychosocial consequences of osteoporosis must add to the burden of cancer treatment and cancer survival. The good news: effective measures/countermeasures are available to prevent bone loss and reduce fracture risk. By preventing fractures, functional and psychosocial consequences can be avoided. 

Background: Fractures are a significant cause of morbidity and mortality in older adults who are cancer-free. We evaluated the effect of fractures in older patients with cancer. Methods Methods: The National Health and Nutrition Study (NHANES) assessed the health and nutritional status of the U.S. The NHANES database is publicly available. All participants provided informed consents both before the interview and examination stages. A total of 62,160 individuals participated in NHANES during 1999-2010. Our analyses included older adults (65 years of age and older) with cancer diagnosis, with a follow-up till 2011.

Results: In total, 1,718 older adults with cancer and with available follow up were included for final analysis. There were 303 participants with fractures (17.6%) and 581 deaths (33.8%) that occurred over a median follow up 4.3 years (range 0. 

C. Fabregat Franco 1 , S. Almendros Sánchez 2 , A. Navarro Martin 2 , J. González Barboteo 3 1 Catalan Institute of Oncology, Medical Oncology, L'Hospitalet de Llobregat, Spain

Radiotherapy applied to treat metastatic bone pain can produce a transitory pain worsening called flare effect (FE) . Different studies have been published trying to demonstrate the efficacy of prophylaxis with corticoids in this issue. Purpose To summarize the evidence available in efficacy and toxicity using corticosteroids to prevent FE.

We performed a peer-review systematic search (PROSPERO PROTOCOL-CRD42018090351), in COCHRANE, MEDLINE and SCOPUS databases until September 2018. Inclusion criteria included clinical trials and cohort series carried out in adult patients with painful bone metastases undergoing to radiotherapy, assessing the use to corticoids to prevent the FE. We admitted studies wrote in English, French, Catalan, and Spanish. The risk of bias was assessed by the Cochrane Collaboration tool.

Of 4393 studies there were 4 eligible clinical trials and 1 prospective cohort study. The overall incidence of FE was 28% (21% vs 37% in the prophylaxis vs non-prophylaxis group). 3 comparative studies described a relative risk reduction of 25, 67 and 72% respectively. Orally dexamethasone at 8mg-od from radiotherapy-day for 5 days was the most studied scheme and it was studied in the best designed studies. One study used methylprednisolone. No remarkable toxicity was reported.

There is strong evidence of using dexamethasone preventing FE for patients undergoing radiotherapy to treat bone metastases. The dose established would be 8mg-od of dexamethasone, from the radiotherapy day to 4 days after. New clinical trials should be performed to confirm these results as well to establish the most aproppiate dosage.

Effective Patient-Provider Communication P. Ginex 1 1 Oncology Nursing Society, Clinical, Pittsbrugh, USA Effective communication between healthcare providers and patients can have positive objective and subjective outcomes including blood pressure control, adherence to medications and improved patient satisfaction among others. Despite these benefits, effective communication does not always occur due to barriers and challenges for the providers as well as patients.

With an emerging emphasis on communication, resources are available to develop strong communication skills. Some of these resources include national guidelines, continuing education and skills training. Providers can develop their core communication skills and skills in specific conversations such as discussing goals of care, clinical trial participation, end-of-life care and costs of care. They can also learn to facilitate family and caregiver involvement in care and learn to overcome barriers to effective communication. Special populations may also require a unique skill set for the provider.

Ongoing research efforts will provide needed information on communication behaviors that lead to better outcomes and how to incorporate communication training into healthcare education. A recent study in cancer survivors found that patients with higher satisfaction had better mental health, general health and fewer office visits than patients with lower satisfaction. Information is emerging that in addition to the diagnosis, prognosis and treatment components of medical care, to help our patients achieve their best we also need to focus on caring and skilled communication. This session will focus on what we know about effective communication in oncology and how this knowledge translates to patients and providers discussing immunotherapy as a treatment option. 

This study aimed to compare the antiemetic efficacy and safety of a fourdrug combination with those of a standard three-drug combination in Japanese patients with breast cancer treated with anthracycline.

We retrospectively analyzed data from Japanese patients with breast cancer, who had received their first cycle of anthracycline and were treated with aprepitant, palonosetron, and dexamethasone with or without olanzapine. This retrospective observational study was performed at Ehime University Hospital using the electronic medical records (approval number: 1804012). Multivariable and propensity score-adjusted analyses were performed to compare the onset of complete response (CR) failure between the groups.

One-hundred and thirty patients were included in this study and the fourand three-drug group had 22 and 108 patients, respectively. The proportion of patients in the four-drug group who had CR in the overall, acute, and delayed phases was 63.6%, 68.2%, and 86.4%, respectively. This improvement was remarkably higher than that in the three-drug group (38.0%, 43.5%, and 52.8%, respectively). Similar to multivariable logistic regression analysis, propensity-adjusted logistic regression analysis revealed that the four-drug group was markedly associated with a decreased odds of CR failure in the overall, acute, and delayed phases (odds ratio (OR): 0.27, 95% confidence interval (CI): 0.10-0.73; OR: 0.28, 95% CI: 0.10-0.76; and OR: 0.15, 95% CI: 0.04-0.57, respectively). Additionally, treatment-related adverse events were well tolerated in both the groups.

These findings suggest that the antiemetic efficacy of the four-drug combination is superior to that of the standard three-drug combination. International antiemetic guidelines recommended the addition of NK 1receptor antagonists to a combination of a serotonin (5-HT 3 )-receptor antagonist (palonosetron) and dexamethasone (DEX) for the prophylaxis of nausea and vomiting in adults receiving highly emetogenic chemotherapy (HEC) or anthracycline and cyclophosphamide (AC)-based chemotherapy for cancer treatment. The analysis was conducted to integrate the effect of antiemetic treatments, such as complete response (CR; defined as the absence of emesis and rescue medication) with the cost of drugs.

The present evaluation was restricted to pivotal phase III randomized controlled trials (RCTs) of netupitant plus palonosetron (NEPA) versus (vs.) palonosetron for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in highly and moderately emetogenic chemotherapy for cancer treatment. We calculated the pharmacological costs necessary to get the benefit in CR, for each trial. The costs of drugs are at the Pharmacy of our Hospital and are expressed in euros (€).

Our analysis evaluated 2 RCTs, including 1720 patients (Table 1) . Referring to both highly and moderately emetogenic chemotherapy, NEPA plus DEX was economic superior to palonosetron plus DEX, with 13 312 € and 7885 € gain in medical costs every 100 patients treated, respectively and with 17 810 € and 10 549 € gain in total costs (medical costs plus indirect costs) every 100 patients treated with NEPA plus DEX vs. palonosetron plus DEX, respectively (Table 1) .

The combination of NEPA plus DEX is cost-effective for the prophylaxis of CINV in highly and moderately (AC-based chemotherapy) emetogenic cancer treatment.

Chemotherapy-induced nausea and vomiting (CINV) are among the worst adverse effects in patients receiving chemotherapeutic agents. This study aimed to assess incidence and predictors of acute and delayed CINV at one oncology center in a lowincome country.

An institution-based cross-sectional study was conducted from March 5 to May 3, 2018 at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. The Multinational Association for Supportive Care in Cancer antiemesis tool was employed to assess acute and delayed CINV among cancer patients. Binary logistic regression and chi-square tests were used to assess predictors of acute and delayed CINV, respectively.

A total of 151 patients were included in the final analysis. The mean age of patients was 41.64±13.68 years. Majority of them were female (68%). Acute nausea and vomiting were reported in 48.3% and 55.6% patients, respectively. Delayed nausea and vomiting were reported in 46.4% to 68.2% of individuals. Cancer type, the presence of comorbidity and residence were identified as factors independently associated with acute vomiting among patients with cancer. Delayed vomiting was associated with chemotherapy cycle (p =0.004) and the presence of comorbidity (p =0.007). Similarly, delayed nausea was associated with chemotherapy cycle (p =0.012).

Acute and delayed CINV were frequently reported among cancer patients at UOGCSH. Emetogenicity of chemotherapeutic agents was not associated with CINV. Rather, lung cancer, the presence of comorbidities, and cycles of chemotherapy predisposed patients for acute nausea and vomiting. Chemotherapy cycles and the presence of comorbidities were also associated with delayed CINV.

H. Iihara 1 , M. Shimokawa 2 , T. Hayashi 3 , H. Kawazoe 4 , T. Saeki 5 , K. Aiba 6 , K. Tamura 7

We previously reported the results of a prospective registry nationwide survey of chemotherapy induced nausea and vomiting (CINV) of patients who were scheduled for moderately or highly emetogenic chemotherapy by the CINV study group of Japan. In the present study, we investigated the frequency of CINV and risk factors for CINV in registry patients who received carboplatin-based chemotherapy.

Methods CINV data were collected from patient diaries for 7 days. Risk factors of CINV were analyzed by multivariate logistic regression models.

In total, 400 patients scheduled for carboplatin-based chemotherapy were registered. Two hundred sixty-seven patients received a 2-drug antiemetic prophylaxis regimen (5-HT3RA and DEX), and 118 received a 3-drug antiemetic prophylaxis regimen (5-HT3RA, DEX, and NK1RA). In these patients, the overall, acute, and delayed phases, the complete response, defined as no vomiting or retching episodes with no rescue medication, rates were 67.0%, 98.2%, and 67.5%, respectively. The rate of no nausea in the overall, acute, and delayed phases was 55.6%, 94.0%, and 56.1%, respectively. The rate of no vomiting in the overall, acute, and delayed phases was 81.3%, 99.0%, and 81.8%, respectively. Logistic regression analysis revealed younger age (P=0.0040), female sex (P=0.0135), 2 antiemetic regimen (P=0.0311), and lung cancer (P=0.0311) as a risk factor for non-CR in overall period.

Under medical practice conditions, adherence to the antiemetic guideline in patients who received CBDCA-based chemotherapy was quite high, but control of CINV is still inadequate. Further improvement in antiemetic treatment is needed to optimize care.

Introduction GSK-3 is a mutifunctional kinase involved in a variety of diseases. Its two isoforms GSK-3alpha and GSK-3beta are constitutively active and upon cellular stimuli turns into its catalytic inactivation by phosphorylation at ser 21 and 9. Our preliminary findings suggest a pivotal role for GSK-3 in vomiting. To investigate a role for GSK-3 in vomiting we examined: i) least shrew brainstem GSK-3α/β phosphorylation following exposure to diverse emetogens, and ii) whether GSK-3 inhibition exerts antiemetic efficacy.

Shrews were treated with fully effective emetic doses of diverse emetogens and brainstem GSK-3α/β phosphorylation at Ser21/9 was examined at several time-points post-treatment via Western blots. Other groups of shrews were pretreated with the GSK-3α/β inhibitor SB216763 (0.25 mg/kg, i.p.) to determine its antiemetic potential against different emetogens.

Increases in brainstem GSK-3α/β phosphorylation at Ser21/9 were observed following administration of the serotonergic 5-HT3 (5-HT or 2-Me-5-HT, 5 mg/kg)-, tachykinin NK1 (GR73632, 5 mg/kg)-, dopamine D2 (apomorphine or quinpirole, 2 mg/kg)-, cholinergic M1 (McN-A343, 2 mg/kg)-receptors, the L-type calcium channel agonist (FPL 64176, 10 mg/kg) and proposed chemotherapeutic thapsigargin (0.5 mg/kg, 0.5 mg/kg). This increase was further confirmed through immunostaining brainstem sections of FPL64176-treated least shrews. Moreover, the GSK-3 inhibitor SB216763 exerted potent and broad-spectrum antiemetic efficacy against vomiting evoked by the above discussed emetogens.

Our findings demonstrate a pivotal role for GSK-3 in vomiting and implies targeting signals up and/or downstream of GSK-3 enzyme may provide powerful novel avenues for developing new and potent antiemetics. 

Dexamethasone is typically administered for multiple days after the start of chemotherapy to prevent delayed chemotherapyinduced nausea and vomiting (CINV). Frequent administration of corticosteroids has been associated with problematic side effects.

Reducing the dose and frequency of corticosteroids administered during chemotherapy treatment may be beneficial in reducing the side effects experienced by patients, as long as it is possible to maintain its efficacy in the prophylaxis of CINV. The aim of this review/meta-analysis is to compare the safety and efficacy of multi-day versus 1-day regimen of dexamethasone Methods A literature search was carried out in Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials. The primary endpoints were proportion of patients achieving complete response and complete control. Secondary endpoints were percentage of patients who experienced no nausea, no emesis, no use of rescue medication, no adverse events, no constipation, no headache, and no fatigue/insomnia.

Seven randomized controlled trials were included, and a total of 659 and 649 patients were randomized to receive 1-day and 3-day dexamethasone, respectively. The two treatments were equivalent in 16 of 17 endpoints.

The aims were to update our 2014 review/meta-analysis comparing palonosetron to other 5-hydroxytryptamine receptor antagonists (5-HT 3 RAs) with respect to efficacy and safety in chemotherapy-induced nausea and vomiting (CINV), and examine the effects of the latest randomized controlled trials (RCTs) to determine whether further RCTs in this subject are required.

Articles found from literature searches in Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials were included if it reported on a primary endpointcomplete response, complete control, no emesis, no nausea or no rescue medications. A random-effects analysis model was used to generate odds ratio (OR), risk differences and accompanying 95% confidence intervals; cumulative OR assessed effect of RCTs over time.

Publication bias was also assessed.

Twenty-five RCTs were included: 4,145 patients were randomized to palonosetron and 4,911 to other 5-HT3RAs. Palonosetron was statistically superior in 10/19 endpoints but only clinically superior in 1 endpoint (emesis in the overall time phase). RCTs published within the last 4-5 years did not change the metaconclusion; it confirmed and only refined point estimates of efficacy/safety. No publication bias exists, suggesting existing literature provides an accurate/representative assessment.

Palonosetron has been extensively studied for prevention of single-day emetogenic chemotherapy. With only 1 endpoint clinically favouring palonosetron, our results support the recent M A S C C / E S M O , A S C O a n d N C C N g u i d e l i n e s i n n o t recommending palonosetron as the preferred 5-HT3RA. Analyses assessing the effect of recent RCTs reveal that studies are not adding new meta-knowledge. CINV trial resources should be dedicated to other prophylactic treatments.

Radiotherapy-induced nausea and vomiting is a common side effect of radiotherapy. Although it is well-established that nausea and vomiting have a negative impact on quality of life (QOL), the relative influence of each of symptom is reported infrequently. This study aimed to compare the effects of nausea and vomiting on QOL in advanced cancer patients receiving palliative radiotherapy.

The Functional Living Index-Emesis (FLIE) is an 18-item QOL questionnaire developed in the chemotherapy-induced nausea and vomiting setting. Three prospective studies conducted at our center used the FLIE to evaluate the efficacy of various anti-emetic medications during and after palliative radiotherapy. FLIE data from these three studies were combined for the present analysis. Univariate and multivariate analyses were conducted to assess the relationships between nausea and vomiting, time of FLIE completion, and patient-reported QOL.

Results 136 patients were included in this study. Nausea and vomiting both decreased patients' QOL (p<0.0001 for both). Multivariate modeling showed that both symptoms significantly impaired patients' ability to enjoy meals (p<0.0001 for all). Nausea was also significantly associated with increased hardship for the patient (p<0.01), while vomiting imposed more difficulty on the patients' loved ones (p<0.01).

Palonosetron has largely replaced first generation 5-HT3 receptor antagonists for the prevention of chemotherapy induced nausea and vomiting in single day chemotherapy. The aim of this audit was to confirm that chemotherapy induced nausea and vomiting is sufficiently prevented using IV palonosetron in combination with other antiemetics recommended in guidelines Methods This audit was conducted in the cancer care outpatient unit in an Australian tertiary hospital. Eligible patients who had chemotherapy with palonosetron were identified using the electronic prescribing system. Consented patients completed a questionnaire on nausea severity, emesis, rescue medications and their effectiveness from day 1 to day 5 of chemotherapy.

A total of 82 patients were included and 40 patients responded. 22 (55%), 13 (33%) and 5 (13%) patients received highly, moderately and low emetogenic chemotherapy, respectively. 32 (80%) patients received at lease MASCC recommended antiemetic regimen, but not olanzapine. Overall, one patient had vomiting and 24 patients (60%) experienced nausea (64%, 62% and 40% of patients received highly, moderately and low emetogenic chemotherapy, respectively). Clinically significant (score >=3 out of 10) nausea was experienced by 13 (33%) patients. Similar numbers of patients experienced nausea from Day 1 to 5. Rescue antiemetics were used by 17 (42.5%) patients. Metoclopramide was the most frequently used antiemetic, followed by ondansetron and Olanzapine.

Vomiting was sufficiently prevented by the recommended antiemetics including palonosetron. However, majority of patients still experienced acute and delayed nausea. 

Full-text reviews are ongoing and summarized findings will be presented. Strategies related to successful implementation of guidelines as well as barriers and facilitators will be reported. Clinical outcomes such as reduction in the incidence of both acute and delayed CINV, side effects and improvement in quality of life will be reported.

Despite clinical practice guidelines on antiemetic use in cancer care challenges remain to implementing these guidelines in practice settings. Findings from multiple studies suggest that interventions to merge the gap between guidelines and clinical practice reduces the incidence of CINV and improves emetic control in patients with cancer.

In cancer chemotherapy, there are nausea and vomiting as side effects that patients feel strongly as distress. Currently the mechanism of emesis is also clarified, but it is not yet fully controlled. For the use of olanzapine, a psychotropic drug of multireceptor action for preventing delayed nausea and vomiting after advanced emetogenic risk chemotherapy including anthracycline and cyclophosphamide in the MASCC / ESMO guideline, the antiemetic effect it is suggested that it is effective.

From April 2016 to December 2018, among surgically available primary breast cancer patients who had undergone preoperative or postoperative adjuvant therapy using anthracycline anticancer agent, 2.5 mg of olanzapine was administered as an antiemetic 29 subjects were used. For regimens using anthracycline drugs, FEC 100 therapy or TAC therapy was used.

The median age was 45 years old (30 to 61 years old). In 27 cases, improvement according to Grade (CTCAE v4.0 of nausea) was improved, 15 cases (51.7%) improved to Grade 0. No cases of oral administration were withdrawn due to adverse events caused by olanzapine.

In adjuvant chemotherapy, it is necessary to take into consideration the balance between maximum therapeutic intensity and minimal adverse reaction symptoms and try to prevent recurrence. In particular, chemotherapy-induced nausea and vomiting (CINV) is a representative side effect, and control over it has an important role in the progress of drug therapy afterwards. Olanzapine, together with a marked antiemetic effect, could help smooth progress of cancer drug therapy. Discrepancies between the various antiemetic guidelines included the addition of dexamethasone to moderate risk antiemetic regimens, the prophylactic treatment of RINV in low risk categories, and the appropriate treatment for breakthrough emesis. The guidelines were in agreement that high risk RT regimens should be treated prophylactically with a serotonin receptor antagonist. For patients receiving concurrent chemotherapy and RT, all guidelines recommended that antiemetic treatment be prescribed according to the emetic risk associated with the patients' chemotherapy regimens. The most dissension between guidelines occurred in the low and moderate risk categories. Low and minimal risk recommendations were based on low level evidence and informal consensus. Conclusions RINV is a frequent and distressing side effect of RT. Further research is needed to establish effective antiemetic guidelines and ensure optimal treatment outcomes.

Introduction management of chemotherapy-induced nausea and vomiting (CINV) remains challenging. OLN might provide several benefits over APR which is current standard of careparticularly in terms of nausea control and cost effectiveness. However, sedation associated with recommended doses of olanzapine precludes its wide use in oncology practice Methods this was randomized phase II single center study aimed to compare OLN and APR in CINV prophylaxis. Key inclusion criteria were: chemo-and radio-therapy naïve patients, planned administration of high emetogenic chemotherapy (cisplatin, carboplatin AUC≥4, doxorubicin etc). Patients were randomized 1:1 ratio in the following arms: olanzapine 5 QD day 0-4 or aprepitant 125 mg day 1, 80 mg day 2,3. All patients received ondansetron 16 mg day 1 and dexamethasone 8 mg day 1-3. Primary endpoint was complete nausea control (no nausea and no rescue medication) 0-120 hours after chemotherapy. Nausea was assessed using MASCC Antiemesis Tool. Sample size: 94 patients to increase nausea control rate from 40 to 70% (α = 0,05; β = 0,80; 10% data loss).

we enrolled 93 patients. The groups were well balanced [ 

Incidence of chemotherapy-induced nausea and vomiting was well controlled in patients receiving single-agent cisplatin with concurrent radiation. Nausea continues to be the greatest challenge when managing antiemetic medication. 

Olanzapine 10 mg added to standard antiemetic therapy including aprepitant, palonosetron, and dexamethasone has been recommended for preventing chemotherapy-induced nausea and vomiting (CINV) caused by highly emetogenic chemotherapy. Guidelines suggest that a dose of 5 mg should be taken into consideration because of sedation.

Olanzapine 5 mg showed an equivalent activity and favorable toxicity to somnolence in several phase II studies. We conducted a randomized, double-blind, placebo-controlled phase III trial to evaluate olanzapine 5 mg combined with standard antiemetic therapy for preventing CINV caused by cisplatin-based chemotherapy.

Patients receiving cisplatin (≥ 50 mg/m2) were randomly assigned to either olanzapine 5 mg or placebo on days 1-4, combined with aprepitant, palonosetron, and dexamethasone ( Figure 1 ). The primary endpoint was complete response (CR), defined as no vomiting and no rescue medications in the delayed phase (24-120 h). A total of 690 patients were required to detect a 10% increase in CR from 65% in the placebo to 75% in the olanzapine, with a one-sided alpha of 2.5% and a power of 80%.

A total of 710 patients were enrolled (olanzapine 356, placebo 354). CR in the delayed phase was 79.1% (95% CI: 74.9-83.3) in the olanzapine 5 mg and 65.8% (95% CI: 60.9-70.8) in the placebo (p < 0.001). Other efficacy results are summarized in Table 1 . The most common treatmentrelated adverse event was somnolence (43.1% for olanzapine, 33.0% for placebo).

Olanzapine 5 mg combined with aprepitant, palonosetron, and dexamethasone can be a new standard antiemetic therapy for cisplatin-based chemotherapy.

Current research has focused on vomiting as the primary problem of chemotherapy-induced nausea and vomiting (CINV). The incidence and impact of nausea is under-reported and remains a major unmet medical need.

This prospective, observational single centre study enrolled 95 pts undergoing intravenous chemotherapy, receiving guideline consistent CINV prophylaxis (GCCP). There were LEC = 25 pts, MEC = 24 pts and HEC = 46 pts. Patient diaries were used to collect data from day-1 to day-5, day-7 and day-10 beginning with cycle-1 for up to 3 cycles. Nausea was reported by the pts using a visual analog scale (VAS). Vomiting episodes were recorded in the patient's diaries and data was analysed as a secondary end-point.

The incidence of nausea of entire population was significantly higher than vomiting for cycle 1 (58% vs 14%; Chi2 22.271 p<0.0000); for cycle 2 (51% vs 14%; Chi2 26.964 p<0.0000) and for cycle 3 (46% vs 18%; Chi2 14.161 p<0.0002). Nausea was continuous in 25% of the patients in all 3 cycles. For patients with documented intermittent nausea, the mean duration was 3.8 hours. The median maximum intensity of nausea was 6 (range 1-10) for all three cycles. The median time to development of first episode of nausea was 29 hours (range 1 to 90). Significant variables predicted for nausea in cycle 1 included, age and history of morning sickness). 

Cancer patients who are scheduled to receive CDDP (≥ 50mg/m 2 ) are eligible. Patients will be randomly assigned to receive either DEX on day 1-4 or day 1 combined with NK1-RA, Palo and OLZ (5mg). The primary endpoint is complete response (CR) rate during the delayed phase (24-120hr post-CDDP administration), defined as no emesis and no rescue medications. The non-inferiority margin is set at -15.0%. We expect that CR rates would be 75% in both arms. Two hundred sixty-two patients are required for at least 80% power to confirm non-inferiority at a one-sided significance level of 2.5%. After considering the possibility of dropouts, we set our final required sample size of 280 (UMIN000032269).

As of January 2019, 18 patients patients recruited.

Conclusions NA

Combining NK1-and 5-HT3-inhibitors plus dexamethasone is effective in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC). The studyaim was to compare different agent-combinations to rank treatments according to efficacy and safety.

We systematically searched for randomized-controlled trials including adults with any cancer type receiving HEC, according to the latest definition. Outcomes of interest were complete response (CR) and complete control of nausea in acute, delayed (DP), and overall phase (OP), adverse events (AE), and quality of life (QoL). Treatment effects are given as risk ratios (RR) with corresponding 95%-confidence intervals (CI). For network meta-analyses, we used frequentist graph-theoretical approach.

Combinations of 5-HT3-inhibitors plus dexamethasone were included to strengthen the network. BMBF Grant-number: 01KG1510

Results, including 61 studies and comprising 24,900 patients and 21 treatment combinations (figure 1), showed highest CR for apre_palo during DP [RR:

1.38 (95%-CI: 1.13-1.68)] (figure 2) and OP [RR: )] compared to granisetron. Full network results will be presented during the conference. There was no discernible trend favoring any NK1/5-HT3-combination over another NK1/5-HT3-combination for AEs, QoL, and completely controlling nausea during DP and OP (figure 3). Reporting of AE and QoL was generally poor and differed between studies. Febrile neutropenia and hiccups were frequently reported side-effects.

Treatment-combinations of 5-HT3-inhibitors plus dexamethasone (5-HT3) and combinations that include an NK1-inhibitor additionally (NK1/5-HT3) are effective in preventing chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy (MEC). The study-aim was to determine whether 5-HT3 combinations are as effective as NK1/5-HT3-combinations and to rank treatments according to efficacy and safety.

We systematically searched for randomized-controlled trials including adults with any cancer type receiving MEC, according to the latest definition. Outcomes of interest were complete response (CR), complete control of nausea in acute, delayed (DP), and overall phase (OP), adverse events (AE), and quality of life (QoL). Treatment effects are given as risk ratios (RR) with corresponding 95%-confidence intervals (CI). For network meta-analyses, we used frequentist graph-theoretical approach. Pairwise meta-analyses were conducted to compare NK1/5-HT3-combinations to 5-HT3-combinations. BMBF Grant-number: 01KG1510

We included 38 studies comprising 12,705 patients and 20 treatment regimens (see figure 1 for exemplary network). NK1/5-HT3combinations compared to 5-HT3-combinations showed better CR in DP [RR: 1.13 (95%-CI:1.08-1.18)] (figure 2) and OP [RR:

1.14 (95%-CI:1.08- 1.19) ]. Results of network meta-analysis showed highest CR for apre_palo during DP (figure 3).

Reporting of nausea-outcomes, AE, and QoL was poor and differed between studies. No discernible trend favored any treatmentcombination. Generally, neutropenia and hiccups were the most frequently reported AEs.

International guidelines recommend prophylactic antiemetics and pain flare medications for subsets of patients receiving palliative radiotherapy for bone metastases. Anecdotally however, prescription rates seem variable. We hypothesized that a simple electronic quality checklist could increase the evidence-based use of these medications.

We implemented a single centre default force-function electronic quality checklist for all patients planned to receive palliative radiotherapy for lumbar spine bone metastases. We reviewed prescription rates from 6 months pre-and post-intervention. Patients were stratified according to if they were treated within a dedicated rapid palliative (RPAL) radiotherapy program or not. Khi-square tests compared rates of prophylactic antiemetic and pain flare medications pre-and post-intervention and RPAL vs not. Results 204 patients were identified with 12% treated in the RPAL program. The proportion of the 204 patients prescribed prophylactic antiemetics and pain flare medications pre-and post-intervention were respectively 31% vs 71% (p<0.001) and 26% vs 48% (p=0.003). The corresponding proportions of the 24 patients from the RPAL program were 41% vs 81% (p=0.05) and 58% vs 100% (p=0.01).

Our data shows that a simple electronic quality checklist can have a significant effect on the evidence-based use of prophylactic antiemetic and pain flare medications for patients treated with palliative radiotherapy for lumbar spine bone metastases. We believe such strategies should be routinely included in other clinical pathways to improve use of symptom control medications.

Unlike other IV NK 1 RAs, fosnetupitant solution does not require a surfactant, emulsifier, or solubility enhancer and contains no allergenic excipients. In a pivotal study, no infusion-site or anaphylactic-like reactions related to IV NEPA (fosnetupitant/palonosetron) were reported in patients receiving cisplatin-based highly emetogenic chemotherapy. Hypersensitivity reactions and anaphylaxis have been reported with IV aprepitant, fosaprepitant and rolapitant, with the highest rate (35%) reported for fosaprepitant in the AC setting. We report on the safety of IV NEPA in breast cancer patients receiving AC chemotherapy.

In this Phase 3b, double-blind study (NCT03403712) female patients naïve to highly/moderately emetogenic chemotherapy were randomized 1:1 to receive a single 30-minute infusion of IV NEPA or a single oral NEPA capsule prior to AC for 4 cycles. Dexamethasone was administered to all patients on Day 1. The primary objective was assessment of safety based primarily on treatment-emergent adverse events (TEAEs). Secondary objectives included efficacy assessments. No formal between groups statistical comparison was planned.

Results 402 patients were included in the safety population. The AE profiles were similar for the two groups; cycle 1 results are reported (Table) . Comparable overall (0-120h) complete response (no emesis, no rescue) rates were seen during cycle 1 for IV NEPA (73.0%) and oral NEPA (77.2%).

There were no IV NEPA-related infusion-site AEs and no anaphylaxis reported for either formulation. Consistent with the pivotal study, IV NEPA is safe and effective in patients receiving AC. As a simplified single-dose formulation, IV NEPA may be better tolerated than other NK1 RAs.

Chemotherapy is hypothesised to induce free radical damage that contributes to a release of 5-HT and an activation of 5-HT 3 receptors to drive the emetic response. HM01 alone, or in combination with palonosetron and netupitant, is useful to reduce cisplatin-induced emesis. However, it is not known if HM01 can prevent emesis induced by other chemotherapeutic drugs, free radicals, or mechanisms associated with elevated 5-HT levels.

Here, we explore the potential of HM01 to prevent cyclophosphamideinduced emesis and the emesis induced by the free radical generator, pyrogallol, and the selective serotonin re-uptake inhibitor, fluoxetine. 

Cyclophosphamide induced 53.7±9.5 retches+vomits that was dosedependently antagonised by HM01 (ID50~2.7 mg/kg; maximum reduc-tion~92 %, P<0.01). Pyrogallol and fluoxetine induced 69.0±21.5 and 49.8±16.6 retches+vomits, respectively. HM01 antagonised the emetic response induced by pyrogallol (ID50~2.9 mg/kg; maximum reductioñ 99 %, P<0.01), but was less effective against fluoxetine (a nonsignificant 46 % reduction was seen at 10 mg/kg, P>0.05).

The profile of anti-emetic action of HM01 suggests that a suppression of free radical production may contribute to mechanisms of emesis induced by chemotherapy. The use of dexamethasone-sparing strategy in cisplatin containing regimens has been a controversial topic in recent years. In view of this, we reviewed the prescribing trends of dexamethasone in head and neck cancer patients at our institution.

We performed a retrospective chart and medical record review of head and neck cancer patients receiving platinum-based chemotherapy between January 2016 to January 2019. We identified 68 patients in two treatment groups: low-dose 40mg/m 2 weekly regimen (n=32) and highdose 100mg/m 2 three weekly regimen (n=36). Patients treated with TPF regimen (docetaxel, cisplatin and fluorouracil) were excluded from the analysis. Our primary endpoint was complete response (CR), defined as no emesis and no rescue medications between 0 to 120 hours post cisplatin infusion.

Patients in the low-dose group typically received 12mg dexamethasone on day 1 with palonosetron and neurokinin-1 (NK1) antagonist. CR was achieved in 53% of patients in this group. In the high-dose group, patients received 12mg dexamethasone on day 1 with palonosetron, NK1 antagonist and 8mg dexamethasone on day 2 to 4 every three weeks. 62% of these patients achieved CR. The patient reported side effects such as hot flushes, ankle oedema, increased blood glucose level and mood changes were similar in incidence rates for both groups.

Dexamethasone-sparing strategy has some roles in low-dose cisplatin regimens for head and neck patients and would be worthwhile explored in further studies. Introduction MASCC antiemetic guidelines recommend upfront triple prophylaxis (NK1 receptor antagonist (RA) + 5HT3 RA + dexamethasone) for patients receiving HEC. Physicians exhibit high variation in HEC guideline adherence, principally regarding NK1 inclusion. Whether HEC adherence is associated with choice of the specific 5HT3 agent is unknown.

In IBM Explorys electronic health records, we identified HEC courses and related nausea/vomiting (NV) from 2012-2018. We defined HEC guideline adherence as triple prophylaxis at chemotherapy initiation. We assigned courses of ≥ 7 day cycles of cisplatin, or AC, or carboplatin ≥ 14 day cycles, to oncologists based on encounter frequency. We categorized each physician treating ≥ 5 HEC courses based on their most commonly used 5HT3.

Of 12,262 HEC courses, 57% involved physicians that more commonly used OND (mean OND to PALO ratio 3.9:1). These courses had lower physician guideline adherence (because of NK1 omission) and higher rates of NV. NV rates for cisplatin did not vary by 5HT3 used. For physicians commonly using PALO (mean OND:PALO ratio 0.2:1) superior guideline adherence and NV rates were seen, despite a slightly higher-risk population (younger and/or female). Conclusions HEC antiemetic guidelines recommend NK1 use, independent of 5HT3 agent selection. However, we observed lower NK1 use when OND was preferred, which may have caused the observed higher rates of NV with OND. Further evaluation should assess whether pharmacy cost minimization is a driver of both OND preference and NK1 omission in HEC.

According to high incidence of Infusion Site Adverse Events (ISAEs) of fosaprepitant from previous studies (10-34%) and our records, pharmacy oncology services unit has modified fosaprepitant dilution by reducing final concentration from manufacturer recommendation to 150 mg of fosaprepitant dilute in saline 200 mL and extend the infusion time from 30 to 40 minutes.

To investigate fosaprepitant-associated infusion site adverse events incidence and efficacy among patients receiving platinum-and anthracyclinebased chemotherapy regimens after applied new mixing method. A descriptive retrospective study of 108 cancer-patients who received fosaprepitant as premedication for platinum-and anthracycline-based chemotherapy regimens. Data collection from electronic medical record since February 2018 to January 2019 from Bumrungrad International Hospital. The Injection Site Reaction (ISR) assessed by CTCAE V.5 and Efficacy defined as no vomiting. 108 patients are 61 females and 47 males, diagnosed with hematopoietic cancers (n=28), genitourinary and gynecologic cancers (n=26) and breast cancer (n=19), received Highly Emetogenic Chemotherapy (HEC) 32%, 96% and 63%, respectively.

The incidence of ISAEs associated with fosaprepitant administration was 4.7% (n=14) of 299 dispensed doses. 8 patients experienced more than one type of ISAE, categorized as Grade 2 ISR. The most common report were: pain (n=5), swelling (n=4), erythema (n=2) and phlebitis (n=2). The incidence of nausea and vomiting was 1.3% (n=4, HEC).

The efficacy of fosaprepitant for Chemotherapy-Induced Nausea and Vomiting (CINV) prevention is over 98%. Although the incidence and severity of ISAEs associated modified fosaprepitant dilution were reduced. Chemotherapy vesicant properties and fosaprepitant appropriateness use need to be concerned.

Dexamethasone are often administered to prevent chemotherapy induced nausea and vomiting. The aim of this study was to assess the incidence of and factors associated with steroid induced metabolic syndrome in cancer patients receiving high emetic risk chemotherapy with antiemetic dexamethasone therapy.

This study was conducted retrospectively chart review of 356 patients who received high emetic risk chemotherapy with dexamethasone, aprepitant, and 5-HT3 antagonist between September 2015 and December 2017 at Chung-Ang university college of medicinel. Fasting plasma glucose levels. systolic blood pressure, diastolic blood pressure, triglyceride, HDL for the diagnosis of metabolic syndrome were performed before chemotherapy and 6 months after the start of chemotherapy.

In total, 256 patients met the inclusion criteria and were included in analysis. The incidence of newly diagnosis metabolic syndrome was 17.5% (45 patients) after chemotherapy. The incidence of newly diagnosis diabetes and hypertension was 5.8% (15 patients), 26.2% (67 patients) after 6 months follow up. The mean metabolic syndrome score was 1.4 (range : 0-4) after chemotherapy. Multivariate analysis showed significant association of the incidence of streroid induced metabolic syndrome with BMI ≥ 25 (OR = 3.497, 95% CI = 1.064 -11.494, p = 0.039) and colorectal cancer (OR = 0.088, 95% CI = 0.010-0.731, p = 0.024).

The incidence of steroid-induced metabolic syndrome after antiemetic dexamethasone therapy was high (17.4%). Therefore, we suggested that carefully measure glucose as well as LDL, triglyceride, blood pressure during antiemetic dexamethasone therapy.

Chemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy. We compared the impact of acute (during the first 24 hours postchemotherapy) and delayed (days 2 through 5 postchemotherapy) CINV on patients' Work Productivity and Activity Impairment after highly or moderately emetogenic chemotherapy (HEC and MEC, respectively) .

This prospective, single centre experience, 50 patients from infusion centre oncology practices enrolled; 50 patients (35 HEC; 15 MEC) completed 100 % of instrument items. The (WPAI:NV) validated instrument to assess Work Productivity and Activity Impairment and the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT) validated instrument to assess the degree and number of nausea and vomiting on day one chemotherapy and on day 4 were used. Results A total of 50 patients were assessable (35 HEC patients, 15 MEC patients). Emesis was reported by 36.4% of patients (13.2% acute, 32.5% delayed) and nausea by 59.7% (36.2% acute, 54.3% delayed). Among all patients, the nausea score was significantly lower than the vomiting score (50.0 and 55.3, respectively; P = .0097). And 9 (18%) patients reported a health care visit for CINV during the 5 days following chemotherapy. Thirty seven % of all patients reported reduced daily functioning and of those with poorly managed CINV and about 15% reported a significant impact on daily functioning.

We previously reported that short-term periodic premedication of glucocorticoids (GCs) used with chemotherapy for gastrointestinal cancer (GIC) caused the reduction of bone mineral densities (BMD) (ESPRESSO-01). We conducted this study to evaluate the efficacy and safety of denosumab for prevention of chemotherapy-induced BMD decreasing.

The eligibility criteria were as the follows: 1) Histologically confirmed GIC. ; 2) A schedules of periodical steroid administration as a premedication of chemotherapy that was weekly, biweekly, and triweekly. ; 3) High risk patient with steroid induced secondary osteoporosis. ; 4) No prior treatment for osteoporosis. The dose of denosumab is 60mg administered as a single subcutaneous injection within a week before the induction of chemotherapy. The primary endpoint is to investigate the BMD change on lumbar spine between baseline and 16 weeks after induction of chemotherapy.

From April 2017 to Feb 2018, 49 cases were enrolled. Two patients did not meet the inclusion criteria. One patient died before treatment and one patient refused just after enrollment. One case was not measured BMD on baseline and four patients were not measured BMD on 16 weeks such as refusal, discontinuation of treatment, and death. In 30 patients (71.4 % of FAS), the levels of BMD at 16w were significantly increase compared with baseline and the average percent change of BMD of lumbar spine was +2.772% (n=42, 95% CI: 1.350% to 4.195%, p<0.0001) . No one suffered any bone fraction in FAS population.

We found that denosumab administration could prevent the reduction of BMD and bone fraction. Osteonecrosis of the jaw (ONJ) is a serious side effect of antiresorptive drugs namely, bisphophonates, denosumab. Risk factors for MRONJ are the potency and duration of antiresorptives, dentoalveolar surgery. Other treatments, such as corticosteroids, immunosuppressors and hormone therapy, may also increase the risk of MRONJ. Methods Subjects with proved malignant disease and bony metastases receiving antiresorptives were accrued. These patients were observed in two groups. Group 1: Patients, referred prior to the initiation of anti resorptive treatment. Group 2: Patient referred after initiation of antiresorptives. These patient's dental status, symptoms were recorded. Patients were observed at six monthly interval. In case of oral complaints, indicated treatment was rendered. Demographic details, and the details of antiresorptive drugs, dental status and were recorded. At every follow up visit the drug details, disease, and oral status were noted. The calcium levels and presence of any skeletal related events, osteonecrosis of jaw (staging and treatment) were recorded.

Details of Age, gender, occupation, socioeconomic status, education, general health, medical history, diet history, tumor site, TNM classification, tumor stage, antiresorptive drugs and dental status, were noted. The calcium levels and presence of any skeletal related events, osteonecrosis of jaw (staging and treatmentwere recorded. Data will be analyzed using descriptive statistic using SPSS software version 20.0 Conclusions Ongoing study. Results of this study will be presented eP032 COST ANALYSIS OF BONE FRACTURE IN COLORECTAL CANCER PATIENTS RECEIVING CHEMOTHERAPY.

Although bone health has gained increasing attention in gastrointestinal cancer care, there is few data of assessing the economical impact of fracture. We investigated the cost caused by fracture in colorectal cancer patients who had received chemotherapy.

We retrospectively analyzed the cost of fracture in colorectal cancer patients from January 2015 to December 2018, reviewing the medical fee bill of health insurance.

Fracture events were detected in 18 patients. Four patients were not able to follow due to the changing hospital for several reasons (14 patients were the full analysis set). Patient characteristics were as follows: median age 70.6 (range 52-85), female/male 9/5, adjuvant/non-adjuvant 6/8, vertebral/hip/pelvic/other fractures 5/2/2/5, fall/osteoporosis/others 7/4/3. The average cost for a month just after fracture was 213,000 Japanese Yen (JPY), or 1,930 United States Dollar (USD). In two patients (14.3% of FAS), hip arthroplasty was done and the average cost for a month in these two cases was 1,280,000 JPY (11,600 USD). There was a significant correlation between hip fracture and surgery (p = 0.011). The cost of hip fracture was significantly higher than that of other fractures (p = 0.026). There was no difference in survival time after fracture between hip and non-hip fracture (p = 0.093).

We found that hip fracture would not affect survival but it was required large medical expenses, which worsened the financial burden associated

Bone metastases one of the most common presentation of various malignancies and typically associated with a short-term prognosis in cancer patients. These patients primarily visit the clinics with complain of pain with poor quality of life and functional disability.

To analyze the demographics, treatment profile and survival of cases treated in different centers combined. A total of 500 patients with symptomatic bone metastases were studied retrospectively over the period of 4 years from 2013 to 2017.

The median age of presentation was 50 years. The most common primary cancer associated with bone metastasis were prostate (32%), breast (35%) and lung (30%). Almost 75% cases of bone metastasis in female patients encountered due to breast followed by cervix and lung. The predominant reason for clinical presentation was bony and/or neuropathic pain (70%), followed by pathological fracture (20%), including spinal cord compression and fracture impending associated with or without soft tissue mass (10%). Out of 410, 30% had synchronous visceral metastasis to single or multiple sites like brain, lung and liver. 90% cases received palliative radiation with multiple radiation dosing schedules, decided a per the patient's general conditions. The median survival observed was 12-60 months in prostate, 7-15 months in lung; 12-30 months in breast cancer and 20 months in thyroid. Conclusions 80% patients had symptomatic improvement with continuous pain management, 90% of patients had improved QOL. Overall bone metastases from primary cancers have poor survival but it is still possible to maintain a good quality of life with prompt diagnosis and proper symptomatic management.

Cancer-treatment-induced bone loss (CTIBL) is a side effect of aromatase inhibitors (AIs) andcan result in osteoporotic fractures. This RCT collected data on the feasibility, safety, and preliminary efficacy of high-dose VITD (with/without exercise) on bone mineral density (BMD) versus the recommended daily allowance (RDA).

Non-metastatic breast cancer patients starting AIs with low VITD (<32 ng/ml) were randomized 1:1:1 into 3 arms: 1) placebo 2) high-dose VITD (50,000 IU/week) or 3) high-dose VITD + Exercise for Cancer Patients (EXCAP): a home-based, personalized walking and resistance band training program for 24 weeks. All subjects received the RDA of VITD 600 IU/day. Serum VITD and calcium levels were assessed at baseline, weeks 6, 12, 18, and 24. BMD was assessed at the hip via DXA at baseline and week 24.

Of the 116 subjects randomized (mean age=60; 94% white; mean VITD=24.6 ng/mL), 90 provided evaluable data. ANCOVA showed significant between-group differences on final VITD (high-dose=63.6 vs high-dose + EXCAP=60.3 vs placebo=32.0 ng/mL; p<0.01) but none in calcium (high-dose=9.4 vs high-dose + EXCAP=9.5 vs placebo=9.4 ng/mL; p=0.78). The placebo group lost a significant amount of hip BMD (−1.7%; p<0.01) while BMD was maintained in the high-dose (−0.1%; p=0.77) and high-dose + EXCAP (−0.2%; p=0.74) groups resulting in significant between-group differences for high-dose + EXCAP vs placebo (p=0.04) and high-dose vs placebo (p=0.05).

Our novel high-dose VITD and exercise intervention significantly reduced CTIBL in breast cancer patients while demonstrating safety and feasibility. A phase III RCT is needed to confirm these findings. Funding:

Medication -Related Osteonecrosis of Jaw (MRONJ) is still being an unsolved problem in dental clinics. Therefore, it is important to assess clinical and radiological features that could help the clinician identify the risk of MRONJ. The objectives of the study was to assess how dependable clinical and radiological features are in diagnosis and follow up of MRONJ. Methods Fifty consecutive patients of a surgeon between December 2015-March 2018 with the risk of MRONJ were evaluated. Clinical examinations included soft and hard tissue of oral cavity along with cervical lymph nodes and radiological features of bone sclerosis, bone sequestration, cortical surface irregularity, osteolytic changes, persistant extraction sockets and periostal response were also screened by cone beam computed tomography (CBCT). The clinical presentation, radiological features were correlated with the diagnosis and follow up of MRONJ suspected cases.

Total of 50 patients (39 female and 11 male) with mean age 62,28 were evaluated. 64% bone sclerosis, 64% cortical surface irregularity, 64% osteolytic changes and 36% bone sequestration were detected with correlation of high prevalence exposed bone and purulence exudation. 22% persistent extraction socket and 20% periosteal reaction were more prone to have silent clinic appearance. Conclusions CBCT has becoming popular in recent years for the imaging of MRONJ. Easy and inexpensive access to 3-dimensional images of bone structures of very high resolution and lower exposure to radiation when compared to computed tomography are the main advantages of CBCT and many signs of MRONJ could be screened and monitored for long time follow up.

Breast cancer is a common neoplastic tumor in women, and the postmastectomy pain syndrome has been reported frequently after surgical treatment. The injury of the intercostobrachial nerve is considered the major cause of this type of pain. Purpose Evaluation of efficacy and safety of pulsed radiofrequency (PRF) and steroid injection on the 2 nd and 3 rd thoracic (T2 and T3) dorsal root ganglions (DRGs) for intercostobrachial neuralgia (ICBN) postmastectomy.

This study was conducted on 100 patients with ICBN postmastectomy. The PRF waves were applied for 120 s twice on T2 and T3 DRGs then 1 ml of 4 mg dexamethasone and 1 ml of bupivacaine 0.25% were injected at each level then the technique was repeated three times 1 week apart for each patient.

After 6 months from the latest intervention, the mean of visual analog scale dropped from 7.48 to 4.7 (P = 0.005712) and the mean of the quality of life scale improved to 6.88 after being 4.66 (P < 0.00001) before the intervention and 64.68% of the patients decided that they would certainly repeat the procedure if they could go back in time and 66.64% would certainly recommend the same procedure to a family member. The analgesics consumption decreased mainly in the 1st month but increased again after 6 months (not significant). No serious complications were recorded. Conclusions PRF and steroid injection on T2 and T3 DRGs assumed an effective and safe method for ICBN postmastectomy treatment.

Endotracheal intubation is a crucial skill in anaesthesia. Uncuffed paediatric endotracheal tube (ETT) size can be calculated by various methods like age-based formula or by using ultrasound to measure minimal transverse subglottic diameter (MTSD). This study aimed to compare both age-based formula and ultrasound to assess the advantage of routine use of ultrasound to determine paediatric ETT size. Methods Forty children of 2-10 years of age. ASA class ≤ II, Mallampati airway classes I and II, scheduled for surgery away from the head and neck were included. Uncuffed ETT size for each child was calculated using agebased formula. After induction of balanced general anaesthesia an ultrasound was done to measure MTSD and an endotracheal tube was selected accordingly. After intubation an air leak test was done and the ETT was accordingly changed (if needed).

ETT size by age-based formula strongly correlated with the size measured by ultrasound (Pearson correlation 0.913; P <0.001). The percentage of the need to change endotracheal tube according to the leak test was only 7.5%.

The ETT size calculation was similar for both age-based formula and ultrasound. So, we could not justify the routine use of ultrasound for calculating ETT size for intubation in paediatric patients. 

Up to 70% of cancer-patients experience pain during the course of illness Physicians are facing different challenges to accurately assess pain NCCCR treating-physicians may prescribe analgesics to their patients or refer them to the Pain Management-Service (PMS) based on their evaluation or as requested by patients This study will explore the factors which might lead to under-treatment of cancer-pain in Qatar, it will focus on cancer-patients' pain managementsatisfaction and PMS-awareness Methods we evaluated patients-perception via a validated Questionnaire (SF-MPQ-2-Arabic & English) & structured-interview by outpatient Pharmacists at a single point of time, to assess patients' awareness towards PMS, if they are receiving pain medications, experiencing any pain, pain-severity, and patients' level of satisfaction A sample of 400 patients was randomly selected from cancer-population visiting NCCCR-Pharmacy over a specific-period of time. Participants were consented & interviewed Results 400 patients agreed to participate; the median-age was 50 Male:Female ratio was 3:7 61% (245/400) of participants were not aware of the existence of the PMS 20% (78/400) were aware and followed by PMS, with satisfaction rate of 76% (59/78) 69% (276/400) were on pain-medications, only 70% (191/276) were satisfied from the satisfied-patients, 57% (109/191) rated their pain as 4-10 at the time of interview (ATI)

Studies showed that 40-50% of cancer patients receive insufficient analgesia, beside the challenges to accurately assess pain In NCCCR, the treating primary physicians (PP) may prescribe analgesics to their patients or refer them to the Pain-Management Team (PMT), based on clinical evaluation or as requested by patients This study will address the clinical concerns of PP, which may lead to refer the patients to PMT, moreover the clinical judgement of PMT on the referred-cases whether they need to be refereed or not Methods PMT is going to assess the referred-patient to their clinics according to pain-assessment methods, any unnecessary-referral will be documented based on the following If the patient; 

There is 12% unnecessary referrals to PMT, which needs improvement via development of a definite referral-criteria to PMT PP should be encouraged to provide basic pain-treatment, to consider multidisciplinarymanagement with appropriate coordination for better improvements in patients' QOL

Breast cancer is one of the most common types of cancer, which accounts for highest rate of morbidity and mortality in women. One of the mechanisms of breast cancer is the oxidative stress, which plays a crucial role in its pathogenesis. The increased production and ineffective scavenging of oxidants may play a crucial role in tissue damage leading to cancer. Methods This study included 50 control volunteers, 50 patients with breast cancer, and 50 patients with post-operative breast cancer. Patients with preoperative cancer were clinically and histopathologically diagnosed for breast carcinoma with stage 0, not having therapeutic history. The control 50 healthy female volunteers had the same socio-economic status, and no history of any cancer. After obtaining consent, venous blood was collected from the volunteers by vein puncture using sterile disposable syringe and needle. The levels of MDA, NO, GSH, and activities of RBC-SOD, NOS, copper, zinc GPx, CAT, and vitamins A, C, and E metabolites were measured in the sera of each group.

The activities of RBC-SOD and the levels of MDA, NO, as well as the NOS were higher in the sera of patients with breast cancer as compared with the controls. However, the levels of GSH and vitamins A, C, and E, also the activities of copper and zinc GPx and CAT were decreased in patients.

Patients with higher levels of MDA showed deficiencies of antioxidants and trace elements in the serum. A poor dietary antioxidant and high oxidant are associated with the risk of breast cancer.

Between 1.6.2012 and 1.6.2013 a total of 48 patients, 33 patients with all Bone metastatic cancers esp. Breast and Prostate cancer was 11 males and 37 females with an average age of 38 years (minimum 27 and maximum 79 years). We reviewed the literature focusing on studies investigating the efficacy of hypo fractionated radiotherapy for bone metastases. We also addressed the problem of treating multiple skeletal lesions with irradiation Results External beam irradiation that our patients treated in Ahwaz center and other radiotherapeutics centers achieves pain palliation in more than 75% of patients with bone metastases, even with EBRT down to a single-dose administration. The results of exclusive radiotherapy in the cord compression syndrome depend on a prompt diagnosis, patient presentation and the intrinsic radiosensitivity of tumor cells in three patients. Palsy can always be avoided in these patients.

In our study the efficacy of external beam irradiation in the palliation of bone metastasis-related symptoms is confirmed by this study, even with short treatments and single-dose administrations. This is important for both patient expectations and the necessity for improved resource allocation with reference to the territorial distribution and waiting lists of radiotherapy centers. The issue of their efficacy in combination with antiblastic drugs (Bisphosphonates drugs such as Zoledronic acid) and/or external beam irradiation (EBRT) remains open and will be clarified only with further randomized clinical trials.

This article describes the nursing experience of a 58-year-old patient who suffering brain tumor with metastasis and being hospitalized because of fever and consious change. During July 12 to 30, the writer collected the data by observation, assessed the health problems of patient by using Orem self-care theory Methods Four major health problems have been found: inactive elimination of the respiratory passages, less than physically needed nutrition, self-care deficit and hopelessness. In addition to improving physical discomfort by giving the appropriate measure of caring for the case, provide the training techniques of sputum clearance to implement correctly. The medical team to jointly develop the use of gastrostomy tube feeding care plan and sustained attention training to assist them in getting enough nutrition needs. Supply the follow-up care and support system according to the individual case, show the concern emotion, encourage patient to express his feelings so that patient can participate the treatment actively, reach self-care ability, Results Through these approaches, the patient learned to release stress, and to express his feelings, so that he could adapt to his current life, changed as it was by the illnesses, and face the impact of those illnesses with a positive attitude and reduce the feeling of hopelessness Conclusions We herein address this nursing care experience to provide deeper understanding of the similar cases for all nursing colleagues, thereby enhancing the quality of care in the future. The objective of this case report was to share the nursing experience with clinical nursing staff caring for patients. THE FEASIBILITY AND ACCEPTABILITY OF A  HOME-BASED, SMART HEALTH SENSING SYSTEM TO  IMPROVE CANCER PAIN MANAGEMENT FOR PATIENTS  AND CAREGIVERS  Introduction Technology can support safe and effective management of cancer pain in the home environment. We tested a package of wearable and environmental sensors, Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C) to: 1) understand the contextual factors that predict and influence the experience of pain; and 2) explore the dyadic effect between patient and caregiver experiences related to cancer pain. Methods Patient-family caregiver dyads were recruited from an outpatient oncology palliative care clinic. In Phase I, interviews explored: 1) challenges of managing cancer pain at home; 2) contextual variables relevant to cancer pain; and 3) design feedback regarding BESI-C components. Responses were analyzed using qualitative content analysis. In Phase II, in-home BESI-C deployments explored: 1) fidelity of data capture; 2) system utilization; and 3) dyad experiences via in-person de-briefings and correlation of ground truth with recorded sensor data.

In Phase I, dyads validated: 1) pain challenges such as impact on sleep, unpredictability, and medication concerns; 2) variables that influence pain related to medication, wellness, interactions, and environment; and 3) high receptivity to the BESI-C system. Phase II deployments iteratively addressed issues related to human-computer interaction, participant burden, and data capture. Preliminary analysis shows the ability of BESI-C to correlate activity/mobility, environmental and ecological momentary assessment data with marked pain events.

Dyads are open to novel approaches to managing pain in the home. Significant potential exists for BESI-C to inform and deliver personalized interventions to patients and caregivers, particularly those in underserved areas or enrolled in home hospice programs. 

In spite of the existing practice guidelines and knowledge for effective pain management, a big proportion of cancer patients are still treated inadequately for pain. Under-treatment of pain is particular important for oncology outpatients, because studies have shown that these patients are often not fully assessed for pain. Methods This is a prospective, cross-sectional study of cancer patients who were seen at outpatient clinics in a cancer center in Taipei, Taiwan. Brief Pain Inventory (BPI), Pain Management Index (PMI), and Morisky Medication Adherence Scale (MMAS) were administered to measure pain intensity, pain management quality, experience and adherence for pain medication at home.

Sixty patients with advanced cancer diseases participated in this study. About 60% of these patients' report of the worst pain in 24 hours was moderate and severe. The average pain interference total score measured by BPI was 24.5+17.3 (range from 0 to 63); in which subscale scores the average affective interference score is higher than activity interference score (11.5+9.8 vs. 9.8+7.4). Bivariate analysis found that patients' PMI was directly related to average pain severity and pain interference scores. About 85% of these patients were in the category of low and moderate pain-medication adherence measured by the MMAS.

Cancer outpatients have to manage their pain at home on a daily basis. Our results identify the need to incorporate patient-reported outcomes in the assessment and treatment of cancer pain in the outpatient settings. The results also highlight the importance of self-management support to enable patients to manage pain at home.

Breakthrough Cancer Pain (BTcP) is one of the symptoms lowering most the patients' quality of life. Although its pharmacological treatment has been improved in the last years, quality criteria on its clinical management are still missing. The aim of this study was to reach a consensus agreement on BTcP clinical management quality indicators. Methods A two round modified Delphi method was used to assess the opinion of 120 representative Spanish experts on BTcP from Pain Clinic, Palliative Care, Clinical Oncology and Radiation Oncology. It was used an on-line survey using a questionnaire with 75 questions which cover 4 dimensions (diagnostic, treatment, patient empowerment and clinical practice). Participants were asked to score each item on a 1 to 9-point Likert scale: median score ≤3 meaning large disagreement; ≥7, large agreement. Items scored as ≥ 7 (with an interquantile range < 4) by at least 66.7% of participants, were stablished as "agreement reached". Rest of items were selected for the next round. Results A total of 115 (96%) experts agreed to participate at the 1st round; Only 14 (18,7%) items needed a 2nd round in which participated 81 (67.5%) experts. After the 2nd round 6 items remained without agreement, all of them regarding pharmacologic treatment. Conclusions A wide agreement in the quality indicators that should be implemented in clinical management of BTcP was reached among Spanish experts. Its applicability should improve the management of BTcP. 

Malignant invasion of peripheral nerves may lead to severe, treatmentrefractory neuropathic cancer pain (NCP). Novel treatment alternatives are urgently needed to palliate this despairing condition. Based on repeated observation of rapid relief of NCP after single doses of intravenous epidermal growth factor receptor inhibitor (EGFR-I), we have successfully treated patients with severe, treatment-refractory NCP with off-label EGFR-Is. Pain research is complicated by endpoint subjectivity. Patients with advanced cancer are heterogeneous, with complex, fluctuating clinical pictures, hampering feasibility of standard drug-trial procedures. The aims of the study are to further understanding of the EGFR-I/NCP association and facilitate planning drug trials. Methods Investigator-initiated, explorative, prospective, systematic observational study of patients with cancer and neuropathy receiving any humanEGFR-I. A variety of evaluation tools assess patients' symptoms and test feasibility for this population. Choice of assessment method is based on what is ethical, feasible and clinically relevant for each patient.

The study is ongoing. 16 patients have been included since 01.2017. Preliminary findings for the 10 patients with NCP treated with an EGFR-I (panitumumab) are presented in the table. Indication for treatment was refractory NCP in nine patients, and intolerance to analgesics in one.

Preliminary findings (including 8/10 clinical responders) strongly support EGFR-Is' potential to be of significant benefit to a range of patients with treatment refractory NCP, compellingly warranting further study.

Pain relief is vital to the treatment of cancer. Microglia play important roles in nociceptive signal transduction. Activated microglia seems to be a shared mechanism in neuropathological pain and cancer pain, since it was previously found that pharmacological attenuation of microglia activation provided satisfactory management in both cases.

In the present study, we investigated the effect of 100 ng Hericium erinaceus mycelium on the morphine-induced activation BV2 microglia cells.

Our results showed that 1 μM morphine enhanced microglia activation and chemotaxis, induced increasing of histone deacetylase 6 (HDAC6) expression, heat shock protein 90 (HSP90) cleavage and deacetylation of HSP90. Pretreatment with 100 ng Hericium erinaceus mycelium not only inhibited morphine-evoked microglia activation and chemotaxis, but also prevented HSP90 fragmentation and deacetylation by suppressing HDAC6 expression.

We suggest that, Hericium erinaceus mycelium inhibits microglia activation can be used as an adjuvant in clinical cancer pain management for patients who need long-term morphine treatment. 

Pancreatic cancer and other malignant tumors of the upper abdominal organs often induce pain that is difficult to control. Celiac plexus neurolysis is a procedure often performed to provide relief to patients suffering from pain related to upper abdominal cancer. However, various studies have reported conflicting results about its effect. Therefore, the present study investigated the effects of celiac plexus neurolysis on upper abdominal cancer pain. Methods Medical records of patients who underwent celiac plexus neurolysis for upper abdominal cancer at the hospital were retrospectively analyzed. The change in pain among patients after the procedure was evaluated with the numeric rating scale (NRS), and the use of opioid analgesics before and after the procedure, as well as complications from the procedure were investigated. Results A total of 99 patients underwent celiac plexus neurolysis for abdominal cancer pain. The NRS scores at 2, 4, 8, and 12 weeks post-procedure were significantly reduced compared to before the procedure (p < 0.05). The post-procedural use of opioid analgesics was also significantly decreased (p < 0.05). Mild adverse events (moderate diarrhea and mild hypotension) were frequent (n = 28); no serious complications were reported and no procedure-related deaths were observed. Conclusions Celiac plexus neurolysis resulted in a decrease in pain and in the use of opioid analgesics in patients experiencing upper abdominal cancer pain, and serious complications after the procedure were rare. These results provide evidence that celiac plexus neurolysis may be useful in the treatment of abdominal cancer pain in a clinical setting.

Hospice care incorporates holistic, team, family, community, and complete care. Hospice care improves the quality of life for the patient and their family and helps the bereavement process. This paper discusses a 52-year-old female end stage stomach cancer patient whose husband could not bear watching her pain and was unsure how to make decisions which lead to feelings of guilt. Methods From July 24 to September 13, 2013, Gordon's 11 functional health patterns were used to observe, interview the patient and conduct physical evaluations. Subjective and objective data was collected and it was determined that the patient suffered from chronic pain, activity intolerance, death anxiety, and ineffective health maintenance.

Lymph massages, and hot compresses were used to help relieve pain, alleviate negative feelings, and help the patient cope. The patient's family was taught to use lavender and orange aroma therapy to relieve pain, and alleviate feelings of helplessness. Family was encouraged to participate in daily care routines, such as bathing, changing clothes, and manicure pedicures to maintain a level of comfort.

Care was provided to establish a relationship with the family, supply feelings of trust, safety, and meet physical needs, and listen to the family's distress regarding losing a loved one in order to help the patient accept death and happily live the rest of her life. This nursing experience is shared to serve as a reference when caring for similar patients in the future to improve quality of care and ensure that physical, mental, spiritual, and social care is provided.

Pain is a complex and subjective experience and various subjective scales have been developed to assess pain. Subjective assessment of pain is not accurate most of the times. Measuring pain objectively will help physician use analgesics according to WHO pain ladder and identify patients who misuse opioids.

This study was carried out on cancer pain patients who were having unbearable pain and were registered at Pain and Palliative Care Clinic in Dr. BRA, Institute Rotary Cancer Hospital, All India Institute of Medical Science New Delhi (AIIMS), India. Pain was measured using numeric rating scale (NRS). Physiological parameters (heart rate, blood pressure, skin temperature and oxygen saturation) were measured by using B125/B105 monitor on 34 patients both before and after giving analgesics. Galvanic skin response (GSR) and Electroencephalogram (EEG) examination was done using MP-45 BIOPAC system on 15 patients.

The conduction velocity of peripheral sensory nerve of the painful area was high as compared to non-painful area. The blood pressure and heart rate decreased as the NRS score of the patients decreased after analgesics. GSR values were more in patients during pain and lower after giving analgesics. Significant EEG wave changes were seen and relation between pain and EEG was statistically significant. Conclusions Physiological parameters can be used to measure pain objectively and in a non-invasive way. Larger sample size with other physiological parameters is being studied to design a pain measuring device which will help physicians in busy clinics to assess and manage cancer pain.

Gabapentin (Neurontin) and Pregabalin (Lyrica) are first and secondgeneration α2 ligands, respectively, and are both approved for use as adjunctive therapy in pain control. Their mechanism of action is not yet fully understood, but research has demonstrated promising results. Despite their similarities, they have been used in combination in both clinical and research settings, and have been noted to have a synergistic effect in pain control without concern for clinically significant pharmacokinetic interactions.

To determine whether there is an evidence to support the combined use of Gabapentin and Pregabalin in clinical settings. Methods A MEDLINE and a PubMed search for "Gabapentin and Pregabalin" OR "pain management" AND "combined use" was conducted from 1995 onwards. Only six articles were deemed to be relevant to the objective at hand. They were reviewed, and the relevant points were summarized. Additional sources were added to the literature search by way of being referenced in the article. Articles in languages other than English were excluded, as well as, studies for which no outcomes were reported.

Antagonism of calcium channels in the central nervous system, and antagonism of N-methyl-D-aspartate receptors, have the most supporting evidence for the synergism between Gabapentin and Pregabalin by producing an increased analgesic effect which can be utilized in pain management in refractory cases.

This combined approach can be valuable in pain management by reducing the dose of individual agent, its side effects, and to enhance therapeutic response compared to a single agent in resistant cases. D EV E LO PI NG CO UN TR I ES O BA FE MI AW OL OW O  UNIVERSITY TEACHING HOSPITAL  Introduction Cancer pain management in developing countries is still a great challenge especially in my center which is a federal government Hospital, many Oncology patients come in at the advanced stages of their disease where pain management and palliative care is essential. The challenge however is that opiods drugs remain most times unavailable and when available it is very expensive beyond the reach of this patients and this happened due to the strict and unfriendly government polices on the importation of opioids analgesia in Nigeria.

As a team managing cancer we decided to form the Oncology/Palliative Care group which is a multidisciplinary team be held meetings with the management on the need for opioids drugs to be readily available and affordable by patients, thus the pharmacists in our team started producing the oral liquid morphine and an awareness program was done in the hospital for all consultants and Nurses about the availability of oral liquid morphine in the hospital.

We discovered that the quality of life of patients was greatly improved, ww observed better patients management outcome, cancer pain which usually are managed with short acting analgesia are now managed with a potent and long acting opioids and patients with advanced stages of their cancer experienced dying in a more dignified way.

In concluding I believe despite finding ourselves in economic constrain countries like Nigeria as proffesionals we can do so much in alleviating pains experienced by this patients and we can actually provide succor and make the terminal phases of their lives meaningful. 

Increasing the total opioid dose is the standard approach for uncontrolled cancer pain. Palliative care interventions are multidimensional rather than simply increasing dose. The purpose of this study was to determine the frequency and factors associated with clinically improved pain (CIP) without opioid dose increase among patients referred to our inpatient palliative care (IPC) team.

We reviewed consecutive patients referred to our IPC team. Eligibility criteria included: 1) taking opioid medication; 2) having ≥ 2 consecutive visits with the IPC team; 3) ESAS pain score ≥ 4 at consultation. Patient demographics, cancer type, opioid prescription (type, route, oral morphine equivalent daily dose [MEDD]), opioid rotation, psychological consultation, and changes in adjuvant medications (e.g., corticosteroids, benzodiazepines, and neuroleptics) were assessed. Chi-squared, Fisher's exact, and Wilcoxon tests, as well as logistic regression, were applied.

Of the 386 subjects assessed, 300 patients with uncontrolled pain were enrolled. CIP was achieved in 196 (66%) patients. Among those, 67% (131/196) of patients achieved CIP without an increase in MEDD. Factors such as better performance status (P = 0.02), less opioid rotation (P < 0.001), adjuvant medication change (P = 0.03), and higher baseline MEDD (P = 0.02) were associated with CIP without opioid dose increase (Table 1) .

Two thirds of patients achieved CIP without MEDD increase, suggesting that multidimensional palliative care intervention is an effective means to improve pain control in opioid tolerant patients without the need of increasing opioid dose.

Cancer pain prevalence is high (52%-77%) and includes pain flares and end of dose failure. Successful pain management requires comprehensive systematic assessment. Methods An Expanded Pain Assessment (EPA) was developed into an electronic care planning system (CPS), combining the Brief Pain Inventory with drill down questions about breakthrough pain (BTP). 52 patients with advanced cancer at three sites completed the tablet-based EPA prior to the clinician visit. Results were presented on a dashboard, and the provider and patient collaboratively established a pain care plan. Effectiveness of pain management planning was measured with the Pain Care Quality Survey (PCQS).

Patients were 63% (n=32) female with mean age of 56 (range 20-93). Mean pain scores were 3.13 (scale 1-10); 88% had a pain flare in the last seven days with mean severity of 8.23; 74% of flares lasted > 30 minutes; 80% had end of dose pain. Participants reported incident pain associated with certain activity (70%) as well as insidious pain not associated with activity (70%). 52 patients selected 132 pain descriptors: burning (11), achy (23), stabbing (20), pins and needles (12), cramping (11) radiating (14), intermittent (20), and continuous (21). PCQS mean score was 10.80 (scale 2-12), SD-1.18. Mean satisfaction with tablet-based EPA use was 3.25 (scale 0-4), SD 0.58 Conclusions Comprehensive pain assessment with an EPA revealed important details that were incorporated into the management plan. Since patients were experiencing severe flares and end of dose pain at home, strategies to engage patients between visits should be evaluated. 

Chronic pain (CP) is a major concern in cancer survivors. The integrated model of Palliative Care (PC), not limited to end-of-life situations should be enhanced to promote opioids access for painful patients. Doctor's reluctance toward opioids prescription has been ever documented. This study aims to provide the prevalence of CP among 5-years cancer survivors, and to identify associated factors with opioids prescription focusing on PC access.

In 2016, 4 174 French cancer survivors were interviewed in the national VICAN survey. We studied factors associated with the prescription of step 2 and step 3 opioids among painful survivors. Multinomial logistic regression were performed using Patient Reported Outcomes, Clinical Reported Outcomes and Medico-administrative data. Results A majority of cancer survivors (63.5%) experiences CP. Among them, 27.1 % and 4.2 % have been prescribed at least one step 2 or step 3 opioid respectively and 0.7% accessed PC during the year of the survey. After adjustment for age, gender, medical and self-reported variables, we found that survivors who accessed inpatient PC were more likely to receive step 3 opioids (aOR: 6.00; 95% CI: 1.29, 27.81) .

When properly controlled, step 2 and step 3 opioids remain the basis of an effective cancer pain treatment when non-opioid pharmacologic therapy is no more appropriate. The present study reports an under prescription/ dispensing of step 3 opioids and a positive relationship between this prescription and PC access. However, PC access remain very marginal in France. Integrating PC in oncology is essential to provide to patients best cancer-related symptom management.

Introduction NCCN cancer pain guidelines include nonpharmacologic acupuncture. However, there are no standards regarding the frequency, duration, and number of acupuncture sessions for pain management. Limited data exist on pain changes following acupuncture longitudinally. The Purpose was to determine treatment patterns and acupuncture pain response trajectory in a large, diverse, outpatient cancer population. Methods January 2015 to November 2018 data were abstracted. Patients reported 0=no pain to 10=worst possible pain before treatment. In patients reporting pain ≥ 3 at baseline with consecutive sessions within 1 month, clinically-significant pain improvement (≥ 2-point pain score reduction) and one-year effect of acupuncture of pain were assessed. Mean pain scores were estimated with repeated measures linear mixed models with random effects for patient. Least squares linear models regressed model-estimated pain by time, weighted by the inverse of standard errors from the mixed model. Results N=784 patients received 4,271 acupuncture sessions. Average number of sessions was 5.4 (range 1-21). 671 (86%) patients had ≥ 2 sessions; average treatment length was 3.7 months, (range 0.1 to 39.4 months). 360 had baseline pain ≥ 3; 218 (61%) achieved clinically significant improvement. In a one-year period, acupuncture was associated with decreased pain of 0.25 points per 2-week treatment period both univariately (p=0.018) and adjusted for cancer treatment (p=0.014).

Over 60% of patients reported clinically-significant pain improvement after acupuncture. Across one year, acupuncture was associated with decreasing pain longitudinally. Future research should explore pain response trajectories at other sites including academic and community acupuncture clinics. 

Pain is a prevalent, debilitating symptom in more than half of cancer patients. Accumulating evidence suggests a bi-directional relationship between gut microbiota and pain, potentially via inflammation. Fusobacterium nucleatum (Fn), a pro-inflammatory anaerobic bacterium, is frequently detected in colorectal cancer (CRC) patients. We investigated associations between pre-treatment Fn and cancer pain at 6-months post-surgery in CRC patients.

We utilized pre-surgery stool samples collected from 80 prospectively followed, newly diagnosed CRC patients recruited from the German site of the international ColoCare Study. Eligible patients were neo-adjuvant treatment naïve and did not use antibiotics for at least 1 month before stool collection. Fn DNA was assessed via quantitative real-time polymerase chain reaction. Patients were median split into Fn-high (>17.27; n=40) or Fn-low (≤17.27; n=40). Cancer pain was assessed using the two pain symptom items from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core-30 (lower score=lower pain) at pre-and 6-months post-surgery.

At pre-surgery, 47.5% of patients reported any pain. After controlling for pre-surgery cancer pain in ANCOVA, we observed significant increase in mean cancer pain at 6-months post-surgery in the Fn-high group vs. the Fn-low group (24.07 vs. 13.44; effect size=0.45; p=0.042), which was maintained even after controlling age, sex, tumor stage and other covariates (29.11 vs. 16.55; effect size=0.53; p=0.029) .

These findings suggest that high Fn is an independent predictor of cancer pain at 6-months post-surgery in colorectal cancer patients. Further research is needed to confirm and understand the mechanisms of these results. Funding: NCI U01CA206110. 

Clinical assessment of pain and the accompanying symptoms on the admission day may provide important data for the resources and measures planning, identifying additionally burdensome conditions, and furthermore for disease pathways evaluation. Methods A structured questionnaire was worked out and deployed as an attempt to optimize the qualification to palliative care. It included information on general conditions, urgent states, and symptoms developed through the multi-iteration work of an expert team as the mandatory tool for qualification of patients to the palliative care in Poland. Each patient was assessed using this questionnaire on admission. P < 0.05 was assumed for statistical significance. Results 157 patients were assessed in 5 palliative care centers on the admission day. The average age was 70.5 years (range 32.3-95.8), 50.3% were women. 83.4% of the patients suffered from pain. The mean pain intensity was 1.64 in [0-4] scale and was higher in men (p=0.022). The pain intensity was positively correlated with the anxiety-depressive disorder, nausea and vomiting, and constipation, and negatively with age. No correlation between pain and other symptoms was found.

Pain occurrence and its intensity, on the day of admission, especially in men and younger patients, should be considered as the distinguishing factor for patients requiring more resources deployed. It may be an argument for the differentiation of subgroups in the health systems based on the Diagnosis-Related Groups. Additional investigations should be conducted to assess whether successful management of nausea, vomiting, constipation and anxiety-depressive disorder will substantially improve pain control.

Patients who receive radiation treatment (RT) for breast cancer often report pain, which contributes negatively to quality of life (QoL). This study aimed to identify demographic, treatment, and disease characteristics associated with pain using the Edmonton Symptom Assessment Scale (ESAS).

We identified all patients diagnosed with non-metastatic breast cancer from 2011 Jan-2017 June at the Odette Cancer Centre with at least one ESAS completed pre-and post-RT. Data on systemic treatment, radiation, patient demographics, and disease stage were extracted. To identify factors associated with pain before and after RT and changes in pain, univariate and multivariate general linear regression analysis was conducted. p<0.05 was considered statistically significant.

This study included 1222 female patients with a mean age of 59 years old. ESAS was completed on average 28 and 142 days before RT (baseline) and after RT respectively. In multivariable analysis, higher baseline pain scores were associated with recently completing adjuvant chemotherapy and eventual receipt of locoregional or chest wall radiation. Two factors, adjuvant chemotherapy and chest wall radiation were associated with significant reduction in pain score after radiotherapy.

No patient, treatment, or disease characteristics were associated with sustained increase in pain after radiation. Pre-existing pain in patients receiving chest wall radiation or adjuvant chemotherapy tended to reduce following RT completion, while pre-existing pain associated with locoregional RT tended to persist. Therefore, patients who receive locoregional RT should be screened for pain and provided pain management interventions and support when necessary.

Opioids seem to interfere with immune response. We analysed the prognostic and predictive impact of opioids in Non Small Cell Lung Cancer (NSCLC) patients treated with immunotherapy.

We retrospectively collected and analyzed data about NSCLC patients treated with immunotherapy at our institution. Progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier method. A Cox regression model was carried out for univariate and multivariate analyses.

Sixty-six patients were enrolled, 50 male (75,8%) and 16 female (24,2%). Median age was 72 (range 25-88). Thirty-one patients (47%) received opioids at the beginning and/or during immunotherapy. This setting of patients had a poorer prognosis (mOS 5.37 months vs not reached, p = 0,0009; mPFS 3.83 months vs not reached, HR: 4.15, CI 95% 2.22−10.66, p = 0,0001). Performance Status (PS) according to Eastern Cooperative Oncology Group (ECOG) had a prognostic and predictive role (mOS 3.23 months vs not reached, p=0.0059; mPFS of 1.7 vs 3.8 months, p= 0,0089). Sex, age (cut-off 70 years), lymphopenia, PD-L1 expression did not result as prognostic and predictive factors. At multivariate analysis opioids and ECOG-PS > 2 were confirmed as independent negative prognostic factors (p=0.0001). Patients requiring higher opioids doses or opioids switch had a lower survival (OS 4.9 vs 16.5 months; p=0, 0030) . A trend of worse prognosis was observed in patients receiving morphine (mOS 4.1 vs 8.6 months, p= 0.059) and fentanyl (mOS 4.17 vs 8.63 months).

Opioid treatment and its escalation at the beginning and during immunotherapy are negative prognostic factors in advanced NSCLC. 

Cannabis treatment seems to be safe and effective for cancer pain improvement. Fifty percent of patients improved both clinically and statistically for worst pain across the three visits. Large longitudinal studies may confirm stronger correlations between longer exposure to cannabis and pain relief.

S. Yennu 1 , Y. Qian 1 , Z. Lu 1 , E. Ongel 1 , S. Naqvi 1 , S. Alloju 2 , J. Williams 1 , D. Liu 3 , E. Bruera 1 1 The University of Texas MD Anderson Cancer Center, Department of Palliative-Rehabilitation-and Integrative Medicine, Houston, USA

Limited data is available on the factors associated with the resolution of opioid induced neurotoxicity (OIN). The objective of this study was to determine the factors associated with resolution of OIN.

In this retrospective study we reviewed 1770 eligible cancer patients from January 2014 to December 2017. Eligible criteria included: 1) taking opioid more than 24 hours; 2) =18 years old or older. Patients' demographics, performance status, Edmonton Symptom Assessment Scale (ESAS), Memorial Delirium Assessment Scale (MDAS), smoking history, renal dysfunction, prescriptions of opioids, pain response, subtype of OIN, management of OIN, OIN improvement, and date of death or last followup were reviewed and analyzed.

OIN was diagnosed in 11% (196/1770) patients. The median age was 60.5 years (Interquartile range [IQR]: 48.0-69.0) and 50.5% were male. The most common OIN symptom was delirium (n=87, 44%). Within 7 days after palliative care consults (PC), 89 patients (45%) reported OIN improvement. The medium days to improve OIN was 3 days (IQR: 1.0-5.0). Delirium (n=62, 32%) was the most common OIN symptom, and the most difficult one to be improved (n=20, 10%). The most common PC intervention was opioid rotation (n=131, 67%), followed by opioid reduction/discontinuation (n=43, 22%). Better pain response after PC consultation (Odds ratio per point 4.8, p=0.0007) was significantly associated with OIN improvement.

Only 45% of patients with OIN had improvement of OIN with a median of three days after opioid rotation or dose reduction. Better pain response after PC consultation was significantly associated with OIN improvement. 

Cancer pain is a multifaceted and difficult problem that affects every aspect of a cancer patient's life. We sought to compare a functional pain scale to the achievement of a personal pain goal in patients with active cancer pain. Methods 87 patients with incurable malignancy and cancer related pain were enrolled in this IRB approved study. Patients were surveyed monthly either in person or by mail. In the survey, patients were asked to set a personal pain goal (number scale 1-10), asked about their pain regimen and the influence of pain on their level of function using the following scale:

A small majority of patients (58%) met their personal pain goal over a 6 month period. In patients who did meet their personal pain goal, most (82%) maintained low scores on the functional pain scale. In patients who did not meet their personal pain goal, a majority (52%) had poor functional pain scores.

The use of a personal pain goal is one way to evaluate cancer pain but does not consider a patient's function and the influence of pain on day to day functioning. This novel pain scale, which includes function, correlates well to achievement of a personal pain goal. 

In this research, we observed the diagnosis, assessment and management of breakthrough pain on cancer patients' and physicians' perspectives. The primary purpose was to find barriers and ways to manage breakthrough pain for effective control. Methods We conducted a cross-sectional study of 59 physicians from 33 teaching hospitals across Korea. The assessment of breakthrough pain was conducted by surveying patients who use narcotic analgesics to control cancer pain. Clinical characteristics, assessment and management of cancer pain and breakthrough pain, physician's knowledge about breakthrough pain, and barrier questionnaire were assessed. Results 956 cancer patients participated in the study. Patients undergoing chemotherapy were 666 (69.67%). The prevalence of breakthrough pain among cancer patients was 73.33%. Physicians who knew the exact definition of breakthrough pain diagnosed breakthrough pain at the rate of 84.6±26.9% which was higher than those from physicians who did not know the exact definition (76.4±34.3%). However, the difference was not statistically significant (p=0.5232). The intensity of the breakthrough pain was reduced to 69.9% on average when short-acting opioids were used, and the overall satisfaction of the short-acting opioids was on average 73.1%. Participants experienced side-effects from short-acting opioids with 'drowsiness' (204, 30.77%) and 'dizziness' (159, 23.98%). Barriers Questionnaire with a five-point scale was given to the patients, with higher scores indicating a higher degree of having misconceptions regarding pain management. Table 1 summarizes the results.

The prevalence of breakthrough pain among cancer pain patients is 73% in Korea. To effectively control breakthrough pain, we have to correct misconceptions about cancer pain.

Orofacial pain (OFP) is an undesirable sensation frequently associated with head and neck cancer (HNC) and its treatment. OFP negatively impacts the quality of life of oncological patients. The approach to OFP diagnosis and management can differ if the patient visits a dentist or physician. The aim of this study was to present a case series of HNC with OFP managed by a dentist team and to discuss its role in the management of OFP.

We recruited twenty-two adult patients with OFP and previous diagnosis of HNC referred to an academic dental clinic from 2015 to 2017.

Nociceptive was more frequent than mixed and neuropathic pain, however 54,4% of the cases showed a neurological component. All types of pain were managed by dentist through removal of pain's cause and appropriated local and systemic treatment. The intensity of pain was reduced in 86,3% of patients, and 45,4% of them reported absence of pain at the end of treatment.

Dentist's assessment plays a distinct and crucial role in the diagnosis and management of OFP in HNC patients throughout the oncological treatment.

Musculoskeletal pain has been reported to affect up to 80% of women taking aromatase inhibitor (AI) for breast cancer. However, the long-term trajectory (after 12 months) of pain is largely unknown, and it is not clear whether pain is reduced following the completion of therapy. The purpose of this secondary analysis was to examine the long-term effect of AI on pain to one year after completion of AI therapy in breast cancer survivors. Methods Pain was assessed by Brief Pain Inventory before AI therapy, semiannually years 1 and 2, annually years 3 through 5, and one year after completion of AI therapy in three cohorts of postmenopausal women who: 1) received AI only (AO); 2) received chemotherapy+AI (CA); and 3) without cancer and matched on age and education. Linear mixed modeling was performed to examine group, time, and group×time effects among the cohorts for the severity and interference of pain.

Caucasian women (n=106), on average 60.4±6.3 years of age, were included. Compared to controls, the CA group experienced higher pain severity at 18 and 48 months after initiation of AI therapy (p=0.03, 0.01), while the AO group reported higher pain severity at every time point (p0.05) except at pre-therapy and 12 months after initiation of AI therapy. No significant time effects within each cohort and group effects for pain interference were found.

Our findings are the first to suggest that AI users experience higher pain severity from 18 months through 1 year after completion of AI therapy.

Chemotherapy-induced peripheral neuropathy (CIN) -pain, numbness, and/or tingling distributed in the hands and feet in a stocking-and-glove distribution-is a severe adverse effect produced by chemo-therapeutic agents Methods An open-pilot trial with repeated observation study design was used. Participants received a 4-week of APA treatment protocol to manage their CIN. After baseline data were collected, participants received a pre-APA fMRI scan, followed by 10 min of APA. Immediately after the treatment, a repeat fMRI was performed (immediate-APA). Participants received another fMRI after completion of a 4-week of APA (post-APA). Results fMRI scans were performed three times: pre-APA, immediately followed by 10 min of APA (immediate-APA), and post-APA (4 weeks APA) from 8 participants with CIN. Across the 11 intrinsic brain networks examined, there was a trend towards the significance of the connectivity of the basal ganglia network (BGN) to the salience network (SAL), which was decreased pre-APA vs immediate-APA (ES=1.04, p=0.07). The BGN also demonstrated decreased connectivity with the language network (LAN) pre-APA vs delayed imaging post-APA (ES=-0.92, p=0.07). Furthermore, there was increased executive control network (ECN) within-network connectivity comparing pre-APA to delayed imaging post-APA, trending towards significance (ES=0.41, p=0.09). When examining trends in connectivity, there was a progressive increase in connectivity within the ECN and SAL from pre-APA and delayed post-APA imaging.

The progressive increase in connectivity between the ECN-SAL networks from pre-to immediate-to post-APA suggests an ongoing alteration in brain functional connectivity following APA, particularly in the insular cortex which plays significant roles in pain, memory, and cognitive function.

Northwell's Palliative Medicine service at North Shore University Hospital developed a co-management model to address the needs of hematology patients admitted to the acute leukemia (ALU) or bone marrow transplant (BMTU) units.

The primary outcome was the time from admission to initial consult. The secondary outcome was length of stay in a goal concordant setting to receive end of life (EOL) care, namely our inpatient palliative care unit (PCU).

There were 106 new consults in twelve months (45 acute leukemia/ lymphoma and 61 bone marrow transplant). The average time to consult for the ALU decreased from 18.8 days at six months to 8.8 days at twelve months. For the BMTU, it decreased from 10.2 days at six months to 4.6 days at twelve months. The mortality rate of patients seen from the ALU and BMTU was 40% and 12%, respectively. Of the ALU deaths, 83% were 65 or older, compared to 29% of the BMTU deaths. Deaths in the ICU were greater for BMTU patients (43%) relative to ALU patients (11%). Fifty percent of the ALU inpatient expirations received EOL care in our PCU, while the remaining deaths were on the ALU (39%). Despite comparable numbers of PCU transfers during the pre-and post-intervention periods, the average LOS in the PCU increased from 1.1 to 5.7 days. Conclusions This partnership allowed for the recognition of different EOL care patterns, decreased time to consult, and increased time in goal concordant settings for patients at the end of their lives.

Music therapy has shown benefits for reducing distress in individuals with cancer. We explore the effects of music therapy on self-reported symptoms of patients receiving inpatient care at a comprehensive cancer center.

Music therapy was available as part of an inpatient integrative oncology consultation service; we examined interventions and symptoms for consecutive patients treated by a board certified music therapist from 9/2016-5/2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS, 10 symptoms, scale 0-10, 10 most severe) before and after the intervention. Data was summarized by descriptive statistics. Change in ESAS symptom and subscale scores [physical distress (PHS), psychological distress (PSS), and global distress (GDS)] were evaluated by Wilcoxon signed rank test.

Data were evaluable for 96 of 100 consecutive patients; 55% were women, average age 50, majority with hematologic malignancies (47%). Reasons for music therapy referral included: anxiety/stress (67%), adjustment disorder/coping (28%), and mood elevation/depression (17%). Highest (worst) symptoms at baseline were sleep disturbance (5.7) and well-being (5.5). We observed statistically and clinically significant improvement (means) for anxiety (-2.3±1.5), drowsiness (-2.1±2.2), depression (-2.1±1.9), nausea (-2.0±2.4), fatigue (-1.9±1.5), pain (-1.8±1.4), shortness of breath (-1.4±2.2), appetite (-1.1±1.7); and for all ESAS subscales (all p's<0.02). Highest clinical response rates were observed for anxiety (92%), depression (91%), and pain (89%). Conclusions A single, live, tailored music therapy intervention as part of an integrative oncology inpatient consultation service contributed to significant improvement in global, physical and psychosocial distress. A randomized controlled trial is justified. 

Fatigue and psychological stress are two of the most common cancer-related symptoms (CRS). They can independently predict changes in patient function, treatment failures, and post-therapeutic outcomes. Parents of children and adolescents with cancer, either report the use of CAM or demonstrate an interest in using these therapies to prevent and manage CRS. However, due to lack of scientific evidence in this context, parents often have not discussed their interest in or use of CAM with the health professionals involved in the care of their child. At the same time, health professionals have struggled to give a trustworthy feedback on this patient demand. This review aimed to identify, analyze and synthesize the evidence of CAM studies to improve control and prevent cancer-related symptoms in children and adolescents with cancer. Methods Eight electronic databases were used for the search. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts, and the full articles, a final sample of nine articles was obtained.

The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises.

It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRS.

This study aims to evaluate the acute toxicity, symptom relief and disease response after hypofractionated radiotherapy in patients with advanced unresectable and inoperable squamous cell carcinoma of head and neck (HNSCC).

A hospital based prospective observational study conducted at National Academy of Medical Sciences, Nepal from November 2014 to November 2015 on 30 patients of stage III or stage IV HNSCC who were offered the radiotherapy of 30 Gy in 10 fractions over 2 weeks. Baseline symptoms including pain, dysphagia, insomnia and dyspnoea were assessed using 11 point numerical scale. Acute toxicities during the treatment were assessed using Common Terminology Criteria for Adverse Events and graded accordingly. At 6 weeks of treatment percentage of symptom relief and disease response was assessed using Response Evaluation Criteria in Solid Tumors. A few patients were selected for further curative radiotherapy. Results Pain (86.7%) and dysphagia (50%) were common symptoms. More than 75% of symptoms relief was noted in 73% of patients with pain, 66.7% with dysphagia, 92.3% with dyspnoea and 60% with insomnia. An objective response rate of 70% was observed. A few patients had progressive disease (13.3%). Acute radiation toxicities were acceptable with no grade 3 or 4 toxicities and no treatment related mortality. Forty six percent patients had mucositis, 13.3% had dysphagia, and 6.7 % had hoarseness and dermatitis each.

Hypofractionated radiotherapy of 30 Gy in 10 fractions is a suitable modality of treatment for patients with advanced unresectable or medically inoperable HNSCC for symptom relief and tumour control, with acceptable toxicity.

Many oral cancer survivors suffer from trismus. This complication has major adverse impacts on individual quality of life. Knowledge regarding the risk factors for trismus is essential for developing intervention to prevent or effectively manage this devastating complication. Methods This is a prospective longitudinal study. 69 oral cancer patients were recruited. The maximum incisal opening was assessed before their surgery, discharge, and 1 month, 3 months, and 6 months post surgery. Measurement scales including a Therabite range of motion scale and the study questionnaires of demographics and disease variables. Statistical analysis was carried out by using SPSS software and descriptive analysis, generalized estimating equations were used to analyze the data.

The average maximum incisal opening distances were 29. 23, 20.85, 23.15, 25 .20 mm at pre-op, one month, three month, and six month, respectively. Using 35 mm as the cutoff point for trismus, there were 60.9%, 89.9%, 88.4%, and 76.8% of the study participants had trismus at pre-op, one month, three month, and six month, respectively. Advanced cancer stage and receiving CCRT were important predictors of trismus.

Patients with advance stage of oral cancer and treated with CCRT showed higher risk for developing trismus. Medical professionals should pay attention to this high risk group and provide them adequate oral rehabilitation exercise. Some participants quick oral rehabilitation exercise due to pain (n=9) and feeling not being effective (n=7). The study results can increase our understandings on the problems with trismus and how to provide appropriate information and nursing care to facilitate patients' recovery. Pain, fatigue, depression, and sleep disturbance impair the quality of life of oncology patients. Among multiple contributors to these symptoms (e.g., treatments, comorbidities), hyperglycemia is one that is modifiable. Interventions focused on decreasing hyperglycemia to improve symptom management during cancer treatment are lacking. The purpose of this pilot study was to evaluate the impact of a prescribed walking program for glycemic control and symptom management among patients without pre-existing diabetes undergoing chemotherapy for breast, lung, gynecologic, or gastrointestinal cancer.

In this prospective study, patients were randomization into a prescribed walking program (intervention) or usual care (control) group and were followed for six months, completed symptom surveys at enrollment, 3months, and 6-months, and had glycosylated hemoglobin A1c (A1c) measured at enrollment and 6-months. Analyses included descriptive statistics and correlations.

Forty-two patients enrolled and 33 (n=15 intervention; n=18 control) completed the study. The majority were women (n=32) with breast cancer (n=24). At month 6, A1c in the intervention group decreased by 0.16/ 5mg/dL (p=.002). In addition, sleep disturbance (p=0.023) and depression (p=0.021) were significantly lower in the intervention group compared to the control group. Mean scores for the intervention group compared to the control group improved from enrollment to month 6 for fatigue (Δ -1.48 vs. -1.11), energy (Δ +1.03 vs. +0.45), current pain (Δ -0.06 vs. +0.98), and weekly pain (Δ -0.75 vs. -0.07).

Exercise may improve glucose management and decrease symptom severity during treatment for cancer. Future studies with larger sample sizes are warranted. The study was conducted at B.R.A.I.R.C.H, AIIMS, New Delhi. The data was collected by convenience sampling from 50 adults who underwent surgery for oral during June 2017 to December 2017. Standardized selfstructured EORTC QOL(H&N) was used to assess the perceived level of the quality of life of post operative patients with oral cancer during hospital stay and at one month follow up. Ethical clearance was obtained from institutional ethics committee. Results 80% patients were male. Majority of the patients underwent mandibulectomy(66%) modified neck dissection(60%) and regional flap reconstruction(56%). The major symptoms perceived during hospital stay were pain(98%), speech problem (84%), problem in opening mouth(82%), felt ill(80%), weight loss(74%), etc. and at one month follow up were problem in opening mouth(90.6%), pain(90.5%), speech problem(83.6%), weight loss(82%), among many others. There was a significant decrease in the perceived pain (11.2+/-2.99) at one month follow up(9.12+/-3.42).

Most of the patients experience pain, problem in opening mouth, sticky saliva, speech problem, trouble in social contact, weight loss, etc. 

Cervical cancer (CC) is the fourth most common cancer among women worldwide, with an estimated 265,700 deaths per year and developing countries have the highest burden. The disease has relatively early onset, occurring primarily during reproductive ages. This study aimed at screening for the symptoms and early detection of CC in women at the University of Jos and how this can be related to public health management in Nigeria.

Of 350 interviewed, 250 consenting women aged ≥16 to 60 years were screened for CC and Human Papilloma Virus (HPV) related diseases. We used modified structured questionnaire after awareness campaign and 250 Pap smear samples were collected and screened by staining technique and slides examined microscopically.

Out of 250 samples screened, 8(3.2%) had low squamous intraepithelial lesion which is a positive indication of CC. The highest prevalence was seen in the age group of women between 16-25 years 5(2.0%), and 46-55 years 3(1.2%). The awareness offered women opportunity to be educated on CC, screened and linked to recommended government healthcare hospitals.

: The conventional Pap smears in screening and primary HPV testing will play an important role as early detection of CC, which is critical to management and eradication of the diseases through the use of effective candidate vaccine particularly among reproductive age group. 

Patients with acute leukemia experience multiple concurrently occurring symptoms that interfere with activities of daily living. Exercise-based interventions have been used as a supportive measure to remedy disease and treatment-related symptoms in patients with cancer. The study explored the impact of a multimodal exercise-based intervention on symptom and fatigue prevalence, severity and the longitudinal patterns of individual and clusters of symptoms in adult patients with acute leukemia. Methods A two-center, randomized controlled trial of patients with acute leukemia during consolidation chemotherapy in the outpatient clinic. Patients were randomized to usual care or a 12-week supervised exercise and counseling intervention. A 13-item Symptom Assessment and six-interference item questionnaire and a 4-item Brief Fatigue inventory were completed weekly during the 12-week study period.

Of the 70 patients randomly assigned to the intervention (n=32) or control group (n=34), 62 patients completed study requirements. We found no difference in symptom prevalence, however the intervention group experienced a statistically significant increase in symptom and fatigue severity during the study as compared to the control group, only to inadvertently reduce, while the control group increased by study completion. Four symptom clusters were identified, and the cluster 'drowsy, fatigue, disturbed sleep and remembering' was significantly more severe in the intervention group during the 12-week study period, peaking at eight weeks.

Though exercise and counseling integrated in the clinical setting increased symptom severity during the study period, a relief in symptoms at end of study shows the potential of exercise in facilitating resumption of everyday activities.

Systematically monitoring symptoms using patient-reported outcomes (PROs) measures during cancer treatment can improve quality of life, treatment adherence, and overall survival and can decrease resource utilization. Little is known about patient willingness to complete PRO measures and about patient preferences as to completion location, administration method, frequency, and desired response from providers. The purpose of this study is to determine patient willingness and preferences around symptom assessment completion.

An investigator-developed questionnaire about preferences for responding to PRO symptom measures was completed by 135 participants with cancer. Data were analyzed descriptively.

Mean participant age was 56.3 years (standard deviation = 13.0); 50.4% of participants were female, 72.6% white, and 79.5% diagnosed with a solid tumor. Participants were surveyed while receiving chemotherapy (76.6%) or during post-operative hospitalization (23.3%). The preferred location to complete PRO symptom measures was in the clinic waiting room (37.0%). The preferred method of completion was paper and pen (26%) or electronic tablet (18.5%) in the clinic or computer (19.9%) or phone (25.3%) at home. Participants preferred to complete only one PRO measure per clinic visit (74.0%) and per week during treatment (76.0%). When reporting high symptom severity, participants preferred a provider to response by phoning them immediately (48.6%). Conclusions Patient preferences regarding location, method of administration, frequency of administration and desired response from providers should be considered in planning symptom monitoring using PRO measures as part of clinical care.

This paper discusses the care provided for a 61-year-old female patient with hemiparesis on the left side due to an anemic cerebral infarction. with bone meta.

After the incident, the patient experienced restricted movement and a loss of control over daily living; this caused physical and mental stress as well as anxiety. Care was provided between April 30 and May 29 and evaluation was conducted using Orem's self-care theory. Data was collected via observations, discussions, and physical evaluations, and the patient's health problems were impaired physical function, physical and mental stress, and anxiety.

This served as the motivation for this discussion. Empathy, encouragement, and accompaniment helped the patient express herself regarding the illness and gradually become more positive about living with her situation. The medical team included a physical therapist who provided the patient and her family with a physical therapy plan to make best use of her physical functions. Other patients with the same condition were also introduced so that their encouragement along with her family's support could lessen her feelings of anxiety and uncertainty while improving selfcontrol, allowing the patient to return to a normal life Conclusions It is hoped that this nursing experience can serve as a clinical reference for the future care of patients with ischemic cerebral infarctions.

The prevalence of malnutrition among cancer patients ranges from 40-80% depending on the stage, tumour site, treatments and the individual. Malnutrition is associated with a reduced quality of life (QOL), increased risk of chemotherapy-induced toxicity, decreased response to treatment and thus, can impact disease progression and survival. Nutrition screening aims to identify patients at risk for malnutrition, ideally leading to early nutrition intervention. At BC Cancer (BCC) a Nutrition Screening Tool (NST), based on the validated Malnutrition Screening Tool (MST), is included within the self-reported outpatient intake form. This study reviewed data collected from the NST. Methods Frequency distributions were analyzed for 62,592 NST scores (0-1=low malnutrition risk, 2-3=moderate risk, 4-5=high risk) collected over 4 years from January 2013-December 2017.

Overall, patients scored 0 (55.9%), 1 (14.8%), 2 (15.5%), 3 (8.4%), 4 (3.6%) and 5 (1.9%). The proportion of patients at moderate to high malnutrition risk was 29.4% (scored 2 or greater). Moderate to high risk, by tumour site, was: gastrointestinal (52.1%), lung (46.3%), head and neck (27.9%), genitourinary (18.2%) and breast (15.7%). About onethird (34%) reported involuntarily weight loss recently. One in five patients (22%) reported that they were eating poorly due to a decreased appetite.

The proportion of cancer outpatients who were at moderate to high malnutrition risk was consistent with the literature. Screening is one tool to guide triaging practice of oncology dietitians. Future research is needed to evaluate the effect of screening on outcomes. 

Malignant pericarditis was observed in 5.1%-7.0% of all cases of acute pericarditis. Malignant pericardial effusion (MPE) can lead to cardiac tamponade in the later stages of cancer. Breast cancer is the second most common primary site associated with MPE. The efficacy and safety of pericardial sclerosis have never been evaluated in breast cancer. In this study, we assessed the efficacy and safety of intrapericardial carboplatin (CBDCA) following catheter drainage in patients with breast cancer-related MPE. Methods A catheter was inserted percutaneously into the pericardial space under echocardiographic guidance. After complete drainage, 150 mg of CBDCA was instilled into the pericardial space through the catheter.

Eight patients with symptomatic breast cancer-related MPE were treated at the Gunma Prefectural Cancer Center, between July 2010 and March 2016. After treatment, the control rate of MPE at 1 month was 100%. Fever was observed in 2 patients (25%), and none experienced chest pain or arrhythmia. The median survival time from the recurrence of breast cancer until death or study follow-up was 2336 days (range: 293-3937 days), while that from intrapericardial CBDCA administration until death or study follow-up was 552 days (range: 35-1637 days).

We found that intrapericardial administration of CBDCA after catheter drainage appears to be safe and effective in managing breast cancerassociated MPE. Because the number of patients in this study was small, further studies are warranted to determine the safety and efficacy of intrapericardial CBDCA in the management of breast cancer-related MPE.

Attentional function is an extremely important outcome for older oncology patients. In previous work, we identified three distinct attentional functional profiles (i.e., low (36.7%), moderate (37.3%), high (26.0%)). This study's aim was to evaluate how these subgroups of older adults differed on the severity of nine co-occurring symptoms (i.e., trait anxiety, state anxiety, depression, sleep disturbance, morning fatigue, evening fatigue, morning energy, evening energy, pain).

Older oncology outpatients (n=365) were assessed for changes in attention using the Attentional Function Index (AFI) six times over two cycles of chemotherapy. Patients completed Spielberger State-Trait Anxiety Inventories, Center for Epidemiological Studies-Depression scale, General Sleep Disturbance Scale, Lee Fatigue Scale, and Brief Pain Inventory. Hierarchical stepwise regression model was used to evaluate the effects of selected co-occurring symptoms on AFI latent class membership.

Differences in state anxiety, trait anxiety, depression, sleep disturbance, morning fatigue, and evening fatigue, among the classes, followed the same pattern (i.e., low > moderate > high class). Compared to the high class, lower income, higher level of comorbidity, higher chemotherapy toxicity score, and higher sleep disturbance, state anxiety, and depressive symptom scores were associated with membership in the low AFI class. Compared to the high class, a higher level of comorbidity, lower levels of morning energy, higher trait anxiety, and previous treatment combinations were associated with membership in the moderate high AFI class.

Phenotypic characteristics associated with membership in low and moderate latent classes can be used by clinicians to identify higher risk patients. Breast cancer is the most prevalent form of cancer and the leading cause of death among women in Ghana. Most patients report late with up to 85% presenting with advanced disease. People with Metastatic Breast Cancer frequently experiences feeling of isolation, shame and stigma associated with the disease. These feeling are aggravated with lack of public understanding. Moreover, there is no support system or followup care for survivors. To address this issue there is the need for information, support and education to the general public.

To establish a structured social media platform for supportive care network that will improve the quality of end-of-life care among Breast Cancer Patients Methods During the one year program, a social media platform and network was created were we identify and recruit prospective breast cancer survivors within Kumasi Metropolis to share their experiences, have their concerns addressed and educate the public about Metastatic Breast Cancer.

Creating of the social media campaign reached out for hundreds of thousands of people. Understanding Metastatic Breast Cancer beyond their personal experiences, broaden their knowledge of resources available for them, a social media as a advocacy tool and grew their personal support network.

Social media is an ideal medium for education and advocacy as it education, advocacy, support features represent an effective model. The survivals shared their personal experiences via the social media. 

Children with cancer experience distressing symptoms, yet routine and systematic screening of symptoms in children is rare. In adult cancer settings, the use of Patient Reported Outcomes (PRO) for symptom screening is common and has demonstrate a range of benefits to patients, clinicians and health systems. Less is known about using PROs in children and if the same benefits can be realized. We aimed to explore symptom burden in a cohort of children, and to examine the feasibility and acceptability of using the Symptom Screening in Pediatrics (SSPedi) tool from the child and family perspectives.

We reviewed free-text records for phone calls made to oncology nurses over a 6 month period. Reasons for calls were categorized and calls about symptoms were further categorized. We then prospectively collected a convenience sample of patient reports of symptom distress using the 15 item SSPedi tool.

There were 717 phone calls regarding 249 patients over a 6 month-time period. Only 12% of phone calls (N=89) were about symptoms. Of these, most (N=23,26%) were regarding pain, with the remainder about 14 different symptoms. Forty-six children aged 8-18 years completed the SSPedi. The symptoms causing the most bother were sleep (51.47%), fatigue (43%) and changes in taste (36%).

The symptoms that cause the most bother to children are not the same symptoms reported as a concern by parents in phone calls. More research is required to better understand how to reduce symptom burden in children. Use of PROs in this patient group is feasible and acceptable. 

Excessive symptom burden remains a distressing problem for survivors with NSCLC stages I-IIIa. This study's objective is to test a tailored intervention, Breathe Easier, which encompasses meditation, varying levels of yoga, and breathing exercises to evaluate feasibility and preliminary effects. Methods A prospective, one-group, repeated measure, mixed-method design tested the hypotheses that participants who receive an 8-week intervention will demonstrate less (a) dyspnea, (b) fatigue, (c) stress and (d) improved sleep post intervention. The FACIT Dyspnea Short Forms, FACIT Fatigue Scale v.4, Pittsburgh Sleep Quality Index, and the Perceived Stress Scale v.4 measured outcome variables. Descriptive statistics summarized five feasibility measures (recruitment, retention, intervention dose, adherence, acceptability).

In six iterations, 164 survivors were reached, with 32 dyads enrolled (62 participants; 20% recruitment and 94% retention rates). Survivors were 44% male and 62% African American. Among all, 74% were not current smokers, 22% used oxygen, and 71% completed a 6MWT post intervention. Survivors reported slightly greater adherence for completion of daily home assignments. All agreed that intervention materials were easy to use, learning yoga and breathing exercises helped them, and that involving a family member was important. For each outcome variable, differences in survivors versus partners, T1 versus T2, and the interaction were calculated. Survivors had less dyspnea and perceived stress over time. Both groups had improved fatigue and sleep scores. Conclusions Recruitment, retention, adherence, and acceptability demonstrated strong feasibility. Preliminary outcome data indicate benefits were experienced over time by both survivors and family members. Sleep disturbances among cancer patients are associated with various psychological morbidities. Among head and neck cancer (HNC) patients sleep disturbances are hypothesized to be highly prevalent. However, there is no precise estimate on the prevalence of sleep disturbance among this population. Our aim is to systematically review the prevalence of sleep disturbances among HNC patients.

Pubmed, Embase, CINAHL and PsycINFO were searched. Studies reporting the prevalence of any type of sleep disturbance among adults with HNC were included. Study selection, data extraction and quality assessment were performed by two independent reviewers. Meta-analysis of prevalence was performed using random effects model, with I2 values to indicate the extent of heterogeneity. Prevalence rates among different treatment type and phases, measurement instrument used and the quality of included studies were examined.

Twenty-nine studies of accumulatively 2,315 HNC patients were included. The quality was fairly poor and the heterogeneity was high. Studies on three types of sleep disturbances were found: insomnia (17 studies) with pooled prevalence 29% (95% CI 20-41%) before, 45% (95%CI 33-58%) during, and 40% (95%CI 24-58%) after treatment; sleep-related breathing disorders (14 studies) with pooled prevalence 66% (95% CI 44-82%) before and 51% (95% CI 34-67%) after treatment; and hypersomnolence (12 studies) with pooled prevalence 16% (95% CI 7-32%) before and 32% (95% CI 20-48%) after treatment.

Sleep disturbances are highly prevalent among HNC patients across all phases of treatment. Screening of sleep disturbances and intervention to improve this condition should be initiated soon after cancer diagnosis. 

Hair loss is a distressing treatment-related adverse event of chemotherapy. Hair loss is often the most visible adverse event and can impact women and men their well-being. Evidence suggests that the use of a scalp cooling device can prevent or lower the amount of hair loss. The aim of this study is to assess cancer patients' experiences about this technique and to examine the effectiveness in relation to hair loss.

The study used a retrospective, cross-sectional study design. A 26-item questionnaire was developed and validated using the delphi method. A consecutive sample of 126 patients from a large Belgian university hospital participated the study. Data collection took place from January 2018 to April 2018.

Scalp cooling was most often proposed by the specialist (57%). Patients stress levels about this unknown technique were significantly lower at the end of the chemotherapy treatment (p<0.001). Scalp cooling was well tolerated by cancer patients. Many patients (74%) also expressed a positive feeling on their appearance. A wig or head cover was used by only 29% of the patients. The effectiveness of scalp cooling was high in combination with paclitaxel or docetaxel.

Cancer patients clearly reported positive experiences and outcomes with scalp cooling. Scalp cooling seems to be particular effective in use of taxanes. Introduction Electrochemotherapy (ECT) is an effective local treatment for cutaneous tumors and metastasis. Treatment involves the administration of chemotherapeutic drugs followed by delivery of electrical pulses to the tumour. To investigate the effectiveness of ECT in ulcerated versus non-ulcerated cutaneous tumors. Methods 22 cancer centres of the INSPECT-group consecutively and prospectively uploaded data to a common database. Electrochemotherapy consisted of intratumoural or intravenous injection of bleomycin, followed by application of electric pulses under local or general anaesthesia.

716 patients with ulcerated (452) and non-ulcerated (264) cutaneous tumors were identified from the database with a follow-up of at least 45 days. Most of the lesions were metastases of melanoma and breast cancer and primary epithelial tumors. Patients with ulcerated lesions are significantly older and have larger lesions. Non-ulcerated lesions (overall response 86 %) significantly responded better than ulcerated lesions (overall response 79 %, p=0.0493). In large lesions complete response (CR) versus non-CR between the two groups is statistically significant (p=0.0395). Prior to ECT, patients with ulcerated lesions have significantly more pain. Immediately after ECT pain is significantly raising in non-ulcerated tumors, whereas in ulcerated lesions it remains stable. Odor, suppuration, bleeding and ulceration is improving over time after ECT in ulcerated tumors. Conclusions ECT is a highly effective local treatment for cutaneous metastases and tumors, with no severe adverse effects. An intense perioperative pain management in non-ulcerated lesions prior to ECT seems to be mandatory since pain raises after treatment. ECT improves quality of life in patients with ulcerated tumors.

Management of locally-advanced breast cancer (LABC) varies, but in patients without distant metastases treatment often involves neoadjuvant systemic therapy, surgery and radiation. If the primary tumour remains unresectable after systemic therapy, radiotherapy may be used for tumour shrinkage before surgery. When distant metastases are present, locoregional radiotherapy is generally reserved for management of tumour-related symptoms. The present study reviewed our institution's experience of high-dose radiotherapy for unresected LABC. Methods A retrospective chart review was conducted of patients with unresected LABC receiving external beam radiotherapy to the breast, chest wall and/or regional lymph nodes. Patients were stratified based on the presence of distant metastases at presentation. Patient demographics, disease characteristics, and treatment outcomes were recorded. Primary outcomes were locoregional progression-free survival (LPFS) and overall survival (OS) from completion of radiotherapy. Patients' symptoms and quality-of-life were also evaluated.

Forty-three cases were identified. Median follow-up was 14 months from completion of radiotherapy. Twenty-four cases (56%) presented with metastatic disease. Tumour shrinkage occurred within 3 months of completing radiotherapy in 36 cases (84%). Ulceration and bleeding were improved in 13 (54%) of the 24 applicable cases. Twenty-six patients (60%) developed moist desquamation but none experienced grade 4 or 5 dermatitis. The median LPFS was 12 months. LPFS (p=0.2) and OS (p=0.4) were not significantly different between patients with and without distant metastases at presentation.

Radiotherapy provided good response and symptom control in most patients in this study; there is a role for palliative radiotherapy in patients with LABC. 

Introduction: AYAs (adolescents/young adults) have a distinct cancer experience because of their developmental stage, cancer types, and complex symptoms. A heuristic approach may support AYAs to better understand and communicate their symptoms. This study describes priority symptoms identified by AYAs using a heuristic app, explores severity and bother ratings, reasons for priority designation, self-management strategies, and congruence with provider documentation. Methods Methods: AYAs used an iPad-based symptom heuristics app, the Computerized Symptom Capture Tool (C-SCAT) to report symptoms prior to two chemotherapy visits. The C-SCAT supports AYAs to explore their own symptom experience, including designation of priority symptoms. AYAs received their C-SCAT image prior to their provider visit to guide discussion of their symptoms. C-SCAT data were analyzed for priority symptoms, reasons for prioritization, and self-management strategies. Providers' documentation was reviewed for evidence that priority symptoms were discussed.

Results: Seventy-seven AYAs (52% male; mean 20.7 years) identified 169 priority symptoms -half of which were not documented by providers. Lack of energy (n=19), nausea (n=18), difficulty sleeping (n=15), and pain (n=13) were most prevalent and more frequently documented relative to other priority symptoms (X2=5.62; p=.02). Provider documentation frequency did not differ based on symptom severity, bother, reason for priority symptom designation, or AYAs' self-report of selfmanagement strategies.

Conclusions: Encouraging AYAs to identify priority symptoms is an initial step in symptom management, followed by a patient-centered dialogue with providers regarding symptom management. Continued research is needed on the ways AYAs and providers communicate and how AYAs prioritize symptoms. 

While some oncology patients experience high levels of stress associated with cancer and its treatment, others appear to be more resilient. Less is known about the associations between stress and the severity of common symptoms in oncology patients undergoing chemotherapy. The purposes of this study were to identify subgroups of patients with distinct stress profiles and to evaluate for differences in the severity of fatigue, sleep disturbance, attentional function, depression, and anxiety among these subgroups.

Latent profile analysis was used to identify subgroups of patients with distinct stress profiles using their responses on the Perceived Stress Scale, Impact of Event Scale-Revised, Life Stressor Checklist-Revised and Connor Davidson Resilience Scale. Differences in symptom severity scores among the latent classes were evaluated using analysis of variance.

Among the 957 patients evaluated, three latent classes were identified (i.e., Stressed (39.9%), Normative (54.3%), Resilient (5.7%)). Compared to the Normative class, patients in the Stressed class were younger, more likely to be female, more likely to live alone, more likely to be unemployed, had less education, had a poorer functional status and a worse comorbidity profile. Compared to the Normative and Resilient classes, patients in the Stressed class had significantly higher scores for morning and evening fatigue, sleep disturbance, trait and state anxiety, and depressive symptoms and worse attentional function scores.

This study is the first to identify subgroups of patients with distinct stress profiles. Increased levels of general and disease specific stress are associated with a higher symptom burden.

For treatment of hepatic ascites, furosemide and spironolactone are generally used, but renal dysfunction and hyponatremia often occur. Tolvaptan (TLV), a selective oral vasopressin V2-receptor antagonist, which was approved for refractory ascites in Japan in 2013, is known to be effective without causing such adverse events, but its efficacy for ascites in patients with hepatocellular carcinoma (HCC) has not been well defined. To define the efficacy and safety of TLV for ascites in patients with HCC group and predictive factors for its efficacy.

We retrospectively reviewed medical records of 155 patients, including 73 patients with HCC, who were treated with TLV for ascites in Kurashiki Central Hospital between December 2013 and November 2018. Among them, we compared efficacy between patients with HCC and those without. Efficacy was defined if body weight decreased 3% or more within one week after start of TLV.

The efficacy rate was lower in patients with HCC (35/73, 47.9%) than in those without HCC (52/82, 63.4%) (p=0.05). In both groups, serum sodium increased significantly, but withdrawal of TLV was not required; serum creatinine did not change significantly. Multivariate analysis, baseline sodium level with 136 mmol/L or more was identified as a significant and independent factor for its efficacy in patients with HCC. Conclusions TLV was effective for refractory ascites in nearly half of patients with HCC without causing hyponatremia, and serum sodium level may help predicting its efficacy.

Immune checkpoint inhibitors (ICI) have shown clinical benefit in various cancer types. However, linked to their mechanisms of action, these treatments exhibit specific toxicities that impact patients' quality of life (QoL). Patient-reported outcome (PRO) instruments are used in clinical trials (CT) to collect symptoms, functional status, and QoL. The question remains whether these instruments capture ICI-specific symptoms and adverse events (AEs). To evaluate their utility in the context of ICI CTs, we conducted a systematic review to identify PRO instruments and juxtapose their content with the most frequently reported AEs. Methods Literature was searched using PubMed, Embase, PsycINFO, Medline and CINAHL databases (June 2017) including keywords related to approved ICI, PRO, and Oncology. Symptoms were extracted from PRO instruments and juxtaposed to the AEs reported for the corresponding cohort.

We identified 13 CTs reporting PRO results. Generic QoL and/or cancerspecific questionnaires were the most widely used PRO instruments in ICI CTs. Five studies combined them with tumor site-specific modules, and one included a symptom-specific questionnaire. Among the 12 most frequent AEs, gastrointestinal and systemic events represented 50% of all AEs, followed by dermatological (20%) and endocrine (9%) AEs. Juxtaposition of AEs with the symptoms contained in the PRO instrument(s) showed a 44% coverage, whereas 31% were not covered. Of these, 66% referred to the dermatological system.

Despite the high frequency of dermatological, endocrine and musculoskeletal-related AEs, these events are not or only partially addressed by the PRO instruments used. Hence, the adaptation or development of ICI-specific PRO tools requires further investigation. 

To investigate the effects of evidence-based nursing on surgeryrelated complications and the quality of life in patients with osteosarcoma. Methods 45 patients with osteosarcoma underwent surgical treatment were randomly divided into experimental group and control group. Control group received routine nursing and experimental group received evidence-based nursing on the basis of conventional nursing. The length of hospital stay, medical costs, complication rate were documented, and the quality of life and nursing satisfaction were assessed in both groups.

The length of hospital stay was shorter, hospital costs were lower and complications were less frequent in experimental group than those in control group (all P<0.05). The quality of life and nursing satisfaction in experimental group were significantly higher than those in control group (both P<0.05).

The implementation of evidence-based nursing after surgery can significantly reduce the incidence of complications, improve the quality of life and satisfaction with care in patients with osteosarcoma. Introduction Therapy outcomes and compliance can be improved through active monitoring of patient-reported (PRO) side effects. To improve symptom management in Dutch oncological care, we developed an online self-reporting application that presents patient-tailored side-effects information, and allows patients to report and visualize their own side effect scores. Here, we report on usability and use of the application. Methods Usability of our application ("BijKanker") has been evaluated in 7 Dutch hospitals. At least once a week patients reported on 12 standard side effects, based on the Dutch 'nursing problem analyses'. During the first log-in and 4 months after initiating their systemic therapy, patients completed a questionnaire about information provision and their experiences with the application. Personalized feedback about the burden of side effects was provided by a longitudinal graph for patients and health care providers.

Patients (n=99) reported in total 1,661 side effects (mean= 10 times data entrance per patient) with highest incidences for neuropathy (20%), nausea (15%) and diarrhoea (13%). Patients rated BijKanker as understandable (74% positive, 23% neutral) and moderately easy to use (33% positive, 33% neutral) and thought the feedback function was important (57% positive, 21% neutral).

Active monitoring of side effects through an online self-reporting application is feasible in Dutch oncological care. Patients experienced BijKanker as a useful tool for self-care management. Current development of the application focusses on allowing patients to report on a treatment-tailored list of side effects, specified per type of cytotoxic agent(s), using the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) for terminology and definitions. 

Electronic systems can facilitate symptom monitoring and management. The purpose of this study was to evaluate the effect of the Cancer Symptom Management System: Symptom Management Improves your LifE (SMILE) which combined electronic symptom management and evidence-based patient education for cancer symptom management. Methods A nonblinded, randomized controlled trial was conducted. Cancer patients starting adjuvant or palliative chemotherapy (CTx) were randomized to control (symptom monitoring), experimental 1 (Exp 1; symptom monitoring + report), or experimental 2 (Exp 2; symptom monitoring + report + ONS PEP-guided evidence-based symptom management education) groups in a 1:2:2 ratio. Generalized estimating equations were utilized to analyze the data (N=249).

Fatigue and sleep disturbance changes were different between Exp 1 and Exp 2 groups, among patients receiving adjuvant CTx, (p=.042 and p=.008). Fatigue gradually decreased after a peak at the 1st CTx cycle in Exp 2, whereas Exp 1 experienced increasing fatigue until the 3rd CTx cycle. A gradual decrease in sleep disturbance was observed in Exp 2 after the 2nd CTx cycle, whereas Exp 1 experienced a steady increase in the symptom. Participants were willing to monitor symptoms using the Cancer Symptom Management System. Evidence-based symptom management education was considered as easy to understand and helpful.

The Cancer Symptom Management System: SMILE incorporating evidence-based symptom management education effectively managed fatigue and sleep disturbance after adjuvant CTx. Integrating electronic symptom management system and evidence-based symptom management education is recommended to better manage fatigue and sleep disturbance among patients receiving adjuvant CTx.

Cancer patients come across various unmet needs throughout cancer journey. Gastric cancer patients' unmet needs has been less well documented. The purpose of this study was to identify factors related to unmet needs and its relationship with quality of life (QOL) among gastric cancer patients. Methods A correlational study was conducted including 180 gastric cancer patients. Unmet needs, anxiety, depression, physical symptoms, and QOL were measured using the SCNS-SF 34, HADS, MDASI, and EORTC QLQ-C30 Korean versions. Pearson correlation, multiple regression and path analyses were utilized to analyze the data.

Highest unmet needs were identified in the health system & information domain, followed by the patient care and support domain. Unmet needs in the physical and daily living domain demonstrated highest correlation with QOL (r=-0.52, p<.001), and significant negative influence on patients' QOL (r2=0.27, p<.001). Physical symptoms and depression explained 34.8% of total variance of unmet needs in the physical and daily living domain (p<.001). Both physical symptoms and depression demonstrated direct and indirect negative effect on patients' QOL which is mediated by unmet needs in the physical and daily living domain. The model explained 54.1% of total variance in the gastric cancer patients' QOL (p<.001).

Gastric cancer patients' unmet needs and its contribution to QOL were explained. Along with interventions to manage physical symptoms and depression, special attention needs to be paid to be aware of and satisfy unmet needs in the physical and daily living domain to improve QOL of patients with gastric cancer.

Randomized Controlled Trials (RCT) determine high level of evidence, but are difficult to perform in the very sick. Methods This is a comprehensive review of RCT, systematic and comprehensive scope reviews on cancer symptoms and Health Related Quality of Life (QOL) from 2006 through 2017 to evaluate factors influencing the evidence of the assessment process -instruments, symptom descriptors, scales and patient-reported outcome measures (PROM).

Five systematic, three comprehensive scope reviews and one RCT provided high level of evidence in the symptom and QOL assessment process. Valid and reliable instruments ESAS, MDASI, SDS, EORTC-QLQC-30, FACT-G and specific study designed comprehensive PROM are recommended, but may not be always clinically feasible. Numerical Rating Scales (NRS) are preferred for pain, relief scales are more sensitive than severity scales. Cut out points on the ESAS 0-10 NRS for moderate symptoms are: pain > 5; other symptoms >4; for severe symptoms > 7-8. Self -assessed PROM improve provider-physician communications, physical symptoms and to a lesser extent QOL, psychological outcomes, but can decrease anxiety and depression during patient communications.

The insufficient evidence data on cancer symptom and QOL assessments precludes developing guidelines, but the following recommendations can be made: 1) Valid, reliable and comparable instruments should be balanced with clinical experience. 2) Self-report is a priority, but caregiver information for physical symptoms is reliable. 3) PROM influence physical symptoms management more than QOL. 4) Generalizable results depend on scale comparability, population, time of assessment, stratification, >3 raters, consistent implementation and continuous provider and patient education on PROM.

The current anti-cancer therapy has limitations of not addressing most of the cancer growth strategies while leaving behind severe side effects. The quest for safer but effective anti-cancer therapy is constant. Anthocyanins, the colored derivatives of polyphenols, found among fruits, vegetables and flowers. Rose petals have major varieties of anthocyanins. Due to no data about anticancer effects, it was envisaged to study in vivo antiangiogenesis in a lymphoma model of mice. Methods Albino male mice (4 week old, n=16) were rendered lymphoma by intraperitoneally introducing DAUDI cells (1 million cells/animal, single-injection) . A batch of lymphoma animal group were supplemented orally with rose-anthocyanins (50mg/kg bw/d, daily, n=8) for all 30 days. A group of animals received only rose-anthocyanins (n=8). Animals were observed for body weight and pain symptoms for 30 days. Terminally the animals were euthanized, peritoneal zones were collected for histopathological studies while blood was assessed for cancer markers. Results Mice exposed to DAUDI cells demonstrated a slight but significant increase in the body weight gained. There were no lumps found on peritoneal tissue while neoplasmic blood vessels were apparent. New blood vessels with excessive branching are suggestive of carcinogenesis caused by the DAUDI cells. DAUDI treated mice receiving the roseanthocyanins showed remarkable recovery against angiogenesis while showing improved pain response. Blood markers for inflammatory response and different lymphocyte patterns were also ameliorated with rose-anthocyanins among DAUDI mice.

Our results strongly suggest the anti-angiogenic properties of rose-anthocyanins. Future studies are focused on individual anthocyanin types from various colored plant sources.

Despite having an excellent prognosis, patients with ductal carcinoma insitu (DCIS) report significant anxiety and depression following their diagnosis. This study evaluated psychological morbidity using the Edmonton Symptom Assessment Scale (ESAS) in patients with DCIS compared to women with early stage invasive breast cancer (EIBC) receiving radiotherapy (RT).

We identified patients diagnosed with DCIS or EIBC (stage I or II breast cancer) from 2011-2017 who had at least one ESAS completed pre-and post-RT. Data on systemic treatment, radiation, patient demographics, and disease stage were extracted from existing databases. Psychological morbidity was evaluated through measurement of depression, anxiety and overall wellbeing within the ESAS. Wilcoxon rank-sum test or chi-square test was performed for continuous or categorical variables.

This study included 137 women with DCIS and 963 women with EIBC (Table 1) . ESAS was completed on average 28 days before RT (baseline) and 142 days after RT. Baseline ESAS scores showed significantly higher rates of depression among women with EIBC compared to those with DCIS (p=0.006) ( Table 2) . Patients with EIBC also reported higher levels of anxiety and lower overall wellbeing than patients with DCIS, but this difference was not statistically significant. Post-radiation ESAS scores showed significantly higher anxiety in patients with EIBC compared to DCIS (p=0.049) ( Table 2 ). Post radiation measures of anxiety and overall wellbeing were higher in patients with EIBC but differences were not statistically significant.

Women with DCIS experience relatively less psychological morbidity than women with EIBC, pre-and post-radiation treatment. 

Symptoms experienced by breast cancer patients often cluster together in groups known as "symptom clusters". The purpose of this analysis is to determine the symptom clusters before, during, and after radiotherapy (RT) in women with breast cancer. Methods All breast cancer patients receiving RT completed the Edmonton Symptom Assessment Scale (ESAS) before, during, and after RT. Exploratory factor analysis (EFA), principal component analysis (PCA), and hierarchical cluster analysis (HCA) were used to identify symptom clusters among the nine ESAS items at all three time points (Tables 1, 2) . Results A total of 1224 patients were included in this study. The PCA and EFA identified the same two symptom clusters before the start of RT: 1) pain, tiredness, nausea, drowsiness, appetite, and dyspnea; 2) depression, anxiety, and wellbeing ( Table 1 ). The HCA further split the symptoms into three clusters (Table 2) . Wellbeing, depression, and anxiety consistently clustered together. Among the ESAS scores collected during and after RT, each statistical method identified different symptom clusters. For the symptom clusters experienced during RT, the following symptoms were always in the same cluster: wellbeing, depression, and anxiety; nausea and appetite; drowsiness and dyspnea. Following RT, depression and anxiety consistently clustered together, with nausea and appetite in the other cluster.

Among the symptom clusters derived before, during, and after RT, the following symptoms consistently presented together: depression and anxiety, nausea and appetite, pain and tiredness, and drowsiness, dyspnea, and tiredness (Table 3) . Well-defined symptom clusters in this population can improve management of symptoms.

Over 70% of patients with advanced cancer experience dyspnea. Dyspnea is predictive of shorter survival and negatively effects quality of life. The present study aimed to identify predictors of the presence and severity of dyspnea in advanced cancer patients. Methods Patient characteristics and Edmonton Symptom Assessment System (ESAS) shortness of breath scores were analyzed from a prospective database of patients attending a palliative radiotherapy clinic. Using the ESAS, dyspnea was classified as mild [1] [2] [3] , moderate [4] [5] [6] or severe [7] [8] [9] [10] . Logistic regression analysis and generalized estimating equations were used to identify predictors of the severity of dyspnea and presence of moderate/ severe dyspnea (ESAS ≥4) at patients' first visit and over time, respectively.

Multivariable analysis (n=252) showed liver metastases (P=0.01), a history of respiratory conditions (P=0.03) and PRFS ≥3 (P=0.03) were predictive of dyspnea severity at the first visit. Over time, liver metastases (P=0.02), lymph node metastases (P=0.02), a history of respiratory conditions (P=0.006) and pulse oximetry<90 (P=0.003) were predictive of greater dyspnea severity. Patients with multiple radiation treatments in the thorax region were less likely to have severe dyspnea symptoms over time (P=0.01). Lung metastases (P=0.04), a history of respiratory conditions (P=0.01) and PRFS ≥3 (P=0.009) were predictive of moderate/severe dyspnea at the first visit. Over time, lymph node metastases (P=0.003), a history of respiratory conditions (P=0.04) and pulse oximetry<90 (P=0.0004) were predictive of moderate/ severe dyspnea.

Increased awareness of dyspnea predictors can promote early intervention for improved patient care and the creation of screening tools for clinical practice.

Knowledge of the prevalence of symptoms is essential for the medical care of all patients. Identification of symptoms is prerequisite for making diagnoses and therefore formulating management plans. Awareness of the relative prevalence of symptoms contributes to the identification of patients' needs in terms of symptom control, and therefore to the rational provision and planning of cancer treatment and Palliative care.

Our study is an observational cross-sectional study of 502 cancer patients admitted in Palliative Care Unit. Patients diagnosed with cancer and giving consent were assessed using the modified Edmonton Symptom Assessment Scale (ESAS).

Assessment of symptoms was done using ESAS in 502 patients. Pain (92.03%) was the most common symptom, followed by fatigue in 278 (55.38 %,) patients, loss of appetite (43.23%) in 217 patients, constipation(35.66%) in 179, nausea 183(36.45%) and breathlessness in 31.47%. In 105 Gastro-intestinal patients, symptom presentation were pain in 96%, nausea in 72%, fatigue in 67%, decreased appetite in 66%. Symptom presentation in 83 Genitourinary cancer were pain in 88%, constipation in 77%, fatigue in 53%, nausea in 47%. Symptom presentation in 72 Thoracic cancer was pain in 88%, breathlessness in 80%, anxiety in 58%, and fatigue in 54%. Symptom presentation in 71 head and neck cancer patients were pain in 95%, fatigue in 63%, dysphagia in 49%.

Using our results, a comprehensive care plan for pain and other symptom can be formulated for all cancer patients, to give them the best possible supportive and palliative care 

High Flow nasal cannula (HFNC) is commonly used in patients with respiratory distress and hypoxemia. HFNC has been proposed as a palliative measure for managing breathlessness in patients near end of life who wish to forgo intubation. HFNC delivery in non-hospital settings is limited. Initiating HFNC may preclude patients from fulfilling wishes to die at home and may limit the use of hospice. Methods This is a retrospective chart review of all patients admitted to a large, urban academic medical center in 2016 who used HFNC. Results 286 patients with orders for HFNC were included. Patients were an average of 60.6 years old, >70% of patients were members of racial or ethnic minority groups, and 51.4% were male. Despite having a high risk of mortality (average age-adjusted Charleson Comorbidity Index = 5.8), only 34 (11.8%) had a DNR order during that admission and 47 (16.4%) received a palliative care consult. Length of stay was prolonged (mean = 23.2 days, median = 15.4 days). Hospital mortality rate was 23.4%. Less than half of patients (130,45.5%) were discharged home. Few were referred for hospice (10,3.5%). Conclusions Although many patients were able to discharge home after initiating HFNC in the hospital, hospital mortality was high, and few received hospice or palliative care services. The use of HFNC may delay or limit the receipt of hospice and palliative care services. This finding should be further investigated and barriers to provision of HFNC in the home should be addressed to provide optimal care for patients at end of life. 

Patients with Head and Neck Cancer(HNC) experience high symptom burden, including emotional distress. Many require, but do not always access, specialized care services. Documentation of symptom screening and clinician response can help the inter-professional team provide integrated person-centered care. This study examined whether HNC clinic documentation of symptoms or response positively correlated with reduced unplanned ER visits.

This retrospective chart review included data extraction from "routine care" physician note. "ER group" patients were those who visited a physician in the HNC clinic from June -August 2016, completed the Edmonton Symptom Assessment Scale(ESAS) screening up to 30 days prior, and presented to the ER with HNC symptoms up to 30 days after the clinic visit (n=46). These were matched with patients who attended the HNC clinic within the same time period, but did not subsequently visit the ER (non-ER group), using these criteria:1) gender; 2) age +/-5 years; 3) total ESAS score +/-5; 4) score of two ESAS domains most relevant to ER visit +/-2; 5) type and timeline of treatment.

Physical symptoms were documented in 59% of charts in the ER group, and 92% in the non-ER group. Documented response to physical symptoms was present in 46% of charts in the ER group and 70% in the non-ER group. Psychological symptoms were documented once in the ER group, although 22 charts had medium-to-severe scores.

Lack of documentation about patient-reported symptoms may indicate that distress identified by ESAS screening was not addressed, possibly resulting in unplanned ER visits. 

Head and Neck Cancer (HNC) is associated with significant physical and emotional distress, yet less than half of those with significant distress access psychosocial oncology or palliative care services. ESAS assesses nine physical and psychological symptoms and is routinely used in cancer centers globally. This study examines whether high ESAS scores are predictive of unplanned emergency room (ER) visits in patients with HNC. Methods Using existing "routine care" data, this study compares HNC patients who visited the ER with patients who did not. The "ER Group" (n=46) consisted of patients who: 1) visited a physician from June 1 st -August 31 st 2016; 2) completed ESAS screening within 30 days prior to this visit; and 3) presented to ER with HNC symptoms within 30 days after the visit. ESAS scores for the ER group were compared to ESAS scores for all patients that attended the HNC clinic within this period. Results ESAS scores were higher in the ER Group than overall scores for all who attended the HNC clinic within the same time period. 18 of 46 patients (39%) who visited the ER had at least one severe (>6) score.

High ESAS scores may be predictive of increased risk for subsequent unplanned ER visits or hospital admissions. These findings suggest that monitoring symptom scores may help physicians improve early symptom management and prevent exacerbation of symptoms, potentially avoiding unplanned ER visits. 

While emerging evidence suggests that multiple co-occurring symptoms are a significant problem for cancer survivors, little is known about demographic and clinical characteristics associated with a higher symptom burden. Study purposes were to: evaluate the occurrence, severity, and distress associated with 32 common symptoms and examine which phenotypic characteristics were associated with a higher number of cooccurring symptoms (i.e., higher symptom burden). Methods Survivors (n=623) completed a demographic questionnaire, and measures of functional status (Karnofsky Performance Status), comorbidity (Self-Administered Comorbidity Questionnaire), and global and cancer-related stress (Perceived Stress Scale (PSS), Impact of Events Scale-Revised (IES-R), respectively). Memorial Symptom Assessment Scale (MSAS) was used to determine symptom burden. Linear regression analysis was done to evaluate phenotypic characteristics associated with a higher symptom burden.

Mean number of MSAS symptoms was 9.1 (±5.2). Most common, severe, and distressing symptoms were lack of energy, problems with sexual interest/activity, and hair loss, respectively. In the regression analysis, poorer functional status, higher level of comorbidity, history of smoking, higher PSS score, and higher IES-R score were associated with a higher symptom burden. Overall model explained 45.6% of the variance in number of co-occurring symptoms.

Findings suggest that cancer survivors report a high number of cooccurring symptoms of moderate severity and distress. Of note, no disease or treatment characteristics were associated with a higher symptom burden. Clinicians need to assess for both general and disease specific stressors and provide referrals for stress management interventions. Future studies need to examine underlying mechanisms for these associations. 

Therapy for head and neck cancer commonly includes ionizing radiation (IR). IR irreversibly damages the salivary glands causing decrements in quality-of-life and oral health. There are no therapies to correct this disorder or its sequelae. Previously, proof-of-concept studies have demonstrated the effectiveness of adenovirus (Ad) vector gene transfer of human aquaporin-1 (hAQP1) to the parotid gland and correction of salivary hypofunction (NCT00372320). We aimed to develop and test adenoassociated virus serotype 2 (AAV2) for gene transfer of hAQP1 to correction of IR-induced xerostomia in humans.

Using well-established preclinical models (e.g., mice and minipigs), we tested the safety, kinetics, and effectiveness of AAV2-hAQP1 to recover IR-induced salivary hypofunction. Using this data, we developed a Phase 1 human clinical trial to test the safety of AAV2-hAQP1 and some measures of biological activity.

In our first Ad-AQP1 trial, all subjects tolerated vector delivery and study procedures well and positive objective and subjective responses were seen in five patients, all at doses <5.8x10^9vector particles (vp)/gland. These findings encouraged us to pursue preclinical studies with AAV2based vectors, which have demonstrated lower immunogenicity and more stable expression than Ad vectors.

Preclinical data on the safety and efficacy of AAV2 based vectors will be presented. A Phase 1 study (NCT02446249) using AAV2-hAQP1 vector is actively enrolling. 

Lung cancer is the most common cause of cancer-related death in the United States and worldwide. Primary non-small cell lung carcinoma accounts for approximately 80% of all lung cancer. Although a large majority of all lung cancer patients present with metastatic disease at the time of initial diagnosis, colonic metastases are rare. This report presents a rare clinical case of rectosigmoid metastasis from primary lung adenocarcinoma. Methods A retrospective chart review was conducted.

Case Presentation: A 64-year-old female was referred to the hospital by her gastroenterologist after a same-day colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. On admission, she complained of right-upper quadrant pain and constipation. She had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed one year prior. She was in remission following radiation and immunotherapy with pembrolizumab. She underwent urgent colonic and rectosigmoid mass resection. Further pathology confirmed a metastatic poorly differentiated adenocarcinoma of the lung. Systemic chemotherapy with pemetrexed and carboplatin followed by localized radiation to the pelvic region was started. She did not respond well to chemoradiation. Subsequent imaging showed refractory tumor growth in the pelvic region and sacral soft tissue. Cessation of chemoradiation therapy occurred after patient experienced a debilitating stroke and she was transferred to hospice care.

This report presented a rare case of colonic metastasis from lung cancer. When patients with a history of primary lung cancer complain of abdominal symptoms, gastrointestinal tract metastasis from lung cancer should be considered. 

Leptomeningeal carcinomatosis occurs in approximately 3-5% of all cancer patients. Leptomeningeal metastasis from primary breast cancer is the most common etiology for all leptomeningeal diseases. Triple-negative breast cancer has significantly higher metastasis rates. Leptomeningeal carcinomatosis can affect any level of the central nervous system. Also, findings may be subtle and isolated. Thus, a patient's symptoms can be overlooked or dismissed. Methods A retrospective chart review was conducted.

Case presentation: A 55-year-old female presented with a past medical history of triple-negative adenocarcinoma of the right breast diagnosed one year prior. Initial patient encounter occurred when she presented to the hospital for seizures, left hemiparesis, and memory loss. Imaging showed a large anterior lobe brain lesion, leptomeningeal enhancement, and a new left breast mass. Frontal craniotomy was performed. Histopathology and immunohistochemical staining of the brain mass suggested primary adenocarcinoma of the breast. Lumbar puncture with cerebrospinal fluid analysis revealed presence of malignant cells. Together with imaging and cerebrospinal analysis, leptomeningeal carcinomatosis was diagnosed.

This case report and literature review is meant to reiterate a classic latestage and terminal complication of breast cancer because early diagnosis significantly impacts morbidity and mortality. When patients with a history of primary breast cancer present with neurological symptoms, we should consider leptomeningeal metastasis. Not only is more research needed to determine better treatment options for leptomeningeal carcinomatosis, but further studies are needed to elucidate what components of a women's previous breast cancer history and treatment regimen increase the likelihood of leptomeningeal carcinomatosis development. 

This study was done to identify the incidence of chemotherapy induced nausea and vomiting (CINV), constipation, diarrhea, mucositis, and pain in patients receiving adjuvant or neoadjuvant chemotherapy for breast cancer who received phone calls and interventions from the pharmacy team throughout their treatment.

We retrospectively reviewed patients with breast cancer receiving adjuvant or neoadjuvant chemotherapy at the Odette Cancer Centre (OCC) from 2010-2015. Patient characteristics and side effect information was collected through electronic charts. Data was analyzed according to independent chemotherapy regimens and cycle numbers, as well as cumulatively across all regimens and cycles. Baseline information was defined as symptoms that were experienced the day before or the day of, prior to the administration of chemotherapy. Prophylactic medications taken were also documented.

The incidence of side effects experienced during 438 cycle baselines, and 713 chemotherapy cycles, received by 444 patients were reviewed. 165 patients received anthracycline plus taxane regimens, 161 received anthracycline plus taxane dose dense (DD) regimens, 87 received TC regimens, 11 received paclitaxel regimens, and 20 received other chemotherapy regimens. Across all regimens and cycles, nausea had the highest incidence (39.13%), followed by pain (35.06%), constipation (24.68%), vomiting (11.92%), and diarrhea (8.84%). Cumulatively, across all regimens, nausea had the highest incidence during cycle 1 (47.38%), and pain had the highest incidence during cycle 5 (57.45%).

Of all 5 side-effects, nausea had the highest incidence, most frequently occurring in the AC DD group, and during cycle 1. Pain had the second highest incidence, most frequently occurring during cycle 5. Introduction RSR improves quality-of-life and decreases unplanned healthcare use in cancer care. An RSR has not been previously used to collect patientreported outcomes in patients receiving chemotherapy in our setting. Therefore, we performed an environmental scan and readiness assessment of implementing RSR using a mobile application in our lung and sarcoma outpatient clinic. Methods An environmental scan established a pre-implementation baseline using several metrics indicating clinic work flow and volume. Mixed methods identified barriers and facilitators to implementation in our telephonebased triage clinic.

In 290 pre-implementation triage voice-mails, the median response time was 28 minutes. 261 (90%) calls were resolved over the phone while 18 (6%) calls required emergency room visits. Mixed qualitativequantitative methods of implementation identified the following: support by administration was universally identified as key; there was additional concern over potential staff work volume and flow. Patient uptake issues revolved around non-English primary language, lack of familiarity with technology, and inappropriate RSR use by patient/family member. Unexpectedly, legal barriers associated with utilizing a commercial RSR platform, including data ownership and secondary commercial use of data were red-flagged by our legal team.

There is wide support among the triage clinic staff for RSR system implementation but there were significant barriers to implementation when using a commercial platform, in addition to patient issues and staff work-flow concerns. Once these issues are resolved, we aim to pilot an implementation study assessing 150 patients in summer, 2019. 

Delivering best-practice cancer care requires partnership between patients, carers, and their multidisciplinary team (MDT). Increasing patient numbers and continued resource constraints necessitates review of service/prioritisation models, to ensure that patients and families receive personalised, holistic, multidisciplinary care. This project compared consumer-reported (patients/family) healthcare needs with services provided by members of the cancer MDT, in a quaternary hospital in Brisbane, Australia. Methods Using a cross-sectional design, patients diagnosed with head/neck (HNC), lung, oesophageal, brain or haematological cancers, and their family member/carer, were interviewed regarding perceived supportive care needs prior to a scheduled outpatient review (medical/MDT), at any time from diagnosis. Blinded clinician data, including identified care needs and intervention +/-referrals actioned were retrieved from electronic medical records. Data sources were triangulated and analysed descriptively.

Patients (n=309; 202 male, age range 19-94) reported a variety of supportive care needs related to physical, practical and psychosocial concerns. Of those, 205 patients (total 66%; HNC 80%, haematology 75%, brain 59%, lung/oesophagus 53%) reported one or more concerns requiring MDT intervention. These issues were not actively identified or managed by clinicians up to 80% of the time. Family member/carer distress was also highly prevalent (40%, 69/173) which was rarely identified or managed by health professionals.

Patients and their families, report multiple unmet healthcare needs throughout the treatment continuum, which are poorly identified by clinicians. Collaborative teams need to explore novel ways to identify and prioritise patients for supportive care intervention, to minimise the burden of cancer for patients/families, as well as cost to health systems. The University of Houston MD Anderson Cancer Center, Behavioral Sciences, Houston, USA Introduction Radiotherapy (RT) to treat head and neck cancer (HNC) may result in debilitating toxicities and functional problems. Yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. The purpose of this pilot RCT was to establish feasibility and preliminary efficacy of a yoga intervention. Because family caregivers report low caregiving efficacy and high levels of distress, we included them in this trial as active study participants. Methods HNC patients undergoing standard RT and their caregivers were randomized to a 15-session yoga intervention or a waitlist control (WLC) group. Prior randomization, both groups completed self-report and cervical range of motion (CROM) assessments. Patients' weight loss, feeding tube placement and hospital admission were extracted from their medical records. Dyads were reassessed within 1 weeks of completing RT and 2 months later.

We consented 63 dyads (72% consent rate) and 53 (84%) completed all assessments. Patients (mean age: 60.3 yrs., 35% female) and caregivers (mean age: 54.9 yrs., 72% female, 76% spouses) completed a mean of 14.3 sessions (range 12-15), all of them rated the program as "very useful." Multi-level modeling using appropriate covariates revealed significant group differences in patients' cancer-related symptoms (MDASI means: yoga=1.67; WLC=4.00; d=3.6; P<.05). Relative to the WLC, the yoga group revealed better CROM, less weight loss and fewer feeding tubes and hospital admissions (all P<.05).

Conclusions Yoga therapy appears to be a feasible, acceptable, and possibly beneficial behavioral supportive care strategy for HNC patients undergoing RT. A larger efficacy trial with a more stringent control group is warranted.

ULLB-0005 is a protein derived from natural fungus with high binding specificity for carbohydrate antigen and strong apoptotic signal leading to death of cancer cells. Natural AA sequence has been modified to make more stable and soluble protein. Protein was purified through different column chromatography and characterized as a single homo dimer protein.

Present study evaluated anticancer activity of ULLB-0005 by determining in vitro cytotoxicity fingerprint, efficacy, mechanism and safety in human cell lines. Promising cytotoxicity observed in 11 different cancer cell line, with good safety profile in human PBMCs. The efficacy as antitumor agent was assessed in respective xenograft immunocompromised mice models in vivo. The molecule showed strong anticancer activity in immune-compromised mice model in various cancers which was observed in the reduction of tumor volume.

Conclusions ULLB-0005 induced strong apoptotic signal by modulating protein mitochondrial membrane depolarization, leading to death in cancer cells. Inhibition of proliferation and migration was observed in human endothelial cells, suggesting potential antiangiogenic effect. Studies to evaluate possible synergistic effect with approved chemotherapeutic agents for Breast and Pancreatic cancers showed good synergy in In-vitro test. 

The purpose of this study is to examine the relationship between subjective cognitive ability and common symptoms (anxiety, depressive symptoms, fatigue) in breast cancer survivors (BCS). Methods Secondary data analysis from pooled baseline data from 2 IRB-approved studies of BCS. 144 BCS met eligibility criteria and had complete data on the following questionnaires (symptoms): Multiple Ability Self-Report Questionnaire (cognitive abilities), Spielberger State Trait Anxiety Inventory -State (STAI-S) (anxiety), Centers for Epidemiologic Studies Depression Scale (CES-D) (depressive symptoms), and Functional Assessment of Cancer Therapy -Fatigue (fatigue). Data was analyzed using descriptive statistics, linear regression, and change point models. Results BCS were on average 54.4 (SD 8.8) years of age and the majority were white (97.2%), 5.1 years post-treatment, and had some college (15.6 years). Increased anxiety was associated with poorer cognitive abilities (p=0.0105-<0.0001), except for visual memory, which had flattened relationship at 35 on the STAI-S. Increased depressive symptoms were significantly related to poorer cognitive abilities (p=0.045-<0.0001); however, depressive symptom scores of ≥ 10 had a different slope than those scores < 10 for visualperception, verbal memory, attention and total score. Increased levels of fatigue were associated with poorer cognitive abilities (p<0.0001). Education level showed statistically significant negative correlations with cognitive ability (p=0.0377-<0.0008).

In general, increased levels of anxiety, depressive symptoms, and fatigue were associated with decrements in cognitive abilities. Potential cutpoints on the STAI-S and CES-D were identified and if validated by future research could be used to screen BCS who may be more likely to have poorer cognitive abilities.

The increase in cancer survival and the development of new therapies, has produced an increase in the hospital admissions through the Emergency Department (ED).

The records of patients admited between July and November 2018 were studied. Results 170 patients (83 men and 87 women) entered the study. The mean age was 61.4 years. The most frequent diagnoses were: lung (20%), breast (17.1%), colo-rectal(14.7%) and pancreatic (12.4%) cancers. Stages: I -II (15.5%), III (10.6%) and IV (75.9%). Type of therapy: chemotherapy (74.1%), immunotherapy (9.4%), targeted therapy (16.5%) and hormone therapy (2.4%). Line of therapy: neo-or adjuvant (18%), first (46.6%), second (18%), third (9.9%) and fourth or subsequent (7.5%). The most frequent symptoms at admission were: fever (31.4%), dyspnoea ( 14.8%) and pain 14.8%). Thirty seven point six percent of admissions were because of tumour related complications, 34.7% because of toxicity and 27.1% because of non-leukopenic infection. The mean hospitalization lenth were 10.3 days. From the 170 patients, 32 died in the hospital and 13 within the first month after discharge. Tumour progression was the cause of death in 75% of the cases and the complications of therapy was in 18.2%. Seventy five percent were receiving a third or subsequent line of therapy and 66.5% received chemotherapy in the last month of life.

There is a necessity to improve the clinical decisions. Clinical Decision Units in the ED, could help to this goal. Or perhaps there is a "missing link" between guidelines and the real clinical practice.

In Vitro Testing In Vvivo Testing 

Breast cancer (BC) is the most common cancer in women worldwide.

Because of the long survival in many patients, the occurrence of second primary malignancies (SPM) after BC is an important issue.

We identified female BC patients in the Breast Cancer Health Database of Taiwan, which includes four different cancer registry datasets between 2002 and 2014 in the country. We compared the incidence of SPM between patients who received chemotherapy and/or radiotherapy with those who did not. Stratified analyses were also performed according to the American Joint Committee on Cancer (AJCC) stage. Cox regression models were used to identify the risk factors for SPM and evaluate their effects.

We enrolled 85,947 eligible BC patients, and 2,571 (2.99%) of them developed SPM. The median duration of SPM was 2.70 (1.14-5.14) years. Radiotherapy was administrated in 40,946 (47.64%) of the patients, and chemotherapy was administered in 52,120 (60.64%). The most common SPM were digestive tract cancers (876, 31.89%). Risk factors for SPM included the AJCC stage, therapeutic strategy, age, and underlying co-morbidities. Chemotherapy and radiotherapy did not increase the risk of SPM in any stages. In fact, patients at stages I, II, and III/IV who received both therapies had lower risks of SPM in comparison with those who did not. After adjustment for other risk factors, the reduced risk was still significant in stage III/IV patients (p = 0.047).

The risk of SPM was different across BC stages. Chemotherapy and radiotherapy did not increase the risk of SPM in BC women. 

Seasonality influenced the symptoms reported by patients with EIBC receiving RT. Future studies are needed to understand when during treatment patients are at highest risk for psychological morbidity and how SAD may affect these patients.

In the 1990s, Fujisaki Kaoru compiled research on body image within the context of Japanese nursing science. These efforts informed the development of the body image assessment tool (BIAT) as a comprehensive body image scale. Thereafter, confirmatory factor analysis of BIAT showed that the fitness of the model decreases if women who received mastectomy are included. Since the concept of body image is cultivated differently by each culture, the cultural aspects of Japanese Confucian teachings and the idea "I care about others' sight" should be considered. Therefore, the purpose of this study was to examine influence on body image in Japanese women who had undergone mastectomy, from a cultural viewpoint.

Semi-structured interviews were conducted with 14 Japanese women who had undergone mastectomy. After further grouping by operation type, we carried out a qualitative inductive analysis.

Women who were treated with Halsted's technique (regarded as standard surgery from 1975 to 1987) were notably influenced by Japanese cultural factors and reported negative body images. However, women who underwent breast conservation surgery (regarded as standard surgery from 2004 to 2012) were not at all affected by cultural factors, and demonstrated positive body images that affirmed continued beauty. Our results that the surgical treatment of breast cancer suggest that even the cultures affecting the construction of the body image after mastectomy are progressing to an unimportant problem. At the Odette Cancer Centre (OCC), the pharmacy team calls patients receiving chemotherapy through out the course of their treatment to follow-up on chemotherapy side-effects, and to provide interventions to reduce these side effects. This retrospective study was done to determine the success of over-the-phone pharmacy interventions throughout the course of treatment in patients with breast cancer receiving adjuvant or neoadjuvant chemotherapy.

We retrospectively reviewed patients from 2010 to 2015 with breast cancer receiving adjuvant or neoadjuvant chemotherapy at the OCC. Information on patient characteristics and pharmacy interventions was collected through electronic charts and records. Specific types of interventions implemented, the reason that they were implemented and their documented success are described.

A total of 1593 over-the-phone pharmacy interventions were implemented for 441 patients and were retrospectively reviewed: 458 were baseline interventions to be implemented before the start of a new chemotherapy cycle, and 1135 were cycle interventions to be implemented during the current cycle. The outcomes of 677 interventions (42.50%) were not documented. There were 455 interventions documented as successful or partially successful (28.56%) and the other interventions were either unsuccessful or immeasurable for various reasons (n=461, 28.94%). In each cycle, an average of 2.19 attempts were made by the pharmacy to contact the patient, and an average of 0.0054 phone calls from patients were missed by the pharmacy.

Pharmacy interventions through out chemotherapy can reduce side effects experienced by patients. A prospective study should be undertaken to determine a more accurate measurement of the impact of these interventions.

Quality of life (QOL) is one of the most critical indicator for cancer patients receiving anti-cancer therapy and is associated with psychological distress. Self-management ability of cancer patients is particularly concerned in the outpatient setting. This study examines whether the association between psychological distress and QOL is mediated by patients' self-management ability.

This cross-sectional study was conducted and a total of 122 outpatients with mixed tumor site at all stages were recruited in a medical center in Taiwan. Patients' psychological distress, self-management ability, and QOL were assessed by Distress Thermometer (DT), self-management ability scale (one item), and SF-12 Health Survey (Physical & Mental QOL). The mediation hypothesis was tested by multiple regression analyses controlling physical function.

Patients reported the mean levels (severity) of psychological distress was 2.9 (SD=2.4); 27% of patients reported over 5 scores (cut-point for further care in Taiwanese). Self-management ability significantly mediated 19% of the effect of the psychological distress on Physical QOL (Sobel zs=-2.28, p=0.02). Self-management ability significantly mediated 14% of the effect of the psychological distress on Mental QOL (Sobel zs=-2.15, p=0.03).

Taken together, our study showed that self-management ability partially explains the association between psychological distress and QOL. How to enhancing patients' self-management ability is important issues and that may improve patients' QOL. Introduction Ipilimumab (IPI), nivolumab (NIVO) and pembrolizumab (PEMBRO) can induce immune-related adverse events (IrAEs). We describe the IrAEs associated with 55 patients (pts). There were 27 pts treated with IPI and 23 pts treated with NIVO, 4 pts received PEMBRO, and 1 pt was treated with combination of IPI and NIVO.

Retrospective data from 54 pts were used treated either in an expanded access program (AEP), clinical trial setting or postregistration protocol.

Patients included metastatic malignant melanoma (MMM), non-small cell lung cancer (NSCLC), renal cell carcinoma and Hodgkin's disease.

In total 266 cycles of NIVO (median = 7, range 1-52), 15 cycles of PEMBRO (median = 4, range 1-6), and 64 cycles of IPI (median = 4 cycles, range 1-4) were administered. Seven IrAEs are described in 15 IPI treated pts. These included endocrinopathy, colitis (1 required infliximab), and hepatitis. Among the pts treated with NIVO, 7 IrAEs were documented. These included pneumonitis in 2 pts, skin rash in 3 pts, mild diarrhea in 1 pt and mild uveitis in 1 pt. One pt developed autoimmune thrombocytopenia, nephritis, and PRES (posterior reversible encephalopathy syndrome). Three chest infections were documented including pulmonary tuberculosis in a NSCLC pt. The pt receiving combination IPI and NIVO had grade 4 skin toxicity and pneumonitis. No IrAEs related deaths were document.

A plethora of IrAEs is described with anti-PD1 and anti-CTLA4 antibodies. Colitis was more common with anti-CTLA-4 while pneumonitis more common with anti-PD1. Prompt diagnosis of IrAEs will result in decreased morbidity and mortality. HCG, radiation oncology, bangalore, India

With benefits of exercise on side effects of cancer treatment not lost on the scientific community, we aimed to evaluate whether cancer survivors are being exposed to the idea of exercise as an effective tool in managing these side effects, their perception of exercise benefits and barriers.

As part of an on-going internal mechanism to establish clinical care pathways, in a tertiary care referral hospital,16 cancer survivors with a primary diagnosis of cancer and receiving chemotherapy and/or radiotherapy were interviewed using a semi-structured questionnaire after obtaining verbal consent. Participants not exposed to exercise benefits were oriented about its benefits during the interview. All participants were asked if it would be possible for them to exercise. The interviews were audio recorded, transcribed and analysed using both qualitative and quantitative methods.

Among the survivors interviewed 50% were not exposed to the idea of managing their side effects such as fatigue, lack of strength, general apathy to their surroundings etc. through exercise Survivors' perspective of their ability to exercise during treatment is depicted in figure. Among the Perceived Barriers, 3 themes emerged; side effects of treatment, co-morbidities and personal factors. The themes and sub-themes are illustrated below.

Lack of exposure of the survivors to exercise as a way to mitigate the side effects of their treatment is evidenced by their responses and by extension, their perceived barriers. The need for repeated and guided exposure to exercise by healthcare professionals at every level can improve better establishment of clinical care pathways. 

This study is in progress with 15 patients enrolled to date. Planned analyses will examine correlations among frailty, CI, and the research variables listed above.

This study is generating preliminary data that will lead to more extensive studies of the role of frailty and/or CI as predictors of outcomes, helping to identify at risk patients before transplant and initiate appropriate interventions. 

Cannabis treatment seems to positively impact symptom burden in cancer patients, with clinically and statistically significant improvements in wellbeing, tiredness, drowsiness and lack of appetite. 

Medical cannabis in addition to standard supportive care seems to improve appetite and stabilize weight over time in cancer patients.

Patient-Reported Outcome Measures (PROMs) are a common mechanism for treatment planning and to evaluate the impact of healthcare on health outcomes as part of a personalized medicine approach. PROMs are standardized, validated questionnaires completed by patients to measure their perceptions of health status and/or well-being. In this presentation, we provide an overview of PROMs research and case examples of PROMs testing for accurate detection of complex cancer symptoms i.e. breathlessness, insomnia, fatigue and acceptability for use in routine clinical care.

Our PROMs lab developed a unique bench to bedside research pipeline to address the need for a cost-efficient applied research enterprise that has accelerated field testing of PROMs for use in routine care. This bench to bedside approach was applied to guide the selection of PROMs for use in routine clinical care in diverse cancer populations and could be a key approach to PROMs uptake in other cancer organizations.

A range of PROMs have been tested for detecting with accuracy core problems in functioning, swallowing problems, sexual dysfunction in prostate cancer, cognitive impairment, and for PROMIS and PRO-CTCAE toxicity measures compared to legacy tools.

PROMs are at the heart of personalized medicine and their integration with other biomedical data is essential to a better health outcomes and care. Our approach will be helpful to other organizations in PROMs selection for routine care. 

Chemotherapeutic agents can impact the brain and its biochemical milieu, causing neurobehavioral impairments. Inflammation is one of the mechanistic pathways through which chemotherapeutic agents can impact the brain and cognitive functioning.

Intact and ovariectomized (OVX) C57BL/6 mice were treated with cyclophosphamide (CP) alone (8 intact/8 OVX), CP with Naproxen sodium (NS) (8 intact/8 OVX), NS alone (8 intact/8 OVX) and saline (8 intact/8 OVX). Five injections of (CP, 100 mg/kg) or saline were administered intraperitoneally every 3 days for 2 weeks. The mice received a diet containing NS (375 ppm) or a control diet starting 1 week prior to CP treatment or saline. Mice were tested using Elevated Zero Maze to assess anxiety-like behavior, Tail Suspension Test to assess depression-like behavior, and an infrared beam chamber to examine exploratory/locomotor activity. We also assessed levels of inflammatory cytokines.

CP treated mice displayed anxiety-like behavior, decreased exploratory behavior and spontaneous locomotor activity (Ps< 0.002, 0.02, and 0.0003, respectively), which seems to be mitigated by NS. We found no effect of CP on spatial memory and depression-like behavior (all Ps> .05). OVX mice displayed more anxiety-like behaviors compared to intact mice, regardless of treatment (p = 0.04). We found a significant difference on IL-6, IL-2, IL-12p70 and MCP-1 in mice treated with saline vs. CP. The difference on IL-2 did not hold in mice treated with NS. Additionally, NS treatment increased IL-10.

Chemotherapeutic agents are linked with inflammation and neurobehavioral dysfunction, which may be mitigated with anti-inflammatory treatment.

This non-randomized controlled, open-label, parallel group experimental design was conducted to determine the effect of progressive relaxation exercises on chemotherapy symptoms in patients with breast cancer undergoing adjuvant chemotherapy. Methods 49 breast cancer patients, from whom samples were taken were identified as intervention (n = 25) and control (n = 24) groups. Patients in relaxation exercise intervention group; it has been carried out in three phases: teaching of the researcher in the clinic, practice in the hospital with the researcher in the clinic, and patients' individual application at home. Patients in control group didn't perform relaxation exercise, only received standard medical care. Measurements were made at 8 different times during 4 cures, before each chemotherapy treatment and on the 11th day after the cure has finished.

After the relaxation exercise, in the comparison between the groups; The severity of pain, fatigue, nausea, sadness, anxiety, insomnia, lack of appetite, feeling bad, shortness of breath, change in skin and nails and canker sore was found to be significantly decrease in intervention group than in the control group, although the severity of these symptoms was seen to be significantly increase in control group (p <0.05).

It was determined that relaxation exercise has a positive effect on decreasing the symptoms of adjuvant chemotherapy. According to this result, the use of relaxation exercise has been recommended for reducing the severity of chemotherapy symptoms in patients with breast cancer receiving adjuvant chemotherapy. 

The graft-versus-host disease (GVHD) is an important complication of the allogeneic hematopoietic stem cell transplantation (AHCT), that affects several organs, including the mouth with impact in patients' quality of life. The aim of this study was to evaluate the incidence and clinical outcomes of oral GVHD in patients undergoing AHCT, as well as to determine predictive factors for its occurrence.

Medical records of 150 patients who were submitted to AHCT between January 2010 to January 2015 were reviewed for clinical features and establishment of risk factors.

A total of 147 patients was included. Three patients were excluded due to multiple AHCT. Ninety-nine patients (66%) presented systemic GVHD.

The skin was the most affected site (44.6%), followed by gastrointestinal tract (27.3%) and oral cavity (17.3%). The mean development time of oral GVHD was 229 days after AHCT. The pain was the main complaint (96,15%) followed by xerostomia (65.38%). The most common manifestations were ulcers (53.84%) followed by white striated ulcers (19.23%), mostly affecting buccal mucosa and tongue. Cox regression revealed that systemic GVHD patients presented a 5.70 higher chance for oral GVHD (p=0,018) from which, patients with skin and lung GVHD presented 3.48 and 3.13 times the risk of oral GVHD, respectively (p-0,010). Seventythree patients (48.6%) died during the first 20 months after AHCT.

The mouth is the third most common GVHD affected topography. Pain, xerostomia, ulcers associated or not with white striae were the main clinical manifestations. Skin and lung GVHD were considered risk factors for the occurrence of oral GVHD.

G. Jaguar 1 , F. Abreu Alves 2 , D. Campanha 2 , L. Campos 2 1 a.c. camargo cancer center, stomatology department, Sao paulo, Brazil 2 , sao paulo, Brazil

Symptoms related to salivary gland damage are one of the most frustrating complications after radioactive iodine ( 131 I) therapy. To the best of our knowledge this is the first study that aimed to evaluate the prophylactic effect of bethanechol on the radioiodine content of salivary gland.

Fifty patients who were referred to 131 I therapy were randomized into bethanechol and placebo groups. Patients received Bethanechol or Placebo (25 mg, 2 times daily), starting 2 hours after 131 I therapy to 1month. Both groups were compared at baseline, 10, 30 and 90 days after 131 I therapy based on the following: (1) symptoms related to salivary gland damage (2) unstimulated whole saliva (UWS) and (3) quality of life using University of Washington Quality of life 4 questionnaire.

Bethanechol group presented significantly lower complaints of dry mouth on 10 (p = 0.047) and 30 (p=0.003) days compared with placebo. Salivary gland pain and swelling were more frequent among placebo patients at 10 days (p = 0.047). Comparison of the two groups by UWS, no statistical difference was found. Placebo group presented worse score related to activity (p = 0.034), saliva (p = 0.05) and humor (p = 0.05) at 10 days; palate (p = 0.05) and saliva (p = 0.05) at 1 month. Interestingly, bethanecol patients who received 131I dose > 125mCi, showed better xerostomia indices when compared to Placebo with same dose.

Bethanechol during 131I therapy was found to be effective in decreasing the acute salivary gland damage with impact on patients' quality of life.

Half of cancer caregivers experience depression, caregiver burden, or stress, yet less than a third have discussed their needs with anyone. Identifying this vulnerable population is challenging since caregivers only interact with the healthcare system in service of the patients. Our objectives were: 1) To test the feasibility of screening cancer caregivers for burden and depressive symptoms during patients' radiation and chemotherapy visits; and 2) To test the feasibility of a brief counseling session for caregivers who screened positive for either.

Methods 50 caregivers of patients with head and neck cancers were recruited from cancer clinic waiting rooms at Palo Alto VA and Stanford. Caregivers completed the PHQ-9 (depressive symptoms), and Zarit Burden Inventory-Short Form (caregiver burden). Participants screening positive for burden (>16) and/or depressive symptoms (>9) were provided psychoeducational resources and the choice to attend 1 brief counseling session with a clinical psychologist.

Of the 50 participants who completed the surveys, 36 (72%) were women and 30 (60%) were significant others. Mean scores for depressive symptoms and caregiver burden were 6.29±5.01 and 11.02±8.62, respectively. 20 participants screened positive for depressive symptoms (n=9) or caregiver burden (n=11); 3 screened positive for both. Of those who screened positive, only 4 indicated an interest in counseling. Main reason for refusal was lack of time, or that they were already receiving mental health care.

Screening caregivers at patient's radiation and chemotherapy visits is feasible and convenient. However, connecting those in need to mental health resources may be more challenging.

A. Pandit 1 , N. Gupta 1 , V. kumar 1 , S. bharati 1 , R. garg 1 , K. madan 2 , S. Mishra 1 , S. Bhatnagar 1 1

Early integration of palliative interventions in patients with Central Airway Obstruction (CAO) has shown to reduce patients' distress due to breathlessness and achieve better outcomes at lower cost. This retrospective review was performed to determine whether rigid bronchoscopic interventions alleviated the symptom burden and the requirement for continued mechanical ventilation in patients with CAO in a tertiary care hospital Methods Detailed records of 105 patients with central airway obstruction were retrospectively studied. The Numerical rating scale (NRS) score for cough and dyspnea, before and after the intervention were noted. A need for an escalation or reduction in level of care was also noted Results The mean NRS score for dyspnea (n=84) reduced from 7.5 (4-9) (before procedure) to 2.5(2-6) after intervention. (p<0.01) The mean NRS score for Cough (n=68) also reduced from 6.5 (4-8) (before procedure) to 4 (3-7) after intervention (p<0.01). Of these patients, bronchoscopic intervention allowed transfer-out of the ICU in 14 patients (42%), and immediate withdrawal of mechanical ventilation in 8 patients (42%) Conclusions There is an instantaneous valuable palliation of symptoms and improved health care utilization with airway tumor debulking and stenting. Multidisciplinary interventions with emphasis delivery of palliative care provide better care of patients with CAO 

Cognitive dysfunction (CD) is poorly described in older adults with GI cancers. The purpose of this study was to quantify the prevalence and identify baseline determinants of patient-reported global and domainspecific CD in older adults with GI cancers. Methods This analysis draws from the CARE Study and includes patients aged ≥60y with a new diagnosis of GI malignancies. CD was measured via the Patient-Reported Outcomes Measurement Information System (PROMIS®) Short Form 4a Cognitive Function survey. Descriptive statistics were used to examine the prevalence of global and domain-specific CD. Scores were dichotomised into normal and impaired (global scores of 4-15; domain scores of 1-3). Bivariate associations between demographic, clinical, and GA domains were tested to identify indicators of CD. Results 185 adults were investigated. Mean age 70.0± 7.20, 60.0% male, and most common cancers included colon cancer (25.4%). 30.8% of participants endorsed CD and 7.5% endorsed moderate/severe symptoms (scores of 4-11). Processing speed was the most common impaired domain identified (33.5%). CD was strongly associated with an increased risk of depression (RR = 6.8 (3.9-12.1), p<0.01), hearing impairment (RR = 3.3 (1.9-5.5), p<0.01), ADL impairment (RR 3.3(1.8 -5.9), p <0.01), anxiety (RR = 2.7 (2.0 -3.7), p<0.01), ECOG ≥2 (RR 2.7 (1.8 -4.1), p<0.01), visual impairment (RR 2.6 (1.5-4.5), p <0.01), and lack of social support (RR 2.5 (1.5 -4.1), p<0.01).

We found a high prevalence of self-endorsed CD in older adults with GI malignancies with highest impairments seen with processing, and CD was associated with several GA impairments. 

Mammo-50 trial has recruited 5235 women in a randomised trial assessing duration of mammographic surveillance for women over 50 years old and 3 years post curative surgery. Patients not wishing to be randomised could be entered into a sister cohort, which recruited 914 patients. These 6000 patients provide rich data to explore long-term symptoms and side-effects for women up to 9 years post-diagnosis. Methods Within Mammo-50, 92% of women who agreed to participate in a quality of life sub-study (QoL) which collects patient questionnaires at baseline and at each follow-up visit, reporting symptoms and long-term side effects. Questionnaires included Distress Thermometer, Fear of Recurrence, Warwick-Edinburgh Mental Well-being Scale and FACT-B. Also 75% of women consented to enter the Qualitative sub-study (QSS) which included semi-structured telephone interviews between 3 and 6 years post diagnosis.

The Mammo-50 baseline patient questionnaires indicated that 25% of patients had distress, with 7% reporting high levels of distress, due to concerns about fatigue, sleep, worry/anxiety, memory/concentration, hot flushes and pain. The patient interviews reached saturation quickly with many patients being concerned about early discharge from hospital follow-up and the fear of recurrence.

Living with and beyond a diagnosis of cancer in the climate of early hospital discharge means that patients are living with distress when thinking about their long-term prognosis. A risk-adjusted patient follow-up would be ideal in order to actively manage symptoms and provide a level of reassurance to patients. Mammo-50 provides the platform to develop a management system for patients reporting symptoms and long-term side-effects. 

African Americans (AA) experience a disproportionate burden of cancer pain. Affective and cognitive symptoms are often associated with cancer, pain, and treatment. The purpose of this study was to assess the relationship between perceived cognitive function and depression with perceptions of pain among AA cancer patients treated with opioids.

The convenience sample consisted of 60 AA cancer patients receiving opioids. Pain (Brief Pain Inventory), depression (Personal Health Questionnaire), and cognitive difficulty (Cognitive Difficulties Scale) were completed. Associations among variables were estimated using bivariate correlations and multiple linear regression.

Mean age was 57; 60% were women, and 52% had at least some college education and were experiencing moderate pain and interference (mean pain severity and interference scores equaled 6.6; ±1.8 and 5.5; ±2.4 on a scale of 0 to 10). Greater perceived cognitive difficulties score was significantly associated with higher pain interference (rho=0.37, p=0.004) but not with higher pain severity, whereas depressive symptoms were significantly associated with higher pain interference (rho=0.68, p<0.001) and higher pain severity (rho=0.45, p<0.001) after controlling for cognitive difficulties. The interaction effects between cognitive and depressive symptoms on both pain interference and pain severity were not statistically significant, although depressive symptoms were positively associated with pain interference (b=0.41, p<0.001) and pain severity (b=0.26, p=0.001).

The association among symptoms is important to consider in cancer patients treated for pain with opioids. These findings enhance understanding of this triad of symptoms and provide information on which to base future work to improve the symptom experience for AA cancer patients. 

Marijuana is one of the most common drugs used. In USA, 30 states and Washington DC have voted on various levels of legalization of marijuana for medical and recreational purposes. In this study, we compared the attitudes of cancer patients in a legalized (Arizona) vs. a non-legalized state (Texas) on legalizing marijuana for medical and recreational use. Methods 200 adult cancer patients were enrolled from the outpatient Palliative Care centers in comprehensive cancer centers in Arizona (legalized) and Texas (non-legalized). Various physical and psychosocial instruments were collected including a survey designed to determine attitudes of patient towards marijuana. All patients were residents of the state where they were enrolled and no identifiers were associated with data recorded.

No significant difference was found between both locations in attitude towards legalizing marijuana medically [Arizona 92%(85-97%) vs. Texas 90%(82-95%); p=0.81]. Patients who favored legalizing marijuana were younger (median age 59 vs. 67y; p=0.027) and had worse Edmonton Symptom Assessment System fatigue (median 5 vs 3; p=0.015) and appetite (median 3 vs 0.5; p=0.004) scores. Patients who have used marijuana were more supportive of its medical legalization (95% vs 88%; p=0.024). Support for medical legalization was significantly different compared to support for recreational legalization in the overall population, Arizona and Texas (p<0.0001 respectively). Overall, patients who supported recreational marijuana were found more likely to support medical marijuana (96% vs 87%, p=0.022).

Cancer patients from both a legalized and non-legalized state showed strong support for legalization of marijuana for medical purposes and not for recreational use.

Cancer-related fatigue (CRF) is a prevalent, multidimensional, and debilitating side effect experienced across all cancer types and varying by disease stage and treatment. Although modest beneficial effects of physical activity (PA) on CRF have been demonstrated, the contribution of varying frequencies, intensities, durations and types of PA on reducing CRF is clinically relevant but presently unclear. This systematic review and meta-analysis aims to understand the effect of PA on reduction of CRF. Methods A systematic review and meta-analysis of randomized controlled trials searching Medline, EMBASE, and Cochrane CENTRAL from inception until December 2018. Studies included some form of PA intervention, an outcome of fatigue, and/or quality of life, and physical functioning. Title and abstract searching, full text review, and data extraction were done by two independent reviewers.

Of the 4,258 studies found from the electronic search, 199 RCTs were included in this review, including 50 new RCTs since the last major review by Mustian et al. in 2017 . A total of 16,306 participants with mean age ranging from 31.5 -73 years old, and cancer diagnoses such as breast (n=91), mixed sites (n=34), prostate (n=27), leukemia and lymphoma (n=8), and other (n=39). Meta-analyses are in progress and will be reported at the meeting.

To our knowledge, this is the most comprehensive and up to date systematic review and meta-analysis on the role PA has on reducing CRF. Our study includes non-traditional PA interventions such as dance, hydrotherapy, and horseback riding, further providing evidence-based knowledge on treating CRF. 

Cancer-related perceived cognitive impairment (PCI) is a common survivorship problem affecting at least 35% of breast cancer survivors that can profoundly impact quality of life and social integration. There are no readily available biomarkers that can help identify survivors at higher risk for these symptoms. Decreased Omega-3 fatty acid levels have been associated with increased levels of inflammatory markers [1] [2] [3] and diminished cognitive function and brain volume. [4] [5] [6] However, to date, no study has evaluated the relationship between Omega-3 fatty acid levels with PCI in the cancer survivorship setting.

We collected finger-spot blood samples from 47 participants who were part of our study for a cognitive rehabilitation program. These samples were analyzed for Omega-3 fatty acid index [expressed as a percent of total erythrocyte fatty acids including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)].

Findings from a partial sample of 39 participants indicated an association between low Omega-3 fatty acid indices and participants' report of worse cognitive function on both the Patient Reported Outcomes Measurement System (PROMIS) Applied Cognition General Concerns and Abilities short forms (p=.04).

If the above correlation is validated with a larger sample, this simple test may be able to be used as an inexpensive biomarker for PCI. Increased intake of foods rich in Omega-3 is postulated to benefit cognitive function in other populations but has yet to be examined for the management of PCI in the cancer survivorship setting. Optimization of the Omega-3 index could represent a safe, low-cost intervention that can be disseminated broadly. 

Digitized health technologies, such as the electronic patient record (EPR), have the potential to educate, activate, and engage patients in unprecedented ways. The move to ensure patients have open access to their medical e-charts may accelerate the uptake of this technology. In this study, I offer a critical analysis of the EPR in the biomedical treatment of advanced cancer to consider how the growing emphasis on virtual medical knowledge might alter cancer care.

This study draws on a narrative literature review of digital health studies and an analysis of a case study of a patient with advanced cancer who used EPR data to make decisions about oncological treatments.

The increasing reliance on EPR may shift the focus of care for both patients and professionals in multiple ways. Three major themes emerged: (1) Perpetuating the Gaze of Medicine -Viewing the diseased body as a primarily medical and electronically mediated text; (2) Reconstituting the Embodied Understanding of Advanced Cancer -Accessing virtual knowledge (independent of medical guidance) that continually depicts a poor prognosis, thereby reshaping the relationships patients have with their vulnerable bodies; and (3) Shifting Patient-Clinician Relationships -Scripting care to involve the simple exchange of electronic data, rather than fostering genuine interactions that consider the complexities of having a life-limiting disease.

Used thoughtfully, EPR could enhance the goals of supportive care. Health professionals first need to think critically about the effects of EPR on perpetuating a biomedical focus, reframing patients' understandings of incurable disease, and eroding compassionate relationships.

Patient-Reported Outcomes (PROs) draw increasing attention throughout the health care system as evidence for its use and effect is being explored these years. In present study we focus on the use of PROs in patients with esophago-gastric cancer undergoing perioperative chemotherapy. With complex multimodal treatment, an optimal symptom management and control during chemotherapy is of great significance. However, there is a lack of recommendations for PRO in patients with esophago-gastric cancer that can support an implementation. The aim of this study is to test the feasibility of an electronic PRO questionnaire in a Danish population of esophagogastric cancer using MyChart-EPIC as electronic platform. Methods Participants in the study are patients with operable esophago-gastric cancer receiving perioperative chemotherapy (n=25), with access to The Internet. Patients are asked to complete the electronic PRO-CTCAE™ questionnaire at baseline and before each treatment evaluation using MyChart-EPIC. Nurses and physicians are instructed to access the questionnaire via EPIC and integrate the information in the clinical decision making. The primary endpoints are the compliance rates of the questionnaires and acceptance as well as an evaluation of the technical platform from the perspectives of the patients, the nurses and the physicians.

The study was initiated in December 2018, results are awaited in the start of 2020.

The study will provide new knowledge about the utility of PROs among esophago-gastric cancer patients while applying the MyChart-EPIC as an electronic platform.

T. Yavan 1 , E. Sahin 2 , M. Demirhan 2 , M. Mert 3 1 Izmir Economics University, Obstetric and Gynecologic Nursing Department, Izmir, Turkey

Informed decision making at every stage of the diagnosis and treatment process of cancers enables patients to cope with cancer diagnosis and to have more realistic expectations. The aim of this study was to determine the use of health literacy and web-based information sources for cancer patients.

The study included 134 cancer patients who were treated in Hematology and Oncology Clinic at an education and research hospital. To collect data,'Data Collection Form' and 'Adult Health Literacy Scale' were used. To analyse data, descriptive statistics, Pearson correlation and Kendall's tau-b correlation, independent samples t test were used.

The mean age of cancer patients in the study was 50.04±15.99. The first of the diagnoses was breast cancer (29.1%). The percentage of patients who search for health on the internet is 47.8%. 32.1% of them stated that they investigated their diseases and treatments, 23.2% cancer types, 17.9% nutrition issues, 29.1% cancer treatment, 18.7% breast cancer, 10.4% lung cancer. There was no statistically significant difference between women and men in terms of health literacy scale scores (p>0.05). The scale scores were found to be statistically higherin these patients; in computer users (t=4.091,p<0.001), those who have internet at home (t =4.500,p<0.001), mobile phones in the internet (t=5.082,p <0.001), those who search the Internet health (t=5.121,p<0.001). As the education level increases, the scale scores increase ( =0.388,p<0.001); scale scores decrease as age increases (r=-0.287,p<0.001).

It is an important responsibility of health professionals to determine health literacy, health information and their usage status and to determine the effect of all these factors on their health. eP147 E-ONCOSALUD: A SMARTPHONE APP FOR HOME MANAGEMENT OF SIDE EFFECTS ASSOCIATED WITH TREATMENT WITH ORAL ANTINEOPLASTICS AGENTS.

Oral antineoplastics agents (OAA) produce numerous side effects (SE). The smartphone app can improve the home management of these SE. Our objective is to evaluate an app in the home management of the SE associated with OAA treatment. Methods A mobile app (e-Oncosalud®) was designed. It includes a module for the management of SE. It is based on an algorithm that emits different recommendations according to the severity recorded by the patient. The SE focuses on the management of fatigue, diarrhea, nausea, and skin toxicity, among others. Since May 2017, the app has been offered to patients who start treatment with OAA.

In May 2018 patients who had been using the app for at least one month were analyzed. 70 patients used the app (50% men), average age 58.9 years (SD=13.1). OAA most frequent: sorafenib (17.1%), enzalutamide (10%) and imatinib (10%). Average time of use of the app: 20.5 [4.3-51 .9] weeks. 48.6% of the patients registered at least one SE in the app. During the first week of treatment, 42.1% registered an SE. The mean of SE recorded per patient was 1.6 (SD=2.2). The most frequent were: fatigue (28.6%), diarrhea (25.7%), skin toxicity (18.6%) and nausea (10%). Thanks to the recommendations trough the app, 4 emergency room attendances were avoided and 6 patients were referred to their general practitioner.

The use of the app has impacted on the health outcomes of our patients. e-Oncosalud® has facilitated the early detection of SE, contributing to the safety of its treatment.

Patients with Head & Neck (H&N) cancer often have a complex care trajectory. The Swedish National Cancer plan states that all patients should receive an individual written care plan (IWCP). The IWCP should be done together with the patient containing what is important from both Health care provider (HCP) and patient perspective. Until recently the IWCP, constituted of an information booklet, and the patient treatment plan in the medical records.

All patients with H&N cancer may choose a standard IWCP or the digital format. The digital IWCP is prepared by the contact nurse (CN). The patients can interact with the CN and also send a NRS scale over different symptoms as well as rehabilitation tool. This quality development project is evaluated by an independent CN, with interviewing both the involved patients and CN involved.

Evaluation of this project is currently undergoing, 10 patients are interviewed so far. Since started 25% of patients prefer a digital IWCP, and patients offer many suggestions for improvement. The CNs´involved assess the digital IWCP as easy, less time consuming and more suited to personalize compared with the book leaflet. The evaluation suggest a greater patient participation.

One enabler for implementation is that the platform is chosen through a national consensus and the HCP and patients may influence the design. Not all patients want a digital version when a paper version is offered. There is a potential for increased use of screening tools and systematic assessment of symptoms with the digital version of the IWCP. 

This study aims to evaluate the usability and feasibility of an oral anticancer medication (OAM) adherence app developed in a user-centred design process that incorporates the elements of health behaviour theories. Methods An OAM adherence app (named MedFC) was iteratively developed and evaluated for its usability and feasibility. Patients who self-managed their OAMs or caregivers who were directly involved in helping patients to manage their OAMs were recruited for the usability evaluation of the first (N=15), second (N=10) and third (N=11) versions of MedFC. Usability was measured using the system usability scale (SUS). SUS scores range between 0 and 100, with higher scores indicating better usability. The pilot feasibility evaluation involved participants (N=5) using the third version of MedFC for a minimum of three weeks. Feasibility was evaluated based on the ability of the app to monitor OAM adherence.

The median SUS scores of the first, second and third versions of MedFC were 65 (IQR: 55; 82), 74 (IQR: 65; 75) and 90 (IQR: 80; 95), respectively. Based on a Kruskal-Wallis analysis, there were statistically significant differences between the SUS scores of the first and third versions (p = 0.001), and the second and third versions (p = 0.020) of MedFC. MedFC was able to capture at least 69.0% of the times the patient consumed their medication, and > 80.0% adherence levels were seen in 3 (60.0%) of the participants.

MedFC was found to be usable and feasible for managing adherence in patients taking OAMs. 

Despite the rapid growth in palliative care (PC) services, regions remain without access to specialty palliative care. Community-based telemedicine may offer solutions to underserved populations from rural areas within the United States. Methods Retrospective review of 22 patients managed in a rural oncology clinic from a University hospital via telemedicine. Consecutive patients over 9 months, with active, advanced cancer referred for symptom management, transitions of care, or both. Care coordinated by the University PC service and oncology clinic, included nurses, nurse practitioner, and oncologist. Regulatory, legal, Information Technology (IT), and systems logistics were developed in partnership for 6 months prior to pilot. Edmonton Symptom Assessment Scale (ESAS) recorded at each visit.

Average age 66, predominately female with metastatic solid tumors. Patients had 1-3 telemedicine visits. Most common symptom was pain, median score 6. Morphine equivalent daily dose averaged 65. Most common opioids were oxycodone, transdermal fentanyl, and extended release morphine. Three visits required physical exam support from onsite providers (one for dermatological, 2 for neurologic exams). Six visits required immediate controlled substance prescriptions (other prescriptions were mailed; non controlled prescriptions sent electronically). Goals of care discussion in 45% (n=10) and advance care planning documents reviewed when applicable. Technological issues occurred in 2 visits and resolved without IT involvement.

Our pilot program integrated specialist palliative care into a rural oncology clinic providing supportive care via telemedicine, including symptom management and goals of care discussions. Further research should define optimal integration of PC telemedicine into rural oncology clinics. Introduction Breast cancer is a major health problem with nearly 459,000 deaths every year. Triple Negative Breast Cancer (TNBC) has bad prognosis compared to other subtypes. Patients often want to know how long they have left to live and it's the first question patients ask after diagnosis. Reliable predictions can help in achieving more personalized care and better management. Here, we test the performance of machine learning an application of artificial intelligence to predict TNBC survival. Methods Patients were identified through the Surveillance, Epidemiology and End Results database (SEER). Clinical data were extracted including: age, race, site, histology, grade, size, lymph nodes (LNs), metastasis, stage, treatment and survival. Records were randomly divided into a training set (80%) and a validation set (20%). Different algorithms were tested to predict survival. Results A total number of 13078 patients were identified in 2010-2011 with mean survival of 47.5 months. Random Forest (RF) achieved an Area under the Receiver Operating Characteristic Curve (AUC) of 92.4% at 6-months, 85.6% at 12-months, 81.1% at 24-months, 80.4% at 36-months and 80.7% at 48-months. Multi-layer Perceptron (MLP) yielded AUCs of 92.6%, 86.8%, 80.5%, 79.3%, 79.1% at 6, 12, 24, 36, 48 months, respectively. Average precision was 85% RF and 86.6% for MLP. The most important model features were number of positive LNs, tumor size and age.

Machine learning achieved a good performance in predicting TNBC survival based on clinical data. High performance of prediction is essential because it can help in making better treatment decisions and planning social and care needs. 

Utilization of electronic patient-reported outcomes (ePROs) can improve quality of life and prolong survival in cancer care. However, there remain unanswered questions regarding trends in missing data, and related effects on care.

We utilized a prospectively collected database of ePROs from oncology clinics administering Patient Care Monitor 2.0 (PCM), a validated symptoms survey assessing 78 items for men, and 86 for women. We tabulated the proportion of missing items, by item and domain (emotional, functional and symptom-related, constituting 11, 14, and 53 PCM items, respectively), and compared these by age, gender and education.

In 21,185 encounters, there were responses to at least 1 PCM item from 6960 patients. The largest proportion of missing answers occurred for: attend a paid job (10.7%), reduced sexual enjoyment (3.8%), and running (3.7%), items which may not apply to certain patient subgroups. By domain, 12.4% of functional, 8.4% of symptom-related, and 1.6% of emotional items were missing. For functional and symptom-related items, the highest rates of missingness were observed in patients >60 years old.

The rate of missingness was highest for functional items, like attending a paid job, and sensitive sexual health questions. We hypothesize that some respondents (e.g., retirees without a paid job) skipped questions that were not applicable to them. More universal issues for cancer patients, such as emotional well-being, had much lower rates of missingness. This suggests that patients differentially complete ePROs based on perceived question relevance. Differential item completion warrants further study, given potential effects on the clinical utility of ePROs. 

While working in a dental oncology office we realized the need for practitioners to know their patients' medical history and the difficulty to obtain this information. Patients during active or after cancer therapy or long-term survivors struggled with collating details related to the complex cancer and supportive care treatments and other key information. CureCancer, a patient-centered tool, was inspired. We aimed to help patients self-create their medical profile and treatment plan and communicate their profile to health care professionals (HCPs) within or outside the oncology setting. Methods Information to be recorded was identified and included patient demographics, cancer type and stage, co-morbidities, cancer therapies and medications, phase of therapy, symptoms and laboratory examinations. The Agency of Personal Data protection was contacted to ensure data protection and secure keeping.

The CureCancer tool, www.curecancer.gr, www.curecancer.eu, was created and can function from a desktop or a mobile application. Patients can record and update their medical information and status, upload laboratory examinations, track their symptoms and share files to facilitate the HCPs. Patient to patient communication, patient-focused information on toxicities, and news on the continuous progress of cancer therapies were included in the platform.

A new online, patient-driven tool helps patients file their treatment plan and communicate their medical records with the HCPs. CureCancer can

Cancer and cancer treatments are associated with multiple symptoms with significant negative impact on quality of life and functioning. Assessment of these symptoms is conducted using evaluation that rely on patients memories of their symptoms and are subject to recall bias. Mobile phones with their large complement of sensors provide a great tool to track behavioral patterns as correlates of cancer-related symptomatology. The objective of the present project is to delineate data from a study conducted by our group to predict depression symptomatology using mobile health (mHealth) technologies and discuss its relevance to track cancer-related symptoms such as depression, fatigue and insomnia. Methods A smartphone sensing app, LifeRhythm, was developed by our study team that collects location and activity information via sensors available on the phones. A total of 103 participants (39 depressed and 64 non-depressed controls) were recruited to install the app on their smart phones and were followed over an 8 month study period. Three sets of data were collected: sensory data collected by the LifeRhythm app, Patient Health Questionnaire (PHQ-9) completed by the participants, and clinical assessments.

Correlational analyses showed that certain features extracted from the data collected by the app (e.g. entropy and number of unique locations) strongly correlated with PHQ-9 scores (p < 0.05). These analyses will be presented. Use of this innovative mHealth technology tool to track cancer-related symptoms including a proposed study will be discussed.

The advances in mHealth technologies provide great opportunities to track cancer-related symptoms in an objective manner and in real-time. 

Studies show that adherence to oral medications which are self administered varies widely ranging from 46%-100%. Correctly taking chemotherapy medication is essential to preventing progression of disease among patients diagnosed with cancer. Patients' who self-administer oral chemotherapy agents do not come in to see their medical team as often as patients receiving traditional IV chemotherapy, therefore are not typically monitored as closely as patients who receive chemotherapy regularly in the environment of a clinic infusion center.

HelpsyHealth is the world's first Artificial Intelligence (AI) symptom management and navigation nursing system. It is an online platform where patients can login daily from their laptop, tablet, or Smartphone and record when they take medications and their symptoms.

HelpsyHealth has developed San, a mobile digital cancer nurse that can help support patients, 24/7. Currently, advisors at HelpsyHealth are working to create an oral chemotherapy tool with common and serious side effects entered. When patients login and answer simple questions about how they are feeling, oncology nurses will be better able to provide recommendations based on this feedback and create a safer care environment for patients.

As cancer care becomes more complex and the number of people diagnosed with cancer rises, nurses can leverage technology in order to care for patients who are increasingly receiving their care outside of the hospital. Utilizing platforms such as HelpsyHealth will improve the overall outcome and safety for cancer patients while allowing nurses to care for more patients safely and efficiently.

The healthcare system is very difficult to understand and maneuver for cancer patients. Over the last few decades, the role of the oncology nurse navigator (ONN) has become an essential part of this healthcare team that patients have learned to rely on to help manage their care. While every healthcare entity structures the job of the ONN differently, there remain core elements that every ONN possesses no matter where they work; these include educating, helping, and advocating for patients to become self-reliant in a complicated medical system. Methods Helpsy Health is a web based platform where both patients and providers can have results uploaded into oncology specific navigation tools. Instead of keeping their own diary of cancer or treatment related symptoms, patients can use Helpsy to record their symptoms and have them tracked in a secure cloud. Additionally, AI helps manage symptoms by directing them to evidence based recommendations, escalating care if needed.

If ONN's get access to this platform, then they can easily, and quickly monitor patient status and provide physicians with more accurate information in order to tailor the patient's treatment plan accordingly. Preliminary results show that providers and nurses who have used Helpsy feel closer to their patients.

As our population gets older and people live longer with more complex illnesses, providing our nurses with the tools to help them manage our community's health and wellbeing is critical to our success in improving the quality of life we can offer individual patients.

V.V. Maka 1 , C. Anupama 2 , H.V. Anuradha 2 1 Introduction A Drug-Drug Interaction (DDI) is a clinical or pharmacological response to the administration of co-exposure of two or more drugs. Since the anticancer therapies are often based on the use of multiple agents, DDIs are a relevant problem in cancer chemotherapy. Aim of study was to estimate the incidence of potential DDIs detected in patients receiving cancer chemotherapy, and to assess the pattern and severity of DDIs in cancer patients by use of easily available digital platform available.

This study recruited 150 inpatients receiving cancer chemotherapy in the medical oncology wards with various types of malignancies from January 2017 to December 2017. The prescriptions were subjected to DDI screening using Medscape©app based Drug Interaction Checker. The incidence of DDIs, their types, pattern and severity, correlation between age and number of drugs prescribed were analysed.

Among 150 patients (49 males and 101 females) that were enrolled in the study, and their prescriptions were screened. A total of 579 DDIs were found among 134 patients,14 DDIs were 'serious', 403 DDIs were in 'monitor closely' category, and 162 were 'minor' interactions. Based on the mechanism, pharmacodynamic DDIs were found to be 53.36%, pharmacokinetic DDIs were 44.55%, and unspecified were 2.07%. A positive correlation observed between number of drugs prescribed, and drug interactions (p=0.01).

The Risk of DDIs increased with the number of drugs in the prescription. The program of medication surveillance by digitial platform apps could prevent a relatively high proportion of patients from experiencing potentially adverse clinical consequences of DDIs in cancer patients.

Oncokompas is an eHealth self-management application to monitor healthrelated quality of life (HRQOL) and to provide personalized information on HRQOL and supportive care. In Oncokompas there are generic cancer topics available, as well tumor specific topics in the modules targeting breast, colorectal, head and neck cancer and lymphoma patients. In this project, Oncokompas is extended with a module for melanoma patients.

The melanoma module was developed according to a participatory design approach: patients, health care professionals and researchers worked closely together in the developmental process. This process consisted of a literature study, a focus group with four patients, interviews with ten health care professionals and two feedback rounds on the content and design of the melanoma module with various experts.

Topics in the melanoma module comprise lymphedema, scar care and pain, sunlight, self-examination, fear of recurrence, changes in future perspective, heredity, work, and communication with others about the illness. Most topics developed target melanoma survivors and patients with a stable disease after immunotherapy.

As a result of the involvement of patients, health care professionals and researchers in the developmental process, it is the expectation that the melanoma module in Oncokompas helps in fulfilling the supportive care needs of melanoma patients. Future research is directed at evaluating the efficacy of Oncokompas and implementing the eHealth self-management application Oncokompas in standard hospital care. In order to enhance patient empowerment in Dutch patients with chronic myeloid leukemia (CML) CMyLife was developed together with patients advocates, nurses, medical specialists and ICT professionals. To provide trustworthy information for patients it is key to know which information is lacking in current care and whether that information is found online by patients.

Before developing CMyLife 203 CML patients treated in 7 different Dutch hospitals completed a survey with validated questionnaires focused on their needs and various aspects of daily life with CML (EORTC-QLQ-C30, EORTC-QLQ-INFO25 and others). After its launch, user statistics of CMyLife during 2017 until 2019 were analyzed.

Questionnaires: The majority (72.2%) of CML patients received written information. One third (35.2%) was not/a little satisfied with the amount of information provided and 35.9% desired more information on possible side effects (40.5%), diagnosis (26%), treatment goals (27%), psychological aid (87.8%), management of their illness at home (85.2%), help outside of the hospital (90.8%), the effect on their social and family life (71%) and sexuality (86.8%). Mean scores on a scale from 0-100 of the EORTC-QLQ-C30 and -INFO25 are listed in Table 1 . User statistics: CMyLife had on average 718 visitors per month (3/5 visited more than once). The most frequent visited pages are listed in Table 2 .

Information supply in current Dutch CML-care is suboptimal, especially on disease and treatment-related topics to everyday life. Provision of this information is actively used by patients. Next step will be to test whether this improves understanding and enables empowerment of CML patients. 

Digital health approaches, including electronic medical records, decision support, wearables and electronic education platforms promise to improve access and personalisation in cancer care. Whilst enthusiastically adopted, some have limited efficacy and safety data. To inform the development of the Australian Digital Health in Cancer Roadmap, we have conducted a meta-review of the literature and interviews with stakeholders about barriers, enablers, needs and opportunities for quality digital health in cancer. Methods A systematic literature meta-review (Jan 2013-June 2018), together with stakeholder consultations (representing consumers, health care providers, researchers, policy representatives, and technology developers) were conducted. Thematic analysis by two independent researchers was then undertaken. This abstract reports on themes identified in these data addressing quality (effectiveness, appropriateness, acceptability, accessibility, efficiency) and safety of digital health approaches.

Ninety-three published reviews and focus groups/interviews with 51 stakeholders were analysed. The main themes relating to quality were i) limited regulatory standards for digital technology, ii) limited credible advice regarding quality, and iii) limited safety data monitoring. Stakeholders agreed with/touched on all themes identified in the metareview, with additional emphasis on the need for a coordinated approach and focus on consumer needs, amid concerns that adoption of new technology outpaces evidentiary and regulatory efforts. Despite their use in cancer care and support, emerging digital technologies such as social media were underrepresented in the literature.

To ensure quality and safety, a strategy is needed for regulation of digital health in cancer that defines a framework for standards, measures, and data collection. 

Oncology Outreach, a department that focuses on helping the public clearly understands cancer's impact on our daily lives is a key component of any cancer center that earns the coveted "comprehensive" designation from the National Cancer Institute. AMPATH Oncology Institute (AOI) is engaged in an extensive, ongoing effort to provide training, education and care. This provides them with information and resources they need to make sound decisions about cancer prevention, screening and treatment. Methods A Point of Care system (POC) was designed and customized for outreach activity. Breast and cervical data collection forms are integrated in the system. Key components of breast and cervical designed to fit the outreach flow. Demographics are collected at registration point. The system is real time for data analytics. The system alerts for follow-up after biopsy Results 8,088 clients screened through 2018 using the digital POC. Screening was done in 27 in Western Kenya Region. 26.6% screened for breast alone, 10.3% screened for cervix alone and 63.0% that were screened for both breast and cervix. 24 % of Males were screened for breast cancer. 181 had breast abnormalities and 129 cervical abnormalities.

Most clients were screened for breast and cervical with males screening for breast. Key benefits of POC system being real time data analytics, follow-up plan and centralization of client's information. There is need to optimize client's management through collaboration and networking involving the county governments and other stakeholders 

During the acute phase of treatment, cancer patients face complex treatment toxicities resulting in high rates of emergency department use and long term morbidity. Ultimately, it is patients (and families) that shoulder responsibility for applying self-management behaviors to reduce the acute effects of cancer treatment on functioning in daily life. However, little attention has been paid to the acute phase of cancer treatment as a "teachable moment" and the quality of self-management support in ambulatory care is poor. The purpose of this paper is to describe the codesign process and features of the online 'I-Can Manage: Cancer Self-Management Program'.

We conducted qualitative descriptive interviews and journey mapping with breast, colorectal, and lymphoma cancer patients; and clinician focus groups to inform the design of the 'I-Can Manage' program. This was followed by usability testing using "think-aloud" techniques with audiotaping and observation in our design lab.

Themes and sub-themes for desired content and features included for example: Normalizing the Experience and Building Our Confidence with tailoring our cancer. Interviews identified the need for online programs that "normalized" the experience of cancer and provided knowledge and information to manage the uncertainty of cancer.

Patients struggle to manage the complex tasks of managing cancer treatment side-effects. Passive dissemination of information is ineffective for activating cancer patients in applying the problem-specific self-management behaviours necessary to effectively reduce acute treatment toxicities. 

The Memorial Sloan Kettering (MSK) Urgent Care Center (UCC) functions as the emergency room for MSK patients. With 23,000+ presentations annually, increasing volume and acuity mean more days over capacity. Patients experience increased wait times to see a provider, complete evaluation, and transfer to inpatient bed. The goal of UCC TeleTriage is to streamline patient flow through UCC and improve patient experience by aligning patient need and volume with resources. Methods UCC TeleTriage began July 2018 with the Gastrointestinal Medical Oncology service. The Service RN refers patients to TeleTriage weekdays, from 9a.m.-4:30p.m. The TeleTriage provider calls patient within 30 minutes, takes history, and determines initial plan. Depending on acuity, evaluation starts prior to registration in UCC, using zip code and GPS to identify appropriate testing site. Patients who are too ill are directed straight to UCC.

TeleTriage patients have (virtual) contact with a provider within 30 minutes and are discharged from UCC 42 minutes more rapidly than non-TeleTriage patients, who waited 110 minutes to see a provider. TeleTriage patients who received imaging prior to UCC, received a final disposition 93 minutes sooner than non-TeleTriage patients. A small number of low acuity patients were fully managed at home or in outpatient clinics.

Discharge of TeleTriage patients is measurably more rapid compared with non-TeleTriage patients. TeleTriage patients also had more rapid contact with a provider and earlier initiation of evaluation. Video-assisted TeleTriage is slowly being added. There is a new trend of managing less acute patients completely remotely. 

Nutrition and physical activity interventions form an important component of cancer care. This systematic review describes and appraises the literature regarding the efficacy of technology supported self-guided nutrition and physical activity interventions for people with cancer. Methods A systematic search of Medline, Scopus, CINAHL, EMBASE, Cochrane library and SPORTDiscus was conducted through to July 2018 for randomised or non-randomised controlled trials investigating technology supported selfguided nutrition and physical activity interventions. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes of interest were measures of behavioural, health-related, clinical, health service or financial outcomes.

Seventeen randomised controlled trials representing 2,719 participants were included. The majority of studies used a web-based intervention (n=10). Six studies assessed dietary behaviour with two reporting a significant benefit on diet quality or fruit and vegetable intake. Fifteen studies measured physical activity behaviour with eight finding significant improvements in muscle strength and moderate to vigorous physical activity levels. Four of nine studies assessing health-related quality of life (HRQoL) reported a significant improvement in global HRQoL or a HRQoL domain. A significant improvement in fatigue was found in four of six studies. Overall, the risk of bias was moderate. Interpretation of findings is influenced by inadequate reporting of both the intervention description and compliance.

This review identified a benefit of technology supported self-guided interventions on physical activity behaviour and fatigue, and some benefit on dietary behaviour and HRQoL in people with cancer. There is lack of evidence investigating the long-term benefit and cost effectiveness. 

Video visits were conducted through the electronic medical record's (EMR) patient portal. TS/SCPs were delivered by specialty survivorship nurse practitioners (NP) who underwent virtual health video visit training. Survivors were selected for a telehealth visit upon review of analytic cases for TS/SCP eligibility in the top 2 disease lines, breast & genitourinary (GU). Survivors were ineligible if they did not have an EMR patient portal account. The remaining patients were contacted by a survivorship NP to schedule a telehealth visit.

Between December 2018 and January 2019, 229 survivors eligible for a TS/SCP were screened for a telehealth visit (breast n=24; GU n=205). Twenty-four survivors were previously provided a TS/SCP. Fifty-four percent had an active patient portal and were contacted for a telehealth visit. Of the 19 survivors who responded, 10 (53%) completed a telehealth TS/SCP visit. Patient experience surveys are in process.

Academic cancer centers with high volumes of TS/SCP eligible survivors contend with barriers in meeting the CoC TS/SCP standard. Initial evaluation of the pilot program suggests this may be a feasible pathway to increase delivery of TS/SCP by improving access to survivorship care. 

Adherence to web-based symptom reporting interventions is known to be low. Yet, few studies have determined factors associated with patient adherence. The purpose of this study is to determine the clinical and demographic factors associated with adherence to web-based remote symptom reporting.

We assessed adherence to daily symptom reporting on the Advanced Symptom Monitoring and Management System (ASyMS). Patients were given a mobile phone with an android app interface pre-installed and were instructed to report symptoms at least once daily. Adherence is calculated as the proportion of days a patient completed at least one report while enrolled in the study. We conducted linear regression to determine factors strongly associated with adherence.

There were 2838 symptom reports collected from 39 patients (Female=27). The mean age of participants was 52.8 years (SD ± 13.8). The median rate of adherence was 70% (interquartile range, 44%-91%). Patients were more likely to be adherent to ASyMS-Can Intervention if they were older in age (β = 0.011, p<0.01) and spent many hours using a PC weekly (β = 0.35, p < 0.01). These still held after controlling for sex, ethnicity and educational attainment. Patient sex, cancer type, employment status and having young children were not strong predictors of adherence.

Paradoxically, older patients were more likely to adhere to web-based symptom reporting. This may be the effect of younger patients undergoing high dose chemotherapy treatments. Future studies should investigate the effect of increased adherence on improving patient outcomes.

Use of telemedicine in the management of cancer patients has so far changed the perspective of disease progression. This paper highlights efficacy of applying telemedicine effectively to new patient populations through caring for individuals with cancer. Methods Emphasis is on use of telecommunications technologies in the management of implementation and delivery of oncology healthcare services where distance is a critical factor. Currently 10 counties are working in partnership with AMPATH to ensure that internet connectivity is maintained, teleconference equipment is installed at consultation rooms with tools critical for diagnostic and therapeutic services.

Improved diagnostics and disease management accounting for over 70% realized through the use of telemedicine.

Telemedicine has a great deal to offer in cancer care. The positive findings from this literature as well as work being done in collaboration with the remote sites in providing care to individuals with cancer suggests that this technology promises to improve access, enhance management of cancer and other conditions, as well as positively change the lives of those affected by the disease. National University of Singapore, Pharmacy, Singapore, Singapore

Fitbit® activity trackers are popular among adolescent and young adults (AYA) (aged 15-39) for tracking physical fitness. However, it is unknown whether they are useful to evaluate physical activity levels in cancer patients undergoing treatment. Hence, this study was designed to compare the adherence to wearing Fitbit® and Fitbit®-derived physical activity measures between AYA cancer patients and healthy controls. Methods This is an ongoing prospective, longitudinal study. Eligible AYA participants were offered a wearable Fitbit® tracker to monitor step count, duration of exercise and energy expenditure. Weeks with at least 4 days of non-zero step count were included in the data analysis for rates of adherence and physical activity measures. All physical activity measures were compared between groups using independent t-tests.

Seventeen cancer patients and 10 healthy controls were recruited, with mean (±SD) age of 33±5 years and 28±5 years, respectively. Majority (82.3%) of the patients were diagnosed with early-stage cancers and all participants were ambulatory at baseline. AYA patients and healthy controls adhered to wearing the tracker for 47.2% and 92.6% of the observational period, respectively. The mean (±SD) daily step count, mean (±SD) weekly total time spent in light-activity and mean (±SD) daily total energy expenditure were significantly higher in the controls compared to the patients (12831±5896 steps vs. 5638±3155 steps, p<0.004; 1404.8±753.6 mins vs. 747.6±430.6 mins, p<0.008; 958.4±391.1 kcal vs. 492.4±190.9 kcal, p<0.004, respectively).

Comparing to healthy controls, AYA cancer patients are less adhered to wearing Fitbit® activity trackers and less engaged to physical activity. 

To supplement healthcare provider (HCP) education and ease the emotional burden of patients and caregivers seeking appropriate information regarding tumor treating fields (Optune®), a FDA approved treatment for GBM, the device manufacturer: Novocure sought to bring innovative platforms to patients and caregivers.

Emerging technology methods were employed focusing on patient and caregiver frequently asked questions. The issues addressed included: treatment overview, mechanism of action, treatment initiation and management. Educational platforms included connecting potential patientscaregivers with current Optune patients-caregivers via live and webbased Open House events and direct patient-caregiver discussions with current Optune patients-caregivers via the phone-based Buddy Program. A dedicated Optune Facebook page was launched. As well as a first ever industry led Facebook Live event was held, allowing patients-caregivers to discuss their unique issues during a national broadcast. Additionally, vignettes including videos and written stories, were shared via a dedicated patient-caregiver website and YouTube channel.

In the ever-growing social and digital era, it is incumbent upon HCPs to become aware of innovative ways in reaching and teaching cancer patients. Utilization of emerging technologies may improve supportive care for cancer patients, by easing emotional burdens and improving communication channels. 

Opioids for long-term therapy of chronic pain among cancer survivors (CNMP) have seen guidelines that recommend reduced opioid doses, patient monitoring and caution for prescribing. These guidelines strongly endorse physician opioid education. The aim of this study was to evaluate changes to practice that physicians plan to implement following a 3-day opioid education course, and any perceived barriers to implementation of current opioid guidelines for chronic pain among cancer survivors. Methods A 3-day opioid education course on prescribing long-term opioids for CNMP was attended by 220 health professionals. The topics included opioid pharmacology; opioid prescribing techniques; risks and side effects of opioid therapy; and current recommendations of recent opioid guidelines. A post-course survey was given to attendees to evaluate any perceived increase in competence, specific plans which would change clinical practice, and any perceived barriers to future changes in practice. Results 147 attendees completed the course evaluation. 88% believed the opioid course increased their clinical competence and 89% believed they were better able to use best practices for long-term opioid therapy. 81% planned to change (Fig 2) their current practice. Most (92%) attendees perceived significant barriers to implementation of current opioid guidelines, including patient compliance (33%), lack of time (26%), and lack of resources (27%). Conclusions 1) Most (81%) health professionals, following an opioid education course, planned to change their clinical management of opioid therapy.

• 2) Most (92%) attendees perceived significant barriers to implementation of current opioid guidelines on long-term opioid therapy. 3) Common barriers were patient noncomplicance, reimbursement issues, and lack of resources.

A. Athar 1 1 Sir Ganga Ram Hospital, Medicine, Lahore, Pakistan

Breast cancer possesses serious health risk for women in Pakistan. It is estimated that one in nine Pakistani women will develop breast cancer at some stage in their lives. Early detection can help save lives. To explore knowledge, attitude and practices regarding breast cancer detection in Pakistani women. Unfortunately no statistical data is available in this regard. Very few researches have been carried out. In Pakistan we do not have a registry at national Methods Descriptive exploratory study was carried out. Two hundred Pakistani women, age 30 and above, not suffering from cancer were interviewed from lady Wallington hospital, Sir Ganga ram hospital and services hospital Lahore. The interview designed contained questions regarding knowledge, attitudes and practices about symptoms of breast cancer, breast self-examination (BSE) and clinical breast examination (CBE). Data was obtained by face to face interview in local language, translated into English afterwards. Results 20% of participants had knowledge about symptoms of breast cancer.16% of participants did BSE only once.10% of participants practiced BSE monthly.8% had undergone at least once CBE during their lives. The majority (70%) didn't know much about breast cancer. Age and education showed no statistically significant relationship with breast health practices.

Pakistani women have minimal knowledge about breast cancer. They don't engage themselves in breast cancer detection practices. They need to be better informed about breast cancer and benefits of BSE and early detection. 

To explore if and how outreach chemotherapy is being offered by clinicians to Gastro-intestinal (GI) cancer patients; what information patients received and what choice they made in relation to where their chemotherapy was administered.

Ethical approval was established in 2017. Data collection occurred over five months between May -September 2017 in a regional hospital. Data included (n = 10) GI cancer patients followed at three time points over chemotherapy treatment cycles using semi-structured telephone interviews (n = 28). HCPs (n = 34) completed six closed questions and (n = 20) one free text response survey. Descriptive statistics and thematic analysis were used to establish themes and make comparisons. Results 100% of staff know the hospital has an outreach service for providing chemotherapy. At the time of the survey, (n = 19, 55.9%) members of staff had referred 0-5 patients in the previous month. Outreach was offered to (n = 5, 50%) participants in total across the three-telephone interview timepoints. Of those, (n = 3, 30%) patients embarked on having their chemotherapy administered in alternative locations. Results demonstrate that HCPs are confused as to whose responsibility it currently is and who should be referring patients. Not all patients received information about available treatment locations, and those that were aware had different views on the organisational process. Conclusions Current information given to patients is inadequate. Suggestions to improve the service include re-writing the current policy, developing a clear referral pathway, establishing a nurse to oversee the outreach service, education and streamlining responsibilities.

Caretakers may be faced with a number of barriers before complying with a referral advice. Such barriers can be financial, geographical and cultural. The most complex aspect of referral care is often the caretaker's acceptance of and compliance with a referral recommendation. The objective of this study was to determine caretaker barriers to compliance with referral in order to improve diagnosis, treatment outcomes and guidelines for the Integrated Management of Childhood Illness (IMCI).

The study was cross sectional conducted at the Paediatric Oncology Unit (POU) at the Komfo Anokye Teaching Hospital (KATH), Ghana from July to September 2018. The POU receives about 28 referrals per month. Seven caretakers were recruited weekly for a period of 12 weeks. A sample size of 84 was used for the study. Data on time of arrival at the referral facility and the barriers to compliance with referral were obtained after informed consent. Ethical approval was sought before the commencement of the study.

The barriers to compliance with referral from caretakers perspective are lack of financial resources 38 (45.2%), time wasting at the referral facility 30 (35.7%), seeking alternative treatment 23 (27.4%), experience and impression of the referral facility 18 (21.4%) and lack of knowledge on disease severity 16 (19.0%).

Lack of financial resources, time wasting, seeking alternative treatment, experience and impression, and lack of knowledge on disease severity are the barriers to compliance with referral. A further study on these barriers to compliance with referral will inform outcome improvement interventions. 

In Algeria, one of the causes of innovation hindering the medical technology sector is the lack of knowledge and skills in medical entrepreneurship. Given this observation, the problematic involves several questions: -What is the importance of scientific research, innovation and medicalentrepreneurship in developed countries, and in Algeria.

-Are there start-ups in Algeria? -Would we start the process of research, innovation and medical entrepreneurship in Algeria, if so, how? Methods This thesis deals with the identification of the different critical steps of the invention (scientific research) to commercialization, the role of academic medical centers in this process and its impact in Algeria.

The Lean Start-up approach and the creation of Clinical-Innovative Pathways in Academic Medical Centers (CMAs) are the solution to this problem, challenging physicians to go beyond their comforts to acquire knowledge about entrepreneurship in the medical sector, which aims to optimize care, reduce health costs and improve the patient's quality of life.

The process of innovation between invention and marketing (application) is essential to the advancement of academic medical centers, and this process must be properly integrated into the educational curriculum of these centers whether state or private.

The objective of this study is to identify the reasons behind delays in scheduled blood transfusion, to promote education and awareness of timely blood transfusions and finds reasons behind delays and how to overcome them. Methods Data was collected in two parts from the patient charts, included demographics of patients, Laboratory and next follow up plan. Duration of this study was 3 months from April to June 2017 and 3 months after intervention from June to August 2018. Inclusion criteria includes thalassemia major, of any age or gender visiting day care oncology for receiving blood transfusion whereas, exclusion criteria includes patients of any age or gender with thalassemia intermedia / minor or haemoglobinopathies.

In part one out of 107 patients 66 (61.68%) received on time blood transfusions, 27 (25.23%) patients received delayed blood transfusions and 14 (13.08%) patients received early blood transfusions. In part two data analysis done after intervention, out of 107 patients 87 (81.30%) patients received on time transfusion,10 (9.34% ) patients received early blood transfusion and 10 (9.34% ) patients received late blood transfusion. During data analysis it was identified that out of 66 (61.68%) patients coming on time for blood transfusion 38 (57.57 %) patients have their Hb level less then 9g/dL in 2017 and 41 (47.12%) patients out of 87 (81.30%) in 2018 have their Hb level less then 9g/dL.

After intervention with educational sessions percentage of patients receiving timely blood transfusion was improved. Patients receiving on time blood transfusion had hemoglobin level less than 9g/dL which needs further workup. 

Pain is one of the most frequent symptoms in cancer patients. Eighty to 90% of patients with cancer experience mild to severe pain in Ethiopia. For proper management of pain, health care providers (HCP) need particular knowledge and attitudes to pain and pain management. The purpose of this study was to describe knowledge and attitudes to, pain and pain management among HCP working in cancer centers in Addis Ababa, Ethiopia, and to determine if various demographic characteristics were related to level of knowledge and attitude. Methods Nurses (n = 121) and medical doctors (n = 79) were recruited from two cancer hospitals of Addis Ababa. HCP completed "Nurses' Knowledge and Attitudes Survey Regarding Pain" (KASRP). Data were analyzed using descriptive statistics, and a binary logistic regression was used to evaluate the association between demographic variables and knowledge and attitudes.

Nearly 60% were female and the majority were between 23-29 years old. Only 40% of the HCP had more than half of the questions in the survey correctly answered, and as few as 25% had at least 80% correct answers. Being male, higher income, having a formal pain management course, and profession as a doctor were associated with higher KASRP total score.

The low KASPR total score among HCP indicate that there is a potential for improvement of knowledge and attitudes to pain. HCP should be encouraged to attend a pain management course supported by the health authorities in Ethiopia.

Stem cell transplantation (SCT) is known to be physically and emotionally stressful procedure because behavioral related factors such as posttransplant isolation period. SCT recipients have therefore been found to at increased risk of experiencing variety of psychosocial difficulties factors impact negatively on quality of life. Studies have shown that levels of antibodies decreases during few years after SCT. its association with developing life threatening infections risk and behavioral isolation to a increase psycho social difficulties, Therefore acceptance of vaccination protocol is difficult to implement in sychosocial problem presence specially depression Present study undertook to know beneficial effect of family psycho social counseling regarding attitude towards positive immunization protocol Methods Total 3 patents between age of 2-8 years age who had SCTfor acute myeloid, chronic myeloid and lymphoma were subject to family psychosocial counseling session were followed with reference to attitude of positive life and vaccination protocol acceptance Results All 3 patients has shown remarkable improvement in personality towards their ability to cope with depression and anxiety level The over anxious fear about post transplant infections was well taken with vaccinations followup advised The family were well versed happy about the family psychosocosial counseling session outcome Conclusions Our small study showed that family psychosocial counseling has beneficial effect on attitude for vaccination and psychological morbidity post transplant patients with immune modulation More large scale community studies may done for further evaluation 

The chemotherapy administration incidence rates increased from 0.008% to 0.04% during2014 to 2015. This project explored the effects of application of team resource management intervention enhance the patient safety of chemotherapy administration in a medical center of Taiwan.

Applied the root cause analysis on the collected data from 2015 to 2018. The total numbers of chemotherapy administration were 49,894, with a total of 11 incident events. Extravasation accounted for 90.9%, with swelling (38.4%), pain (30.8%), red (23.1%) symptoms, 5FU accounted for the most; administration error accounted for9.1%. The problems identified were incorrect of port-A catheter fixation and angle needle size selection, insufficient awareness of chemotherapy extravasation, complex chemotherapy orders without standard prescription, calculation error in the flow rate, absence of double checking., lack of pharmacy information and further training. We then develop a series improvement strategies included by medical resource integration, develop of port-A catheter care DVD, chemotherapy extravasation prevention handbook, integrated chemotherapy order package by information system, implementation of barcode administration system, and educational training programs for safety administration and standardizing.

The chemotherapy administration events incidence rate reduced from 0.04% to 0% ; chemotherapy extravasation rate reduced from 0.04% to 0%; the chemotherapy administration time was also shortened by120 seconds each. Satisfaction of the medication barcode administration system also rose from75.0 points to 85.6 points from January 2015 to September 2018.

Team resource management was central to this project. It not only enhanced professional competence, but also improved the chemotherapy administration safety.

V. Lee 1 1 The Chinese University of Hong Kong, School of Pharmacy, Shatin, Hong Kong S.A.R.

Pharmacy students in Hong Kong face the common challenge of having limited opportunities to experience professional clinical practice.

We have a pioneering project in Hong Kong using immersive virtual reality (IVR) techniques to enable students with no clinical experience to work through interactive cases. We have developed two IVR teaching modules using real patient cases. We have brought the clinical ward setting into the classroom. Students experienced first-hand clinical exposure in class with guided, step-by-step teaching material to translate clinical knowledge into practice. Beside IVR, we also had case studies in paper format. We invited the students to conduct user feedback surveys to compare their learning experience on both paper and IVR.

We found that the students preferred to have paper format for case discussion or even watching video than using IVR. However, most of them gave positive feedbacks on the use of IVR and thought it was interesting to have a simulated interaction with a patient. In short, technical problem was the major issue we encounteredas there was only one full set of IVR equipment with remote control in the classroom. Most of the students had to use their smartphone and provided headset to experience the IVR cases. Conclusions IVR in pharmacy education is still new in Hong Kong. It has potential to be developed into other therapeutic areas including supportive care in cancer management. However, proper guidance, hardware and software improvement, and clear instruction are required for in class deployment of IVR.

Management of lymphedema is very important to increase quality of life of cancer survivors. Therefore the education about it should start in undergraduate health sciences programs. Pilot study of this research was presented at the 2015 International MASCC/ISOO Symposium. The aim of this study is to increase numbers of participants to make more realistic implications about understanding the knowledge status on lymphedema of the final year students to improve the education programs. Methods A 10-item questionnaire, which was used on pilot study, was applied to 83 physical therapy and rehabilitation (PTS) and 65 nursing students (NSS) from two different universities. Results 39.76% of PTS and 27.69% of NSS wrote the correct definition of lymphedema. 31.33% of PTS indicated 3 or more causes;mastectomy (56,63%), radiotherapy (28,92%), chemotherapy (15,66%). 46.15% of NSS indicated only one cause;mastectomy. 32.53% of PTS and 55.38% of NSS saw any case. 60.24% of PTS, 35.38% of NSS indicated that lymphedema occurs on any body parts. 54.22% of PTS commonly indicated 3 or more treatment approaches;manual lymphatic drainage (81.93%), bandaging (72.29%), compression garments (53.01%). 47.69 % of NSS did not indicate any treatment approaches. 42.17% of PTS and 72.31% of NSS did not know about the role of nurses. 8.43% of PTS and 53.85% of NSS did not know about the role of physiotherapists.

This extended study shows that although the knowledge status about lymphedema of the PTS is better than NSS, it should find more places on curriculum. It is better to make internship opportunities on cancer clinics to increase cancer and survivorship awareness. 

Sann-Jhong-Kuey-Jian-Tang (SJKJT) is a traditional Chinese medicine prescription has been used as complementary medication for solid cancer in Taiwan. SJKJT can inhibit human breast cancer MCF-7 cells and BT-20 cells through inducing apoptosis. Programmed cell death-ligand 1 (PD-L1) is expressed on many cancer cells, which played a protective role against the cytotoxicity. PD-L1 interacts with programmed cell death-1 receptor (PD-1) to inhibit the T cells and block the antitumor immune response. PD-L1 expression is a favorable biomarker for the prognosis of breast cancer; therefore, immune checkpoint blockade agents may be offering the opportunity to be the future treatment for breast cancer. Methods BT-20 and MCF-7 cells were treated with SJKJT in vitro. The cytotoxicity of SJKJT was evaluated by MTT assay. The effects of SJKJT on the protein expressions of PD-1, PD-L1, Cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), B7-1 (CD80) and B7-2 (CD86) were measured by Western blotting. Results SJKJT can induce the proliferation inhibition with time and dose dependent. SJKJT treatment inhibits the protein expressions of PD-L1 in breast cancer BT-20 and MCF-7 cells significantly.

BT-20 and MCF-7 cells were treated with SJKJT can inhibit the activity of PD-L1 significantly. These results suggest that one of the molecular mechanisms for SJKJT to inhibit breast cancer BT-20 and MCF-7 cells maybe through inhibiting the protein expression of PD-L1. SJKJT may to be one of the immune checkpoint blockade agents for human breast cancer cells. 

Sann-Jhong-Kuey-Jian-Tang (SJKJT) is a traditional Chinese medicine prescription. SJKJT consists of 17 species of herbs and has been used for much solid cancer in Taiwan. Breast cancer is the leading cause of cancerrelated death for women in worldwide. SJKJT could inhibit the MCF-7 cells through decreasing the expression of Vascular endothelial growth factor receptor-1 (VEGFR-1), insulin-like growth factor-I receptor (IGF1R), then to block the PI3K/AKT/mTOR signaling pathway. The present study focused on the effects of SJKJT in the Her2/3 and Ras/ Raf/MERK/ERK pathway in human breast cancer cells MCF-7.

The effects of SJKJT on the protein expressions of Her2/3, Ras, Raf, MERK, ERK, LC3-II and β-actin in the MCF-7 cells were examined by western blot analysis.

The results showed that SJKJT can inhibit the protein expressions of Her2/3, MERK and ERK, but increase LC3-II in MCF-7 cells.

These findings indicated that SJKJT could inhibit the MCF-7 cells. One of the molecular mechanisms may be through decreasing the protein expressions of Her-2 and Her-3, then to block the MERK/ ERK signaling pathway; the other may be through increasing LC3-II to induce autophagy. The traditional Chinese medicine prescription SJKJT may become a possible therapy option for human breast cancer. 

The use and prescription of oral chemotherapeutic medications is growing with several new oral drugs in development. While there are numerous benefits associated with the use of oral chemotherapy, there are several risks to which a patient must be comprehensibly informed. The aim of this study was to examine how patients received, understood and acted upon healthcare professional education about their oral chemotherapeutic regimen throughout their treatment.

Over 60 hours of observational data were digitally recorded from interactions between 9 oncology doctors, 6 oncology nurses, 8 patients and 11 family members over a period of six months in outpatient departments within one hospital in Northern Ireland. Sixteen semi-structured interviews were conducted with patients during and after their treatment. Three focus-groups were carried out with health care professionals at the end of the study. Information leaflets given to patients were also examined. Data was thematically analysed.

The three themes of knowing, doing and disclosing emerged with regards to communication processes about safe management of oral chemotherapy. These themes related to patient/family understanding about oral chemotherapy (knowing), oral chemotherapy medication-taking practice (doing) and patient/family management and reporting of chemotherapy risks and side-effects (disclosing).

There is a prominence of non-personalised education for people in receipt of oral chemotherapeutic treatment. This approach was not detrimental to patient safety in this study, however it did lead to patients having unmet needs regarding appropriate oral chemotherapy adherence, reporting of side-effects and long-term sequalae of treatment.

A. Cetinkaya 1 , B. Yigit 1 , N. Tunali 1 1 Halic University, Physical Therapy and Rehabilitation, Istanbul, Turkey

The aim of this study was to investigate cancer consciousness of health sciences students and to understand the nature of cancer education. Methods A 20-item online questionnaire that was generated by researches was applied to 112 physical therapy and rehabilitation(PTS), 26 nutrition and dietetics(NDS) and 30 nursing(NS) students. Results Some information about participants is shown at There was a significant relationship between taking a lesson and having medical knowledge about cancer (p=0.000) ( Table 2 ). 5.1% of PTS, 46.2% of NDS and 67.9% of NS indicate that breast cancer is the most seen on women. 35.7 of PTS, 26.9 of NDS and 28.6% of NS indicate lung and prostate cancer are the most seen on men. There is no any difference on these parameters (p>0.05). All groups know about methods of coping with stress and can apply them (p=0.000). Most of all participants fear to get cancer. 35.7% of all participants told "I know the causes of cancer and take precautions to protect them" and 32.7% told "I want to be protected from risk factors, but the living conditions are not appropriate" (Table 3) .

The cost of cancer prevention is less expensive than treatment. More conscious health professionals provide more conscious public about cancer prevention. Students who took lesson about oncology and successfully adapt their knowledge into their life are considered to be efficent health professionals in the future.

W. Tan 1   1 Mayo clinic, Hematology/oncology, Jacksonville, USA

Educational interventions developed for Advanced practice providers (APP) are often not focused for this group of practitioners. Learner specific development of curriculum and addressing their needs are often challenging. The Florida Society of Clinical Oncology (FLASCO) since 2016 have a 1 day free course offered to new APP's who are beginning their clinical careers in hematology/oncology. Topics that are relevant to their initial practice integration are discussed during this course. Methods A survey was done to assess the attendees perception of the course from their perspective. This was offered to those who verbally agree to participate on this. Results 23 attendees agreed to participate in the survey.10/23 who answered the question, that the course met a professional gap 10/10 (100%), 21/23 agree that the course increased their knowledge 90%, 85% felt that the course change their competence,85% felt that the course will change the way they take care of patients. Topics that were useful for most of them included pathology, oncologic emergencies, assessment of toxicities, basic principles of treatment, and radiation oncology. The topics that the attendees felt important for them included delivering bad news, supportive care management, billing and coding, specific cancer management, multidisciplinary care of the patient. Challenging topics to understand included pharmacology, disease specific treatment and complications, genomics, chemotherapy, surgical treatment and pathology. Conclusions An APP centered course was adequately implemented and was felt to meet their educational goals, applicable and practical for daily practice. The results of this survey will help develop future courses and help improve this course.

Introduction Background: Young nurses avoids death and dying discussion in children during training. Neverthless, it is important for students to understand death and dying early in training, hence cope with difficult situation in clinical placements. Methods : 62 nursing students were selected to take role play of nurses, parent, friend, sick child and complete questions on chronic illness, breaking bad news, loss, bereavements and coping strategies knowledge.

: Majority didn't know the definition of pediatric palliative care and important of breaking news. 68% had some information about PC and the 32% of the students knew the definition of PPC. 72% didn't know the different between palliative care nursing and general nursing; 55% didn't like idea of working in PCU: 45% avoided loss questions. Most of the students 76% requested more accessibility to the information. 48% had relatives/friends who with chronic illness or died with, 92% interested in attending bereavements session: 32% declined to discuss own death and dying: 38%wished to attend advanced training, 62% preferred other courses, 62% were not kin in role playing as a sick child. 68% PPC is difficult to understand that general nursing, 88% need of supportive counselling center.

There is need to introduce pediatric palliative care early in training for young nurses benefits. Most of palliative care assignment need be role play for nurses to understand and have, confident in caring for children. Results indicates lot of work needed to be done by palliative providers. 

Children who are in school age do have prolonged periods of absences and younger children at times are delayed in enrollment into schools. Most parents do not prefer to lose school years, even if it is for treatment and tend to skip the missed classes and move on to the next class. In India, either in private or public schools, there is no provision for schools or the education department to provide mandated educational support while child is in hospital or recuperating from a chronic illness. Parents do not emphasize on academic learning during the treatment process as they are more concerned about their health at that time.

The aim of the study was to explore if academic functioning was affected due to frequent and prolonged absence to school. Key objectives were to explore any delays or deficits in their academic functioning and to observe any differences between younger and older children. Children and adolescents attending active and maintenance or follow-up in the Department of Pediatric Oncology was evaluated using standardized tools for assessment of cognition and reading, writing and math skills were assessed based on the grade level of the children.

Results indicated those children who were in 6th grade and above demonstrated minimal or no difficulties with academic performance as compared to children who were in classes 5 and below. Conclusions It can be concluded that skipping classes could result in missing basics of academic foundation during the early years or during primary school could result in learning difficulties. 

Fungating wounds are defined as an abnormal growth of cells at a primary tumor site, frequently protruding through the skin as a mass of tumor cells. These wounds can be challenging for clinical staff and patients to manage due to pain, odor, bleeding and excessive drainage. As the incidence of cancer in the United States increases, nurses are more likely to encounter patients with these complex wounds. Currently, nursing literature lacks details on the care of these patients and reveals an important knowledge deficit within nursing practice.

To address these needs, a nurse in a healthcare agency within the United States developed an evidenced-based clinical module to educate nurses in the management of fungating wounds. The module details a pathway of care focusing on didactic training of nurses in fungating wound management and provides resources that support the need for pain, psychiatry, chaplaincy, and cosmetology referrals.

Through a pilot study, new nurses utilized this module during orientation and all other nurses completed a competency on the module in a twomonth time span. Once the competency was completed, a survey was conducted to assess nurses' knowledge of fungating wounds. The survey revealed that after completing the module, nurses were more knowledgeable about fungating wounds and were more prepared to manage them.

Nurses who are trained in wound care management and supportive resources for patients with fungating wounds are better prepared to provide holistic care and advocate for their needs. This serves to improve the patients' quality of life and outcomes. 

The management of surgical wounds and ostomies are frequently the responsibility of floor nurses. The literature reveals a high correlation between a patient's attitude towards self-care and surgical site complications. Preventing infection and other complications will require increased patient knowledge about care and utilization of products that will enhance healing. During admission, primary care nurses who are trained to provide wound and ostomy care, will need to determine the patient's attitude towards learning to facilitate the development an individualized plan of care to manage wounds and ostomies. Methods A literature review was conducted and several journal articles revealed that the patient's knowledge of self-care, as well as a willingness to learn resulted in less wound and ostomy complications.

Patients whose nurses provided hands-on education with returndemonstration skills; video teaching access; shared product contact information; and stressed the importance of learning were more informed and prepared to self care and less likely to have infected wounds or complications with their ostomies.

Patients differ in their approach to learning as well as their desire to selfcare. It is critical for nurses to understand the barriers to care in order improve patient outcomes in lowering post-surgical complications. 

To identify an ideal cervical cancer screening model to reduce false negative errors in a country with high prevalence of cervical cancer. Methods We conducted a cross-sectional study including 33,531 women who underwent routine cervical cancer screening in Korea. Colposcopic examinations were performed after abnormal results on their screening tests. Diagnostic capacities including sensitivity, specificity, and false negative rate of each screening scenario were analyzed at the CIN1 or worse (CIN1+) threshold with colposcopic biopsy results considered the gold standard.

A total of 4117 women had valid results for Papanicolaou (Pap) cytology, human papilloma virus (HPV) tests, cervicography, and colposcopically directed biopsy were included in this study. The disease prevalence of CIN1+ was 38.1%. Pap-alone resulted in the highest false negative rate of 46.9%, followed by HPV-alone at 25.1%, cervicography-alone at 18.7%, Pap/HPV-combined at 15.0%, Pap/cervicography-combined at 6.9%, and Pap/HPV/cervicography-combined at 2.9% in a sample of 1570 women with CIN1+ lesions. Conclusions Cervicography demonstrated excellent performance for the detection of CIN or cervical cancer and markedly reduced false negative errors when used in combination with Pap cytology and HPV tests. 

In 2016 HeGYO had 235 members (135 trainees, 150 men). HeGYO organized educational seminars and workshops on different topics such as "Bioinformatics and Oncology", "Acute Oncology" and participated in Hellenic Academy of Oncology. HeGYO participated in all annual HeSMO conferences with interesting roundtables ("Education and Career Development in Oncology", "HeSMO Guidelines", "Survivorship in Oncology") and organized 2 years the well attended seminar on "Making the right career choices as a young oncologist". It completed a European survey on "Education and Career Development in Oncology". Results of survey were announced at HeSMO, ESMO and ASCO conferences. Three similar surveys are ongoing on "Toxicity Management", "Acute Oncology", "Thrombosis and Cancer". HeGYO members took over Greek translation of ESMO Patient Guides, publication of informative manuals for patients and of a manual on "New Biological Therapies in Oncology". A HeGYO member is sitting in ESMO Young Oncologist Committee (ESMO YOC) providing the link between committees.

HeGYO is an integral and dynamic part of HeSMO and with its ongoing support it had the opportunity to organize interesting scientific events and other actions for the benefit of patients and young colleagues.

A collaboration between Oslo University Hospital and Oslo Metropolitan University developed a 10 ECT new master course: "Psychosocial Support for adolescents and young adults with cancer" based on a clinical practice guideline. The course consists of two weeks lectures including theory and practical skills. Different learning activities (i.e., interaction, individual and group assignments) were used with a final individual exam. The aim of this study was to examine how the students evaluated the course according to the learning outcomes. Methods All students (N=16) answered an individual questionnaire which assessed the relevance, content and the presentation of each lecture. At the end of the course, the students first answered questions related to the learning outcomes in groups, and thereafter orally all together. Data were analyzed using content analysis.

The results from the individual questionnaire showed that the lectures were relevant and well performed. The combination of clinicians, faculty, former patients and family members made a very good contribution to the course. The students highlighted positively the extensive use of interactive activities and the training of practical skills. Students reported that the content of the course was relevant for the learning outcomes. However, there were too many lectures about how to conduct a network conference. In addition, the student wanted more focus on AYA's development, particularly their neuropsychology. Multicultural aspects should be more emphasized.

Overall, the students evaluated the course very well. The content of the course should be revised according to the students' evaluation. 

Older adults experience a high number of cancer treatment-related side effects (mean 7.15) but engage in few self-management behaviors (mean 3.36). Evidence suggests that older adults do not believe provider recommended self-management strategies are effective at managing side effects. Not managing side effects can lead to unplanned hospital and emergency department admissions. Therefore, a novel, serious game using avatar-based simulation scenarios was created to engage and prepare older adults with cancer to manage chemotherapy induced nausea and vomiting better at home. The purpose of this abstract is to report acceptability and usefulness of the serious game Methods Eighty older adults participated in a randomized clinical trial. The game was played on an iPad either at their first (experimental group) chemotherapy appointment or fourth (control group). Participants completed a survey about the game to determine: ease of play, likability, clarity of choices, usefulness, realism of setting/scenario, and consistency of choices. Participants used a 5-point agreement Likert scale (1= strongly disagree, 5= strongly agree). Mean scores were computed.

Fifty-three participants completed the survey. Overall, the game received a positive response. Overall participants believed the game was easy to follow (4.10), likable (3.87), had clear choices (4.08), was useful in helping them manage nausea and vomiting (4.02), realistic (3.92) , and had choices consistent with nurse teaching (4.08). Qualitative comments included suggestions for improvement.

Researchers and clinicians should consider technology-based educational interventions as an acceptable and useful strategy in educating older adults about managing side effects. 

To inform and guide palliative care education decision-making, and to understand whether and why progress is being made, it is necessary to analyse factors at the level of national palliative care education systems, such as major legislation, policies on palliative medicine lecturers, curriculum and assessment, finance and governance practices, non state palliative care education programmes and recent reforms. Methods This paper discusses the need for inter-national information echange to enhance monitoring of palliative care education systems. Results A broad range of valiated indicators of palliative care education systems and policies is urgently needed to support the effective monitoring of palliative care educational programmes in sub Saharan Africa. However, palliative care education system diagnoses differ widely in their objectives, scope, methodology and use. Much could be done to addresss gaps and reduce overlap among diagnosic instruments. Sharing experienes between countries and promoting policy dialoque based on broadly comparable qualitative information on palliative care education systems, will facilitate effective decision making. While a global and / or regional framework for reviewing palliative care education systems and policies might be desirable, in practice a regional or sub regional approach is more feasible. Many regions have common palliative care education contexts and can structure reviews to better reflect their their shared values, objectives and challenges.

The key to successfully exchanging information on palliative care education systems betweeen countries is strong coordination mechanisms from regional intergovernmental entities that have palliative care education development among their primary bjectives.

Pharmacists are an integral member of the palliative care team. Thorough symptom assessment and medication management is essential to quality palliative care. We describe an educational exchange between a pharmacist in the US and a pharmacist in the UK through ties with their respective national professional societies. Funding was obtained through a combination of grants and educational scholarships.

The US based pharmacist spent 1 week observing palliative care pharmacist practices in the UK including inpatient hospice, inpatient academic palliative care unit and palliative care consult service. Key observations of similarities and differences of palliative care pharmacy practice were recorded and discussed.

Observations were categorized into 2 primary categories and used to identify opportunities for future educational and research endeavors. Categories: Team structure and function (role of the pharmacist, disciplines on team); and medication utilization (medications not available in US/UK, place in therapy differences; route of administration differences). The visiting pharmacist shared observations with the host palliative care team to further educational dialogue.

The second exchange is planned for June 2019 in which the UK based palliative care pharmacist will visit the US practice including hospice, outpatient palliative care clinic, inpatient palliative care unit and inpatient palliative care consult service. Several educational projects are also under development as a result of this rich informative exchange program including medication utilization surveys of pharmacists in the US and UK to quantify the observations made during educational exchange. 

Despite improved treatment and care, children and adolescents diagnosed with cancer continue to die, while many of those cured are burdened by treatment-related sequelae. The best clinical management of children and adolescents with cancer depends on healthcare professionals with various skills and expertise. In the process of developing interprofessional education in paediatric cancer we wanted to identify and evaluate existing interprofessional education interventions in paediatric cancer.

We utilised the scoping review methodology to identify gaps in existing literature and examine extent, range and nature of interprofessional education in paediatric cancer. We searched PubMed, Scopus and Education Resources Information Center. Inclusion criteria were postgraduate studies targeting more than one profession in the education and evaluation of the educational intervention.

Nine studies out of 411 references fulfilled the inclusion criteria. None evaluated systematically knowledge, skills, attitudes or the effects on patient outcomes or quality of care. We systematized the outcomes based on the six non-hierarchical levels of the modified Kirkpatrick model. One study reported on the reaction of participants to being part of the intervention. Three studies reported on acquisition of knowledge and fours studies evaluated the modification of attitudes among healthcare professionals. Four studies measured behaviour change outcomes, including increased compliance to guidelines and increased self-awareness. Three studies reported on improvements in patient's health.

Evidence-based practice and evaluation is necessary to derive the most benefit from educational interventions for clinical practice in paediatric cancer. However, there is a lack of well-structured, interprofessional education in paediatric cancer that has undergone evaluation.

The educational and psycho-social challenges school-aged children with cancer experience at school re-entry, calls for supportive interventions. The RESPECT study includes a 60-minutes age-adjusted nurse-led education session in the school class of hospitalized children with cancer, aimed at enhancement of teachers and classmates' knowledge and attitudes about cancer and cancer treatment. Methods Pre-and post the educational session, a study specific questionnaire was mailed to 120 teachers of hospitalized children with cancer.

Study inclusion occurred a median of 5 [0-110] days following the child's cancer diagnosis, and the education session was conducted at a median of 10 days hereafter. Despite 72% of the teachers searching information prior to informing the classmates, 40% faced questions they were unable to answer. Furthermore, 27% of teachers felt insecure and 33% had insufficient resources to address the situation. Post-education, the teachers were satisfied with the content (100%), duration (98%) and level (98%) of the educational session. Furthermore, teacher's attitudes changed as they felt more secure and comfortable in: addressing cancer with the classmates (83%), having the child with cancer in the class (61%), and in cooperation with the family (73%). The educational session significantly reduced the teacher's insecurity related to having a child with cancer in the class (p=0.005). The educational session increased 66% of the teachers' and 98% of the classmates' undertraining of the child´s cancer disease and strain of the cancer treatment.

Enhancement of teachers to children with cancer's knowledge and attitude provides a cornerstone in easing children with cancers' school re-entry. 

Colorectal cancer (CRC) is the cancer with the highest prevalence in Taiwan. Care coordination has received increased attention because it critically affects patient safety and care quality across services.

Patients with CRC who agreed to participate (n = 100) were randomized to either experimental or control group. The experimental group participated in a psychoeducational intervention (PEI). The PEI was constructed with two separate parts: educational information and materials relating to depression, anxiety, EORTC QLQ-C30, and self-efficacy. The intervention group participated in the PEI for at least 1 hour per section for 6 sections, in addition to using an educational manual designed and presented by the researchers. Participants in the control group were exposed only to the traditional pamphlet education. Data were collected just before the chemotherapy (T1), the 3rd (T2) and 5th weeks of chemotherapy (T3), and 2 weeks after the final session of chemotherapy (T4).

Values for anxiety, depression, and quality of life two weeks (T4) after chemotherapy treatment ended showed significant differences for CRC patients who received PEI. Significant differences in self-efficacy were shown between the two groups after the fifth chemotherapy treatment (T3). The effects of anxiety, depression, and quality of life remained significant when group and time interactions were included in the model, showing a positive relationship between PEI and the variables of anxiety, depression, and quality of life. Conclusions Face-to-face PEI can be used effectively for CRC patients before chemotherapy in clinical oncology settings to reduce the degree of emotional disturbance and accelerate adaptation.

Lymphoma has the highest prevalence among all cancer types in Taiwan. Care coordination has received increased attention because it critically affects patient safety and care quality across services. This study examines and evaluates the effect that adopting a nurse navigator interventions for newly diagnosed lymphoma patients.

In this retrospective study, 212 lymphoma patients were recruited between January 2009 and December 2013. The experimental group comprised 115 patients who had received nurse navigator interventions. The nurse navigator coordinated the recruitment, liaison, care plan implementation, conducted disease education, telephone consultations, follow-ups, and evaluations. The control group comprised 97 lymphoma patients. The patients in the control group had similar characteristics to those in the experimental group, and received routine care.

Adopting a nurse navigator interventions in lymphoma care increased patient follow-up appointment compliance rates at 3 months (p =0.007). The model also effectively reduced the patients' 14-day readmission rate (p =0.05). Furthermore, these improvements were statistically significant. The results also indicated that the survival rate for patients receiving care from lymphoma. A nurse navigator interventions was superior to that of the control group receiving traditional care.

Adopting a anurse navigator interventions in lymphoma care effectively enhanced clinical treatment adherence, increased survival rates, and reduced the 14-day readmission rate. This study provides evidence that standardized nurse navigator programs can improve patient outcomes in cancer care. Traditional health messaging such as translated fact sheets or posters may be inaccessible to some immigrants for cultural, language or literacy reasons. Partnering with existing adult immigrant language and literacy organisations may be a feasible means to improve both cancer literacy and language skills. This study used the RE-AIM translational research framework to identify factors that may facilitate or hinder the development and uptake of a cancer literacy English-as-a-Second-Language (ESL) curriculum specific to the Australian context. Methods Using a participatory action research approach, focus groups and interviews (N = 22) were held with ESL teachers of new immigrants attending government-sponsored language programs in South Australia.

Through the lens of RE-AIM, two broad theme categories were identified that highlighted barriers and facilitating factors to Reach to immigrants; Adoption by teachers. A third theme category addressed factors associated with Implementation into existing language programs and Maintenance over time. Findings indicated that an Efficacious cancer literacy curriculum resource could be facilitated by developing flexible and culturally-sensitive content. In addition, the proposed curriculum should be developed according to national curricula frameworks; include different language levels, and incorporate varied communicative activities and media.

This study offered insight into barriers and facilitating factors to guide the development of an ESL resource feasible for inclusion into current government-sponsored ESL immigrant language programs in Australia. The rotations at MDACC are focused on our hospitalist service and subspecialty internal medicine services. In addition, didactic sessions include morning report and lectures that focus on cancer-related internal medicine.

Since the program's inception the number of applicants have far exceeded the number of slots available.

The interest in the program has been very robust. We plan to track the career paths of our graduates and through surveys gain feedback from our trainees to further enhance our program.

Managing uncontrolled symptoms related to advanced lung cancer is common for the nurse working in the hospice and palliative care settings. It is uncommon for the undergraduate nursing student to have hands-on experience since clinical opportunities are limited in this specialty. They report their lack of experience, confidence, and comfort in dealing with complex patient issues. The goal of this study was to mediate a resolution of a difficult and complex patient situation in a controlled, safe, and interactive learning environment. Methods Using a quasi-experimental one-group designed study, two cohorts of undergraduate nursing students (n=112) from an accelerated BSN program participated in a structured and scripted high fidelity simulation. The simulation consisted of a distraught spouse and a breathless manikin presenting with severe dyspnea, extreme anxiety, and moderate pain. Students were instructed in the pre-brief to assess and intervene with the spouse with teaching him about medication use and witnessing the administration of medications. During the debriefing, students completed three instruments (SSSL, SDS, EDQ) found to be reliable and valid for simulation.

Descriptive analysis found that students responses were overwhelmingly positive for the simulation resembled a real life situation, designed specifically for their level of knowledge and skills, felt self-confident in learning.

The study accomplished our goal of teaching students how to resolve a common palliative care situation. The high levels of confidence, comfort, communication, and satisfaction toward managing a trio of uncontrolled symptoms validated our premise of using high fidelity simulation. 

Introduction: the effect of disturbing in sleeps and rest for cancer patients is vital and impact on Quality of Life and on symptoms severity. Inpatients report serious sleep problems during hospitalization. In 2017, a national program, called "SueñON" was implemented to help rest during hospitalization. Objective: to describe effectiveness after implementation of multimodal program with professionals, patients & families to increase rest environment and sleep.

Methods: observational study conducting a multimodal intervention; 1st phase determining sleep problems on patients and professionals determined barriers interfering resting. 2nd phase patients and families answered to a semi-structured interview to evaluate quality of sleep, hours, medication taken and distribution of activity and rest during day and the specific factors causing lack of sleep. Final phase some changes were consensus to do in the units.

Results: sample N=113, (63 patients & 47 family members), probabilistic selection from the Oncology, Haematological and Palliative units. In our series, patients have sleep disorders, higher incidence of insomnia in women than men 68.32% / 52.20% (p =0.036). Reason for deterioration in sleep was anxiety, followed by pain and, much lesser extent other factors; need to use bathroom, pain, dry mouth or taking prescribed treatments. Conclusions Conclusion: a multimodal intervention was effective to change to a supportive environment making professionals, patients and family members more sensible about resting and sleep facilitating patterns. In our series of inpatient 2 of 3 have sleep disorders, having higher incidence of insomnia in women than men.

Printed materials are important strategies for supporting educative activities, since they help the individual to assimilate the amount of information transmitted. The objective of this research was to validate of an educative manual for breast cancer patients undergoing radiation therapy. Methods Descriptive methodological research. A minimum agreement rate (AR) of 80% was considered to guarantee the validation. The data were collected from October to December 2017, by means of assessments tools for two different groups of participants: 17 experts in the theme area of the educative manual, and 12 women that received RT previously to treat breast cancer.

Only two items of the assessment tool for the experts, one related to the manual's ability to promote behavioral and attitude changes and the other related to the extent of its use for other health services, obtained agreement rate (AR) < 80%, and were reformulated based on the participants' suggestions and in the literature. All other items were considered appropriate and/or complete appropriate in the three blocks proposed for the experts: objectives -89%, structure and form -93%, and relevance -93%; and good and/or very good in the five blocks of analysis proposed for patients: objectives -100%, organization -100%, writing style -100%, appearance -100%, and motivation -100%.

The appearance and content validation of the educative manual proposed were attended to. The educative manual was considered relevant and pertinent and may contribute to the understanding of the therapeutic process by breast cancer patients during radiation therapy.

In light of the growing need for palliative care in 2010, a part-time, postgraduate, multi-professional Master's program, "Master Online -Palliative Care" started in the Medical Faculty of the University of Freiburg, Germany. This interdisciplinary, practice-oriented and research-based degree qualifies students take on various positions in both inpatient and outpatient palliative care settings, ranging from management to work with patients. One particularly innovative element of this Master's program is its use of blended learning, which allows students to continue their career alongside their studies. Blended learning combines traditional face-to-face classroom methods with e-learning, utilizing the strengths of both methods to communicate knowledge, skills and attitudes.

Qualitative and quantitative evaluation were undertaken to evaluate whether a blended learning approach is appropriate to teach and learn complex issues like palliative care.

The Master's program admitted 123 students and succeeded in bringing together students from various professional backgrounds. Half of the enrolled students were physicians, one third consisted of nurses, 15 students worked in the field of psychosocial and spiritual care and 7 participants came of the vocational fields of research, pharmacy and others. Since 2010, 43 students successfully completed the Master's Program. Data of the qualitative and quantitative evaluation shows a positive response to the blended learning approach and to the courses offered within the program. 

Informed consent in cancer clinical trials represents a major step in strengthening the respect for patient autonomy. However, patient misunderstanding of cancer clinical trial participation is identified as a critical issue. Lack of the communication guideline to drive the consent process may be the reason of limited effects.

The Delphi consensus method was used to identify essential information to support patient decision making regarding participation in cancer clinical trials. Experts directly or indirectly involved in informed consent process were invited to participate, including people with cancer, their family members, clinical research nurses, physicians and other health professionals.

Two rounds of the Delphi surveys would be conducted. The results of each round would be reviewed by the reference group and provide their comments on the analytical decisions. The final results would form the basis of the content for the guideline document. Statements to be included with the guideline document would be written through a peer review process with the research team and advice from the reference group. The draft guideline would be applied from a recently completed trial to pilot the informed consent process using a scenario simulation. Further revision would be needed according to the participants' feedback from a scenario simulation.

The guideline document would guide health professionals to conduct informed consent and support patient understanding of cancer trial participation. Ongoing updates of the guideline document, and further testing of the guideline in clinical practice is recommended.

The reduction of health mortality being a target of SDG 3, statistics show that the rate of maternal mortality death in Subsaharan African countries is still high. Kayum (2012) found out that health MDGs were not achieved in this region because the target population are not reached in a language they master. This research therefore aims at verifying the effectiveness of reaching target populations in their local language while paying attention to their cultural background when communicating on innovations in a multicultural world. Our case study is an experiment on the communication of knowledge on breast cancer in three sub-Saharan countries (Ghana, Tchad and Cameroon health). Methods A questionnaire was submitted to local populations in 5 localities in these countries to determine the cultural barriers hindering the effective communication of knowledge on breast cancer. Sensitization documents on breast cancer were translated into Ewe, Mbaye, Ghomala', Ewondo and Fufulde in Cameroon. In Bandjoun, a health programme using TfD was organised for different target groups. For one of the groups, cultural barriers were taken into consideration whereas in the other groups, they were not. Another questionnaire was disseminated nine months later to verify the level of appropriation of those who attended the campaign.

The group in which cultural barriers was taken into consideration had a higher level of appropriation of knowledge. Conclusions This paper discusses cultural barriers to the effective communication of issues on breast cancer hence contributing in breast cancer prevention and education in the research target localities eP209 NOVEL APPROACH FOR CANCER-RELATED FATIGUE: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL Introduction Paullinia cupana, a medicinal plant, has shown promising results for treatment of chemotherapy-induced fatigue, the most prevalent symptom for survivors.

Phase II randomized double-blind clinical trial comparing a standardized dry purified Paullinia cupana extract (PC-18) -in doses of 7.5 mg and 12.5 mg given orally twice a day -to placebo in women with early breast cancer scheduled to receive their first cycle of adjuvant systemic chemotherapy. Only patients that experienced increase in either BFI, HAD or Chalder fatigue scales following the first cycle of chemotherapy were included. For associations between qualitative variables, Chi-square test was used. Poisson regression was used to test for the relationship between the drug used and the outcome regarding the difference assessed in scores aforementioned. The significance level was 5%. Results PC-18 on 7.5 mg has not been statistically significant with any improvements on assessed scores when compared to placebo ( 

We investigated the differences in muscle strength, balance function, quality of life (QOL), and fatigue between cancer survivors and healthy subjects. Furthermore, we aimed to investigate the relationship between balance function, QOL, and fatigue among cancer survivors and healthy subjects Methods Forty-one cancer survivors and 33 healthy subjects were included. Muscle strength was evaluated via handgrip and knee extensor strength. Balance function was evaluated using the Timed Up and Go (TUG) test, and body sway was tested using a force platform. QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory.

Cancer survivors exhibited significantly decreased muscle strength, higher TUG, lower QOL, and higher fatigue than healthy subjects (P < 0.05). There were no significant differences between the two groups for any parameters of the body sway tests. There was a relationship between body sway test and QOL (P < 0.05) for cancer survivors, but these relationships were weaker than those among healthy subjects. Additionally, there was a relationship between some subscales for fatigue and QOL (P < 0.05) among cancer survivors; these were stronger than those observed among healthy subjects.

Cancer survivors have the same balance function as healthy subjects despite their decrease in muscle strength. Cancer survivors initially tend to have decreased muscle strength, and thereafter worse balance function. The findings from this study will be relevant for the planning of rehabilitation programs for cancer survivors. 

Cancer-related fatigue (CRF) can significantly impact patient and family lives. Guidelines for CRF management are available but not widely used. This research aims to identify contemporary patient and health provider facilitators and barriers to talking about, and managing fatigue that can be used to inform local strategies for implementing a CRF guideline. Methods This health services research used a qualitative exploratory design. Five cancer survivors and 31 nursing, medical and allied health professionals participated in semi-structured interviews and / or focus groups at a major cancer centre. Interviews and focus groups explored different aspects of CRF guideline recommendations. A rapid method of deductive content analysis accelerated this implementation research.

Key health professional barriers to fatigue management included: insufficient knowledge about fatigue and its management, and lack of time, accessible resources and services for fatigue. Consumer barriers included health professional language and attitudes towards fatigue, relative priority of fatigue in health consultations and limited stamina for extended or extra visits. Facilitators to optimal management for health professionals were alignment with existing systems, increased knowledge of CRF guidelines and tools, with improved referral pathways. Consumers emphasised the importance of their health professionals addressing fatigue as part of treatment, discussing a personal plan for preventing or managing fatigue, self-directed monitoring, management outside clinic appointments and use of telehealth consultations.

The findings can inform care delivery systems. Specifically, time pressures for hospital staff coupled with low consumer stamina indicates that fatigue screening, assessment and management should be time effective. 

Cancer-related fatigue guidelines recommend routine fatigue screening. There is currently neither a gold-standard, nor a broadly accepted screening method and the impact of screening on care processes is poorly understood. The aim of this study was to estimate the extent of fatigue in outpatients at a specialist cancer hospital.

Hospital outpatients attending cancer clinics completed a paper-based survey with three fatigue screening items: one 0-10 numeric rating scale for current tiredness and two five-point pictorial scales rating tiredness last week and the impact of fatigue (Fatigue Pictogram). Demographics and documentation of fatigue for the clinic encounter on the day of survey completion and the following week were extracted via medical record audit. If people reported severe fatigue according to Canadian Association of Psychosocial Oncology cancer fatigue guideline definitions, researchers notified a clinical team member and recorded fatigue in the medical record.

Of 1709 outpatients attending all clinics during one week, 529 (31%) completed the survey. Records were audited for 452 (85%) participants who made their surveys identifiable. Severe fatigue was reported for at least one question by 192 people (36%). Tiredness was reported as moderate or severe 'now' by 57% and 'last week' by 55% of participants. Fatigue had a major impact on daily activities for 23% of participants, yet was seldom recorded in clinical notes. Patient characteristics will be presented.

Over half of cancer outpatients may be experiencing moderate to severe fatigue. Clinical recording of fatigue was poor. Increased documentation may assist fatigue management.

Istanbul University -Cerrahpasa Florence Nightingale Nursing Faculty, Medical Nursing, Istanbul, Turkey

Salt warm foot-bath is a traditionally way to relax and relieve fatigue after a long day, in our country. However, there is no knowledge about its effect on fatigue. This experimental study was planned to assess the effect of salt warm foot-bath on chemotherapy-related fatigue.

This research was carried out between November 2017 and May 2018, in Istanbul University Institute of Oncology. 75 chemo-patients who rated fatigue severity on a 0-5 ONS Fatigue Scale equal to or above 3 were randomized into control (n=37) and intervention (n=38) group. All patients received the standard information and a booklet about chemotherapy-related fatigue. Daily 20 minutes' salt warm foot-bath was recommended to the intervention group, for a week. Subjective fatigue perception of patients was assessed at the 1 st and 7 th day of treatment by using Piper Fatigue Scale. Daily fatigue severity was assessed by using 0-5 ONS Fatigue Scale, for a week.

Most of the patients were married (80%), housewives (52%), had a primary school education(61.3%), and had low level of income (36%). The weekly course of fatigue was similar in both groups. However, decrease in the physical, affective, emotional and cognitive fatigue scores after a week was statistically significant for the intervention group, but not for control group.

This study showed that the salt warm foot-bath could be effective in reducing the negative effects of fatigue on physical, affective, emotional and cognitive functions. However, well-designed randomized controlled trials are needed to confirm its effectiveness in management of chemotherapy-related fatigue. 

Physical activity (PA) is a modifiable behavior and has been proposed as an important non-pharmacologic mean to improve fatigue among colorectal cancer (CRC) patients during chemotherapy. Therefore, identifying factors of high PA (HPA) is important to improve PA. This study aimed to explore factors of HPA among Japanese CRC patients in chemotherapy. Methods A cross-sectional, self-report survey was conducted with 113 CRC patients who underwent chemotherapy. Data were collected while they visited an outpatient clinic of a teaching hospital and the National Cancer Center in Japan. The Japanese version of International Physical Activity Questionnaire was used to assess PA. HPA was defined as exceeding 18 MET hours per week (MET). Logistic regression model was applied to assess the relationships between HPA and other factors including individual factors, disease related factors and communication regarding self-care during chemotherapy.

Of 113 CRC patients, 61.1% were low PA (LPA). The mean PA was 23.1MET. Related factors of HPA included younger age (adjusted odds ratio (AOR) = 0.96, 95% confidential interval (CI) = 0.92-0.99), HPA in pre-diagnosis (AOR = 5.06, 95% CI = 1.71-14.96), without depression symptoms (AOR = 5.14, 95% CI = 1.33-19.85), communicating "Necessity of spending a daily life actively via housekeeping or hobby even during treatment" (AOR = 2.92, 95% CI = 1.15-7.40).

The relevant factors would be useful when considering support to promote PA among CRC patients during chemotherapy. Nurses should also attempt to communicate with the patients regarding reasonable measures to have PA in their daily life. 

Fatigue is a common and debilitating symptom during cancer-related radiotherapy. The purpose of this study was to investigate fatigue in patients undergoing radiotherapy for cancer and to investigate factors in relation to fatigue, for example physical activity and quality of life (QoL).

Of 507 available patients, 458 patients (52% women, mean age 65 years, breast (38%), prostate (32%), or other cancer types) answered a questionnaire once, after receiving mean 33 (+/-17) Gy fractioned radiotherapy.

Of the patients, 321 (72%) reported presence of fatigue (median 4, interquartile range 4, rated 0; never to 10; all the time). Factors related to greater likelihood to experience fatigue were <45 years age (p<0.01), living alone (p<0.01), radiotherapy to thorax/mediastinum/lung (p=0.02), accumulated radiotherapy dose of >44 Gy (p<0.01), concomitant chemotherapy (p=0.04), any other disease beside cancer (p<0.01), and ≥ six symptoms, other than fatigue (Memorial Symptom Assessment Scale, p<0.01). Patients experiencing fatigue compared to non-fatigue patients experienced worse QoL (Functional Assessment of Cancer Therapy-General score, p<0.01), were less likely to adhere to physical activity recommendations (39% versus 67%, p<0.01), and more seldom perceived a healthy balance between rest and activity (33% versus 75%, p<0.01).

Three quarters of patients during radiotherapy experienced fatigue and subgroups of patients were more likely to experience fatigue. Patients experiencing fatigue practiced less physical activity and experienced worse QoL than other patients. Cancer care professionals may considering paying attention to the subgroups of patients presenting greater likelihood to experience fatigue, to reduce symptom distress, and improve physical activity level and QoL. 

One of the most common side effects of cancer therapy in pediatric oncology is Cancer-related Fatigue [CrF] . CrF is multidimensional, with the most distressing symptoms affecting quality of life. The purpose of our study was to evaluate the effects of a computer-based exercise program at the beginning versus in the middle of cancer therapy on CrF. Methods Exercise program at the beginning of therapy [bt] had a duration of two month and includes twelve subjects (mixed cancer, age 13.3±2.5 years, 2 females) and started 14.8±9.8 days after beginning of therapy. Exercise program in the middle of therapy [mt] had a duration of three month and includes nine subjects (mixed cancer, age 11.3±2.2 years, 6 females) and started 58.2 ±62.0 days after beginning of therapy. PedsQL Multidimensional Fatigue Scale questionnaire was completed before and after intervention.

Patients in bt show an overall CrF score of 67.94±10.85 pre and 62.71 ±18.96 post intervention (p=0.288), higher scores indicate lower CrF. CrF related to sleep/rest was 57.29±16.30 pre and 53.47±25.18 post intervention (p=0.607). Patients in mt show an overall CrF score of 65.96±17.41 pre and 75.62±18.8 post invention (p=0.127). CrF related to sleep/rest was 59.26±22.22 pre and 75.93±21.11 post intervention (p=0.022).

Exercise intervention in the middle of cancer therapy seems to be more effective on CrF than at the beginning of therapy. Results underline the importance of physical activity for quality of survival in pediatric oncology. Introduction A large number of women with breast cancer suffer from fatigue, and social support is described as having a positive effect on health in stressful life situations. The aim of this study is to assess social support in a sample of breast cancer outpatients with fatigue during treatment. In addition to explore the association between cancer related fatigue and social support and, further, between social support and demographic and treatment characteristics. Methods Breast cancer outpatients with fatigue (n=160) were recruited from a Norwegian hospital. The research instruments included Social Provisions Scale (SPS), which measures «attachment», «social integration», «reassurance of worth», and «nurturance», and Fatigue Questionnaire (FQ), which measures total, physical and mental fatigue. Data were analysed using descriptive statistics, and linear regression analysis.

Median total score for SPS was 59 (min/max = 39/64). A significant association were found between mental fatigue and the provisions «reassurance of worth» and «nurturance». In addition, association were found between social support and living with someone.

To a large extent, the breast cancer patients with fatigue in this study experienced social support from their surroundings. The fact that significant associations were found between mental fatigue and two of the provisions of SPS suggest that social support is more related to mental fatigue than physical fatigue. Findings from this study suggest that living with someone is significant for the experience of social support during treatment for breast cancer. Clinicians need to evaluate breast cancer patients with fatigue's social support. Anemia frequently occurs in patients undergoing chemotherapy; fatigue is a common symptom, and substantially impacts QoL. We evaluated the correlation between QoL and fatigue in cancer patients treated with biosimilar epoetin alfa (Sandoz) for CIA. Methods CIROCO was a non-interventional, prospective study conducted in France. Patients had solid tumours or haematological malignancies, ≥2 cycles of chemotherapy after inclusion and received biosimilar epoetin alfa for CIA. Data were collected on day of inclusion (T0) and after 2-3 (follow-up; T1) and 4-6 (end of follow-up; T2) chemotherapy cycles. Fatigue was assessed using a visual analogue scale (VAS, range 0-10), and QoL with the EORTC QLQ-C30 questionnaire. Results 854 patients were included in the Full Analysis Set: solid tumors, n=678; hematological malignancies, n=176. Mean (SD) hemoglobin was 9.6 (±0.8) g/dL at baseline, 10.9 (±1.5) g/dL at T1 and 11.3 (±1.5) g/dL at T2. From T0-T2, mean (SD) change in patient-reported and physicianreported fatigue VAS score was -4.4% (±85.9%) and -6.8% (±81.9%), respectively, and mean (SD) improvement in patient-reported QoL was 31.3% (±88.7%). The Pearson correlation coefficient for fatigue and QoL was: T0 -0.39 (p=0.0152), T1 -0.54 (p<0.0001), T2 -0.64 (p<0.0001). In the safety population (n=921), 33.9% had ≥1 adverse event (AE), 16.5% ≥1 serious AE and 2.5% ≥1 treatment-related AE.

Metastatic breast cancer patients may experience daytime fatigue, sleep disturbance, and altered sleep-wake cycles. Identification and treatment of underlying sleep disorders may alleviate symptom burden. Methods All metastatic breast cancer patients who underwent formal sleep consultation at MD Anderson Cancer Center between 4/1/2009 and 6/30/2014 were identified. Cancer characteristics, sleep-related history, laboratory and polysomnographic data, were collected.

Patient characteristics are listed in Table 1 . The most common sleep symptoms included snoring (85%), daytime fatigue (72%), daytime sleepiness (71%), sleep onset insomnia (43%) and sleep-maintenance insomnia (21%). Many used sleep aides (35%) and pain medications (38%). Pittsburgh Sleep Quality Index revealed poor sleep in 83%, and Epworth Sleepiness Scale confirmed daytime sleepiness in 59%. Sleep disorders are described in Figure 1 , and polysomnography was performed in 71%. Obstructive sleep apnea was diagnosed in 42 patients of which severity was mild (45%), moderate (21%) and severe (33%). Positive airway pressure therapy was prescribed in 76% (40) patients with 65% compliant with therapy. Other sleep disorders included insomnia (36%) and inadequate sleep hygiene (40%). Most patients (67%) followed up in one year.

Patients with metastatic breast cancer may have significant sleep complaints. Sleep surveys can help screen for underlying sleep disorders, and signs and symptoms of sleep-disordered breathing should prompt referral for formal sleep evaluation. Diagnosis and treatment of underlying sleep disorders such as obstructive sleep apnea, insomnia and suboptimal sleep hygiene, may alleviate symptom burden and improve fatigue. Fatigue, or tiredness, is one of the most commonly reported symptoms in breast cancer patients treated with radiotherapy (RT). This study aimed to identify characteristics associated with fatigue in breast cancer patients receiving adjuvant RT.

Patients with non-metastatic breast cancer receiving RT at the Odette Cancer Centre from 2011-2017 were included in our study if they completed at least one ESAS pre-and post-RT. Existing databases were queried for information regarding patient, disease, and treatment characteristics, supplemented by data from chart review. To identify variables associated with fatigue scores pre-RT, post-RT and changes in fatigue scores, a univariate and multivariable general linear regression analysis was conducted; p<0.05 was considered statistically significant.

Our study included 1223 female patients (mean age 59 years old) who completed ESAS on average 28 days before, and 142 days after RT. In multivariable analysis, higher baseline fatigue scores were found in women with higher disease stages (p=0.001), and those to receive locoregional radiation (p<0.001). No variables were significantly associated with post-RT fatigue scores. While adjuvant chemotherapy and locoregional RT were associated with higher baseline scores in univariable analysis, in multivariable analysis, they were associated with significant reduction in fatigue post-RT (p=0.011, p=0.007 respectively).

Fatigue is associated with higher disease stage and receipt of locoregional radiation. While the relationship between anxiety or depressive symptoms and fatigue is well-established, a major gap exists in our understanding of its etiology and treatment; further investigation to address this can better improve patient quality of life.

The aim of this three-arm randomised controlled study was to examine the effects of mindfulness-based stress reduction (MBSR) and progressive muscle relaxation (PMR) on fatigue, coping with and quality of life in breast cancer patients receiving adjuvant paclitaxel regimen.

The study sample was randomly assigned to either a MBSR (n=20), (PMR) (n=19) or control group (CG) (n=15). Participants were instructed on MBSR and PMR. The steps of interventions were recorded a voice recorder, and participants were asked to listen the audio files during exercises. The intervention groups continued MBSR or PMR 20 min. each day, totally 12 weeks at their home. The CG received only an attention placebo. Data were collected by Brief Fatigue Inventory (BFI), Brief COPE, and Functional Living Index-Cancer (FLIC). Fatigue, cope with, and QOL scores were measured at baseline, week 12, and week 14 for follow-up assessment. Results BFI scores were significantly decreased in the MBSR, PMR groups compared with the CG at week 12 and at week 14 (p<.05). The sub-dimension scores of Brief COPE including denial, behavioral disengagement, acceptance, humor, using emotional support, using instrumental support, substance use, planning, and positive reframing were significantly higher in the MBSR, and PMR groups than the CG at week 12 and at week 14 (p<0.05). Regarding FLIC scores, there were no significant differences between the groups at week 12 and at week 14 (p>0.05). Conclusions MBSR and PMR are effective supportive interventions that can be used to manage fatigue and coping with in breast cancer patients. 

Prevalence of weight loss and depression and/or anxiety among lung cancer (LC) patients is high. Aim of this study was to examine malnutrition risk and presence of psychiatric disorders among geriatric LC patients as well as its influence on overall survival (OS).

This study was conducted at the Institute for Pulmonary Diseases of Vojvodina, Serbia. Assessment of malnutrition risk was done by the Malnutrition Universal Screening Tool (MUST) and for assessment of psychiatric disorders Hospital Anxiety Depression Scale (HADS) was used. Survival follow-up was 5 years.

Out of total 119 observed patients with diagnosed LC 39 (32.8%) were aged over 65 and included in further analysis. Majority of this patients were male (71.8%) in ECOG PS 1 (79.5%). We observed psychiatric disorders in 43.6% of patients and 23.1% of patients had combined anxiety with depression. Malnutrition risk was observed in 41.0% of patients, out of those high risks in 30.8%. Combined psychiatric disorder and malnutrition risk was observed in 25.6% of patients. Median OS was 17.8 months. Significantly lower OS was observed in patients with combined malnutrition risk and psychiatric disorders (p=0.010). One-year survival was 64.1% (25/39), 3-years 15.4% and 5-years 2.6%.

Using easy-to-use questionnaires should be of great importance in everyday practice with the aim of early recognition of psychiatric disorders and prevention of cachexia. Considering decreased physiological reserve and other health conditions in the elderly special attention and personalized treatment approach should be made for each of those patients in order to improve their QoL. 

The number of older adults diagnosed with cancer is expected to increase by 67% between 2010 and 2030. However, little is known about age differences in the use of coping strategies to deal with the effects of cancer and its treatment. The purpose of this study was to evaluate for differences in the use of coping strategies between younger (<65 years) and older (>65 years) during cancer chemotherapy. Methods Patients were dichotomized into younger (n=933) and older (n=352) age groups. Patients completed a demographic questionnaire and medical records were reviewed for disease and treatment information. Coping strategies were assessed using the 28 item Brief Cope Inventory (Carver, 1997) and scored into fourteen subscales. Between group differences were assessed using Independent sample t-tests and Chi Square analyses.

Compared to younger patients, older patients were more likely to be male and living alone, and have a lower annual income, a higher level of comorbidity, and a poorer functional status. No age differences were found the following coping strategies: acceptance, denial, substance use, and behavioral disengagement. Older individuals were less likely to use the following coping strategies: active coping, planning, positive coping, humor, religion, emotional support, instrumental support, distraction, venting, and self-blame.

Clinicians can use these findings to enhance positive coping strategies in older oncology patients receiving chemotherapy.

We examined PROs (Edmonton Symptom Assessment System (ESAS) and psychosocial needs) to determine differences in young versus older patients' (OPs') symptom severity. Methods A population-based cohort in Alberta, Canada that completed PROs within +/-60 days of diagnosis. Patients were divided into young (age <70) versus older (age >/=70) groups. Logistic and linear regression evaluated predictors of symptom severity.

There were 1310 patients: 30.5 % were older and 53.8% were males. OPs were more likely to have metastatic disease (49.4% versus 42.6%) and more comorbidities. Mean ESAS physical and psychological sub-scores were similar between ages. Compared to young patients, OPs had different psychosocial needs and symptom profiles including worse fatigue (p<0.001) and breathlessness (p=0.001), but better nausea (p=0.03) and wellbeing (p=0.05). Almost 90% of OPs reported some fatigue, and >50% reported some breathlessness, appetite changes, anxiety, and wellbeing changes. Generally, OPs reported fewer psychosocial needs, except walking/mobility and nutritional problems. Predictors of moderate to severe fatigue among OPs included hematological cancer (OR 7.7) or anxiety (OR 1.2), while breast cancer (OR 0.2) or early stage disease (OR 0.2) were protective (all p<0.05). Predictors of high ESAS physical subscore in OPs included advanced stage (β=0.3), whereas breast (β= -0.2), colorectal (β= -0.2), or prostate (β= -0.3) cancers were protective (all p<0.01). Predictors of high ESAS psychological sub-score in OPs included colorectal (β= 0.2) or lung (β= 0.2) cancers (all p<0.05).

OPs experience different symptom profiles and psychosocial needs than young patients, underscoring the value of age-specific symptom interventions. 

A U N I V E R S I T Y O F R O C H E S T E R N C I C O M M U N I T Y O N C O L O G Y R E S E A R C H P R O G R A M G E R I AT R I CASSESSMENT

Aging related deficits eventually manifests as frailty, which may identify older patients with advanced cancer who are at risk of deteriorating emotional health. Methods Secondary analysis of baseline data from a nationwide cluster randomized trial. Patients aged ≥70 years with stage III/IV solid tumor or lymphoma and ≥1 Geriatric Assessment (GA) domain impairment (e.g., function, cognition) were enrolled. Frailty was assessed using the deficit accumulation frailty index (DAFI; range 0-1) based on GA after excluding the psychological domain. Patients were stratified based on DAFI into robust (0-<0.2), pre-frail (0.2-<0.35), and frail (≥0.35) categories. Patients completed the Generalized Anxiety Disorder-7 (range 0-21), Distress Thermometer (range 0-10), and Geriatric Depression Scale (range 0-15). Multivariate linear regression models examined the association of frailty with psychological outcomes, controlling for relevant patient covariates. Beta(β) coefficients are reported. Results 541 patients (mean age: 77 years; 70-96) were included. DAFI ranged from 0.04 to 0.94, with 27% patients classified as robust, 42% pre-frail, and 31% frail. Patients had mean depression score: 3.09 (SD 2.74), anxiety score: 2.88 (SD 4.01), and emotional distress score: 2.90 (SD 2.71). Compared to robust patients, frail patients had increased scores for depression (β=3.35), anxiety (β=2.71), and emotional distress(β=2.16); all p<0.01; while prefrail compared to robust patients reported higher scores for depression (β=1.10) and emotional distress (β=0.83) (both p<0.01), but not anxiety.

Our results demonstrate that in older patients with advanced cancer, frailty is associated with poorer emotional health. Interventions aimed at improving frailty might also improve emotional health.

Older patients with cancer are underrepresented in clinical exercisebased trials. To engage older patients in physical activity (PA), it may be necessary to consider age-related decline in health, comorbidities and practicalities. The aim of the study was to explore attitudes towards PA and exercise among older patients with cancer to inform future exercise-based interventions.

Individual interviews (N = 23) were conducted in patients ≥ 65 years with advanced lung, biliary tract and pancreatic cancer who were treated with oncological systemic treatment. Patients were recruited with a purposive sampling strategy. A semi-structured interview guide focusing on attitudes towards PA and exercise, including perceived barriers, facilitators and motivators, was used.

Identified themes were: 1) a general positive perception of PA 2) comorbidities and external circumstances prevent PA, 3) fatigue overshadows life, 4) social support is key to short and long-term motivation, 5) fixed conditions keep one focused, 6) familiarity raises confidence and motivation.

Even though perceptions of PA were positive among older patients with cancer, most struggled to stay physically active. Several factors related to cancer and aging were identified as barriers towards PA, most profoundly was the overwhelming feeling of fatigue. Improving physical and mental well-being, fixed conditions (e.g. group-based exercise and supervision) and social support were identified as motivators and facilitators for PA. Preferences for PA varied, but activities that were familiar increased motivation. Health care professionals should aim to develop holistic and multi-supportive exercise programs adjusted to each patient's limitations, needs and personal resources. 

Quality-adjusted life years (QALY) are usually estimated using the quality of life (QOL) scale. However, a long-term collection of questionnaire and complex utility analysis become a burden on both patients and researchers. The aim of this study is to explore whether performance status (PS) could be a substitute for QOL scale in cost-effectiveness analysis.

We prospectively recruited patients aged ≥70 years with newlydiagnosed advanced non-small-cell lung cancer scheduled to initiate chemotherapy (Trial registration number, UMIN000012845). All patients provided written informed consent. EuroQol 5 Dimension questionnaire and ECOG-PS, graded from 0 to 5, was obtained every 12 weeks. The utility value for PS was calculated as 0.2×(5-PS). The mean cumulative medical costs (¥, Japanese yen) for QALY and performance-adjusted life years (PALY) were calculated and compared. Results A total of 29 patients were enrolled. Median age was 74 (70-83) years. Median follow-up period was 15.1 months. Treatment included cytotoxic chemotherapy (52%), targeted therapy (24%), and others. PALY was highly correlated with QALY (Spearman rho=0.9847, p<0.0001, R 2 =0.9742). Mean cumulative costs for QALY or PALY were ¥3.6 or ¥3.3 million/person at the first year, and ¥8.4 or ¥8.4 million/person at the second year. The difference between QALY-and PALY-related costs widened after the third year.

In elderly patients with advanced non-small-cell lung cancer, PALY could be used as a substitute for QALYuntil the second year after the diagnosis. This easy-to-use methodology for cost-effectiveness analysis may help socioeconomic research in the geriatric oncology. 

National organizations advocate older adult enrollment in clinical trials and PRO inclusion, with the goal of improving quality of life for this growing, understudied population. Despite these recommendations, concerns persist regarding the ability of older adults with advanced cancer to complete PRO. The aim was to determine the percentage of older patients needing assistance in completing PRO, and identify associated factors.

This was a secondary analysis of a cluster randomized trial (URCC 13070; PI: Mohile) of patients aged 70+ with advanced solid tumors or lymphoma and at least one impaired geriatric domain. The dependent variable was whether the participant required assistance with PRO completion (Yes/No). Demographic, clinical, and geriatric assessment (GA) domain impairments were examined for association with needing PRO assistance using logistic regression.

From 2014-2017, 541 individuals with advanced cancer were enrolled from 31 practices (mean age 77 years, range70-96, 49% female, 48% high school or less). At baseline, 72% completed PROs independently and 28% needed assistance; most received help from a caregiver (44%) or research assistant (37%). Help included reading the questions (69%) and writing responses (48%). Variables associated with needing assistance were increasing age (p=.017) and less education (p<.001). GA domain impairments significantly associated with needing assistance included cognition, polypharmacy, comorbidity, function, psychological status, and vision and hearing difficulties (all p's<.05). At 4-6 weeks, 52% needing assistance at baseline continued to require assistance.

While the majority of older adults with advanced cancer were able to independently complete PROs, assistance was required for almost 30% of patients. 

We report an uncommon case of a rapidly growing gargantuan squamous cell carcinoma of the right upper eyelid and its management in an elderly hospice patient.

An 84-years-old nonsmoker cognitively-impaired female, with poor functional status (ECOG 3), on hospice care, developed a rapidly growing, foul smelling, painful mass arising from the lateral right upper eyelid within the course of three months. It measured 9 centimeters by 8 centimeters in greatest dimensions, and it interfered with her quality of life, as it was causing complete ptosis impairing her daily activities. Cemiplimab, an anti-PD-1 agent, was initially recommended prior to surgery, but the risk of potential development of an immune-related adverse event in this frail elderly woman outweighed the potential benefits. After addressing goals of care with her family, the decision was made to proceed with radical wide excision of the tumor with repair with a cervicofacial flap. Excisional biopsy showed moderately differentiated squamous cell carcinoma invasive to subcutis without any lymphovascular invasion. The patient was discharged to home hospice three days later in stable conditions and asymptomatic.

Squamous cell carcinoma in the eyelid occurs much less common than basal cell carcinoma, but are more aggressive and invasive, and can metastasize and invade the orbital and intracranial structures. Addressing goals of care is of utmost importance when formulating a plan of care especially in elderly frail patients. 

Approval of multi-targeted tyrosine kinase inhibitors (TKIs),), sorafenib, sunitinib, and pazopanib significantly improved outcomes for patients with metastatic renal cell cancer(mRCC). Several studies demonstrated increased cardiotoxicity in patients treated with TKIs. We studied the cardiovascular complications of TKI therapy in elderly mRCC patients. Methods This is a retrospective analysis of prospectively collected data of elderly patients( age 65 and above) with mRCC started on TKI from 2013-2017 referred for cardiac monitoring. We examined the incidence of cardiovascular adverse events through December 2017 including cardiomyopathy, acute myocardial infarction (AMI), hypertension and arrhythmias Results Out of 138 patients who were referred for monitoring of TKI induced cardiotoxicity 27 were elderly. The median age was 68 years and males were predominant( 92.6%). Among pre existing risk factors 22.2% had diabetes,59.3% hypertension(HT) and 14.8% had ischemic heart disease. The median follow up by echocardiography was 13 months ( range 1-50 months) .3(11.1%) were treated with only sunitinib, 8(29.6%) with sorafenib, 11 (40.7%) with pazopanib, and 5(18.5%) were treated with a combination . 6(22.2%) patients developed new onset HT, 2 (7.4%) patients developed dilated cardiomyopathy, one patient had supraventricular arrhythmias and one patient sustained myocardial infarction.

Alarge proportion of elderly patients with metastatic RCC have preexisting co morbidities and many develop new onset HT. Close monitoring for cardiovascular toxicity is very important in elderly patients of mRCC receiving TKIs. A dedicated cardio oncology clinic at cancer centres will help in integrating care and improving outcomes in high risk population.

Elderly oncology patients who are receiving chemotherapy may have increased risk of drug-related problems (DRPs) due to polypharmacy from cancer and non-cancer drugs. To identify and manage patient's DRPs, we provide Medication Therapy Management (MTM) service in National Cancer Centre Singapore (NCCS). This study aims to re-examine the pharmaceutical needs of these patients and explore new model of care provision.

We performed a retrospective chart review of DRPs incidences detected over a year. Semi-structured interviews were conducted with patients receiving treatment in NCCS and have 3 or more chronic medications. Interviews were audio-recorded with consent and transcribed verbatim. Thematic analysis, in the context of grounded theory, was done using Quirkos (version 1.5.2) to analyse patient responses. Results A total of 383 charts were reviewed. Common DRPs detected included indication without drug, adverse drug reaction, nonadherence and potential drug interaction. Fifteen in-depth interviews were conducted. Patients' main concerns were side effects of chemotherapy and pre-existing medications, confusing administration schedule and pill burden. Informational needs regarding similar topics were often met but the demeanor of the pharmacist was crucial in building pharmacist-patient relationship. Face-to-face communication was preferred, but some were open to telepharmacy. The majority of them were satisfied with the current mode and standard of service delivered, citing convenience over privacy as an important factor.

The type of DRPs commonly encountered generally coincides with patient's concern. Pharmacists remain a valuable resource to help address and manage these problems. Determining patient's archetype may help to improve MTM service to meet patient's expectations.

E. Soto-Perez-de-Celis 1 , C. Gomez-Moreno 1 , A. Perez-de-Acha 1 , J.C. Aguilar-Velazco 1 , M.L. Moreno-Garcia 1 , C. Perez-de-Celis-Herrero 2 , E. Lira 2 , Y. Chavarri-Guerra 3 1 Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Department of Geriatrics, Mexico City, Mexico

Conducting a GA is recommended for all older adults with cancer, but this might be difficult in low-and-middle income countries (LMIC) with limited resources. We evaluated the feasibility and reliability of a fully self-administered GA obtained using an electronic tablet among Mexican older adults with cancer. Methods Spanish-speaking patients aged ≥65 with a cancer diagnosis were included. The GA included validated tools measuring various geriatric domains, chemotherapy toxicity risk, and life expectancy (Table 1) . Patients were randomly assigned into three arms: a) tablet GA twice; b) paper-andpencil GA twice; and c) tablet GA followed by paper-and-pencil GA. We evaluated the feasibility and reliability of both methods and compared them among each other.

Results 150 patients (median age 73, range 65-91, 41% female) answered the GA at least once. 38% had ≤elementary school education, and 52% had gastrointestinal tumors. Median time to answer was 18.3 minutes (range 3.5-67.1), with no differences between tablet and paper-and-pencil (18 vs 19 minutes, p = 0.39). 68% completed the GA without help (77% tablet vs 59% paper-and-pencil, p<0.01). 76% thought the GA's length was appropriate, and 65% considered it easy to complete. The test-retest reliability for the entire assessment and for each of the included scales was high for both methods (Table 2) .

A self-administered digital GA was feasible and reliable among older adults with cancer living in a LMIC. This methodology could improve the care of older patients with cancer in the developing world through the prompt and reliable identification of deficits and supportive care needs.

E. Plotkin 1 , L. Lucas 1 , E. Dotan 2 , G. Nightingale 3 , K.P. Loh 4 , P.S. Burhenn 5 , P. Allen 6 , R. Oyer 7 , M. Karuturi 8 , S. Lichtman 9 1 Association of Community Cancer Centers, Provider Education, Rockville, USA

Addressing the needs of older adults with cancer is critical for the delivery of high-quality, patient-centered care. The Association of Community Cancer Centers (ACCC) has identified barriers and best practices for serving this growing patient population in order to help support the multidisciplinary team in understanding and performing this type of care.

A online survey was administered to 332 cancer professionals of differing size and region. Three multidisciplinary, in-depth focus groups were conducted. Results 95% of survey respondents agreed that their older adult patients would benefit from a comprehensive geriatric assessment (CGA), yet only 17% are performing CGAs. Top barriers to this were time/personnel and familiarity with validated tools. Techniques for evaluating fitness, cognitive status, psychological status, comorbidities, and toxicity risk were often informal. To evaluate psychological status or depression 55% use the NCCN distress thermometer, 36% the patient interview, and 34% ask the patient directly if they're depressed. >25% of respondents don't evaluate cognitive status at all, and 54% (top answer) ask simple questions to assess orientation. When abnormalities from CGA were identified, 83% noted referral to supportive services as the most common step, followed by discussing the results with patient/family and coordinating with appropriate specialties. Challenges with palliative care referrals were prevalent, with 68% reporting that patients don't understand the benefit, 55% saying it's occurring late in the treatment experience, and 40% claiming physicians don't understand the benefit. Conclusions ACCC has compiled resources to address deficits in care, particularly in the community or lower-resourced settings at accc-cancer.org/geriatric.

Abiraterone is an effective agent used in the management of metastatic castration-resistant prostate cancer, significantly improving overall and progression free survival. Due to the pharmacodynamic and pharmacokinetic properties of abiraterone, concurrent use with anticoagulation may pose a challenge for clinicians. Thrombosis within the cancer setting continues to increase patient mortality therefore appropriate anticoagulation management can reduce adverse events and increase quality of life. Clinician guidance is needed on the safe and effective use of anticoagulants with abiraterone and prednisone. Methods A systematic review of the literature was preformed to identify relevant randomized controlled trials, meta-analyses and retrospective studies. Studies including oncology patients and an active intervention were considered relevant. Major society guidelines were reviewed to further aid in developing algorithms for the use of anticoagulants with abiraterone.

Our review identified abiraterone can pose a challenge for patients receiving concurrent anticoagulation due to PK and PD interference. We describe the potential interactions between abiraterone and various anticoagulants, and provide management strategies based on the most recent literature for atrial fibrillation, venous thromboembolism and mechanical heart valves (Figures 1.0-3.0).

Abiraterone therapy has become a mainstay of the management of advanced prostate cancer, and is often used over prolonged years. In this review we summarize a framework of how to use abiraterone in men with prostate cancer on anticoagulants. Evidence available to date suggests that patients with an indication for anticoagulation such as atrial fibrillation, VTE and mechanical heart-valves can be treated safely with abiraterone with appropriate monitoring. 

Thromboembolic disease is a frequent complication in cancer patients. However, the real incidence in patients with sarcoma is unknown. The aim of this study is to analyze the incidence of cancer-associated thrombosis in a cohort of ambulatory patients with sarcomas.

We performed a retrospective review of patients with sarcoma attended in the Medical Oncology Department of 6 hospitals from the network of Cancer & Thrombosis Working Group of the Spanish Society of Medical Oncology (SEOM). Between January 2012 and December 2016, two hundred and nineteen patients were identified and included in the analysis.

Patients characteristics (Table 1) . Median follow-up was 36 months (range 0-338). Thirty-five patients (16%) experienced thromboembolic disease (20 lower extremity deep-vein thrombosis (DVT), 2 upper extremity DVT, 3 catheter-associated thrombosis, 7 pulmonary embolism, 1 visceral vein thrombosis, 2 other locations). One patient experienced arterial thromboembolism. According to histology, the incidence was 11.8% in GIST patients, 15% in osteosarcomas, 5% in Ewing sarcomas or PNET and 18.4% in soft tissue sarcomas. None of the patients diagnosed of chondrosarcoma suffered VTE. 45.5% of patients were deemed to have incidental thromboembolisms. 40% of the events occurred at the time of diagnosis or within the first 6 months. Khorana's predictive model ( Table 2 ). More than 50% of patient with VTE were considered low-risk based on Khorana score. 

In the present study, the incidence of VTE in patients with sarcomas has been higher than expected. It would be desirable to increase the sample size and confirm this figure.

Thrombosis is the 2 nd cause of death in cancer patients. CAT is common, could delay anti-cancer therapy and increase costs. Oncologists should be aware of CAT and its clinical significance. Methods Prospective observational study conducted by HeSMO to record CAT clinical management. Patients with active cancer received antithrombotic agents for treatment or thromboprophylaxis were enrolled. 

We are reporting on a patient with a fatal case of cancer-associated thrombotic microangiopathy (CA-TMA).

A 65-year-old female with metastatic esophageal adenocarcinoma to lymph nodes and liver, status post several lines of therapy, began noticing scleral icterus two weeks after a second dose of an icos agonist with a PD-1 inhibitor. Three days later she became hypotensive and hypoxemic, requiring admission to the hospital where initial exam confirmed jaundice and hepatomegaly, and labs showed normocytic anemia (hemoglobin 5.8), thrombocytopenia (platelets 39), elevated LDH (> 7000), indirect hyperbilirubinemia. Blood smear showed anisopoikilocytosis, many spherocytes and schistocytes, teardrop forms, nucleated RBCs, burr cells, bands, metamyelocytes; no blasts and no hypo or hypersegmented neutrophils were seen. These findings were consistent with TMA. The patient was unresponsive to treatment including 4 transfused units of blood, corticosteroids (methylprednisolone 1 mg/kg IV every 12 hours) and best supportive care. Her hemolytic process was relentless, and she developed severe hypoxemic respiratory failure, unresponsive to mechanical ventilation, succumbing five days after admission. Conclusions TMA is a disorder characterized by microvascular occlusion due to platel e t a g g r e g a t i o n , t h r o m b o c y t o p e n i a a n d o rg a n d a m a g e . Thrombocytopenia, schistocytosis, and elevated levels of LDH are enough to form a diagnosis in clinical practice. The majority of cases are idiopathic, but several etiologies have been recognized, including cytotoxic chemotherapies. TMA may also be caused by the underlying malignancy itself. Clinicians should be aware of TMA due to its potentially lethal progression.

The SELECT-D trial demonstrated greater efficacy but increased bleeding with rivaroxaban compared to dalteparin for the treatment of venous thromboembolism (VTE) in cancer patients, at 6 months. Uncertainty remains around the optimal duration of anticoagulation in this population.

In Phase 2 of SELECT-D, after 6 months of trial treatment for VTE, patients with active cancer who had residual DVT (RDVT) or index pulmonary embolism (PE) were eligible for randomisation to a further 6 months of rivaroxaban or placebo. Patients with no RDVT stopped anticoagulation. The primary outcome was VTE recurrence at 12 months. Results 406 patients were randomised into SELECT-D. The second randomisation closed due to futility to recruit after 92 patients had entered. Those patients tended to have a better performance and cancer status. VTE recurrence after 6 months from second randomisation was 14% (95% confidence interval [CI] 7-29%) with placeboand 4% (95% CI 1-16%) with (HR=0.32; 95% CI 0.06-1.58). The corresponding major and clinically-relevant non-major bleeding rates were 0% and 0% with placebo; and 5% (95% CI 1-18%) and 4% (95% CI 1-17%) with rivaroxaban, respectively. None of the patients with no RDVT at 6 months had a recurrent VTE. For all trial patients, disease stage, ECOG performance status and site of primary tumour (all p<0.0001) were significant predictors of overall survival within 12 months.

Clinicians, alongside patients, should consider 12 months of anticoagulation for people with active cancer and VTE, on an individual basis. 

Radiation-induced oral mucositis occurs frequently in patients with nasopharyngeal carcinoma during radiotherapy. The effect of rapamycin on radiation-induced oral mucositis were evaluated. Methods 61 patients with NPC were randomly divided into two groups. Pain incidence, radioactive oral mucositis incidence, xerostomia incidence and dysphagia incidence were recorded and compared. We test if rapamycin could decreases serum proinflammatory cytokines (interleukin-6) levels and lead to nasopharyngeal tumors and lymph nodes subsided. In addition, we also evaluate adverse events in two groups.

Tumor stage, age and gender between two groups did not statistical significance (P>0.05). The overall pain degree in testing group was lighter than that in control group (P=0.046). The severe pain incidence in testing group was significantly lower than that in control group (P=0.045). Meanwhile, the radiation dose of moderate pain and severe pain in testing group was higher than that in control group (0.045). The mucositis (grade III and IV) incidence in testing group was significant lower than that in control group (P=0.008). Meanwhile, the radiation dose of mucositis (grade III) in testing group was higher than that in control group. Dysphagia (grade I) incidence in testing group was lower than that in control group (P=0.01). However, we could not retrieve the significant differences in xerostomia incidence ( and related radiation dose), IL-6 difference, T lymphocyte absolute counting, blood platelet, white blood cell, hemoglobin, the regression of nasopharyngeal oncology and enlargement lymph nodes between two groups. Conclusions Rapamycin could decrease oral mucositis (grade III and IV) and severe oral pain incidence during radiotherapy. 

Oral mucositis is a common side effect caused by radiochemotherapy and may adversely affect the quality of life (QoL) of patients. Honey may reduce the grade of mucositis in patients. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate t he p r o p hy l a c t i c a n d t h e r a p e ut i c e ff e c t s o f h on e y o n radiochemotherapy-induced oral mucositis. Methods PubMed, Embase, CINAHL, and Cochrane Library databases were searched for RCTs. The primary outcome includes the grade of mucositis and pain score. Secondary outcomes included the recovery time and QoL. The study was registered with PROSPERO, number CRD42018108486.

Nineteen RCTs including 1276 patients were reviewed. The use of honey for prophylaxis and treatment significantly reduced the severity of mucositis. In prophylaxis phase, the result significantly favored the honey-treated group with regard to preventing the development of intolerable mucositis (RR=0.18, 95% CI=0.09 to 0.41). Patients treated with honey had a significant reduction in pain scores at month 1 (WMD = −3.25, 95% CI −4.41 to −2.09) and at the end of treatment (WMD = −2.32, 95% CI = −4.47 to −0.18).

The use of honey could prevent and result in more effective healing of mucositis in patients who underwent radiochemotherapy. Treatment with honey significantly reduced the grade of mucositis and resulted in a more painless healing process with a shorter recovery duration. Moreover, honey is a relatively cheap and easily available product. Therefore, we recommend the use of honey during and after radiochemotherapy to prevent and treat mucositis. 

Oral mucositis is one of the annoying side effects of chemotherapy in patients undergoing bone marrow transplantation. Up to now, the common methods of oral mucositis therapy have failed to show a significant effect.

In this single blinded randomized clinical trial, 29 patients undergoing stem cell transplantation in Iran were selected by convenience sampling and randomly allocated to control (n=13) and intervention group (n=16). In the intervention group, cryotherapy was applied while control group received the normal saline mouthwash. The severity of mucositis and neutrophils rate investigated in five periods based on the World Health Organization (WHO) scales. Data were analyzed by descriptive and inferential statistics, using the SPSS 13.

In both groups, mucositis reached its peak intensity in 7th day and the least intensity obtained up to 21st day. The neutrophils rate reached the minimum value in 7th day, then increased to 21st day. The two groups showed no significant difference between mucositis severity in 14th and 12th days (p=0.164), while the severity of mucositis in cryotherapy group was significantly less than saline mouthwash (1.81<2.54 and 0.13<0.92, respectively) at 7th and 14th days (p<0.05). There was no significant difference in neutrophils rate between groups.

Cryotherapy is more effective than saline mouthwash in reducing the severity of mucositis. This method is recommended for prevention of mucositis in bone marrow transplantation.

Ozone therapy can be defined as a versatile bio-oxidative therapy with immunostimulant, analgesic and antimicrobial properties.

Patients from 20 to 65 years of age that underwent stem cell transplantation and presenting OM grade 3 or more during the hospitalization were eligible for this study. Oral mucositis grade was scored according the Common Toxicity Criteria Scale of the WHO. Lesions were classified as Grade 0 = none; Grade 1=soreness and erythema; Grade 2=erythema and ulcers without difficulties in swallowing solid food; Grade 3= ulcers requiring only a liquid diet and Grade 4= introduction of parental nutrition. Pain was evaluated at the same timing of OM scoring through the Visual Analogue Scale (VAS) where 0 indicates no pain and 10 indicates severe pain. Patients were treated with ozone therapy (Ozone DTA-Sweden & Martina) for 5 consecutive days, from the onset of OM. Patients were monitored and evaluated 5 and 7 days after the first application of ozone therapy. The same clinician performed OM scoring and pain evaluation on day 1 (before the beginning ozone therapy-T0), on day 5 (after finishing ozone therapy-T1) and on day 7 (T2) as a follow up. Results 8 patients were included in the study; all patients already demonstrated pain improvement from day 5 (T1) after the first application of ozone therapy; the OM grading significantly reduced both at T1 and T2 and erythema significantly improved in size and discomfort.

Mucositis is a debilitating side-effect of chemotherapy administered for cancer treatment. Currently there is no truly effective mucositis treatment and patients often terminate chemotherapy to facilitate repair of the damaged mucosa, Anecdotal evidence suggests that the herbal medicine Orengedokuto reduces the incidence of chemotherapy-induced diarrhoea, highlighting a potential preventative effect. This study aimed to investigate the effect of Orengedokuto in a mouse model of mucositis. Methods Female BALB/c mice (8 weeks) were injected (intraperitoneal; day 0) with saline or 5-Fluorouracil (5-FU). Mice (n=10/group) were gavaged daily with water (160μL) or Orengedokuto (80μl at 0.5mg/kg; or 160μl at 1g/kg). Bodyweight and disease activity index (DAI) were measured daily. Behavioural analyses (facial grimace/burrowing) were conducted on days -1 and 3. Mice were euthanized on day 4 and intestinal samples collected for histological analysis. p<0.05 was considered statistically significant.

Results 5-FU significantly increased DAI (days 3-4), stool-consistency (days 3-4) and real-time facial grimace and reduced burrowing activity (day 3) compared to normal control (p<0.05). Additionally, thymus weight and jejunal-ileal length decreased, while colon weight and crypt depth increased, compared to normal control (p<0.05). Importantly, 1g/kg Orengedokuto improved stool consistency compared to 5-FU treated control (days 3-4; p<0.05) and 0.5g/kg Orengedokuto (day 3; p<0.05). Orengedokuto did not impact other indicators of mucositis.

1g/kg Orengedokuto improved stool consistency in mice with 5-FUinduced mucositis; however other indicators of mucositis severity were not significantly impacted. Future studies should consider higher Orengedokuto doses and modified administration protocols to fully explore its potential to alleviate mucositis symptoms. 

Oral mucositis is a common, painful side effect of chemotherapy. The objective of trial was to evaluate the preventive effect of mucoadhesive hydrogel (MuGard) on the development of oral mucositis in the patients who had oral mucositis during previous chemotherapy.

In conventional multi-institutional, double-blind, randomized, placebo-controlled group, phase III study, we enrolled patients who had a World Health Organization (WHO) grade 2 or higher oral mucositis in previous cycle chemotherapy were randomized to receive either MuGard or saline during chemotherapy. Subjects completed the validated Oral Mucositis Daily Questionnaire. Weight, opiate use, and WHO oral mucositis scores were recorded. Subjects who dosed at least once daily during the first 2 weeks of chemotherapy were included in the efficacy analysis.

Of 49 patients enrolled. 38 patents (control, N = 18; Mugard, N= 20) were eligible for efficacy analysis. Recurrent rate of Mucositis grade ≥ 2 was 2 patients (11.1%) for control versus 5 patients (25.0%) for MuGard (p =0.270). Time to first occurrence of Mucositis grade > 2 was 4 days for control versus 7 days MuGard (p = 0.291). No significant adverse events were reported and the incidence of adverse events was not different between the MuGard group and the control saline group.

Although not statistically significant compared to saline, Mugard appears to have the effect of delaying the occurrence of severely graded ( > 2) Mucositis when used in patients with a previous WHO grade 2 or higher mucositis. 

Basic oral care is the most common recommendation for managing oral mucositis (OM) in autologous hemaotopoietic stem cell transplantation (ASCT) patients. The MASCC guidelines suggest the use of a soft manual toothbrush. In a healthy population, powered toothbrushes have reported benefits in plaque removal and gingivitis reduction. It is unknown whether the use of an powered toothbrush has similar benefits in patients with OM. Objectives To compare a manual and an powered toothbrush (MT and PT) when used by patients undergoing ASCT, regarding the removal of plaque, severity of OM and patients compliance. Methods A RCT with two groups (n=23 MT, n=23 PT) was conducted in ASCT patients. During the hospitalization period, OM, plaque and patient compliance were scored daily.

No differences were seen in OM and plaque scores between both groups (OM p=0.430; 95% CI: [-1.09, 0.46] and plaque p=0.812; 95% CI: [-5.62, 4.40] ). A significant positive correlation between plaque scores and OM was observed (R2=0.154, p=0.010 and 95% CI [0.04, 0.27]). There was no difference in patient compliance between both groups. Patients complied to the protocol to brush their teeth, but did not brush 4 times a day as recommended.

There was no significant differences in the removal of plaque, incidence and severity of OM between the MT and PT and compliance with both techniques was similar. Therefore, it is recommended to update the guidelines managing OM in respect to the brushing technique. 

Oral mucositis (OM) is a common dose-limiting side effect of conditioning therapy for patients with hematologic cancer undergoing hematopoietic stem cell transplant (HSCT). Using exome sequencing in a pilot study, we have previously identified nine genes with SNPs associated with OM in HSCT patients. Our objective was to validate the candidate SNPs using targeted allelic sequencing. Methods Saliva DNA from HSCT patients (n=63), that was previously analyzed by whole genome exome sequencing, was subjected to targeted allelic sequencing for nine candidate genes. Sequencing was performed by llumina HiSeq TruSeq paired-end sequencing of PCR amplicons of the targeted regions. SNPs/INDELS were identified using basic variant detection model within CLC Genomics Server software v9.0.1.

Of the nine genes, LAMC1, had 8 SNP locations which were either all heterozygous or homozygous for 56 out of the 63 patients. The full homozygote variant genotype was overrepresented in patients with OM WHO score 1-4. While targeted allelic sequencing confirmed the genotypes for the 56 patients, of the 16 ambiguous SNP locations for remaining seven patients, 11 were corrected per conserved pattern. Indeed, one patient (WHO score=1), who had 5 ambiguous SNP locations in LAMC1, was confirmed having the full homozygote variant genotype. While SNP correction was related to low DNA concentration, noncorrection was associated with lower DNA quality. Overall accuracy for the 9 genes, including 13 corrections, was 99.3%.

Targeted allelic sequencing is an effective approach for confirming select SNPs prior to engaging into large sample size investigation of SNPs associated with OM in HSCT patients. Introduction Tomotherapy (TOMO) has shown promising dosimetric advantages in treatment of nasopharyngeal carcinoma (NPC), however, radiationinduced oral mucositis (ROM) is common seen during treatment period. This study is aim to evaluate two oral mucosa contouring methods (oral cavity contour, OCC and mucosa surface contour, MSC) in NPC patients receiving TOMO and find a reasonable method for oral mucosa by using TOMO technique. Methods A total of 125 AJCC 7th stage II-IVB NPCs receiving TOMO from our center were included. OCC and MSC were applied to radiation treatment plans. ROM were prospectively assessed weekly. Absolute DVH data was exported from RayStation V3.0 system. T-test, logistic regression and ROC curve were used to analyses.

Morbidity of ≥3 grade acute ROM was 34.4%. A significant relationship between oral mucosa related dosimetric parameters and ≥3 grade ROM were found by using both methods in univariate analysis: V10, V15, V45, V55, V60, V65, V70 of OCC and V55, V60, V65, mean dose of MSC were relevant factors for≥3 grade ROM (Vx, percentage volume of organ received more than x Gy, all P 0.05). In multivariate analyses, gender was found related to ≥3 grade ROM (P=0.037 and 0.027 for OCC and MSC). Only V60 of MSC were independent dosimetric parameter related to ≥3 grade ROM (P =0.006), cut-off value was 4.23%, AUC was 0.637 (P =0.012) with sensitivity and specificity of 0.442 and 0.793.

We recommend MSC as a more reasonable method for oral mucosa in tomotherapy treatment plan for nasopharyngeal carcinoma patients. 

Oral mucositis (OM) as adverse event of chemotherapy often interfere with food intake and result in weight loss and worsen quality of life. Oral cooling system (Cooral® BrainCool AB) is a new device that is to reduce the temperature of the mouth. We aimed to evaluate the feasibility of oral cooling system for oral mucositis in patients receiving chemotherapy. Methods Eligible patients had solid tumor and received alkylating agents, platinum, anthracycline, antimetabolite, or taxanes for out patients. All patients provided written informed consent before enrollment. Cooling begins 30 minutes before the start of chemotherapy. Cooling continues until 30 minutes after the termination of the cytostatic infusion. During treatment the patient may if necessary take out the component and replace it again, for a maximum of 10 minutes. Following each cooling session a questionnaire, specifically developed for the study to assess feasibility, was completed. Primary endpoint is feasibility.

A total of 4 patients were enrolled. Median age is 55.5 (range 52-71). Three of those completed the full cooling time. One patient extended time of taking out for failure of the machine. Two patients felt unfit of mouthpiece and slobber. One patient felt senseless, although no patient was cool. One patient made OM of grade1 on day2 due to mouthpiece. It healed next day. Two patients did not develop in a taste disorder and gingivitis that developed before. Conclusions Oral cooling system is well tolerated. The next step will be to evaluate oral cooling system in a randomized clinical to establish its efficacy of preventing OM. 

The role of virus in the pathogenesis of oral mucositis (OM), either in its severity or as a triggering factor, in patient submitted to allogeneic hematopoietic stem cell transplantation (alloHSCT), has been timidly investigated in the last decades.

The present study evaluated through the PCR and enzymatic digestion the oral excretion of Herpesviridae family in 32 adult patients submitted to alloHSCT (12 patients who developed OM and 20 patients who did not develop OM) pre, during and post-transplant. The samples were collected from the oral mucosa, supragingival and subgingival area at five moments of clinical follow-up, adding two more samples in patients who developed ulcerative OM, at beginning and at resolution of the lesion.

By the moment that the samples were collected the detection of HSV-1, HHV-6A, HHV-6B, CMV, EBV and HHV-7 was observed in 4,34%, 4,34%, 5,53%, 6,32%, 19,36% and 43,08% in the group without OM and 3,84%, 0%, 1,7%, 2,13%, 18,8% and 71,79% in the group with OM, respectively. A qualitative analysis showed a lower presence in the subgingival site. The oral shedding of HHV-7 was significantly higher in group with OM. In most cases, the positive samples for EBVand CMV in the oral shedding were detected earlier than in the serologic samples. Six patients had positive samples for HHV-6B and 5 of them died because of the relapse of the disease or due to complications inherent to alloHSCT. Conclusions These findings suggest that the presence of HHV-6B is a negative prognostic factor for patients submitted to alloHSCT. 

Oral mucositis (OM) is a common side effect of hematopoietic stem cell transplantation (HSCT). This study aimed to determine the incidence and severity of OM in patients who underwent different types of HSCT in a single Australian center.

Patients who underwent HSCT were consecutively included. Daily OM grade was recorded by the nurses using WHO scale. Patients were asked to retrospectively grade their OM severity on their hospital discharges (nil, mild, moderate or severe). They were also asked whether they had used cryotherapy and mouthwashes. Prior to HSCT, all patients received OM education and encouraged to use mouthwashes. They were routinely offered cryotherapy if they received melphalan.

In total 57 patients were included (allogeneic N=47, autologous N=10). 89% developed OM according to WHO score. Grade 3-4 OM was seen in 35% (40% with allogeneic vs 10% with autologous). Self-reported OM incidence was 56% (39% moderate to severe). When comparing commonly used different conditioning regimens, OM incidence and severity were 100% (80 % grade 3-4) with cyclophosphamide/TBI myeloabrative regimen, 96% (38% grade 3-4) with fludarabine/melphalan reduced intensity regimen, and 88% (0% grade 3-4) with high dose melphalan autologous regimen. All except one patient used cryotherapy with melphalan. Mouthwashes were used by all patients except one.

Despite a good compliance with oral care and cryotherapy, OM is a significant complication of HSCT. The incidence and severity were higher in allogeneic HSCT vs autologous, and myeloablative Cyclophosphamide/ TBI vs reduced intensity fludarabine/ melphalan.

Photobiomodulation (PBM) is emerging as an effective strategy for the management of oral mucositis (OM) in cancer patients, a condition where reactive oxygen species (ROS) play a relevant role. Here we report the results of a clinical and experimental study, aimed at evaluating the effect of PBM at different wavelengths on oxidative stress.

The study was approved by the local ethical committee. A diode laser device was employed. 10 patients affected by OM meeting inclusion/ exclusion criteria were enrolled and underwent 4 daily PBM sessions (970nm) when clinical parameters were recorded and saliva samples were obtained for total oxidant status (TOS) measurement. In parallel, oxidative stress following 5-fluorouracil or H 2 O 2 and different PBM protocols applied individually or in combination (660, 800 and/or 970nm) was evaluated in vitro in neutrophils and keratinocytes. In addition, we used a roGFP2-Orp1 genetically-encoded sensor to monitor in real-time oxidative status changes in living keratinocytes in response to oxidative stress and different PBM protocols.

While 970nm PBM was effective in treating OM, salivary TOS levels significantly decreased after each PBM session (p<0,01) but increased again after 24h (Figure1). This transient antioxidant effect was confirmed in vitro in both cell types. In contrast, 660nm increased ROS production. The most marked reduction in ROS levels, particularly evident in realtime imaging, was detected in cells exposed to the 800nm laser light individually or to the combination of the three wavelengths.

Our study showed how various wavelengths differentially modulate ROS production and prompts the validation of a multi-wavelength protocol in clinical settings. 

Oral mucositis, a progressive, inflammatory, and ulcerative condition of the mucous membranes and it is one of the common side effects of cancer treatment. Primary objective of this study to was to evaluate requirement of opioids for chemotherapy induced oral mucositis Methods It was a prospective, non-interventional single -centre observational study. The cancer patients who had developed chemotherapy induced mucositis requiring intravenous opioid requirement for symptom control were included in the study. Oral mucositis with the WHO oral mucositis grading, pain, the performance status, opioid requirement and quality of life using EORTC QOL-C30 questionnaires were assessed. Chemotherapy received were also noted. Patients were followed up for 7 days after initiation of intravenous opioid administration Results Total 100 patients were included in the study. 61% patients were male. Mean performance status of the patients with KPS scale was 57%.. Average gap of development of mucositis and last dose of chemotherapy was 6.7 days. 84% of the patients were managed with IV morphine administration initially. As the time passes eventually total 93% patients required morphine administration for symptom control. Mean intravenous morphine consumption was 26 mg in 1stday of presentation. Median WHO grading of mucositis was 3.Global health status, physical functioning, role functioning, emotional functioning, cognitive functioning and social functioning were improved on day 7 in comparison to day 1.

Chemotherapy induced mucositis often require strong opioids like morphine administration for symptom control. Initial intravenous morphine consumption can be as high as 26 mg per day.

T. Konishi 1 , K. reiko 1 , M. Yurika 1 1 National Cancer Center Hospital East, Dentistry, chiba, Japan

Immune checkpoint inhibitors, such as nivolumab, are drugs that inhibit immunosuppressive activities of tumor cells, thereby enhancing immunity to tumors. The indications have been rapidly expanded in recent years, increasing the number of cases treated with these drugs. Currently, there are only a few reports of oral adverse events associated with the use of immune checkpoint inhibitors. We herein present our experiences with 6 cases of oral mucositis, which appeared to be an irAE induced by the anti-PD-1 antibody nivolumab. Methods Among cases treated with drugs including immune checkpoint inhibitors between 2016 and 2018, 6 cases were retrospectively reviewed; these cases were referred to a dentist who subsequently confirmed them to be oral mucositis.

The 6 patients with oral mucositis included 1 man and 5 women aged between 41 and 68 years. Their primary diseases were pancreatic, colorectal, lung (2 patients), tongue, and uterine cancers. The time interval between the start of treatment and the onset of mucositis ranged from 4 months to 22 months. The majority of the cases were characterized by lacy or granular white patches, suggesting that the lesion of mucositis often appears similar to that of lichen planus, which is an autoimmune disease.

Although infrequent, oral mucositis resulting from the use of immune checkpoint inhibitors is difficult to diagnose and may cause negative effects such as interfering with oral intake. With immune checkpoint inhibitors, oral mucositis may develop as an adverse event, warranting close monitoring of the oral condition during the treatment period. 

(1) HPPCLS Mucositis Registry Study had a low risk of bias in all three domains of the ROBINS-I tool.

(2) Based on statistical assessment of HPPCLS data using GRADE criteria, HPPCLS should be classified as a Grade 1A/1B intervention for prevention and rapid sustained elimination of CRTM. (3) Positive impact on both QOL and CRTM's actuarial costs suggests a favorable NCCN evidence block index value for HPPCLS. Conclusions These findings support health economic clinical research initiatives to explore the suitability of HPPCLS as a NCCN Category 2A recommended antidote for treating CRTM resulting from treatment of head and neck cancer (HNC) and for managing gastrointestinal mucositis. By integrating outcome-specific, minimally disruptive HPPCLS protocols into daily oncology practice, sufficient data could be generated to form a multiinstitutional consensus on the clinical utility of HPPCLS. Few treatments for OM are currently recommended. Viscous lidocaine is commonly combined with other ingredients (Magic Mouthwash), but has a short duration of action and lacks validated studies. Oral topical therapies for OM are diluted by saliva and removed from the oral cavity by swallowing. This limits their resonance within the oral cavity, lowering effectiveness.

Our group has developed a soft device (BocaLiner™) constructed of silicone rubber that is held in the mouth together with topical gels, mouthwashes and rinse treatments for OM. The device has a fitting portion corresponding to the dental arch, "wings" that cover portions of the buccal mucosa, alveolar arches and ostia of the parotid and submandibular glands, and soft bite flanges. Two designs were optimized for comfortable fitting in regular and petite mouths. Preliminary tests of the effect of the standard size device and the small size device for retention of oral topical alginate using the ETOH Retention Test were performed. Duration of oral numbing from 2% viscous lidocaine was also measured.

Mean retention of topical alginate increased from 12 to 23.5 minutes and mean measurable area under the curve increased from 0.931 to 1.78 units/ minute using the devices (Figures 1 and 2) . Increased duration of oral numbness from topical lidocaine was also noted.

A novel device has been developed to enhance the retention of topical agents for OM. This represents a simple, low cost addition to therapies for OM. Introduction Photobiomodulation (PBM) is efficacious for the management of cancer therapy-induced mucositis and it is part of practice guidelines. However, the safety of PBM, regarding a detrimental role on tumor growth, has been raised.

We reviewed the charts of 361 patients who had been treated at the IJB between 2005 and 2009 and evaluated their overall survival (OS), time to local recurrence (TLR) and progression-free survival (PFS). Patients who received PBM (62%) were treated with an energy density of 2-3 J/cm 2 , applied 3 times daily in accordance with recent recommendations. Radiation therapy consisted of IMRT in all patients; 39% received concomitant chemotherapy.

The staging of the tumor (TNM) and clinical characteristics were roughly comparable between the 2 study groups. There was no statistical evidence for a difference in OS (p=0.86); the 5-year OS being 48% and 50% in those with or without PBM. TLR was not different in the 2 groups (p=0.52) neither the PFS (p=0.49); the 5year PFS was 41% and 35%, with or without PBM. Adjusting the comparisons in multivariate analysis for 10 clinical and therapeutic characteristics, there was no statistical evidence that PBM was related to decreased OS, TLR or PFS.

We did not detect any statistically significant impact for PBM for cancer therapy-induced oral mucositis on OS, LTR or PFS in patients with head/neck cancer. From this however retrospective study, we do not document any argument against the use of PBM for the management or oral mucositis in such patients.

Mucositis, a side-effect of chemotherapy treatment, induces alterations in the composition of the gut microbiota. The redox active compounds vitamins B2 and C have been shown to reduce inflammation and to enhance the growth of anaerobes in the gut. We therefore aimed to 1) validate the ability of these vitamins to promote bacterial cell growth in vitro, and 2) determine their prophylactic efficacy in a rat model of mucositis. Methods Bacterial growth curves were performed to assess the growth kinetics of bacteria exposed to vitamins C/B2 (0.5mM). Male wistar rats (150-200g) were received vitamins B2 (2,6 or 12mg/day) and C (50mg/day) via daily oral gavage (from day -1 to day 10). MTX (45mg/Kg) was administrated via I.V. injection (n=4-8/ group) on day 0. Body weight, water/food consumption and diarrhea were assessed daily. Blood and faecal samples were collected longitudinally to assess citrulline levels and gut microbiota composition.

Vitamins C/B2 enhanced the growth of anaerobic bacteria Blautia coccoides and Roseburia intestinalis (p<0.001). In vivo administration of vitamin C significantly attenuated clinical symptoms of mucositis, decreasing MTX-induced weight loss and promoting food consumption (p<0.05). Vitamin B2 was surprisingly detrimental to MTX-treated animals. Neither vitamin was able to attenuate the decreasing in plasma citrulline and the changes in the composition of the gut microbiota.

Vitamins B2 and C enhanced anaerobic bacterial growth in vitro, however their ability to mitigate MTX-induced mucositis was limited. Further in vitro studies should be performed to understand the effect of vitamins on the mechanisms of mucosal injury. 

Painful oral mucositis (OM) is a debilitating complication in Head and Neck Cancer (HNC) patients receiving RadioTherapy(RT)/ ChemoRadioTherapy(CRT). Therapy-induced pain can be nociceptive and/or neuropathic. Neuropathic pain (NP) in HNC patients often remains underdiagnosed and undertreated. The Douleur Neuropathique 4 questionnaire (DN4q) is validated for NP diagnosis. This study's purpose was to identify the OM-induced NP. Methods Forty HNC patients were evaluated during RT/CRT. Patients completed a DN4q as soon as they reported moderate or severe pain on a 0-10 Numeric Rating Scale (NRS>4). Mucositis and xerostomia were assessed. Pain medication was also recorted.

Twenty-six patients (mean age 63.54±13.96 years) with moderate/severe pain completed a DN4q (mean NRS score 7.46±1.42). Five patients (19.23%) had a positive for NP, DN4q score ≥4. The most common NP descriptor was "burning" (34.62%) followed by "electric shocks" (30.77%) and "pins-and-needles" (30.77%). Statistically significant (p<0.05) differences between positive and negative DN4q scores were observed for the "electric shocks", "tingling", "pins-and-needles" and "numbness" NP descriptors. Nine (34.62%) patients didn't report any NP descriptors. A direct correlation was observed between DN4q score and intensity of pain, mucositis and xerostomia (p<0.02). Pain medication was administered to fifteen (15/26, 57.69%) patients. Adjuvant medication for NP was administered to 1 (1/5, 20%) patient with positive DN4q score.

Oral mucositis induced NP was assessed for the first time during RT/CRT for HNC. Neuropathic pain was recorded in 5 patients with 1 of them receiving adjuvant NP medication. This study highlights the lack of adequate recognition and management of OM related NP. 

Conditioning chemotherapy for the treatment of haematological malignancies is highly mucotoxic, resulting in severe diarrhea and associated complications. A major challenge in developing effective interventions is our incomplete understanding of the pathobiology of mucositis caused by these agents. This is particularly the case for melphalan-induced mucositis, for which there are no validated animal models. We therefore aimed to develop a rat model of melphalan-induced mucositis for fundamental and translational research efforts.

Male Wistar rats (8 weeks; 180-220 g) were administered 4, 5, 6 and 8 mg/kg melphalan (5 mg/ml) via i.v. injection (n=3-6/group). Body weight, diarrhea, food/water intake were assessed daily before all rats were euthanised on day 10. Blood was collected every second day for assessment of plasma citrulline (marker of small intestinal enterocyte mass).

Melphalan caused mucositis at doses ≥5 mg/kg, indicated by clinical parameters of weight loss, diarrhea and reduced food/water intake. These effects were dose-dependent, with rats treated with 6 mg/kg and 8 mg/kg euthanised due to excessive toxicity. Clinical parameters occurred in a biphasic manner, with an initial episode of mucositis observed at day 4, followed by a second, less severe episode at day 7. In contrast, plasma citrulline decreased most significantly on day 2 and returned to baseline by day 6 and did not differ between doses. Conclusions 5 mg/kg melphalan causes moderate, self-limiting mucositis. Disparities in the onset of clinical symptoms and dynamics of plasma citrulline suggest mechanisms unrelated to small intestinal atrophy contribute to melphalan-induced mucositis. Investigation of these mechanisms is therefore warranted. 

Oral mucositis is a common adverse effect of anthracyclines and can be a dose-limiting toxicity. Ulceration due to inflammatory cytokines is exacerbated by infection. Oral dexamethasone is frequently used as an antiemetic but may increase the risk of infection. We evaluated whether the use of oral dexamethasone is associated with the incidence of oral mucositis.

We conducted a retrospective cohort study using medical records of Kyoto University Hospital. In total, 170 breast cancer patients were treated with anthracycline combination chemotherapy (TAC [docetaxel + doxorubicin + cyclophosphamide], FEC [5-fluorouracil + epirubicin + cyclophosphamide], or AC [doxorubicin + cyclophosphamide]) from 2012 to 2017. We excluded patients who received oral cryotherapy from the first course. The primary endpoint was incidence of oral mucositis during anthracycline therapy (up to 3 weeks after last anthracycline administration). Dexamethasone users were defined as patients who took oral dexamethasone on the 2nd and 3rd day of each cycle. We assumed regimen and preceding chemotherapy as confounders and performed multivariate logistic regression analysis.

Among 166 patients, oral mucositis developed in 33 of 99 dexamethasone users (33.3%) compared with10 of 67 non-users (17.2%). In univariate analysis, oral dexamethasone was significantly correlated with onset of oral mucositis (odds ratio [OR]: 2.85, 95% confidence intervals [CI]: 1.29 to 6.29). Multivariate analysis also showed significant correlation between oral dexamethasone and oral mucositis. (OR: 3.28, 95% CI: 1.32 to 8.19).

Oral dexamethasone during anthracycline combination therapy was associated with the development of oral mucositis. 

Oral mucositis (OM) is a common toxicity of cancer treatments. It results in the development of diffuse ulcerative lesions of the movable mucosa of the mouth and oropharynx, with consequent pain of such severity as to require opioid-level analgesics. A medical device containing Verbascoside, Polyvinylpyrrolidone, and Hyaluronic Acid (Mucosyte®) resulted effective for the treatment of OM. Thus, the aim of this study was to assess the efficacy of the device for the prevention.

Patients before undergoing chemotherapy, target therapies or immunotherapies for solid tumors were retrospectively enrolled in this study. We enrolled both patients treated with Mucosyte®(2 rinses/day) in prevention, and patients who where given only instructions of oral hygiene. Therefore, we compared the incidence of mucositis in patients treated with Mucosyte®, and in those not treated, with similar basal characteristics. Ulcerative lesions were clinically evaluated at every cycle (for a total of maximum 3 months), according to WHO, RTOG, NCI-CTC, and OMAS scales.

Fourty two patients were enrolled: "Mucosyte® Group" (n=21), and "Control Group" (n=21). Median age was 66 years. There were no clinical and demographic differences between two groups. Mucosyte® Group experienced OM in 3 cases (Grade 1); Control Group experienced OM in 9 cases (4 patients with Grade 2, 5 patients with Grade 1), with a significant statistical difference (p<0.001).

Our previous study showed the efficacy of Mucosyte®in the treatment of OM in cancer patients. Present study could demonstrate the effectiveness of the device also in prevention. A prospective study is underway.

The aim of this study was to evaluate the association between non-erosive reflux disease (NERD) and a specific oral mucosal traumatic alteration in children with dysphagia undergoing chemotherapy. Methods Children manifesting both dysphagia and chemotherapy-related oral mucositis (OM) within the last year were considered for this study. Oral lesions characterized by a traumatic appearance i.e. milky opalescent mucosa, edema and teeth imprints were selected. Every patient received an otolaryngology consultation to evaluate NERD related changes. Since as defensive reaction to swallowing the children clench, patients were instructed on how to avoid it and, in case of indirect signs of reflux, were treated with sodium alginates and proton pump inhibitors. A hyaluronic acid topical therapy was also recommended. Oral mucosal pain was evaluated through the Visual Analogue Scale (VAS) at T0 and after a week (T1).

Out of 54 patients with OM,8 patients (14.8%) were included in the study. All children presented indirect signs of NERD and were consequently treated, besides receiving anti-clenching instructions. They all physically manifested closed-off expression (closed eyes and shoulder, limited interaction) due to dysphagia discomfort. After therapy, at T1 they demonstrated a significant improvement in pain and the resolution of oral lesions.

All these elements configure a whole nosological entity, which includes Clenching, OM, closed-off Expression, and Dysphagia, summarized in the acronym "COMEDY." Recognizing the COMEDYpattern in children undergoing chemotherapy could help to direct treatment toward a combination of conventional NERD therapy and a behavioral approach, besides topical treatment, to resolve oral mucosal lesions.

During the past decades, ice chips have effectively been used to alleviate the onset and duration of chemotherapy-induced oral mucositis (OM). However, although effective, this preventive measure entails discomfort as shooting pain in the teeth. This study aimed to investigate the efficacy and tolerability profile of a novel intraoral cooling device (ICD) (Fig. 1) , employing higher cooling temperatures than those provided by ice (+ 0.5°C).

Methods xIn total, 20 healthy volunteers were enrolled in this randomized crossover study. Intraoral temperatures were registered, using an IR-camera, at baseline and following 30 and 60 minutes of cooling with the ICD, set to 8°C or 15°C respectively. Following each cooling session, tolerability was assessed using a questionnaire.

The statistical analyses showed a significantly higher temperature reduction using 8°C compared to 15°C, following both 30-and 60 minutes (1.9°C, p < .001) and (2.5°C, p < .001) (Fig. 2) . In contrast, cooling with 15°C was better tolerated and preferred over 8°C by 15 out of 20 participants (p < .001).

Intraoral cooling using a temperature of 15°C is better tolerated than 8°C but displays inferior capacity in temperature reduction of the oral mucosa. However, to elucidate whether this discrepancy of approximately 2°C is of clinical importance, the optimal temperature for prevention of OM needs to be identified. 

Incidence of mucositis in conditioning for hematopoietic stem cell transplant is between 75 and 99%. Objective this study is to present the protocol and preliminary results of symptoms and control of mucositis in patients submitted to autologous stem cell transplantation (ASCT).

From September 2016 to January 2019, the protocol for the prevention of mucositis in patients submitted to ASCT in Clinical Hospital of São Paulo State University, Brazil, was: children toothpaste, nistatine, daily mouthwash with ice cold chamomile tea, cryotherapy, low level laser therapy, 2J, 20s, per point in oral cavity and oropharynx, diary starting with mobilization until engraftment of the bone marrow, 660 nm, 100 mW. Sulcralfate was administrated in the first symptoms of dysphagia, clenil 250cmg spray three times a day at the beginning of mucositis GII. Mobilization for Multiple Myeloma (MM) was used Melphalan, for lymphoma cyclophosphamide, cytarabine, etoposide, carmustine.

Thirty four patients were divided in 2 groups: GI 16 MM, GII 16 lymphoma. GI 44.44% presented mucositis ( 22,22%, 16.67% oral (OM) and gastrointestinal (GM) respectively, 5.56% OM+GM). GII 18.75% OM. Leukoedema was observed in 33.33% in the GI and 31.25% GII, dysphagia and dry mouth in 33.33% of GI and GII 25% and 31.25% respectively.

Low incidence of mucositis in ASCT suggest that the protocol seems to be effective in the control of mucositis Higher incidence of mucositis, leukoedema, dry mouth and dysphagia in MM patients comparing with lymphoma, suggesting that the drugs used in MM are more cytotoxic for the mucosa. In the latter, GC4419 demonstrated statistically significant reduction in SOM duration (p=0.024, median 1.5 days @ 90 mg vs 19 days placebo) and meaningful reductions @ 90 mg in SOM incidence (43% vs 65%) and Gr 4 incidence, 16% vs 30%). The safety profile was acceptable and consistent with the known toxicities of IMRT/cisplatin. Methods 335 patients at multiple U.S. and Canadian centers, with locally-advanced, nonmetastatic head and neck cancer (oral cavity/oropharyngeal) receiving 70 Gy IMRT (>50 Gy to > 2 oral sites) plus cisplatin (40 mg/m 2 qwk x 6-7, or 100 mg/m 2 q3wk x 3). Randomization (double-blinded) 3:2 to 90 mg GC4419: placebo, M-F before RT. Stratification: cisplatin schedule, treatment setting (definitive/post-op). WHO-OM assessment: BIW during RT, qwk x2 post-RT. Primary efficacy endpoint: incidence of SOM through IMRT. Secondary: severity (Grade 4 OM incidence through IMRT), & days of SOM (first to last SOM) for all patients. Days of SOM for the subset developing SOM will be described. Follow up: one year post IMRT for tumor progression/recurrence, two years for survival.

Enrolling, trial in progress.

Pending; in progress. 

The aim of this study is to determine the expression of salivary proinflammatory cytokines during the hematopoietic cell transplantation (HCT), and to verify whether there is an association between these cytokines with oral toxicity.

We collected stimulated saliva from autologous and allogeneic HCT patients (n=72) at baseline (T0, before the HCT conditioning), during the neutropenia (T1), and after the marrow engraftment (T2). Salivary levels of IL-6, IL1β, and TNFα were quantified by ELISA assay. Data about conditioning regimen, time duration of neutropenia, oral mucositis, xerostomia, and body weight loss was collected.

The levels of salivary IL-6, IL-1β, and TNF-α increased significantly at T1 compared to T0, with significant differences for IL-6 (p=0.039) and TNF-α (p<0.001). In an adjusted regression model analyzing the three cytokines, only high levels of IL-1β were significantly associated with a long duration of oral mucositis (OR=0.44, p=0.017) and xerostomia (OR=0.49, p=0.038). The highest levels of IL-1β at T1 were found in autologous HCT (OR=0.35, p=0.002), mainly after melphalan conditioning (OR=2.00, p=0.040). In addition, a significant association was found between body weight loss during the transplantation and high levels of salivary TNF-α at T0 (OR=2.35, p=0.010).

There is an increase in salivary pro-inflammatory cytokines at neutropenia. Among the analyzed cytokines, only salivary IL-1β exhibited a discrete association with oral mucositis and xerostomia. Salivary TNF-α at baseline was a predictive factor for body weight loss, suggesting that the saliva could signalize the systemic metabolic alterations caused by TNF-α during the HCT.

The aim of this study was to investigate the levels of salivary antioxidant enzymes during hematopoietic cell transplantation (HCT), and their association with oral toxicity. Methods Stimulated saliva of patients who underwent autologous and allogeneic HCT (n=72) was collected at baseline (T0, before the HCT), neutropenia (T1), and after marrow engraftment (T2). Activity of superoxide dismutase (SOD) and levels of catalase (CAT) and glutathione reductase (GR) in the saliva were also determined. Association tests of these enzymes with oral mucositis and xerostomia were performed.

From T0 to T2, the SOD activity increased, with significant differences between T0 and T1 (p<0.001), and T0 and T2 (p<0.001). CAT and GR showed reduced levels in T1 compared to T0, with recovery to basal levels at T2. The GR levels were significantly reduced at T1 in relation to T2 (p<0.001). In a regression model including the three enzymes, long duration of oral mucositis was statistically associated with high SOD activity at T1 (OR= 0.451, p=0.031). Xerostomia was also associate to high SOD activity (OR=2.550, p=0.017) and to high levels of GR (OR=2.300, p=0.042) at T1. High SOD activity at T0 was a predictive factor for xerostomia (OR=2.71, p=0.006).

Expression patterns of salivary SOD, CAT, and GR during HCT periods are different, with a trend to SOD activity increase and CAT and GR reduction. SOD activity increase is related to a long duration of oral mucositis and xerostomia, suggesting that some protective antioxidant activity persists even in conditions of intense oral toxicity.

This study was conducted at a medical center in Taiwan. The main purpose of this study is (1) analysis of related factors of head and neck cancer effect of oral mucositis. (2) analyze the correlation between dry mouth and oral mucositis. Methods This a longitudinal study, from March 2015 to August 2017, total of 38 people. In patients before radiotherapy, after treatment and treatment were completed "dry mouth questionnaire" and to NCI CTCAE questionnaire. And the former to radiation therapy, after treatment and treatment. Fill EORTC QLQ-H&N35 questionnaire. After data collection with descriptive statistics, generalized linear model and Pearson correlation statistical analysis.

The results is: (1) after the first three weeks of treatment smoking habits significant difference (p = 0.011), there are smokers more serious case of oral mucositis, 2 to 5 accounted for 95.65%. (2) smoking habits and the quality of life there is significant correlation (p = 0.03), quality of life than smokers who do not smoke difference (p < 0.1). (3) Drink and oral mucositis have significant differences (p < 0.1), there are those who drink more severe oral mucositis, 2 to 5 accounted for 95.45%.(4) and betel nut chewing habits and the quality of life there is significant correlation (p < 0.001).

In this study, we found that patients with head and neck cancer undergoing surgery or chemoradiotherapy will have different levels of dry mouth. Those who have bad habits of smoking, drinking and chewing betel nut will produce more serious mucositis due to dry mouth. 

Mucositis disrupts QOL significantly in subjects relieving high dose chemotherapy/concurrent chemoradiotherapy. Attempts to look for tools predicting the probability yielded encouraging results (JCRT :2010 6(4):448-51) There is no prospective validation of the scoring system done for predicting development of mucositis. we validated the riskscoring system developed by Attili et al to predict probable incidence and severity of mucositis. Methods This is a prospective analysis conducted at a tertiary care cancer center with approximately 6,000 new cases annually. The considered risk factors as per the literature were the following cutoff values were selected: age > 40 years, ECOG PS > 2, WBC < 3000/μL, elevated ESR, albumin < 3 gm/dL and more than or equal to stage III disease presence of more than one co-morbid conditions. A score of 1 was assigned for the above risk factors. Results 508 patients from 2017-2019 were prospectively classified into Low risk (score < 3%), Intermediate risk (score of 4-6) & high risk (score > 6). All patients received either chemoradiation (cisplatin 40mg/m2 /week+local radiation 60-70 Gy depending on primary site)/high dose chemotherapy.

For low risk subjects there is 8%(95% CI-5-12%) probability of developing grade 3/4 mucositis, while patients having intermediate risk have 26%(95% CI-18-22%)&high risk [patients have 58%(95% CI-45-72%) of severe mucositis. The positive(86%)& negative(89%) predictive values favor the use of the same in clinical practice Conclusions we could successfully validate clinical utility of existing tool in predicting mucositis in patients receiving either high dose chemotherapy/ chemoradiotherapy. This will further help clinicians to adopt preventive strategies as well as better counseling.

Gastrointestinal mucositis is a side-effect of chemotherapy that causes significant gut toxicity. This results in clinical manifestations that affect the course of chemotherapy. Currently, there is a limited number of in vitro systems suitable to study the mucosal damage. Therefore, we aimed to validate a chemotherapeutics-induced model of mucositis using organoids grown in a 3D fashion.

Intestinal organoids derived from mouse ileum were grown for 7 days and incubated with different concentrations of methotrexate (MTX), ranging from 0-1000 ng/ml. Metabolic activity, citrulline levels and cytokine/ chemokine production were measured to determine the optimal dosage and incubation time. To link the model to clinical practices, folinic acid (0.0005-50 μg/mL) was added in combination with MTX. To evaluate the effects of short-chain fatty acids in the organoid model, different concentrations of butyrate (0.25-2mM) were added for 96 hours. Results MTX (100-1000 ng/ml) treatment resulted in reduced cell metabolic activity and citrulline levels (p<0.001). However, recovery after 96 hours was only observed with a MTX dose of 100 ng/ml, showing that 100 ng/ml is the optimal concentration in this model. Folinic acid treatment was able to restore organoid function when applied simultaneously or/up to 24 hours after treatment. Simultaneous addition of 0.25-1mM butyrate showed a protective effect on MTX toxicity Conclusions MTX causes significant organoid damage, which can be reverted upon removal of MTX. The protective effects of folinic acid suggest that the model is clinically relevant. Treatment with butyrate might be a valuable strategy for mucositis treatment. 

Oral mucositis (OM) remains a significant complication developed by many patients undergoing radiotherapy (RT) to the head and neck region. Emerging data suggest oral bacteria contribute to the onset and severity of this acute side effect. Methods Swabs were collected from the buccal mucosa and lateral tongue of head and neck cancer patients during RT. Molecular microbiological techniques were employed to study the bacterial communities present on these oral surfaces and how they change with increasing radiation dose and mucositis severity. The potential to use the bacteria present on the buccal mucosa prior to RT as a predictor of OM was investigated.

The abundance of obligate and facultative anaerobic Gram-negative bacilli (GNB) Bacteroidales G2, Capnocytophaga, Eikenella, Mycoplasma and Sneathia, as well as anaerobic GNB in the periopathogenic genera Porphyromonas and Tannerella, were all positively correlated with ≥ grade 2 OM and negatively with ≤ grade 1 OM sites. Significant increases in the relative abundances of Bacteroidales G2, Fusobacterium and Sneathia were identified in buccal swabs at sites of ≥ grade 2 OM (p < 0.05). The abundance of several GNB (Haemophilus, Fusobacterium, Tannerella, Porphyromonas and Eikenella) on the buccal mucosa prior to RT may increase patient susceptibility to developing OM.

Our findings support previously hypothesised associations between oral health, oral bacteria and the pathogenesis of OM and highlights the importance of oral health interventions for head and neck cancer patients.

A. Saraf 1 1 teerthanker mahavir university, orthopedics, amritsar, India

Sciatic nerve is the thickest nerve in human body. Neural sheath of sciatic nerve is rich in microvasculature. We compared neuroma formation after tying the sciatic nerve with leaving its cut end open in patients who undergo above knee amputation.

We followed a total of 90 patients who underwent above knee amputation. In half of these patients, cut end of sciatic nerve was left open and in other half, the nerve was tied. Patients in both the groups were age, sex and BMI matched. Neuroma formation in the stump was assessed one year after surgery. This assessment was done by measuring the diameter of sciatic nerve ending using sonogram. Sciatic nerve diameter was measured bilaterally at the same level, and the value of the normal limb was taken as control.

Of 45 patients who underwent tying of sciatic nerve, only 10 patients developed thickening of the cut end of sciatic nerve in comparison to opposite limb. On the other hand, 45 patients in whom the cut end was left open, 33 patients developed neuroma formation. This result was statistically significant Conclusions Rich microvascularity of sciatic nerve results in the formation of haematoma beneath the cut end, if it is left open. This haematoma eventually results in growth of neural fibres. As a result of this, neuroma formation occurs at cut end of sciatic nerve in above knee amputation. We thus conclude, it is always wise to tie the cut end of sciatic nerve in above knee amputation to prevent neuroma formation.

Oxaliplatin (OXA) is frequently used in the treatment of patients with colorectal cancer, and OXA-induced neurotoxic side effects are common. Reports on real-time patient-reported neurotoxic side effects and impact on the patient's daily activities are sparse in existing studies. The aim of this study was to identify and assess patient-reported OXAinduced neurotoxic side effects and their impact on the patient's daily activities, during and after chemotherapy.

In a multicenter prospective longitudinal study, 46 chemo-naïve patients with colorectal cancer treated with postoperative adjuvant OXA-based chemotherapy were monitored during treatment and at 3-, 6-, 9-, and 12-month follow-ups. Patients were recruited from September 2013 to June 2016. In total, 370 Oxaliplatin-Associated Neurotoxicity Questionnaire responses were available for analysis. A mobile phonebased system was used to receive real-time assessments.

All patients reported neurotoxic side effects and impact on daily activities during treatment. The side effects changed in character and body location over time and had an impact on the daily activities.

The high prevalence of OXA-induced neurotoxic side effects significantly interfered with the patients' daily activities. We found significant differences between baseline data and follow-up time points for neurotoxicity. The realtime assessment using mobile phone technology seems to be a valuable tool for monitoring patient-reported neurotoxicity and interventions for tailored care. Effectively identifying neurotoxicity and its impact on the patient's daily activities is important in supportive cancer care.

Oxaliplatin is used as part of FOLFOX to treat colorectal cancer (CRC). Oxaliplatin produces chemotherapy-induced peripheral neuropathy (OIPN). We report that controlled-release oxycodone (CR oxycodone) attenuates the pain of OIPN and extendes FOLFOX. We investigate the efficacy of CR oxycodone for OIPN and its association with patients' survival time.

Stage III or IV CRC were included in this study. All patients underwent surgery to extirpate the primary CRC and received FOLFOX. Patients administered CR oxycodone were defined as OXY group, and those who did not receive CR oxycodone were defined as non-OXY group. Incidence and severity of OIPN and the number of FOLFOX cycles were measured. Neurological toxicities were assessed according to the CTCAE version 3.0. Survival time was calculated using the Kaplan-Meier method.

All patients had OIPN. Grade 3 sensory neuropathy was observed in 2 patients in the non-OXY group. FOLFOX therapy was discontinued in 10 patients of the non-OXY group due to severe OIPN. The median number of FOLFOX cycles in the OXY and non-OXY groups was 13 and 7 respectively (P <0.05). The median value of cumulative oxaliplatin dose was 1072.3 mg/m2 in the OXY group and 483.0 mg/m2 in the non-OXY group (P <0.05). Patients in the OXY group had relatively longer survival than those in the non-OXY group (median survival, 58 months vs. 36 months; P=0.06). Conclusions CR oxycodone may attenuate the severity of OIPN and extend FOLFOX therapy. CR oxycodone for OIPN might be relatively effective for better patient compliance with FOLFOX, and longer survival. The prevalence of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors is as high as 60%. CIPN is the most common and severe adverse drug reaction associated with neurotoxic chemotherapy. No pharmacologic interventions are available to prevent CIPN. A critical barrier to the development of efficacious interventions is the lack of understanding of the mechanisms underlying CIPN. Neuroinflammation (NI) is associated with development and maintenance of CIPN. In this pilot study, we evaluated for differences in perturbations in NI-related pathways between breast cancer survivors with and without PIPN. Methods GE in peripheral blood was assayed using RNA-seq. We evaluated for perturbations in NI-related pathways between survivors who received paclitaxel and did (n=25) and did not (n=25) develop PIPN.

Breast cancer survivors with PIPN were significantly older; more likely to be unemployed; reported lower alcohol use; had a higher body mass index and a poorer functional status; and had a higher number of lower extremity sites with loss of light touch, cold, and pain sensations, and higher vibration thresholds. No between group differences were found in the total dose of paclitaxel received. Five significantly perturbed NIrelated pathways (i.e., cytokine-cytokine receptor interaction, NF-kappa B signaling, GABAergic synapse, Adipcytokine signaling, and IL-17 signaling) were identified.

Chronic PIPN is associated with perturbed NI-related pathways derived from peripheral blood. Our findings support the hypothesis that NI is a mechanism that contributes to PIPN and suggest additional genes for validation and potential therapeutic targets. The aim was to evaluate the duloxetine's efficacy and adverse effects profile in an observational study including first one-hundred patients with symptomatic-CIPN consecutively treated in a single-institution. Methods CIPN was graded employing the TNS© and NCI-CTC. Response to duloxetine was assessed with Patient Global Impression of Change (PGIC) scale (1:no benefit; 7:excellent response) and considered at PGIC >4.

Results: Median age was 62 (29-81). Severity of neuropathy was grade 1 (20%), grade 2 (66%), and grade 3 (14%). Median time from finishing chemotherapy to duloxetine initiation was 6 months. Fifty-seven (57%) patients discontinued duloxetine, due to intolerable side effects (37%) or lack of efficacy (20%). Most frequently reported adverse events were cognitive (26%), gastrointestinal (14%) and genitourinary (9%). Men more frequently discontinued duloxetine due to perception of lack of efficacy (35.7% vs 8.6% p=0.001). PGIC scores were higher in women (4[1-7] vs 1 [1] [2] [3] [4] [5] [6] [7] , p=0.001), patients receiving taxane (4[1-7] vs 1 [1] [2] [3] [4] [5] [6] [7] , p=0.042) and patients with short-lasting CIPN (≤ 6 months) (4 [1] [2] [3] [4] [5] [6] [7] vs 1 [1] [2] [3] [4] [5] [6] , p=0.008). Patients with chronic CIPN had a higher rate of suspension due to adverse events (47% vs 27%, p=0.038) and less rate of continuation of duloxetine (26% vs 48%, p=0.023). Female gender (OR:9.7; CI 95%:0.021-0.506, p=0.005) and short-term (≤ 6 months) CIPN (OR:7.29; CI 95%:1.641-32.430;p=0.009) were identified being associated with a favorable response to duloxetine. Conclusions Conclusion: Low tolerability, male gender and long-lasting CIPN may limit duloxetine usefulness in treatment of CIPN.

Cognitive impairment is often present throughout the disease course for patients with central nervous system malignancies. Cognitive testing (CogT) is routinely used to assess impairment and can be a clinical trial endpoint. Understanding the factors that influence CogT metrics is critical in the interpretation of clinical outcomes and endpoints in clinical trials. We sought to understand the contribution of tumor laterality on CogT in patients with primary brain tumors.

We queried CogT performance from 2 clinical trials: study 1 (NCT01303835) and study 2 (NCT01740258) in newly diagnosed high grade glioma patients (WHO grade III/IV). CogT included a computerized battery (CNS Vital Signs®); domains were verbal memory, visual memory, processing speed, psychomotor speed, reaction time, cognitive flexibility, complex attention, and executive function. We obtained descriptive statistics for both studies and compared post-chemoradiation performance based on tumor laterality with lower scores identifying poorer performance. Results Study 1 had 105 patients: 48.6% (n=51) having R tumor and 51.4% (n=54) having L tumor. Study 2 had 61 patients: 44.3% (n=27) having R tumor and 55.7% (n=34) having L tumor. Verbal and visual memory did not differ based on tumor laterality. More complex domains such as cognitive flexibility and executive function differed noticeably with R tumor patients performing better than L tumor patients (Study 1 executive function R: mean=91.4 (sd=20.3) and L: mean=75.4 (sd=30.5)).

Lesion laterality is important in the interpretation of cognitive testing performed in primary brain tumor patients for complex cognitive domains but not for simpler memory domains. Currently there are limited studies on radiotherapy for MCEC and its impact on outcomes. The primary aim of this study was to evaluate mobility outcomes after radiotherapy for MCEC. Secondary aims were to review the response to pain, bowel and bladder dysfunction and measure survival following MCEC.

This was a retrospective review of 103 patients treated with radiotherapy for MCEC in South Western Sydney from Jan 2008 to Dec 2017. Patients were identified by retrieving data on all patients who had radiotherapy to lumbosacral spine sacrum within 72 hours from their 'ready-for-care' date. It excluded patients with multi-level compression and paraplegic patients from previous injury. Results 46 of 103 (45%) patients were ambulant at presentation, 56 of 88 (64%) were ambulant at week 1 and 39 of 59 (66%) were ambulant at 1 month after radiotherapy. 10 of 79 (13%) patients had reduction in opioid dose at 1 week post-radiotherapy. 14 of 38 (37%) patients had improvement in bladder symptoms and 9 of 19 (47%) patients had resolution of faecal incontinence at one week following radiotherapy. 2 of 44 (5%) later developed bladder dysfunction and 8 of 62 (13%) later developed faecal incontinence. Median survival from diagnosis of MCEC was 2 months.

The use of palliative radiotherapy was associated with improved mobility outcomes and sphincter dysfunction in patients with MCEC. However, there was minimal improvement in pain. The diagnosis of MCEC was associated with poor survival. 

Cancer-related cognitive changes are under-recognized by both GPs and oncologists, such situation burdens patients' state. The aim of this study was to assess prevalence of cognitive decline in paIliative care settings Methods Observational survey was undertaken. Patients were consulted at home They were classified as having cognitive impairment based on clinical judgment with additional MMSE if necessary Results 4131 patients (men 1514, women 2617, average age 74.7 ± 5.6 years) were examined for variety of malignancies. Cognitive disorders were detected in 880 (21.3%), much higher than in agematched non-cancer people (4%). Usually such decline remained quite mild (MCI), memory loss becoming highlight. Less common presentations of MCI included lack of attention and conсentration difficulties. More severe cases were identified with dysfluency, visuospatial skills disorder; as a rule they were associated with preceding chemotherapy. Such symptom cluster could indicate thiamine deficiency which was confirmed in preliminary study. This value was measured in small patient group In our group relationship between cognition and adherence was noted, as earlier had been observed, particularly in aged patients. By final phase of life this decline precipitated, contributing general deterioration.

Our findings provide additional evidence supporting the need to recognize and take care of cognitive dysfunction. Its management would improve quality of life in patients with far-advanced cancer. 

Background: For millions of cancer survivors, cognitive dysfunction is a prevalent, severe, and persistent problem that is associated with poorer quality of life. Unfortunately, the scientific basis for managing these cognitive changes in cancer survivors is extremely limited. The purpose of this 2-group, double-blind, randomized controlled trial is to test the feasibility, satisfaction, and preliminary efficacy of a computerized home-based cognitive training program compared to attention control in breast cancer survivors (BCS). Methods Methods: A total of 68 eligible BCS will be randomized to computerized cognitive training or attention control. A blinded and trained tester will perform data collection and neuropsychological testing at two time points: baseline prior to intervention (T1) and immediately after the 10-week cognitive training -program (+/-7 days) (T2). Feasibility and satisfaction will be assessed through objective indicators (study adherence, completion rate) and selfreport (facilitators, barriers, and perceived satisfaction) and cognitive performance will be assessed through objective neuropsychological tests. Data will be analyzed using descriptive statistics and a general linear mixed model (GLMM). Simple main effects analyses will be used to follow up statistically significant interactions.

Results and Conclusions: Preliminary results of this trial will be presented, including an assessment of treatment fidelity measures used in this intervention trial.

This work will represent the first rigorous trial of computerized cognitive training delivered in the home to BCS. Positive or negative study findings will provide empirical evidence for clinicians' Support Care Cancer (2019) 27 (Suppl 1):S1-S302 S133

recommendations and survivors' treatment selections for managing cognitive impairment in BCS.

Dehydroepiandrosterone and its sulfated form, jointly referred to as DHEA(S), are neurosteroids known to regulate brain development and function. We hypothesized that higher pre-chemotherapy plasma DHEA(S) levels protect breast cancer patients from onset of cancerrelated cognitive impairment (CRCI). The study's objective is to evaluate association between pre-chemotherapy plasma DHEA(S) levels and CRCI in breast cancer patients receiving chemotherapy.

In a prospective cohort study, self-perceived and objective cognitive function of patients were assessed before, during and after chemotherapy. Plasma samples were assayed with ultra-high-performance liquid chromatography-tandem mass spectrometry for quantitative determination of DHEA(S) levels. Multivariable logistic regression was used to evaluate the association between pre-chemotherapy plasma DHEA(S) levels and CRCI, incorporating clinically important factors.

Eighty-one patients (mean age ± SD = 48.9 ± 9.3 years) were analysed, with 27.8% of patients reporting CRCI based on global FACT-Cog scores. The mean ± SD pre-chemotherapy plasma DHEAS and DHEA levels were 1.61 ± 0.91 μmol/L and 19.21 ± 13.13 nmol/L respectively. Associations were found between DHEAS levels and impairment in self-perceived cognitive domains of verbal fluency (adjusted OR = 0.27, 95% CI= 0.08-0.96) and mental acuity (adjusted OR = 0.25, 95% CI = 0.08-0.74). Conversely, DHEA was not associated with any cognitive sub-domains.

Our findings suggest that patients with higher pre-chemotherapy DHEAS levels are at lower odds of developing self-perceived cognitive impairment in verbal fluency and mental acuity. Future studies are required to validate our findings in independent cohorts and should evaluate whether DHEAS supplementation can serve as pre-emptive intervention.

A. Wechsler 1 , A. Qdaisat 1 , M.K. Jomaa 1 , S.C. Yeung 1 1 The University of Texas at MD Anderson Cancer Center, Emergency Department, Houston, USA

While radiotherapy (RT) is an established treatment for primary and secondary brain tumors, it is also considered a risk factor for intracranial hemorrhage. This study aims to assess how prior cranial irradiation affects the short term survival of patients with acute spontaneous intracranial hemorrhage (ICH). Methods This is a retrospective cohort study of all patients presenting with spontaneous ICH to the Emergency Department (ED) of The University of Texas MD Anderson Cancer Center from 9/1/2006 to 2/16/2016. Patients were identified using all ICH related ICD-9 codes in a billing database. Then data regarding the patient's cancer type, RT status and outcomes was collected from the electronic medical record. Associations between prior brain irradiation and short mortality were investigated with logistic regression models.

There were 678 unique patient visits for spontaneous ICH during this 10 year period. This is a preliminary analysis of the 398 patients with complete data, 92 (23%) of whom had prior brain irradiation. For all ICH patients mortality was 12.6% at 7 days and 26.1% at 30 days post-ICH. Mortality at 7 days was less for ICH patients with prior brain irradiation, odds ratio=0.33 (95%^CI; 0.11-0.790), P=0.023. By 30 days this benefit no longer observed, odds ratio=0.73 (95% CI: 0:41-1.25), P=0.262.

Although prior cranial irradiation is an established risk factor for ICH in cancer patients, and nearly a quarter of our cohort had prior RT, their short term survival after spontaneous ICH was higher suggesting a protective effect. 

Infection is an important treatable cause of mortality in advanced cancer.

An observational study was conducted in the integrated supportive medicine setting (outpatient department and ward) of a tertiary cancer hospital. Results 28 patients were analysed during one month. The youngest was 2 and the eldest patient was 73 years old. Mean values for the haematological and biochemistry variables were as follows -Hb level 9.21 gm/dl, TLC 8997/ul, Platelet count was 169741/ul, ANC was 8818/ul. Mean creatinine was 0.83 mg/dl and albumin levels were 2.9 gm/dl respectively. The most frequent indication for antibiotic prescription was malodour from malignant fungating wound (39.3%), followed by febrile episode, discharge per rectum and surgical site infection (7.1% each). The indications also included cotrimoxazole prophylaxis against URTI in patients with involvement of lung parenchyma and doxycycline for geftinib induced skin rash. The most common antibiotic prescribed was Metronidazole (53.6%) followed by Amoxycillin clavulanate (10.7%) and Levofloxacin (7.1%). 9 (32.1%) patients were prescribed combination of antibiotics. The mean duration of treatment was 8.5 days. However, Metronidazole in a low dose of 400 mg per day (fungating wounds) and cotrimoxazole (400/80) in a dose of two tablets twice daily three times a week (to prevent recurrent LRTI) were continued as long term prophylaxis.

The importance of a restrictive antibiotic stewardship programme in palliative medicine needs to be recognized. The role, indications and effectiveness of long term antibiotics (lesser than usual dose) in the prophylaxis and treatment of infection in advanced cancer need to be studied further. 

FNH is a potentially life-threatening side effect of MC often leading to treatment disruption. Although use of MC is evolving there is no data describing the changes in incidence of FNH following initiation of MC. Methods Using the 100% Medicare database, we created annual cohorts of patients initiating MC between 01/01/2010 and 11/30/2017, overall and for patients with breast, lung, colon cancer and non-Hodgkin's lymphoma (NHL). Patients were required to have 12 months continuous enrollment prior to, and 30 days following, MC. FNH was defined as first five positions of the inpatient claim having: i) diagnosis of fever, infection, or neutropenia (sensitive definition); and ii) diagnosis of neutropenia (specific definition). Incidence (%) and 95% confidence interval of FNH within 30 days of initiating MC were calculated for annual cohorts.

A total of 1,151,313 patients met study inclusion criteria. There was a decline in incidence of FNH (sensitive definition) from 2010 to 2017 for the overall cohort (9.5 to 8.6%; Fig 1) : breast (8.1 to 7.8%), lung (12.6 to 10.8%), colon cancer (6.6 to 6.3%), and NHL (18.0 to 15.3%). In contrast, the incidence of FNH using specific definition was stable from 2010 to 2017 for the overall cohort (2.8 to 2.8%; Fig 2) : breast (3.7 to 4.0%), lung (2.7 to 2.7%), colon cancer (1.4 to 1.7%), and NHL (7.9 to 7.6%).

Despite the guidelines for using myeloid growth factors and changes in MC, hospitalization for febrile neutropenia continues to be a burden for patients receiving MC. 

Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) is widely used in senile lymphoma patients, while previous study found that serum level of cytokines will increase to some extent after the application of G-CSF. Methods 132 elder lymphoma patients treated with chemotherapy were included. Among them, 60 patients receiving PEG-rhG-CSF and 72 patients without PEG-rhG-CSF injection were recruited as the prevention group and control group, respectively. The incidence of grade 3-4 neutropenia and febrile neutropenia (FN) and the side effects induced by PEG-rhG-CSF were analyzed. From the first cycle of treatment, serum level of cytokine interleukin-(IL-) 1β, IL-2 receptor (IL-2R), IL-6, IL-8, IL-10 and tumor necrosis factor-(TNF-) α were detected before each cycle and were compared.

Significant lower incidence of grade 3-4 neutropenia and FN were seen in the prevention group ( Table 1) . As for adverse effects, 18.3% patients experienced slight bone pain. After cycle 1, IL-6 elevated in patients using short-term G-CSF in the control group, while decreased in the prevention group, with statistical significance (median values of the changes of IL-6 before and after cycle 1: 0.6850 vs -0.4200, P = 0.035), but there was no significant difference in the changes of other cytokines between the two groups, as well as changes of the cytokines in cycle 2-6 (P > 0.05).

In senile lymphoma patients, PEG-rhG-CSF demonstrated significant prophylaxis for grade 3-4 neutropenia and neutropenia-related events. Furthermore, compared with traditional G-CSF, PEG-rhG-CSF do not result in a increased expression of cytokines. 

Bleomycin, cisplatin and etoposide (BEP) based combination chemotherapy is established as standard treatment for testicular germ cell tumors. As these tumors are highly curable, so management is crucial in terms of long term toxicity particularly lung toxicity. With standard BEP there is increased toxicity which leads to poor compliance. So we at a tertiary care centre assessed modified BEP regimen in such patients and evaluated its effectiveness in terms of response and toxicity as compared to standard BEP.

Forty-eight patients of testicular germ cell tumors were enrolled in this study from January 2012 to December 2016. The modified BEP regimen consisted of bleomycin 30 IU Day 1, cisplatin 20 mg/m2 Day 1-5 and etoposide 100mg/m2 Day 1 to 5, given every three weeks. The planned drug intensities were 33.3 mg/m2/week for cisplatin, 166.7 mg/m2/week for etoposide and 10 IU/body/week for bleomycin. The schedule for chemotherapy was as follows: four courses of modified BEP for stage I patients and six courses of modified BEP for stage I S, II and III patients.

Overall Response rate in our study was seen to be 81.2% which was comparable with the available evidence. Five (10.4%) patients had febrile neutropenia. Two (4.1%) patients showed clinically evident bleomycin induced pulmonary toxicity. Lower toxicity seen in these patients led to better overall compliance.

Modified BEP protocol is a good alternative to standard BEP with comparable efficacy and reduced toxicity. 

Febrile neutropenia (FN) is a common complication in oncologic patients. Risk-stratification scores, like MASCC score, should be performed as part of initial approach at the General Emergency Department (GED) to identify low-risk FN patients (MASCC score ≥21).

Retrospective study of patients with solid neoplasm diagnosed with FN in a Portuguese GED between 2014 and 2017.

Of the 118 patients admitted in the GED with neutropenia, 66 were excluded because they didn't have solid neoplasia or had neutropenia without fever. 52 patients included in the study. 57.7% were female, with a median age of 66 years (30-84). The most frequent cancers were breast (36.5%), lung (17.3%) and colorectal (17.3%). 44.2% had metastatic disease. MASCC score was calculated in 9 patients (17.3%). Of the 7 patients with low-risk, 5 were admitted to the hospital with intravenous antibiotic therapy (AT). We calculated, a posteriori, the MASCC score of the remaining 43 patients and 51.3% presented a low-risk, in which 1 patient was treated at home with oral AT. All hospitalized patients received intravenous AT. The regimen most widely used was Piperacilin/Tazobactam plus an aminoglycoside (76.6%). Blood cultures were positive in 17% of patients and the most common agent was a multisensitive E. coli. 85.7% of hospitalized patients were treated with G-CSF, with half presenting at low-risk.

This study aims to demonstrate that the MASCC score is rarely performed at the GED, in which practically all patients are hospitalized for broadspectrum intravenous AT and for G-CSF, including low-risk, despite the recommendations from leading oncology societies stating the opposite. Introduction Grastofil® (filgrastim) is a biosimilar to the reference biologic drug Neupogen® (filgrastim) and is used for the primary prophylaxis (PPx) of febrile neutropenia (FN). The aim of this study was to compare the incidence of FN in breast and lymphoma cancer patients who received PPx with Grastofil® versus Neupogen® at our centre.

Beginning January 2017, breast and lymphoma cancer patients receiving chemotherapy with neoadjuvant/adjuvant intent (breast cancer) or curative intent (lymphoma) received PPx with Grastofil®. A retrospective chart review of all eligible breast and lymphoma cancer patients receiving PPx with Grastofil® during January 2017 to September 2018 and Neupogen® during 2013-2017 was conducted. Patient, disease, and treatment characteristics were collected along with Grastofil® and Neupogen® usage. The primary endpoint was the occurrence of FN. Secondary endpoints included dose-delays and dose-reductions. Results 120 Grastofil® and 202 Neupogen® patients were included in the present study. Overall, 10 (8.3%) Grastofil® patients experienced FN during treatment, 21 (17.5%) experienced a dose-delay and 65 (54.2%) received a dose-reduction. In comparison, 17 (8.4%) Neupogen® patients experienced FN, 44 (21.8%) experienced a dose-delay and 112 (55.4%) received a dose-reduction.

The incidence of FN in patients who received PPx with Grastofil® was comparable to patients who received PPx with Neupogen®. Moving forward, Grastofil® and Neupogen® patients will be case-matched for chemotherapy regimen, planned dose intensity, age at treatment, hemoglobin, sex and bone marrow involvement (for lymphoma patients only), in a 1:1 ratio to compare the rates of FN with an equivalence statistical design. Neutropenia-infection and myelosuppression, Hematology, Bucharest, Romania Introduction I have noticed over the years as acute leukemia appear and the relapse of the disease occurs mainly in spring and autumn, so I want to study "possible viral involvement in DNA modifying of patients with acute leukemia". For that, I want to research the possibility of involving certain viruses. Most leukemias are discovered by an infectious process. I believe that a screening test would be useful regarding common infection (for exemple: Influenza virus, coronavirus, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, herpes simplex virus, HTLV). We make serological screening for usual infections, but we don't make screening for the viruses described above. A molecular analysis it would help us more. The number of samples available is 25 and the number anticipated in one year is 50.

We make serological screening for usual infections, but we don't make screening for the viruses described above. A molecular analysis it would help us more.

Most leukemias are discovered by an infectious process. I believe that a screening test would be useful regarding common infection (for exemple: Influenza virus, coronavirus, parainfluenza, respiratory syncytial virus, rhinovirus, adenovirus, herpes simplex virus, HTLV). Support Care Cancer (2019) 27 (Suppl 1):S1-S302 S136

I have noticed over the years as acute leukemia appear and the relapse of the disease occurs mainly in spring and autumn, so I want to study "possible viral involvement in DNA modifying of patients with acute leukemia" 

Severe neutropenia and infections are frequent adverse events associated with standard chemotherapy regimens. We tightly monitored absolute neutrophil counts (ANCs) in a patient population undergoing anthracycline and cyclophosphamide treatment. Results prompt us to recommend apposite time points to monitor ANCs.

MyeloConcept is a randomized, double-blind, placebo-controlled, multicentre phase 2a trial, in which patients received adjuvant or neoadjuvant chemotherapy for the treatment of breast cancer. This abstract reports on the placebo group of 65 patients who received chemotherapeutic treatment with epirubicin (E) 90 mg/m 2 BSA + cyclophosphamide (C) 600 mg/m 2 BSA q21d. Patients' ANCs were measured at least 9 times (on average every three days), throughout the first chemotherapy (CTX) cycle.

The mean time after CTX start to the ANC nadir was 13.8 days (SD 1.31; median 14.0). ANC CTCAE severity grades 3 and 4 were reached in 65 (100%) and 53 (81.5%) subjects, respectively, and mean duration of grade 3 and 4 neutropenia was 7.81 days (SD 2.46; median 7.77) and 5.57 days (SD 2.48; median 5.44), respectively, in the first CTX cycle. The onset of grade 4 neutropenia occurred between day 10 and day 15 ( Table 1 ,2).

ANC monitoring may be most informative if measured on day 11 or day 12 to assess the first occurrence (incidence) and on days 13 to 15 for the presence of grade 4 neutropenia (prevalence). A reliable and early detection system for grade 4 neutropenia offers an opportunity for the instigation of preventative measures to mitigate the infection risk for patients. Introduction FOLFOXIRI/bevacizumab (bev) is a valid option as first-line therapy for unresectable metastatic colorectal cancer (mCRC), as reported in TRIBE and TRIBE2 trials. Here we aim at describing neutropenia (N) and febrile neutropenia (FN) associated with its use in order to estimate their clinical relevance. Methods Safety data of 1175 patients enrolled in the TRIBE and TRIBE2 studies were reviewed. The incidence and severity of N and FN, and the use of G-CSF in the triplet/bev and in the doublets/bev arms were compared using the Chi-square or the Fisher exact test as appropriate. Results Table 1 

94% of policies highlight NS as a medical emergency, with 98% defining a target 'door to needle' time for first dose antibiotics or stating antibiotics must be given immediately. 98% of clinicians also aim for 60 minutes or less to first dose antibiotics, with 47% reporting this is easy to achieve. Diagnostic criteria used in policies and by clinicians continue to vary; although 76% of clinicians report making a diagnosis is easy. Most policies encourage peripheral and central blood cultures (92%) and that several routine blood tests are checked (79%). 100% highlight that central lines do not need removed routinely and 64% that chest x-rays are not required unless clinically indicated. 85% of policies promote initial beta lactam antibiotic monotherapy (compared with 36% prior to NICE guidance), with significant reductions in empirical aminoglycosides and glycopeptides.

Although definitions and diagnostic criteria vary this work demonstrates a consistent approach to emergency NS management across the UK. Local policies and clinicians reported practice confirms the prioritising of NS as a medical emergency and reflects natonally recommended initial investigations and antibiotic regimens. 

For patients presenting with neutropenic sepsis (NS) clinicians are encouraged to assess their risk of septic complications using a validated tool. This approach is promoted by national UK NS guidelines (NICE), and international organisations such as MASCC, ASCO and ESMO. Methods 53 local adult NS policies from across the UK were reviewed for approaches to risk stratification, along with 217 responses from an electronic survey of clinicians' standard clinical practice.

53% of policies encourage identification of 'low risk' patients within 24 hours of presentation and consider discharge on oral antibiotics prior to 48 hours in hospital (45% calculate a MASCC score, 8% their own criteria). This compares with approximately a third of policies when practice was reviewed in 2012. 40% of clinicians routinely risk stratify patients within 24 hours (70% MASCC tool, 30% institution's own risk scoring system, Modified Early Warning Score or Clinical Index of Stable Febrile Neutropenia). Awide range of approaches to early oral antibiotics, discharge and ambulatory care are described in policies and by clinicians. There is limited evidence of empirical oral antibiotics for low risk patients (9% policies, 5% clinicians) but a preference for initial intravenous antibiotics for all patients.

There has been some enhanced uptake of routine risk assessment and consideration of early outpatient oral antibiotics for low risk patients. However this does not appear to be widespread standard practice. Further efforts are therefore required to improve the usability and performance of currently validated tools and optimise and promote low risk management care pathways. 

Bacteremia or bloodstream infection is a cause of morbi-mortality in cancer patients, due to its severity, longer hospital stay, chemotherapy withdraw and increased costs. Its prevalence ranges 11%-38% and the mortality rate is around 40%. These numbers tend to increase with the emergence of multidrug-resistant bacteria (MDR). The authors aim alert the community to this emerging problem.

The authors collected every cancer patient hospitalized in our cancer center, who developed bacteremia during their stay in hospital or at admission, in the last 8 years. Data was treated with SPSS.

A total of 184 bloodstream infections were reported, with positive cultural isolations. Almost half of the patients had gastrointestinal cancer (47,8%), followed by breast cancer (15,8%). Males were predominant (56,5%) and the median age was 65 years-old. The catheter totally implanted (CTI) was the responsible in 37,5% of the cases, and 30,4% had no identified focus. The infection contributed or was the cause of death in 38,6% of the patients. The responsible microorganism was the Escherichia coli in 24,5%, followed by the staphylococcus aureus in 14,7% of the infections. From all bacteria, 17,4% were MDR and 24% were resistant to at least one antibiotic. The staphylococcus aureus was meticilin-resistent in 37%.

Bacteremia is a major cause of mortality and morbidity in cancer patients and currently there are no guidelines regarding prescription of antimicrobial therapy in cancer patients or in palliative care. More than a third of the patients die and the CTI is the main source of infection. 

Anorexia cachexia syndrome has been recognized as an important modifiable factor in cancer prognostication.

A questionnaire based assessment comprising of demographic characteristics, symptoms of CACS, secondary nutrition impact symptoms, haematological and biochemical parameters was performed among 61 patients who presented to the out patient setting.

The average age of participants was 47.4 years. 63.9 percent had an ECOG performance score of 1. The most common site of involvement was Breast followed by Head and Neck squamous cell carcinoma. 21 (32.8 %) patients were receiving ongoing chemotherapy. The optimal treatment of cancer-related malnutrition remains unknown. A real-world study was performed to compare the effectiveness of enteral nutrition (EN) and megestrol acetate (MA) with MA alone in the treatment of cancer-related malnutrition.

Methods 101 patients were observed during June 2016 to August 2017, including Arm 1 (n = 53, 52.5%) using MA (160 mg/d), and Arm 2 (n = 48, 47.5%) using MA (160 mg/d) combined with EN (Enteral nutrition powder, 55.8 g/t.i.d). Treatment duration was 12 weeks. All patients could receive anticancer therapy. The primary endpoints were improvements in body mass index (BMI) and Eastern Cooperative Oncology Group (ECOG) score. Secondary endpoints were assessed by appetite, mid-upper arm circumference (MAC), serum pre-albumin levels, and serum albumin levels.

Baseline levels were comparable between Arm 1 and Arm 2 patients. Primary (ECOG, P = 0.001) and secondary (appetite, P = 0.005; serum pre-albumin, P = 0.011; and serum albumin, P = 0.003) endpoints improved significantly after treatment in Arm 2. Toxicity was negligible and comparable between Arm 1 and Arm 2.

Conclusions MA combined with EN may be a safe, convenient, and effective treatment option for cancer-related malnutrition. 

Cancer cachexia, is a syndrome characterized by weight loss, anorexia and malnutrition, which has been shown in about 50%-80% of cancer patients and accounts for 20% of the causes cancer-related mortality. IL-6 is an inflammatory factor shown frequently in cancer cachexia patients. The aim of our study was to investigate the association between IL-6 and nutritional status in metastatic cancer patients

We measured serum IL-6 level in blood samples were collected from a total of 31 metastatic cancer patients. We divided into two group high and normal IL-6 level, and analyzed the correlation with nutritional status through blood test.

Of 31 

Nutritional status plays an important role in the postoperative outcome and the prognosis of various cancers. This study evaluated preoperative nutritional status-related indices associated with clinical outcome of malignant patients who underwent pancreatectomy.

Data were prospectively collected from 76 patients who underwent pancreatectomy from August to September 2017 and retrospectively analyzed. Nutritional status assessment included a diagnosis of malnutrition (ASPEN), body weight, body mass index, serum albumin, prognostic nutrition index(PNI) and intake at discharge.

In multivariable analysis preoperative low PNI (≤44) was an independent prognostic factor for long hospital stay after surgery in patients underwent pancreaticoduodenectomy and total pancreatectomy [odds ratio ( 

Cancer-related malnutrition and sarcopenia are independently associated with reduced survival, increased treatment toxicities and poorer function. International evidence-based guidelines exist to guide nutrition screening and interventions. However, despite the severe consequences, little is known about Australian cancer clinicians' awareness of these conditions and practices relating to their identification and management. This study aimed to determine clinician awareness, understanding and perceptions of malnutrition and sarcopenia in people with cancer. Methods A cross-sectional survey of Australian cancer clinicians was undertaken between November 2018 and January 2019. The 30-item online survey was circulated through professional organisations and health services.

The 111 participants represented dietetic (38%), nursing (34%), medical (14%) and allied health (14%) clinicians. Overall, 95% and 93% clinicians were aware of accepted definitions of malnutrition and sarcopenia, respectively, with 93% agreeing these were extremely or very important conditions in the overall management of people with cancer. However, perception of responsibility for identification of these conditions varied considerably. Further, 21% and 43% of clinicians had limited or no confidence in their ability to identify malnutrition and sarcopenia, respectively. Greatest barriers to identification of malnutrition were a lack of time and services to manage malnourished patients. Greatest barriers to identification of sarcopenia were lack of evidence to support this practice and not being an organisational priority.

Awareness of cancer-related malnutrition and sarcopenia are high among Australian cancer clinicians. Although, the identification of these conditions is limited by variation in perceived responsibility and lack of confidence. A national position statement is required to improve care. 

Cancer patients often suffer from Malnutrition which raises the risk of infections. Being immunocompromised, there is a marked reduction on quality of life (QoL) and health outcome. Malnutrition also enhances the incidence of postoperative complications such as delayed wound healing, wound dehiscence, morbidities and mortalities. To investigate malnutrition among cancer patients and to assess the nutritional status of patients receiving chemotherapy.

The study was conducted in Sir Ganga Ram Hospital, Lahore. Simple screening tool (Short screening sheet) for malnutrition was used. Nutritional assessment of 80 patients receiving chemotherapy was done by assessing BMI, mid upper arm circumference MUAC, triceps skinfold thickness TST, serum albumin, Total lymphocytes count. Nitrogen Balance and intake of macronutrients were also analysed.

According to full nutritional assessment, 42 patients (52.5%) out of 80 were found malnourished. Short screening sheet identified 51 patients as malnourished who were receiving chemotherapy. The SSM had a specificity of 0.88 and sensitivity of 0.72. 62% of the patients exhibited negative nitrogen balance.

Nutrition is the most neglected area of clinical care. Early nutritional support and counselling is essential in order to improve patients Quality of Life (QoL). Mass media should be involved so that adequate attention can be given to nutritional issues arising in diagnostic and therapeutic procedures 

Oncology clinicians support the nutritional management of cancer patients thus improving their nutritional status, quality of life and reducing morbidity. The aim of this study was to investigate the attitudes, practices and behaviours of the MASCC Nutrition and Cachexia Study Group as well as clinicians from other health professional organisations.

An online survey was disseminated through the mailing lists of MASCC and multiple healthcare organisations over 3 months. The survey consisted of 46 questions with a mixture of Likert scale and open-ended questions, and respondents could select common issues from a supplied list as well as providing "other" options.

We received 232 responses from 22 countries; the majority of clinicians being: Dietitians (34%), Physicians (16%) and Nurses (12%). The greatest challenges were health services barriers (37%), health literacy of patients (34%) and inconsistent patient followup (40%). Qualitative data indicated inconsistent health messaging between the professions, a need for better interdisciplinary action and common interdisciplinary resources. Most (95%) clinicians had nutrition screening in their facilities and half felt confident in its use (major nutrition screening tools being: MST (45%); PG-SGA SF (12%); and MUST (9%). The most common nutrition assessment tools were PGSGA (35%) and SGA (23%). Body composition (BIA (12%) and CT scans (6%)) and hand grip strength (16%) were less frequently used.

This survey provides a baseline summary of the knowledge, behaviour and needs of a cohort of international and multidisciplinary oncology clinicians which can be used to target the development of interdisciplinary guidelines and oncology nutrition education. 

There is no doubt that cancer is a major health burden and a driving force behind the most of the novel therapies however, therapeutic failure is a vital problem that may be related to gut bacteria according to growing body of evidence in medical literature. We all familiar with the concepts of Microbiome, Prebiotics, Probiotics and synbiotics. Postbiotics are soluble products and metabolites of microorganisms that have biological activities and may be a safer alternative to live microorganisms especially in immunocompromised hosts such as cancer patients. Aim of this study is to review the current literature about the use of postbiotics in patients receiving chemotherapy. Methods Keywords "postbiotics" and "Chemotherapy" or "Cancer" were searched in databases of Pubmed and Web of Sciences until 01.01.2019.

This search yielded only 5 articles, of which 4 of them are reviews and only one article was about postbiotic use in inflammatory bowel disease.

Bacteriocins, exopolysaccharides, and short chain fatty acids, classified as postbiotics, exhibited efficacy in terms of attenuation of mucositis in animal studies and in vitro cell cultures via increased apoptosis and decreased cancer cell survival. However, no human data was encountered during the search, that underlines the necessity of human studies on this popular and promising area with the virtue of safety and most of the health benefits of probiotics. 

Cancer Anorexia (CA) affects between 40-60% of all cancer patients, and 50-80% of patients with advanced disease. Anamorelin and cannabinoids are among the most promising therapeutic agents for CA.

Anamorelin is a potent ghrelin mimetic. Ghrelin is a peptide hormone, predominantly secreted by gastric endocrine cells, to induce food intake. Ghrelin is a ligand for the G-protein-coupled ghrelin receptor, which is highly concentrated in the paraventricular, ventromedial and arcuate nuclei of the hypothalamus. This coupling stimulates neuropeptide Y (NPY) and agouti-related peptide (AgRP) activity. Increasing concentrations of NPY increases food intake and decreases energy expenditure, while AgRP acts as an antagonist to anorexigenic melanocortin receptors. As with ghrelin, anamorelin binds to the ghrelin receptor, leading to the downstream expression of NPY and AgRP, thus leading to appetite stimulation. Cannabis, particularly delta-9-tetrahydrocannabinol, acts on the CB1 cannabinoid receptor to stimulate appetite, partly through the modulation of ghrelin production. Ghrelin levels increase and Peptide YY (PYY) levels, an anorexigenic peptide released by gastrointestinal mucosa, decrease after smoking cannabis in HIV patients. Cannabis-related changes in these hormones have a magnitude similar to what is observed with food intake over the course of a day in healthy volunteers, suggesting physiological relevance.

Hypogonadism is common among men with advanced cancer. Little is known about the impact of hypogonadism on symptoms and body composition in cancer cachexia.

A retrospective chart review of men referred to a Cancer Rehabilitation Program was performed. All men had bioavailable testosterone (BT) measured. Patients were classified as hypogonadic (hypo) or eugonadic (eugo) based on age-specific cutoffs. Additionally, patients were identified as cachectic (C), as defined by Vigano et al. (Clin Nutr. 36:1378 -1390 , 2017 . Body composition was measured using dual-energy X-ray absorptiometry; appendicular skeletal muscle index (ASMI) was calculated. The revised Edmonton Symptom Assessment System questionnaire (ESAS-r) was completed. Men who had prostate or testicular cancers were excluded.

Eighty patients were included (mean age 67.2±10.2 y). The overall prevalence of hypogonadism was 31.2%. When comparing the eugo+C and hypo+C patients respectively, ESAS-r scores for appetite (4.78±3.34 vs 6.54±2.43; p=0.02) and wellbeing (4.66±2.50 vs 6.37±2.51; p=0.006) were significantly greater in hypo+C patients. In addition, fatigue exhibited a statistical trend between the two groups (5.20±2.54 vs 6.29±2.17; p=0.07). A statistically, but not clinically, significant difference in ASMI was found between the eugo+C versus the hypo+C patients (6.27±0.87 vs 6.50±0.75 kg/m2; p=0.029); both groups fell far below the cutoff (7.26 kg/m2) for normal muscle mass.

Male hypogonadism may negatively impact quality of life and cancer symptoms, but not ASMI, in cancer cachexia. Consequently, when cachexia is clinically established, testosterone replacement therapy may be of greater use for symptom management, rather than preservation of muscle mass. 

Significant changes in nutritional status are the major concern in the patients with pancreatic tumor after surgery. The risk factors with poor nutritional status among this population have not been studied. Therefore, the aim of this study was to explore the risk factors related to poor nutrition within one year after surgery in patients with pancreatic tumor. Methods A longitudinal study was conducted in surgery clinics. Patients with pancreatic tumor were going to receive surgery were recruited. The data were collected at four times including before surgery (T0), 3, 6, and 12 months after surgery (T1, T2, T3). Mini Nutritional Assessment (MNA), Symptom Severity Scale, and demographic and disease information were used, and the risk of poor nutritional status has been identified as score less than 12 in the MNA. Generalized estimating equation with unstructured working logit matrix was used to explore the risk factors with poor nutritional status.

Among 75 patients, patients having regular exercise (OR = 0.395), operation with PPPD (OR = 0.242) and at T3 (OR = 0.431) had lower risk with poor nutritional status. However, the patients had surgical complication (OR = 2.579), higher symptom severity (OR = 1.041) and at T1 (OR = 2.434) had higher risk with poor nutritional status.

Encouraging patients keeping with regular exercise might be the modifying factor to prevent from poor nutrition and decreasing surgical complication and symptom severity were the factors that health care providers could pay more attention on them after surgery for this population.

Nutrition-related problems in cancer are under-recognised and undertreated. Few healthcare professionals discuss nutrition/diet with cancer patients. Consequently, patients may seek information from other sources. Information sources and types of advice accessed are unknown. This study aimed to determine the source and type of nutritional/dietary information accessed by cancer patients prior to first dietetic assessment and the degree to which advice was followed.

This prospective, multi-center, cross-sectional observational study recruited consecutive cancer patients at seven tertiary centers. During initial dietetic assessment, a dietitian determined all nutritional/dietary information accessed since cancer diagnosis.

Results 49 participants recruited. Median age: 61. Median time from diagnosis to initial dietetic assessment: 4 months. In rank order the sources of information prior to dietetic referral were; 1) family/friend (n=20), 2) healthcare professional (n=14), 3) media (n=9) and 4) online forums/ websites (n=9). Nine (18%) accessed no information. Avoidance of certain foods, particularly sugar, dairy and meat was most common advice. The consumption of fruit, vegetables, protein, juices and wholegrain was promoted. 53% followed and 8% partially followed advice. Many expressed regret that dietetic referral had not occurred earlier. To investigate the cognition difference among patients with cancer, their family members, their physicians and their nurses in nutrition status and nutritional therapy.

The enrolled patients were evaluated by NRS2002 nutritional risk scale and QLQ-C30 scale. The patient-centered groups, including the patient, the main caretaker, the physician and the nurse, were given a questionnaire on the cognition and attitude of cancer nutrition therapy.

The incidence rate of nutritional risk in hospitalized patients with thoracic cancer was 13.8%. There were significant differences in the accuracy rate of nutritional risk assessment among the four groups (P < 0.001), in which nurse's was 70.3%, 55.1% of physician, 38.7% of family members and 33.0% of patients, which was the poorest accuracy rate. However, there was no significant correlation between the accuracy of nutritional risk assessment and the education level and personal monthly income of each population (P > 0.05). Nearly all the four groups considered it necessary to learn more about the knowledge of cancer nutrition therapy. For patients and their families, the main way to understand the knowledge of tumor nutrition was communicating with patients and professionals; for doctors was new media, and nurses was professional training.

Nurses ' assessment of nutritional risk in cancer patients achieved the highest accuracy, while the poorest accuracy raised from the patients. The vast majority of patients and their families, as well as all physicians and nurses, deemed it necessary to understand cancer nutrition therapy, but the need to access relevant information varies. 

Adult T-cell leukemia is resistant to chemotherapy and with no known cure. The leukemogenesis of the virus is attributed to the viral oncoprotein, Tax, that activates the nuclear factor kappa B (NF-κB) which in turn stimulates the activity and expression of the matrix metalloproteinase-9 (MMP-9) which are important in angiogenesis and metastasis. The objective of this study is to investigate the efficacy of a specific nutrient synergy (SNS) on Tax expression, NF-κB levels as well as on MMP-9 activity and expression both at the translational and transcriptional levels in HuT-102 and C91-PL cell lines.

The effects of non-cytotoxic concentrations of SNS ranging from 0-350 μg/ml were evaluated for their efficacy on proliferation, Tax expression, NF-κB mobility and the activity and expression of MMP-9. ELISA and EMSA were used to assess the effect of SNS on NF-κB mobility. Zymography was used to determine the activity and secretion of MMP-9. The expression of MMP-9 was done using RT-PCR at the translational level and Immunoblotting at the transcriptional level.

Results A significant inhibition of proliferation was seen in both cell lines starting at SNS concentration of 200μg/ml in a dose dependent manner. SNS induced a dose dependent decrease in Tax expression, which was paralleled by a down-regulation of the nuclearization of NF-κB. This culminated in the inhibition of the activity of MMP-9 and their expression both at the transcriptional and translational level.

The potential role of nutrients should be emphasized in the treatment of cancer.

H. Sekido 1 , K. Sekido 2 , K. Harada 2 , S. Uemura 3 , K. Tsutsumi 4 , H. Takeichi 5

We can assume that diet does not only represent nutritional support for cancer patients in the terminal stage. This study is intended to clarify the actual status and meaning of diet for cancer patients in the terminal stage by analyzing written records of patients' battles against the disease, using text mining methods.

Methods Eight records of their battles against the disease, written by cancer patients and their families, were analyzed by extracting sentences and words about diet using text mining methods.

The following most commonly used words were identified through word frequency analysis: "diet", "patient" and "favorite food". As a result of cluster analysis, descriptions about diet were classified into four clusters. The four clusters were interpreted as follows; "Eating by mouth means life", "The last hope", "Pleasure in eating", and "Appreciation of being able to eat food". The co-occurrence network analysis showed that words with high centrality included "eat" and words strongly associated with target words included "life" and "pleasure ".

Cancer patients appreciated every day when they could eat, and they considered eating to be their last remaining pleasure. Therefore, it was suggested that eating could provide them with a real feeling of living, and play an important role in connecting them with the hope of living. It is essential to support cancer patients in the terminal stage to allow them to eat without experiencing as little pain as possible, because eating plays a very important role in the mental health of these patients. To the best of our knowledge, we report the largest series of patients suffering from dry mouth induced by immune checkpoint inhibitors.

Clinical and immunohistological characterizations of 15 patients treated by ICI and addressed the Oral medicine department of a reference center.

We report a series of 15 patients with xerostomia induced by immune checkpoint inhibitors. All patients were treated for metastatic cancer. They were treated with an antiPD1/PDL1 antibody, either in monotherapy or in association with an anti-CTLA4 antibody. The mean time between the initiation of ICI first infusion and the occurrence of dry mouth was 17 weeks. Most patients had low grade symptoms. Biopsy of accessory salivary glands was performed. Chisholm mean score was 2 (range 0-4). Autoantibodies (anti-SSA/Ro, anti-SSB/La, antinuclear antibodies) were negative except in one patient who developed a Sjogren syndrome. Immunohistological analysis individualized lymphocytic infiltration, showing a predominance of T-cells CD4 positive infiltrate. Oral basic support care to manage xerostomia was prescribed with no or moderate improvement.

Xerostomia induced by immune checkpoint inhibitors may appear either in isolated manner or exceptionally in the context of Sjogren syndrome.

This study proposed that the implementation of appropriate oral care education in a clinical care setting can not only promote oral comfort and reduce the incidence of lesions, but also prevent the occurrence of treatment-related side effects and, thus, improve the therapeutic effect of treatments.

1. An oral care educational video was filmed. The film covered issues such as the importance of oral hygiene, assessment methods, cleaning procedures, tool preparation, cleaning steps, and mouth washing procedures.

2. Depending on the patient's condition with respect to pain and in accordance with physician orders, analgesic drugs or mouthwashes with analgesic effects may be prescribed, such as in the case of patients who find it difficult to open their mouths due to the presence of tumors; a 10cc syringe and rubber tube may be used to extract the mouthwash and simulate the act of rinsing, after which a small cotton swab and suction tube may be used to assist in the cleaning process..

Through the use of the health education leaflets and the QR code to promote access to the health education video and information on actual procedures, patients and their family members were able to understand the health information better, resulting in an increase in the oral care implementation rate of the patients to 85%.

The nursing issues most commonly encountered by head and neck cancer patients are those related to the oral mucosa, and proper oral care or oral hygiene can help prevent the occurrence of issues such as oral mucositis. 

Guidelines suggest that odontogenic infections should be eliminated prior to initiation of chemotherapy. Particularly, patients with newly-diagnosed acute myeloid leukemia (AML) are at risk of infection during induction chemotherapy (IC) which results in profound neutropenia and thrombocytopenia. Accordingly, we initiated a prospective clinical screening program intended to diagnose and treat acute odontogenic infections in patients with AML prior to IC, with the goal of reducing the rate of infectious dental emergencies (historic rate 4.28%; 95%CI:2.0-6.56%) during the induction period.

Screening examinations are recorded in a dental database. The database and dental charts (n=1888) were reviewed to identify cases fulfilling the following inclusion criteria: 1) Diagnosis of "AML or other related neoplasms" 2) Admission for IC to authors institution 3) Presented for dental screening or dental emergency while admitted for IC between Nov 1, 2014 and Dec 31, 2016. Two independent reviewers assessed each chart to determine if the dental emergency represented an infectious dental emergency.

In total, 337 patients with AML were admitted for IC to the authors' institution from Nov 1, 2014 Globally, India has a high burden (20%) of oral cancer with 1% prevalence of premalignant lesions. Most cases are attributed to modifiable risk factors such as substance abuse (tobacco and alcohol), dietary deficiencies, and environmental exposures (solar radiation and air pollution) aggravated by delayed detection and care especially in rural areas.

An unmatched case-control study was done at two randomly chosen rural health centers in Jodhpur, India. A total of 84 cases and 168 controls were included during 6 months study period (2016). Randomly selected outpatient department attendees were interviewed and screened for oral cancer and pre-malignant lesions. A structured questionnaire interview along with comprehensive oral, head and neck examination was conducted. Data were analyzed using multivariate logistic regression, and confidentiality of data was maintained.

The majority of the study participants were rural residents (82.9%) with poor socioeconomic status. Opportunistic oral screening revealed a variety of cancerous and precancerous lesions. Most common case pathologies were submucosal fibrosis (40.5%), inadequate mouth opening (35.7%), cheek bites (28.6%), leukoplakia (23.8%) etc. Multivariate analysis suggested that tobacco intake (adjusted odds ratio = 13.6, P ≤ 0.01) dietary deficiency (7.4, <0.01), oral sepsis (7.0, <0.01), oral lesions (6.8, <0.01), and sun radiation exposure (9.5, <0.01) were significantly associated with oral cancer pathology.

The study provides strong evidence that tobacco, dietary deficiency, oral sepsis and lesions, and sun radiation exposure are independent risk factors for oral cancer. It also reiterates the importance and application of opportunistic oral cancer screening at primary care level. 

An investigation was undertaken and it found that the correctness for selforal care was only 63.4%, the satisfaction of patients towards the instructions for the oral care given by the nursing staff was only 80.3%.

Measures for improvement were started in January 2016 which included:

(1) establishing a standard guideline for oral care care after head and neck cancer surgery, (2) creating leaflets and manuals for post-operative care of head and neck cancer surgery, (3) recording the oral care instructions in multimedia format and corresponding QR codes easily accessible through mobile devises,(4) designing a checklist of appropriate oral care instruments which the patients can tick off according to their personal needs, (5) designing patient self-care care progress sheet, (6) conducting regularly phone interviews and follow-ups and building a data base on the analysis of the results.

After the implementation of the above-mentioned measures, the correct rate of self-oral care for patients with head and neck cancers was remarkably increased from 63.4% to 90.2%. The satisfaction of patients towards the instructions for the oral care given by the nursing staff was increased from 80.3% to 94.8% as well.

The design of leaflets, manual and multimedia material for oral care after head and neck cancer not only enhanced the convenience in the instructions by the nursing staff but also greatly improved the learning efficiency and correctness by the patients and their primary caregivers, thus achieving the goal that the patients could take care of themselves correctly on their own. 

Radiation-related caries is one of the major long-term side effects in the oral cavity related to head and neck radiotherapy. Although dental caries is a biofilm and sugar dependent disease, the pathogenesis of this disease when associated with radiotherapy remains poorly understood and the possible oral microbiome changes after head and neck radiotherapy needs better investigation and characterization. Therefore, this study aims to characterize the microbiota of caries related to radiotherapy. Methods 28 individuals were divided into groups: IC: irradiated patients with dental caries; NIC: non-irradiated patients with dental caries. Carious dentin, oral mucosa, supragingival plaque and gingival crevicular fluid samples will be collected at the time of initial diagnosis of caries lesions and submitted to metagenomic and PCR assays to identify the microbial population profile from the sequencing of the 16S ribosomal gene on the Illumina platform. Bioinformatics analyzes will be performed to determine the differences in the composition of microorganisms in each group and correlation with clinical parameters.

Preliminary results showed that irradiated patients had lower alfa-diversity (Kruskal-Wallis; p-value=0,014) when compared with control patients. Compositional analysis demonstrated increased relative frequency of genera Veillonella, Lactobacillus and lower abundance of Porphyromonas and Tannerella in irradiated samples compared with non-irradiated samples.

Head and neck cancer patients had lower microbiota's alfa-diversity and notable presence of genus related with lactate production.

Head and neck radiotherapy is associated with acute and chronic complications in the oral cavity. However, there are still gaps in the understanding of the risk factors for these complications. The objective of this study was to evaluate the clinical conditions correlated with acute (mucositis and candidiasis) and chronic (radiation caries and xerostomia) outcomes in patients undergoing radiotherapy for head and neck (H&N) cancer.

Observational study with 40 patients submitted to a minimum dose of 5.000cGY by IMRT in HN region. The incidence of these complications was correlated with: 1-Patient conditions (age and Decayed-Missing-Filled Index), 2-Tumor conditions (location and staging) and 3-Treatment (surgery, chemotherapy and surgical gland injury). The correlation between the outcomes was also evaluated.

Mucositis: tumors in cervical localization had lower incidence of mucositis than the other localizations (p: 0.02); Candidiasis: Stages III-IV presented higher incidence of infection (20.6%), than stages I-II (0%), (p: 0.03); Radiation caries: surgical lesion of the submandibular gland was a risk factor for caries (odss r.: 4.89); Xerostomia: None of the studied clinical conditions were associated with xerostomia but there was a strong correlation between caries and xerostomia (xerostomia: 33.3% with caries against 0% of caries in patients without xerostomia), p:0.04.

Tumor localization reduced the risk of mucositis, while staging III-IV presented a higher risk of candidiasis. Surgical damage of submandibular gland and xerostomia increased the risk of caries.

Intraoral devices may be useful for patients under radiotherapy in head and neck region due to mechanical separation of oral structures, distancing healthy tissue that does not need to receive radiation and, therefore, reducing side effects resulting from radiotherapy and improving patients' quality of life. The aim of this research was to evaluate the use of intraoral devices in patients submitted to Intensity-modulated radiotherapy and its side effects. Methods Individuals were divided into two groups: control group (CG), 12 patients without the device and study group (SG) 12 patients using the device. Patients were followed up from oral care before radiotherapy to after cancer treatment. Oral mucositis was evaluated according to World Health Organization criteria (CG and SG) and Oral Mucositis Assessment Scale (SG). Development of trismus (SG) was assessed through questionnaire.

There was a greater incidence in severity of oral mucositis in CG and lower degree of development of erythema and oral mucosa ulcers in SG (p <0.05). The mouth opening capacity after radiotherapy treatment in SG was decreased by an average of 10.3%.

The planning of distribution of isodoses in tumor and adjacent areas by computed tomography was facilitated using the device due to mechanical spacing of oral structures not compromised by cancer. The stabilization of the mouth and tongue position during radiotherapy made the treatment more comfortable for the patients, besides benefiting the work of the radiotherapist and medical physicist. 

Radiation therapy and chemotherapy are inherently associated with the production of various complications, ranging from the initial oral mucositis, xerostomia to osteo radio/chemo necrosis.

The aim of this study was to develop an oral care protocol and evaluate its effectiveness in HNC patients receiving chemotherapy and radiation therapy. This interim analysis included a single-blind randomized control trial conducted among 44 HNC patients in which 22 were assigned to experimental group and 22 to a control group who received standard of care (SOC) of oral care. Intervention group received oral care kit which consisted of ultra-soft bristle toothbrush, fluoridated toothpaste, oral rinses, chewy tube and patient education material. The outcome variable was measured by an oral health assessment tool and WHO oral mucositis grading scale.

Oral care protocol did not affect the development of the incidence of oral complications. However, median days to mucositis, taste loss, infection, bleeding gums and xerostomia were statistically significant in comparison with control (p<0.05). Significant difference was found in mucositis grading on 3rd, 4th and 5th week assessment (p<0.05) and severity was lower in the experimental group. The experimental group oral health assessment score during admission was decreased by .483 and at its end of treatment score was decreased by .270 indicating improved oral health.

Administration of a specific oral care protocol by trained staff nurses shown to improve oral health and awareness regarding oral complications among patients. This study recommends implementation of oral care protocol for all HNC patients in cancer nursing practice. 

Delayed alveolar repair after dental extraction are frequently observed in patients submitted to head and neck radiation therapy, and its adequate management is important to prevent osteoradionecrosis. This study aimed to evaluate the efficacy of photobiomodulation the alveolar mucosal repair of patients submitted to dental extractions after head and neck radiation therapy.

Forty surgical procedures randomly allocated into two groups: Photobiomodulation (PBM, 19 procedures: -dental extraction + PBM -808 nm, 40mW, 100J/cm2, 70s, 2.8 J/point and area of 0,028cm 2 ) and Sham-PBM (21 proceduresdental extraction + sham-PBM). Both groups received antibiotics and primary closure of the surgical site. The primary outcome was complete mucosal lining at 14 days, and the secondary outcomes were infection and postoperative pain at seven days. The patients were evaluated every 7 days during a time interval of 28 days.

Alveolar mucosal repair was shown to be faster in PBM; at 14 postoperative days 18/19 (94.7%) patients evolved with complete alveolar mucosal lining (p-value<0.001, number needed to treat=1.056). PBM patients reported post-operative pain less frequently (21.1% x 66.7%, p-val-ue=0.005), and also reported lower analgesics intake (p-value=0.005).

This study primarily demonstrated the efficacy of PMB in promoting a faster alveolar mucosal healing with less post-operative pain following dental extractions in patients submitted to head and neck radiation therapy. 

This study developed the Oral health-related Self-Efficacy scale for the Cancer patients (OSEC), which contains 17 questions with four response options each.

Between July 2018 and February 2019, 120 participants were enrolled in the study. We conducted the survey to examine the validity and reliability of OSEC. Concurrent validity was determined by correlations with the selfefficacy scale for advanced cancer (SEAC). Discriminant validity was examined using cancer stage grouping between stages I-II and III-IV. Predictive validity was examined using plaque control record. This study was conducted with the approval of the Medical Ethics Committee of Shimane University Faculty of Medicine (No.3243). We calculated two-tailed p-values in all of the analyses. The alpha level of significance was set at 0.05.

Factor analysis revealed five factors in OSEC. Cronbach's α coefficient, an indicator of internal consistency, was 0.77-0.86. Intraclass correlation coefficient of the OSEC total score, an indicator of test retest reliability, was 0.89. OSEC scores were significantly associated with scores for each factor of the SEAC. The difference of total score and all subscales of OSEC were statistically significant between clinical tumor stages I-II and III-IV (P<0.05). The plaque control record of the high score group of OSEC was significantly lower than low score group of OSEC (P<0.05).

We developed the OSEC as a multidimensional oral health-related selfefficacy scale for the cancer patients.

Xerostomia is one of the main acute and late complications that result in decreased patient's QOL during and after head and neck radiotherapy (HNRT). IMRT is widely accepted as a technique for preventing xerostomia caused by HNRT. However, the effectiveness of IMRT has been mainly reported about late xerostomia, and the effectiveness of IMRT for acute xerostomia has not yet been made clear. Therefore, the amount of saliva and the patient's symptoms during HNRT was investigated to identify the effectiveness of IMRT for acute xerostomia.

Patients with HNRT were divided into two groups, the IMRT group and the 3DCRT group. The change of salivation and the patient's symptoms were prospectively investigated in each group. In addition, the relationship between the mean radiation dose of the salivary glands and the reduction of salivary function was investigated.

In both groups, the amount of saliva was significantly decreased and the patient's symptoms were also significantly worse. Additionally, there was no statistically significant difference between the two groups. After HNRT, 3DCRT group did not show any tendency to recover them. On the other hand, the IMRT group recovered the stimulated saliva statistically significantly.

Conclusions IMRT could alleviate late xerostomia, unfortunately the effectiveness for acute xerostomia was not indicated. Therefore, even though IMRT is selected, it is necessary to provide management of acute xerostomia similar to 3DCRT. Since the IMRT group showed the need for a long time to recover salivary function, management of late xerostomia after HNRT is important for keeping patients' QOL. 

Trismus is a common adverse effect of mouth cancer treatments. It has negative impacts on the survivors' life. Although trismus can be treated with conventional exercises either using simple tools or advanced devices, the efficacy of these exercises is limited because the exercise programs are difficult and therefore not appealing to the affected population.

This study aims to develop a user-friendly and interesting program called "Mouth Opening Laughter Yoga" for the mouth cancer survivors and assess its effects on trismus-related symptoms.

Fifty mouth cancer survivors who have trismus will be recruited from a Taiwanese hospital. The subjects will be randomly assigned to either an experimental group (n = 25) and a control group (n = 25). The experimental group will conduct "Mouth Opening Laughter Yoga" following a 20-minutes film daily for 10 weeks. To decrease the attrition rate, the researcher will guide the subjects to conduct laughter yoga together once a week. The control group will do mouth exercise following a conventional mouth exercise CD for the same exercise frequencies as the experimental group. The outcome will be measured by a Jaw ROM Scale, Okayama University Hospital, Hospital Dentistry, Okayama, Japan

Perioperative oral management is important to avoid dental/ systemic problems. However, routine perioperative professional dental checkup is generally not performed, and management might rely on a patient's answer to this simple question: "Do you have concerns with your mouth when undergoing surgery?" This study aims to evaluate the sensitivity and specificity of this simple question.

In this study, 361 consecutive preoperative patients with cancer (M, 192; F, 169; 24-90 y, median, 69 y) who presented to our division were enrolled. Patients were requested to answer this simple question: "Do you have concerns with your mouth when undergoing surgery?" Thereafter, dentists examined patients with the aim of (1) preventing acute odontogenic pain caused by pulpitis and/or acute odontogenic infection during the perioperative period, (2) enabling patients to achieve oral nutrition/ingestion by dental treatment, and (3) preventing dental injury during orotracheal intubation. The sensitivity and specificity of this question were retrospectively evaluated.

Overall, 73 patients answered "Yes," and 50 were found to have some oral problems, whereas 23 were without problems. Moreover, 288 patients answered "No," but 117 were found to have some oral problems, whereas 171 were without problems. The sensitivity and specificity of this question were 0.30 and 0.88, respectively.

The simple question, "Do you have concerns with your mouth when undergoing surgery?" for preoperative patients with cancer had low sensitivity but high specificity. Patients with some oral concerns should be examined and treated professionally. Routine pre-examination under general anesthesia by dental professionals is desirable for surgical safety. 

Tooth infection is often seen in the myelosuppression period after cytotoxic chemotherapy and can impede regular administration of the drugs, which could deeply affect the treatment outcome. To prevent this problem, we have conducted oral health management. In this study, the outcome of the oral health management in the patients with malignant musculoskeletal tumor was investigated.

The patients who received chemotherapy for malignant musculoskeletal tumor and professional oral health care from January 2012 to January 2019 were eligible for the study. The exclusion criteria were edentulous patient, no examination of the periodontal pocket depth and panorama Xray, and tumor or metastasis located in head and neck. The medical records were retrospectively analyzed.

Seventy-one patients were eligible. Fourteen patients had over 6mm of the periodontal pocket depth. Forty-nine patients had 3rd molars, 32 of them had impacted or semi-impacted 3rd molars. Thirty-three patients had apical periodontitis. Tooth infections occurred in 10 patients, G2 tooth infections in 6 patients and G3 in one patient. Acute periodontitis occurred in 3 patients, in 2 of them, the teeth with over 6mm of the periodontal pocket depth were related. 6 patients had pericoronitis, half of them were related with impacted or semi-impacted 3rd molars. One patient had acute apical periodontitis. Tooth infections accompanied with G3 or G4 neutropenia in 6 patients and with febrile neutropenia in one patient occurred.

This study indicated oral health management during the chemotherapy for malignant musculoskeletal tumor was important. Further studies are required to prevent febrile neutropenia from tooth infection. 

Mastication is a coordinated process, integrating control, sensory input, and muscle function. Food is positioned on the occlusal surfaces by the cheek and tongue and pulverized through chewing. The objectives of this study were to observe the impact of oral oncological treatment and recovery after treatment of several tongue functions (i.e. force, mobility and sensory functions), and to study the influence of these tongue functions on masticatory performance.

Masticatory performance and tongue force, mobility and sensory functions were determined in 123 patients with oral cavity cancer. Assessments were performed 4 weeks before and 4 to 6 weeks, 6 months, 1 and 5 years after treatment. Generalized estimation equations and mixed model analyses were performed, correcting for previously identified factors in the same population.

A significant deterioration in tongue mobility and sensory function was observed in patients with mandible and tongue and/or floor of mouth tumors. Better tongue force and sensory function (thermal and tactile) influenced masticatory performance positively, and this effect is stronger with a decreasing number of occlusal units. The effect of both the tongue force and maximum bite force is weaker in dentate patients in comparison to patients with full dentures. A web based application was developed to provide insight in the coherence between the found factors in the mixed model.

Tongue function deteriorates after oral oncological treatment, without statistical significant recovery. Adequate bite and tongue force is especially important for patients with poor prosthetic state. Patients with sensory tongue deficits especially benefit from more occluding pairs. 

Based on the experience gained with oral rehabilitation in patients with cancer submitted to therapies with antiresorptive and/or antiangiogenic agents combined with scientific evidence in databases, this case series aims to describe oral rehabilitation recommended by the Clinical Research Center at Bauru School of Dentistry of the University of São Paulo. We described specific management of the patient during the rehabilitation process and the choice of the most suitable dental prosthesis ( Figures 1A and 1B) .

Figures 1A and 1B. Patient with chronic myeloid leukemia submitted to Imatinib therapy rehabilitated with teeth supported overdenture to avoid dental implant use.

Methods were investigated in scientific literature for rehabilitation to minimize the chances of MRONJ that may be caused by trauma related to these prostheses, as well as the management of these patients during the rehabilitation clinical stages.

Eight patients with history of cancer and submitted to an antineoplastic therapy which may cause MRONJ were treated with dental prostheses according to their specific needs and limitations. No patient was diagnosed with post rehabilitation MRONJ. Follow-up period ranged from 3 to 41 months. (Table 1) . Table 1 . Recommended methods for rehabilitation for each patient.

Dental rehabilitation considering systemic limitations imposed by MRONJ, excluding clinical stages that may bring harm to both soft tissues and bone like extended surgeries, implants and conventional removable prostheses seems to be possible and favorable. However, it is cleared the need for more solid evidence described in literature.

A. Derosa 1 1 Weill Cornell Medical College, Samuel J. Wood Library, New York, USA

Patient Family Advisory Councils (PFAC) can play a pivotal role in fostering a culture of patient-and family-centered care within a department, specific service line, and larger organization or medical center. The success of PFACs on quality improvement initiatives and the patient experience hinges on the steps taken to developing and implementing these groups.

The major phases of PFAC development will be demonstrated: (1) inception and idea; (2) stakeholder identification and buy-in; (3) medical/health care team members; (4) promotion and outreach; (5) recruitment; (6) identification of projects and initiatives; (7) evaluation and maintenance.

Barriers and other special considerations to PFAC development will be presented, specifically related to the phases described in the methods section. Best practices and lessons learned will also be discussed as it relates to development of a PFAC devoted to the oncology population.

Conclusions PFAC influence and impact on the patient experience and satisfaction will be presented, particularly through real-world examples of patientprovider collaborations and partnerships in the oncology setting. The benefits to both the patient/caregiver and healthcare populations as a result of PFAC partnerships will also be examined and discussed. Future perspectives and potential collaborative projects between oncology healthcare providers and PFAC members will be listed. The ongoing success of PFACs depends on these partnerships and connections. 

In our prospective observational study of 124 consecutive patients reporting to the Cancer Registry of our department we identified 9 patients of lower limb DVT after routine Doppler screening. Out of 8 patients, 3 patients (37%) had carcinoma ovary, 2 patients (25%) had carcinoma breast, 1 patient (13%) each were suffering from carcinoma colon, hepatocellular carcinoma & pancreatic carcinoma. 3 patients were post-operative patients. All these patients were treated with prolonged course of LMWH followed by resolution of thrombus. With this protocol, there was no subsequent mortality from thromboembolism in these patients as observed on follow up. Conclusions DVT can be identified by routine screening procedure and venous thromboembolism is thereby a preventable risk factor by suitable therapeutic and prophylactic measures to reduce mortality.

Introduction TLS is an oncological emergency caused by the breakdown of malignant cells resulting in massive release of cellular components into the blood. Rasburicase is a urate oxidase enzyme used for prophylaxis and treatment of hyperuricemia associated with TLS. Our institutional TLS guidelines were updated to recommend the use of a single dose rasburicase. The objective of the study was to assess the compliance to TLS guidelines, evaluate the effect of guidelines update on consumption and cost of rasburicase and assess the efficacy of a single rasburicase dose in lowering uric acid levels.

It is a retrospective cohort study, including oncology and hematology adult patients who developed or were at risk of TLS in Qatar. The study included 103 patients divided into 2 groups based on the date of the TLS guidelines update; 48 patients before and 55 patients after the guidelines update.

The rate of compliance to the institutional TLS guidelines after the update increased from 77% to 87% (P=0.17), from 46% to 78% (P=0.001), and from 56% to 95% (P < 0.001) in terms of proper indication, proper duration and G6PD screening, respectively. Rasburicase consumption and cost were significantly reduced by 43% after the guidelines update. Furthermore, the single dose rasburicase was efficacious in controlling uric acid within 24 hours in 98% of patients.

Updating the institutional TLS guidelines had a significant impact on compliance to guidelines and optimization of rasburicase use. Moreover, the use of a single rasburicase dose demonstrated efficacy in lowering serum uric acid levels.

Free Pap smear screening only provide for females more than 30-year-old once a year or at least once every 3 years in Taiwan. If females are lower than 30-year-old would need to pay for the screening, this might inference the willingness to undergo the screening. The aim of this study was to examine the effects of self-pay and free Pap smear screening on the willingness of females aged 20-29 years to undergo the screening.

This survey-based study was conducted using a self-designed Pap smear willingness questionnaire and recruited 416 females aged from 20-29 years old. On a 5-point scale, higher scores represented greater willingness. Validity of the questionnaire was determined based on the following: Cronbach's α coefficient, 0.830; KMO, 0.781; and total variation, 60.72%.

After comparing the recruited 416 females and the government data, finding the sample to be representative. 46.9% of the participants had sexual intercourse, 71.3% had their first intercourse before age of 20, 32.3% had ≥3 of past sexual partners, and 67.2% without condoms every time during sexual intercourse. When free Pap smear screening was provided, the mean willingness score for undergoing the test once a year was 4.0(±0.8) and that for undergoing the test every 3 years was 4.1(±0.7). Conversely, when self-pay was required, the mean willingness score for undergoing the screening every 3 years was 3.3(±0.9).

Our result showed risky sexual behaviors were common among younger females aged 20-29. If extending age criterion of free screening for younger females, the willingness of screening will increase. 

Periodontal disease (PD) is a common oral complication in head and cancer patients (HNC) who undergo radiation therapy (RT). It has been previously shown that genetics play an important role in PD development.

Our objective was to identify candidate single nucleotide polymorphisms (SNPs) associated with PD in radiation-treated HNC patients.

Saliva DNA was extracted from HNC patients (n=65) at baseline prior to RT. Clinical attachment loss (CAL) increment of >0.2 mm was used as threshold to define PD development (PD group). A total of 44 patients among 65 developed PD. Exome sequencing and variant detection were performed using Ion Proton sequencing platform. SNPs associated with PD were identified by logistic regression using PLINK v1.9 software (unadjusted p<0.05). Predominance of the homozygote SNP genotype for the alternate allele in patients who developed PD was determined using two-tailed z-test. STRING, PANTHER and GeneCodis programs were used for molecular network and gene ontology analyses.

A total of 454 candidate SNPs (385 genes) were identified, including 92 (60 genes) over-represented variant homozygous genotypes in PD group. Of these, 22 genes formed seven tight networks (90% confidence level), including a collagen network and previously identified HLA-A and MMP2. These 22 genes were also integrated within a 66-gene network including 37 previously identified in PD association studies. Gene ontology analysis of this network showed the overrepresentation of biological processes such as collagen-dependent cell adhesion and the inflammatory response.

Polymorphisms affecting the integrity of the collagen matrix might confer susceptibility to PD in HNC patients undergoing RT. 

Oral cancer is an important health problem in South East Asia, several parts of Europe and Africa. Though tobacco and alcohol are the important causative agent, Human Papilloma Virus (HPV) infection is also attributed in the carcinogenesis of oral and oropharyngeal cancer. However information on the prevalence of HPV virus in oral cancers from India is sparse.

The objective of the study is to identify the frequency of HPV infection in oral cancer and its correlation to p 16INK4A expression and to assess its impact on treatment response and survival. A total of 201 paraffin embedded tissue blocks of oral squamous cell carcinoma (SCC) patients treated at Regional Cancer Centre, Thiruvananthapuram, India during the period of 2009-2011 were retrieved. HPV DNA was isolated from these tissue blocks by Polymerase chain reaction and expression of p16 INK4A was analyzed by immunohistochemical method. Survival curves were obtained by using the Kaplan-Meier method and were compared with log rank test.

The frequency of HPV 16 in oral SCC patients in the present study was 6.6% and all the HPV positive cancers were carcinoma tongue. All HPV positive cases showed intense p16INK4A expression and the survival was better.

In future the expression of p16INK4Aand HPV status will be a good marker in decision making for oral cancer management. Methods A self-designed questionnaire was used to survey the participants. They were asked about the attitudes and preferences of the willingness, donor, input pathway, expenditure and adverse effect toward FMT. Logistic regression was used to identify factors associated with the willingness toward FMT.

Most cancer patients showed the willingness to choose FMT. The patients with higher educational level and the later clinical stage preferred to use FMT in their treatment. Some factors of demographic and clinical characteristics influenced their attitudes and preferences of the donor, input pathway, expenditure and adverse effect toward FMT.

Our findings indicate that most cancer patients showed the willingness to use FMT in their treatment and some factors of demographic and clinical characteristics influenced their willing to designate FMT.

Exercise intervention studies have rarely discussed the adherence of experimental groups or the contamination of control groups. We identified the predictors of exercise adherence and contamination in randomized controlled trials.

This is a 12-week exercise intervention trial of 122 patients with lung cancer. We measured the patients' the demographic and disease characteristics, exercise habits before cancer diagnosis, and Karnofsky Performance Scale (KPS) and then instructed them to log their 3-day physical activity record .

The result indicated that the exercise adherence rates of the patients who exercised regularly before cancer diagnosis were significantly higher than those of the patients who did not exercise regularly before cancer diagnosis (82.87% vs. 53.46%, t = 2.751, P = 0.011). The KPS were significantly correlated with the exercise adherence rates (r = 0.282, P = 0.029). The results revealed that the patients who exercised regularly before cancer diagnosis were 11.55 times more likely to be contaminated than were their nonexercising counterparts (odds ratio [OR] = 11.55, p = 0.016).

Exercise habits before cancer diagnosis and KPS were a predictor for exercise adherence rate and contamination. When conducting a RCT study on exercises, we should know the patient's past exercise experience, KPS, and the number of minutes of physical activity performed daily during the pre-test and keep tracking. To confirm whether the patients in the experimental group can exercise and monitor the control group for the risk of contamination. 

Among 91 cases of HNSCC, only 6 (6.59%) cases were found to be positive for high risk HPVon real time PCR. Among these 6 positive cases, two cases were positive for HPV 16 and one case was positive for HPV genotype 56. Among others, two cases were co-infected with high risk HPV genotypes 16 and 51 and one sample had HPV genotypes 16 and 18. Among all high risk genotypes, HPV 16 was positive in 5 out of 6 cases.

The findings of current study will be helpful in launching public health awareness and future vaccination programs against specific HPV types in Pakistan to lessen the burden of HPV related HNSCC.

Self-management refers to the ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes while living with chronic conditions. For many cancer patients, self-management requires collaborative effort amongst patients, their caregivers and healthcare providers. This study aimed to describe current knowledge concerning collaborative care involving caregivers, patients and healthcare providers. Methods A narrative literature review was conducted in PubMed and CINAHL using relevant keywords in mid-2018. Searches were limited to English language and studies of the adult population.

Ninety matches resulted, 34 articles were relevant. Of the 34 articles, 2 were non-empirical, 20 were descriptive studies and 9 included an intervention on caregivers. A majority of studies included both patients and their caregivers(n=14). Very few included patients, caregivers and healthcare providers(n=5). The most number of studies described the caregiver's experience(n=6) or communication with healthcare providers(n=6). Of the nine intervention studies to support caregiving, three focused on education, two on communication, two on decisionmaking, one tested the use of a coordinator role and one on personalized medicine. Outcomes of intervention studies were primarily related to mental health(e.g., burnout, n=7), quality of life(n=4) of both patients and caregivers and physical health of patients(n=4). A majority of these studies reported improvement post-intervention(n=5).

Findings validated that, supportive interventions improved both patient and provider outcomes. A comprehensive framework is needed to support the development of collaborative partnership with caregivers, patients and providers. In addition to patient and caregiver outcomes, evaluation of outcomes related to collaborative partnership and process is needed. 

During the period from 1991 to 2018, 5862 cancer patients with small cell or non-small-cell bronchogenic carcinoma, breast carcinoma, ovarian carcinoma FIGO (IIIB -IV) and carcinoma of the colon, rectum or stomach and 68 cancer specialists were involved in a transversal survey. Patients' and doctors' views on Phi role in supportive care and differences between them: agreement with statements rated on a 5-point scale, ranging from "strongly disagree" to "strongly agree." Results Cancer patients less than doctors consider the immunomodulating, antithrombogenic and adaptogenic effects of PhI (mean 3.6, 1.9 and 2.2 versus 4.6, 4.1 and 4.9) and cancer patients much more than doctors believe that Phi cures cancer and prolongs survival time of patients with advanced cancer (mean 4.2 and 4.9 versus 1.9 and 4.7).

Cancer patients appeared to differ from doctors in views on the role of Phallus impudicus in supportive care. Nevertheless, both groups consider the necessity to use PhI to achieve relevant prolongation of survival time of cancer patients. Introduction CML is characterized by Philadelphia (Ph)-chromosome that originates from t(9q34;22q11) and carries the chimeric/mutant BCR-ABL oncogene. The oncogene causes overproduction of tyrosine kinase (TK), and thus, targeted for therapeutics. Imatinib is the first such TK-inhibitor (TKI) and considered for front-line therapy for its efficacy to render fast elimination of Ph-positive clone. However, delay in treatment outcome/relapse of the disease was reported due to occurrence of point mutation within BCR-ABL and/or individual genetic composition. Similar outcome was apparently noticed among 1136 patients known two have distinct food habits in the present study.

From the heterogeneous treatment-group, 232 patients receiving imatinib were considered for bone-marrow cytogenetics with a view to understanding the effect of food habit on treatment outcome. The patients were known to consume two distinct types of food such as one never consumes beef (Group1) and the other consumes more of beef than other items (Group2). Analysis of G-banded metaphase chromosomes or BCR-ABL signals following FISH has collected data on partial response (<100% Ph+ve), no response (100% Ph+ve) and complete cytogenetic remission (CCR; 100% Ph-ve), which was considered for X 2 -statistics.

In all, Group2 patients (60%) didn't exhibit any response till one year of treatment compared to Group1 (42%), which was significant in males and for the cumulative data. However, the difference between the two genders was not significant since the females of the two food-groups have achieved similar outcome.

Food, especially red meat interferes in treatment outcome, and that is aggravated by smoking and other factors in males.

Darfur region in western Sudan has been engulfed in civil war since 2005 that has resulted in over 2.3 million displaced peoples (approximately 30% of its 8 million population). Overall, Sudan is experiencing a growing cancer problem and Darfur is no exception. In this research, we review the available cancer incidence data from the major cancer hospital in the country ( Risonance and Isotopes Center_Khartoum) to assess the variation of the occurrence of different types of cancer related to the geographic region of Darfur and associated risk factors.

Data summarized from other local and international publications are used to highlight differences in incidence of different types of cancers between Darfur region and the rest of country. Statistical incidence data are also augmented with targeted questionnaire for a representative sample to collect information on likely risk factors such as sex, age, socioeconomic status, behavioral factors (e.g., tobacco use), environmental risk factors (serious environmental problems related to water and soil pollution with arsenic, mercury, grease and suspended small particles, etc.), and psychological risk factors (stress, war trauma, etc.).

We provide frequencies reported for cancers detected in adults and children, as well as information on risk factors with most likely impact on cancer patterns.

This research contributes to the effort to build knowledge base on the status of cancer prevalence in war torn Darfur region. This research work also documents key knowledge gaps and future research agenda for collaboration with international bodies. 

Cancer survivors experience many debilitating co-occurring symptoms. Current understanding of the exact biological mechanisms underpinning symptoms is limited. Emerging studies suggest that extracellular vesicles (EVs) play a key role in cell-to-cell signaling, genetic material exchange between cells, and contain heat shock proteins (HSPs) and microRNAs (miRNAs). HSPs directly modulate immune responses and miRNAs regulate gene expression, immune cell differentiation, and proliferation. Thus, EVs may fill the gap in understanding the etiology of symptoms. To our knowledge, there have been no reviews on the role of EVs in symptoms. The purpose of this review is to investigate the association of EVs with symptoms.

Electronic literature searches in Embase and PubMed databases were conducted with assistance from a medical librarian. The inclusion criteria are: 1) English language; 2) inclusion of at least one of the following symptoms: fatigue, pain, depression, sleep disturbances, and cognitive impairment; and 3) association of EVs with symptoms. Studies that investigated non EV-derived miRNA and HSP and/or did not include symptoms as one of the outcomes will be excluded.

The search retrieved 6974 articles, 1919 duplicates were removed, and 5055 articles are undergoing eligibility screening. Full text review of remaining articles will be conducted applying the eligibility criteria. Eligible studies will include animal and human models.

This review will describe a current state of evidence into the role of EVs in the etiology of symptoms. The findings will guide researchers for future validation studies and the development of optimal management for symptoms. Introduction BRCA1 and BRCA2 aid in non-homologous DNA repair, and germline mutations in these two tumour-suppressor genes account for a majority of hereditary breast and ovarian cancers. This often leads to hereditary breast and ovarian cancer syndrome (HBOC). HBOC is commonly characterized by a family history of breast cancer, ovarian cancer, and to a lesser extent, prostate cancer, pancreatic cancer and melanoma. De novo pathogenic variants in BRCA1 and BRCA2 are rare. In the literature, to date, twelve BRCA1 (including the present) and six BRCA2 de novo pathogenic variants have been published (Table 1) . Methods A retrospective chart review was conducted.

We present a 33-year-old woman of Scottish and English descent, with a de novo BRCA1 substitution diagnosed with triple negative breast cancer ( Figure 1 ). The patient was referred for genetic counselling. Neither of the parents carries this mutation and paternity testing was done to confirm the absence of a non-paternity event. Mosaicism, chimerism, and de novo mutation are all plausible explanations for this case.

Support Care Cancer (2019) 27 (Suppl 1):S1-S302 S159

Cases of BRCA1/2 mutations are of significant clinical value in breast and ovarian cancer prevention and management. Knowledge of the rate of de novo mutations would provide additional information to practicing geneticists and genetic counsellors to aid in pedigree assessment for the HBOC syndrome phenotype in families. Knowing the frequency of de novo mutations in the BRCA1 and BRCA2 genes would also aid geneticists in the identification and referral of probands with a BRCA-consistent phenotype but no family history. 

Understanding the patient's perspective of care is critical for improving quality of care, especially in cancer care. Many countries have been using patient experience data to measure healthcare quality, but most of them are from western countries, the view of eastern country is lacking. Therefore, the purpose of this study is taking Taiwanese cancer patients as example to investigate the patient's experience, and explore whether the experience is varied among patient's characteristics.

The UK's cancer patient experience survey questionnaire was selected, and the formal translation and cultural adaptation procedure was applied. After that, a total of 4,000 questionnaires administered in all certificated cancer care hospitals (n=19). Otherwise, we followed Macmillan Cancer Support's suggestion to classify patient's experience into 9 categories for analyzing the results in detailed. Results 1,010 questionnaires returned (25.25% response rate), and 148 were excluded because the information of patient's characteristic was missing, 862 questionnaires were kept for analysis. Our finding showed most respondents had positive experience of cancer care, but the experience was varied among categories, respondents were most satisfied with physical environment (90%) and least satisfied with "timely referral into secondary care" and "shared decision making" (64%). The experience was also varied among patient's gender, cancer type, cancer stage, cancer history, hospital level and age at the time of having cancer as well.

This study provides an insight into cancer care in eastern settings from the patient's perspective. Establishing a patient-centered care model for cancer care should be the next step in Taiwan 

In breast cancer patients with anxiety symptom undergoing neoadjuvant chemotherapy, severity of chemotherapy related symptoms affects the anxiety persistence.

Cancer is a very important health problem not only in Korea but also in the worldwide. The purpose of this study was to investigate the relationship between cancer screening and health checkup rates and the incidence and mortality rates for cancer in Seoul.

Among the database data constructed from 62 data sources, 435 indicators, and 1995 items surveyed in 17 cities/provinces and 254 cities/ counties/districts from 2008 to 2016 under the leadership of the CDC. In this study use the data from 2009 to 2013. Pearson's correlation and multiple linear regression were used to examine the relationship between cancer screening and health checkup rates and the incidence and mortality rate for cancer in Seoul.

The overall OR between cancer screening and health checkup rates and all causes cancer incidence rates 2. 

It was found that the cancer screening and the health checkup rates in Seoul were related to all cancer incidence and mortality rates. Especially, the higher screening rates, the more mortality rate decreased. Therefore, we can confirm the usefulness of the national screening project, and plan to increase the screening rate for the improvement of public health and cancer mortality rate.

Although smoking prevalence has declined over the past decade, it is still associated with many types of cancer and is the leading cause of lung cancer. Rural populations are especially at risk as they have been consistently more likely to smoke. However, most research has ignored the marked heterogeneity of rural America, focusing solely on a rural/urban dichotomy.

Using Rural-Urban Commuting Area Codes (RUCAs) from the 2018 Health Information National Trends Survey (HINTS-5) database (n=5,099), we analyze the odds of smoking across four geo-political contexts: urban, large-rural, small-rural, and isolated-rural areas. This gives us a potentially more detailed understanding of place and health across the urban-rural continuum. Using an established social determinants framework, a series of logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (CIs) for smoking.

Across all models, those living in small rural towns had between 1.7 -1.9 times the odds of smoking compared to urban-dwellers (p<0.01). However, this relationship did not exist for large and isolated rural areas. Additionally, age, gender, race/ethnicity, education, and housing status were independently associated with smoking (p<0.05).

In this study, compared to urban-dwellers, those living in small rural towns appeared to have increased odds of smoking. This was not the case for those living in large or isolated rural areas. These findings have implications for allocation of resources and the design of interventions aimed at smoking cessation. 

Dyspnea is a common symptom among patients with advanced disease. Fan therapy has been proposed as one component of the complex clinical interventions used in the relief of dyspnea, but there is a lack of consensus regarding its efficacy. We performed a systematic review of fan therapy for the treatment of dyspnea.

We searched Medline, EMBASE, Web of Science, Scopus, CINAHL, PsycInfo, and Cochrane Library databases for literature published prior to September 2018. Search terms included "dyspnea," "dysponea," "dyspneic," "short of breath," "shortness of breath," "breathless," "breathlessness," "breathing difficulty," "labored breathing," and "fan." Searches were limited to English or Chinese language. Bibliographies of electrically identified articles were also manually searched. Three authors independently assessed papers for inclusion.

Ten out of the 92 unique records identified met the inclusion criteria, describing 9 randomized controlled trials and 1 observational study. Most studies (9; 90%) were conducted in the hospital setting, and none were double blinded. Nearly half (159; 46%) of the 344 total subjects had a diagnosis of cancer. The most common non-malignant disease was chronic obstructive pulmonary disease (COPD). The most common duration of fan therapy was 5 minutes. Six (60%) studies reported significant improvement in dyspnea with fan therapy (Table 1) .

The use of black nail polish for patients undergoing chemotherapy treatments with Docetaxel to reduce nail toxicity has been commonplace for over a decade using only anecdotal evidence. A literature review using the search terms 'chemotherapy' (as a keyword) and 'taxanes', 'nail toxicity' and 'nail polish' (as a MeSH subject headings) was undertaken. The literature identified that nail toxicity was a common toxicity from the administration of taxane chemotherapy but there has been no conclusive evidence for nail polish use overall. An in vitro assay testing the growth of cells after UV exposure identified that opaque nail polish can protect the cells in this controlled setting.

To test the hypothesis that nail polish protects from taxane-induced onycholysis and determine if there is an observable difference in nail toxicity, a pilot study of 20 participants was undertaken. Participants painted nails of one hand with neutral -beige polish. The participants other hand was used as a control. For the study to be considered noninferior a >= 30% reduction in nail changes were identified. Results 20 participants were recruited, 17 of those recruited were included in the data analysis. Of those recruited only 3 (17%) showed and observable difference >30% in the hand using nail lacquer.

The results of this pilot study showed that there is no benefit in protecting nails from the use of nail polish. These results are practice changing and should be considered in all centres where patients still use nail polish to protect their nails during taxane chemotherapy. Anemia of inflammation and bone marrow suppression are the main causes of anemia in patients with advanced cancer. However, other pathways blockade when targeted therapies are used, can be the reason for reduced Hb levels in such patients.

Systematic review and meta-analysis reporting pooled incidence of anemia with biological agents were considered. Studies regarding hematological diseases were excluded.

Risk of all grades anemia was 44% (G3-4 were about 5%) and was in particular high with oral multitarget TKIs, probably because of the interference with bone marrow erythropoiesis due to FLT-3 and KIT receptors. Anemia due to immunotherapy was evaluated in a systematic review of 47 studies with PD-(L)1 inhibitors for a total of 9,324 evaluable patients. Incidence of G1-4 and G3-4 anemia associated with PD-(L)1 inhibitor was 9.8% (95%CI, 6-13.6%) and 5% (95%CI, 3.3-6.7%) respectively. Other agents that are associated with anemia onset are PARP-inhibitors and CDK 4/6 inhibitors. Six studies with approved CDK 4/6 inhibitors report a risk of all grades and G3-4 anemia of 3.57 and 2.8%. In PARP inhibitors (olaparib and niraparib) risk of severe anemia were 8.2 and 25.3%.

Conclusions risk of anemia with targeted therapies is not negligible (about 40-50%) with reduced risk associated with immunotherapy (about 10%). Management is conservative, with transfusions indicated for severe anemia only, otherwise supportive care and iron supplementation is suggested. Oral iron should be firstly considered, in particular new generation delivery systems, like Sucrosomial®iron per our experience, ensuring high tolerability and bioavailability.

M.B. Inamdar 1 , H. narendra 1 , K.V.S. babu 2

Patients undergoing major oncological surgery are at risk for severe bleeding and coagulopathy due to the tumour biology, preoperative cancer therapies, anatomic features of the surgical area and complexity of the resection. The rate of perioperative blood transfusions the rate still remains high. The maximum surgical blood order schedule (MSBOS) was designed to aid the control of blood bank products stock by improving the efficiency of ordering blood for use in elective surgery Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Medical Oncology, Napoli, Italy

In cancer patients, a leading cause of hyponatraemia is syndrome of inappropriate ADH secretion (SIADH). Several publications associate hyponatraemia with a poorer survival than that seen in eunatraemic cancer patients. Methods 68 evaluable cancer patients with hyponatraemia were enrolled in an observational prospective non-interventional study (ClinicalTrials.gov number, NCT02573077), in oncology departments of 18 intuitions in Italy. Primary outcome was change in serum [Na+] from the baseline to the end of the first month of observational period or until earlier discontinuation from the study.

Patients in Group 1, received at least one dose of tolvaptan during the study (N=25), while patients in Group 2 were never treated with tolvaptan (N=43). Primary outcomedemonstrated a numerical improvement for tolvaptan (p=0.089). The median overall survival time was in favour of Group 1 vs Group 2 (123 vs 56 days, p=0.001). The linear regression analysis in the full cohort showed that tolvaptan dose intensity correlated significantly with clinical response after six months (p=0.003, Figure i) . 20 patients completed a six-month observation period, 9 from Group 1 and 11 from Group 2. Patients in Group 1 achieving a serum [Na+] ≥ 130 mmol/L at 6-months resulted significantly higher than in Group 2 (83.7% vs. 60.0%; p= 0.033, Figure ii) .

Hyponatraemia secondary to SIADH is a potentially modifiable risk factor implicated in the survival of cancer patients. Acting effective and timely on the normalization of sodium levels preferentially by the use of pharmacological treatment rather than with other non-pharmacological routinely applied in clinical practice might have a positive effect on prognosis. 

Recreational cannabis is planned to be legalized in Canada in 2018. However, its effects on public health have been unclear. This scoping review will provide an overview of Canada's planned legalization framework with attention paid to distribution channels, analysis of legalization economics, and recently completed international studies assessing its potential public health implications. Methods A detailed review the grey literature provided an overview of planned legislation. A scoping review was conducted using Ovid Medline, Embase, and Google Scholar to identify articles assessing cannabis legalization on opioid use and abuse, and alcohol use.

Canada's framework for cannabis distribution is varied across provinces, and jurisdictional responsibility is mixed across provincial and federal levels. Few studies assessed the outcomes of opioid use and abuse, and alcohol use. Opioid prescriptions and mortality declined following legalization in several studies. Alcohol use also decreased following legalization, but cannabis use increased significantly.

The results of the scoping review provide a positive outlook for Canadian recreational cannabis legalization. It is important to understand the cultural and legislative differences between jurisdictions examined in this review which may affect the applicability to Canada's case. Further research is needed to understand the full implications of legalization. 

Microtubule inhibitor Eribulin is approved for the later line chemotherapy for metastatic breast cancer (MBC). Several phase III studies revealed its efficacy similar to other single agent treatment option. However, data of effectiveness and safety profile of eribulin in real practice is still limit.

The retrospective medical record review was perform in 55 MBC patients who received eribulin at King Chulalongkorn Memorial Hospital since the year 2013 to 2018. Effectiveness was evaluate in terms of time to treatment failure (TTF) and overall survival (OS). Adverse events during treatment were also records to assess safety of this drug.

The average age of patients was 56.85 ± 14.4 years old. Most of patients (approximately 96%) had performance status of ECOG 0-1 at the starting of eribulin treatment and 34 patients (61.8%) received eribulin as the second or third line chemotherapy. Total eribulin treatment cycles were ranged from 1 to 10 cycles with the median at 4 cycles. The most common grad 3-4 hematologic adverse events were found in this study was neutropenia at 38.2%. Grade 1-2 peripheral neuropathy was also commonly found at 52.7%. The median TTF was 77 days (range 7-237 days). Twenty-five patients (44.6%) died after receiving eribulin treatment resulted in 54.5% overall survival rate with median survival at 208 days (range 74-953 days).

Effectiveness of eribulin treatment in real clinical setting was relatively less reported in clinical trials. While the incidence of grade 3-4 neutropenia was lower while the rate of grade 1-2 peripheral neuropathy was higher. 

Cancer treatment has evolved rapidly since the advent of immunotherapy (checkpoint inhibitors). As compared to chemotherapy, immunotherapy agents are associated with a more favourable but distinct side effect profile. Mortality within 30-days of chemotherapy in cancer patients has been accepted as a clinical indicator of preventable harm and used as an auditing tool for clinical practice and improving quality of life. This should be investigated in the current era of immunotherapy. (8), process (5) and structure (4) indicators. The list of selected QIs is available in Figure 1 .

These QIs can also be put to a group of non-hospital professionals and to patients for validation of the QI set. They will then be collected from the experts' institutions to validate the metrological qualities of the indicators.

Actinic Cheilitis (AC) is a malignant lesion localized principally on the lower lip vermilion, with potential to develop into Squamous Cell Carcinoma (SCC). Objective this study is to report the casuistic of AC treated by vermilionectomy, its clinic pathologic profile and association with degree of dysplasia. 

Totally Implanted Central Venous Catheter (TI-CVC) is a device widely used in oncology. So it requires that nurses know how to handling these devices with accuracy. This study aimed to compare the effectiveness of two teaching strategies for handling TI-CVC.

Quasi-experimental study was carried out with nurses from the Universitary Hospital of Brasília. The sample consisted of nurses who performed nursing care in adult patients with a TI-CVC. Those with a specialization in oncology were excluded. At first, nurses were asked to answer a cognitive knowledge questionnaire about TI-CVC and demonstrate their practical skills in low-fidelity catheter simulator. After this, they received a procedures manual on catheter handling (intervention A) and were instructed to study the contents of this manual. After one week, the nurses had cognitive knowledge and practical skills reassessed. Then, a theoretical-practical class (intervention B) was held with the contents of the procedures manual. At the end of the class, the nurses had their cognitive knowledge and practical skills reassessed.

Results 53 nurses enrolled the study. The cognitive performance mean score was 24.9 points. The practical skills mean score was 53,3. There was a statistically significant difference between the initial practical skills score of all the techniques evaluated, after reading the manual (p = 0.00) and after the theoretical-practical class (p = 0.00).

The two teaching strategies were effective in improving scores. However, the mean scores are higher after theoretical-pratical class, which highlights that the sum of the strategies provides greater scores of knowledge and practical performance.

Cancer patients who continue to smoke gain less benefit from treatments, experience greater toxicities, and are at increased risk of cancer recurrence, second primaries and mortality. Despite awareness of these negative health consequences of continued smoking, a systematic approach to help cancer patients quit smoking is uncommon.

In 2012, Cancer Care Ontario (CCO) established a Framework for smoking cessation across all 14 regional cancer centres (RCCs) in Ontario, Canada. The Framework included: implementing the 5As (Ask, Advise, Assess, Assist, Arrange) model; recruitment of regional champions to promote the program; and centralized data collection and reporting. Tobacco Use Screening rates became a performance metric to drive implementation and were reviewed quarterly with leadership. During 2014/15, just over 50% of cancer patients were screened for tobacco use. Efforts to improve performance included transitioning to the 3As (Ask, Advise, Act) model, monitoring "Accepted a Referral" rates as a performance metric, and use of an "opt-out" approach to referrals (where tobacco users are automatically referred unless they refuse). An environmental scan and site visits resulted in RCC-specific improvement plans.

The majority of RCCs are exceeding the Tobacco Use Screening target of 75%, but the proportion of smokers who Accepted a Referral remains low. The opt-out approach is anticipated to increase referral rates, and preliminary data are encouraging.

Since June 9, 2016 California's End of Life Option Act (EOLOA) allows terminally ill adults with decisional capacity to obtain and self-administer aid-in-dying drugs (AIDD 

In supportive care, as a necessarily multi-disciplinary field that encompasses the whole course of cancer, new and diverse evidence is constantly emerging across multiple fields. A challenge for clinicians, consumers, and researchers is keeping up and ensuring that the best, most up-to-date evidence underpins diagnosis, treatment, survivorship, and end-of-life care. Scoping reviews are a new, purpose-built approach for handling evidence from different sources, study designs, and perspectives. They can integrate knowledge from expert and consumer viewpoints with results from randomized controlled trials as well as qualitative research. Methods Different evidence synthesis methodologies have been developed over the years resulting in an expanding repertoire of approaches. One recent approach is the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). The PRISMA-ScR was developed through a multi-stage process involving survey and Delphi methods and repeated consultation, debate, and testing with multi-disciplinary groups.

Focusing on supportive cancer care, indications for undertaking scoping reviews will be described along with the latest methodological developments. Notable elements differentiating scoping reviews from other review types will be presented. Tools and resources for undertaking highquality scoping reviews in the context of supportive care will be introduced and described along with considerations for how scoping reviews can underpin best practice supportive cancer research and care. Conclusions Scoping reviews are a relative newcomer to the evidence-based healthcare movement that have considerable application in the diverse, multi-disciplinary field of supportive cancer care. Researchers and clinicians should be aware of new evidence synthesis developments to enable rigorous research and reporting. Introduction ICF Core Sets are a selection of ICF categories that best defined a minimum standard to perform functioning assessment in specific health situations.

Objective: To describe the development and reliability analysis of a Core Set for functioning assessment of adults treated for cancer at Hospital discharge.

Descriptive study of the process of developing a Core Set, which included five stages: (1) systematic review; (2) identification and linking of concepts with ICF categories (3) expert's consensus (4) operationalization (5) analysis of inter-rater reliability. Population: 21 experts participated in stage 3; 63 experts in stage 4 and 31 adults treated for cancer in stage 5. The study was approved by the scientific ethics committee (December 15, 2015) Results 47 articles were included, from them 55 instruments were extracted. 208 concepts were identified from the instruments, of which 204 could be linked to CIF categories. In the expert's consensus 24 categories were selected, which were operationalized. In the reliability analysis, 23 codes obtained a significant correlation that varied between r = .916 and r = 1.0. The code d240 (stress management) did not obtain good inter-rater reliability, which is why it was eliminated.

The ICF provides a valuable frame of reference for identifying significant concepts related to the functioning of patients treated for cancer at hospital discharge. After the process of 5 stages we obtained a Core Set with 23 categories, this will soon undergo a validation process in a multicentric study with the participation of 5 health institutions, national and international

T. Li 1 , L. Aimin 1 , C. Changying 1

To explore the appraisal and experience of medical staff in oncology for precision medical, and provide basis for more accurate treatment and care for patients.

Using the phenomenological research method, the purpose sampling method was used to conduct semi-structured in-depth interviews with 8 doctors and 14 nurses in a third-grade hospital in Henan Province, using Colaizzi analysis method for data analysis.

Oncologists extracted two themes in precision medicine: precision medical brings a high professional mission and sense of value to oncologists, the current limitations and expectations of precision medicine. Oncology nurses extracted two themes in the changes brought about by precision medicine: the update of the precise care concept corresponding to precision medicine, and the opportunity for precise care communication that is eager for precision medicine.

Oncology medical staff attach great importance to precision medicine, pay attention to the development trend of precision medicine, and have a greater need for the rapid development of precision medicine and clinical effective integration. 

Swallowing function is often not preserved in up to 50% of patients receiving RT as part of curative HNC treatment. Dysphagia is of high relevance to various stakeholders who likely hold different perspectives about its health impact. In preparation for a large pragmatic RCT comparing effectiveness of different swallowing interventions, it was critical to ascertain outcomes relevant to all stakeholders by which to compare these interventions.

A formal stakeholder engagement process was mobilized to elicit recommendations on outcomes to measure effectiveness of dysphagia interventions. Four similar homogeneous stakeholder groups were organized in Canada and United States including patients/caregivers, allied clinicians, medical clinicians, and policy makers. Sessions included open dialogue and priority setting exercises led by expert facilitators to achieve consensus on relevant outcomes. Subsequently, representatives from each stakeholder group met as a heterogeneous Stakeholder Advisory Board (SAB) to arrive at overall recommendations.

Each homogenous group identified a list of potential outcomes meaningful from their perspectives. The SAB members reviewed all outcomes in light of primary/secondary outcomes previously planned by trial investigators and considered the extent of survey burden, additional recommendations for secondary outcomes and potential confounders. The consensus-building discussions with SAB members resulted in a comprehensive list of specific outcomes capturing all perspectives addressing: swallowing-related physiology, function, quality of life, mental health, health burden, and health system variables.

This engagement process resulted in a set of relevant outcomes, representing all viewpoints, and a high degree of investment and commitment by stakeholders regarding participation in future research efforts. 

Family caregivers take the responsibility in providing care that often interferes caregivers' schedule. Although the caregiver burden might be a stress for caregivers, caregivers' resilience and positive perspectives might contribute to improve adaptation. The aim of this study was to identify the caregivers' resilience in providing care for cancer patients who underwent anticancer therapy.

This is a one-year survey study and currently proceeded in a teaching hospital in the northern Taiwan. We interviewed caregivers as they escorted cancer patients for treatment. In order to understand caregiver resilience, instruments included The Impact of Event-Revised, The Self-Efficacy, The Family Relationship index, The Work Interference scale, Post-traumatic growth scale, Life Oriented tool-revised, Benefit finding scale, The resilience scale and the MOS Short Form12 v.2.

The average age of caregivers was 43.5 (SD±11.4). Caregiver burden were significantly negative correlated with post traumatic growth. Significantly, caregiver resilience is positively correlated to benefit finding, while it negatively correlated to the caregivers' schedule interference and family abandonment. Benefit finding has a significant correlation with resilience, family relationship, post-traumatic growth, and optimism. Caregiver burden was significantly negatively correlated to the posttraumatic growth. Most caregiver had less time to do exercies.

Family caregivers in Taiwan were optimised as cancer patients recieved treatment. They focused more on providing meal and being with patients. Older caregivers had better optimism and mental health. As caregivers had better family relationship and perceived personal growth can increase caregivers to find the benefits in providing care also contribute to increase resilience.

Introduction

Oral adverse events (OAEs) are frequent and clinically relevant reactions arising from targeted anticancer therapies including multi-targeted tyrosine kinase inhibitors (TKI) and mammalian target of rapamycin inhibitors (mTORI). We evaluated the efficacy of supersaturated calcium-phosphate mouth rinse (SCPR) in reducing OAEs of patients on active treatment in a multicenter, double-blind, crossover, randomized phase III trial.

Patients treated with sunitinib, sorafenib, pazopanib, everolimus or temsirolimus with OAEs were randomized for a 14-days rinse period with SCPR or NaCl. Patients with persistent or reappearing OAEs while on active targeted treatment switched to the opposite treatment arm for a second rinse period. The primary endpoint was the severity of patient-reported OAEs, as determined by the change in the modified Vanderbilt Head and Neck Symptom Survey (VHNSS) 2.0, measured 3 times a week.

A total of 59 out of 64 randomized patients started the first rinse period, using SCPR (n=20) or NaCl (n=39 

Due to financial incapability and absence of manpower poor families often fail to carry their advanced cancer patients to the nodal centres. This pilot study will explore whether communication by mobile phone can lessen this burden. To identify and try to solve to the extent possible the main difficulties in giving palliative care to the terminal cancer patients of the area.

Initially a plan was generated regarding management of an advanced cancer patient in a nodal centre at District Head Quarter. Subsequently every two week a trained social worker attached to nodal centre will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient's family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between.

Since initiation cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover patient's family were really overwhelmed by the emotional support offered by the team over phone. Only 24% of cancer patients has to attend the nodal centre for expert advice from Palliative Care specialists.

This novel approach helped:-In providing regular physical and emotional support to the patients and their families. In significantly reducing the financial and manpower problems of carrying patients to the nodal units.

In improve the quality of life of patients by continuous guidance. 

As in any developing countries state of West Bengal in India has a huge burden of cancer patients in advanced stage coming from rural area where awareness regarding the usefulness of palliative care in rather poor. Our goal is to give a pain free good quality of life in these advanced stage cancer patients. Objective of this study is to identify the main difficulties in achieving the above goal in a rural village setting in India.

Advanced cancer patients in need of palliative care in various villages in of rural India were selected for this study. Their symptoms and managements in that rural surroundings were evaluated by an NGO (under the guidance of a senior palliative care specialist) working in that area. An attempt was made to identify the main obstacles in getting proper palliative care in a rural setting.

Pain, fatigue are the main symptoms effecting these patients. In most patients pain and other symptoms control were grossly inadequate due to lack of properly trained manpower in the rural India. However regular homecare visits by a group of social workers were of immense help in the last few months of life. NGO team was well guided by a palliative care specialist.

There is a wide gap of trained manpower in this filled in rural areas of India. Dedicated groups from rural area itself need encouragement and proper training, so that difficult symptoms can be managed locally along with necessary social and psychological support to these patients. 

Due to financial incapability and absence of manpower poor families often fail to carry their advanced cancer patients to the nodal centres. This pilot study will explore whether communication by mobile phone can lessen this burden.

Initially a plan was generated regarding management of an advanced cancer patient in a nodal centre at District Head Quarter. Subsequently every two week a trained social worker attached to nodal centre will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient's family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between.

Since January 2016 to January 2018, 245 cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover patient's family were really overwhelmed by the emotional support offered by the team over phone. Only 24% of cancer patients has to attend the nodal centre for expert advice from Palliative Care specialists.

Here in India almost 75% of cancer patient die a sad death of neglect due to lack of awareness about palliative care and low economic level. Surveys in India show that two third of cancer patient do not get proper care during the terminal phase of their life. Palliative care through volunteers can make a significant difference in this respect. To identify Methods Feedback from patients and their relatives regarding the palliative care they receive from nursing home and from volunteers and compare the two. Also feedback from volunteers regarding their positive and negative experience while delivering palliative care service. Then evaluate the data to compare and improve the quality of service.

We carried out two studies. One study was undertaken in nursing home palliative care and another was in home setting by volunteers. Both studies were in adult palliative care services. Since January 2016, 416 cases were studied to enquire about their experience in both home based care and nursing home care. Both the studies fulfilled our quality appraisal criteria. One found that those families and patients who received home visits from volunteers were significantly more satisfied. The study highlighted the value of the role of volunteers in better satisfaction of patients and their families.

Further research is needed to evaluate the role of volunteers in palliative care and how it can be delivered appropriately and effectively. We also wish to compare our findings with similar studies elsewhere. 

Results of research studies show that clinicians typically avoid discussing goals of care (GoC) and prognoses with patients. However, in order for patients facing serious illness to receive the care they want that is consistent with their values and wishes, clinicians must be skilled at challenging conversations. Currently, GoC documentation is variable between generalist providers leaving the palliative care clinicians unclear if the discussions took place or what was understood regarding quality of life goals. Because of this, a standardized GoC form was implemented in the EHR to help facilitate communication between clinicians that would be accessible for subsequent admissions and sudden changes in the patient's condition.

The current standard of care is for clinicians to review GoC with patients upon admission and to document them in the GoC section in the EHR utilizing specific criteria. After an education session to all clinicians regarding the essential information to be included, GoC discussions were reviewed for all palliative care consults. Monthly standardized e-mail messages are sent to providers acknowledging good documentation as well as to offer assistance to improve discussion and documentation.

GoC discussions and documentation increased by over 25% during the initial study intervention. A secondary analysis of individual provider results is in progress.

Providing feedback to clinicians helped improve GoC discussions and documentation in the EHR. By educating providers regarding how to have difficult conversations surrounding GoC increased documentation leading to care that aligns with the patient's wishes. 

Qualitative research design using semi-structured interviews with 16 purposively sampled health professionals with experience in caring for people with life-limiting illness. Interviews were audio-recorded and transcribed verbatim, and subjected to qualitative descriptive analysis techniques. Consolidated Criteria for Reporting Qualitative Research guidelines were followed.

Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of VAD. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing VAD. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high quality care equitable and widely available. All participants reported a commitment to reducing human suffering and facilitating best possible dying experiences for the patients in their care.

Common dedication to facilitating 'good' dying experiences exists among experts despite their divergent views on VAD. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for providing safe and equitable care to patients at the end of life.

Susan (2004) reported that constipation is a common problem among persons receiving opiates for treatment of pain. It is often under assessed and under treated by both physicians and nurses, leaving many patients to grapple with this problem alone. Because of the above, I carried out an audit to assess the practice of managing constipation among cancer patients on oral morphine at J.O.Y Hospice Mbale Uganda in 2014 specifically looking at determining the proportion of patients on oral morphine assessed for constipation, whether patients are prescribed a laxative and nutritional advice given and identifying the common laxatives prescribed.

It was a retrospective audit conducted at J.O.Y Hospice medical services Mbale Uganda, including all patients prescribed oral morphine, children and adults male or female at initial three subsequent visits while excluding those files of patients on oral morphine missing dates on which patient were seen, files having unclear handwriting and files for patients who didn't turn up for the initial three subsequent visits Results 46(86%) patients were assessed for constipation and 07(13%) not assessed. 51 (96.2%) patients were prescribed a laxative only and 2 (3.8%) not prescribed anything. Bisacodyl was the commonest laxative prescribed at 49(96%) of the 51 patients assessed. None of these patients was given nutritional advice or prescribed lactulose or Senna seeds.

All patients on oral morphine must be assessed for constipation at all visits. It is good to prescribe a laxative but better if both a laxative and nutritional advice are given to these patients to prevent constipation.

In 2016, a hospice palliative care unit was initiated in Beijing Haidian Hospital, which was the first pilot study program in Beijing. Challenges of implementing the program and the process to facilitate change in healthcare and society culture in China.

This Hospice Palliative Care Haidian Initiative program has been partnered with global organizations OHI and HPCAF at beginning of the program development in order to streamline the program design and establish SOPs. The program was operated by a Trans-Disciplinary Team(TDT) which is the first of these kinds of team structure in China, including the education, research and translational groups, program manager, physicians, nurses, pharmacists, technicians, social workers, psychologic counsellors, chaplains and volunteers.

The implementation of the program has been full of obstacles, encompassing the lack of trained professionals, limited financial resources, higher staff turnover, and professional misunderstanding and public rejection. Now HPCHI upgraded to National Pilot model of China, sponsored by National Health Commission and Ministry of Civil Affairs, the trial program team led by the program manager, has overcome core barriers/

The great demand caused by problems such as the aging and high incidence of malignant diseases has formed a great contrast with the lagging Hospice, Palliative & Supportive Care(HPSC) in China. From the perspective of the national pilot studies, it is both imperative and urgent to accelerate the development of HPSC and service system.

This article analyzes the current situation and problems of the development of the HPSC in China, summarizes the research progress of the HPSC system, and comprehensively sorts out the stakeholders of HPSC for the first time, classifies them into eight categories and uses Mitchell scoring method identifies core stakeholders.

On this basis, a three-dimensional service system for HPSC was constructed: First, the framework of the three-dimensional service system for HPSC was designed, and the horizontal and vertical relationships among various stakeholders were straightened out; Second, propose countermeasures to build a three-dimensional service system for HPSC, including propaganda and education, policies and regulations, quality management, talent supply, and information systems, etc.

According to the combing and induction of the literature, this article believes that current academic community lacks systematic research and in-depth analysis of the construction of HPSC stakeholders and service system with inter-departmental mechanisms. Few studies focusing on strategic level and micro-practice, and they are relatively scattered. Lack of deep research on the value consensus, concept, and universal model of collaboration, and lack of representative theory; especially at strategic heights to examine China. Also few studies on the government inter-departmental mechanism construction under the big governments.

D. Tanada 1   1 Hyogo college of Medicine, Department of Anesthesiology and pain medicine, Nishinomiya, Japan

In Japan, June 2017, sustained release hydromorphone hydrochloride (hereinafter abbreviated as HyH) and the rapid release HyH were released for the cancer pain. HyH intravenous injection was released in July 2018. Our hospital also used cases for cancer pain accompanied by dyspnea symptoms. There are few reports on the effectiveness of HyH on respiratory distress symptoms in Japan.

We 

Cancer patients participating in Phase 1 Clinical Trials often represent a population with advanced disease, symptoms and QOL impact from disease and treatment This analysis was conducted using data from a randomized trial in progress testing a palliative care intervention for solid tumor patients on Phase 1 trials to evaluate goals of care and advance care planning.

In this analysis, the investigators evaluated chart audit data from patients at baseline and 6 months after initiating a Phase 1 trial.

Patients (N=284) were at a mean age of 60, 56% were female and 32% were ethnic minorities. Predominant diagnoses were lung cancer (18%), colon (15%) and pancreatic (12%) cancers. Thirty six percent (36%) of these patients died within 6 months of initiating the Phase 1 trial. At 6 months post trial initiation, forty four percent (44%) had no advanced care plan and 58% remained full code status. Forty four percent of those who died were full code status. Forty five percent had no documented goals of care conversation and 32% had no proxy decision maker. Thirteen percent (13%) of those who died received chemotherapy in the last two weeks of life. Only forty four percent (44%) of those who died received hospice care and only fifty seven percent (57%) had received palliative care referrals.

As helpers' age, gender, characteristics, and job attributes is consistent with terminal cancer colleagues, whose unconsciously project inner thoughts and feelings onto the relationship. It's knotty and difficult challenge to professional helpers. The study objectives are to explore the experiences of caring for terminal cancer colleagues.

Semi-structured, open-ended interviews were conducted with thirteen hospice nurses who are women and work over two years in the unit from a medical center in central Taiwan.

Complicated feelings are divided into three themes: 1) sadness and powerless emotion: it's not easy to nurses treat colleagues as the patient. They feel shock, uncomfortable, and embarrassingly at first, and subsequent emotions are sympathy and compassion. If colleagues' physical pain and suffering are not been relieved that afflict nurses to much helpless and guilty; 2) professional selfdoubt: nurses feel stressful and frustration. They worry whether cancer colleagues trust themselves or not, on the other hand they uncertainly selfcapability to the best care and discuss death issues ; 3) Intimate or alienated nurse-patient relationship: because of various emotions and cognitions resulting in close or aloof intentionally. Some nurses spend more time and care exceed patients' needs. Others decrease interact with patients to reduce negative mood.

Helpers must be strongly awareness of negative countertransference reactions. Besides self-awareness educational training, on-going support groups and case study meetings are able vented their feelings, share particular stresses and problems they face. It expected to support professional helper to maintain the mutual trust, and humanity relationship with cancer colleaguese. Results 596 patients were included for analysis. The most common primary cancer was lung (n=165, 28%) and the most common site of metastases was bone (n=475, 80%). Brain metastases were reported in 75 (13%) patients. Actuarial median survival was 15.3 months for the 2014-2017 population. In 1999 (n=395), a primary of lung (n=143, 36 %) and metastases to the bone (n=277, 70%) were most prevalent. 72 patients in this population had brain metastases (18%). The actuarial median survival of the 1999 population was 4.5 months.

Clinician-predicted survival (CPS) is a vital aspect of palliative care as it allows for the determination of treatment intent and setting best suited to the patient. The primary objective of the present study was to assess CPS accuracy in cancer patients referred to the Rapid Response Radiotherapy Program (RRRP) for palliative radiotherapy. Secondary objectives included an analysis of factors associated with CPS accuracy, an assessment of the accuracy of CPS over subsequent clinic visits, and a comparison to the previous study conducted in the RRRP in 2005.

From August 2014-March 2017, CPS was provided by one of four radiation oncologists. Karnofsky Performance Status (KPS), primary cancer, and site of metastases was recorded. Date of death was obtained from the Patient Care System and Excelicare. Mean difference between actual survival (AS) and CPS was used to determine the accuracy of survival predictions.

172 patients were included for analysis. Survival was overestimated in most patients (n=135, 78.5%) by 19.0 weeks on average. KPS (p=0.2), primary cancer site (p=0.08), and site of metastases were not significantly related to CPS accuracy. Gender was significantly related to CPS accuracy upon multivariable analysis (p=0.04) but not after excluding prostate and breast cancer patients (p=0.2). The mean difference between AS and CPS did not significantly change over subsequent visits (p=0.5) and CPS accuracy was significantly lower compared to the previous RRRP study (p=0.04).

The survival estimates provided by radiation oncologists are inaccurate and overestimated. Further research should aim to validate prognostic models to improve accuracy.

Self-expandable metallic stent (SEMS) is widely used for malignant large bowel obstruction as endoscopic intervention for bridge to surgery or palliation of the obstruction. However, occlusion of SEMS is one of common problems in palliative cases. In this study, we aimed to clarify current status of the occlusion of SEMS and evaluate the safety and efficacy of its re-intervention.

We retrospectively reviewed medical records of 31 patients with malignant large bowel obstruction who had undergone SEMS placement for palliation from May 2013 to October 2018 in Kurashiki Central Hospital.

The average age was 83 years old, and 10 (32%) were female. Causes of the obstruction were colorectal cancer (n=25), gastric cancer (n=3), pancreas cancer (n=2), and ovarian cancer (n=1). Technical and clinical success rates were 96.7% and 87.0%, respectively. Adverse events during observation period of 63 days, 5-689 (median, range) were perforation (n=2, 6.4%) and occlusion of SEMS due to ingrowth or overgrowth of the tumors (n = 6, 19.3%); the median interval to occlusion was 89 days (range, 71-115). In 5 of the 6 patients with occlusion, additional SEMS placement was carried out, and clinical success was achieved in all of them without any complication; the median survival time after reintervention was 89 days (range, 51-173).

Occlusion of SEMS may occur in about 20% in palliative treatment of malignant large bowel obstruction, but additional SEMS placement is effective and safe for the occlusion. Herbal medicines are considered as part of palliative care. Although total alkaloids, which are extracted and isolated from Kusheng and gentian etc(AH05 herbal formula), have neurotoxicity, it could be used as palliative care medicine in advanced cancer in proper dose. In this study, inhibitory effect and mechanism on hepatocellular carcinoma was investigated.

The total alkaloids were identified by High performance liquid chromatography (HPLC). H22 and HepG2 cell lines models and H22 xenograft model were established. Cell proliferation and migration activity were measured by MTT, Crystal violet and Wound healing assay. For mechanism, cytoflow and western-blot were used to investigate immune environment and the expression of the mitogen-activated protein kinase (MAPK) and PI3K/AKT/mTOR pathway. For safety, tissue toxicity were tested by HE stain.

In vitro, the total alkaloids, which consist of oxymatrine and matrine etc, were identified. It significantly inhibited cell proliferation and migration ability as a dose and time-dependent manner between 1.0mg/ml to 2.0mg/ml, respectively. In xenograft model, tumor volume and weight were smaller and lower compared to control group. Interestingly, in tumor microenviroment, the expression of p-ERK and p-MEK were activated, accompanied with expression of mTOR, NF-κB P50 and p-AKT were inhibited. Meanwhile, the percentage of CD4+CD8+ T cells in spleen was increased. For safety, slight intestinal mucosa edema was found without the lung, kidney and spleen injured.

Alkaloids from AH05 formula could inhibit liver cancer in proper dose by impacting on the PI3K/AKT/mTOR/NF-κB and MAPK pathway. It may be a potiental herbal extracted ingredients against cancer. 

We found that DNR orders were always signed late during the last hospitalization. Cancer patients who signed DNR orders beyond 3 days before death were less likely to undergo aggressive procedures but more likely to be given comfort measures, compared with those within 3 days. Further studies are necessary to better understand the optimum timing and promote early DNR orders in advanced cancer patients.

According to Bangladesh Cancer Society the economic burden of a new adult cancer patients was 250000/yr., and approximately 75% of the cancer patients who were admitted to receive treatment were incurable and they received treatment in palliative setting. 30-40% of these patients were in end days of life with substantial amount of sufferings and their admissions were refused by the hospital. Through palliative home care, we could reduce the frequency readmission in hospital.

This is a retrospective study based on cancer patient's record. The records of total 40 patients were reviewed who needed palliative care at home January 2018 to July 2018.

Among the patients' 53% were females and 46% males. Prior receiving the home care majority of them received conservative treatment 50%, 32% patients received chemotherapy and 3% patients had surgery. However 14% did not receive any treatment. From beginning of the home care 39% patients were suffering from pain and breathlessness and others were hypotension (17%) and cough (3%). Those who died during the study period, 46% of them died at home and 21% in the hospital. 32% of our study patients were alive. The pain managed at home effectively (80%) and was reducing the hospital readmission (80%) and reduce the economic burden (60%).

The evolution and growth of palliative care service and hospice should be from the combined effort of both the public and the private sectors. There are a number of challenges, that still make access to palliative home care almost impossible despite the need.

Well preplanning funeral arrangements is particularly significant in Chinese culture. It will be enhanced the bereaved family members' perceptions of a good death for the patient. The purpose is to improve the completeness of funeral preparations for palliative care nurses in a medical center in Central Taiwan.

Investigation through literature review, clinical observation and discussion indicated that the major causes.

The major causes included (1) insufficient knowledge in funeral custom and heedless of dying signs, (2) lack of standard procedure of funeral preparation, and (3) a shortage of funeral instruction tools. Strategies included (1) conducting training courses to enhance nursing staff's education about signs of dying and funeral custom, (2) setting up standardized funeral arrangement instruction procedure, and (3) producing a booklet contains the dying process and funeral preparation. Results showed that the completion of funeral preparation record increased from 36.8% to 96.7% and the family satisfaction increased from 79.6% to 93.4%.

Palliative nurses need to aware patients with dying signs and symptoms of approaching death, as well as to remind family members to carry on with funeral preparations at appropriate time. It expected that can enhance the quality of a good death care and support families during the death of a loved one will be reached. Feb 2013 -Jul 2015 . A structured interview guide conducted the assessments, exploring the relationship between cognitive changes, existential concerns and deeply held values. Analysis of cognitive dysfunction was performed considering the percentage of agreement between interview content (subjective experience) and neuropsychological tests (objective knowledge). Subjective e x p e r i e n c e s w e r e a n a l y z e d t h r o u g h I n t e r p r e t a t i v e Phenomenological Analysis (IPA) to identify interferences on existential values.

Above 50% of the patients had low performance or reported issues regarding cognitive function. A high agreement was noted between the interview content and 3 neuropsychological tests (92% -100%), while a moderate agreement was observed with 2 tests (54% -77% 

Clinicians' predictions of survival in palliative cancer patients are usually based solely on clinical intuition, which is often inaccurate. The PiPS models use objective clinical data to predict whether patients with advanced cancer will die within "days", "weeks" or "months+". We are currently validating PiPS in a large sample of palliative patients (n=1884) with advanced cancer. This paper presents data from a nested qualitative study that explored clinicians' views on the acceptability and utility of predictor models in practice, and barriers and facilitators to their use.

We recruited a purposive sample of clinicians (n=32), which included palliative care specialists, oncologists, GPs and nurses. Clinicians' were asked about their experiences of discussing prognosis with palliative patients and carers, views and opinions of prognostic models and facilitators and barriers to the use of PiPS models within clinical practice.

Overall participants considered the PiPS models to be acceptable and beneficial in three main ways: a) more accurate in predicting life expectancy, compared with clinicians' intuition b) a useful aid to help share prognostic information with patients and carers c) beneficial as an educational tool to improve clinicians' confidence in making accurate prognostic predictions. Barriers identified were: time and resource constraints, preferring to rely on own clinical judgement, clinicians' avoidance of life expectancy discussions.

Our study demonstrates the acceptability of PiPS models for use by clinicians.

We identified a number of important facilitators and barriers to use, that need to be addressed if PiPS models are to be implemented into clinical practice.

Methadone is an opioid with a unique mechanism of action, that offers several advantages in treating pain associated with cancer. Dosing and conversion calculations involving methadone can be tricky, and require close attention to detail. Results of a consensus-building process used to develop recommendations to maximize safety and efficacy of methadone dosing will be presented.

A panel of 13 providers (12 from USA, one from Canada) skilled in methadone dosing convened to develop guidelines. The American Pain Society guidelines for safe and effective methadone dosing were used as a starting point, and consensus was gained in the areas of selection of appropriate candidates for methadone therapy, opioid-naïve and opioidtolerant dosing, and monitoring.

Criteria to identify both appropriate and inappropriate candidates for methadone therapy were identified. Criteria for risk stratification were also developed prior to initiating methadone. Initial dosing of methadone for opioid-naïve patients (and patients receiving up to 60 mg oral morphine equivalents [OME] per day) is recommended to be between 2 and 7.5 mg oral methadone per day. Conversion to methadone from other opioids (> 60 mg OME per day) 

The median age of the patients was 75 (range, 54-93) years, and 22 patients (29.3%) were female. CS were administered for improvement of symptoms, to 18 patients before hospitalization, 12 patients immediately after hospitalization, and 12 patients sometime after hospitalization; however, 33 patients did not opt for the therapy. They were administered mainly for conditions such as dyspnea, general fatigue, anorexia, and/or pain. Irrespective of the type of CS administered to them, temporary improvements in the symptoms of 13 (31.0%) patients was observed before their deaths. However, it was observed that an early dosing tended to be more effective after hospitalization.

Although our sample was small, it was found that ALC patients can be successfully treated using steroid therapy.

Survival prediction is an important aspect of supportive care, and especially palliative care. However, robust survival prediction remains elusive. Machine learning approaches offer the potential to identify novel prognostic indicators, and so to develop more robust prognostic algorithms. The objective of this feasibility study was to develop a prognostic algorithm using machine learning for testing in a definitive study. Methods 50 patients with advanced cancer and an estimated prognosis of < 1yr were recruited. 149 variables were collected, including demographics, cancer diagnosis, ECOG performance status, cancer / other treatments, Memorial Symptom Assessment Scale Short Form (MSAS-SF) data, Pittsburgh Sleep Quality Index (PSQI) data, sleep diary information, wrist actigraphy parameters, and overall survival. A total of three regularised regression methods were applied / compared: 1) elastic net; 2) lasso; and 3) ridge. A leave-one-out cross-validation approach was used in the performance analysis. The accuracy of each algorithm was assessed by the R 2 statistic.

The lasso-derived algorithm demonstrated the highest accuracy in predicting overall survival (R2 -0.72). Fifteen variables were identified as most relevant for predicting survival, including nine negative predictors and six positive predictors. These included variables associated with venous blood samples (e.g. serum creatinine; neutrophil count; C-reactive protein), use of opioid analgesia, and various sleep parameters (e.g. wrist actigraphyget up time; PSQIsleep disturbance).

Machine learning methods confirmed certain established, and identified some novel, predictors for survival in this group of patients. A definitive study is now planned to test the accuracy of this new prognostic algorithm. 

The interaction PCGC with the oncologist was traduced in earlier referrals and symptom management.

Religious leaders are well respected in most Nigerian communities and are often called in to provide support for terminally-ill patients. Many Nigeria communities still view cancer as a stigmatized disease. This study sought to elicit the perceptions of Christian and Islamic religious leaders and explore problems associated their involvement in end-of-life care for cancer patients.

Participants were recruited among religious leaders. Four focus group discussion sessions were then be conducted with open-ended questions on previous involvement in end-of-life care of cancer patients and whether they would like to do more. The discussions were audio-taped, transcribed and coded using the NUDIST software.

Twenty-one respondents participated in the FGDs. The age ranged from 31 to 61 years. Seventeen (73%) of them had never heard of the term 'palliative care' in cancer care. Two out of the 4 (50%) who had heard about cancer care would be willing to convince others to use them when they are available. The fear of being labeled "soft" would be the greatest hindrance to accepting the patients. Comments include "you need to be careful about what people will say when the patients come'.

We observe that peer pressure would play an important role in the acceptability of end-of-life activities in this group. This could be used in the positive light in designing interventions.

Patients with incurable cancer have to deal with a wide range of symptoms due to their disease and treatment, influencing their quality of life. Nowadays, patients are expected to adopt an active role in managing their own health and health care. Oncokompas is an eHealth self-management application developed to support patients in finding optimal supportive care, tailored to their quality of life and personal preferences. A randomized controlled trial will be carried out to determine the efficacy and costutility of Oncokompas compared to care as usual.

Methods 136 adult patients with incurable lung, breast, colorectal and head and neck cancer, lymphoma and glioma, will be included. Eligible patients have a prognosis of at least three months and no curative treatment options. Patients will be randomly assigned to the intervention group, which directly has access to Oncokompas, or the waiting-list control group receiving care as usual, having access to Oncokompas after three months. The primary outcome measure will be patient activation. Secondary outcome measures comprise self-efficacy, health-related quality of life and costs. Measures will be assessed at baseline, two weeks after randomization, and at three months follow-up.

This study will result in knowledge on the efficacy and cost-utility of Oncokompas among patients with incurable cancer. This study protocol is registered in the Netherlands Trial Register (identifier: NTR7494).

The recruitment of patients in this trial started in January 2019 and is expected to be complete in January 2020. 

Understanding patients' and family members' medical decision-making and information-disclosure preferences is important for quality of care. Factors that influence Chinese advanced cancer patients'/family members' decision-making and information-disclosure preferences have not been studied before. We aim to describe the preferences and intend to identify whether the preferences are related to various factors.

Two hundreds patients with advanced cancerand their family members were surveyed using questionnaires. The factors examined included the Decision-Making Preferences Questionnaire, the Information-Disclosure Preferences Questionnaire, the Satisfaction with Decisions and Care Questionnaire.

The patients' median age was 56.5 year old, 28.5% female. Patients' preferences for decision-making were 30.5%for passive, 67.5%for shared, 2% for active. In univariate analysis, the religious belief (p=0.016) and the medical payment by patient (p=0.001) correlated with patients' decision-making. In multivariate logistic regression, increased percentage of payment by the patient was associated with a lower preference for passive decision-making (OR=0.97, 95% CI 0.96-0.99). Patient's with any religion belief is associated positively with a preference for passive decision-making (OR=3.452, 95% CI 1.304-9.138). In addition, all patients and family members wanted to receive information regarding the diagnosis and the chances of being cured, but 50% family members desired to hide the true information from the patients.

Majority of Chinese advanced cancer patients and family members prefer to make shared decisions. Their desires for active decision-making are associated with financial burden. The conflict on information disclosure between patients and their family members continue to present as an important ethical dilemma for Chinese physicians.

Caregivers to patients with life-threatening brain cancer experience a process of crisis and grief because they live in a constant state of anxiety and fear of losing the patient. They experience a demanding shift in roles are at risk of developing symptoms such as depression. They tend to neglect their own physical and emotional needs during the disease-and treatment trajectory. This presentation relies on a study that explores the perspectives of newly bereaved caregivers to patients with high-grade glioma and a systematic literature review on informal caregivers' experience and how they manage their life situation as bereaved.

Individual semi-structured telephone interviews with bereaved caregivers to patients with high-grade glioma who deceased during participation in the mixed-methods Neuro-oncological Rehabilitation study. Moreover, a systematic search was carried out in 2017 to explore how informal caregivers of patients with primary malignant brain tumour experience and manage their life situation after the death of the patient.

Bereaved informal caregivers experience psychosocial consequences and emotional reactions after bereavement, resulting in feelings of isolation and loneliness. They experienced depressive symptoms and fatigue, resulting in a reduced work capability and social network. Some caregivers use coping strategies such as disavowal, both prior to and postbereavement Conclusions There exists limited evidence on how the bereaved caregivers prefer to be supported, and further research is warranted. We suggest incorporating systematic information on bereavement in clinical practice and increased cooperation across sectors. Introduction Anticipatory medications (AM) have been widely used in various settings across many countries in people approaching end of life. Access to palliative care in rural and remote areas of Australia is lacking as are other medical services when compared with the metropolitan setting. Our aim is to identify challenges with the administration and access to AM in rural and remote communities with outcomes to guide improved delivery of care.

An online survey administered using Qualtrics, a secure survey platform was distributed to a total of 18 managers from 18 rural and remote organisations across the South East of Victoria in Australia.

A total of 29 nurses completed the survey (response rate 28%). Almost a third of all nurses surveyed did not have specific guidance regarding the use of AM for their patients. Opioids (55%) were by far the most commonly used AM followed by anti-emetics (45%). The most common decisions taken by nurses to administer AM were cited as patient deterioration or in their terminal phase with a fluctuating level of anxiety and patients' agitation. Access to AM and lack of staff education were major challenges in rural and remote areas.

Provision of timely AM has the potential to improve the quality of life of patients and their caregivers. Key barriers to access AM can be overcome with community-level planning and nurses' education. Advanced nurses' roles have the opportunity to provide specialised care where access to specialist physicians is challenging.

Palliative care is an approach that improves the quality of life of patients and families facing challenges associated with life-threatening illness. In Alberta, most people who received palliative care received it late (within last 3 months of life), which has negative implications for patient and caregiver experiences, greater emotional distress, and decreased quality of life. This study aims to understand patient and caregiver experiences of advanced colorectal cancer care to inform development of an early palliative care pathway.

Qualitative study that is embedded within a larger program of research on implementation of Palliative Care Early and Systematic (PaCES). Semistructured telephone interviews with patients living with advanced colorectal cancer and caregivers were conducted to explore their experiences with cancer care services received pre-intervention. Interview transcripts were thematically analyzed supported by the qualitative analysis software, NVivo.

Results 15 patients and 7 caregivers from Edmonton and Calgary were interviewed over the phone. A total of 6 main themes generated: 1. Meaning of Palliative Care; 2. Communication (subthemes: communication of diagnosis, communication between patient and oncologist, communication amongst providers); 3. Relationship with healthcare providers (including oncologist, family doctor, and nurses); 4. Access to care; 5. Patient readiness for advance care planning; 6. Patient and family engagement in care.

Most participants misperceived palliative care to mean 'end of life care', suggesting a need for improvement in the delivery of palliative care information to patients and caregivers. Understanding the care experiences of patients and caregivers will inform the development of a care pathway for early palliative care. In this NHL cohort, the incidence of ≥ grade 2 diarrhea was 16% for enterade® versus 86% for placebo (p= 0.02). In NHL patients consuming >7 days of study product, compliance increased to 45% for enterade® and 55% for placebo. Diarrhea ≥ grade 2 incidence was 33% in enterade® versus 73% in placebo (p=0.08).

Studies show that language barriers and use of interpreters impact disparities in end-of-life care. However, the precise ways in which language barriers and interpretation affect hospice and palliative care services for diverse patient populations remain under-examined.

This qualitative, individual interview study was conducted with stakeholders in end-of-life care as part of a broader study examining multiple barriers to hospice enrollment in diverse patient populations. This study specifically focuses on how language barriers contribute to such disparities. One researcher conducted all interviews, which were audio-recorded, transcribed verbatim, and coded using NVivo11 software. Three researchers analyzed coded sections related to language barriers and interpreters, using the immersion/crystallization method, individually and during group analysis meetings until consensus regarding initial themes was achieved. Currently all three researchers are analyzing interviews in their entirety to ensure that no themes were lost in the coding procedure. IRB approval was obtained.

Results 22 participants included physicians, nurses, social workers, chaplains, nursing assistants, administrators, and patient caregivers, who selfidentified from a variety of ethnic backgrounds. Initial themes regarding how language barriers impact hospice and palliative care: (1) precision of translation (medical terminology, word choice, and inclusion of cultural context), (2) manner of interpretation (intonation, body language, and rapport), (3) interpreter training level, and (4) structural barriers to accessing interpreters. While these themes are relevant across healthcare settings, the delicacy of end-of-life conversations heightens their impact.

Preliminary results suggest that interpretation quality impacts disparities in end-of-life care in multiple, interrelated, nuanced ways. Innovative solutions are required.

Introduction All patients are assessed by the palliative care consultation team before admission to the acute palliative care unit (APCU). Even so, patients may die within 24 hours of admission, causing distress to clinicians and to the patient's family. Risk factors associated with this sudden death are unknown.

A retrospective study of medical records of patients transferred to the APCU from October 1, 2013 to October 1, 2017 was performed to identify those who died within 24 hours after transfer. Characteristics of these patients were compared to a control group composed of a random sample of patients that were alive 24 hours after transfer to the APCU.

A total of 79 patients died within 24 hours after transfer to the APCU. Compared to the control group, the patients that died within 24 hours were more likely to have a higher Memorial Delirium Assessment Scale (MDAS) score (P = 0.0001), a hematologic malignancy (P = 0.0002), to be transferred during weekdays (P = 0.0002), to be unresponsive (P = 0.0023), to be on oxygen therapy (P = 0.0395), and to have a higher Eastern Cooperative Oncology Group performance status (P = 0.0275). There was no significant difference in the Edmonton Symptom Assessment System scores between groups.

Patients with delirium, oxygen requirements, hematologic malignancies, low performance status, and unresponsiveness at the time of transfer are more likely to die within 24 hours of APCU transfer. A more thorough pre-transfer evaluation of these patients is required to minimize distress to patients, families, and staff. 

Limited researches evaluate effectiveness of cancer patients home care management. Our project represents an opportunity for patients who may benefit from chemotherapy, but with physical and social problems that prevent day-hospital access, and a model of "no profit" contribution to the Public Health System.

Our Oncology Department, supported by a no-profit organization, conducted this project from 2014 to 2018. We included frail patients selected with G8 score (<14), with advanced diseases, treated with oral or subcutaneous therapies and supportive cares, with limitations to day-hospital access, co-morbidities and at least six months life expectancy. A multidisciplinary team included 4 Nurses, an Anesthetist, a Psychologist, a Physiotherapist and an on call Oncologist. Satisfaction was evaluated with the FAMCARE scale.

A total of 135 patients (median age 73 years) with metastatic disease and a median G8 score of 8.8 (range 3-13) were enrolled. They received supportive cares and anticancer treatment. Median duration of taking care was 162 days (range 7-853). We performed a total of 189 nursing and 145 medical visits per year, with an average of 1.5 and 1.8 visit per month, respectively. Median number of in-line patients was 20 (range 17-24). Hospitalization occurred in 18.4%. One third of them died at home. FAMECARE assessed a high patients and caregivers satisfaction.

Our experience shows the effectiveness of integration between supportive care and anti-cancer treatment in home setting. If confirmed in prospective pharmaco-economics studies, our data suggest that home cancer treatment provides high quality of assistance to frail patients. 

In palliative care unit (PCU), palliative care team provide physical, psychosocial, and spiritual care to patients and their families.

To improve quality of care, we must measure whether palliative care really improve their physical, mental and spiritual well-being.

The Korean version of Edmonton Symptom Assessment System (K-ESAS) were filled out within 3 days from admission and weekly thereafter by advanced cancer patients in PCU of Pusan National University Yangsan Hospital. This study is retrospective analyses of the K-ESAS written from March 2018 to December 2018.

Totally 173 patients were admitted in PCU. Among them, 97 patients (56%) could fill up 222 K-ESAS questionnaires. Median age is 62 years (33-90) and there were more male (n=55, 56.7%) than female. To evaluate the change of symptoms over time, we focused on K-ESAS of patients who filled-up three-times (three weeks) or more K-ESAS. There were 28 patients who met this conditions, and these patients completed total 130 K-ESASs. For each items of K-ESAS, the score of fatigue (p=0.001), nausea (p=0.011), anxiety (p=0.025), shortness of breath (p=0.004), and insomnia (p=0.045) showed gradually decreased (test of linearity by One-way ANOVA). For the each symptom scale, similarly, comparison of mean value of 1st to 3rd K-ESAS versus 4th to further of it showed that the score of fatigue, nausea, shortness of breath, and insomnia were significantly decreased (p=0.013, 0.010, 0.045, and 0.042 for respectively; t-test). <Dotplot of representative symptom scale over time>

Some symptoms of terminal cancer patients measured by K-ESAS were improved over time in PCU.

Advance care planning (ACP) is the process of ongoing communication among patients, family and healthcare professionals regarding what plans for future care are preferred. The present systematic review aims to evaluate the formats and effectiveness of ACP training programs for healthcare professionals. Methods A literature search for intervention studies was conducted independently by two reviewers in July 2018. Participants included healthcare professionals working with adult patients suffering from terminal illness. The Effective Public Health Practice Project appraisal tool was used to examine the quality of the studies included.

A total of 4,025 articles were identified, and 10 eligible articles, covering 1,081 participants, were included in the review. A PRISMA flow chart of the study retrieval and selection process with reasons for exclusion at each stage will be presented. The overall quality of the intervention studies was moderate. All the studies included used instructional sessions in their interventions, while some contained group discussion, role-play and the use of advanced technology and decision aids. The training programs improved the knowledge, attitudes towards shared decision-making, perceived communication skills, confidence, and experiences concerned with discussing end-of-life (EOL) issues. Patient advocacy, job satisfaction and perceived level of adequate training for EOL care were also improved. The use of 'decision aids' were rated as acceptable and clinically useful.

To validate the Sheffield Profile for Assessment and Referral to Care (SPARC) as an effective tool for screening the needs of palliative care in Korean cancer patients Methods English version of the SPARC was translated by 4 Korean oncologists and merged by a Korean language specialist. Established the 1 st version of the Korean-SPARC (K-SPARC) was back-translated into English was performed by a professional translator and bilingual oncologist. Back-translated version was reviewed by the original author (Ahmedzai SH) and some modifications were made (version 2). The second version of the K-SPARC was tested with other questionnaires including FACT-G and ESAS.

A total of 15 patients was enrolled in the pilot trial. Nine were male and the median age was 58 years. Four had ECOG PS more than 2, while 10 received education beyond high school. All patients were receiving palliative chemotherapy in an in-patient setting. Mean score for each item was not significantly affected by gender. Internal consistency (Cronbach 's α score) for physical symptoms, psychological issues, religious and spiritual issues, independency and activity, family and social issues, and treatment issues were 0.852, 0.783, 0.567, 0.653, 0.729, and 0.801, respectively. Correlation coefficient of SPARC and FACT-G for physical domain was 0.697 (p=0.004) and social domain was -0.069 (p=0.808). Social domain showed difference per gender.

The Cronbach 's α scores in our pilot study indicate that K-SPARC might be a valid tool to screen for the needs of palliative care in Korean cancer patients. Further study is ongoing to validate our findings.

Early access to palliative care (PC) improves patient/caregiver and health system outcomes. Rural PC is characterized by late referrals, limited access to specialized care, and poorer symptom control. The objectives of this patient/caregiver study were:

1. how they perceive early PC referral; 2. how to improve PC alongside cancer treatments; 3. how to transition from disease control/cure-focused treatment to palliative-focused care.

This qualitative study utilized interpretive description methodology (Charmazian Grounded Theory) to guide data collection and analysis.

Participants interviewed comprised thirteen patients and nine caregivers living with advanced cancer in rural Alberta. The themes were: 1. Rural patients and families appear uninformed (unaware?) about the availability of PC treatment option, or as adjuvant care alongside curative and disease control therapies. Most recognize PC as focused on comfort and quality of life, and useful only at end of life. 2. Patients and families want PC to be introduced early, based on patient readiness, with information delivered in a straightforward manner. 3. Rural patients and families face challenges common to all those living with advanced cancer, exacerbated by long travel times and scarcity of specialized services. 4. Home care, nurse/patient navigators and satellite cancer clinics are critical services. 5. Support groups for patients and caregivers are crucial, but lacking.

The availability and benefits of PC remain largely unknown to rural Albertans. When PC is recognized as a supportive modality available throughout the disease trajectory, patients and caregivers reported they would benefit from early palliative interventions. Anorexia/cachexia occurs in many patients with advanced NSCLC. In the randomized, double-blind phase 3 trials ROMANA 1 (NCT01387269) and ROMANA 2 (NCT01387282) in NSCLC patients with cachexia, the ghrelin receptor agonist anamorelin was well tolerated and significantly increased body weight, lean body mass (LBM), fat mass (FM), and reduced anorexia symptoms. A body mass index (BMI)<20 kg/m 2 is a diagnostic criterion for cachexia. This analysis assessed changes in body composition of anamorelin in people with BMI<20 kg/m 2 compared with those who had BMI≥20 kg/m 2 .

Stage III/IV NSCLC patients with cachexia (BMI<20 kg/m 2 or a weight loss of ≥5% during the prior 6 months) were randomized 2:1 to 100-mg oncedaily oral anamorelin or placebo for 12 weeks. A pooled post-hoc analysis measured changes from baseline to end of study (EOS) in body weight, LBM, and FM, in patients with BMI<20 kg/m 2 and BMI≥20 kg/m 2 .

In patients with BMI<20kg/m 2 at baseline (N=182), anamorelin significantly increased body weight, LBM, and FM at EOS (Table) . This was also observed in patients with BMI≥20 kg/m 2 , to a lesser extent, however.

In NSCLC patients with anorexia/cachexia and BMI<20kg/m 2 , anamorelin produced a clinically relevant increase in each measure: body weight, LBM, and FM. These results suggest that patients with more advanced cachexia can still benefit from anamorelin treatment. Current phase 3 studies further evaluate the effect of anamorelin on body weight and anorexia symptoms in people with NSCLC and BMI<20 kg/m 2 . 

We assessed information provision and information needs about illness course, treatments, palliative care and euthanasia in cancer patients.

Cancer patients consulting a university hospital (N = 620) filled out a questionnaire. Their cancer related data were collected through the treating oncologist. This study is performed in Belgium, where "palliative care for all" is a patient's right embedded in the law and euthanasia is possible under certain conditions.

Around 80% received information about their illness course and treatments. Ten percent received information about palliative care and euthanasia. Most information about palliative care and euthanasia was given when the patient had a life expectancy of less than six months. However, a quarter of those in earlier phases in their illness trajectory, particularly those who experienced high pain, fatigue or nausea requested more information on these topics.

Many patients want more information about palliative care and euthanasia than what is currently provided, also those in an earlier than terminal phase of their disease. Practice implications: Healthcare professionals should be more responsive, already from diagnosis, to the information needs about palliative care and possible end-of-life decisions. This should be patienttailored, as some patients want more and some patients want less information. 

Communicative behaviours and patient-centered care are important determinants for timely initiation of palliative care. We aimed 1) to understand and explain the behaviour 'starting a conversation about palliative care with a health professional' from the perspective of people with incurable cancer by using behavioural theories (eg Theory of Planned behaviour) and 2) to formulate a behavioural model for the defined behaviour. Methods A qualitative study using semi-structured face to face interviews with 25 persons with incurable cancer: 13 not (yet) receiving palliative care and 12 already receiving palliative care. Identified determinants related to 'starting a conversation about palliative care with a health professional' were fitted in concepts of behavioural theories (eg 'attitude' of the Theory of Planned Behaviour).

Both positive and negative stances towards starting a conversation about palliative care with a health professional were found. The oncologist and the family physician were the preferred health professionals. Factors facilitating and hindering the behaviour were identified such as awareness (eg perceived health threat); knowledge (eg about palliative care possibilities); attitude (eg association of palliative care with quality of life or death); social norm and influence (eg the relationship with the health professional); and perceived behavioural control (eg self-confidence) and modelled in a behavioural model applied to palliative care initiation.

The identified modifiable determinants of our behavioural model can be used to develop promising interventions promoting palliative care communication initiated by the patient and improving timely palliative care initiation.

Delirium is common in patients receiving palliative care, which reduces the quality of life of the patients. Although nearly half of the delirium among such population is reversible, the importance of early detection and timely management is often overlooked. In this study, we investigated the prescription rates of drugs administered for delirium management, using claims data from the Health Insurance Review and Assessment Service (HIRA) in South Korea.

We obtained information on palliative care among a nationwide cohort of 20,556 patients whose diagnoses were registered as palliative care from January 1, 2013 to December 31, 2016, based on HIRA claim data. The prescription rates of antipsychotics, benzodiazepines, opioid analgesics and other sedatives according to year, age, and hospital levels were analyzed by Cochran-Armitage test.

The prescription rate of antipsychotics significantly increased from 19.8% in 2013 to 26.2% in 2016 (p < 0.001). As age increased, the prescription rate of quetiapine significantly increased (5.6% in ≤60 years to 11.5% in >80 years, p < 0.001) and that of benzodiazepines significantly decreased (35.7% to 25.4%, p = 0.024). As the level of the hospital increased from primary-level hospital to tertiary hospital, the prescription rate of antipsychotics significantly increased (17.1% to 33.2%, p < 0.001).

The prescription rate of antipsychotics in patients receiving palliative care increased during 2013-2016, indicating the improvement of physicians' awareness of delirium management. However, prescription rates of antipsychotics varied widely by hospital level, suggesting that education and palliative consultation on delirium management for palliative care providers may be required. 

The MASCC Palliative Care Study Group formed a sub-group to develop evidence-based recommendations on the management of constipation in patients with advanced cancer.

The recommendations were developed in accordance with the MASCC Guidelines Policy.

Recommendations ( 

Ambulatory palliative care clinics are increasingly recommended for optimum early palliative care. However, little is known about the characteristics of patients referred urgently to these services, and how they may differ from patients referred for routine assessments. Our objective was to compare these two groups.

We retrospectively reviewed all urgent referrals between January 2016 and December 2017, comparing these to a random selection of patients referred for routine assessment in a 1:2 ratio. Data was collected on patient demographics, tumour site, referral source, reason for referral, and disposition after the clinic visit.

A total of 113 patients were referred urgently to the palliative care clinic and were compared to 226 routine assessments. The mean age was 64±15 (vs. 67±13 for routine referrals, p=0.06) and 53% were female (vs. 48%, p=0.36). The most common tumour sites for urgent referrals were lung (23%) and gynecological (17.7%), compared to lung (17.3%) and gastrointestinal (20.4%) for routine assessments. A total of 79.6% of urgent referrals were for symptom management, while 20.4% required palliative care planning; medical oncology accounted for 58.4% of referrals. Sixteen percent of urgent referrals were admitted to hospital following their palliative care clinic visit, and 60.2% continued to be followed in the palliative care clinic.

There is a trend towards younger patient age for urgent referrals, most of which are for symptom control. Palliative care clinics need to consider how best to incorporate urgent referrals into their services. 

Hospice is crucial for providing high quality supportive care at the end of life. However, predictors of utilization of hospice by older patients with advanced cancer treated in community oncology practices are not welldescribed.

This is a secondary analysis of patients aged 70+ with advanced cancer who died within one year of enrollment from a nationwide clusterrandomized geriatric assessment (GA) (URCC 13070; PI: Mohile); patients had ≥ 1 GA domain impairment when enrolled (e.g. cognition, function). Hospice use and place of death were captured. We conducted bivariate and multivariate logistical models to examine predictors of hospice use, including demographics, study arm, and clinical variables [cancer and total number of GA domain impairments].

Among 541 patients (age 70-96), 178 (33%) died within one year, of these, 69% utilized hospice. Place of death were home on hospice (51%), hospice facility (14%), home not on hospice (7%), long term care facility (7%), inpatient hospice (4%), inpatient not on hospice (5%), and unknown (13%). On bivariate analyses, patients who were younger or received chemotherapy were more likely to utilize hospice while patients on hormonal treatment were less likely to utilize hospice (all Ps ≤.05). On multivariate analysis, only receipt of chemotherapy was associated with hospice utilization ( 

We evaluated whether early and systematic integration of palliative care (PC) into oncology care, which benefits people with advanced cancer in comparison with usual care, also has an impact on informal carers.

We randomly assigned advanced cancer patients with a lifeexpectancy of one year and their informal carers to early and systematic integration of PC into oncological care (n=60) or usual care (n=55). Eligible carers lived with or had in-person contact with the patient at least twice a week and were likely to accompany him/her to the hospital. Carers completed validated measures assessing quality of life [SF-36v2 Health Survey] at baseline, 12 weeks and six weekly thereafter until death.

Carers from the intervention group reported greater improvement in the mental component score ( 

The majority of studies assessing goals, and quality of palliative care (PC) are about 'end of life' care in general. However, to improve care of the imminently dying, a focus on the 'last days of life' is essential. We aimed to better understand the needs of families during the last days of life of a dying family member.

After ethical approval, between 2017 and 2018, 16 family members representing 13 deceased patients participated in-depth interviews/focus groups. Data were thematically analysed.

All the deceased had died of cancer. In the last days of life, six main themes were central: 1) the need for taming time, 2) the need for clearer and caring information, 3) the need for individualised support and companionship, 4) the need for interconnected, attentive and caring health professionals, 5) the need to feel in the right place of care, and 6) the need to create positive memories of the dying phase despite the circumstances. Within these themes several subthemes were identified.

Dying in an acute palliative care unit can be remembered positively but due to existing practices, including late referral, families are confronted with many time-dependent issues. At such a late phase, time is rarely negotiable but through the identified themes, treating teams can improve how people die and how families adjust to death. Most importantly, many of the identified aspects can and should occur outside PC, thus, our findings can enhance the support given in other settings of care, including hospitals, hospices, aged care and the home.

Delirium is a common and serious medical complication during hospitalisation. Multicomponent non-pharmacological strategies prevented delirium in one in three older hospitalized patients in previous studies, and require testing in inpatients with advanced cancer. Methods A phase II (feasibility) cluster randomised controlled trial of a multicomponent non-pharmacological intervention to prevent delirium for adult inpatients with advanced cancer at four Australian palliative care units, with control sites waitlisted to the intervention. The intervention included strategies to promote optimal sleep, vision and hearing, hydration, orientation, mobility, and family partnership. We collected data for the first seven days of enrolled patients' admission. Outcomes focused on delivery of care (with adherence the primary outcome); delirium incidence and severity; and adverse events. Data were analysed using descriptive statistics.

Data were collected for 65 eligible patients (20 intervention, 25 control, 20 waitlist intervention) May-September 2018. Adherence was higher at waitlist intervention sites, where 28% of patients received all prevention strategies and 50% received any strategy within at least four domains for at least five of the first seven days of admission. Highest delivery of the intervention was by nurses (67%), then medical staff (16%), allied health (8.4%), family caregivers (7%) and volunteers (0.5%). There was 98% completion of delirium screening and 77% completion of diagnostic assessment. Delirium incidence was lower in the intervention (20%) and waitlist intervention sites (20%) compared to controls (32%). The intervention resulted in no adverse events or complaints.

Results from this feasibility study inform the development of a phase III trial of the intervention.

To support the early integration of palliative home care (PHC) in cancer treatment, the EPHECT intervention was developed and pilot tested with 32 advanced cancer patients in Belgium. The intervention consisted of systematic consultations with a PHC team, supported by a semi-structured conversation guide. Telephone-based contact was used to facilitate transmural collaboration between home and hospital, with the general practitioner (GP) as coordinator of care. Aim: to determine feasibility and acceptability of the EPHECT intervention as perceived by the patients and healthcare professionals involved.

Interviews with patients (n=15), oncologists and GPs (n=9) and a focus group with the PHC team. Data were analysed using thematic analysis.

Most intervention components were found feasible and acceptable, except for 'transmural collaboration' and 'GP as coordinator of care'.

Healthcare professionals mentioned problems with being reachable and reported that it was difficult to estimate when contact was needed. According to GPs and the PHC team, the responsibilities and task allocations of the different professionals remained unclear. The intervention had no perceived effect on the involvement of GPs, according to patients, family carers, the PHC team and GPs.

Telephone-based contact seems to be insufficient to facilitate transmural collaboration in a model of early PHC embedded into cancer treatment. Furthermore, the role of the GP might have to be reconsidered, as most of them were rarely involved. Based on these results, we are able to further refine the intervention model before implementing it in a phase 3 randomized controlled trial for the evaluation of its effectiveness. 

Delirium is a serious and common medical complication for people with advanced cancer during admission to hospital. During a phase II trial of a multicomponent non-pharmacological delirium prevention intervention for inpatients with advanced cancer, we sought patient, family, staff and volunteer perspectives of the feasibility and acceptability of the intervention and study measures.

An embedded qualitative study. Following implementation of the intervention (delirium screening, diagnostic assessment, and prevention strategies addressing sleep, vision, hearing, eating and drinking, orientation, mobility and family partnership) at four participating Australian palliative care units, we conducted semi-structured interviews with patients, family, staff and volunteers. Data were analysed using directed content analysis according to the Behavior Change Wheel (BCW) theoretical domains.

Participants were multidisciplinary staff (n=28), patients (n=6), family members (n=4), and one volunteer. Influences upon intervention delivery aligned with the BCW core domains of 'capability', 'motivation' and 'opportunity', which we will report within seven sub-themes. Overall, participants generally believed the delirium prevention intervention was feasible and acceptable for patients with advanced cancer, and that adherence to the intervention in a phase III trial will be enhanced by i) simplifying the intervention; ii) aligning strategies to discipline roles; iii) modifying documentation and data collection processes; and iv) developing structured process to better engage family and volunteers in the delivery of patient care.

Findings informed both the processes and results of the trial, as well as the development of a phase III trial of the intervention.

Since the implementation of the Life-Sustaining Treatment Decision (LSTD) Act in February, 2018, end-of-life (EOL) care decisions have become an urgent issue in Korea. However, the execution rate in clinical practice is still low due to lack of prior discussions and patients' perceptions. This study is to explore the incidence and timing of LSTD in recurrent gynecologic cancer patients after the initiation of the new legislation.

Retrospective observational study was performed of patients that were treated for recurrent gynecologic cancer at a tertiary hospital. Patients who signed the LSTD consent form during this study period were assessed. Cancer type, previous number of treatments, type and time from first recurrence to LSTD documentation, survival after consent and barriers to consent were analyzed.

A total of 277 patients were treated for recurrent gynecologic cancer during the study period. Among them, 37 patients (13.3%) gave consent for POLST by themselves and decision of 7 patients' (2.5%) were made by the family due to physical inability of patient to sign. The median number of chemotherapy regimens before the consent was 3 (range 1-6). Eighty percent of patients were in the disease progression state and the median number of days from the POLST consent to death was 45 days . The most common cause of reluctance to decision making for EOL care was lack of information and insight on the disease status.

Findings suggested that family discussions on LSTD is needed in advance to resolve resistance to early hospice-palliative care. 

Palliative Care referrals (PCR) improve symptom management, provide psychosocial and spiritual support, clarify goals of care and facilitate discharge planning; however, very late PCR do not allow patients and families to benefit from the full spectrum of interdisciplinary care. Methods Consecutive first-time inpatient PCR from September 2014 to August 2017 were reviewed to determine the frequency and predictors of PCR within 24 hours of death. Clinical characteristics were compared with a random sample of patients who were discharged alive or died >24 hours after first-time PCR.

Results 154/7322 first-time PCR (2%) died within 24 hours of referral. Patients with PCR within 24 hours of death were older (p=0.0029) and had higher scores for depression (p=0.0009), drowsiness (p=0.0190) and shortness of breath (p=0.0082 Registered nurses in the UK have the authority to prescribe for their patients (including controlled drugs) following successful completion of a recognised qualification. Evidence suggests that specialist nurses are not using their qualification due to various factors such as lack of confidence and limited support. The SPCT within a district general hospital and cancer centre has 5.4 WTE clinical nurse specialists (CNSs) 3 of whom are NMPs. The team were interested to evaluate the prescribing activity of the NMPs including the scope of medications prescribed and to highlight any barriers.

A prospective review of all consultations and the prescribing activity of 3 non-medical prescribers (NMPs) between 1st August 2018 and 31st October 2018. Information was recorded and analysed using micosoft excel.

A total of 493 consultations with 186 individual patients were carried out in the time period. 247 consultations resulted in a prescription; 209drug started; 23 -dose change; 15 drug stopped. 246 consultations with no change in prescription; 234no indication for change; 10advice given; 2advice sought. Table 1 shows the range of drugs prescribed No. of times prescribedStrong opioid123Antipsychotic57Conventional

Children and adolescents with cancer experience social, psychological and educational difficulties, because of treatment-related absenteeism, once they return to school. This results in 20% of the children having to repeat a class. New technology may facilitate education by connecting the child to the classroom despite being physically absent. This pilot-study explores if and how telepresence-robots can support school-aged children with cancer to maintain socially and academically connected with their class during treatment, and thereby facilitate their social and educational development.

The intervention pilot-study, entails implementation and extradition of AV1-robots for children with cancer, during treatment. School-aged children (n=3, 12-14 years) diagnosed with cancer or cancer-related illness were included, along with their parents (n=3), teachers (n=2), classmates (n=15) and medical-professionals (n=4) in 2017-2018. Data were collected by semi-structured interviews and focus group interviews combined with participant observation in the classrooms.

Three themes were found relating to sociality, learning, and technology. The study showed that telepresence robots can facilitate social interaction processes with classmates and inclusion in learning activities, which reduced the sense of loneliness and exclusion. However, the robotintervention is influenced by multiple factors that determine whether the robot technology is inclusive or exclusive for the child, including; the technical functionality of the robot, the well-being of the child, and the expectations between the parties involved.

The telepresence-robots may provide new possibilities for school-aged children to continue their regular education, despite being hospitalized or isolated at home. However, technology improvements and further evidence-based research are needed.

Undergoing chemotherapy can produce physical and psychological symptoms that lead to reduced physical function, activity, and quality of life (QOL). Exercise is useful to decrease fatigue and depression and improve function and QOL. Study purpose was to compare characteristics of patients based on the number of minutes per week they exercised during chemotherapy treatment.

Oncology patients completed questionnaires related to exercise, symptoms, over-all physical and mental health and QOL experienced in the week prior to the initiation of a chemotherapy cycle. Three exercise groups were created based on the amount of time the patients reported exercising in the past (i.e., 0 minutes (non-exercisers), <150 minutes (low-exercisers), and >150 minutes (high-exercisers). Analysis of variance was used to evaluate for differences among the three exercise groups.

Of the 1033 respondents, 37.2 % were non-exercisers, 43.7% were lowexercisers, and 19.1% were high-exercisers. Compared to the two exercise groups, non-exercisers had higher BMI, lower Karnofsky Performance status score, and a higher number of comorbidities. Compared to the high-exercisers, non-exercisers reported more pain, lower attentional function, higher depression, poorer sleep, and higher morning fatigue. In addition, non-exercisers had poorer physical function, and reduced QOL.

Patients undergoing chemotherapy who do not exercise have poorer physical and mental health compared to those who exercised for any amount of time per week. Patients may experience health benefits by incorporating some physical activity into their daily routine while in treatment. 

To improve quality of life (QOL), these survivors must deal with treatment-related side effects through self-regulation (SR). This study evaluated the psychometric properties of a culturally adapted Taiwan Chinese version of the self-regulation questionnaire (TC-SRQ) for gynecologic cancer survivors. Methods A cross-sectional study. The TC-SRQ was adapted from a German version through translation and back translation. Pilot (N=37) and formal tests (N=287) of TC-SRQ with a sample of these survivors were conducted. Construct validity was evaluated by confirmatory factor analysis; convergent validity tested by using EORTC QLQ-C30 while discriminant validity using age, family support, health status, and sleep quality. Reliability was evaluated by internal consistency and test-retest reliability.

Analying data fit for TC-SRQ measurement model found significant difference (χ2=311.23, p=0.0) failed to reject the null hypothesis but satisfied by popular fit indices (RMSEA=0.088; NFI=0.97, CFI=0.98, NNFI=0.97). SR correlated positively with QOL in overall and in partial of functional domains and negatively with fatigue and pain. SR also distinguished by age, family support, health status, and sleep quality. Thus, TC-SRQ demonstrated good convergent and discriminant validities. A Cronbach's α of .91 indicated good internal consistency; the test-retest reliability coefficient was .82. Conclusions TC-SRQ is valid and reliable for assessing self-regulation in gynecologic cancer survivors. With TC-SRQ, self-regulation of gynecologic cancer survivors can be measured clinically and regularly.

This study aims to examine the long-term effects of mindfulness added to body-mind-spirit group therapy on improving depressive symptoms, physical distress (physical symptoms and functions), psychological well-being (mindfulness status, holistic well-being, meaning in life) among NSCLC survivors.

This study adopts the randomized controlled trial (RCT) design. Total 62 patients who are the stage 0-IIIA of non-small cell lung cancer (NSCLC). The subjects in a control group receive 120 minutes every week for 2-month education with supportive group.

In the same period of time, in addition to contents of education provided in control group, subjects in an experimental group also receive 120 minutes every week for 2-month mindfulness added to body-mind-spirit group therapy (mindfulness with BMS) (mindfulness skills and boy-mind-spirit empowerment strategies).

Total 62 patients participated in this study. For the baseline characteristics, except age, there were no significant differences between two groups. During the 5-month follow ups, while there were no significances in reducing depression levels in both groups, the greater reductions in emotions vulnerability and spiritual disorientation of BMS scale occurred in the experimental group than in control group. Moreover, the greater increases of global health scores and mindfulness levels were observed in the experimental group than in control group.

The results suggest BMS could decrease depression levels for the participants in both experimental and control groups during the 5-month follow ups. Additional mindfulness to BMS group therapy could reduce emotional vulnerability and spiritual disorientation, and increase global health status and mindfulness levels.

A. Kurihara 1 , O. Hino 2

Traditionally, the relationship between mother and daughter is known to have many conflicts. A purpose of this study is to clarify the suffering of the female cancer patient who has a problem for mother and child relations.

This study was a descriptive qualitative-exploratory research, in which 5 participants were selected through purposive sampling and had semistructured interviews about a current suffering. Interviews were recorded, transcribed and analyzed using an inductive approach to identify common themes.

4 themes emerged about the meaning of suffering in female cancer patients who has a problem for mother and child relations: an invalid family coping, gave up already, avoid direct view, forced self-affirmation. But while i listening to their stories, the hope to the future life changed from negative to want to live.

It was revealed that female cancer patient had problems with parenthood relationships, family life, long-term planning, and self-identity. Nursing intervention for patients with family function problems is difficult. But, listening closely of life review is effective for people who have been deeply bruised feelings in the past. 

Cancer is a chronic disease that generates social consequences in the short, medium and long term. What are the patients' social needs? What kind of social support for these patients?

At the Oscar Lambret center, there are two social workers. One social worker is dedicated to adults and the other one to children, adolescents and young adults. Their missions are based on the referential of the Francophone Association of Supportive Care in Oncology as well as the various Cancer Plans. Patients are assessed and supported regarding the different issues identified.

Main patients' needs are related to access to care, disease recognition, family life, professional situation, financial aspects, housing issues and family organization. There are three main axes: technical-administrative work, help relationship and social mediation. The social worker works in a multidisciplinary team and in partnership, essential to a collegial reflection on patients' life project. Relying on patient's skills will guarantee a comprehensive and personalized care.

Our approach is systemic so that the norms, values, culture and history of the patient are respected and integrated in patient care path. For an always more qualitative support, two new projects are being investigated: collective interventions focused on professional integration and support for caregivers. The construction of an individual subject takes time, is not linear, is made of changes that must be supported, the aim is to get back autonomy eP494

The significance of alopecia and preference of hair wigs, which is highly tabooed and stigmatized in a culturally built country like India is under explored. This study attempts to investigate the awareness among patients about hair wigs, their preference and its impact on their quality of life. Methods Patients (N=294) with cancer, aged 13 and above, receiving chemotherapy were assessed for awareness and preference of hair wig, using an author-constructed interview schedule. Patients who preferred wigs were issued one, following the assessment of quality of life using Cancer Institute Quality of Life questionnaire, while 88 patients completed post assessment on completion of chemotherapy. The data thus obtained was analyzed using descriptive statistics, chi-square and Pearson's correlation.

Majority (94.2%) of the patients were aware of alopecia and reported psychological (27.9%) and social (40.8%) as major area of concerns. While only 53.1% perceived hair loss to be highly significant, 65% preferred to have wigged. There was a significant association between education and awareness about wig (p<0.01) and preference for wig (p<0.01). Preference for wig was significantly correlated with age (r=0.220; p<0.01), perceived significance of hair loss (r=0.380; p<0.01) and awareness of wig (r=0.341; p=0.000). Similarly, there was significant difference (p<0.01, t=6.856) in QOL of patients before and after usage of wig. Majority (64.7%) reported that the wig was very useful in attending social events, work and shopping.

Alopecia is perceived as highly significant by patients receiving chemotherapy, while the use of wig enhances body image, interpersonal relationships and better quality of life. 

Quality of life (QOL) among caregivers of cancer patients is often diminished. Lower-income caregivers in the developing world may face greater difficulty. We sought to evaluate QOL among caregivers of lung cancer patients undergoing management at a public referral center in Delhi, India.

We administered a Hindi-version of the Caregiver Quality of Life Cancer (CQOLC) Index to 100 regular caregivers of patients with advanced lung cancer. Mean CQOLC scores were correlated with baseline demographics using t tests and ANOVA for 3 or more variables. Scores were required to differ by at least 0.5 standard deviations in magnitude to confirm clinically meaningful difference (CMD). Individual items leading to the greatest impact on overall scores were identified.

A majority (56%) of surveyed caregivers were over 40 years of age. The median annual income per capita was 24038.5 rupees, which is equivalent to $369.82 US. Worse CQOLC index scores were found for female caregivers (p = 0.02), caregivers who had provided care for more than 4 months (p = 0.001), and caregivers who had completed less than a 12th standard of education (p = 0.05). A CMD was observed for those who provided care for more than 4 months. The three individual items that contributed most to overall scores were related to positive adaptation.

Lower-income cancer caregivers in the developing world suffer deterioration in QOL. Psychological resilience is commonly reduced. Resourceful interventions designed to improve QOL among women, the lesser-educated, and those providing care for longer durations of time are warranted. 

The quality of life during chemotherapy decreases. Furthermore, it is important to patients to have a high quality of life. Patients have stress because of side effects of treatment, experiences associated with the expected outcome of treatment and an increased need for the support of loved ones. In this regard, there is a big challenge to help them to cope with a sharp increase in stress levels.

Art therapy has a noticeable positive effect. It was decided to use the new method of art therapy proposed by P. Piskarev, neurographica. Neurographica has a clear algorithm that consistently includes different levels of functions, according to the expressive therapies continuum by V.Lusebrink. One month program of 4 thematic sessions was developed and realised online.

The classes were conducted online, in order to test the methodology for use in the conditions of a lack of psychological assistance to cancer patients during the medical treatment in Russia. As a result, it can be concluded that the quality of life in patients is increased by improving the general physical condition, role-playing, reducing the symptoms of nausea, sleep disorders, weakness, shortness of breath.

Neurographica allows in a short time to reduce the level of stress and to create the desired image of a healthy state, which is firmly fixed, forming a new unconscious dominant, according to Ukhtomsky's theory. Neurographica special program can be conducted by oncopsychologists trained in neurographica, as well as neurographica's specialists with minimal training in cancer patients support.

We examined routinely collected PROs (Edmonton Symptom Assessment System (ESAS) and psychosocial needs) to determine symptom severity, and their predictors.

A population-based cohort in Alberta, Canada that completed PROs within +/-60 days of diagnosis. Patients were divided into: breast (Br), lung (L), colorectal (CR), prostate (Pr), hematology (H), and others (O). Logistic and linear regression were used to evaluate predictors.

We included 1310 cancer patients: 19% Br, 24% L,11% CRC, 8% Pr,12% H, and 26% O with equal numbers of early versus advanced stages. Median age was 65 and 56% had >/=1 comorbidity. Mean physical (14.8/60) and psychological ESAS sub-scores (4.5/20) were low, but symptom prevalence was high with up to 90% of patients experiencing some fatigue and >50% facing some anxiety, depression, or poor wellbeing. Physical, emotional, and informational needs were prevalent. Across tumor types, there were differences in symptom severity and prevalence, and in psychosocial needs. 

Psychological stress after any natural disaster is intense. Cancer patients may experience more stress as they fear uncertainty of medical care and social support. The purpose of this study was to evaluate the psychological impact of Hurricane Harvey on mood symptoms in cancer patients.

Adult patients seen in the MDACC outpatient psychiatric-oncology clinic (September 5, 2017-January 5, 2018) were included. The primary cohort included individuals who received an ICD code diagnosis for hurricane related stress. Comparative groups were contacted by phone and consented to participate in this study by answering two Yes/No questions about "being impacted by the hurricane", and whether they "experienced stress during this period". Depression was assessed using the PHQ-9 (scale 0-27), anxiety was assessed using the GAD-7 (scale 0-21), and distress was assessed using the NCCN distress thermometer (scale 0-10). Data are presented as mean±S.D.

The study consisted of 3 groups: Hurricane diagnosis (Hd; N=28), Hurricane Self-Report (Hsr; N=25), No Hurricane Controls (NoHsr; N=15). There were no significant differences among groups according to age, sex, race or ethnicity. As compared to patients in the NoHsr group, patients in Hd and Hsr groups reported significantly higher levels of depression (F2,65=4.2, p=.02), anxiety (F2,65=3.7, p=.03) and distress (F2,65=6.1, p=.004).

The current data shows that cancer patients who had a hurricane diagnosis or self-reported hurricane related stress exhibited significantly higher levels of depression, anxiety and distress as compared to controls (selfreport no impact and no stress). The data confirms the impact of natural disasters on mood symptoms. Introduction Cancer patients are responsible for self-administering oral chemotherapy under limited hospital monitoring but adherence rates can be as low as 16%. Mobile phone-based interventions seem to increase medication adherence in other chronic diseases, but more evidence on whether these types of interventions support oral chemotherapy adherence is needed. Findings from the researchbased process of development of a novel intervention are described.

The design process consisted of an extensive literature review of the main reasons for oral chemotherapy non-adherence, a scoping review to examine what was known about available oral chemotherapy adherence-enhancing interventions delivered via mobile phones, semi-structured interviews with 9 oral chemotherapy users (ages 20 to 71 y/o) to explore their preferences on the structure of the self-management program and collection of information from oncology health professionals (clinicians, nurses and pharmacists). The intervention design follows Darlow and Wen's 8 best practices for developing mobile health interventions.

Main reasons for oral chemotherapy non-adherence were identified: sideeffects, forgetfulness and poor treatment knowledge. The scoping review highlighted high acceptability and satisfaction with the available mobile phone-based interventions as well as the relevance of using a design framework, including end users engagement. Findings from the qualitative study and information collected from health professionals informed the structure of the program (e.g. timing, content, delivery methods).

The developmental process of the self-management program can be used as guide in the design of future medication-adherence mobile health interventions in cancer and other chronic diseases. A proof-of-concept study will follow the development phase. 

This study aimed to quantitatively assess distress and difficulties related to appearance concerns in Japanese cancer patients using the Derriford Appearance Scale 59 (DAS59) and to reveal patients' information needs and care needs related to appearance.

We conducted a questionnaire survey using the DAS59 among cancer patients with a prior history of chemotherapy, molecular targeted therapy, or immunotherapy, who were recruited from the Kindai University Hospital.

Responses from 114 patients were included in final analysis. Participants were patients with a mean age of 62.9 years; 70.2% were female, 86.0% had metastatic or locally advanced unresectable cancer. Among participants, 78.1% had concerns about some aspect of their appearance. Mean DAS59 full-scale score was 77.7±36.4. Younger and female participants had higher full-scale scores in univariate analysis (p<0.05 for both), and younger participants were found to have higher full-scale scores in multivariate analysis (p<0.05). The most frequently selected response about information needs was "explanation from doctor about appearance changes before starting treatment." When appearance changes occur, those who wanted support from doctors and those who wanted support from nurses were about the same proportion.

Young and female patients tended to have high full-scale scores of DAS59. Healthcare providers need to be aware of the potential psychosocial impact of appearance changes due to cancer treatment and provide basic information regarding appearance changes to all patients before initiating cancer treatment and care when appearance change actually occur. Because the amount of information and care to provide is large, a multidisciplinary approach is required.

Cancer is a severe and acute life-threatening disease with long-term multimodal treatments. Adolescent and young adult (AYA) with cancer are in a vulnerable phase in life, experiencing psychological stress both as an individual and family. Thus, it is necessary to raise awareness to the young patient special psychosocial needs and to increase their psychological outcomes and quality of life. The aim was to develop an evidencebased guideline to ensure a comprehensive and structured psychosocial follow-up throughout the cancer trajectory.

The guideline development group consisted of a multidisciplinary team of health providers and three AYA patient representatives. A systematic literature search was made to identify the evidence. Relevant literature was read and critically evaluated by using checklists from The Critical Appraisals Skills Program. The findings were discussed with stakeholders before making recommendations from the evidence. Finally, the draft was sent to clinicians for comments that were processed before the guideline was completed

The work resulted in a clinical guideline consisting of seven documents: 1. Psychosocial support for AYA patients with cancer 2. Checklists with interventions for each stage of the patient pathway 3. Interdisciplinary meetings 4. Network Meetings and supervisory group 5. Communication with young patients 6. Rights and support for AYA patients 7. Rehabilitation plan Conclusions Based on the evidence we recommend that clinicians use the clinical guideline in a structured manner. We hope that the guideline will improve the psychological outcomes for the AYAs and their families. National Cancer Centre Singapore, Nursing, Singapore, Singapore

The purpose of this study was to evaluate quality of life (QoL) of patients undergoing chemotherapy; and the level of burden and self-efficacy of their caregivers. Assessments of psychosocial constructs have not been part of the standard care protocol in the local clinical context. The lack of systematic communication between healthcare professionals, and patients and their caregivers relating to these outcomes would lead to these being unaddressed.

Methods A cross-sectional study was conducted in an outpatient cancer centre in Singapore. 92 patients diagnosed with cancer and undergoing chemotherapy; and 92 caregivers of the patients were recruited. Questionnaire administered to patients include the Functional Assessment of Cancer Therapy -General. Questionnaires administered to caregivers included the Zarit Burden Interview and General Self-efficacy Scale.

39% of patients reported that they were at least "somewhat" bothered by side effects of treatment, and 75% indicated some degree of being worried that their condition may get worse. 60% of patients chose not to comment on their sex life. There was significant difference in caregiver burden across caregivers' gender, age group, education levels, and relationship to patient. 20% reported that they at least "sometimes" felt strained. 61% reported that they felt they should be doing more, and 65% felt they could do a better job. More than 75% of caregivers reported high levels of self-efficacy.

These findings can help guide educational and psychosocial support interventions by healthcare professionals, in the aim of helping patients and caregivers adapt to lifestyle changes, enhance their coping, and improve QoL. 

The 59-item Comprehensive Needs Assessment Tool (CNAT) for cancer patients is an English language survey for needs assessment developed and validated in South Korean cancer patients. The objective of this study was to validate the English version of CNAT in advanced cancer patients in Singapore.

Cross-sectional survey: advanced cancer patients completed the CNAT in English. Confirmatory factor analysis was used to assess construct validity. For known groups validity, independent samples t-test was used to compare CNAT scores based on Karnofsky performance status and outpatient versus inpatient setting. Cronbach's alpha was used to measure internal consistency.

Among the 328 advanced cancer patients recruited, the mean age was 59.6 years and 49.1% were male. Majority (68.0%) were Chinese, 20.4% were Malay, 7.9% were Indian and 3.7% were of other ethnicities. The 7factor model previously established in Korea showed sufficient construct validity with Root Mean Square Error of Approximation 0.037 and Comparative Fit Index 0.944. All 59 items had a factor loading ≥0.5.

Group invariance test showed no difference in pattern of factor loadings between ethnic Chinese and other ethnic groups (P=0.155). For known groups validity, there were significant differences in CNAT scores by performance status and outpatient versus inpatient setting. The CNAT total and factor scores showed good internal consistency with Cronbach's alpha of between 0.80 and 0.937.

The CNAT showed construct and known-group validity and internal consistency in our study sample and can be used to assess the level of unmet needs for advanced cancer patients in the Singapore context. 

Chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect. Anthracycline-based regimen as the neoadjuvant chemotherapy is a high risk of emesis. We previously reported that late chronotype could be associated with development of CINV after initial cycle of chemotherapy. However, the factors associated with CINV in following cycles remain unclear.

In this single-institution, prospective, observational study conducted, we analyzed women with breast cancer treated with neoadjuvant chemotherapy. Candidate factors associated with CINV were assessed using the Munich Chronotype Questionnaire before initial cycle of chemotherapy, and Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale before 2nd cycle. CINV was assessed by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool before each cycle of chemotherapy. CINV in following cycles was defined as CINV occurring after 2nd cycle and 3rd cycle repeatedly.

Among 192 participants, 108 (56.3%) experienced CINV after 2nd cycle and 98 (51.0%) experienced CINV after 3rd cycle. And 85 (44.3%) experienced CINV in both following cycles. In the univariate analyses, CINV in following cycles was significantly associated with depression (odds ratio [OR], 2.50; p= 0.006) and CINV after initial cycle (OR, 6.69; p<0.001). Morning chronotypes (OR, 1.95; p=0.077) was marginally associated with CINV in following cycles.

In the multivariate analyses, depression (OR, 2.22; 95% CI, p= 0.039) and CINV after initial cycle (OR, 6.72; p<0.001) remained significantly associated with CINV in following cycles.

These data suggest that clinicians need to assess and consider depression in the management of CINV. 

Despite of development of cancer screening and treatment, the recurrence rates of breast cancer is still high and lots of breast cancer survivors have fear of cancer recurrence (FCR). The purpose of this study was to develop a middle-range theory for explaining the factors related to FCR and the outcomes of FCR in breast cancer survivors.

This study used theory synthesis by Walker and Avant (2011); 1) specify focal concepts, 2) identify related factors and relationships and 3) construct an integrated representation. Firstly, FCR was defined as the fear about cancer returning or progressing. Secondly, the literatures published until November, 2016 were searched in PubMed, CINAHL, Web of Science and RISS. A total of 14 articles were selected. Finally, the factors related to FCR and the outcomes of FCR were categorized to make relational statements and hypothetical model was provided.

Factors related to FCR were categorized controllable (psychosocial characteristics; anxiety, perceived risk, stress, disease perception, selfefficacy, social support) and uncontrollable (demographic characteristics; age, race, children, level of education / disease-related characteristics; length of diagnosis, stages, cancer screening, genetic predisposition, radiotherapy) ones. FCR led to positive (increase in cancer screening, use of supportive groups, and cognitive coping strategy) and negative (uncertainty, decrease in exercise, increase in attention bias for the words for cancer, functional impairment, unnecessary uses of medical services and self-accusing adaptation) outcomes.

The intervention to manage FCR should be developed, and the hypothetical model of this study should be revised and confirmed through empirical researches. 

Social support is important in cancer treatment process. However, there are no studies on the effect of chemotherapy related symptoms according to the perceived social support (PSS) of the patient's family, friends, and spouse clinically. We examined the effect of PSS on chemotherapy related symptoms in family, friends, and spouses of patient with breast cancer.

This study is a prospective, observational study that periodically assessed chemotherapy related symptoms from the time of diagnosis of breast cancer to 6 months after the end of neoadjuvant chemotherapy. In 184 patients with breast cancer, Multidimensional Scale of perceived social support(MSPSS) subscale(family, friends, and spouses) was assessed before the first neoadjuvant chemotherapy, and M.D. Anderson Symptom Inventory(MDASI) was assessed 8 times before neoadjuvant chemotherapy. The MSPSS subscale scores were divided into the MSPSS low, moderate, and high group. The MDASI subscale score was analyzed by linear mixed model to determine the difference between the two groups until the end of the chemotherapy.

In the MSPSS subscale family; insomnia (p<0.001), MSPSS subscale friend; nausea (p = 0.019), insomnia (p <0.001), distress and numbness (p = 0.007), MSPSS subscale significant others; insomnia (p <0.001) and sadness (p = 0.048) were higher in the low level of MSPSS subscale group than in the moderate to high level of MSPSS subscale group respectively.

In chemotherapy related symptoms, PSS related to friends showed more tolerable symptom than PSS related to family or significant others (spouse). Future research needs to be done on the effects of PSS on chemotherapy related symptoms.

Existential distress in cancer patients is a vague but widely used concept in the medical field. However, there is no consensus on the concept of existential distress. The lack of a recognized conceptual framework may hinder further research further studies on existential distress.

The Walker and Avant's concept analysis approach was applied. Literature searches were conducted using PsycARTICLES, Cochrane, PubMed, EMBASE, Medline, CINAHL, China National Knowledge Infrastructure, China Science and Technology Journal Database and WanFang Data Knowledge Service Platform with a timeline from the establishment of the database to June 1, 2018.

The analysis demonstrates that the concept of existential distress in cancer patients has four core attributes: (a) meaninglessness, (b) loss of autonomy,(c) lowered self-esteem, (d) hopelessness. Existential distress is a key factor that causes cancer patients to reduce the quality of life, adjustment and emotional state of cancer patients, and even end life prematurely. Its recognition is often underpinned by pain, serious psychological morbidity, lack of meaning for current life and future, the ability to fight problems of survival diminished.

This concept analysis may be used as a basis to advance understandings of the theoretical structures, meanwhile not only contributes to the development of research and practice, but also improves the mental health of patients.

H. xiao 1 1 Fujian Medical University, School of Nursing, fuzhou, China

Life review is effective in improving the psychospiritual well-being of palliative patients. However, traditional life review programs are limitedly applied in clinical practice.

This was a non-concurrent controlled quasi-experimental design study. 92 cancer patients were recruited from April 2017 to February 2018, with 44 patients in the control group receiving routine care and 48 in the experimental group receiving a six-week WeChat-based life review program(WBLRP) plus routine care. The WBLRP consisted of four-section e-life review interviews and four life review modules. The interviews covered each participant's entire life, including the present (cancer experience), adulthood, childhood and adolescence, and a summary of their life. The life review modules included Memory Prompts, Review Extraction, Mind Space, and E-legacy products. Compliance with the program, difficulty in participation, satisfaction with the program, anxiety, depression, self-transcendence, meaning in life and hope were measured.

All experimental participants who completed the program used the WeChat platform. 39 participants had no difficulties in operating the platform, and 40 were satisfied with the program. Statistically significant effects were identified on anxiety, depression, and self-transcendence. An increase in the levels of meaning in life and hope was observed in the experimental group after the program.

The innovative WeChat-based life review program is a promising nonpharmacological intervention in improving psycho-spiritual well-being of cancer patients. It provides an alternative approach to deliver psychological interventions for cancer patients in community. 

Stepped care (SC), consisting of watchful waiting, guided self-help, problem-solving therapy and psychotherapy/medication is, compared to care-as-usual (CAU), effective in improving psychological distress. This study presents secondary analyses on subgroups of patients who might specifically benefit from watchful waiting, guided self-help, or the entire SC program.

In this randomized controlled trial, head and neck and lung cancer patients with distress (n=156) were randomized to SC or CAU. Univariate logistic regression analyses were performed to investigate baseline factors associated with recovery after watchful waiting and guided self-help. Potential moderators of the effectiveness of SC compared to CAU were investigated using linear mixed models.

Patients without a psychiatric disorder, with better psychological outcomes (HADS: all scales) and better health-related quality of life (HRQOL) (EORTC QLQ-C30/H&N35: global QOL, all functioning and several symptom domains) were more likely to recover after watchful waiting. Patients with better scores on distress, emotional functioning, and dyspnea were more likely to recover after guided self-help. Sex, time since treatment, anxiety or depressive disorder diagnosis, symptoms of anxiety, symptoms of depression, speech problems and feeling ill at baseline moderated the efficacy of SC compared to CAU.

Patients with distress but who are relatively doing well otherwise, benefit most from watchful waiting and guided self-help. The entire SC program is more effective in women, patients in the first year after treatment, patients with a higher level of distress or anxiety or depressive disorder, patients who are feeling ill, and patients with less speech problems.

The aim of this study was to explore experiences and stigma perception of women with ovarian cancer.

A qualitative research was conducted at a private university hospital in Ankara, Turkey. A purposeful sampling was applied until data saturation was reached and 16 women with ovarian cancer were included. Five semi-structured questions on meaning of cancer diagnosis, how the diagnosis and treatment effected their lives and feelings including experiences of stigma were guided to the interview. Each interview was lasted about 20-40 min, audio-taped, transcribed verbatim and analysed thematically.

Participants were aged 46-80 years, mean duration of diagnosis was 3 years (range 1-12). Main themes emerged from data were 'fear, sadness/inability to speak feelings, influence of life, guilt and struggle'. Under the theme of fear; 'dependence on others, pain / suffering, fear of death, metastasis / progression of the disease' were presented. 'Unable to do things due to fatigue, protective approaches at home, inability to meet with friends, lack of desire to do anything because of having cancer' were grouped under influence of life theme. The theme of guilt was presented as 'being late in diagnosis and not paying attention to their health'. The sub-themes for struggle were 'strong belief, trusting to doctor and believing to be healed'.

The expressions of fear of death related to the disease and their unwillingness to receive social support suggest that internal stigma exists in these patients.

Oncokompas is an eHealth self-management application to monitor health-related quality of life (HRQOL) and to provide personalized information on HRQOL and supportive care. We used the RE-AIM framework to investigate the Reach, Effectiveness, Adoption, Implementation, and Maintenance of Oncokompas. The aim of this cross-sectional study was to investigate the reach. Methods Cancer survivors (breast, colorectal, head and neck cancer, lymphoma) treated with curative intent 3 months to 5 years earlier were invited to complete a survey on HRQOL and supportive care. Eligible survivors (those with internet and email) were invited to participate in a randomized controlled trial (RCT) evaluating the (cost-)effectiveness of Oncokompas. Reach was based on eligibility and participation. Multivariable logistic regression analyses were performed to identify factors associated with eligibility and participation.

Of the 655 respondents, 444 had internet and email (eligibility rate 68%). Survivors who were male, younger, had lymphoma, lower level of unmet supportive care needs, higher fighting spirit, and higher health literacy were more likely to be eligible. Of the 444 eligible respondents, 201 agreed to participate (participation rate 45%). Higher education, more unmet sexual supportive care needs, higher belief in control of their health by powerful others, and higher fighting spirit were associated with participation.

Among cancer survivors, the reach of eHealth in general (estimated on 68%) and Oncokompas in particular (estimated on 45% among eligible survivors) is associated with several socio-demographic, clinical, and personal factors. These findings contribute to tailored strategies for implementation of eHealth applications among cancer survivors.

Latina breast cancer survivors are at higher risk of psychological distress than their white counterparts. We examined associations of intrapersonal and interpersonal resilience resources with psychological distress among Spanish-speaking Latinas with breast cancer. Methods Analyses used baseline data from a RCT study of a stress management intervention among 151 Latinas with non-metastatic breast cancer. Outcome measures were health distress and anxiety. Intrapersonal resources included spirituality (meaning/peace), stress management skills (assertiveness, coping confidence with general problems), and cancer self-efficacy (patient activation, positive attitude and coping with breast cancer treatment). Interpersonal resources were social support (emotional, tangible) and neighborhood cohesion. Linear regression analyses examined bivariate and multivariate associations of resources with health distress and anxiety. Resources associated with outcomes at p<.20 in bivariate models were included in multivariate models. Final models regressed each outcome on remaining resources, controlling for education, marital status, cancer stage, surgery type, and treatment.

Self-efficacy for coping with breast cancer treatment was associated independently and inversely with both health distress (p<0.05) and anxiety (p<0.05). Coping confidence with general problems (p<0.05) and having a sense of neighborhood cohesion (p<0.05) were associated independently and inversely with health distress. Feeling a sense of peace (p<0.05) and having tangible social support (p<0.05) were associated independently and inversely with anxiety.

Interventions that enhance self-efficacy in coping with problems and managing cancer side effects, and that foster skills to identify sources of support or a sense of peace may decrease feelings of psychological distress for Latinas with breast cancer.

Informed consent is an essential ethical and legal procedure in medical practice. However, recent studies highlight discrepancies between patients' need of complete and correct information and their desire to autonomously choose their treatment. Quality decision-making regarding treatment options impacts patients' health and resilience. The paternalistic approach towards patients is still prevalent in Romanian medical system. The present study aims to assess decision quality regarding cancer treatment in relationship to fear of recurrence in Romanian breast cancer patients.

Methods 73 patients with early stage breast cancer took part in the study. 43 patients underwent radical mastectomy and 30 had lumpectomy.

Patients' answers show strong ambivalence regarding their decision even in post-treatment phase. Only one patient answered correctly all five questions assessing their knowledge about treatment and survival rates. 43% of women who underwent conservative surgery and 63% of mastectomy patients report no health care provider discussed with them about the other surgery option. Better informed patients worry less about cancer related death. However, patients with higher fear of recurrence discussed more about treatment options with their health care providers.

Our results indicate breast cancer patients are poorly informed about their treatment options. They show limited knowledge about surgery consequences and survival rates. Implications on post-treatment adjustment and resilience are discussed. 

Psychosocial factors have become central concepts in oncology research since distress and quality of life have been called the sixth vital sign. However, the role of psychosocial factors in the prognosis of the disease is not yet well established. The results of studies on this issue are contradictory. We examined the relationship between psychosocial factors, stress hormones and inflammatory markers in breast cancer patients using 12 months longitudinal data.

Patients with stage I to III breast cancer (N=70) were assessed longitudinally, over a period of 12 months. They completed scales to measure quality of life and illness perception. Blood and urine samples were obtained to measure stress hormones (cortisol and ACTH) and inflammatory markers (CRP, ESR and fibrinogen).

Patients who consider their illness to be chronical, unpredictable, with important negative consequences over their lives, report a lower quality of life. Patients who perceive their illness to be unpredictable and those who trust their treatment will help control its evolution, have a higher ESR at baseline and higher fibrinogen values one year later. Women who report a higher personal control over their illness, have higher levels of urinary free cortisol at baseline. No other significant relationships were found between psychosocial factors and inflammatory markers. Services designed to provide wide-ranging support to people diagnosed with cancer are increasingly available. Despite enhancement of the quality and quantity of these services, many cancer survivors are not aware of, or do not use, them. This may reflect poor knowledge or understanding of the importance of support that extends beyond disease treatment, both in the targeted population and in the community generally. Methods 369 participants (221 females), aged 18-90 (M=40.1, SD=17.1) were recruited for an online survey. Measures included Awareness of Cancer Supportive Care, the Internal Locus of Control Scale (LoC), Health Selfefficacy (HSE), Attitude to Seeking Psychological Professional Help (ATSPPH), and the Perceived Importance of Supportive Cancer Care (0-100 analogue scale). Participants also rated the level of responsibility for supportive care of a number of different groups.

Most participants were somewhat or very aware of supportive care services (64.8%) and indicated that they were important (M=74.4, SD=16.0). Support for emotional issues was rated most important (M=81.6). Support for each domain correlated positively with ATSPPH (p's<.01), and negatively with HSE, but was not associated with LoC. The impact of HSE was reduced to non-significance in regressions. Perceived responsibility for the provision of help differed in each domain, although the patient and their family/friends were deemed uniformly responsible.

The public hold positive views about the provision of supportive cancer care. Strategies for breaking down barriers to mental health support seeking may improve use of services. Attribution of responsibility may help explain reluctance to seek support.

Many types of cancer surgeries are almost entirely performed on an outpatient basis. As the number of outpatient surgeries increase there is less time for health care providers to support the anxiety of the peri-operative cancer patient, leaving a gap in our understanding about the impact of these anxieties on recovery. The purpose of this study is to explore the prevalence of preoperative anxiety in patients undergoing outpatient cancer surgery and whether there is an association between preoperative anxiety and postoperative patient outcomes.

We conducted a retrospective cohort study to investigate the prevalence of preoperative anxiety and association with postoperative outcomes in patients undergoing outpatient cancer surgery. The analysis included 8,665 patients undergoing procedures at an outpatient facility over 16 months; 16.7% had preoperative anxiety. A multivariable logistic regression model was created to examine the association between preoperative anxiety and postoperative outcomes.

In patients with preoperative anxiety, higher rates of adverse outcomes were seen, including PONV (adjusted difference 1.8%, 95% CI 0.12%, 3.4%, p=0.029), UCC visits within 30 days (adjusted difference 1.5%,

Children living with parental cancer are vulnerable to distress and developmental disruption. However, little 'voice' has been ascribed to patients' children, particularly regarding current intervention efficacy, with much of the research focusing on parent's perspectives. This review aimed to identify current interventions available for patients' children and summarise how children have responded to these. Methods Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane guidelines, a broad search strategy was conducted between 25 May 2015 and 6 August 2018. 7 databases were searched, and grey literature was also vetted.

Twelve papers of varying design and quality which evaluated 8 interventions, were retained for analysis. Due to this heterogeneity, methods of narrative synthesis were employed to combine results. Five key themes were identified across qualitative outcomes, including reduced isolation, improved sense of normalcy, and enhanced communication. Quantitative results were less consistent. Results from a small number of studies suggested that current interventions can improve PTSD symptoms and depression. However, interventions are yet to demonstrate success at ameliorating other symptoms, particularly those of anxiety.

Findings indicate a growing body of research that is yet to sufficiently meet the methodological rigour, theoretical guidance, and reporting quality necessary to confidently interpret research results. Qualitative feedback suggests interventions are positively received by children, while quantitative results are yet to demonstrate efficacy. This review highlights the potential for further investigation regarding how children respond to their parent's cancer, and the possibility of conceptualising this in a theoretical model. 

Understanding the roles and contexts of spirituality among patients with cancer allows us to develop better supportive care. The aim of the systematic review is to determine spirituality perception and experiences of cancer patients from qualitative studies. Methods Electronic databases (EBSCOhost, PubMed and WOS) were used for searching the studies with the following key words "spirituality", "cancer patient" and "qualitative study". The methodology used for this systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Identified publications were screened by using the following inclusion criteria; qualitative studies and English language, full text journals, published in last 10 years. Reviews, conference abstracts, letters to the editor were excluded.

The initial search identified 89 articles and 13 studies met eligibility criteria. Majority of the studies were from USA (4) and Iran (4) rest of them were from UK, Taiwan, Thailand, Brazil, Canada, New Zealand and China. In most of the studies semi-structured interview were used while self-report questionnaires were used in two studies. Participants in these studies were breast cancer (3), advanced cancer (3), brain tumors (2), HSCT patients/survivors (2) , colorectal cancer and mix group of cancer patients. In most studies, spirituality was identified as religious beliefs and relation with god. In one study, patient felt receiving specialized spiritual care would have a positive effect.

Main focus of the studies was meaning of the spirituality, as a coping mechanism and spiritual care/support needs.

Living with parental cancer can have a profound and ongoing impact on a developing child, rendering them vulnerable to a host of internalising and externalising problems. However, literature and clinical practise remain uncertain regarding how children are affected and how to support them. Past studies have relied on adult reports, thus missing crucial pieces of information only children can provide. From a multi-informant perspective that includes children, this study aimed to unpack how children are impacted by their parent's cancer diagnosis. Methods Semi-structured interviews were conducted with key informants, including health professionals (n = 12), parents (n = 10), and children (5 -17 yrs, n = 11). Informed by guidelines outlined by Braun and Clarke (2006) and Pope and Mays (2006) , thematic analysis was performed to identify preliminary themes. NVivo 12 Pro software was used to facilitate data organisation and analysis.

Preliminary findings indicate several consistent themes across informants. For HPs, themes included accessibility, knowledge and expertise of children, pre-existing challenges, and recommendations. For parents, themes included coping, support networks, protecting, knowledge, and awareness. For children, themes included coping strategies, comprehending, support networks, communication, family dynamics, and lifestyle changes. Conclusions These preliminary findings demonstrate the impact that a cancer diagnosis can have on children. Our findings also highlight the difficulties and challenges regarding providing support to these children. There appears to be scope for the development of a model which conceptualises the complex nature of how children are impacted by their parent's cancer, to further inform research and future intervention development.

Cancer care guidelines from national and international organizations highlight that competent care for sexual and gender minority (SGM) patients should involve: 1) helping patients feel safe disclosing their sexual orientation and gender identity (SOGI) and 2) including SGM patients' caregivers in care. While organizations have addressed these recommendations by including SOGI in electronic health records and training providers, it is unclear whether these efforts have improved the experience of SGM patients and caregivers.

We conducted in-depth semi-structured qualitative interviews with 24 SGM patients seeking cancer care in upstate New York, along with their 24 caregivers (N=48 participants). Interview topics included SOGI data collection, inclusion of SGM patients' caregivers, and recommendations for improving cancer care. Interviews were recorded, transcribed, and analyzed using an inductive coding strategy by two independent coders. Codes were then refined to establish themes within and across patient/ caregiver dyads.

Five themes were identified: 1) Disclosure of SOGI in cancer care is typically initiated by SGM patients. 2) Providers vary in their competence when responding to SOGI. 3) Provider competence with SOGI is related to provider competence discussing sexuality. 4) Caregivers are invisible when disclosure of SOGI does not occur. 5) SGM patients and caregivers want to be treated with respect.

Despite efforts to address the recommendation to collect SOGI data, SGM patients often disclose identities themselves. Facilitating disclosures could improve cancer care for SGM patients, enhance the visibility of caregivers, and improve provider competence in general. Empiricallybased interventions to increase provider comfort are needed to implement these recommendations.

Patients diagnosed with and fighting with cancer are facing multiple distressing factors that could adversely affect compliance with medical care and the outcomes of cancer therapy, and even the overall survival. Distress also significantly affects the quality of life a patient might have.

The Department of Supportive Care Medicine has developed the SupportScreen that is an automated touch-screen tool designed to identify biopsychosocial problem-related distress and to facilitate patient -physician and multi-specialist communication. Patient were asked questions about their physical and emotional symptoms they noted during their journey cancer. Results 42,623 screenings were conducted, and 24,413 patients were interviewed with a less than 1% refusal rate. Data collection identified the most distressing factors (emotional, physical, social, communication, spiritual etc.) for our patient population with sleep, fatigue and fear of side effects from chemotherapy being the most prevalent. It was also noticed that the distress factors varied amongst various cancer diagnosis groups (GI, Breast, Lung etc.) and that the distress factors were not similar between the patients and their caregivers.

Careful screening of both patients and their caregivers and addressing the distress factors improves quality of life in patients with cancer and therefore screening for distress should be an integral part of patients' complete evaluation in any oncological practice. Literature review indicated that distress could be further reduced by a proper coordination of care, hence, the Department of Supportive Care Medicine developed a clinical triage algorithm to ensure that all distressing factors are appropriately addressed.

It is well-known that up to 40% of carers of patients with head and neck cancer experience significant distress during treatment. This study aimed to examine the incidence and causes of distress over the course of treatment using an electronic, web-based screening tool for carers. Methods A longitudinal cohort design was used to investigate the incidence and factors contributing to distress among carers of patients undergoing radiotherapy treatment for head and neck cancer. Carers of patients with head and neck cancer undergoing radiotherapy were enrolled at radiotherapy planning, and completed an electronic, carer reported screening tool, "ScreenIT" weekly during treatment. Cohort data was analysed descriptively.

From June 2015 -September 2018, 141 carers completed ScreenIT during their family members radiotherapy treatment for head and neck cancer. Across the 141 carers, 393 entries were recorded (m = 2.8, range 1-10). The majority of carers identified as spouses (n= 283, 72%) or son/ daughter (n= 78%, 18%). More than half the carers reported distress at at least one timepoint during treatment (55% >4 Distress Thermometer). The factors contributing to distress included emotional (worry 32%, fears 12%, sadness 12%), patient's physical symptoms (eating/drinking 27%, fatigue 28%, sleep 13%), and practical (suitable food/drinks 20%, planning meals 14%, and preparation/cooking 10%). Only 4% of carers wished to discuss their concerns with a health professional.

During radiotherapy treatment, carers of patients of head and neck cancer commonly report distress related to emotional, physical and practical concerns, however very few wished to discuss their concerns with a health professional.

The Patient-Reported Outcomes Measurement Information System (PROMIS) assesses physical, mental and social health in clinical and research settings. Despite interest in using PROMIS in clinical trials, limited reference data on cancer populations exists. Methods At the UCSF Breast Care Center (BCC), new patients receive electronic intake questionnaires assessing self-reported medical history, demographics, and 8 PROMIS domains: depression, anxiety, fatigue, sleep-related impairment and disturbance, cognitive function, applied cognition and physical function. This information triages patients to appropriate supportive care resources. 2886 patients with a self-reported breast cancer diagnosis completed questionnaires and consented to research. PROMIS T-Scores were calculated using the Health Measures system and compared across patient groups.

For all assessed domains except depression, cognitive function and applied cognition, BCC patients had clinically significantly (>3 point difference) worse PROMIS scores than the US population mean of 50. Compared to stage 0-III, stage IV patients had worse mean values for all assessed domains (p<0.05). Clinically meaningful differences were observed between Stage 0-III and Stage IV women < age 50 in depression, anxiety, and cognition (table 1) . Patients with less than high school education suffer worse sleep impairment and disturbance at all stages, and Stage IV patients in this group experience higher depression and anxiety.

Conclusions PROMIS scores among UCSF BCC patients indicate impaired quality of life in multiple domains. While not directly comparable to populationbased samples, these PROMIS scores provide insight into the physical, mental and social health of our patients and can serve as robust estimates for breast cancer trials and clinical care. 

Sleep disturbance is a critical cancer outcome associated with depression, diminished quality of life, and morbidity. Empirical evidence corroborates the effectiveness of Cognitive Behavioral Therapy for insomnia (CBTi) in breast cancer survivors. We previously demonstrated significant effects of CBT for insomnia and pain (CBTip) on Total Wake Time (TWT) in women with gynecologic malignancies. The current analyses explored CBTip effects on other subjective sleep variables in this sample. Methods Participants were 35 women with insomnia status/post-surgery for gynecologic cancer randomized to CBTip (N=18) or Psychoeducation (PE; N=17). Subjective Sleep Efficiency (SE), Sleep Quality (SQ), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO) were assessed via 14-days of sleep diaries at baseline, post-intervention, and 2-month follow-up. Intent-to-treat analyses utilizing mixed linear modeling were conducted to examine longitudinal group differences on sleep variables controlling for age and advanced cancer (i.e., Stage III-IV).

There were significant fixed effects of time and condition on SE and SOL, such that CBTip participants demonstrated higher SE (9.68, p<0.01) and lower SOL (-17.53, p=0 .01) compared to Psychoeducation participants. Despite significant fixed effects of time on WASO, effects of condition on WASO and those of time and condition on SQ were non-significant. The study lacked power to demonstrate significant fixed effects of groupXcondition.

Hospital clowns has been shown to enhance emotional and behavioral processes but few studies have comprehensively examined the effectiveness of this practice using biomarkers. Our purpose was to evaluate the effect of a clown intervention on the levels of psychological stress and cancer-related fatigue in pediatric oncology patients undergoing chemotherapy.

Sixteen patients who met all criteria from a pediatric oncology inpatient unit in a Brazilian comprehensive cancer care hospital participated in this quasi-experimental study. Eight saliva samples were collected, comprising 4 at baseline and 4 after clown intervention (+1h, +4h, +9h, and +13h post-awakening). Salivary cortisol and α-amylase levels were determined using high sensitivity enzyme-linked immunosorbent assay kits. Stress and fatigue were measured by the Child Stress Scale-ESI™ and the PedsQL™ Multidimensional Fatigue Scale respectively. Relationships among stress, fatigue and biomarker levels were investigated using nonparametric statistics.

In comparison with baseline measurements, the total psychological stress and fatigue levels improved after the clown intervention at the collection time point +4h (p=0.003 and p=0.04, respectively). Salivary cortisol showed a significant decrease following clown intervention at the collection time points +1h, +9h, and +13h (p<0.05); however, α-amylase levels remained unchanged. Conclusions These findings provide preliminary evidence that clown intervention merits further study as a way to reduce stress and fatigue in pediatric cancer inpatients, and that self-report and biomarker measures are feasible to collect in this patient group. 

The generation of posttraumatic growth (PTG) among patients with lymphoma was confirmed in previous research. The present study examined major variables that may influence PTG. Specifically, this study explored the association of PTG with cognitive emotion regulation and social support after individuals were diagnosed with lymphoma.

The Posttraumatic Growth Inventory (PTGI), Cognitive Emotion Regulation Questionnaire (CERQ), and the Social Support Rating Scale (SSRS) were used in this cross-sectional study to interview 384 lymphoma patients in a tertiary hospital from March 1, 2014 to March 30, 2016 Demographic and health-related variables, CERQ and SSRS were used as independent variables, while PTG was used as the dependent variable in univariate (t-tests and one-way analysis of variance), bivariate (Pearson's correlation) and multivariate analyses. The multivariate analysis employed stepwise linear regression.

Among the 407 patients who agreed to participate in the study, 384 completed the survey (90.3% response rate). Three demographic variables (income, cancer stage, and religious preference), cognitive emotion regulation (i.e., acceptance and refocus on planning), and social support (utilization of social support) significantly predicted PTG in the stepwise regression.

Cognitive emotion regulation strategies and social support were independently associated with PTG. Clinical medical workers should pay more attention to promoting the mental health of lymphoma patients, which can help to improve their level of PTG.

The cancer experience is known to induce psychological trauma in a minority of cancer survivors, with rates for severe psychological trauma ranging from 5-22% (Abbey, Thompson, Hickish, & Heathcote, 2015; Chan et al., 2018) . Psychological trauma may negatively affect emotional well-being and quality of life. Associations between trauma symptoms, other psychological variables, and quality of life have not been adequately examined. The purpose of this study is to examine relationships between psychological trauma, cancer distress, depressive symptoms, anxiety, resilience, and health-related quality of life (HRQOL) in persons undergoing cancer treatment. Methods This is a prospective, cross-sectional, descriptive study. Data will be collected on 100 participants who will provide data on psychological trauma, distress, depressive symptoms, anxiety, resilience, and HRQOL via iPad. An estimated minimum sample size of 85 participants will adequately power the study. Correlation coefficients and logistic regression will be used to identify the strongest predictors of psychological trauma.

The study was approved by the IRB and we are currently enrolling participants. A total of 91 participants have provided data so far and we expect to finish data collection and analysis by May, 2019. We hypothesize that there will be a strong positive relationship between psychological trauma, cancer distress, depressive symptoms and anxiety, and that resilience and HRQOL will be negatively correlated with psychological trauma.

This data will provide important information related to relationships between psychological trauma, anxiety, depression, resilience and healthrelated quality of life, which will inform future research aimed at reducing psychological trauma and its associated psychological factors.

To date, the use of alcohol and tobacco represent the two most important risk factors increasing the incidence of developing cancer and death of cancer, particularly for women suffering from breast cancer. However, data remains minimal regarding consumption profiles of women receiving treatment for breast cancer in France.

The present study aims to describe the frequency of tobacco and alcohol consumption and their relationships with patient's sociodemographic, medical and psychological characteristics within a sample of French women receiving treatment for breast cancer. In addition, all patients participated in a screening and brief intervention (SBI).

In total, 120 women with breast cancer were included for this study. The majority of the patients were hospitalized for a primo cancer (80, 8%), type Invasive Ductal Carcinoma (IDC) (70, 8%) and received surgery as primary treatment (45%). Furthermore, 30.8% reported tobacco consumption and 38.4% a high-risk alcohol consumption (score AUDIT-C>3). Overall, no significant relationships were found between consumption scores and sociodemographic, medical and psychological characteristics. However, patient's age was associated with tobacco consumption.

Both tobacco and at-risk alcohol consumption are frequently reported during breast cancer treatment. The need for the implementation of risk reduction methods in breast cancer care is outlined. Social media (SM) use is prevalent. However, little is known about its use among breast/gynecologic cancer patients and survivors. This study aims to explore SM use, purpose, and associated factors in this population. Methods 196 breast (77%) and 59 gynecologic (23%) cancer patients and survivors were recruited in-clinic (14% declined). Participants completed questionnaires on SM usage (designed for this study), QOL (FACT-G), social support (Duke FSSQ), and distress . Results SM users (76%) were younger (mean=53, SD=12) than non-users (24%; mean=58, SD=12; p=.023). There was no difference for overall QOL, social support, or distress between users and nonusers. Reasons for use were "for social support" (35%), "when I feel lonely" (26%), and "for coping" (18%); followed by "to gather health information" (14%) and to "share my cancer diagnosis" (13.5%). Pearson correlations showed that patients more likely to use social media when feeling lonely had lower QOL (p<.001), less social support (p<.001), and more distress (p=.001). Those who reported using SM for coping also had lower QOL and less social support (all p-values<.05). Higher use of SM for social support was correlated with having less social support (p=.016). There were no associations between those who reported using SM to find health information or share diagnosis and QOL, social support, or distress. Conclusions Breast/gynecologic cancer patients and survivors reported differences in QOL, social support and levels of distress related to their reasons for SM use. Further research is needed to understand the psychosocial effects of SM use in this population. (2003) ); were comparable with caregivers of Bipolar disorder (Jain A 2014) and better than care givers of Schizophrenia and Dementia. Correlation between resilience score with different domains of QOL was moderate to weak. The resilience of caregivers of advanced cancer patients is comparable to caregivers of other illnesses. Resilience is correlated with quality of life (weak to moderate).

Given the prevalence of psychosocial distress in patients with cancer, screening and referral to psychosocial oncology services is advised and may be enforced. While the collaborative care model has demonstrated strong evidence, there are numerous care delivery models, secondary to institutional variability and the vast scope of expertise and practice of psychosocial care providers. We present a novel care delivery model delivered by a dually trained internist-psychiatrist and an oncologic nurse practitioner with certification in marriage and family therapy. We demonstrate the breadth and depth of psychosocial needs that are both explored and managed effectively to highlight the importance of attending to the developmental stages of individuals with cancers, caregiver distress, and indications for psychopharmacology.

We present 10 cases with variable demographics, cancer diagnoses and treatments, and psychiatric distress symptoms. Each of these patients was encountered by the aforementioned providers at different time-points. Outcomes were measured using screening tools, therapeutic alliance scales, patient testimonials, and provider satisfaction ratings.

We demonstrate the positive outcomes of patients receiving psychosocial care from providers with knowledge and understanding of the disease process and also expertise in therapy practices and prescribing. We describe the benefits of working collaboratively in a co-located setting and optimizing the internal relationships to facilitate the care of our patients with cancer.

We conclude that patients, caregivers and providers benefit from a model of care that includes a range of professional expertise while also providing focused, well-coordinated, effective psycho-oncologic interventions.

Radical hysterectomy (RH) remains to be the primary surgery for selected early stage cervical and endometrial cancer. Functional disorders of the lower urinary tract are the most common complications following radical surgery necessitating catheterization. This study evaluated the average day of removal of urinary catheter after radical hysterectomy and assess the practicability of earlier removal of catheter without compromising the bladder function. Methods A descriptive retrospective study of patients who underwent RH for cervical or endometrial cancer. Medical, intraoperative and anesthesia records and results of the histopathologic diagnosis of each patient were reviewed. Demographic, clinical and histopathologic data needed in this review were recorded.

Between January 2016 and July 2018, a total of 26 patients underwent RH (25 patients for cervical cancer and 1 for endometrial carcinoma), with a median age of 51. The average operative time is 2.48 hours and the average blood loss is 500 ml. The average size of cervix, length of vagina and lateral width of parametria were 3.0 cm, 2.2 cm and 4.2 cm, respectively. Catheters were removed between 3rd and 10th postoperative day. All patients had adequate (more than 100 ml) spontaneous void (SV) within 6 hours after removal.

Removal of catheter after RH from 3rd to 10th postoperative day resulted to adequate SV with no complaints of urinary retention. This outcome supports the hypothesis that an earlier removal of catheter seems to be a safe and practical option compared to long-term catheterization providing comfort to patients after RH without causing morbidity.

A. Lindgren 1 , A. Enblom 2 , D. Gail 3 , G. Steineck 4 , K. Bergmark 4 1 Linköping University, Department of Medical and Health Sciences-Division for Physiotherapy, Linköping, Sweden 2 Karlstad University, Department of Health Sciences-Division of Nursing, Karlstad, Sweden

We investigate the frequency of physical activity among female pelvic cancer survivors and if survivors who practiced physical activity less than once a week differed from survivors practicing physical activity at least once a week with respect to urinary and faecal leakage, clinical and sociodemographic characteristics, Quality of Life (QoL), depressed and anxious mood.

Female pelvic cancer survivors (n=578, mean age 64 years) answered a questionnaire 6-48 months after radiotherapy. A multivariable regression model analyzed factors explaining frequency of physical activity. We compared QoL, and depressed and anxious mood between women practicing physical activity at least or less than once a week.

Of 568 women delivering data, 186 (33%) practiced physical activity less than once a week while 382 (67%) practiced physical activity at least weekly. Women who leaked a large or all volume of stools (p=0.01), had just elementary school (p<0.001), smokers (p=0.049), or had lymphedema without receiving lymphedema-treatment (p=0.030) were more likely to practice physical activity less than weekly (50%, 45%, 45% and 37%, respectively) compared to other women. Women practicing physical activity at least weekly reported better QoL (p<0.001) and lower frequency of depressed mood (p=0.044) compared to the others.

Female cancer survivors experiencing faecal leakage were less likely to practice weekly physical activity than survivors without leakage, and the survivors practicing weekly physical activity experienced better QoL and experienced depressed mood less frequently than the others. Cancer-care professionals may want to actively encourage survivors to engage in physical activity.

A. Saraf 1 1 teerthanker mahavir university, orthopedics, amritsar, India

Quality of life of a trans-tibial (TT) amputee is not only determined by his functional rehabilitation but also social, economical and psychological rehabilitation. A number of studies have analyzed the influence of lower limb amputation on these factors. This study analysed the effect of functional recovery on other parameters of quality of life in a TT amputee.

This was a 10 years retrospective and 2 years prospective study. A total of 160 patients of trans-tibial amputation were followed. Their postoperative ambulatory status was calculated using Pinzur's ambulatory level. Their quality of life was determined on the basis of answers to a five point questionnaire which included their social, economic and psychological aspects. These parameters were correlated to assess the influence of functional recovery on the quality of life Results All the amputees with Pinzur's 0-1 level of ambulation suffered loss of income consequent to loss of job. All of them felt increased level of depression and anxiety after amputation. 50% of the patients with postoperative 0-1 level of ambulation felt socially neglected. Comparatively much less percentage of amputees with 5-6 level of ambulation suffered economic, social and psychological crisis.

Quality of life of a TT amputee is determined not only by his functional rehabilitation but also social, economical and psychological factors. From this study we concluded that post operative functional outcome significantly affects the quality of life of an amputee. An amputee with better ambulation level fares better economically, psychologically and socially in comparison to an amputee with poor ambulatory outcome

Shoulder dysfunction and pain following breast cancer treatment is common, impacting upon postoperative quality of life. There is some evidence to suggest that early postoperative exercise is safe and may improve shoulder function. However, there is uncertainty around the timing and dosage required for optimal results. Methods PROSPER is a pragmatic two-armed, multicentre RCT which aims to evaluate the clinical and cost-effectiveness of an early supervised structured exercise programme compared to usual care, for women at high risk of developing shoulder problems after breast cancer surgery. The aim was to recruit 350 women from 17 UK centres; postoperative follow-up was done at 6 weeks, 6 and 12 months postrandomisation. Participants received the exercise intervention or best practice usual care. The primary outcome was upper arm function assessed using the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire at 12 months. Secondary outcomes included acute/chronic postoperative pain, complications, health related QoLand resource use. Painful symptoms are captured using VAS (0-10) and the Doleur Neuropathique (DN4) scale respectively. The physiotherapy-supported exercise intervention was developed using guidance for the development of complex interventions and incorporated behavioural strategies to encourage adherence. Qualitative interviews informed recruitment processes.

To add 

There is no evidence up to date to conclude that there is high certainty of the benefit of massage therapy, which is due to the fact that only a few rigorous trials have been conducted. Besides the negative impact on patients' QoL, cancer-related symptoms also play an immunosuppressive effect by changing levels ofbiological markers. . We aimed toinvestigate the effects of a novel massage protocol on quality of life (QoL), sleep, stress, fatigue, cytokines, cortisol and α-amylase.

Females over 18 years diagnosed with breast cancer were invited to participate (IRB approval protocol #16-112). Twenty-four participants underwent 1 hour/week of massage for 8 weeks. Data was collected in three phases: (i) baseline (ii) during an 8-week intervention period and (iii) endpoint. Fatigue, sleep and QoL were assessed through validated questionnaires. Sleepwasmeasured with a Motionlogger Actigraph Monitor. Saliva was collected to quantify biological markers.

A paired-samples t-test was conducted to compare if there was a difference between pre and post-intervention period. There was a significant difference in QoL scores between baseline and endpoint (t(5)=-2.45, p=0.002). Fatigue also significantly improved (t(5)=-4.85, p=0.005) from baseline to endpoint. Significant improvement (t(5)=3.369, p=0.020) was also observed in stress from baseline (M=24.1, SD=5.7) to endpoint (M=20.3, SD=8.1). There was a statistically significant improvement in systolic blood pressure following the Swedish massage -an improvement of 3.50 ± 1.16 mmHg. Sleep efficiency pre and post-intervention also showed improvement.

Our 8-week Swedish massage program showed potential benefits for improvement of CRS. 

Studies have shown that breast cancer patients who smoke during cancer treatment, along with a higher symptom burden, exhibit a dramatically higher risk of death (HR 3.52) . Majority of studies report that only 8-14% breast cancer survivors smoke, although recent research shows low smoking cessation in breast cancer patients in Western population after cancer diagnosis. Currently, although around 30% of females in Croatia are active smokers, no analysis regarding smoking cessation have been done.

The study was cross-sectional research in two clinical hospital centers in Croatia and involved 168 breast cancer patients undergoing active treatment, using a questionnaire.

Breast cancer patients are relatively young (57.6±11.31 years) and rarely metastatic (22%). Only around a quarter of breast cancer patients smoked at the time of cancer diagnosis. However, 96% of breast cancer patients continue to smoke after a cancer diagnosis, although the percentage of patients who smoke over ten cigarettes a day dropped from 70% to 36%. However, these numbers are higher compared to other patients and are much higher than previously reported for the Western population.

Although breast cancer patients are expected to exhibit relatively long survival compared to other cancers, they are one of the patient groups least likely to engage in smoking cessation during the treatment, possibly due to low perceived risk. With new research emphasizing the dangers of smoking during cancer treatment, breast cancer patients should be one of the focus groups, especially in transitional countries with a high number of female smokers.

Lower-extremity edema is often multifactorial and poorly managed with diuretics alone. Long-term use of diuretics may induce chronicity of the edema by disturbing the renin-angiotensin relationship. Compression therapy, although effective against venous edema, is underused.

In this retrospective case series, 7 inpatients at a major cancer center who were referred to a lymphedema-certified therapist to manage refractory bilateral lower-extremity edema were identified. None had a diagnosis of lymphedema or chronic venous insufficiency for which compression therapy would be the standard of care. Their limb circumferences were measured by a lymphedema-certified therapist, and Functional Independence Measure (FIM) scores were assessed by a physical therapist. Limb circumferences were documented for all patients on first day before starting compression bandaging, and on last day, for those who completed the treatment sessions, after removing compression bandaging.

The etiology of the patients' edema were multifactorial (Table 1) . Compression bandaging was discontinued in 2 patients because of dyspnea. The other 5 patients underwent at least 3 consecutive days of compression bandaging. All 5 of these patients had improvement in limb circumferences ( Table 2 ). The median FIM score for first day of compression bandaging was 1 and the median FIM score for last day was 3.5 with a change (improvement) of 2.5 FIM score.

This case series demonstrated that multicomponent compression bandaging can be applied to manage refractory peripheral lower

Patients' involvement in their own care is important for those with upper abdominal tumours. Care is often conducted according to standardized fast-track care programmes (FTCP), and a shorter hospital stay is one of the goals. However, there is no research providing an in-depth perspective on patients' experiences of involvement in care. In this qualitative study, we explored experiences of involvement among patients who had surgery for upper abdominal tumours and were cared for according to an FTCP. Methods Qualitative face-to-face interviews about patient involvement in care were conducted with twenty patients who had surgery for liver, bile duct or pancreatic cancer using an open-interview guide.

The most important findings are that customized information and active dialogue about care decisions stimulate patient involvement. We identified three themes from the analysed data: Involvement depended on the quality of information, communication and involvement during the care period and safety at discharge.

Individualized care and continuous information about treatment and care goals in the FTCP during the care process create trust between patients and healthcare professionals and increase patient experiences of involvement. 

Before operation, FVC correlated body weight (P < 0.05), knee extensor muscle strength (P < 0.05), handgrip (P < 0.001) and 6MWD (P < 0.05). After operation, FVC correlated body weight (P < 0.001), knee extensor muscle strength (P < 0.05) and handgrip (P < 0.001).

Before and after P/D, pulmonary function related physical function, especially muscle strength. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies for patients with MPM who completed P/D.

To improve quality of life for patients with the liver cancer is really needed, for the treatment of liver cancer, such as radio frequency ablation and transcatheter arterial embolization, do a comparison to understand the difference between. This study expects to understand the differences between the radio frequency ablation and transcatheter arterial embolization for patients with liver cancer in postoperative complications and quality of life, and looking forward to provide medical staff reference and to enhance quality of life for patients.

The study was conducted in the Chi Mei Medical Center, Liouying, Taiwan (IRB No: 10601-L07) by using the structured questionnaire, and the patients with liver cancer for population, convenience sampling to research objects (N=60).

The survey found that more than 60% of patients rated their quality of life as a general. The results of the study found that the two groups of patients (each group respectively, N=30) with their lifestyle model reflect the postoperative complications did not have a statistically significant difference (p> 0.005). There was no statistically significant difference in the quality of life between the two groups (p> 0.005).

The results may make medical staff to understand radio frequency ablation and transcatheter arterial embolization for patients with liver cancer in postoperative complications and quality of life, although no statistics significant differences, but the relevant research results still need to be further confirmed and to provide reference for future clinical data and improvement of their quality of life. 

Cigarette smoking is one of the most researched factors that cause cancer and is also associated with a higher total symptom burden during cancer treatment. Transitional countries such as Croatia exhibit a large number of smokers (around 30%), however, not much is known about the smoking habits of our patients during cancer treatment.

The study was cross-sectional research using a simple questionnair in two clinical hospital centers in Croatia and involved 441 cancer patients with history of smoking, who were undergoing active treatment.

The median age of cancer patients was 62. Patients younger than the median age were more often previous smokers (72% vs. 56%), smokers at the time of cancer diagnosis (63% vs. 39%) and during the cancer treatment (52% vs 35%). Before cancer diagnosis, > 10 cigarettes a day was smoked by around 80% of patients, regardless of the age, while during the cancer treatment significantnly more younger patients smoke the same number of cigarettes (39% vs. 28).

There is a significantly higher percentage of younger smokers both before, during and after cancer diagnosis. Also, younger patients are shown to smoke a greater number of cigarettes during cancer treatment. We can expect a dramatic rise in the incidence of smoking-related cancers and treatment complications as the younger patients approach the median age of cancer incidence in Croatia. The data shows that urgent anti-smoking public health campaigns are of utmost importance for transitional countries such as Croatia.

We monitored serial changes of physical function in hematopoietic stem cell transplantation (HSCT) patients through the de Morton Mobility Index (DEMMI) score to determine the effect on quality of life (QoL) during the acute post-transplant period. Methods This prospective cohort study included 41 patients admitted for planned autologous or allogeneic HSCT. Physical impairment was defined as a decrease in the DEMMI score of more than 2 points after HSCT. The outcome variables for QoL included visual analogue scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Zung Self-rating Depression Scale (SDS) at enrollment and discharge.

Based on DEMMI scores, 24.40% of all HSCT patients showed physical impairment, for whom the DEMMI score showed an overall decrease during hospitalization with significant differences in scores at 1, 2, and 3 weeks after HSCT, between 1 week before and 3 weeks after HSCT, and between 1 and 3 weeks after HSCT. There was no significant difference of VAS between admission and discharge between the groups. Each functional subscale of EORTC QLQ-C30 differed significantly between the groups, with lower scores in the physical impairment group. There was only a significant difference in SDS at discharge between the groups.

QoL pre-transplantation can be a predictive factor for physical impairment during the acute post-transplant period, which can be detected in the early period after HSCT. Therefore, monitoring of standardized functional outcome measures is important to prevent physical impairment following HSCT.

Multiple myeloma makes a heavy symptom burden and reduces quality of life (QoL). QoL and physical function of patients with multiple myeloma are deteriorated and there are still few studies. We tried to find out the relation between physical function and QoL in multiple myeloma patients.

Patient's data with multiple myeloma who were consulted to the department were reviewed. Physical function was evaluated with Mini-Balance Evaluation Systems Test (Mini-BESTest). EORTC QLQ-C30 and QLQ-MY20 for evaluation of QoL and Fatigue severity score and Beck Depression Index were assessed. Compare to normative value of mini-BESTest based on previous study, patients were divided into control group (N=32) and impaired group (N=25). Clinical features were reviewed to find out the contributing factors to physical function: age, sex, disease duration and stage, cancer type, duration after transplantation, and baseline and current laboratory findings.

Positive correlation was present between mini-BESTest score and global health status and QoL score (r=0.279, P=0.035). Physical function and QoL score were decreased with lower albumin level, severe disease related symptoms, and depressed patients. The impaired group showed significantly lower hemoglobin and albumin. Furthermore, this group had shorter duration after stem cell transplantation (P=0.017), and shorter disease duration, though not statistically significant.

In patients with multiple myeloma, QoL has a relationship with physical function. Low albumin level, severe disease related symptoms, and depression were related to decreased physical function. Not only phschosocial status but also object medical condition affects physical function, and it consequentially affects QoL in multiple myeloma patients. 

Androgen deprivation therapy (ADT) is associated with an increase in cardiovascular (CV) events among patients with prostate cancer (PC). CV comorbidities and risk factors screening is mandated according to international and local guidelines. Mexico has one of the highest rates of metabolic syndrome, and we lack local studies that evaluate compliance with these guidelines in our PC population.

Retrospective chart review of patients with PC who started ADT in a single institution from January 2013 to January 2018. We evaluated the screening of CV comorbidities and risk factors from the previous 12 months to the first 3 months since ADT initiation. Implemented therapeutic interventions based on abnormal findings in screening were also assessed. Results 100 patients were included, baseline characteristics are described in Table 1 : 68% had metastatic disease and GnRH analogs as ADT were used in 92%. Screening of CV comorbidities and risk factors is depicted in Figure 1 : diabetes mellitus and overweight/ obesity had the highest and lowest detection frequency, respectively. Compliance with international guidelines recommendations is shown in Table 2 . 6% of patients had major CV adverse events: 1% myocardial infarction, 2% stroke and 3% pulmonary embolism.

Screening of CV comorbidities in this Mexican cohort with PC is suboptimal, although greater than reported by similar studies. Treatment adherence to guidelines recommendations contrasts with data from cardiooncology clinics. This real-world setting report stresses the necessity to develop interventions to overcome the unmet needs in our PC population, as resources are scarce. 

To investigate the relation between physical activity (PA) and quality of life (QoL) through nationwide multi-institutional questionnaires. Methods Data from 1156 questionnaires obtained from breast cancer survivors after adjuvant radiotherapy were analyzed. After screening uncertain information and heavy activity for PA (>900, minutes/week), 682 questionnaires were available and divided by three groups of inactivity (<150), regular activity (150-450) and moderate activity (<450-900). Global physical activity question, 5-dimensional questionnaire by EuroQol (EQ-5D), EORTC QLQ-BR23 and were used including clinical and socio-demographic information. A linear-to-linear correlation test and Spearman's test for each item of EQ-5D and summation of EQ-5D, respectively and multiple comparison by Tukey test after Kruskal-Wallis analysis for QLQ-BR23 were conducted. Results 144 (21.1%), 309 (45.3%) and 229 (33.6%) survivors had inactivity, regular PA and moderate PA, respectively. There was no difference for age groups (P=0.246). The age distribution For EQ-5D, mobility (P=0.021), usual activity (P=0.049) and anxiety (P=0.022) were aggravated in inactive PA. The survivors showing scale 5 for summation of EQ-5D (the best score on all 5 items) were 24.8%, 32.1% and 39.0% for inactive, regular and moderate PA, respectively and the extent of PA was inversely correlated with summation of EQ-5D (P=0.004). For QLQ-BR23, systematic therapy symptom (P=0.010), and body image (P=0.048) and future perspective (P=0.004) for functional area were improved by regular and moderate PA. However, the differences between regular and moderate PA were insignificant in all areas.

Emotional QoL as well as physical QoL could be improved by PA and PA duration had only a minimal effect. 

Growing numbers of cancer survivors with multiple primary cancer (MPC) diagnoses are at risk for negative outcomes. Previous studies of psychological factors in this population have lacked conceptual models to guide inquiry. Using an adapted psychobehavioral stress-response model, this study evaluated hypothesized conceptual relationships in adult MPC survivors. The model was tested through examination of associations among latent variables (perceived stress, psychological and behavioral responses, financial toxicity, social role, and physical health) and explored associations between individual characteristics and latent variables.

Adult MPC survivors (n=211) with first cancers (stages I-III) diagnosed within 1-10 years were recruited via tumor registry. Cross-sectional data included valid, reliable self-report questionnaires, tumor registry data, and medical record review. Structural equation modeling was performed to fit, test, and modify the hypothesized model.

Following modifications, a four-factor measurement model provided a good fit to data including: self-management behavior, distress, financial toxicity, and functional health latent variables; modified linear relations among latent variables; and covariate adjustment, χ2(200, N=206)=332.06, p<.01; TLI=.95, CFI=.96, SRMR=.06, RMSEA=.06. Overweight BMI, higher education, less neuroticism, and higher social support predicted better self-management; poorer self-management, greater neuroticism, and lower social support predicted increased distress; greater distress predicted financial toxicity; and greater distress and financial toxicity predicted poorer functional health (all p<.05).

Self-management behavior and distress represent modifiable targets for future interventions to mitigate financial toxicity and improve functional health. MPC survivors with high BMIs, less education, greater neuroticism, and lower social support should be considered at risk for poorer self-management behavior and negative outcomes. 

Financial toxicity following cancer negatively impacts treatment adherence, as well as the quality of life, and future prospects of cancer-stricken families. We sought to gain an in-depth understanding on financial needs of households affected by breast cancer in a middle-income setting.

Twelve focus group discussions were conducted with women diagnosed with breast cancer at least one year prior to the study. Patients of various socio-demographic backgrounds and cancer stages were recruited from five public and private Malaysian hospitals. Data were examined using thematic content analysis.

Three major themes were identified. 1) Health costs; mainly covered conventional medical care including second opinions, reconstruction surgeries, adjuvant therapies, breast prosthesis, and outpatient consultations. Apart from having to "pay out-of-pocket" for many items that were not covered, participants with health insurance lamented on the burden of "paying first, then claim". Citing "the need to try", patients also reported spending on complementary medical goods and services including dietary supplements, organic food, and traditional medicine. 2) Non-health costs; included expenditures for transportation, parking, childcare, and hiring domestic helpers. 3) Employment and earnings; the loss of earnings by patients and their caregivers strained household finances. Returning to work remained a major challenge. Employed patients frequently voiced dissatisfaction over difficulties in accessing welfare support from the government-owned Social Security Organization.

Health insurance coverage in resource-limited settings must be tailored to meet the needs of cancer patients. Besides health insurance, national policies must focus on establishing efficient welfare support programs and income protection schemes for cancer-stricken households. 

Weight gain commonly occurs in women undergoing treatment for breast cancer. In addition to body image issues and psychological distress, weight gain is associated with an increased risk of cardiovascular disease and cancer recurrence, as well as poorer survival. Methods Women with early stage breast cancer were enrolled into the Nutrition and Exercise during adjuvant Treatment (NExT) study within the first half of their prescribed chemotherapy. Group-based, supervised aerobic and resistance exercise training was performed 3x/week during adjuvant treatment (chemotherapy +/-radiation) and 1-2x/week for 20 weeks post-treatment. Participants also attended a single group-based healthy eating information session with a registered dietitian. Weight (WT) and waist circumference (WC) were measured at baseline (n=73) and three additional timepoints including end of adjuvant treatment (T1) (n=57), end of program (T2) (n=59) and one-year follow-up (T3) (n=46). Each outcome was analyzed using a generalized linear mixed model and Bonferroni adjustment for multiple comparisons was used to detect significant differences (p<0.01) between timepoints.

There was no increase in WT or WC observed from baseline to any successive timepoint (p>0.05). The WT trend from baseline was -1.1 kg(T1), -2.2 kg(T2) and -2.7 kg(T3). The WC trend was -2 cm(T1), -4 cm(T2) and -5 cm(T3) which reached statistical signifcance at end of program and one-year follow-up (p<0.01).

Women engaging in supervised exercise training and nutritional counseling as supportive care were able to maintain their weight during adjuvant breast cancer therapy. With continued exercise training following completion of cancer treatment women demonstrated significant reductions in WC. 

This study describes a first-time acute stroke patient(a 66-year-old female), who was found to be suffering from weakness in the left hand and dysphagia, after combine Esophageal Cancer, underwent nasogastric intubation as a result, and subsequently refused rehabilitation as she was depressed and unable to accept her condition. Methods From December 29th, 2016, to January 7th, 2016, the author utilized a variety of methods, including direct care, physical assessments, face-toface interviews, and Gordon's 11 functional health patterns, to collect and analyze data, which revealed that the patient was primarily suffering from impaired physical mobility, dysphagia, and body image disturbance.

The patient's rehabilitation status was observed, nasogastric tube feeding and nursing guidance were provided, active care and listening were implemented, the patient was encouraged to express her feelings, cooperation with a cross-specialty team, a swallowing and upper-limb rehabilitation program was developed, and the patient's family members participated in her rehabilitation activities, resulting in the patient's nasogastric tube being successfully removed and the restoration of strength in her left hand.

It is hoped that this nursing experience can provide guidance to clinical nurses on the use of empathy and the provision of care to patients, such that patients will be able to face themselves and accept the changes they undergo and so that appropriate rehabilitation programs for patients can be designed, thus increasing their willingness to cooperate in their treatment and rehabilitation and, in turn, allowing them to regain their preillness status as soon as possible.

The Commission on Cancer's (CoC) Standard 3.3 requires that at least 50% of patients at CoC-accredited hospitals receive survivorship care plans (SCPs) by 2019. A focus on older breast cancer survivors is needed, as they are the majority of the breast cancer population, and their experiences and perspectives about SCPs are limited in the literature.

This pilot study utilized a mixed methods approach (focus groups and self-report questionnaire data) to gather information from breast cancer survivors age 65 years or older. Topics covered were cancer survivorship, communication with their healthcare providers, and the value of SCPs. Questionnaires were completed individually by the participants prior to the focus group, and contained items on their demographics and health status following cancer treatment.

Only a minority of women who attended the focus groups actually developed a SCP. Those who developed a SCP in collaboration with their providers valued the personal care and attention received. However, some participants reported poor communication with their providers and healthcare team, resulting in frustration and confusion. Participants' suggestions for ideal SCPs included better education and personalization, particularly in appropriate nutrition and exercise, and managing side effects and comorbidities. Lastly, the women believed that additional longterm care resources, such as health coaches, were important in improving their survivorship.

These findings provide insight into enhancing the content, communication, and application of SCPs to improve the survivorship experience of older breast cancer survivors.

Survivorship care plans (SCPs) should be coordinated with multiple healthcare providers including the survivor's primary care physician (PCP). Despite the growing consensus of the importance of PCPs in survivorship care, research examining PCPs' experiences and opinions regarding survivorship care and survivor outcomes under their care is limited.

This pilot study utilized a web-based questionnaire and semi-structured interviews to evaluate PCPs' role in survivorship care of older breast cancer survivors, their experiences and opinions of SCPs, and suggestions for improving care coordination and facilitation of SCPs among older (≥65 years) breast cancer survivors.

Physician participants (n=29) had an average 13.5 years in practice. PCPs surveyed that their main role was to provide general health promotion and their least common role was to manage late-and/or long-term effects. Semi-structured interviews indicated that the majority of PCPs did not receive a SCP from their patients' oncologists and that communication regarding survivorship care was poor. Participants' suggestions for improvements to SCPs and survivorship care included regular communication with oncologists, delegation from oncologists regarding roles, and mutual understanding of roles.

Participants indicated that survivorship care and SCPs have room for improvement regarding communication and roles related to their patients' survivorship. These findings provide insight into enhancing the content, communication, care coordination, and application of SCPs to ultimately improve the survivorship experience of older breast cancer survivors. More attention needs to focus on the importance of PCPs, as they are an integral part of dual management for older breast cancer survivors post-treatment.

Ovarian cancer treatment consists of extensive surgery with multi-drug chemotherapy and such intensive treatment is associated with significant morbidity. As there is diversity in ovarian cancer survivorship, addressing the issue of Quality-of-life (QOL) is becoming important for themselves and their families. QOL has been used as an endpoint in clinical trials to identify the consequences of cancer treatment, assessment of rehabilitation needs and predict response to future treatment. Our goal was to assess the QOL in long-term ovarian cancer survivors and to identify the factors related to poor QOL. Methods In this prospective cross-sectional study, EORTC QOL questionnaires (EORTC QLQ-C30 and OV28) were administered in ovarian cancer survivors on an outpatient basis. All the clinical parameters were tested for association with QOL scores. Results A total of 84-women participated and completed the QOL questionnaire. The median age was 45-years (range; 17-72) with 86% having epithelial carcinoma and 14% having germ cell tumors and sex cord stromal tumors. Women with stage-I(50%), II(2.5%), III(43%) and IV(5%) were treated with primary treatment of surgery(16.7%) followed by chemotherapy(73.8%) and radiation(9.5%). Global QOL scores varied with age(p=0.019) and number of chemotherapy cycles(p=0.007). Clinical parameters; age, comorbidities, stage, and number of chemotherapy drugs were associated with significant EORTC scores in physical functioning(p=0.031), role of functioning(p=0.001), cognitive functioning(p=0.002), and social functioning(p=0.001) respectively.

In ovarian cancer survivors clinico-pathological factors; stage, histology, and comorbidities didn't have a significant impact on Global QOL. The number of chemotherapy cycles and drugs has significant impact on financial difficulty QOL scores. 

Lung cancer is the leading cause of cancer deaths. Though the use of combined-modality therapy is recommended for locally advanced NSCLC but majority of our patients do not tolerate this treatment and result in poor quality of life. With this study, we aim to find out whether we can achieve better quality of life with comparable local control, tolerability and survival with Accelerated radiotherapy (ART) in comparison to that of conventional chemo-radiation(CRT). We did this study to compare the quality of life in patients recieving accelerated radiation (six fractions per week) and conventional chemoradiation in locally advanced non-small cell lung cancer. Methods Total 50 patients were enrolled and randomized into two groups the study(Accelerated Radiation n=25) and control group(Conventional CRT n=25 ). Quality of life assessment was done using Quality Of Life Questionnaire -Core 30(QLQ-C30).

Our study showed comparable improvement in Qol parameters in both arms. The parameters which developed or worsened on treatment were: dysphagia, parasthesia, alopecia and sore mouth. Alopecia and sore mouth worsening was more in control arm and it was statistically significant.

Better QOL parameters scores were observed in ART arm. Hence ART may prove a good alternate to concurrent CRT in lung cancer patients who are not a suitable candidate for CRT.

Cancer is recognised as a most prominent healthcare condition with predictions of 21.7 million cases (excluding non-melanoma skin cancer) by 2030. Improvements in surveillance and treatments, has resulted in increasing numbers of individuals living beyond a cancer diagnosis. As a result, provision of care and support to individuals throughout cancer survivorship has become a key area of interest for policy makers, practitioners and researchers. Objectives: To conduct a National Cancer Survivorship Needs Assessment to ascertain the most suitable model of survivorship health care for use in Ireland. Methods Three phases: (1) a scoping review (n=44 papers); (2) focus group interviews with healthcare professionals (n=49); and (3) an online survey distributed (n=184).

Models of survivorship care were generally categorised by either the person who led the care or by the setting. Qualitative themes identified were: the needs of patients and their families, key survivorship principles and the requirement for a designated survivorship pathway. The most commonly cited available cancer survivorship services included: patients having an identified person whom they could contact (90%); informing patients about late/chronic effects (75%); and a follow up-care plan communicated to the general practitioner once treatment completed (67%). Healthcare professionals noted the need for a survivorship pathway underpinned by the key survivorship principles of Assess, Link in, Link out and onward, Inform, Empower, Support and Services abbreviated to "ALLIES during cancer survivorship".

There is substantial variation in the types of cancer survivorship care offered which can be rectified through having a clearly defined and resourced cancer survivorship pathway.

Patients ask for acupuncture for cancer-therapy induced side-effects and cancer care need to explore their interest to be able to meet their caring needs. The aim of this study was to explore the use of acupuncture and belief in acupuncture effects among patients with cancer and non-cancer individuals, and to compare beliefs in acupuncture effects between subgroups of study participants. Methods A total of 820 participants answered a study-questionnaire: 457 patients with cancer during radiotherapy and 363 non-cancer individuals.

Of the patients with cancer, four (1%) had used acupuncture during their cancer therapy, 368 (83%) were interested in receiving acupuncture, and 289 (63%) believed acupuncture to have effect on at least one symptom. Of the non-cancer individuals, 33 (9%) had used acupuncture within the past year, 262 (78%) were interested in receiving acupuncture, and 308 (85%) believed acupuncture to have effect on at least one symptom. Women (p<0.001), individuals younger than 65 years (p<0.001), and non-cancer individuals (p<0.001) expressed higher belief in the efficacy of acupuncture than others. Conclusions Few patients used acupuncture during cancer therapy but two thirds believed acupuncture to be effective, and more than 80% were interested in receiving acupuncture. One of ten non-cancer individuals had used acupuncture within the preceding year, nine of ten believed acupuncture to be effective and three quarters were interested in receiving acupuncture. The observed subgroup differences in beliefs indicate the importance of collecting expectancy data in future acupuncture efficacy studies to be able to treat expectancy as an effect-moderator.

Individuals with cancer experience high symptom burden that impacts their quality of life. An individualized, community-based Nordic pole walking (NPW) program may help. OBJECTIVES: Primary objective: assess the feasibility of a NPW program for individuals with non-small cell lung (NSCLC), prostate, colorectal, and endometrial cancer. Secondary objective: determine the effects of NPW on physical function and healthrelated quality of life (HRQoL). Methods Eight-week multi-centred randomized controlled feasibility study: NPW (supervised and independent NPW sessions) or control (usual daily routine). The Thabane four-criterion framework (2010) assessed feasibility (Process, Resources, Management, Scientific) . Descriptive and nonparametric comparative statistics assessed effects of NPW over time and between groups. Results N=8 were recruited, mean age 67 years. The study was feasible with recommended modifications: 1) recruit participants at hospital cancer centres; 2) individualize NPW and integrate behavioural change techniques; 3) use pedometers or accelerometers to measure physical activity levels; 4) organize NPW NSCLC programs alongside programs for other chronic respiratory diseases. Compared to baseline, the NPW group had a significant improvement in the 30-s chair stand test (median 10.5 to 14.3, p<0.05) and decreased thigh circumference (median right thigh: 49.4 to 48.5cm; left thigh: 49.0 to 46.3cm, p<0.05) . There were no significant improvements between groups, though there was a trend toward improved physical activity and HRQoL Conclusions Examining the effects of NPW on individuals diagnosed with cancer is feasible with modifications, and may improve physical function. Further research with larger sample sizes should be completed to more conclusively determine the impact of NPW.

Brachytherapy is a treatment option for cancer of the base of the tongue. This includes external radiation-and brachytherapy in form of pulsed dose rated radiation. Brachytherapy is given every two hours during 24 hours via permanent catheters during 3.5 days. The aim of the study was to describe how people diagnosed with base of tongue cancer experience the time after combination therapy with external radiation therapy and brachytherapy.

The study has a qualitative method with a descriptive design. Data was collected by semi structured interviews. Eight participants who received brachytherapy against cancer of the base of tongue were interviewed. The analysis was conducted with qualitative content analysis.

The patients described that they had a changed body that led to a new life that needed new solutions in their everyday life. Dry mouth affected their life to a greater extent than they ever expected. The relationship to food and taste changed, as it lost its pleasure and changed their social context. Their energy declined and the patients were unprepared for the increased inconvenience and the impact on life. Uncertainty about if the side effects would be permanent as well as an anxiety and fear that the cancer would return were present.

The results of this study highlights the impact of the treatment is greater than they expected. The result can provide insight into the problems that may arise for the patient after treatment as well as possibilities to tailor interventions targeting improvement in the information and care.

In 2005, the Institute of Medicine endorsed survivorship care plans (SCP) with insufficient evidence under the assumption that SCPs would improve care. To date, there have been numerous studies on their effectiveness with mostly inconclusive results. The purpose of this study was to determine the impact of receiving a survivorship care plan (SCP) on meeting cancer survivors' overall, informational, physical, emotional and practical needs. It was hypothesized that those who received a SCP would have greater needs met than those who did not receive a SCP. Methods All Nova Scotia survivors who met specific inclusion criteria and unmet the exclusion criteria were identified from the Nova Scotia Cancer Registry and sent the 83-item survey to assess experiences and needs across five domains (overall, informational, physical, emotional and practical) . Descriptive statistics (frequencies, percentages) and Chi-square analyses were used to examine and report survey findings.

The response rate was 44.6%, with 1514 respondents. SCPs were significantly associated (p<0.00001) with receiving timely help and support to meet survivors' overall, informational, physical, emotional and practical needs post-treatment. For the most part, survivors' clinical characteristics, such as cancer type, time since treatment, chronic comorbidities and metastases, did not result in differences among the five outcomes.

Those who received a SCP reported higher agreement on all five outcomes in comparison to those who did not receive a SCP. Further work should evaluate the delivery of SCPs and the components of SCPs that are most likely to contribute to positive survivor outcomes. 

Cancer survivors usually experience considerable stress, which has depressive effects on their daily life. This study clarified whether laughter yoga helps in reducing the psychological stress of cancer survivors. Methods Participants were recruited through posters and newspaper advertisements; they had to participate in 50-minute laughter yoga sessions conducted by a yoga teacher. The participants were four female and one male cancer survivors; two had survived breast cancer; the remaining three were each gastric, lung, and prostate cancer survivors. Their saliva was taken to measure salivary cortisol and they completed the Center for Epidemiologic Studies Depression(CES-D) Scale and the questionnaire about relaxing state.

The participants were aged 56-72 years. One participant was suspected to suffer from depression, considering the score of 35 points on CES-D; however, the other four participants scored less than 15 points The mean of salivary cortisol before and after the laughter yoga sessions was 0.170 ±0.044μg/dL and 0.118±0.049μg/dL, respectively; thus, the mean of salivary cortisol significantly decreased after the laughter yoga (p = 0.042). There were no significant differences in the mean of relax score (p = 0.066) before (27.2±6.4) and after (34.2±4.9) the laughter yoga sessions.

The results of the five participants indicate that the laughter yoga may have reduced psychological stress, yielding relaxing benefits. 

Patient expectations about their role in choice and decision making have been influenced by living in a consumer society. The purpose of this cross-sectional study was to explore the relationships among autonomy preference, depression and quality of life (QoL) for the gastrointestinal cancer patients in Taiwan. Methods A total of 153 gastrointestinal cancer patients who know their cancer diagnosis were recruited by purposive sampling from the gastrointestinal wards and OPD in a medical center located in northern part of Taiwan. Questionnaires included: characteristic of demographic and diseaserelated information, Autonomy Preference Index, Taiwanese Depression Questionnaire, EORTC QLQ-C30, and EORTC QLQ-CR29.

Subjects were characterized as: rectal cancer, stage III, male, lower educated, and unemployed. For API scale, the mean of overall score was 46+ 8.6. The mean of subscale _ "when face with physician" was 2.8 + 0.43 whereas the mean of subscale "when faced with family" was 2.9 + 0.64. The levels of "information seeking" subscale was moderate to high (mean=76 +13.1). A moderate level of QoL was reported with a highest satisfaction with "cognition" domain whereas "social" domain was the least satisfied one. A negative correlation was found between depressive symptoms and QoL. Only one vignette and preference in autonomy of information seeking and Information seeking subscale were correlated with certain dimensions of QoL.

Certain relationships existed within autonomy preference, depression and QoL for these subjects. These results could help the health care personnel understand the preference of decision-making and information seeking. Thus, individualized care could be provided. 

Radiotherapy is a life-saving treatment for pelvic cancers but may be associated with long-term adverse effects. When cured, many cancer survivors are left with unmet needs and intimate symptoms, which are often too embarrassing and shameful to disclose, and unfortunately seldom inquired about by health-care professionals. The aim of this study is to describe the development of a model that manages late effects among female pelvic cancer survivors in a nurse-led care setting. Methods A model for managing late effects in female cancer survivors was developed, and a nurse-led care clinic was established that offers education, medical management, dietary and sexual counselling, selfmanagement and life-style interventions in accordance to evidenced based research. Women who received pelvic radiotherapy from 2007, were identified from 2011 and baseline data was collected by means of a self-reported questionnaire. The questionnaire also served as an inventory of health status and as a foundation to individualize the intervention prior to the visit.

To date more than 900 baseline-questionnaires have been collected. The analysis of both baseline and evaluation data is ongoing.

The study outlined in this protocol present a holistic and person-centered health care approach that supports pelvic cancer survivors in managing late radiotherapy-induced effects. In contrast with previous research, our wide range of questions prior to the visit gives rich insights to the survivors' present physical status, especially concerning private issues such as sexual health and incontinence of feces. The unique data-set will contribute to future development of evidence-based management strategies in pelvic cancer rehabilitation.

Cancer is one of the main reasons of mortality in the world. Cancer is of huge concern for the world and is the cause of millions of deaths each year and most of the world's cancer cases are now in developing countries including Bangladesh. Methods It is a descriptive cross-sectional study. Our study population included all the diagnosed cancer cases in public and private pathology centers of northern city of Rajshahi, Bangladesh from January-August 2018. Sampling method was census. Descriptive statistics were used to state the results.

All under study patients were 820 whom their cancers were diagnosed in pathology centers of northern city of Rajshahi. Stomach cancer is the most common cancer among patients; breast cancer and colon cancer are in the next ranks after it respectively. The first five cancerous causes of death among Rajshahi City population were as; neoplasm of stomach, gallbladder, liver, colon and lung respectively. Conclusions Generally, having ignored the observed differences in distribution of the frequency of cancers in Rajshahi City from global and country patterns, the most common diagnosed types of cancers in this city are related to stomach and breast which is congruent with country pattern. Local epidemiological information about most common cancerous diseases and most common cancerous cause of death in Rajshahi city can be used to evidence based decision making by health manager, and help them to more effective interventions toward primary, secondary and tertiary prevention.

Over the last 2 years, I had my first experience in working with people with cancer. After 25 years of clinical practice, a PhD, and 8 years working as an academic, I was suddenly immersed in a caseload I did not feel comfortable with. I did not feel like I was an "expert" in "cancer". I soon learned the "experts" were my patients. I am a speech pathologist working in rural Victoria, Australia. After specialising in working with people with a neurological diagnosis, I now was also working with people with cancer. I had a lot to learn. Methods Talking to people that had had treatment for cancer opened my eyes to the things that really mattered: "sounding normal", "having a beer", "being able to get up onto the tractor", "eating pork crackling", and "being OK with dying". I received referrals from my team for people with breast cancer, lung cancer, prostate cancer, ovarian cancer, brain cancer, and other malignancies. Difficulties with word finding, being seen as "retarded", remembering names, swallowing, and wanting to be a "Jazz Singer" once again were recognised by my team as a flag to refer to speech pathology.

The Speech Pathologist plays a vital role in the cancer survivorship team. From preventing aspiration pneumonia, to giving survivors a voice. A loud voice. Conclusions A Speech Pathologist should be a member of every Cancer Survivorship team. 

The number of professional lymphedema therapists in Japan is small. In 2009, as a commissioned project by the Ministry of Health, Labour and Welfare, the Lymphedema Training Steering Committee (LTSC) was organized. The LTSC created "educational guidelines for professional lymphedema training". The training time was over 100 hours (33 hours of classroom, 67 hours of practical training). In line with these guidelines, as training for the classroom part, the LTSC started the classroom course in 2013. The aim of this study was to evaluate the effect of the lymphedema training program.

The classroom course program is based on lectures, case studies, and demonstration. Those who complete this course proceed to the accredited lymphedema therapist practical training school nationwide. In this study, the demographic data of all participants of the classroom course were analyzed.

Seven courses were delivered from 2015 to 2017(1926 people qualified). The results of the questionnaire survey after the first classroom course in 2017 are shown below. Of the 294 people who participated. Concerning the degree of comprehension, 275 people (93.5%) answered "I understood enough or mostly". Regarding the satisfaction level, 287 people (97.6%) answered "very satisfied or satisfied". Regarding behavioral change, 290 (98.6%) responded that they would like to incorporate the contents of the training into future medical treatment.

This survey demonstrated that many multi-disciplinary health professionals have been educated by our classroom course. In order to foster professional lymphedema therapists whose quality is assured, we will brush up our classroom course.

Apart from good clinical management of cervical cancer patients it is also important to take care of the quality of life ( QOL ) of these cancer survivors. To improve the QOL understanding of the factors which affect it is essential. The objective of this study was to find out these various factors so that by modifying these factors, the best quality of life can be provided to them.

This was a prospective cohort study which was conducted in the Department of Obstetrics and Gynaecology and Department of Radiotherapy, King George's Medical University, Lucknow. The cases were selected from patients visiting the OPD or who were admitted in the Department of Obstetrics and Gynaecology and Department of Radiotherapy, KGMU. The data information was collected in form of face to face interview using EORTC QLQ C30 and EORTC QLQ-Cx24 questionnaire.

Results 90 subjects fulfilling the set criteria were selected for the study. Subsequently out of 90 patients 5 cases were lost to follow up. 3 patients expired before the completion of the treatment while 1 was lost tofollow up and 1 developed vesicovaginal fistula. Finally data information was from 85 patients. Health related quality of life was separately studied in terms of overall General quality of life and cancer cervix specific quality of life and various factors affecting QoL were studied by multivariate analysis. Conclusions Education, tobacco use, degree of differentiation of tumor, size of tumor were independent factors found to have statistically significant effect on QOL of cervical cancer survivors.

Medical advances within oncology are resulting in greater nursing challenges and managing symptoms is the core of oncology nurses' role. Gynecological cancer and breast cancer has a mental connection to the female body, and may have a negative impact on the women's self esteem and quality of life. Most societies value men higher than women. Living in a society where men and women aren't equal is likely to affect women's health. Even though men and women are at risk for the same endemic diseases, women may have an increased risk due to biological and social factors which may also result in reporting symptoms different.

The study population is adult female cancer patients living in the region of Örebro County, diagnosed with cancer during a one year period. Through the Information Network for Cancer, 521 women were identified. A cross-sectional survey study was conducted using postal questionnaires. Data were analyzed using descriptive and analytic statistics.

One third of the women reported to have no or low interest in cancer rehabilitation needs (30.5%). Several rehabilitation interventions were wanted by more than 25% of the women. Most wanted intervention was Information and supportive groups with people with the same diagnosis (38%). Both Avoidance scale and Distress scale were found to correlate negatively with all items of the quality of life questionnaire.

Nursing should focus on individual needs, not solely patient characteristics. Further studies need to provide knowledge on the complexity of cancer rehabilitation needs. The authors welcome gender perspectives on future research. 

Patients categorization aim to bring survivorship into personalized medicine era. People who have cancer develop different experiences of illness and therefore manifest different needs. We evaluated the impact of categorization that takes into account the stages of disease (acute, chronic, long-term, cured) in a cohort of cancer patients.

The monophasic and monocentric study was conducted on a sample of 50 patients, 26% male and 74% female, with at least 5 years from the diagnosis of breast cancer (48%), gynecological (12%), gastro-intestinal tract ( 30%), genitourinary tract (8%), other (2%); 32% of the sample consists of patients defined by the oncologist "chronic"; 4% "long-term" patients; 64% "cured". Through a semi-structured interview, they were asked if they believed that their experience of illness was due to a condition of recovery or a condition with or without disease; the interpretations of the terms were examined. Results 72% of respondents accepted the use of the term used to define their own phase of illness. 12% believe that these terms represent a label, it is not so for 66%; 22% can not answer. Patients were also asked which other term would be suitable to identify the condition of the person who lives or lived cancer, 48% said "that's okay", 36% do not know which other term to indicate, the remaining 16% gave answers such as "lucky", "unlucky", "normal", "brave".

From the results that emerged, it is assumed that the terms "chronic", "long-term" and "cured" reflect the condition of the interviewees' without representing a label.

The aim of this review was to systematically identify, appraise, and synthesize qualitative research evidence on the experience of breast cancer patients receiving chemotherapy. Methods A systematic search of the literature was performed in February 2018. Qualitative studies were included if they investigated breast cancer, chemotherapy and patient experience. Quality of the articles was appraised using a standardized critical appraisal instrument from the Joanna Briggs Institute System. Themes were identified using the meta-aggregation from Joanna Briggs Institute methodology.

Thirteen articles presented findings generated by 211 patients who had all received chemotherapy. Sample sizes of the included studies varied from 7 to 30 patients; studies originated from 9 countries and were published between 2000 and 2017. Five analytical themes emerged: (1) prepare for chemotherapy, (2) side effect, (3) influence, (4) adjustment, and(5) adaptation.

Receiving chemotherapy for breast cancer patients is a challenging experience, so they struggled with their situation, mobilize all resources and capabilities to survive and finally reached a adaptive status. Research projects should focus on the experiences of breast cancer patients throughout the whole chemotherapy journey and researchers should develop evidence-based interventions to improve the quality of life, social participation, and functioning of breast cancer patients. 

Osteonecrosis (ON) is a painful, disabling and long-lasting side effect of cancer treatment in teenagers and young adults (TYAs, aged 16 to 24 years). It involves the degeneration and collapse of affected joints, and has no cure. However, little is known about the impact of ON on affected TYAs. This study therefore aimed to explore the experience of ON in TYAs living with and beyond cancer. Methods This single-centre study was based at a specialist centre for TYAs with cancer in England. Eligible individuals were those who had received (or were continuing to receive) treatment for any form of cancer between the ages of 16 and 24 years; had been diagnosed with ON of any anatomical region; and were aged between 16 and 30 years at the time of recruitment. Data were collected via semi-structured interviews, and analysed using thematic analysis.

Eight young people with ON participated in the study. Thematic analysis produced four themes related to the experience of cancer-related ON in TYAs: loss, uncertainty, "juggling act" and psychological wellbeing. Participants found the impact of ON to be entirely negative.

This study is the first to explore the experience of ON in TYAs living with and beyond cancer. Findings suggest that ON has a wide-ranging, negative impact, producing additional challenges and uncertainties in the context of lives already disrupted by cancer. Future research into multiple aspects of cancer-related ON in TYAs is required, in addition to improvements in the information and support provided to those with the condition. 

Lymphoma cancer survivors are a rapidly increasing population with unique supportive care needs related to treatment effects and a demographic profile comprised of both adolescent, young adults, and older individuals. The purpose to this project was to identify the availability of clinical practice guidelines for psychosocial supportive care of lymphoma survivors.

We conducted a systematic literature search of bibliographic databases (Ovid MEDLINE, EMBASE) from database inception to Dec 2018. The search for grey literature included the Trip database and websites of international cancer care organizations, oncology-related professional associations, and guideline developers. An academic health science librarian verified the search and a clinical expert was consulted to identify any additional clinical resources not identified through the previous methods. Screening was conducted by a single reviewer and selected guidelines were reviewed by a second reviewer for consensus.

Of 1806 citations screened, a total of two clinical practice guidelines met the eligibility criteria. Both guidelines were developed by the same organization but addressed different lymphoma subtypes. In both guidelines, recommendations for psychosocial supportive care were based on generalized survivorship care recommendations for all cancer survivors and lacked specificity related to lymphoma survivors.

Currently, a lack of available clinical practice guidelines addressing the psychosocial supportive care specific to lymphoma survivors exists. Moving forward, is it beneficial to lymphoma survivors and clinician stakeholders to establish clinical guidelines on psychosocial supportive care in order to address the increasing need for psychosocial supportive care for the growing lymphoma cancer survivor population. 

Icon Group is Australia's largest dedicated provider of cancer care with 28 departments across the nation delivering all aspects of cancer care. Our delivery of service is varied across the group and one size does not fit all. To ensure our patients receive the best possible comprehensive care as close to home as possible we have developed a framework for a flexible, scalable, sustainable model of supportive care/rehabilitation programs.

Identify key principles to underpin the model Develop framework that accommodates common tumours streams at each department Identify key local service providers and engage all stakeholders Implement framework into existing workflows Evaluate programme through patient and stakeholder feedback Results Supportive care and rehabilitation programs are now part of standard care for all patients attending Icon Cancer Centres. The flexible framework allows for innovation in care delivery e.g. telehealth-allied health providers in our remote centres and utilises local service providers where possible. Having a framework ensures consistency across the group and allows for scalability as services grow. Evaluation has seem improved patient experience, satisfaction and outcomes. Conclusions A flexible framework for supportive care/rehabilitation services ensures consistent cancer care is available to as many patients as possible as close to home as possible across the nation. Engaging local service providers allows each department to monitor and evaluate satisfaction with service and patient outcomes. has benefits for the patients, Icon Cancer Centres and the local communities'. 

In 2016, Castlemaine Health received a Victorian government grant to establish a cancer rehabilitation service. At the time it was common for clients with a cancer diagnosis to be overlooked for multidisciplinary assessment and intervention, and to be seen by clinicians without specific training in cancer care. The model of care sought to offer comprehensive, coordinated and tailored intervention to address the complex range of problems faced by cancer survivors.

Existing allied health and nursing resources were re-oriented into a new cancer-specific stream. A team of clinicians ( Figure 1 ) were upskilled to provide a coordinated outpatient cancer rehabilitation service, shaped by consumer input. Clients participated in a comprehensive initial needs assessment that informed an individualised goal-directed care plan. The plans addressed a broad range of physical, emotional, social and practical needs often experienced by cancer survivors.

During the first year, 60 people were referred to the service ( Figure 2 ). Clients set an average of four goals, with 76 percent of goals attained at discharge. The most frequently reported problems at baseline were fatigue (73%), pain (49%) nervousness (46%) and poor memory/concentration (46%). Clients' healthrelated quality of life improved ( Figure 3 ) and staff reported an increased confidence in their knowledge and skills.

The service addressed a gap in local clinical expertise, reduced the burden of travel for rural survivors and improved their quality of life. The model of care enabled a broad range of concerns to be addressed for cancer survivors in a comprehensive and coordinated rehabilitation model.

Each year over 20,000 men are diagnosed with prostate cancer (PCa) in Canada with the majority undergoing radical surgery and/ or radiotherapy. Short-and long-term side effects of active forms of PCa treatment include urinary incontinence, sexual dysfunction, emotional distress and reduced physical function. In a feasibility study of a 28-day home-based program we assessed the adherence rates for the various components of the program (physical exercise, diet, meditation, sleep habits, social connection), program compliance, protocol feasibility, impediments that may restrict patient adherence to this program, the usefulness of technology in maintaining adherence to the program, patient use of this technology, and whether the use of social support was beneficial to participants. Methods 30 PCa patients and survivors with email access, who did not have any health conditions that prevented them from exercising, participated in the study. Program compliance was assessed weekly, for four weeks. Physical and quality of life (QoL) measurements were performed preand post-intervention.

Physical (BMI, heart rate variability, EEG) and psychological (QoL) changes from pre-to post-intervention assessment along with aspects of the program that were revealed to require changes, and an assessment of the use of technology for delivering a pre-habilitation program in this population will be revealed and discussed.

Results show that pre-habilitationpreventive life habits programs that can empower men and address many of the issues faced by men undergoing active forms of PCa treatments -are well received and adopted by patients and survivors.

Chemotherapy induced peripheral neuropathy (CIPN) is a frequent damage of drugs used in the treatment of cancer. This side effect can affect from autonomy, sensor or motor nerve. There are different physiotherapy techniques that can improve or reduce the symptoms of peripheral neuropathy induced by toxicity. Methods A systematic review was done in databases Cochrane Library, PEDro, Pubmed, Crown BioSicence, CEBP and ERIC.

There are different physiotherapy techniques that can improve the symptoms of the CIPN, however, none is intended to prevent its appearance. Publications concerning adults and it does not specify if these techniques can be used for pediatric.

There are physiotherapy techniques such as manual therapy, TENS, massage for peripheral neuropathy, specific neuromodulation techniques, including acupuncture, which reduce the symptoms of CIPN in adults.

Survivorship care may require adaptation to account for contextual differences of the intended population (e.g. differences in culture). This presentation describes provider perspectives on the survivorship care of young African American breast cancer survivors.

In a preliminary study exploring perceptions of a quality of life intervention targeted to young African American survivors, we conducted semistructured interviews prompting providers to recall care of this population of survivors. Interview transcripts were analyzed using content analysis. Two reviewers independently coded the data. Reviewers iteratively reduced the coding structure until inter-coder agreement was met.

Participants included ten interdisciplinary care providers (registered nurses, advanced practice nurses, physicians, and social workers) with 9-33 years (mean: 21 years) of experience in their professions. Most (60%) saw young African American survivors on a weekly basis. Providers perceived the needs of these survivors were similar to those of other racial/ethnic backgrounds. Providers indicated general ambiguity of culture and cultural needs that would influence the survivorship care provided, rather they addressed individual needs during their discussion of general survivorship topics. Consensus around potential cultural differences from other survivors were young African American survivors' references to the importance of spirituality and extended family for social support.

Care of young African American survivors is predominately need-based. Findings suggest that culture may not be integrated into the survivorship care of these survivors, potentially presenting barriers to optimal assessment and care. Provider cultural competency training may reduce these barriers, improving care acceptability and survivorship outcomes. 

The outpatient setting has now become a standard alternative to the traditional inpatient approach for autologous stem cell transplantation (ASCT) for multiple myeloma and lymphoma. Outpatient ASCT involves family/friends assuming round-the-clock caregiving responsibilities, and though it is perceived as potentially providing superior patient quality of life (QOL), supporting evidence is limited. Furthermore, little is known about caregiver QOL and lost opportunity costs (wages/travel time). Our objectives were to compare QOL of patients and their caregivers in the inpatient vs outpatient settings, and to delineate costs. Methods Patients completed 4 questionnaires (FACT-BMT, FACT-Fatigue, EQ5D, and distress impact), and caregivers completed 3 questionnaires (C-QOLC, distress impact, and financial impact). The timepoints were: D0 (baseline), D+7, D+14, D+28 and D+100.

In total, 52 patients and 51 caregivers enrolled (21 inpatients/31 outpatients). Patients' median age was 57 (range: 18-70), and 67% male. Majority of caregivers were spouses (73%). In the overall population, FACT-BMT scores significantly declined at D+7, then increased to above-baseline by D+100. FACT-Fatigue worsened significantly at D+7, then improved to lower than baseline at D+100. Additionally, EQ5D scores (imaginable health status) significantly declined at D+7 and D+14, then increased to above baseline at D+100 (albeit p>0.05). QOL scores were insignificant when comparing inpatients vs. outpatients, though trends still existed. Caregiver QOL scores were consistently higher for inpatients, though insignificant. Average lost opportunity costs for caregivers was $4195.

There was significant deterioration of various aspects of QOL in the overall population. Inpatient caregivers report better QOL than outpatients, though sample size limits further analyses. 

Childhood cancer caregivers use social media (SM) to raise funds to offset cancer-related financial burden from diagnosis through end-of-life. However, the characteristics of SM users for fundraising are poorly understood. The purpose of this analysis was to examine relationships between socio-demographics (race, education level, income level) and SM fundraising among childhood cancer caregivers. Methods An online survey was distributed in two support networks by key stakeholders. Data about caregiver education, income, race, and SM use were collected. Frequency counts and Chi square analyses were used to uncover relationships between SM fundraising and race, education or income. Results N=209 caregivers responded to questions regarding SM use. Those who used SM for fundraising (N=145) were primarily white (91%) with ≥ a bachelor's degree (50%), and incomes ≤ 200% or less (42%) of the 2018 federal poverty level (FPL). Non-users (N=64) were also primarily white (83%), with ≥ bachelor's degree (63%) and incomes ≤ 200% (27%) of the 2018 FPL. The relationship between SM fundraising and income was significant (chi square=4.56, df=1, p=.033), therefore suggesting an association between income and SM fundraising. Race (chi-square 2.95, df=1, p=.086) and education level (chi square=2.64, df=1, p=.104) were independent of SM fundraising.

Previous research suggested that SM fundraising was more common among wealthier caregivers, however this difference was not significant. Our results support a relationship between income and SM fundraising and indicate that future work should identify the strength and direction of this relationship in order to better understand current coping mechanisms and give direction for future intervention. 

Loss of functionality and symptomatic burden are significant problems in Palliative Care (PC) because of the sense of disability and greater vulnerability. The aim of this study was to evaluate the changes in functional status, symptoms and quality of life of palliative patients with advanced cancer after participating in a rehabilitation program.

Patients were invited to physical therapy sessions twice weekly during two weeks. Pre-and post-changes in functionality, symptoms and quality of life were measured using the Wilcoxon test and correlations between variables through Spearman test. P value of 0.05 or less was used to determine statistical significance.

Twenty-two patients were included. Statistically significant changes were observed in functionality (6MWT distance p= 0.00008, Karnofskyp = 0.001, ECOG p= 0.005 and FIM p= 0.0003); symptoms (fatigue p= 0.0003, wellbeing p= 0.006, dyspnea p= 0.017 and pain p = 0.011) and quality of life (perception of health status p= 0.0002). Inverse correlation was observed between functionality and depression p= 0.033 and a positive correlation between depression and fatigue p= 0.003.

Rehabilitation dignifies and improves functionality, symptoms and quality of life in patients with advanced cancer, even within the first two weeks of treatment. It should be included in PC as a feasible and potential intervention. 

Diabetes is associated with an increased incidence of breast cancer as they share some risk factors such as aging, obesity, diet and physical inactivity. But for breast cancer survivors, whether lifestyle behaviors and general health differ between women with and without diabetes is unclear.

We analyzed data from the 2016 Behavioral Risk Factors Surveillance System (BRFSS), which included a nationally representative sample generated using the multi-stage random sampling methods. Ten states/territories administered the cancer survivorship module. We included adult women diagnosed with breast cancer who had completed cancer treatment at the time of the survey. We excluded women who were underweight. The final sample included 1,106 participants. Variables included general health (poor/fair versus good to excellent), weight (normal versus overweight/obese), physical activity (exercised within the past 30 days), and sleep (<7 hours versus ≥7 hours).

Nearly half of the participants were long-term survivors with more than a 10-year history since diagnosis of breast cancer (48.7%). Results are displayed in the 

Head and neck cancer and associated treatments have significant effects on overall health. Co-morbidities may include dysphagia, odynophagia, changes in voice and communication, musculoskeletal impairments, weight loss, fatigue, constipation, and pain. Integration of cancer rehabilitation in the management of this patient population may improve outcomes.

Our head and neck outpatient center is affiliated with an academic medical program. A multidisciplinary clinical approach was developed with the goal of improving patient experience and outcomes through enhanced coordination of care. Patients are evaluated by members of the clinic including a Head and Neck oncology surgeon, and rehabilitation team including a cancer rehabilitation physician, speech-language pathologist, dietitian and lymphedema specialist. Patient self-reported assessments evaluating quality of life and head and neck specific symptoms are completed by the patient before their cancer rehabilitation physician evaluation including the EORTC QLQ-C30 and EORTC H&N35. The cancer rehabilitation evaluation includes a functional assessment and education on topics including exercise and diet.

Our center has been successful in embedding cancer rehabilitation as part of a multidisciplinary approach to supporting the health of this medically complex head and neck cancer patient population. We have been successful in having patients complete patient reported outcome assessments as part of the standard of care prior to their cancer rehabilitation evaluation with a physiatrist.

We have successfully integrated cancer rehabilitation in the management of head and neck cancer patients. We have more to learn about the effectiveness of such an intervention, including a planned analysis of treatment outcomes and patient reported outcomes.

A. Fonfa 1 1 Annie Appleseed Project, Nonprofit, Delray Beach, USA

Annie Appleseed Project has been gathering evidence around simple natural steps that can make a big difference in the way people go through cancer treatment. We all agree that there is too much pain and suffering and it can start early on in treatment and sometimes last a very long time. Thus we suggest immediate acceptance and implementation of all 3 Steps.

Many epidemiological studies suggest that the Mediterranean diet is an excellent one for health. It is has been shown to reduce cancer risks, heart disease, diabetes, etc.

Physical activity/movement/exercise has been well studied and shown to be helpful in any stage of cancer, i.e. in treatment and through survivorship, but also shown to improve overall health. Exercise professionals stressed first 60 minutes a day, then 30 minutes of vigorous physical activity. Lately studies are showing that just ten minutes daily can make a difference. Stress has been shown to be a major factor in both mental and physical health. It is how stress is handled that seems to matter.

Step 1 of our plan is to eat ONE more fruit and ONE more vegetable each day. We start this so simply because asking people to make huge changes that may benefit their health in many ways, should begin with a step easily taken.

Step 2 of our plan is to take a walk. Start at 'your' level.

Step 3 is take 7 deep breaths before bedtime (sleep issues), before treatment or at any time needed.

This matters to Patients/Survivors.

The EORTC QLQ-C30 quality of life(QOL) questionnaire is designed to measure cancerpatients' physical, psychological, and social functions.

There are few reports on the impact of radiotherapy(RT) on QOL; thus, we investigated QOL changesduring the RT period and 1 month after RT.

We scored EORTC QLQ-C30 (version 3.0) questionnaires from 66 patients. The questionnairecontained 30 items, including 1 item on financial concerns, a global health domain, 5 functional domains, 3symptom domains, and 5 single-symptom items. Assessmentswere performed before RT, at the end ofthe day after RT, and 1 month after RT. Correlationsbetween the patients' characteristics (e.g., age, sex, organ, RT response) and QOL change were evaluated.

No specific patient characteristic significantlycorrelated with a QOL change during RT. In 15 QLQC30items, those items in which the change in score achieved statistical significance (P< 0.05) were the following:physical function was improved from the endof RT to 1month after RT; role function worsened fromthe end of RT to 1month after RT; and emotional functionworsened from the start of RT to 1 month afterRT.

The QOL was poorest at the end of RT. If treatment was completed, physical function improved, but role function and emotional functionworsened just 1 month after treatment. For role andemotional function, observation by medical staff isnecessary.

productivity through changes in employment). Study purposes were to evaluate for inter-individual differences in cancer's level of interference with employment and phenotypic and symptom characteristics that were associated with these inter-individual differences.

Breast cancer patients (n=387) were enrolled prior to surgery and followed for 12 months. Interference with employment was measured using a 0 (no problem) to 10 (severe problem) rating scale. Multilevel regression analysis was used to evaluate for inter-individual differences in trajectories of employment interference and characteristics associated with employment interference at enrollment and over 12 months.

Patients were~55 years of age and underwent breast conservation surgery (80.6%). Mean employment interference score was 3.2 (+3.7).

Unconditional model for employment interference demonstrated a decreasing linear trend (-0.076). Characteristics associated with higher employment interference scores at enrollment included: younger age, lower household income, having an axillary lymph node dissection, and higher breast pain scores. Characteristics associated with both initial and ongoing employment interference scores included having a sentinel lymph node biopsy and higher sleep disturbance scores.

This study is the first to describe characteristics associated with higher levels of employment interference in a relatively large sample of breast cancer patients. Knowledge of these characteristics may help clinicians identify high risk patients and initiate appropriate interventions (e.g., social service referrals, information on legal rights, more effective symptom management). 

Patients' lived experiences, perceptions and considerations concerning non-participation in exercise revealed that there was a discrepancy between the freedom to act and make decisions, and the limitations of having to act in a certain way. The meaning of non-participation in exercise rehabilitation after lung cancer was thus affected by the contradiction between freedom and necessity as a general meaning structure in the analysis. The patients found themselves in a grey area between a healthy life and a good life, as influenced by societal norms and their responsibility for their own health and rehabilitation.

The patients' underlying narrative concerning values and the good life; their balancing of priorities in daily life; their social context and the norms embedded in their self-understanding are crucial to gaining insight into when to include patients in rehabilitation after lung cancer. 

This mixed methods single-arm feasibility studyevaluated a 2-month intervention delivered via written survivorship care plan and booklet, mobile phone application with activity tracker, and telephone coaching. Acceptability and feasibility were examined via implementation tracking, debriefing interviews, and satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month structured interviews and average daily steps per the activity tracker. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing follow-up care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps.

All women (n=23) were Spanish-speaking immigrants and had public health insurance. Nineteen of 23 participants (83%) completed all five coaching calls. The majority (81%) rated the overall quality of the app as "very good or excellent." Compared to baseline, post-intervention fatigue (ß = -0.26, p <.05) and health distress levels (ß = -0.36, p <.05) were significantly lower, and knowledge of recommended follow-up care and resources (ß = 0.41, p <.05) and emotional well-being improved significantly (ß = 1.42, p <.05). Average daily steps increased significantly from 6,157 to 7,469 (ß = 1311.8, p <.05).

Preliminary results support further testing of the intervention, with significant two-month improvements in fatigue, health distress, and emotional well-being, and increased knowledge of recommended follow-up care and average daily steps among this group of vulnerable cancer survivors. 

People with metastatic cancers experience fatigue, decreased physical function (PF), and poor quality of life (QoL). Exercise improves these symptoms in the curative setting, but the efficacy and safety in patients with metastatic cancer is uncertain. Methods Studies were identified from 3 prior systematic reviews and updated using a PubMed search. Included studies were randomized trials of moderate/high intensity aerobic exercise or resistance training intervention versus control in patients with metastatic solid cancers. The mean and standard deviation (SD) for validated outcomes (QoL, PF, and fatigue) were extracted for intervention and control groups at baseline and post-intervention. The effect of exercise was evaluated as the pooled change between baseline and postintervention. Groups were compared using the Mann Whitney test.

Twenty-one trials met inclusion criteria and 7 were excluded due to incomplete data. Among patients with mean baseline scores, exercise was not associated with significant change in fatigue, PF or QoL. In those with baseline scores 2 SD below mean, there was clinical improvement in PF (0.44 vs 8.5) and avoidance of decline in 6-minute walk test (-29.75 vs -0.38m), without statistical significance. There was a statistical improvement in sit-tostand (STS) at the mean and 2 SD below the mean (2.5 vs 6.5, p=0.029) for both groups. There were no differences in falls, fractures, or pain.

In patients with metastatic solid cancers, exercise interventions are associated with clinically meaningful improvements in PF, and statistically improved STS scores in patients with baseline score at the mean or lower. 

There has been a significant interest in the role of exercise and supportive care following a cancer diagnosis to prevent disruption of physical, emotional and social capacity. Rehabilitation challenges vary across cancer diagnoses, treatment, age groups and lifestyle. The purpose of the CIRE program (2012-2019) was to optimize rehabilitation for patients with a variety of cancer diagnoses with emphasis on exercise and supportive care. The program consisted of six randomized controlled intervention trial (n=919) and based on the concept EEX-ACT: 1) Early initiation from time of diagnosisduring chemotherapy; 2) EXercise and supportive care (12 weeks, 2-9 hours/week; 3) patient ACTivation -daily life activities. Multimodal interventions were conducted by multidisciplinary clinical teams (physicians, nurses, physiotherapists).

Cross-cutting analysis; clinical, physiological, psycho-social outcomes and qualitative interviews with cancer patients.

The program included children with leukemia and adults with lung cancer, breast cancer, prostate cancer, leukemia. Average adherence rate 70%; children with high adherence (97%) and lung cancer patients with low adherence (50%). The EEX-ACT concept was successfully integrated in clinical contexts at the hospital. Across studies, improvements in muscle strength (1RM), cardiovascular fitness (VO2 peak), physical activity level, fatigue and anxiety were observed. Interviews with 510 participants confirmed patients' perception of improved physical functioning, emotional wellbeing and strengthened social capital; attained by oncologist's recommendation, nurse counselling, group setting with peers and family involvement.

Exercise interventions initiated at time of diagnosis can improve and maintain the physical, emotional and social capacity of cancer patients during and after chemotherapy. 

The incidence of leptomeningeal disease has been reported to be increasing perhaps due to more effective systemic chemotherapies which are unable to cross the blood brain barrier. Despite the significant rehabilitation needs of these patients, there are no published papers regarding the rehabilitation of leptomeningeal disease patients. The purpose of this retrospective descriptive study is to analyze the acute inpatient rehabilitation outcomes of LMD patients.

This descriptive retrospective study analyzed acute inpatient rehabilitation admissions of patients with a pathology confirmed diagnosis of leptomeningeal disease within 6 months of rehabilitation transfer admitted between 9/5/2014 and 7/30/2018. Demographic information, cancer characteristics, and inpatient rehabilitation admission data were analyzed. 

This study aimed to investigate the effectiveness of a guided self-help Head and Neck exercise program on swallowing, speech, and shoulder problems in patients treated with total laryngectomy (TL).

This randomized controlled trial included patients treated with TL in the last 5 years. Patients randomized into the intervention group received a self-help exercise program and a self-care education program, whilst the control group received a self-care education program only. Both groups completed patient-reported outcome measures before randomization, at 3 and at 6 months follow-up. The primary outcome was swallowing problems (SWALQOL). Secondary outcomes were speech problems (SHI), shoulder problems (SDQ), patient activation (PAM) and health-related quality of life (HRQOL: EORTC QLQ-C30/H&N35). Adherence was defined as moderate to high in case the patient exercised >1 per day. Linear mixed model analyses were conducted to investigate the effectiveness of the intervention group compared to the control group and to investigate whether severity of problems and neck dissection surgery moderated the effectiveness.

Adherence to the exercise program was moderate-high (59%). Patients randomized to the intervention group (n=46) reported less swallowing problems over time compared to the control group (n=46) (p-value twoway interaction=0.013). Also, less communication problems were reported over time (p-value two-way interaction=0.004). No difference was found in speech, shoulder problems, patient activation and HRQOL. Severity of problems and neck dissection surgery did not moderate the effectiveness of the exercise program.

The guided self-help exercise program improves swallowing and communication in TL patients.

Key in addressing causes of suffering for cancer patients, is Dignity therapy, a form of psychotherapy. The primary aim of this study was to evaluate the outcome of dignity therapy (compared to usual care only) on quality of life of advanced cancer patients undergoing palliative care using parameters stipulated in Edmonton symptom scale (Quality of life tool). Secondary objectives were to determine the most common types of cancers and comorbidities in this population Methods

The study population was 144(72 in each arm) patients with advanced cancer. The intervention group received dignity therapy (in addition to usual care) while Group 2 received usual care only. Baseline ESAS scores were determined. Data, collected through taped interviews and written forms (Legacy documents), was edited and legacy documents presented to group one participants after the study. They reviewed the legacy document at least once after which post intervention ESAS scores were then determined in both groups after 6 weeks.

Tthe mean symptom distress score was significantly lower in the intervention group (Mean difference= -8.60; 95% CI -15.29 to -1.90, p=0.022). Dignity therapy group showed a trend towards statistical improvement in anxiety (p=0.059) between the two groups. The largest positive effects were seen in appetite improvement, anxiety and increased wellbeing (Cohen effect size 0.3, 0.5 and 0.31 respectively)

Prostate cancer and its treatment can have a negative impact on men's health and quality of life. Despite evidence of the benefits of physical activity, only 10-32% of people living with and beyond cancer engage at recommended levels. Support for healthy lifestyle behaviours is increasingly important but innovations are needed.

This mixed-methods, multi-site UK study tested a novel 3-month community pharmacy lifestyle intervention for prostate cancer survivors.

Outcomes assessed at baseline, 3 and 6 months post-intervention included physical activity (accelerometry) and patient reported outcomes (European Prostate Cancer Index Composite, EPIC-26; EuroQOL 5-dimension, EQ5D-5L).

Invitation letters were sent to 403 eligible men and 172 (43%) expressed interest. A socio-economically representative sample of 116 men (mean age 70.4±7.2 years, range 50-85) commenced the intervention in nine pharmacies. 99 men completed the intervention (15% withdrawal), and 88 men provided 3-month and 6-month accelerometry data (24% attrition). From baseline to three months, moderate to vigorous physical activity (MVPA) increased significantly by 34±152 minutes (p=0.018), but this was not sustained at six months (p=0.509) ( Table 1) . Although no statistically significant change was recorded in global quality of life at six months, there was a significant improvement in sexual and hormonal domains ( Table 2) .

To our knowledge this is the first study to test a lifestyle intervention for men with prostate cancer delivered in community pharmacy. This study shows that community pharmacies could have an important role in supporting cancer survivors. Innovative approaches are needed to provide long-term monitoring and support sustainability of health behaviour improvements. 

Evidence supporting the benefits of exercise surrounding cancer treatment has led to internationally published guidelines, with minimal uptake by oncology care providers (OCPs). There is a need to understand how to implement research evidence into practice.

We developed a questionnaire to assess OCPs' knowledge of exercise guidelines and barriers / facilitators to exercise counseling and program referral. We validated the questionnaire using the Theoretical Domains Framework (TDF), a knowledge translation (KT) framework used to implement evidence-based guidelines into practice. Each questionnaire item was mapped to its relevant TDF domain. Statistical analyses were used to confirm appropriate grouping (inter-item correlations and means). Reliability was tested by calculating Cronbach's alpha between items within each domain. Construct validity was assessed by examining associations between variables conforming to expected patterns.

Nine out of 14 TDF domains were considered relevant to this context. Chronbach's alpha for questions mapped to these domains were high (see Table 1 ), with the exception of "beliefs about consequences" and "intentions." OCPs who reported meeting Canada's Physical Activity guidelines were more likely to report good knowledge on how to provide exercise counseling (χ2 = 6.44, p = 0.011) and OCPs tested guideline knowledge was associated with self-reported ability to provide exercise counseling (χ2 = 8.28, p = 0.004).

The Clinicians Perspectives on Exercise in Patients with Cancer (CliPEC), is a validated instrument that can be used by cancer programs and researchers to inform the design and implementation of interventions to promote exercise discussion & referral in oncology practice. (3) building an evidence base for models of innovative chronic disease management in primary health care will be described.

The team expects a new NP led model for chronic disease survivorship to be implemented that is patient-centric, family centered and technologyenabled that, generates evidence for best practice in Western Australia. This program will create new research opportunities and NP education in the community setting.

There is area of opportunity to bring the management of chronic conditions back into the community. The designed survivorship clinic will be an innovative model of care for Western Australia, delivering coordinated services for all chronic diseases, including cancer. It will focus on management of chronic conditions taking a holistic family centered approach to assessment and management (physical, social, spiritual, lifestyle and psychological well-being) within the community setting. Patients with metastatic spine tumors may have an increased risk for losing skeletal muscle and decreasing physical function due to bed rest and restrictions in movements. The purpose was to clarify the relationship between changes in skeletal muscle quality and functional prognosis in those patients.

In this historical cohort study, the medical records of inpatients with metastatic spine tumors who received radiotherapy and physiotherapy at Shizuoka Cancer Center were retrospectively collected. Skeletal muscle quantity and quality were evaluated at the time of diagnosis of metastatic spine tumors (Baseline) and one month after starting radiotherapy (T1). Muscle quantity was evaluated with skeletal muscles index (SMI) and quality was evaluated with the proportion of low attenuation muscle area (<29 Hounsfield unit) in the whole muscle area (LAM) on L3 CT slice. The amount of changes in SMI and LAM between baseline and T1 were expressed as ΔSMI and ΔLAM. Single logistic regression analysis was used to assess the effect of ΔSMI and ΔLAM on functional prognosis, or the ability to walk at T1.

A total of 29 patients were analyzed. Five of them (17.2%) were judged as having unfavorable functional prognosis. Variables significantly related to functional prognosis were ΔLAM of the whole lumbar muscle (odds ratio 23. 

It was revealed that patients with reduced quality of skeletal muscle during treatment had poorer functional prognosis one month after starting radiotherapy.

The diagnosis and treatment of cancer can cause disruption to employment and income among cancer patients, particularly in AYAs who are at a critical point of their careers and have yet to achieve financial stability. This study aims to evaluate the impact of employment and financial challenges on cancer survivorship among AYAs.

Eleven focus group discussions were conducted among 23 AYA cancer survivors and 18 healthcare professionals who work with AYA cancer patients. All sessions were audio-recorded, transcribed verbatim and coded for thematic content analysis.

Among cancer survivors, 16 (69.6%) were working, 2 (8.7%) were unemployed and 5 (21.7%) were studying. Survivors were affected by cognitive impairment and physical disability, consequently impairing work and study performance. Related to employment, survivors struggled with the disclosure of their medical history and were worried about not keeping up with expectations. Working survivors were also apprehensive about changing jobs and voiced concerns about career advancement. In addition, obtaining insurance was a concern as many survivors were denied insurance coverage due to their medical history. Nevertheless, survivors consistently expressed their desire to be treated normally despite challenges at work. Both AYA survivors and healthcare professionals highlighted the need for information provision and services to assist survivors in resolving work-and insurance-related issues.

Conclusions AYA survivors face difficulties at work and in obtaining insurance coverage. Existing survivorship services for AYA survivors should incorporate career coaches and financial counselors to assist survivors return to work and resolve financial issues.

Patients on Phase I trials help advance science through their participation but there is a paucity of data regarding QoL of patients and their caregivers.

Phase I trial patients from a single Asian centre were assessed at baseline and at 3 time intervals after treatment initiation with EORTC-core (QLQ-C30) and Comprehensive Score for Financial Toxicity (COST) questionnaires. Caregivers' QoL were assessed with Zarit-Burden Interview (ZBI). Pairedsample t-tests were used to test for QoL differences at different time intervals. Results Table 1 summarises patients' characteristics. QLQ-C30 scores range from 0 to 100, higher scores represent a high level of functioning and QoL. Table 2 presents their scores. Patients were most bothered by fatigue and pain. 65.7% experienced grade 1 or 2 financial toxicities based on COST. There were significant improvements in physical (14.5 +/-16.7, p < 0.001), cognitive (18.1 +/-25.0, p = 0.002) and emotional (10.5 +/-18.4, p = 0.012) functioning scores at baseline and 1-month post-treatment.

Patients experienced a reduction in fatigue, but no change in pain or financial concerns. Only 28.6% of patients were referred to palliative care medicine. 8 of 19 caregivers experienced mild to moderate levels of burden.

This study aimed to gather perspectives of primary care physicians (PCPs) from private and public institutions in Singapore on their role in delivering sharedcare services to breast cancer survivors and formulate an optimal care plan.

Eleven focus groups and six in-depth interviews were conducted with 70 PCPs recruited by purposive sampling. All sessions were audio-recorded, transcribed verbatim and coded by three independent researchers. Thematic content data analysis was performed using NVivo 12.

Majority of the participants reported spending less than one-fifth of consultation time to manage survivors' cancer-related problems as they prioritized presenting complaints over the cancer history. PCPs recognized their value in delivering shared-care by: (1) providing holistic patient-care to include survivorship issues, 

An optimisation clinic for cancer patients with complex needs was introduced at Peter MacCallum Cancer Centre in August 2017 providing up to eight weeks of nutritional counselling, exercise prescription, fatigue management and psychological support tailored to individual need. This study examined how well the clinic was implemented into usual care.

Retrospective study for 185 patients referred to the optimisation clinic, August 2017 to December 2018. Implementation outcomes (acceptability, adoption, fidelity and appropriateness) were evaluated using operational, medical records and patient interview data.

Adoption, including intention to try and uptake, were acceptable: 88% (162/ 185) of referred patients agreed to screening and 71% (74/104) of eligible patients (criteria presented in image 1) agreed to participate in the clinic. Fidelity was mixed, secondary to inpatient admissions and disease progression interrupting patient participation. An individualised program was developed for every patient, but only 41% (30/74) attended at least 80% of scheduled appointments. Compliance with outcome assessment was variable at program commencement (dietetic, 95%; physio, 91%; OT, 33%; quality-of-life, 30%) and low at program completion (dietetic, 32%; physio, 13%; OT, 10%; quality-oflife, 11%) mainly due to non-attendance. Patient interviews revealed a high satisfaction and perceived appropriateness of the clinic (image 2). Image 1 -Model of care

To transit from an oncologist-led to a shared-care cancer survivorship model in Singapore, this qualitative study was designed to elicit perspectives from primary care physicians (PCPs) on the design and delivery of a proposed shared-care model among breast cancer survivors.

Eleven focus groups and six in-depth interviews were conducted with 70 PCPs recruited by purposive sampling. All sessions were audio-recorded, transcribed verbatim and coded by three independent researchers. Thematic content data analysis was performed using NVivo 12.

Strategies to maximize patient selection, effectiveness, adoption, implementation and maintenance of a shared-care model were reported. PCPs proposed for shared-care to be initiated among survivors who were previously on regular follow-up in the primary setting to leverage on the existing rapport built. At the institution level, buy-ins from a few representatives as early adopters of the new model would generate a positive momentum of change. Key implementation strategies included: (1) Baseline functional level and dosage of rehabilitation are main factors related with functional improvement. This study contributes with evidence on the effectiveness of implementing rehabilitation in standard oncology treatment. Further larger and randomized control trials are needed to confirm our results.

Management of poor body image and low self-esteem are top American Cancer Society priorities in the survivorship care of men with prostate cancer (PCa); however, interventions to improve self-esteem in this population are lacking. We investigate whether exercise can improve physical self-worth, a critical component of self-esteem, in men with PCa. Methods A secondary analysis was performed of a phase II randomized controlled trial to evaluate the effects of Exercise for Cancer Patients©® (EXCAP), a structured, home-based 6-week exercise intervention combining aerobic and resistance exercise, on physical self-worth. Men with non-metastatic PCa receiving radiation or androgen deprivation therapy (ADT) were randomized to EXCAP or usual care (UC). Physical self-worth was measured by the validated Physical Self-Perception Profile, a 30-item questionnaire where increased score represents higher physical self-worth, at pre-and post-intervention. Changes between arms were compared using analysis of covariance.

Fifty-eight men with PCa were randomized. The effect of the 6-week exercise intervention on physical self-worth was moderated by subjects' self-worth at baseline. Compared to UC, EXCAP significantly improved physical self-worth in those with higher self-worth at baseline (subject baseline self-worth >50th percentile, p=<0.04; >25th percentile, p<0.01).

Exercise improves physical self-worth in men with PCa receiving radiation or ADT, a population that struggles with body image. This benefit appears greater in those with a higher physical self-worth at baseline. Exercise should be recommended as part of PCa survivorship care to boost body image, self-esteem, and self-worth. Interventions for those with low baseline physical self-worth warrant further investigation. 

There is an increasing focus on factors that facilitate return to work for survivors of cancer. However, less work has quantitatively examined the factors that contribute to a positive return to work experience. This study examined the relative impact of workplace support and social inclusion on the quality of the return to work experience for cancer survivors.

Online survey of cancer survivors diagnosed from 2015-2017 who had returned to work following treatment. Measures included contact with employers/co-workers while absent from work, perceived workplace support (Work Practice Questionnaire) and perceived social inclusion (Workplace Loneliness Scale) at the time of returning to work, and satisfaction with the return to work experience (7-item scale designed for this study). Participants were recruited through workplaces, hospitals, social media and a market research company panel.

Results 189 cancer survivors participated. The sample was 62% female, with an average age of 55 years (SD=12) and a range of diagnoses. Contact with employers/co-workers while absent from work predicted a positive return to work experience. Greater perceived workplace support and perceived social inclusion at the time of returning to work predicted a positive return to work experience. Further analyses indicated that the relationship between workplace support and satisfaction with the return to work experience was fully mediated by social inclusion.

Perceptions of social inclusion and contact with the workplace while absent from work are crucial factors facilitating a positive return to work experience. Return to work initiatives should foster teamwork and relationships, as well as providing support for practical issues. 

Appearance Care means any cosmetic compensation for visual changes caused by cancer treatments, e.g. wigs for hair loss and camouflage makeup for surgical scars and chemotherapy-induced pigmentation. The Japanese government has updated the Basic Plan to Promote Cancer Control every 5 years. The latest plan, approved in 2017, picked up "Appearance Care" as one of the important issues for Cancer Survivorship. However, the specific measures have not been instructed yet.

We asked the participants in a workshop on Appearance Care for interview about the approach on Appearance Care at their hospitals.

Nine participants responded to the interview voluntarily. Their affiliation included three major hospitals in Tokyo, and three major hospitals and small hospitals in regional towns. The efforts on Appearance Care at their facilities were various from "Nothing done at all" to "Nurses provide the required information". The major hospitals in urban cities tended to act positively than regional small hospitals. However, all respondents felt that "Current care is not enough for patients", and that "Cooperation and understanding of other staff have not been obtained." A nurse in regional small hospital felt even that "Some doctors have opponent opinion against Appearance Care".

The fact that the government has begun to take Appearance Care as necessary issues shows improvement in awareness for cancer patients' quality of life in Japan. However, our small interview survey suggested that Appearance Care in Japan is not adequate currently. A large survey on current status should be necessary to establish concrete measures for Appearance Care. 

Exercise, as evidenced numerous times, has beneficial effects on physiological symptoms and quality of life of cancer survivors. Sociocultural barriers surrounding exercise, particularly pertaining to its initiation and adherence, are significant among the South Asian communities. These barriers in conjuncture with the stigma surrounding cancer are augmented post diagnosis.

With an intention to improve awareness and attitude towards exercise, a group therapy programme was employed between Oct-Dec 2018 for 213 survivors receiving physiotherapy services at a tertiary care hospital among which 126 survivors enrolled for group exercise sessions (group size 4-7 members). The current study aimed to assess the impact of an on-going group exercise programme on motivation and attitude towards exercise among survivors receiving cancer therapies. Methods A qualitative design using a phenomenological approach was used to conduct in-depth interviews. A semi structured questionnaire was developed and after obtaining verbal consent, 13 participants (9 men, 4 women; age 18 -65 years) receiving cancer therapies were interviewed in their native language. The interview was audiotaped, transcribed and analysed for themes

The interviews revealed four prominent themes viz awareness, benefits, willingness and barriers. Participants had low awareness about exercise and its benefits prior to enrollment in the program. Benefits were perceived across physical, functional and emotional domains. All expressed willingness to exercise after discharge and seemed motivated. Fatigue and lack of guidance at home were perceived as barriers.

Group exercise was well received by survivors undergoing cancer therapies and helped develop a positive attitude towards exercise. 

Consistent with work in other populations, results suggest that patient-caregiver reports of patient independence in ADLs/IADLs are correlated, but caregivers report that patients receive significantly more assistance than patients report receiving. Results provide additional insight about patient-proxy ratings of functional status in the context of advanced cancer. Findings suggest that the relationship context influences perceptions of patient independence, and high disagreement may reflect "invisible support" from spouse-caregivers. 

There is a growing body of evidence on the role of exercise in alleviating the side effects of chemo radiation during head and neck cancer treatment.

There is a need for research to determine the optimal mode and intensity of exercise in this patient population.

This study was a pilot randomized controlled trial where 22 subjects were either assigned to the aerobic training group (n= 11; 9 males and 2 females) or aerobic plus resistance training group (n= 11; 8 males and 3 females). Both the groups followed a 7-week exercise program consisting of 5 weekly sessions of exercise as tolerated by the patient & supervised by an experienced physiotherapist. Aerobic training group received a brisk walking intervention for 15min, 5days a week for 7 weeks while the other group received a combined program of aerobic & progressive resistance training (strengthening with Thera-band for 15-20 minutes, 3days a week for 7 weeks for major muscle groups). Functional capacity, quality of life, skeletal muscle & fatigue were assessed at baseline, end of 3 weeks of chemo-radiation & at the end of chemo-radiation at 7 weeks.

This pilot study demonstrated that exercise training prevented a steep decline in the functional capacity, QoL & fatigue in both the groups, while the muscle mass improved. The between group analysis did not show a statistically significant difference.

Even though both the exercise interventions prevented a decline in outcome measures in these patients there was no significant difference between the two types of exercise interventions given in this study. 

No studies thus far have evaluated the impact of a supervised trimodal prehabilitation program on functional exercise capacity in hepatobiliary and pancreatic cancer patients undergoing surgery. Methods A single-centre, parallel-arm randomized controlled pilot trial was conducted. Patients were assigned to either a prehabilitation or rehabilitation program. The prehabilitation group received a trimodal program comprising exercise (once-weekly supervised and home-based), nutritional counselling with whey protein supplementation, and relaxation exercises initiated 4 weeks before surgery. The rehabilitation group received the same trimodal program (minus once-weekly supervised exercise) initiated immediately after surgery. Both study arms continued the program for 8 weeks after surgery. The primary outcome was functional exercise capacity measured using the 6-minute walk test (6MWT).

Thirty-five patients were randomized to receive prehabilitation (n=17) or rehabilitation (n=18 

In bivariate models, intrusive thoughts were associated positively with depressive (β=0.022, p=0.0014) and anxiety (β=0.047, p<.0001) symptoms. Adjusting for other factors, intrusive thoughts remained associated with depressive symptoms (β=0.022, p=0.008), regardless of level of social support (for all support dimensions). For anxiety, there were significant interactions of tangible (β=-0.013, p=0.034) and affectionate (β=-0.022, p=0.005) support with intrusive thoughts. Intrusive thoughts were associated more strongly with anxiety symptoms among women reporting less tangible and affectionate support than those with higher levels of these types of support.

Tangible and affectionate support had protective effects on anxiety symptoms among Spanish-speaking Latina breast cancer survivors experiencing intrusive thoughts, but not depressive symptoms.

The loss of physical function is a common struggle amongst patients with advanced colorectal cancer. Therapeutic exercise is recommended; however, due to physical impairments, voluntary exercise participation is not always possible. Neuromuscular electrical stimulation (NMES) may represent a practical short-term approach. The primary aim of this study was to assess the safety, feasibility and efficacy of a personalised and progressive NMES exercise intervention in adults with advanced colorectal cancer.

Three adult patients with advanced colorectal cancer were recruited. A personalised and progressive NMES exercise intervention was implemented in each case over a 4 week period. The 30 seconds sit to stand test (STS), 6minute walk test (6MWT), and EORTC QLQ C-30 were performed pre-and post-intervention. For patients deemed unsuitable for the 6MWT, the timed up and go test (TUG) was used to assess functional mobility. Patients completed semi structured interviews post intervention to explore their experiences and views on the intervention, and its impact on their daily lives.

All 3 patients completed the intervention and completed pre-and post-assessments. Two of 3 patients improved STS, 2 of 3 patients improved 6MWT. One patient completed the TUG and improved post intervention. Two of 3 patients improved Global QoL. Perceived benefits included improved leg muscle strength and motivation to be more physically active.

A personalised and progressive NMES exercise intervention appears safe and may improve functional capacity and QoL in adults with advanced colorectal cancer. Replication of these results in a controlled prospective study is warranted prior to clinical implementation.

We started the Breast Cancer Survivorship Navigation Project (BCSNP) to understand needs and gaps experienced by underserved breast cancer survivors and their caregivers (racial and ethnic minorities, less formally educated, limited English speaking, and gender and sexual minorities). For the initial purpose of this project, "survivor" is defined as anyone who had been diagnosed with breast cancer, treated with curative intent, and no longer receiving treatment except for adjuvant hormonal therapy.

The BCSNP team includes survivors, patient navigators, clinicians, advocates and researchers representing organizations aiding underserved patients. We collaboratively created a survey to assess regional survivors' needs. The survey was administered in three languages through eight organizations across the San Francisco Bay area.

We received 63 complete responses; 62 met eligibility criteria. Respondents identified as African American (28%) Lymphedema is a well-known side effect of cancer treatment. It affects quality of life by causing functional impairments such as dysphagia, odynophagia, changes in voice and communication, musculoskeletal dysfunction, and pain. We sought to identify a marker for internal lymphedema that can be objectively measured in routine post-treatment surveillance radiography.

We identified 174 patients from our tumor board database who underwent treatment for oropharynx cancer at our institution. Twenty-one patients had contrast-enhanced neck CT both before treatment and at least once after treatment. All but one patient had radiation therapy. Thirteen patients also underwent transoral surgery with seven having undergone neck dissection. Epiglottic thickness and submental soft tissue radiodensity were measured by two neuroradiologists.

In patients undergoing radiation therapy, the epiglottic thickness increased by 245% (average, axial) and 110% (average, sagittal) with a range of 106% to 418% (axial) and 43% to 253% (sagittal). Radiodensity of the submental tissues was noted to increase by an average of 31 units with a range of 2.4 to 99 units change in patients undergoing radiation, reflecting increased interstitial edema. The singular patient who did not undergo radiation had no change in these parameters.

Epiglottic thickness and submental tissue radiodensity increased in all twenty patients who underwent radiotherapy. It's our contention that submucosal edema of the pharynx and larynx as seen on post-treatment radiography may serve as a method to evaluate internal lymphedema. Future studies may serve to correlate these radiographic parameters to functional impairment of swallow, voice, airway, and neck range of motion. Introduction Approximately 40% of pts with HR+, HER2-ABC have tumors with a PIK3CA mutation, resulting in PI3K pathway hyperactivation. In SOLAR-1, the oral α-specific PI3K inhibitor alpelisib (+fulvestrant) significantly improved (vs placebo+fulvestrant) both PFS and ORR in the PIK3CA-mutant cohort. PROs offer insight into therapeutic benefit by measuring whether quality of life (QoL) is maintained during treatment.

Postmenopausal women or men with HR+, HER2-ABC whose disease progressed on/after an AI were randomized to receive alpelisib 300 mg QD (or placebo) +fulvestrant 500 mg Q28d + C1d15. Secondary objectives included PROs using EORTC QLQ-C30, EQ-5D-5L, and BPI-SF scales. PROs were collected at screening, every 8 weeks for 18 months then every 12 weeks thereafter, at end of treatment, and during follow-up for efficacy. Linear mixed effects models were used to assess score changes from baseline. Time to 10% deterioration (TTD) was compared between arms' survival distribution per Kaplan-Meier methodology.

Of pts in the PIK3CA-mutant cohort (n=341), 93% and ≥75% completed questionnaires at baseline and post-baseline, respectively. Patients experiencing a lack of interest, a lack of self-discipline were more likely to not achieve the recommended 150 minutes of physical activity. Patients with symptoms of pain or fatigue were significantly less likely to adhere to the guidelines (p=0.007 and p=0.005).

Although universal recommendations are given for physical activity in supportive care and rehabilitation clinic, adherence to exercise recommended is low. Issues of motivational type appear to be the main predictor including lack of interest, self-discipline and fatigue. Therefore interventions aimed at increasing motivation, and treating fatigue are likely to result best alternative to improve the situation.

EDUCATIONAL ATTAINMENT AMONG CHILDHOOD CANCER SURVIVORS: A META-ANALYSIS Introduction Despite significant developments in the treatment of childhood cancer, some studies have suggested that cognitive and educational sequelae remain. The factors that influence these outcomes require further investigation. This meta-analysis examined evidence for the negative impact of childhood cancer on educational attainment. Secondary aims were to examine whether diagnosis prior to adolescence results in poorer educational attainment than a later diagnosis, and the disease and treatment factors that influence this relationship. Methods A systematic literature search was conducted in Embase, Medline and PsycINFO, using terms based on the key concepts "cancer", "childhood" and "educational attainment". Eleven eligible studies were identified. Physical activity level (IPAQ), body composition (BMI, body fat percentage, muscle mass), biochemical profiles, and quality of life (EORTC QLQ-C30) were assessed at baseline and endpoint. At the 6-week midpoint, exercise intensity was individually adjusted.

Of the 37 patients, 31 completed the 12 weeks of intervention. Grip strength improved significantly after 12 weeks of intervention. The 30-second chair stand test and 6 minute walk test showed significant improvement after 6 and 12 weeks, and from 6 to 12 weeks. Muscle mass and IPAQ score increased significantly after 12 weeks of intervention without biochemical deterioration.

Twelve weeks of mhealth care, including an individually prescribed rehabilitation exercise program, significantly improved physical fitness, body composition, and physical activity without any complication or biochemical deterioration in compensated HCC patients who had completed therapy. 

Despite advancements in cancer treatment, chemotherapy is still characterized by a high degree of toxicity and involves several side effects that deeply affect the quality of life and the functional state of cancer patients.

One hundred and sixty-five patients treated for gynecological cancer at the San Raffaele Hospital completed the European Organization for Research and Treatment of Cancer -Quality of Life Questionnaire (EORTC QLQ-C30) after their first, third and fifth chemotherapy infusion. The five functional scales (physical; emotional; role; cognitive; and social) and the quality of life scale were considered. Comparisons were performed with nonparametric test. P-values <0.05 were considered significant.

The mean age of the sample was 58.23 (SD=13.19); 110 patients had a primary tumor, while 55 a recurring disease. There was no significant difference between the two groups in the scales at first infusion. A significant improvement was registered for all the scales between the first and third infusion, except for the cognitive functioning scale, which remained stable. There was no significant change between the third and the fifth infusion.

These findings show that patients' quality of life improves between the first and the third chemotherapy infusion and stabilizes afterwards. This could suggest that, after the initial stress of a diagnosis, patients progressively adjust to the new situation and cope with the side effects of treatment and its consequences. 

Patients with metastatic cancer frequently require Peripherally Inserted Central Catheters (PICCs) to deliver chemotherapy in the ambulatory setting. PICCs have a higher incidence of Venous Thrombo-Embolism (VTE), infections, need to be removed when patients have a treatment break and also require weekly line flushes. A group of patients began asking about the potential to have a Totally Implantable Vascular Access Device (TIVAD) inserted, however we didn't offer this service.

As the nurse consultant for haematology and oncology I was keen to explore the potential to introduce a nurse-led TIVAD service that wouldn't require any form of x-ray guidance. I contacted pfm medical UK Ltd. who were able to supply 1:1 on-site clinical training until competency was achieved. We use Ultrasound and ECG technology so as to avoid the need for fluoroscopy. 

Nearly 50% of CS are still untreated although they are eligible for statin therapy. This means that the management of CVD is poor, and that primary care for CS is not being carried out well. This emphasizes the need for a more shared approach to primary care, to prevent CVD among CS.

Cellular immunity using T-cells and their chimeric antigen receptors to redirect their cytotoxic specificity against tumor cells (CAR T-cell therapy) is a new and emerging treatment for a number of cancers. Cytokine Release Syndrome (CRS) and CAR T-cell related Encephalopathy Syndrome (CRES) are common toxicities and can cause significant medical and functional morbidity.

Although not previously documented in CAR T-cell treated cancer patients, acute inpatient cancer rehabilitation has been shown to be effective in patients with neutropenic and thrombocytopenic precautions, requiring frequent transfusion support, and with significant neurologic deficits.

Case report from retrospective chart review Results From initial hospitalization status post CAR T infusion until discharge from the inpatient rehabilitation unit the patient's CRS score varied from 0 to 2 (ICU), CRES score varied from 0 to 4 (ICU) and FIM mobility score varied from 1 to 5 (inpatient rehab unit.) The patient required platelet transfusions 4 of 7 days and PRBC transfusion 3 of 7 days on the rehabilitation unit. He was safely discharged home with family assistance. 

Pooling data from 10 randomized controlled trials and the results showed that exercise had positive effects on physical function (g = .91, 95% CI= .14 to 1.68), sexual activity (g = .45, 95% CI= .16 to .73), sexual function (g = .56, 95% CI= .28 to .84), and social function (g = .24, 95% CI= .01 to .48) in men with prostate cancer in this meta-analysis. But, no significant effect of exercise on QOL (g = .52, 95% CI= -.12 to 1.16), mental function (g = .45, 95% CI= − .05 to .95) and depression (g = .20, 95% CI= − .04 to .44). No deaths attributable during intervention, but one adverse event was in exercise group was design as higher exercise intensity at 50 to 75% VO2max.

Exercise can significantly improve social, physical, and sexual function.

In future, exercise can as a support care and cobmining with psychological intervention for prostate cancer patients to enhance physical and mental well-being. Vanderbilt University, School of Nursing, Nashville, USA

As survival rates for patients with head and neck cancer improve and patients continue to be diagnosed at a younger age, there is an increased need to holistically support the survivors of this disease. Both the disease and its treatment can cause significant disfigurement of the face and neck, as well as impairment of sight, speech, smell, taste, breathing, facial expressions, and neck movement. These abilities are often critical to an individual's sexual function and sexual well-being. As sexuality is an important aspect of quality of life, the purpose of this study is to examine patient priorities and preferences for discussing and receiving information about sexuality from healthcare professionals.

Participants were recruited via flyers, targeted emails, and online survivorship communities. After providing informed consent, participants completed study surveys electronically in REDCap. Descriptive statistics were used to summarize participant characteristics and survey responses.

Participants (n=73) ranged from 23 to 76 years of age. The majority of participants (54.2%) indicated that it was "very important" for them to receive information about sexual issues from their healthcare provider while an additional 30.6% indicated it was "somewhat important." Participants preferred the timing of this information sharing to occur at the time of diagnosis, at some point during treatment, and immediately after completing treatment. Printed material, in person discussions, and digital media were the patient preferred methods of communication.

This study supports patient-centered timing and methods for approaching the subject of sexuality with patients with head and neck cancer.

Sexual satisfaction is a vital component of well-being for cancer survivors. However, the cancer treatment affects both physical and psychosexual functioning which may lead to decreased sexual satisfaction, especially for gynecological cancer survivors. The study was to examine sexual satisfaction and sexual functioning among women with gynecological cancers by comparing these women with those without cancers. Methods A cross-sectional survey was conducted on 209 women, in which 106 were with gynecological cancer and 103 were age-and educationmatched women with no history of cancer undergoing routine cervical cancer screening. Self-evaluations included the Female Sexual Function Index (FSFI) and Sexual Satisfaction Scale for Women (SSS-W). ANOVA was conducted for group comparison on sexual satisfaction and sexual functioning.

Being a signatory country of Sustainable Development Goals, Indian is needed to achieve Universal access to reproductive and sexual health services by 2030. However, current statistics showed that one-fourth of young adult (aged15-24 years) Indian women's demand for family planning remained unsatisfied. This paper explored possible gateways to reach the young adult women for delivery family planning services to improve their reproductive and sexual health.

Using data from most recent round of the National Family Health Survey (NFHS) conducted in 2015-16, this paper identifies key gateways across contextual factors, maternal and child healthcare service utilization, program outreach, and quality of family planning care, for increasing modern contraceptive prevalence rate (mCPR) among young married women (15-24 years) in India. Bivariate association, binary logistic regression analyses, and marginal predicted effect analyses are used.

Preliminary result shows that, mCPR is only 21% among young Indian women with a huge geographical variationranging from 5% in Bihar to 43% in West Bengal. Among the various ways, connecting women to the community health workers is most effective in accessing family planning services. For instance, women contacted with the health workers were 2 times more likely (odds ratio 2.33, p<0.001). to use modern contraceptives than those who are not contacted.

Improving health workers contact for family planning is most important programmatic opportunity for increasing modern contraceptive use among young Indian women. The other gateways areoffering family planning counselling when women visit health facilities for maternal and child healthcare services.

G. Ilie 1 , R. Rutledge 2

Prostate cancer (PCa) is one of the most commonly diagnosed cancers in Canada and worldwide and accounts for 15% of all cancers diagnosed in men. Men with cancer of the prostate often suffer from treatment related side effects including and not limited to sexual and urinary dysfunction, social isolation with concomitant worsening quality of life during survivorship. Little educational and empowerment help is provided to support this population with sexual, intimacy and connection issues during survivorship.

This presentation offers evidence based data outlining the need for intimacy and connection education among PCa survivors. Five evidenced-based teaching sections that constitute the elements of an Intimacy, Connection and Sexuality Patient Empowerment Program that has been successfully presented and received during four PCa support groups workshops in Canada (PEI, Ontario, and BC) will be presented and discussed.

Each of the five components of the program will be described, along with their evaluation by PCa survivors attendees (n=60). These components are: (1) Healthy Aging / Sexuality (2) Types of Intimacy;(3) Emotional connection (4) De-cluttering relationship exercises leading to an intimate connection; and (5) Practical solutions for erectile dysfunction.

The results presented show that patient education and empowerment programs that include aspects related to intimacy, connection and sexuality for PCa survivors are in high demand and very well received in this population. Investment in the development of these types of programs for this population are warranted. 

Sexual distress is a predominant factor affecting the survivor ship of cervical cancer survivors. In addition to the various demographic factors that influence the sexual well-being among the survivors, a significant number of modifiable factors are also present. This study highlights the need for rehabilitation pertaining to sexual concerns and well-being of the survivors.

Sexual dysfunction is a prevalent problem in cancer patients. Indian women seek less assistance for sexual dysfuntion, despite undergoing physical and marital problems. We collected a data of prevalence of these problems in woman attending cancer clinic of a tertiary care hospital.

We did a questionnaire based study comprising of 120 patients from January, 2017 to June, 2017. The questionnaire was designed on the basis of prior validated tool with modifications by the authors in context to our patient scenario. Results 86% patients had some sort of sexual problem. Only 14% patients said that they had no sexual problem and were satisfied with their sexual life. 65% of women couldn't talk regarding their sexual dysfunction to their partners. 65% women reported of desire dysfunction, 77% complained of arousal disorder, 51% had lubrication disorder, 56% had dyspareunia, and 74% had sex related anxiety. When asked about the sexual frequency, 4% women had sex more than five times in last one month. It is important to note that 78% women knew the importance of sex in life. The reasons for decreased sexual activity were ill health in 65% women, 25% had lack of libido, lack of privacy and other social reasons in 5%, and 5% had fear of disease deterioration due to sex.

Sexual dysfunction is common in women with cancer. They are however, reluctant and shy to discuss this problem. The focus should not only be on treating 'cancer' but also improving their quality of life including sexual health. 

Despite profound impacts on sexual well-being and impaired sexual functioning prevalent among gynaecological cancer patients, sexuality care has been neglected in most countries. This study aims to develop a practice model and protocol to guide and promote sexuality nursing care in clinical practice.

The study adopted a concept mapping approach which consisted of three phases. In Phase I, 30 gynaecological cancer patients and their spouses/partners, 20 registered nurses and physicians working in the gynaecological oncology unit were interviewed to elicit their perceptions of good nursing practice in sexuality care. A list of statements was generated and then returned to them to rate the level of similarities and perceived level of importance in good sexuality care. Based on these ratings, a concept map was constructed by using multi-dimensional scaling and cluster analysis.

A total of 50 statements were generated and organized into seven themes: (1) Information giving; (2) Discussion about sexual impact of treatment; (3) Attitudes towards sexuality care provision; (4) Mode of sexuality care delivery; (5) Personnel involved in sexuality care delivery; (6) Timing of sexuality care delivery and (7) Organisational support. A concept map was constructed and used to guide the development of a practice model and protocol to promote the provision of sexuality care for gynaecological cancer patients.

This study produced a practice model and protocol guiding nurses to deliver timely and effective sexuality nursing care for gynaecological cancer patients. 

The International Index of Erectile Function (IIEF) is one of the most used patient-reported outcome measures for evaluating erectile dysfunction and other sexual problems in males. We performed a systematic review of the measurement properties of the IIEF-15 and the IIEF-5.

A systematic search of scientific literature up to April 2018 was performed. Data were extracted, and analyzed according to the COSMIN guidelines for structural validity, internal consistency, reliability, measurement error, construct validity, criterion validity and responsiveness. Evidence of measurement properties was categorized into sufficient, insufficient, inconsistent, or indeterminate, and quality of evidence as very high, high, moderate, or low.

Forty studies were included. The evidence for criterion validity, and responsiveness of the IIEF-15 was sufficient (high quality), but inconsistent (moderate quality) for structural validity, internal consistency, construct validity, and test-retest reliability. Evidence for structural validity, testretest reliability, construct validity, and criterion validity of the IIEF-5 was sufficient (moderate quality), but indeterminate for internal consistency, measurement error and responsiveness.

Besides criterion validity and responsiveness, more evidence is needed on the other measurement properties of the IIEF-15. While there is sufficient evidence on most measurement properties of the IIEF-5, unidimensionality (which is required for determining whether the sum score represents one construct) has not yet been investigated. 

The Female Sexual Function Index (FSFI) is one of the most used patient reported outcome measures for evaluating female sexual (dys)function (FSD). We performed a systematic of the measurement properties of the FSFI-19 and FSFI-6.

A systematic search was performed of Embase, Medline, and Web of Science for studies that investigated measurement properties of the FSFI-19 or FSFI-6 up to April 2018. Data were extracted, and analyzed according to the COSMIN guidelines for structural validity, internal consistency, reliability, measurement error, construct validity, criterion validity and responsiveness. Evidence was categorized into sufficient, insufficient, inconsistent, or indeterminate, and quality of evidence as very high, high, moderate, low.

Eighty-three studies were included. The evidence was sufficient for criterion validity (high quality), internal consistency (moderate quality), reliability (low quality); but inconsistent for construct validity (moderate quality), and structural validity (low quality); and indeterminate for measurement error, responsiveness, and cross-cultural validity, for the FSFI-19. The evidence was sufficient for criterion validity (moderate quality); but inconsistent for reliability (low quality), and construct validity (very low quality); and indeterminate for structural validity, measurement error, responsiveness, and cross-cultural validity, for the FSFI-6.

Besides criterion validity, measurement properties of both the FSFI-19 and FSFI-6 are not well substantiated and need further research.

More than 65,000 women are diagnosed with endometrial or cervical cancer annually in the US. Significant disruption in body image, sexuality, and sexual functioning occurs but these concepts have rarely been studied simultaneously. The primary aim of this study was to examine relationships among body image, sexuality, and sexual functioning, and the secondary aim was to understand the factors that influenced women's views of these concepts, and their perceptions of significant impact. Methods A cross-sectional descriptive design was used to examine these concepts in survivors of cervical or endometrial cancer. Inclusion criteria: women of reproductive age, diagnosed with stage I-III cervical or endometrial cancer, within 3-36 months after completing treatment, and without diagnosis of major mental illness. Exclusion criteria: women under eighteen, post-menopausal at diagnosis, metastatic disease, multiple cancer diagnoses, history of prior cancer, cancer recurrence, ostomies prior to cancer diagnosis, and transgender individuals. Participants completed the Body Image Scale, Female Sexuality Questionnaire, Female Sexual Function Index, and several open-ended questions.

Twenty women were enrolled in the study. The sample was primarily white and non-Hispanic women (n=9) with cervical cancer (n=13). Data analysis is ongoing, but preliminary examination of qualitative data indicates significant disruptions in body image and sexual functioning, accompanied by little communication with providers about these issues.

Early data analysis affirms the significance of these issues. Final analyses are anticipated to further elucidate relationships among body image, sexuality, and sexual functioning and their impact, and to provide direction for future research. 

Most ovarian cancers are either ovarian epithelial cancers or malignant germ cell tumors. The objective as to evaluate cytotoxicity and in vivo efficacy of ULLB-0005 in ovarian cancer Methods ULLB-0005 is a protein derived from natural fungus with high binding specificity for carbohydrate antigen and strong apoptotic signal leading to death of cancer cells. For in vitro study, PA-1 cells were treated with ULLB-0005 at concentration ranging from 2.5-80 μg/mL. Following incubation, the cell cytotoxicity was estimated by calcein AM assay. For in vivo experiments, athymic nude mice were subcutaneously implanted with tumor fragment which was obtained from PA-1 cells. Animals were injected with test item and reference standard. Tumor volume was recorded twice weekly and body weight was recorded daily throughout the experimental period. Finally, tumor growth inhibition was calculated.

Based on in vitro study, cytotoxicity was found to be 72.0% for ULLB-0005 and 82.3% for doxorubicin. ULLB-0005 showed tumor growth inhibition of 62.15%, whereas doxorubicin standard showed 84.48%. In order to find if ULLB-0005 is cytotoxic to PA-1 cells, calcein AM assay was performed. This was followed by experiments to find safe dose in-vitro and efficacious dose in-vivo. The results demonstrated that ULLB-0005 is cytotoxic for PA-1 cells. Based on xenograft study, reduction in tumor volume and inhibition of tumor growth was observed Conclusions Based on in vitro and in vivo data, ULLB-0005 which is a novel protein is a potential anticancer drug for treatment of ovarian cancer.

Para ID="Par10235">Cancer-related sexual dysfunction affects over 60% of survivors. Internet interventions have improved sexual function and satisfaction. This pragmatic online trial aimed to evaluate online selfhelp interventions without clinician contact. Methods Participants were cancer survivors or partners, 18 or older, recruited and consented online. The PROMIS Brief Sexual Profile (version 2) was the primary outcome. Three months of website access followed baseline completion. Questionnaires at baseline and 3 months also assessed demographic and medical variables, mental and physical health, anxiety, depression, and the use of sexual aids.

Baseline questionnaires were completed by 285 participants; 76% female, mean age 54, 78% married, 74% with a college degree or more, and 90% Caucasian. Cancer diagnoses included 53% breast, 12% gynecological, and 13% prostate. Attrition was high with 39% completing 3-month questionnaires. Participants in relationships were more likely to complete the 3-month assessment (42% vs. 21% of singles, P=0.02). Participants who spent more time on the website were more likely to complete the 3month assessment (mean 108.5 versus 45.0 minutes, P=0.00001). Analyses were only conducted for female patients due to power limitations. A baseline observation carried forward analysis suggested significant improvement on Brief Sexual Profile scores across time among female patients (P=0.0003, Effect size 0.312). Significant gains in being sexually active (P=0.0001, Effect Size 0.522), and increased use of sexual aids (P=0.009, Effect size 0.343) also occurred.

Despite high attrition, women survivors who persisted with the intervention had significant benefit. Revisions are being implemented to the websites to improve patient engagement. 

Cutaneous lesionsbenign and malignantoccur frequently in organ transplant recipients receiving long-term immunosuppressive therapy. These patients are at greater risk of skin cancers as well Methods Twenty five patients (12 men and 13 women) were consecutively examined for benign and malignant skin complications since transplantation Results About 95% cosmetic side effects seen in early stage. Infectious diseases like folliculitis seen in 80%, fungal infection in 12% and viral warts in 40% seen mostly. We found six cases of malignancy in these patients in that four cases were skin cancers, including one case of SCC, one BCC, and two cases melanoma Dermatologic problems occur most frequently in transplant patients especially skin cancers which have higher frequency in these patients than general population. Sun exposure has an important role in developing epithelial skin cancers following transplantation. The age of developing skin cancer in these patients was early than normal population.

Skin examinations and monitoring transplant recipient to obtain an early diagnosis and treatment of cutaneous manifestation. Patient should be aware about the skin changes and examination regularly. Avoiding direct sun light and application of broad spectrum sunscreen. Supportive care and education is important in the era of transplant surgery. 

Cancer therapy-associated paronychia is a frequent adverse event related to cytotoxic and targeted therapies. There are no evidence-based management strategies nor approved agents currently available.

This was an 8 week prospective, multi-center, randomized, double-blind, vehicle-controlled phase 2 study designed to evaluate the efficacy and safety of twice daily 1% or 2% povidone-iodine topical solution versus vehicle-control in adult cancer patients with cancer therapy-associated paronychia. Patients were randomized to one of three treatment arms: twice daily application of 1% PVP-I topical solution, 2% PVP-I topical solution, or vehicle-control solution. The primary endpoint was defined as a two-grade reduction or reduction to zero on a six-point Paronychia Severity Grading scale. Secondary endpoints included the effect on quality of life questionnaire and safety.

In the 2% povidone-iodine topical solution group, 88/167 (52.7%) affected nails achieved the primary endpoint (P = 0.0063), whereas in 1% povidoneiodine topical solution and vehicle-control group, 83/205 (40.5%, P = 0.6059) and 64/169 (37.9%) of nails, respectively achieved the primary endpoint (Figures 1 and 2 ). In the 2% povidone-iodine solution group, 19/29 (65.5%) of subjects reported moderately or very painful nails at baseline, 15/29 (51.7%) at visit 2 and 5/29 (17.2%) at visit 3 via the quality of life questionnaires (Figures 3) . Related adverse events were limited to mild irritation/dryness in 6/85 (7.6%) of all subjects.

Topical 2% povidone-iodine resulted in statistically significant improvement in cancer therapy-associated nails with paronychia. Treatment with twice-daily 2% povidone-iodine topical solution is a safe and effective option for cancer therapy-associated paronychia.

The clinical evidence regarding the efficacy of photobiomodulation therapy (PBMT) in the prevention and management of acute radiodermatitis (ARD) is growing steadily in the field of oncology. However, many clinicians are concerned whether the application of PBMT in cancer patients is safe. This study aimed to assess PBMT's safety by evaluating the disease-free survival (DFS) and overall survival (OS) of breast cancer (BC) patients treated with PBMT for ARD.

A retrospective data analysis of 120 BC patients treated with prophylactic PBMT (n=60; 2x/week, 808-905nm, 4J/cm 2 , 0.168W/cm 2 ) or placebo (n=60) during their radiotherapy (RT) course (25x2Gy, 8x2Gy) between April 2015 and June 2017, was performed (TRANSDERMIS trial). During follow-up, patients underwent a clinical evaluation every 6 months, and a blood analysis and mammography yearly in the first 5 years after the end of RT. DFS and OS were estimated.

Data from 93 patients was available (PBMT n=46; placebo: n=47). After a median follow-up of 26 months (range: 1-41), a preliminary analysis of the data by the logrank test demonstrated that the DFS was not significantly different between the PBMT and placebo group (98% vs. 100%, resp., p=0.323) and the OS was equal in both groups (100%).

This is the first retrospective study that investigated the safety of PBMT in BC patients undergoing RT. These preliminary results indicate that the use of PBMT is statistically unrelated to locoregional recurrence, development of secondary tumors, or OS. Although, a follow-up of 5 years is needed to validate these results in a broader patient population. 

There is no gold-standard approach in the management of radiation induced dermatitis (RID). The aim of this clinical investigation is to evaluate the efficacy of Xonrid ® , Class IIa Medical Device, in the prevention and treatment of RID in breast (BC) and head and neck cancer (HNC) patients, when compared to the Standard of Care (SOC) as defined by MASCC guidelines.

From June 2017 to July 2018, 40 HNC and 40 BC patients, curatively treated with standard radiotherapy dose, were randomized to receive Xonrid®+SOC (Group A) or SOC (Group B) from the beginning up to two weeks after radiotherapy completion. Group B subjects experiencing Grade (G) 2 RID received an additional standard treatment (according to the Investigator's opinion). Both arms patients who reached G3 RID discontinued the study. Erythema was graded according CTCAE v.4. The primary objective was to evaluate the proportion of patients without G2 RID at week 5 of radiotherapy. Among secondary endpoints, the median time to G2 RID development was considered.

In the BC group, the proportion of subjects without G2 RID at week 5 was higher in the Xonrid®+SOC group than in the SOC one (55.6% vs. 27.8%, respectively, p=0.09). For HNC patients, no difference was detected between the two groups (p= 0.81). Only for BC patients, Xonrid®+SOC treatment prolonged the medial time to G2 with respect to SOC (p<0.05).

These preliminary results show that Xonrid® could be effective in prevention and treatment of RID for BC patients, while further analyses are needed for HNC patients.

Dysregulation of N-glycosylation in Dolichyl Phosphate Cycle (DPC) may increase susceptibility to skin adverse reactions. Polyprenol (Pp) is a substitute of DPC and the rate limiting factor in N-glycosylation and could prevent cell-mediated cytotoxicity against skin fibroblasts. In our earlier work (2015) we have demonstrated approach of Palmar Plantar Erythrodysesthesia (PPE) prevention with the use of the Atorvastatin and Pp. The purpose of this study was to evaluate the efficacy of Polyprenol (Pp) alone in PPE prevention.

The NCI-CTCAE version 3.0 was used to measure the severity of skin toxicity and to evaluate the effect of PPE prevention with and Pp (40 mg/day, per os) in a randomized, double-blind, placebocontrolled study in 104 breast cancer patients during capecitabine 500 mg monotherapy. Leukotriene E4 and dolichol (Dol) were assayed in urinal excretion, IgE levels in serum, dolicholphosphate transferase (GPT) in fibroblasts.

PPE was observed in 37% of patients in control group and in 6 % of patients with PPE prevention during capecitabine therapy. Groups who started prevention course one or two weeks before capecitabine, developed symptoms of PPE in 8% and 1% of patients. Patients with PPE were found to have a statistically significant increase in leukotriene E4 (4-fold) and Dol (5,9-fold) excretion, IgE level and GPT activity in fibroblasts. Significant difference of PPE symptoms severity between Polyprenol (40mg) and placebo groups (P <0.01) was recognized.

The present study suggests metabolic substitute therapy with Polyprenol as a prevention of PPE and potential treatment for many other chemotherapy induced skin toxicities. Odette Cancer Centre-Sunnybrook Health Sciences Centre, Radiation Oncology, Toronto, Canada

Despite clear benefits of radiotherapy in breast cancer management, it has many acute and late side effects, one of the most common being radiation dermatitis. There is no clear or consistent evidence suggesting superiority of any product for its prevention or treatment. Therefore, we aim to systematically review the literature for guidelines on radiation dermatitis management in and present a summary of the current recommendations. Methods A literature search was conducted on Medline and Embase databases using keywords such as "radiotherapy", "breast cancer", and "guideline". The search generated a total of 648 results that were screened by two authors (SA, BW) by title, abstract, then full text using defined criteria.

Four studies were included. Multiple guidelines suggested that patients should wash the skin gently with or without mild soap or shampoo. There are inconsistencies across guidelines regarding prophylaxis of skin reactions using topical agents such as steroids or silver sulfadiazine cream. Multiple guidelines agreed that there is insufficient evidence on care for acute skin reactions, including use of dressings, topical agents, and systemic agents. Regarding reducing recovery time, there is also insufficient evidence on use of dressings, sucralfate or hydrocortisone cream, honey or trolamine.

There is some accordance among guidelines regarding management of radiation-induced skin reactions. Studies agreed that the majority of prophylactic or treatment methods had inconclusive evidence. More studies are needed to enable a consistent approach to skin assessment and care, which will translate to improved outcomes in radiation dermatitis.

Cutaneous metastases represent skin involvement from internal malignancies or in-transit metastases from high-risk skin cancers. Knowledge of the microbial flora of skin lesions in patients with cutaneous metastases is critical towards mitigating associated symptoms of discharge, malodor, and pain, all of which may negatively impact quality of life and cutaneous health. We characterized the microbial flora and antimicrobial management of cutaneous metastases.

We conducted a retrospective chart review of patients referred to the Dermatology Service at Memorial Sloan Kettering Cancer Center between August 2006 and June 2015.

We identified 64 patients with cutaneous metastases. Culture swabs yielded 17 distinct bacterial and fungal species. We detected pathogenic and/or opportunistic bacteria in 50% of skin lesions. The most commonly isolated organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Patients treated with oral antibiotics, alone or in combination with topical agents, had a statistically significant better improvement in infectious symptoms than those treated without oral antibiotics.

The normal skin microbial flora is disrupted in patients with infected skin metastases. Oral antibiotics may provide benefit when used as first-line therapy of infected skin lesions in patients with symptomatic cutaneous metastases. 

Effective treatment of the hand-foot skin reaction (HFSR) is an essential component of the comprehensive treatment of patients receiving antitumor therapy with multikinase angiogenesis inhibitors.

Methods 29 patients were under study, they received antitumor treatment with multikinase angiogenesis inhibitors (sorafenib, lenvatinib) and displayed clinical signs of II-III degree HFSR.

The 15 patients of the experimental group (EG) received a combination of alpha-lipoic acid, 600 mg per day, and an ointment containing 0.005% calcipotriol and 0.05% betamethasone dipropionate twice a day. The 14 patients of the control group (CG) received treatment with a combination of dermatic medicationsa cream containing 10% urea and an ointment containing 0.05% betamethasone dipropionate. After a week, the regression of skin symptoms was more prominent within EG including erythema, paresthesia, pain, and burning sensation; the Dermatology Life Quality Index (DLQI) has shown greater improvement compared to CG with the statistical significance of p<0.05. After 2 weeks the DLQI was 17,4 within EG and 22,8 within CG (р<0.0001). After 3 weeks EG has demonstrated greater improvement in erythema, skin desquamation, paresthesia (р<0.0008), pain (p<0.0001), and DLQI (р<0.0001). At the end point of the study (after 4 weeks) the improvements in symptoms and DLQI were greater in EG compared to CG with the statistical significance of p<0.0001, correlation presented in table 1.

Patients receiving targeted therapy with multikinase inhibitors are recommended to receive treatment for HSFR with a combination of alpha-lipoic acid per os and topical therapy with an ointment containing calcipotriol and betamethasone dipropionate. 

Inhibitors of the epidermal growth factor receptor (EGFR) cause severe signs of acneinform rash, which may serve as a reason for changing the methods of cancer therapy, making the effective correction of this side effect especially important.

Methods 35 patients with I-II grades of acneiform rash were split into 3 groups. All patients received systemic antibiotic therapy, 100 mg of doxycycline twice a day for 10 days, and different topical medications: tacrolimus, metronidazole, and betamethasone valerate combined with fusidic acid. Assessment was performed using Acne Dermatology Index (ADI) and Dermatology Life Quality Index (DLQI).

After the first week of systemic doxycycline therapy all groups have demonstrated significant regression in rash. Afterwards the first group, receiving treatment with tacrolimus cream, has demonstrated the weakest treatment response (patients were transferred to the 3rd group's treatment schedule after 1 month of therapy). Second group, receiving metronidazole gel, has demonstrated a greater treatment response. The first group, where patients received a combined cream containing betamethasone valerate and fusidic acid, has demonstrated the fastest regression in terms of both ADI and DLQI ( fig. 1,2) .

Skin toxicity is a common side effect of radiation therapy (RT). However, no definitive guidelines are available for management of radiation dermatitis (RD). The aim of this review was to summarize approaches and findings of studies testing various methods for management of RD in breast cancer patients.

Medline, Cochrane, and Embase databases were searched up to August 2017. Randomized trials comparing ≥ 2 treatments for RD in breast cancer patients receiving external beam RT were eligible. Review articles, retrospective studies, case reports, case series, and nonrandomized trials were excluded.

The search returned 3534 results, of which 96 were included in the final analysis. These evaluated the effect of different radiotherapy techniques, topical treatments, supplements, skin care regimens, and treatments on RD. Few topical agents and oral supplements demonstrated effectiveness across multiple randomized trials; however, various RT techniques including intensity-modulated radiotherapy, hypofractionated RT, accelerated partial breast irradiation, simultaneous integrated boost, and prone positioning consistently demonstrated decreased rates of radiation dermatitis, despite the limited number of studies in which they were evaluated.

Progress in the development of new topical treatments and supplements for the prevention and treatment of RD has been slow. However, modes of RT delivery such as IMRTand hypofractionation are now widely used and have been shown to decrease skin toxicity. Other methods such as SIB, APBI, and prone positioning have also shown promise. Continued research into improved modes of RT delivery is likely the best method to prevent RD in breast cancer patients. 

Immune checkpoint inhibitors are associated with a variety of dermatologic immune-related adverse events (irAEs). These irAEs diminish patients' quality of life and in some cases lead to discontinuation of cancer therapy. In this report, we describe the prolonged hospital stay (50+ days at the time of submission of this abstract) of a patient with grade 4 Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)-like rash associated with Nivolumab use.

We present a case report of a patient with metastatic melanoma who developed SJS/TEN-like eruption after his first Nivolumab infusion.

A 59-year-old male with metastatic melanoma developed grade 4 SJS/ TEN-like eruption 16 days after his initial dose of Nivolumab as first-line therapy. He was treated with intravenous immunoglobulin (IVIG) and supportive Burn ICU-level wound care. His presenting cutaneous condition improved. His hospital stay was complicated by several episodes of bacteremia and fungemia, encephalopathy, acute hypoxic respiratory failure, and renal failure. After the resolution of SJS/TEN-like eruption, he developed severe edema bullae which improved after volume status optimization. He then experienced multifactorial delayed cutaneous wound healing in the context of increased skin fragility given sequential cutaneous insults.

Prompt identification and management of severe cutaneous irAEs and multiorgan failure is essential to improve cancer patient outcomes. We strongly encourage multidisciplinary collaboration between dermatologists, oncologists, and other medical specialists.

Capecitabine induced hand-foot syndrome (HFS) has a detrimental effect of patient's quality of life while on chemotherapy. The effect of a structured teaching module (STM) for reducing the incidence and severity of HFS in patients on chemotherapy was evaluated.

Patients with colorectal cancer receiving capecitabine or capecitabineoxaliplatin were enrolled into the study. This non-crossover phase III double-blinded clinical trial randomized patients in a 1:1 ratio to receipt of a STM on HFS administered by a trained oncology nurse at regular intervals(case) versus standard information on HFS care administered by treating clinician (control). The primary endpoint was comparison of fraction of patients in both arms developing at least grade 2 HFS.

Between 15 

The use of an oncology trained nurse was feasible in administering a structured teaching module, but did not reduce the incidence and severity of capecitabine induced HFS. Further therapeutic interventions are required to alleviate HFS in patients receiving capecitabine.

Introduction Papulopustular rash occurs in 80% of patients receiving Epidermal Growth Factor Inhibitors (EGFRI) for cancer treatment. The rash often results in decreased quality of life and discontinuation of EFGRI therapy. Effective rash management is imminent to optimize therapeutic outcomes. Topical Vitamin K1, a phosphatase inhibitor, could reduce rash severity in the skin without systemic interference of EGFR inhibition in the tumor. This study evaluated the safety of a topical 0.1% Vitamin K1 product for potential use in patients with EGFRI-induced rash.

Topical application of 0.1% Vitamin K1 product resulted in Vitamin K1 blood concentrations ranging from 0 to 8.22ng/ml in 10 healthy subjects. To determine if Vitamin K1 reversed cetuximab-induced EGFR inhibition, A549 lung cancer cells were treated in vitro cetuximab (55μg and 160μg) followed by Vitamin K1 (2.5 to 100ng/ml) and EGF (200ng) 

These data suggest that Vitamin K1 levels systemically absorbed by topical application would not reverse cetuximab-inhibition of EGFR. Our topical 0.1% topical Vitamin K1 product appears safe to use in patients receiving EGFRI-therapy.

Up to 90% of cancer patients receiving epidermal growth factor receptor inhibitors (EGFRi) develop a cutaneous papulopustular eruption. PPE is initially sterile, however secondary bacterial infection occurs frequently. Topical clindamycin and oral tetracyclines are gold standard for prevention and management of EGFRi-induced PPE, however monotherapy antibiotic use may contribute to antibiotic resistance and to refractory cases of PPE that do not respond to antibiotics.

We conducted an IRB-approved, retrospective chart medical record review of the Stanford Cancer Institute Research Database. Patients included in the cohort were diagnosed with at least grade 1 EGFRi-related PPE and had a subsequent skin culture that yielded bacterial organisms. We collected dates of EGFRi inhibitor therapy, time and duration of antibiotic exposure to topical clindamycin and/or oral tetracyclines, and bacterial wound culture results, including antibiotic susceptibility testing.

In our retrospective chart review of 122 patients, there was increased risk of antimicrobial resistance in patients with history of monotherapy antibiotics use with either topical clindamycin (HR 1. 94, 95% CI 0. 83-4. 50, p<0. 12), or oral tetracycline-class antibiotics (HR 3. 15, 95% CI 1. 45-6. 85, p<0. 004). The incidence of resistant bacterial infection was greater in those treated with antibiotic monotherapy for >4 weeks.

Chemotherapy-induced alopecia (CIA) is one of the most dramatic side effect in course of chemotherapy, and actually no guidelines are available for its prevention and treatment. Several devices and drugs are reported to be utilized, but results are often deluding. In this work we will focalize on CIA induced by classic anticancer drugs, with the aim to analyze the devices that have been proposed in literature and give our opinion about.

We analyzed the literature searching for therapeutic devices and drugs utilized for the treatment of CIA and we analyzed their mechanisms of action trying to correlate CIA pathogenesis with a correct therapeutic rationale.

Scalp cooling is the only agent that has been approved by American FDA for CIA prevention. In our opinion minoxidil and bimatoprost should not be used during chemotherapy administration, but they can be employed after chemotherapy discontinuation in order to obtain a greater regrowth.

The aspect we want to emphasize, is that therapy should always be modulated on the patient and no fixed protocol should be used. Trichoscopy and trichogram could be a useful tool for this scope. 

In patients receiving concomitant chemo radiotherapy as a treatment for OSCC, cytological changes were seen not only in neoplastic epithelial cells but the non-neoplastic epithelial cells are also affected resulting in cytopathological atypical changes. Thus, the present study was designed to observe oral epithelial atypical changes induced in contralateral normal buccal mucosa in OSCC patients receiving CCRT.

The study included 76 patients of OSCC treated by Concomitant Chemoradiotherapy (CCRT) were collected from Institute of Nuclear Medicine and Oncology Lahore (INMOL) Hospital Lahore. Cytological smears were obtained from contra-lateral normal buccal mucosa of oral squamous cell carcinoma patients. Serial scrape smears were taken from contralateral normal buccal mucosa on specific days of therapy i.e. before, immediate (after first exposure), at 17th day (mid of therapy) and at the end of therapy with the wooden spatula, whereas, 20 patients were taken as normal health control and they were not exposed to CCRT. The smears were stained with Hematoxylin and eosin and Papanicolaou stain. Pearson's Chi-square test was used for statistical significance.

CCRT induced epithelial atypia was more evident at the 17th day of treatment whereas oral epithelial atypical changes were predominantly noted at the end of therapy. Significant association was observed between days of CCRT, epithelial atypia, oral epithelial atypical changes and epithelial cells (degenerated, anucleated squames and apoptotic cell) were noted. Atypia was not observed in any control group Conclusions On contralateral normal buccal mucosa ionizing radiation therapy induced atypical/ reactive changes which may lead to secondary malignancy in radiation field

Finding overall toxicity incidence for a typical teaching hospital population proved difficult. A telephone assessment 24 hours following the administration of a first cycle of chemotherapy in a teaching hospital was undertaken for all oncology patients, with the aim of reducing admission due to toxicity through advice and intervention.

Data was obtained after 1 year. Toxicity incidence and severity, admission rates and length of stay (LoS) were established. Regression modelling identified predictors of these outcomes. The commonest toxicities were explored as secondary outcomes.

Results 1539 patients were studied and the overall incidence of toxicity was 35.6%. Disease site and number of chemotherapy agents given predicted toxicity, with breast and upper gastrointestinal cancers having a higher likelihood of toxicity. The more anticancer agents used, the higher the risk of toxicity. Disease was predictive of toxicity grade, with urology, gynaecology and lung patients experiencing higher grades of toxicity than other tumour sites. The rate of admission was 13.1% and mean LoS 4.4 days. Disease and number of drugs in the regimen affected the risk of admission, with gynaecology, head and neck and lung patients and patients who received 3 drugs having a higher likelihood of admission. Predictors in the sub-groups of breast, lower gastrointestinal and lung cancers matched the whole population and the number of drugs was shown to be a predictor of nausea, vomiting and fatigue when explored as secondary outcomes.

The burden of acute chemotherapy toxicity of a heterogeneous population was elucidated.

A. Aziz 1 , Z. Shaheen 1 1 The Aga Khan University Hospital, Oncology, Karachi, Pakistan

The aim of our study is to assess how the quality of life of patients with Breast cancer is affected by the side effects of chemotherapeutic drugs Doxorubicin, Cyclophphamide and Taxane.

Questionnaire form was developed which includes questions on side effects of chemotherapy, that ask presence and severity of psychological, spiritual and social well being and extent of fear in patients receiving chemotherapy. The questionnaire forms are filled by patients after taking their written consent and explaining the study to them. The patients' data is collected from Oncology daycare at The Aga Khan University Hospital.

The most common problems for patients receiving chemotherapy for Breast cancers are fatigue, changes in appetite and generalized pain affecting more than 90 percent patients. More than eighty percent patients have fear of recurrence or spreading of their disease and financial burden. Around sixty to seventy percent patients have issues with their psychological wellbeing like lack of happiness and satisfaction in life, difficulty to concentrate and feeling usefulness of life. Ninety percent people feel stress in their family but on the other hand receive same amount of support too. Almost ninety percent people are markedly motivated towards religious activities.

This study can be concluded as that severely affecting problems to most of the patients are fatigue, pains, changes in appetite, sleep and financial burden. Religion and spiritual activities becomes the primary point of interest, overall most of the people feel happy, hopeful and find their selves still useful. 

The Chimeric-antigen receptor T-cell adoptive immunotherapy (CAR-T) has shown outstanding efficacy in the treatment of B-cell malignancies. Cytokine release syndrome (CRS), one of the most severe

Cisplatin (CDDP) is a choice of cancer chemotherapy for cervical cancer with common side effects from CDDP. Factors that cause side effects are many factors together to reach the patient's age. Some researchers report that age is an important factor influencing the side effects of CDDP.

Prospective descriptive research in 70 new cervical cancer patients of Ramathibodi hospital. During the period from 1 August 2017 to 30 June 2018. Data were collected by two sets of research tools were used.

A large number of patents for antineoplastic drugs are expiring. Faced with a market fueled by soaring prices for innovative medicines and pressure from pharmaceutical companies for accelerated approval of medicines, issues involving the safety of generic drugs and the importance of pharmacovigilance is paramount.

Program implementation to monitoring adverse reactions after changes in cytotoxic suppliers. Formulary to registration of adverse events and introduction of data on the National RAM Platform.

Between 2016 and 2018, 47 adverse reactions to cytotoxic drugs were reported. In 10 patients, the reaction occurred after changing the drug supplier and the analysis of the RAM National Platform, attributed possible relation with the use of the drug. The acquisition to the supplier was suspended and treatment initiated with the original drug.

We assume that the nature of the disease and its symptomatology, coupled with the conviction that the side effects of chemotherapy are expected and normal, lead to underreporting. It is necessary the intervention of the medical and nursing team to sensitize patients to report. The position of

Glucuronidation represents a major route of drug detoxification in human. However, deconjugation of glucuronides by bacteria beta-glucuronidase in the intestinal microflora can induce severe toxicity during cancer chemotherapy. The currently used anticancer drugs such as irinotecan (CPT-11), 5-FU, and oxaliplatin have been found to induce a serious side effect of chemotherapy-induced diarrhea (CID). CID is a common problem, especially in patients with advanced cancers. Therefore, discovery of selective bacteria beta-glucuronidase inhibitors is in an urgent need. 

Selection of specific patient-reported outcomes(PROs) for cancer patients requires careful thought to the purpose and population at aim. Here we report the process of choosing which Patient-Reported Outcomes Version of the Common Terminology Criteria of Adverse Events(PRO-CTCAE) symptoms for a bladder cancer population in chemo-or immunotherapy. Methods PRO-CTCAE symptoms were chosen through 1) journal audit 2) interviews and 3)summary of product characteristics from European Medicines Agency and Food and Drug Administration for the applied chemo-and immunotherapies. The selected questions were applied in a prospective cohort of 78 bladder cancer patients receiving chemo-or immunotherapy at Rigshospitalet and Herlev Hospital, Denmark. Symptoms were included in the final module if included in ≥3 of the following groupings a) the most frequent PRO-CTCAE symptoms overall during treatment b) the PRO-CTCAE symptoms reported in conjunction with hospital admissions or mentioned in focus group interviews discussing which symptoms were prevalent in this patient group with specialized c) nurses or d) physicians. Symptoms were also included if they were present in two of the above groups and defined as actionable by clinicians.

From the initial selection of PRO-CTCAE symptoms a total of 45 PRO-CTCAE symptoms explored by 84 PRO-CTCAE questions were retrieved. Through the second selection process, the study group agreed on 15 PRO-CTCAE symptoms explored by 30 PRO-CTCAE items to be appropriate and relevant for the bladder population during medical oncological treatment.

The selection of disease specific PROs was feasible. The process revealed many necessary steps towards a final module for clinical application.

Checkpoint inhibitor immunotherapeutics (ICIs) are increasingly used to treat cancer, but comparatively little is known about patient-reported outcomes (PROs) and health-related quality of life (HRQoL) for this population. We performed a systematic review to examine PROs and HRQoL among cancer patients receiving ICIs.

We searched PubMed, CINAHL, Embase, Web of Science, and Scopus for articles on August 7, 2018 and extracted relevant references. Eligible articles were required to involve cancer patients treated with ICIs and to report PRO and/or HRQoL data.

We screened 1,453 abstracts and 88 full texts, including 15 articles representing 15 randomized controlled trials in our analysis. Studies included a variety of cancer types (melanoma, lung, genitourinary, and head/neck cancers), utilized four different ICIs (nivolumab, pembrolizumab, atezolizumab, and ipilimumab), and compared ICIs to a wide range of other therapies (chemotherapy, targeted therapies, other immunotherapies, or placebo). In general, patients receiving ICIs had similar-to-improved overall HRQoL to patients in the comparison arms. In contrast, high rates of clinician-reported adverse events requiring treatment interruption/discontinuation of ICIs were noted in some trials, suggesting a possible discordance between patient-reported and clinicianreported experience with ICI treatment.

Despite the high profile and broad clinical trials experience of ICI therapies across cancer types, relatively few randomized studies reported patient PROs and HRQoL data. Available data suggest that the therapies are well-tolerated in terms of HRQoL compared to other anticancer therapies although the conclusions are limited by the heterogeneity of studies and instruments. Currently used instruments may fail to capture important symptomatology unique to ICIs.

Neratinib is a pan-ErbB tyrosine kinase inhibitor, used for treatment of HER2+ breast cancer, with diarrhea frequently observed. Our previously developed rat model for neratinib-induced diarrhea indicated diarrhea pathogenesis includes anatomical disruption and intestinal inflammation. We showed the corticosteroid, budesonide, reduces diarrhea. This study aimed to evaluate whether another corticosteroid, dexamethasone, could also effectively reduce neratinib-induced diarrhea in rats.

Male Albino-Wistar rats (n=64) were orally gavaged daily for 14 or 28 days with 50 mg/kg neratinib or vehicle control (5% DMSO/1% carboxymethylcellulose). One group was additionally gavaged with 1 mg/kg budesonide daily, and another group every second day with 0.1 mg/kg dexamethasone. Diarrhea was graded 4x daily and blood neratinib concentration was assessed via mass spectrometry. ErbB1 expression was measured by Western blot.

In contrast to budesonide, neratinib-induced diarrhea was not significantly reduced by dexamethasone. Rats receiving dexamethasone had significantly less weight gain than other groups. Dexamethasone increased serum neratinib concentration from day 14 compared to neratinib alone

Immune-related adverse effects (irAEs) of check-point inhibitors are specific and a result of overstimulation of the immune system. Myocarditis is a rare irAE of immunotherapy, with 8% fatality rate (Wang et al.). Awareness of irAEs among patients undergoing immunotherapy is a topic of great importance.

We present a case of fatal irAE myocarditis in a lung cancer patient treated with pembrolizumab Results A 40-year old female patient with no cardiac comorbidities presented on day 10 cycle 5 of pembrolizumab to a local emergency department with severe epigastric pain, nausea and dyspnea (CTC gr.3). Thoracocentesis was performed due to pleural effusion, with a marginal improvement of symptoms. No ECG was done at that time. She presented to our team a full four days later with worsening dyspnea and epigastric pain, CTC gr.3, elevated cardiac and liver enzymes, CTC gr.4. and hypotension. ECG finding (figure 1) indicated urgent transfer to a cardiac unit.

Echocardiogram showed acute heart failure, ejection fraction less than 30% and global hypokinesis. By exclusion of pulmonary embolism, myocardial infarction and pericardial effusion, a probable diagnosis of immune-related myocarditis was made. Treatment with methylprednisolone 1mg/kg and intensive cardiac support was initiated. Her condition was rapidly worsening and she died six days after onset of symptoms. Autopsy was not performed Conclusions Education of all parties involved in the care of oncological patients is imperative for the timely recognition of irAEs and the start of appropriate therapy. Early recognition of irAEs and commencement of therapy is crucial to achieving a favorable outcome. 

Cardiotoxicity is a known concern of anthracycline-containing chemotherapy (AC-CT), limiting treatment options and contributing to morbidity/mortality among breast cancer survivors. Physical exercise (PE) has been suggested as a non-pharmacological approach able to mitigate this issue, but its real value is yet to be proven.

This is a study protocol for a two-arm prospective randomized controlled trial that will analyse the cardioprotective effect of a PE program in the prevention of anthracycline-related cardiotoxicity. This study received ethics approval and is registered on International Standard Randomised Controlled Trial Number: ISRCTN32617901. Ninety women with early breast cancer and therapeutic decision to receive AC-CT, will be randomly assigned (1:1) to an intervention group or a control group. Patients in the intervention group will perform a 3-weekly PE program combining resistance and aerobic training with progressive intensity during AC-CT. The control group will receive usual cancer care. Resting left ventricular (LV) global longitudinal strain (GLS) and resting LV ejection fraction (LVEF) will be assessed at: 1-14 days prior the start of the AC-CT (M1); 1-5 days after the end of the AC-CT (M2) and 3 months after M2 (M3). To analyse N-terminal pro-B-type natriuretic peptide, blood samples will be collected at M1, M2, M3 and 24 hours before each anthracycline cycle. Cardiorespiratory fitness will also be assessed at M1, M2, M3, by a cardiopulmonary exercise test on a treadmill.

We expect this study, using novel clinical biomarkers, will add new knowledge and contribute to clarify the role of PE at counteracting anthracycline-related cardiotoxicity.

Lung complications and general toxicities of the respiratory system are relatively common following radiotherapy of thoracic tumors. In breast cancer (BC) patients, lung complications as a result of radiotherapy are grouped according to two major clinical syndromes: acute effects such as radiation pneumonitis (RP), or long-term effects. We aim to review existing literature on the assessment tools used to classify and diagnose RP.

We searched the Medline, Embase, and Cochrane Central databases for studies conducted in the English language, reporting on RP assessment. Keywords including "breast cancer", lung toxicity", "pneumonitis", and "radiation injury" were used.

A total of 97 articles were included in this review. Overall, 48.0% (n=47) of studies used the Common Terminology Criteria for Adverse Events (CTCAE), 17.3% (n=17) used pulmonary function testing, 15.5% (n=15) studies used Normal Tissue Complication Probability (NTCP), 13.4% (n=13) studies used the Radiation Therapy Oncology Group (RTOG) scale, 5.2% (n=5) studies used the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic (LENT-SOMA) scale, 3.1% (n=3) studies used thoracic CT scans, 2.1% (n=2) studies used a patient reported symptoms scale, and 1.0% (n=1) of studies used a Quality of Life scale. 6.2% (n=6) of studies used a combination of the above assessment tools to assess RP (Table 1) .

Radiation induced pneumonitis in BC patients remains a prevalent issue, with varying definitions and assessment tools used. A better understanding of lung toxicities as a result of BC treatments may help identify potential risk factors, prevention techniques, and assessment strategies for future diagnoses. 

Myxedema coma is a sever decompensated hypothyroidism that associated with high mortality. Cancer treatment of squamous cell carcinoma of head and neck tumor usually includes combination of radiotherapy and chemotherapy. The risk of hypothyroidism due to this therapy is reported in few number of studies. Methods 55 years old male patient's with a history of squamous cell carcinoma treated with cisplatin cetuximab combination few months ago. The patient admitted to the hospital due to shortness of breath, confusion, low body temperature and swelling of the body especially the face, tongue and lower legs. Final diagnosis of respiratory failure, myxedema coma and cardiogenic shock were documented, TSH 52 (mIU/L), HR: 63/ min, SPO 2 : 94 and BP: 60/40 mmHg. Noradrenaline infusion, 80 mg prednisone and 300 mg levothyroxine tablet ( through nasal tube) were given. The patient's TSH started to decrease after few days, so levothyroxine dose decreased to 100 mg and noradrenaline infusion stopped. Few days later the TSH level increased again and the dose of levothyroxine increased to 150 mg. By reviewing the medication chart the patient started pantoprazole in these few days which affected levothyroxine bioavailability.

Pantoprazole stopped and famotidine described to the patients to be taken 2 hours after levothyroxine. Twenty days later the TSH level retained to normal value 1.7 (mIU/L).

Combination therapy of cisplatin + Ceutiximab in head and neck cancer patients may associated with severe hypothyroidism. Early diagnosis and follow up of these patients may save their life and prevent the life threatening myxedema coma. 

We report that hypothalamic tumor necrosis factor-α (TNF-α) mRNA expression via histamine H4 receptors contributes to cisplatin-induced anorexia (Neurosci Lett. 676: 103-107, 2018) , but its precise mechanisms remain unclear. It has been reported that orexin is a neuropeptide that regulates appetite via the histaminergic system in the hypothalamus, and the administration of TNF-α impairs the orexinergic system. We investigated the involvement of orexinergic and histaminergic system in the therapeutic effect of an H4 receptor antagonist against cisplatin-induced anorexia.

Mice received cisplatin and JNJ7777120 (an H4 receptor antagonist) with or without pretreatment with JNJ10397049 (an orexin OX2 receptor antagonist), then their food intake was monitored. Additionally, we examined the effect of YNT-185 (an OX2 receptor agonist), ciproxifan (a histamine H3 receptor inverse agonist), or VUF5681 (an H3 receptor antagonist) on cisplatin-induced anorexia. Finally, we investigated the effect of JNJ7777120 on the cisplatin-induced hypothalamic expression of prepro-orexin (PPO) mRNA, which encodes precursors of orexin.

Although the pretreatment with JNJ7777120 completely abolished cisplatin-induced anorexia in mice, its therapeutic effect was antagonized by JNJ10397049. We observed that both YNT-185 and ciproxifan also inhibited the cisplatin-induced anorexia, but we found that the inhibitory effect of the YNT-185 was antagonized by VUF5681. Cisplatin decreased the hypothalamic expression of PPO mRNA and the period of expression decreased in parallel with the onset of anorexia: however, the pretreatment with JNJ7777120 inhibited the decrease in expression.

The activation of the orexinergic and histaminergic pathway is involved in the therapeutic effect of an H4 receptor antagonist against cisplatininduced anorexia.

eP698 ALL-TRANS RETINOIC ACID SYNDROME (ATRA): A CASE REPORT

Acute myeloid leukemia (AML) is a hematological malignancy associated with life-threatening coagulopathy. All trans retinoic acid (ATRA) therapy is one of the treatment approaches of AML M3. Acute respiratory failure may occur in patients receiving ATRA therapy, which require close monitoring for respiratory function in patients receiving this medication.

A 34 year old female admitted to intensive care unit with dsypnea. The patient have previous history of AML M3. After first ATRA treatment, she suffered from hypoxia, respiratory failure and transfered to the intensive care unit (ICU). Hemodialysis and plasmapheresis were applied alternately during the treatment for cytokine removal. Mechanical ventilation and drug therapy were started.

The patient's hemoglobin, Oxygen saturation and blood pressure returned to normal after mechanical ventilation support, antihypertensive therapy, nutritional support with Total Parenteral Nutrition, antibiotic therapy and erythrocyte suspension replacement therapy for low hemoglobin and hematocrit level.

It should be considered that ATRA can cause respiratory problem such as life-threating Acute Respiratory Distress Syndrome. Close monitoring and respiratory assessment must be done. Early intervention and discontinuation of ATRA may be life saving in this group of patients.

C. Smith 1 , A. Wahner Hendrickson 2 , M. Grudem 2 , C. Klampe 2 , E. Deering 2 , A. Jatoi 2

Paclitaxel is a commonly prescribed antineoplastic agent. Unfortunately, 70% of patients who receive this drug develop diffuse myalgias and arthralgias. Several attempted palliative approaches, including opioids, have not shown efficacy in treating these symptoms. However, based on anecdotal reports, loratadine appears to merit further study.

We screened medical records and then reviewed in depth postoperative ovarian and endometrial cancer patients who received concurrent paclitaxel and loratadine between January 1 st , 2001 and December 31 st 2017.

Eight hundred sixty-two patients were administered post-operative paclitaxel; 40 received concurrent loratadine and are the focus of this study. The median age of this group was 61 years (range: 40, 79). Twenty-seven (67%) had ovarian cancer, and the rest endometrial cancer. Eight experienced paclitaxel-induced myalgias and arthralgias and then took loratadine. Of these, 6 (75%; 95% confidence interval (CI): 35-97%) manifested symptom improvement. Medical record documentation after loratadine revealed "the joint pain was better" and "the pain was not as bad as previously". Thirty-two patients were already receiving loratadine with paclitaxel. Of these, only 11 (34%; 95% CI: 19-53%) developed myalgias and arthralgias (in contrast to the previously-reported rate of 70%). No major adverse events were attributed to loratadine. Paclitaxel was not discontinued because of myalgias and arthralgias.

Our results support further study of loratadine for paclitaxel-induced myalgias and arthralgias. 

Diarrhea is the most frequently observed adverse event of the oral, irreversible pan-HER tyrosine kinase inhibitor, neratinib. This study aimed to determine if neratinib changes gut microbial composition, and whether targeting these changes with probiotics useful in improving chemotherapy/ radiotherapyreduced diarrhea, may also improve diarrhea here.

Cecal contents from Wistar rats treated daily with 50mg/kg neratinib (n=6) or vehicle (n=6) were taken to analyze bacterial composition by 16S pyrosequencing. A second study of 48 rats treated with 50mg/kg neratinib, and receiving concomitant 4x10 8 cfu VSL#3 (probiotic cocktail) or vehicle for 28 days, was conducted to examine the efficacy of probiotics for prevention of neratinib-induced diarrhea and intestinal injury.

Compared to controls, rats receiving neratinib had a significantly lower Firmicutes:Bacteriodetes ratio (P=0.041) and levels of the genus Blautia (P=0.001). Neratinib treatment was also associated with higher levels of the genus Prevotella (P=0.026) ( Table 1) . Levels of these groups compared to control levels were not correlated with diarrhea severity. In the second study, rats treated with VSL#3 did not have significantly altered diarrhea or intestinal damage scores compared to neratinib alone (P>0.05) ( Table 2) .

Neratinib treatment caused changes to the cecal microbiome, increasing levels of Prevotella and decreasing Blautia. However, targeting these changes with a multi-species probiotic did not alter diarrhea levels. We are now exploring why the main genera in VSL#3 (Streptococcus, Bifidobacterium and Lactobacillus) were unable to alter the development of neratinib-induced diarrhea, when they have previously had positive results in models of chemotherapy and radiation-induced diarrhea. 

The severity of nausea and vomiting increases at the beginning of AC administration and the pain, fatigue, insomnia, distress, dyspnea, memory loss, anorexia, drowsiness, dry mouth, sadness, and numbness increase from the D administration.

Depending on the type of chemotherapeutic agent and the time of administration, there is a change in chemotherapy induced related symptoms. Expectations for completion of chemotherapy appear to reduce the severity of chemotherapy induced related symptoms. 

Although extravasation (EV) is an established complication of parental chemotherapy, it often goes under-documented and underestimated. The incidence and severity of extravasation can be influenced by patient, drug or procedure related factors. An understanding of the risk factors and predictors promotes precaution during chemotherapy. Methods A prospective study was conducted for one year in patients satisfying study criteria. Patient information such as demographics, history, disease, treatment regimen and EV related information was documented. Severity of EV was established using CTCAE 4.3. The captured data was subjected to appropriate statistical analysis using SPSS ver. 20.

Among the 217 patients reviewed 46(21.20%) experienced EV [Grade 2(67.39%) and Grade 3(32.61%)]. Cluster statistics revealed age, gender and ambulation to be the most important predictors. Ambulation caused an 8 fold increase in the risk of EV (p<0.001, [2.01-14.2] ). Females were observed to be 2.5 times susceptible to EV (p=0.001, [2.5-5.9 ])than males. Progressive age i.e. beyond 60 years the risk of EV increases 2.02 times (p=0.005, [1.3-3.8] [1.27-3.76 ] increased the risk of the patient getting severe EV injury.

Patient, drug and procedure related risk factors influence the incidence of chemotherapy induced EV injury. In the studied population, age, gender, ambulation and co-morbidities were established as predictors of extravasation. Multi-disciplinary approach and patient counselling can contribute to minimizing the discomfort and complication of EV.

Localized radiotherapy (RT) can cause immune dysfunction. Bojungikkitang is known to restore immune function. We investigated the absolute counts and percentages of peripheral blood (PB) lymphocyte subtypes in end stage cancer patients before and after RT and after oral administration of Bojungikki-tang water extract (BJITE) and to evaluate the changes mediated by RT and BJITE.

Absolute counts and percentages of lymphocyte and lymphocyte subsets were determined in whole blood using the TetraONE System (Beckman Coulter, USA). Flow cytometry results were compared before and after RT and after administration of BJITE.

Absolute numbers of CD3+, CD4+, and CD8+ T cells and CD19+ B cells decreased significantly after RT (). Absolute numbers of CD3-CD56+ cells did not change in both groups. No significant differences were observed in the absolute counts of lymphocyte subtypes before and after administration of BJITE or vitamin group. When BJITE group was compared with vitamin group, absolute numbers of CD19+ B cells increased. RT-induced decrease in T cells and B cells in PB suggests that immune deterioration occurs after RT. Administration of BJITE might be effective in the restoration of number of B cells.

In conclusion, RT-induced decrease in helper T cells, cytotoxic T cells, and B cells in PB suggests that immune deterioration occurs after RT. Administration of BJITE might be effective in the restoration of number of B cells.

Acral erythema is a commonly reported side effect during chemotherapy, pathogenically related to a toxic reaction. Still controversial the reason why the acral site is the most frequent affected area. It is most frequently linked with capecitabine treatment, but a large number of other chemotherapeutic agents have been reported. In its pathogenesis, a fundamental role is played by a conspicuous overexpression of Cyclooxygenase-2 (COX-2) due to the toxic damage of basal keratinocytes, followed by an increased production of prostaglandins and free radicals, with maintenance of the inflammatory process. Therefore, the use of a systemic COX inhibitor in the treatment of acral erythema is suggested in literature.

Considering that COX inhibitors are not free of side effects, the aim of our study is to evaluate the efficacy and safety of topical COX-inhibitor. Methods Ten oncological patients, affected by different cancers and receiving distinct chemotherapy protocols, were referred to our Department for the development of chemotherapy-induced acral erythema. We instructed the patients on applying diclofenac gel topically twice-daily for fifteen days, followed by a one-daily application for another fifteen days.

A reduction of erythema, edema, pain and burning sensation was observed in all patients. No cutaneous or systemic adverse events were detected.

Our results are encouraging and the therapy was well-accepted by patients due to its topical application. The use of topical COX inhibitor may be proposed, in order to reduce anti-inflammatory process and production of Cyclooxygenase from damaged keratinocytes. However, further investigation and more clinical experiences are requested. 

Social support is important in the cancer treatment process. However, there is no study of the effect of perceived social support(PSS) on chemotherapy related symptoms. Therefore, we examined the effect of PSS on chemotherapy related symptoms.

This study is a prospective, observational study that periodically assessed chemotherapy related symptoms from the time of diagnosis of breast cancer to 6 months after the end of neoadjuvant c h e m o t h e r a p y. I n 1 8 4 p a t i e n t s w i t h b r e a s t c a n c e r, Multidimensional Scale of perceived social support(MSPSS) was assessed before the first neoadjuvant chemotherapy, and M.D. Anderson Symptom Inventory(MDASI) was assessed 8 times before neoadjuvant chemotherapy. The MSPSS score was divided into the MSPSS low group and the moderate to high group. The MDASI scores were analyzed by linear mixed model to determine the difference between the two groups until the end of the chemotherapy.

In the ongoing chemotherapy, Severity of pain(p=0.002), nausea(p=0.011), insomnia(p<0.001), distress(p=0.001), dyspnea(p=0.005), memory loss(p=0.018), sadness(0.042), vomiting(p=0.014), numbness(p=0.010) were higher in the low level of MSPSS group(n=62) than in the moderate to high level of MSPSS group(n=122).

Low PSS patients with breast cancer suffered more distress due to chemotherapy related symptoms. Further studies are needed to determine whether PSS intervention can help improve chemotherapy-related symptoms. 

The addition of human epidermal growth factor receptor 2 (HER2) antibodies to anthracycline-taxane-based neoadjuvant chemotherapy (NACT) for the treatment of HER2 expressing breast cancer (BC) resulted in improved pathologic complete response (pCR) rates. However, cardiac toxicity and long-term outcome is rarely investigated. We report cardiac safety, pCR-rate and data on disease-free (DF) and overall survival (OS). Methods 83 patients with HER2 positive early BC were treated with liposomal doxorubicin (50 -60 mg/m 2 ), docetaxel (75 mg/m 2 ) and concurrent with

Immune checkpoint inhibition augments the immunologic reaction against tumor cells in several cancer types, with improved survival in various malignancies, but increased autoimmunity as side effects. These conditions are collectively called immune-related adverse events (irAEs).

We report on selected uncommon high-grade potentially life-threatening toxicities encountered in three patients with metastatic squamous cell carcinoma of the lungs who received the anti-PD-1 agent nivolumab.

Case #1: 76 years-old man who developed edema with elevated troponin T, NT-ProBNP, and an AV block one week after his third dose of nivolumab. His workup was consistent with myocarditis, treated with high doses of corticosteroids, plasmapheresis, infliximab (anti-TNF-alpha), and rituximab (anti-CD20) to further suppress both T and B cells. Case # 2: 66 years-old woman who developed progressive symmetric lower extremities weakness and hyporeflexia nine days after her second dose of nivolumab. She developed a Guillain-Barre like syndrome, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variant, and received five doses of IVIG with excellent results. Case # 3: 69 years-old man with progressive muscle weakness, dysphagia, ptosis and difficulties holding his head up one week after his third dose of nivolumab. He had myositis and myasthenia gravis, which were successfully treated with high doses of corticosteroids and five doses of IVIG.

Although rare, fulminant and fatal toxic effects may present with immune checkpoint inhibition. Knowledge about these conditions expedites the ability of the practitioner to properly manage them, therefore ensuring the best possible outcomes. Some high-grade irAEs with nivolumab are managed with corticosteroids and other immune modulating agents. 

Immune checkpoint inhibitors have radically changed the outcome for several cancers including lung cancer, melanoma, renal cell carcinoma, bladder cancer or head and neck carcinoma. We review factors affecting ipilimumab associated toxicity in various National Cancer Institute (NCI) sponsored phase I clinical trials. Methods NCI sponsored phase I clinical trials evaluating ipilimumab were retrospectively reviewed after an IRB approval. Results 373 patients from 11 phase 1 clinical trials were analysed. Grade 3 and 4 adverse events (AEs) were associated with better radiological responses. Mean grade 3 and 4 AEs in CR+PR cohort was 1.167 vs 0.645 in nonresponder cohort (p=0.001). No significant differences in low or high grade AEs were noticed in study cohorts differentiated based on ECOG PS (0 vs 1/2). Pretreatment lymphocyte count, LDH or albumin was not predictive of increased ipilimumab associated toxicity. Ipilimumab associated grade 3 and 4 toxicity was directly associated with the number of concurrently used study agents used. Mean grade 3 and 4 AEs were as follows in following cohorts: Ipi alone; 0.631 vs Ipi+ 1 drug; 0.877 vs Ipi+ 2 drugs; 1.408 (p=0.0035). Low grade (grade 1 and 2) toxicity was

Acute left ventricular (LV) dysfunction is a common manifestation of cardiotoxicity related to modern cancer treatment, including novel immunotherapies. As immune checkpoint inhibitor (ICI) therapy is increasingly used, different clinical forms of LV dysfunction are observed.

This case series was conducted at The University of Texas MD Anderson Cancer Center between January and December 2018. The institution's catheterization laboratory registry was searched for patients who underwent coronary angiography for suspicion of ICI cardiotoxicity.

We present 3 cases of ICI-induced cardiotoxicity with a common denominator, an acute drop in LV ejection fraction, but with 3 different etiologies. Patient 1 is an 81-year-old woman with a history of myelodysplastic syndrome treated with nivolumab and ipilimumab who presented with dyspnea. Electrocardiography revealed nonspecific T-wave abnormalities and ventriculography was suggestive of apical Takotsubo stress cardiomyopathy. Patient 2 is an 82-year-old man with acute myelogenous leukemia treated with azacitidine and nivolumab presenting for worsening anxiety. Coronary angiography revealed triple vessel disease, the culprit of his systolic dysfunction, precipitated by ICI treatment. Patient 3 is a 68year-old man on combination immunotherapy with durvalumab and tremelimumab for 1 month for metastatic pleomorphic gluteal sarcoma who presented for weakness and dyspnea. Myocardial strain measurement showed global hypokinesia and LV ejection fraction of 30%, suggestive of myocarditis.

Conclusions ICI-induced cardiotoxicity may have heterogeneous clinical presentations. Suspicion for ICI-induced cardiotoxicity prompts a complete cardiovascular evaluation, including transthoracic echocardiography and global longitudinal strain. Clinicians must be aware of the potential risk for immune-related adverse events, including the various forms of cardiotoxicity. 

Sarcopenia is a negative prognostic factor in cancer patients and is widely determined by computed tomography (CT) measurement of muscle attenuation at the L3 psoas level. Previously we established that higher percentage of muscle attenuation correlated with lower metastatic burden and improved survival in metastatic non-small cell lung cancer patients (mNSCLC.) Here, we aim to evaluate if larger proportion of low muscle attenuation can predict increased toxicity and impact chemotherapy response.

We identified 182 patients with mNSCLC receiving systemic therapy. CT scan before treatment was used to measure muscle attenuation at the L3 psoas level. Increased toxicity was defined as dose reduction or discontinuation of therapy, hospital admission or death in cycle 1/2/3 unrelated to progression. Response was evaluated by CT scans after 2-3 cycles of therapy or per clinician documentation. The primary outcome was percentage of muscle attenuation and its relation to response. The secondary outcome was impact of muscle attenuation on toxicity.

Of the 171 patients with scans, 135 patients had responding disease. Lower performance status (PS) at scan predicted for response (p=0.031). On a multivariate analysis, increasing percentage of muscle attenuation did not predict for response (OR=1.224, 95% CI 0.724-2.069, p=0.45). 66 patients (37.5%) had dose reduction in Cycle 1/2/3 or stopped chemotherapy because of toxicity. There was no association with muscle attenuation and toxicity (OR=0.800, 95% CI 0.547-1.208, p=0.30).

Variation in muscle composition demonstrated no reliable difference in outcomes; therefore, baseline muscle attenuation at L3 psoas level is not a predictor of chemotherapy toxicity and response.

Neratinib is an irreversible pan-HER tyrosine kinase inhibitor (TKI) used for the extended adjuvant therapy of early-stage HER2-positive breast cancer. Diarrhea is the most common adverse event associated with TKIs, including neratinib, and may impact duration of treatment if left unmanaged. CONTROL (NCT02400476) is an open-label phase II study investigating the effectiveness of various prophylactics in preventing diarrhea and improving tolerability of neratinib. Methods Patients (n=485; ≥18 years) with early-stage HER2+ breast cancer treated with oral neratinib (240 mg) after adjuvant therapy participated in the study. Primary endpoint is incidence of grade ≥3 diarrhea. Study cohorts: loperamide prophylaxis (n=137); loperamide + budesonide (n=64); loperamide + colestipol (n=136). Two additional strategies (colestipol + prn loperamide and dose-escalation) are being evaluated.

CONTROL data indicate that mandatory loperamide prophylaxis reduces the incidence and duration of grade ≥3 neratinib-associated diarrhea.

Adding budesonide or colestipol further reduces this incidence. The median cumulative duration of grade ≥3 diarrhea ranged from 2.5 to 3.5 days for the entire treatment period. No grade 4 diarrhea has occurred in CONTROL. Examples of real-world strategies in managing neratinibinduced diarrhea will also be presented.

The study confirms that proactive antidiarrheal prophylaxis provides an effective means of reducing the incidence, severity and duration of neratinib-associated diarrhea, thus improving tolerability. Patient education and close monitoring are critical for managing diarrhea. Benefits of effective prophylaxis are seen in patients receiving neratinib in daily practice. 

Peripheral Neuropathy (PN) is a common long-term effect of cancer treatment, but no study has reported results across a wide range of survivors. This study addresses that gap in the literature.

Included in analyses were 3,061 post-treatment adult cancer survivors who completed the 2010 LIVESTRONG survey including items related to current and past PN, sociodemographics, cancer diagnosis and treatment. Respondents were excluded if they had metastatic/recurrent cancer or more than one primary cancer. Bi-variate and multivariate analyses were conducted to identify factors associated with post-treatment PN.

Participants were 49.1 (sd=11.8) years old and 4.8 (sd=5.4) years post-diagnosis. More than half were female (62.9%), married/partnered (70.6%), White (87.3%), college educated (52.9%), employed full-time (60.5%) and had health insurance (82.9 %). The most prevalent cancer types were: breast (29.9%), testicular (9.2%), and prostate (7.5%). Over half of participants received chemotherapy (57.9%) alone or in combination with radiation and/or surgery. Post-treatment PN was reported by 33.7% of survivors (n=1031); prevalence was highest among colorectal (63.9%), lung (60.8%), and ovarian (57.5%) cancer survivors. In logistic regression the strongest independent (p<.05) predictors were: chemotherapy [z (1) 

Chemotherapy, certain cancer types, and PN prior to cancer were associated with higher risk for post-treatment PN. Time since diagnosis, full-time employment and higher income were associated with lower risk. Additional research is needed to determine whether these sociodemographic factors are predictors or consequences of post-treatment PN.

Previously, nasal vestibulitis symptoms were retrospectively reported by 71% of patients undergoing taxane chemotherapy. This study describes the incidence, characteristics, and severity of nasal vestibulitis symptoms among patients undergoing paclitaxel chemotherapy.

Eligible participants, without baseline nasal symptoms, enrolled in this natural history trial at the initiation of a new chemotherapy regimen. Participants completed nasal symptom logs each time they received a dose of therapy. This abstract reports upon the participants who received paclitaxel. A larger ongoing trial will describe and compare nasal symptoms among participants receiving each of the follow therapies: paclitaxel, docetaxel, nab-paclitaxel, bevacizumab, or other.

Twenty patients received paclitaxel chemotherapy. All patients were female with a mean age of 58.5 years, and an average time on study of 4.0 months. 18 (90%) experienced new nasal symptoms, including dryness (10, 56%), bleeding (13, 72%), pain (4, 22%), scabbing (8, 44%), runny nose (10, 55%), and congestion (6, 33%). Nasal symptoms started at a median of 20.5 days after initiation of paclitaxel therapy and symptoms lasted until the last dose in 94% (17) of participants. Five participants' providers recommend therapy for their nasal symptoms.

Patients receiving paclitaxel chemotherapy experience a high incidence of nasal vestibulitis symptoms.

Due to an increase in survival rates, many cancer survivors are now impacted by toxicities associated with treatment. Platinum-based chemotherapy, although highly effective, is known to cause ototoxicity, presenting as high frequency hearing loss, and tinnitus. Hearing loss and tinnitus are associated with a higher risk of depression, dementia, social isolation and anxiety. Methods A systematic review was carried out, aiming to collect information about ototoxicity and the impact on quality of life. Furthermore, online health forums were then reviewed and thematically analysed to explore the lived experiences of people suffering from ototoxicity. This data then led to two clinical studies being designed. A cross-sectional study aims to identify the prevalence and severity of ototoxicity in the cancer population, and another mixedmethodology to identify the impact on quality of life and what support is available compared to what is needed.

With high actuality of toxic effects of antitumor therapy the aim of the research: to analyze the intensity and nature of damage to the dental tissues after chemotherapy and radiation therapy during the rehabilitation period in children and adolescents who have been treated of malignant neoplasms.

During the period 2017-2019 in the Rehabilitation Centre "Russkoe Pole", 2005 patients undergoing treatment for Malignant Neoplasms. All of them received varying degrees of radiation therapy: acute lymphoblastic leukemia 12 Gray; CNS tumors and soft tissue head-neck tumors 35 -90 Gray; total irradiation before bone marrow transplantation of 12 Gray to the site. The duration of remission is 4.9 ± 1.95. The median age of the patients at the time of the survey ranged from 3 to 17 years, M 8 ± 2.3.

On this cohort, it was revealed that, the younger age the child at the time of receiving therapy, the more pronounced changes in his dental status. The most severe changes were observed in patients from the Department of Neuro-oncology. This is due to high doses radiation therapy in the head-neck area (1,2 pictures of the boy 7 years Diagnose: Medulloblastoma (chemotherapy, radiation therapy 56 Gray, neurosurgery). Conclusions nder the conditions of a specialized rehabilitation center, in which convalescents are concentrated, it is advisable to conduct prospective in-depth studies of the effect of tumor, chemotherapy and radiation on changes in the hard tissues of teeth, saliva homeostasis and caries-resistanc. Colson, D. eP659, eP667 Cong, W. eP569 (continued) 

SCNS-SF34) survey, which contained physical, social, informational, sexual and psychological scales. gynecologic cancers based on age, SES, and race in the phys-I

All patients were evaluated for erectile function with the 5-item version of the International Index of Erectile Function (IIEF-5) before and after the first cycle/month of the first-line targeted therapy with sunitinib, pazopanib, bevacizumab+ IFN, sorafenib, or temsirolimus. Results Median age was 59 years (range 43-67 years). 89 (67%) patients had at least one cardiovascular risk factor. At baseline, IIEF-5 mean score was 19 (SD, 2.6). Patients with 2 and more IMDC risk factors (39%) had a lower IIEF-5 mean score (14; SD, 3.3). 99 (75%) patients reported a negative change in their sexual life since the start of the targeted therapy. 35 (27%) patients had no sexual activity. After the first treatment cycle/month IIEF-5 mean score reduced to 8 (SD, 1.9), which was statistically significant (P<0.001). The IIEF-5 scores were not associated with a type of anticancer treatment (P>0.05). Conclusions Prospective evaluation in a large cohort of patients with mRCC revealed mild ED (19/25) in the treatment-naive male population and severe ED (8/25) after the first cycle/month of the first-line therapy. Significant decrease in erectile function should be considered as a potential adverse event in male patients undergoing treatment of mRCC with targeted agents

Helsinn Integrative Care, Helsinn Integrative Care

data have been collected in a prospective, longitudinal scalp cooling registry. Patients with all types of solid tumors, all stages of disease, all ages and both sexes could participate

Associate Professor

Sunnybrook Odette Cancer Centre

Cantor Center for Research in Nursing and Patient Care Services

Unmanaged CIPN negatively affects function and chemotherapy dosing. Yet, evidenced-based CIPN assessment and management guidelines/strategies are often poorly implemented into practice. The purpose of this analysis is to explore clinicians' CIPN assessment and management documentation patterns when providing care to patients receiving neurotoxic chemotherapy. Methods Data for this analysis originate from the usual care period (Period-I) of a two-period, pre/posttest study. Patients receiving neurotoxic chemotherapy for gastrointestinal or breast malignancies or multiple myeloma completed standardized CIPN surveys (e.g., Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events Numbness/Tingling items [PRO-CTCAE], 0-10 worst CIPN pain intensity) prior to three consecutive clinician appointments. At the third appointment, clinicians' documentation of CIPN assessment (e.g., numbness/tingling/pain) and management (e.g., chemotherapy dose modification, medicine) were abstracted from the medical record. Results Eighty-one patients and 45 clinicians were recruited. At the third appointment, 44/63 (69.8%) patients self-reported mild CIPN or worse (PRO-CTCAE numbness/tingling severity≥1/4). Of patients with CIPN

toxicities (acute eosophagitis-AE, radiation pneumonitis-RP) and late toxicities

UNCOMMON AND POTENTIALLY LIFE-THREATENING COMPLICATIONS FROM THE IMMUNE CHECKPOINT INHIBITOR NIVOLUMAB AT AN ONCO-HOSPITALIST INPATIENT SERVICE N. Brito-Dellan

G1T28-03: previously-treated, receiving topotecan 2. G1T28-05: newly-diagnosed

G1T28-02, newly-diagnosed, receiving E/P well-being (PWB), functional well-being (FWB), fatigue, and FACT-An. domains

The changing RRRP population is associated with visible increases in survival. This may reflect differences in the proportions of specific primaries and sites of metastases, with the 1999 population reporting a greater proportion of lung primaries (36% vs. 28%), which generally convey unfavourable outcomes. 2014-2017 reported a greater incidence of bone metastases (80% vs 70%), which convey greater longevity relat ive to other metastases . Improvements in systemic therapies may also have led to improvements in survival. The increasing availability of palliative radiation may affect patient demographics, although it would not change actual survival. Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, Toronto, Canada calculated. PC-D/OS (days) was calculated to illustrate the comparison of the duration of palliative care in the overall length of the disease.

The mean age of 155 enrolled advanced NSCLC patients was 62.83 years. Before referral to PC, 128 patients received anti-cancer treatment including surgeon (46.5%). 63 patients (40.6%) died in PCU. The median OS of 144 patients with end cut-off was 19 months (mean=31.49, 95% CI=25.86, 37.12). The median 95%CI=60.37, 87.40) . The mean interval of PC-D/OS of 144 patients with definitely death time was 0.22. The shorter PC-D/OS indicated relatively late referral to inpatient PC services. A high proportion of patients reported loss of appetite (92.8%) and fatigue (91.4%) at the initial of referral to PC. Conclusions This retrospective study, in a population of patients with advanced NSCLC, gave detailed information about PC services in a Tertiary cancer center. 

Eleven days of two 8oz bottles of liquid is difficult during ASCT, especially for MM patients with nausea, altered taste/poor appetite. For those NHL patients, compliant per protocol (>11 days), enterade® significantly reduced diarrhea. At >7 days of enterade® treatment there was also a signal for effect. The use of enterade® to prevent high dose chemotherapy associated-diarrhea should be explored further in populations capable of reasonable oral intake. 

Gynecologic cancer patients with insomnia randomized to CBTip had higher subjective SE and lower SOL than those randomized to PE during acute post-surgical treatment phase. Future research will focus on the effects of CBTip on pain. Introduction India contributes to nearly one third of Oral Cancers in the world and is the most common cancer in males and third most cancer in females. The mortality due to oral cancer has decreased in the last two decades due to a number of reasons, which include better surgical techniques, newer chemotherapeutic drugs, better radiotherapy, and also due to low malignant potential. However, Surgery is ssociated with both functional and structural morbidities. Study was undertaken to assess the quality of life in Oral cancers (excluding tongue) following reconstruction.

The prospective study was done at the K G Medical University, from 2012 to 2017, in whom surgical extirpation was followed by reconstruction. All patients were assessed for quality of life at 6 months and 12 months. University of Washington -Quality of Life version 4.1was used. It encompasses physical attributes, functional status and mental parameters. Normative scores were collected from 50 patients who were attending dental out patient department. Results 328 Patients were analysed individually and collectively. Comparisions were also made between distinct groups (like early staging vs late staging) or between Surgery only vs Surgery plus chemo/ radiotherapy. Type of reconstruction was also taken in relation to the outcome so as far health of the individual was considered.

The results showed an intersting and complex interplay of factors. Education and socioeconomic status also affected the quality of life. Type of reconstruction, post operative adjuvant therapy also affected the health of the individual. Among breast cancer survivors, women with diabetes had higher risks for physical inactivity, overweight/obesity, sleep less than 7 hours, and fair/poor health than those without diabetes. Lifestyle interventions are needed to target survivors with diabetes, especially those with low socioeconomic status.

A MULTIDISCIPLINARY PATIENT CENTERED APPROACH TO HEAD AND NECK SURVIVORSHIP CLINIC S. Naqvi 1 , C. Gutierrez 2 , R. Karni 1 1 The University of Texas Health Science Center Houston, Otorhinolaryngology Head and Neck Surgery, Houston, USA 2 The University of Texas Health Science Center Houston, Physical Medicine and Rehabilitation, Houston, USA

There was symptomatic improvement after dignity therapy which was mainly in anxiety with a trend towards statistical significance. This form of therapy can therefore be used to improve the quality of life of cancer patients

Breast care nurses can be trained to effectively deliver a group CBT intervention for the alleviation of hot flushes in women who have had breast cancer. 

Lower limb lymphedema (LLL) has a negative effect on quality of life (QOL). However, it is unclear which patient characteristics or background factors lead to lower QOL. The aim was to clarify factors affecting QOL in LLL with the life measure for limb (LYMQOL) .

In this cross-sectional, prospective study, patients with secondary LLL due to gynecological cancer were recruited from lymphedema outpatient clinics at Keio University Hospital from January to November 2018. We assessed the International Society Lymphology (ISL) stage, symptoms, neurotoxicity with FACT/Gynecologic Oncology Group-Neurotoxicity, and LYMQOL, which consists of the domains 'function', 'appearance', 'symptoms', 'mood', and 'overall QOL'. Potential factors affecting QOL using LYMQOL were evaluated by multiple linear regression analysis. Results A total of 56 female patients with a mean age of 65.5±7.4 years were enrolled. Significant factors affecting the LYMQOL score were history of cellulitis and severity of neurotoxicity. Of the domains of the LYMQOL, 'function'was related to fall history and severity of neurotoxicity, 'appearance'was related to history of cellulitis and ISL stage, 'symptoms'was related to history of cellulitis and severity of heaviness, 'mood'was related to history of cellulitis and severity of neurotoxicity, and 'overall QOL'was related to severity of neurotoxicity; all were significant. Conclusions QOL in LLL patients was not only determined by the stage of lymphedema, but it was also affected by various background characteristics and symptoms, and it depended on the domains of QOL. Therefore, supportive care to manage symptoms and maintain activities of daily living is important in patients with LLL.

Despite an increasing focus on developing survivorship services tailored for adolescent and young adults (AYA) cancer survivors, current recommendations on service design rarely incorporated viewpoints from healthcare professionals (HCPs). This study evaluated AYA cancer survivors' and HCPs' perceptions of existing and prospective survivorship services, in order to propose strategies for service optimization.

We conducted 11 focus groups involving 23 AYA cancer survivors and 18 HCPs caring for AYA survivors. All sessions were audio-recorded, transcribed verbatim and coded by two independent researchers. Thematic content data analysis was performed using NVivo 12.

Both AYA survivors and HCPs agreed that existing support groups were valuable and should be continued. However, AYA survivors reported barriers in communicating with non-AYA survivors who formed the majority in these groups as they did not share similar problems and disease knowledge for meaningful engagement. Survivors would also prefer additional nutritional support, financial and employment advice during their transition back to normalcy. Key proposals for prospective services included: (1) extending supportive services to AYAs' dependencies (caregivers, children); (2) introducing a care navigator to serve as a consistent contact point;(3) ensuring services are accessible, interesting, useful and highly goal-oriented; and (4) creating a centralized platform to disseminate information on the availability of such services.

Existing services for AYA survivors should be reinforced by age-specific considerations. To maximize survivors' perceived utility of services, prospective service providers can benefit from constructing clear and relevant goals to encourage participation in the long-term. 

BRCA test is only insured after diagnosis of cancer in Korea. Cascade testing among mutation positive ovary cancer patient is cost effective method for cancer prevention. We investigate this. Methods A retrospective review of patients who agreed and undertook cascade testing for same mutation with proband. Clinical information was collected from medical records Results Total population wad 9. Median age of proband and relatives are 64(42~75) and 45(20~52). They are eight 1st degree relatives and one 2nd degree relatives. We found 4 daughters and 2 sons. Others were one niece and two sisters. Advanced stage patients are most (7/9). There are 7 BRCA2 mutations and 2 BRCA1 mutations. There was no family history of BRCA related cancer (One had a stomach cancer mother and leukemia brother). Median time from cancer diagnosis and cascade testing were about 6 months (2~34).

There should be more active and cost-effective cascade testing for family members of BRCA mutation cancer patients. Duke-NUS Medical School, Oncology Academic Clinical Programme, Singapore, Singapore 10 National Cancer Centre Singapore, Department of Pharmacy, Singapore, Singapore

Adoption of the optimisation clinic was successful. Interview responses suggest patients feel the optimisation clinic is both acceptable and appropriate. This indicates a multidisciplinary clinic model is an important aspect of comprehensive, timely and effective care. However, fidelity was low secondary to the complexities of the patient cohort. 

The women with gynecological cancer reported significantly (p < .001) more sexual dysfunction, and lower sexual satisfaction. There are polarized score distributions in sexual satisfaction as a result of sexual functionality status among women with cancer which revealed the larger mean differences of sexual satisfaction between sexually functional and sexually dysfunctional women with gynecological cancer than those obtained from women without cancer.

This study provided evidence that gynecological cancer and its treatments can have significant consequences for women's sexual functional and sexual satisfaction in Taiwan. Besides, sexual functioning determines whether women are sexually satisfied, rather than suffering from cancer. These results highlight the need for interventions to teach patients effective sexual communication after sexual changes due to cancer treatment. 

Sexual dysfunction in gynaecologic cancer patients is a field of increasing interest. The demand for dialogue between health care professionals and patients on all aspects of adverse effects after treatment is increasing. Patients treated for cervical cancer by external beam & intracavitary RT (EBRT & ICRT) are likely to experience radiation-induced damage to the vaginal mucosa, causing stenosis and fibrosis that may lead to sexual dysfunction. This retrospective study aims to describe the self-reported sexual function in females treated for cervical cancer by RT. Methods A total of 50 patients of cervical cancer referred for RT were included. The patients were assessed for sexual function, using a validated selfassessment questionnaire-European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-CX24), at the termination of RT and 1, 3 & 6 months later. The results were compared with pre-diagnosis sexual function of the patients. Wilcoxan's signed rank test was applied and a p-value of <0.05 was considered significant. Results Persistent sexual dysfunction was reported throughout the 6 months after RT. Approximately 80% had low or no sexual interest, 30% had moderate to severe lack of lubrication, 50% had mild to severe dyspareunia, and 25% were dissatisfied with their sexual life. Despite sexual dysfunction, 60% of those sexually active before having cancer remained sexually active after treatment, although with a considerably decreased frequency.

Patients who are clinically disease free after RT for cervical cancer are at a high risk of experiencing persistent sexual problems. 

Systemic therapy with doxycycline at the early stages of I-II grade acneiform rash results in a significant clinical effect and prevents further deterioration in skin condition. Combined treatment including doxycycline and simultaneous application of topical medication containing 0.1% betamethasone valerate and 20% fusidic acid results in a faster and more prominent clinical effect as compared to other combinations: doxycycline with tacrolimus cream, and doxycycline with metronidazole gel. 

About 90 to 95% of the patients undergoing radiotherapy (RT) as part of their cancer treatment develop acute radiodermatitis (ARD), an inflammatory skin reaction. Previous studies demonstrated that photobiomodulation therapy (PBMT) is effective in managing ARD in breast cancer patients. The aim of this study was to investigate the effectiveness of PBMT in the prevention of ARD in head and neck cancer (HNC) patients. Methods A prospective, single blind, multicentric, clinical trial was set up at the radiotherapy department of the Jessa Hospital (Hasselt, Belgium) and Ziekenhuis Oost-Limburg (Genk, Belgium). HNC patients planned to undergo RT with or without concomitant chemotherapy (i.e. stratification factor) were randomized into the placebo or PBMT group. Sham or PBM treatments were applied twice weekly during the complete RT course. An experienced nurse evaluated the skin reactions at baseline, at a dose of 40 Gy, and at the end RT (60-70 Gy) by using the Radiation Therapy Oncology Group (RTOG) criteria.

For this preliminary analysis (February 2019), data of 37 patients was available. The percentage of HNC patients presenting a RTOG grade ≥ 2 was significantly higher in the placebo in comparison with the PBMT group at the end of RT (70,6% vs. 25%, resp.; p=0.01). Moreover, the results indicated that the skin toxicity aggravated in the placebo group (p=0.03), while it remained stable in the PBMT group towards the final RT session (p=0.47).

This is the first, placebo-controlled, multicentric trial demonstrating the positive effect of PBMT for the prevention of ARD in HNC patients. 

In Taiwan, 31% of patients with advanced lung cancer receive targeted therapy as the first-line treatment. Many patients reported cutaneous toxicity such as papulopustular eruption, dry itching, mucositis, and hair and nail changes. However, few studies explore this issue about cutaneous toxicity related life experience. Thus, the purpose of this study was to describe cutaneous toxicity related life experience of advanced lung cancer patients receiving oral targeted therapy in Taiwan.

The qualitative interview by using phenomenological approach was conducted in this study. Patients with advanced lung cancer (stage IIIB & IV) were recruited in oncology outpatient settings at a medical center in northern Taiwan. Open-ended interview questions focused on cutaneous toxicities related life experiences. Data were collected by in-depth interviews by conducted face-to-face. Data were analyzed by using content analysis techniques. Results A total of 15 advanced lung cancer patients completed at least one time targeted therapy (e.g., Iressa, Tarceva, Giotrif and Tagrisso). Five major themes emerged that were related to the participants' cutaneous toxicities related life experience during receiving oral targeted therapy, including (i) changes in daily life; (ii) changes of social relationships; (iii) emotional and psychological impact; (iv) unknown future; (v) insufficient and inconsistent information in cutaneous self-care.

It is important to understand and recognize the common cutaneous toxicity related life experience. These findings from this study provide health professionals help those patients with cutaneous toxicity to discuss with their concerns in clinical setting. It might be good for health professionals to offer support. 

Introduction: Radiation therapy (RT) requires pre-treatment marking to ensure reproducibility of set-up and accurate treatments. Permanent tattoos of 2-3 mm in diameter near the irradiated site are standard of treatment. Radiation tattoos are created with blue or black ink, and may mimic pigmented lesions, including melanoma.

Here we describe 2 cases of radiation tattoos clinically mimicking malignant melanoma, in order to help providers avoid unnecessary biopsies in cancer patients and to describe alternatives to standard permanent ink tattoos.

Both patients presented with a chief complaint of new blue skin lesions. One had a history of stage 3 melanoma treated with excision, RT, and adjuvant immunotherapy. The second had a history of desmoid tumor on the abdomen and denied any prior RT. She had forgotten that RT had been intended, and she had received tattoos but did not end up completing treatment. In both cases, the lesions were small blue macules with homogenous blue pigment on dermoscopy. Biopsy demonstrated extracellular pigment in the dermis, consistent with a tattoo in both cases.

Cutaneous metastases from melanoma and radiation tattoos can be indistinguishable on clinical exam as well as dermoscopy. In cases of unreliable patient history and lack of records of exact radiation tattoo placement, unnecessary biopsies may take place. Alternatives to permanent ink tattoos for RT markings, such as temporary henna tattoos and fluorescent ink tattoos, have recently been studied for RT marking and may provide the added benefit of improving patient self-image 

Radiation dermatitis (RD) occurs in up to 95% of patients receiving radiation therapy (RT). Dermatologists are not often involved in the management of RD. We aim to describe radiation oncologists' referral practices for the treatment of RD and to identify barriers to dermatology referrals.

We emailed a survey to radiation oncologists across the USA regarding RD management. Information regarding demographics, experience managing RD, and rates of referral to dermatologists were solicited.

Out of 5505 emails sent, 705 (12.8%) physicians responded. Fifteen percent of radiation oncologists reported that they ever refer patients to dermatology. Private practitioners referred at a rate of 8%, which was significantly less than providers in academic (18.4%) or oncology (13.4%) centers (p<0.01). Practitioners within 5 miles of urban cities were more likely to refer (OR 1.91, 95% CI 1.20-3.00, p<0.01). Radiation oncologists in the Southeastern USA were less likely to refer (OR 0.29, 95% CI 0.13-0.67 p<0.01). Those who did not refer cited preference to treat the patients themselves, excessive wait times and referral to wound care specialists as the most common reasons.

Dermatologists can play an important role in a multidisciplinary approach to the study and treatment of cancer therapy-related toxicities. Lack of timely access in various geographic areas may be one barrier to dermatologic care, consistent with reported dermatology shortages in rural areas and the Southeast. Addition of dermatologists to cancer treatment teams could improve access and stimulate needed research into strategies for the treatment of RD. 

Hand-foot-syndrome (HFS) is one of the common adverse events that limits capecitabine treatment. Previous pharmacogenetics studies of HFS almost use candidate gene approach, but up till now, the pathophysiology and mechanism of HFS is still unclear, and the effective predictive biomarkers of HFS is yet to be found.

We used a two-stage GWAS design including 1104 CRC patients who received capecitabine-based treatment in Sun Yat-sen University Cancer Center. We performed a genome-wide association analysis in 514 patients, including 148 cases (grade 2-3 HFS) and 366 controls (grade 0-1 HFS), and validated the top associations in an independent cohort of 590 patients. Sanger sequencing of the coding regions of TYMS was performed in 268 patients. All statistical tests were two-sided.

In this retrospective study, we found the patients with capecitabine-based combination treatment had a lower HFS incidence compared with those treated by single-agent capecitabine (OR=0.22, 95% CI=0.22-0.50, P<0.01), although patients almost received the same dose of capecitabine. By genome-wide association study, we identified two variants, rs2853741(OR=2.01, 95% CI=1.63-2.49, Pcombined=9.72 10 -11) in the promoter region of TYMS, and an intergenic polymorphism rs1890775(OR=0.62, 95% CI=0.5-0.76, Pcombined=3.91 10 -6) were strongly associated with HFS. TYMS an essential enzyme for DNA synthesis and repair is a critical target of capecitabine. Additionally, the coding regions sequencing of TYMS identified two novel variants in patients with severe HFS.

This genome-wide association study identifies two novel SNPs significant association with HFS in colorectal cancer patients in Chinese, which could help to elucidate the underlying mechanism of hand-foot-syndrome. 

Up to 60% of breast cancer patients with chemotherapy experienced skin dryness due to decreased sebum contents. To evaluate effectiveness of a tailored moisturizer on skin dryness due to chemotherapy among breast cancer patients.

It is a double-blind randomized controlled trial conducted. Breast cancer patients experiencing skin dryness after 1 cycle of chemotherapy were randomly assigned to 3 groups (A: tailored moisturizer; B: regular moisturizer; and C: no product). Participants of the intervention groups were asked to apply the study product twice per day until 1 month after completion of chemotherapy. Skin dryness, dullness, QoL, and changes in sebum level were assessed at baseline, 3 weeks after randomization and 1 month after completion of chemotherapy.

A total 174 patients were randomized to group A (n = 59), B (n = 56) and C (n = 61). After 1 month after completion of chemotherapy, patients of the group A (8.5%) and B (8.9%) were less likely to report severe skin dryness compared to those of C (27.9%, P<0.001). Patients in the group A also reported significantly lower levels of stress due to skin dryness (1.5 vs. 2.8; P = 0.01), skin dullness (3.1 vs. 4.6; P = 0.012) and better skin related QoL (2.0 vs. 4.8; P < 0.001) than controls. Sebum contents in cheek of the group A was significant less decreased compared to group C.

We confirm the effectiveness of tailored moisturizer for chemotherapy-induced skin dryness and dullness as well as QoL among breast cancer patients. 

Epidermal growth factor receptor inhibitors (EGFRIs) have been well established for the therapy of some cancers. Unfortunately, anti-EGFRIs therapy was halted to treat cancer patients due to its cutaneous skin toxicities in many cases. In order to reduce the side effects, understanding of the mechanisms of the skin toxicities caused by EGFRIs is arising important issue. However, these are only partially understood. Therefore, we investigated the mode of action of rhEGF on EGFRIs induced skin toxicities using human epidermal keratinocytes and 3d-cultured human skin cell tissue.

Cetuximab was used to treat the cells or the tissue with various concentrations of rhEGF. Then, expression level of skin barrier related proteins, inflammatory cytokines and antimicrobial peptides (AMPs) were measured by using RT-qPCR, ELISA, or immunofluorescence.

Although cetuximab downregulated expression of skin barrier related protein such as filaggrin, claudin-1,-3 and occludin in 3d-cultred cell tissue, but co-treated tissues with rhEGF were recovered. Moreover, cetuximab increased IL-1α, IL-8 and TNF-α expression and it decreased AMPs (especially hBD-2 and 3) expression in keratinocytes. Interestingly, decrement of cytokines expression and increment of AMPs expression were observed in rhEGF co-treated cells. EGFR and phosphorylated EGFR (pEGFR) expression, also, were decreased in cetuximab treated cells while EGFR and phosphorylated EGFR (pEGFR) expression were increased in rhEGF co-treated cells.

The results reveal that rhEGF may have protective effects on the skin toxicities induced by EGFRIs through modulating inflammatory reactions and skin barrier function.

We found that antibiotic monotherapy during EGFRi therapy for cancer is correlated with increased incidence of antibiotic resistance on wound culture in patients receiving topical clindamycin and/or oral tetracyclines. Consideration of addition of bactericidal agents to antibiotics may lead to better control of cutaneous adverse events of EGFRI therapy. 

Chemotherapy-induced alopecia (CIA) ranks among the psychologically most devastating effects of cancer treatment for oncological patients, with an overall incidence of 65%. Nowadays trichoscopy is largely employed in the diagnosis of alopecia, but no description of CIA trichoscopic pattern are present in literature. We want to create an organic description of CIA trichoscopic aspects.

Oncological patients candidate to chemotherapy drugs, afferent to our trichological outpatient were studied. Anamnesis, clinical exam, clinical global photography, pull test, trichogram and trichoscopy were conducted at the different moments of therapeutic treatment.

A definite trichoscopic pattern in the different phases of treatment was observed. After the first 3 weeks of chemotherapy rare and scattered black dots, broken hairs, flame hairs and pohl pinkus appeared. At the end of chemotherapy besides the features described above, numerous thin hair in regrowth were detected, together to rare terminal hair, scattered black dots and circle hair. 3 months after chemotherapy a progressive increase of follicular units and elongation of the existing hair were visible.

We propose a description of CIA trichoscopic pattern and its evolution during the different phases of chemotherapy. the pharmacist, directly involved in the systematic and multidisciplinary study of the drug, is determinant in the analysis of the budget impact of the change of supplier of each cytotoxic drug versus the benefit / risk ratio for the patient. We call attention to the need for the pharmacist to collaborate in the Oncology Unit, allowing the evaluation of the administration of cancer medications, implementing risk minimization measures and communicating these to health professionals and patients. 

Immune checkpoint inhibitors (ICIs) have emerged as promising class of anti-cancer treatment in several types of tumor, but immune-related adverse events are occasionally encountered during ICI treatment. Autoimmune meningoencephalitis is a rare but fatal adverse event. However, little has been known about the natural course and optimal strategies to manage immune-related meningoencephalitis (irME).

We retrospectively reviewed clinical characteristics and the natural course of three urothelial carcinoma of bladder patients who developed irME induced by ICI.

All the cases received anti-programmed death-ligand 1 (PD-L1) antibody. The most common presenting symptoms were fever and altered mentality, with the median onset of 14 days. Cerebrospinal fluid analyses revealed pleocytosis and elevated protein level, but negative results for infectious etiologies. Malignant cells were not detected in cerebrospinal fluid. Paraneoplastic antibody was observed in one patient. As irME was highly suspected, the patients were given steroid. Case 1 was completely recovered with concurrent steroid plus immunoglobulin (IVIG). Case 2 received IVIG as he did not show improvement with steroid and responded transiently, but finally recurred. In case 3, steroid resolved her altered mentation, but weakness of bilateral extremities due to Guillain-Barré syndrome remained and was partially recovered with IVIG and intravenous rituximab. Tumor size was decreased in 2 patients.Conclusions irME associated with ICI develops early after the first dose given within two weeks. The natural course varies and fatal. The prompt use of high dose steroid and IVIG treatment after exclusion of infectious cause might be essential for neurologic recovery. 

Head and neck cancers constitute 6% of cancers worldwide. The management requires a multidisciplinary approach. Concomitant chemoradiotherapy with cisplatin is the standard approach for locally advanced head and neck cancers but increases toxicities. The most commonly used regime uses three weekly cisplatin which is more toxic. Low-dose once-aweek cisplatin is substituted because of perceived lower toxicity and convenience in a low resource country like India. Methods Squamous cell carcinoma of stage III, IVA and IVB of oropharynx, hypopharynx and larynx were studied for one year. 82 patients were studied. Total dose of radiation was 66Gy/33#/6 ½ weeks from Monday to Friday with inj. Cisplatin 40mg/m 2 i.v. infusion weekly. Acute skin, mucosal, pharyngeal, laryngeal and salivary reactions were carefully monitored during treatment. Results 88% of patients were able to complete five or more weekly chemotherapy cycles with cumulative dose of 200mg/m2. Grade 2 and 3 acute toxicities were seen with weekly cisplatin but were conservatively managed. Grade 2 oral mucositis was the most common and was seen in 67% of patients. Similarly Grade 2 skin and pharyngeal toxicities were seen in 66% and 65.6% of patients respectively. Due to toxicities treatment was interrupted for some patients and some required nasogastric tube feeding.

Painful oral mucositis and skin reactions interfere with further treatment options and impairs patients quality of life. Also, acute toxicities lead to various treatment interruptions which affects the response. 

While clinicians routinely documented CIPN assessment, CIPN management was suboptimal. In Period-II, we will explore how the implementation of a treatment algorithm delivered to clinicians will impact frequency of CIPN assessment documentation and adherence to evidence-based treatment guidelines. The University of Adelaide, Adelaide Medical School, Adelaide, Australia associated with duration of treatment. r=0.456 (p<0.0001). High grade (grade 3 and 4) toxicity was not associated with duration of treatment with ipilimumab. r=0.032 (p=0.546). Conclusions Ipilimumab associated grade 3 and 4 toxicity predicts response to therapy and is associated with higher CR/PR. Addition of two or more antitumor agents to ipilumumab has potential to cause a significant increase in serious AE's. The diagnosis and treatment of neuroendocrine tumor is a continuous distress for caregiver and patients. We aim to find the affect of treatment options and disease status on quality of life among those diagnosed with neuroendocrine tumors. Methods A survey was conducted in Sir Ganga Ram Hospital, Lahore from 2015-2018. A total of 500 patients were identified. Inclusion and exclusion criteria was made. Questionnaire was based on demographic and disease related questions. We investigated the impact of treatment on quality of life patients. The treatment options were surgery alone, surgery and somatostatin analogue, endoscopic resections and other treatments. Patients were asked about bowel movement frequency, appetite, sleep, fatigue etc.

Out of 500 patients, 67% were female and male 33% were male. The most common symptom affecting the QOL was increased bowel frequency 74%, fatigue 67%, abdominal discomfort 52%, loss of appetite 47%, Patient Reported Outcomes Measurement Information System (PROMIS) revealed depression 39%, anxiety 27% and lethargy/ difficulty with physical activity 21%. We found poor QOL in 286/500 patients with ongoing treatment. In terms of disease status, patients with recurrence of tumor reported significantly higher ratio lethargy, depression and mental stress. Disease burden was correlated with QOL. Conclusions There is need to incorporate patients into the diagnosis and treatment process so that we can over come the effects of treatment options, disease burden and disease status on quality of life. This can only be possible through appropriate education and emotional support programmes. 

To evaluate cytotoxicity of ULLB-0005 on breast cancer cells as a new treatment option Methods ULLB-0005 is a protein derived from natural fungus with high binding specificity for carbohydrate antigen and strong apoptotic signal leading to death of cancer cells. For in vitro study, MDA-MB-231 cells were treated with ULLB-0005 at concentration ranging from 2.5-80 μg/mL. Following incubation, the cell cytotoxicity was estimated by MTT assay.

Based on in vitro study, cytotoxicity was found to be 60.9% for ULLB-0005 and 50.2% for doxorubicin. In order to find if ULLB-0005 is cytotoxic to MDA-MB-231 cells, MTT assay was performed. The results demonstrated that ULLB-0005 is cytotoxic.

Based on in vitro data, ULLB-0005 is a potential anticancer drug for the treatment of breast cancer and will be a newer treatment available fro breast cancer National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore 2 National University Health System, Department of Haematology-Oncology, Singapore, Singapore 3 National University of Singapore, Singapore Institute for Neurotechnology, Singapore, Singapore 4 National University Health System, Department of Neurology, Singapore, Singapore 5 National University Health System, National University Cancer Institute, Singapore, Singapore 6 Kantonsspital Lucerne, Department of Neurology, Lucerne, Switzerland 7 Johns Hopkins University, Department of Biomedical Engineering, Baltimore, USA

Scalp-cooling is a recently approved therapy for chemotherapy-induced alopecia, while limb cryocompression is being developed to reduce chemotherapy-induced peripheral neuropathy (CIPN). We assessed feasibility, safety and tolerability of concomitant scalp-cooling and limb cryocompression.

Breast cancer patients receiving weekly paclitaxel chemotherapy underwent concomitant scalp cooling and cryocompression of all four limbs for the duration of their chemotherapy infusion (maximum 4 hours), for a maximum of 12 cycles. Limb cryocompression was administered at a constant cyclic pressure of 5-15 mmHg and temperatures starting at 11 o C (established as lowest tolerable temperature in a healthy volunteer study), adjusted according to tolerance. Tolerability was assessed via various subjective tolerance scales, and CIPN was assessed via EORTC Quality of Life Questionnaire-CIPN20 before (QOL pre ), after completion (QOL post ) and 3-months post chemotherapy (QOL 3m ). Results 14 patients enrolled in the study, of which 9 have completed all 12 cycles of concomitant scalp-cooling and limb cryocompression during chemotherapy, with the rest currently ongoing therapy. None of the patients had intolerance to scalp-cooling. 7 patients completed 12 cycles of cryocompression at the lowest tolerable temperature of 11oC. 2 patients found 11oC intolerable and completed all 12 cycles at 17oC and 25oC respectively. 1 of the 14 patients withdrew at the 6th cycle, finding 25oC intolerable. Median QOLpre was 19 (range 17-19), QOLpost 20 (18-29) (p = 0.04, Wilcoxon signed-rank) and QOL3m was 19 (18-21) (vs QOLpre; p = 1).

Delivery of concomitant scalp-cooling and limb cryocompression is feasible, safe and tolerable. Validation studies are ongoing to establish efficacy of cryocompression. 

The present study investigated, through the application of specific questionnaires to 1370 health professionals (1.032 dentists, 239 physicians and 99 oncology nurses), the knowledge and the awareness of the role of health professionals that assists these group of patients in the prevention and management of MRONJ and theirs perceptions of the importance of dentist in the care of these patients.

In general, health professionals presents unsatisfactory knowledge about prevention measures, signs and symptoms of MRONJ, although the professionals who take care oncologic patients and with more professional experience present a tendency to a greater knowledge when compared to the others. Dentists who take care of oncologic patients have a greater knowledge about drugs side effects and definition of MRONJ and, for dentists and physicians the professional experience had a positive impact. A significant number of MRONJ diagnosis and follow-up were performed by dentists and physicians who take care oncologic patients and with more experience. The few knowledge about staging and therapeutic management in early and advanced stage were observed for physicians and dentists.

The findings shows that health professionals have low awareness and deficient knowledge regarding MRONJ, although most of them have contact with patients who use AR and AA. 

Over half of patients receiving taxane, platinum, or bortezomib chemotherapy experience CIPN-a dose-limiting toxicity with numbness, pain, and muscle problems in the extremities. This randomized pilot study explored whether exercise improves CIPN symptoms and physical function.

Nineteen patients to receive taxane, platinum, or bortezomib were randomized to exercise (home-based, low-moderate-intensity, walking+resistance training; EXCAP ©® ) or nutrition education (control) for 12 weeks upon first infusion. At 0, 6, and 12 weeks, we assessed CIPN symptoms via CIPN-20 sensory scale (9-36, higher is worse). We assessed physical function via leg strength (Biodex) and six-minute walk. Linear regression modeled each outcome, tested for effects of exercise, and controlled for baseline and age because controls were older. Because this is a pilot study, we present effect sizes, not p-values.

The 19 patients were 65±11 years, 52% women, with cancer: 42% breast, 32% gastrointestinal, 16% myeloma, 10% genitourinary. Exercise mitigated CIPN symptoms. At 6 weeks, exercisers increased 11.0 to 12.5 whereas controls increased 11.0 to 15.5 (+1.5 vs. +4.5; ES=0.81). At 12 weeks, exercisers increased 11.0 to 14.8 whereas controls increased 11.0 to 16.2 (+3.8 vs. +5.2, ES=0.46). Exercisers improved leg strength vs. controls (ES=0.35 and 0.28 at 6 and 12 weeks) and six-minute walk distance at 6 weeks vs. controls (1, 721 vs. 1, 631 ft; ES=0.22 ) but walked slightly less than controls at 12 weeks (1, 679 vs. 1, 705; .

Exercise during neurotoxic chemotherapy mitigated CIPN symptoms and improved physical function. Future work should test for replication with a larger sample. NCT03021174. 

The systematic review found 10 papers representing 11 studies, all which were inconsistent in their diagnostics. The online forum review, however, found that there was indeed a lack of information and awareness of ototoxicity. The two clinical studies are in progress.

There is currently little good-quality information and support offered to patients who experience ototoxicity, which can potentially lead to many being undiagnosed and untreated. Ototoxicity can be permanent and progressive, therefore it is essential that a deeper understanding and increased awareness of how hearing loss and tinnitus affects the quality of life of cancer survivors can improve long-term symptoms management and support offered. 

Bullous pemphigoid (BP) classically presents with pruritis and tense bullae, though a small proportion of patients never develop bullae in their clinical course. Nonbullous pemphigoid (NBP) often presents as an intensely pruritic, polymorphic eruption, which often presents a diagnostic challenge for clinicians. Additionally, immune checkpoint inhibitor (ICI) therapy has been associated with the development of BP, though NBP associated with ICI has not been previously described.

We performed a retrospective case series of 4 cases of NBP that developed in patients while they were receiving anti-PD-1 therapy.

Clinical characteristics and diagnostic testing for patients in our case series are summarized in Tables 1 and 2. All of the patients had intense pruritus and nonspecific eruptions that required a combination of clinical, histopathological, and serological studies to confirm the diagnosis of NBP. All of our patients had a primarily urticarial morphology at presentation (Figure 1 ). Each of the four patients were treated with oral corticosteroids early in their course due to the severity of their pruritus, but they were ultimately able to achieve complete resolution of NBP using steroid-sparing biologic agents.

Given the nonspecific presentation of NBP, we advocate for performing histopathology, direct and indirect immunofluorescence, and serum antihemidesmosomal antibody studies in patients on ICI with refractory itch and/or pruritic eruptions. Once the diagnosis of NBP is established, we encourage early introduction of a targeted, steroid-sparing agent to avoid long term broad immunosuppression when possible. 

Chemotherapy-induced alopecia (CIA) is often one of the most psychosocially impactful aspects of cancer care for patients. Recent data has shown that scalp cooling is highly effective in preventing or decreasing the extent of CIA. Our study is the first to examine geographic access to scalp cooling centers in the United States.

We identified locations of cancer treatment centers in the United States that offer scalp cooling as of Fall 2018 using The Rapunzel Project website, the Dignicap Scalp Cooling System website, and the Paxman USA website. We used 2016 Medicaid data to evaluate the number of chemotherapy infusions occurring in each 5-digit zip code in the United States.

There are 366 cancer centers in the United States that offer scalp cooling therapy. Six states have no scalp cooling centers, while another seven only have one scalp cooling center in the entire state. 32% of cancer centers with scalp cooling therapy are located in New York, California, or Florida. Of 3000 5-digit zip codes in which chemotherapy infusions occurred in 2016, only 272 (9.1%) also have a scalp cooling center in that same zip code.

Scalp cooling therapy is highly effective in preventing CIA, but geographic access significantly limits the number of patients that are able to reduce or prevent hair loss using this method. Many of the scalp cooling centers are located in urban areas, meaning patients in more rural areas of the country would have to travel unreasonable distances to pursue this therapy. 

Anti-Epidermal Growth Factor Receptor (EGFR) drugs are currently used for the treatment of some solid cancer types as metastatic colorectal cancer (mCRC). Despite the improvements in survival outcomes of mCRC patients, these target therapies such as panitumumab (pmAb), have been associated with several toxicities, including oral adverse events such as mucositis/stomatitis which has been reported in 5-21.3% patients.

Herein, we reported a series of 6 well-documented cases of mCRC patients undergoing pmAb associated with irinotecan complaining of mouth sores during cancer treatment.

Four female and 2 male patients diagnosed with wild-type RAS adenocarcinomas, and with a mean age of 54 years (ranging from 37 to 68-yearold), were documented. The oral lesions manifested in approximately 8 days after drug infusion and all patients complained of pain and feeding discomfort, with 4 patients reporting moderate pain and the 2 remaining patients reporting mild and severe pain, respectively. They presented round/ovoid-shaped shallow ulcerations associated with a surrounding erythematous halo, showing an aphthous-like appearance. Additionally, 1 patient presented a non-ulcerated, tender and reddish tongue lesion that resembled benign migratory stomatitis, and five cases were associated with an acneiform cutaneous rash of face and trunk. The patients were successfully managed either with low-level laser therapy or topical corticosteroids, and the lesions self-resolved in a short time following drug interruption in 2 cases.

In summary, we highlight the need to recognize, prevent and treat appropriately this condition which remains unclear, and can negatively impact patients' quality of life and their ability to tolerate cancer treatment.